Lippincott Nursing Pocket Card - March 2020

Cross-Cultural Nursing Considerations

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Background

  • Nurses are uniquely positioned to provide direct care to patients of varied ages, races, ethnicities, and cultures within the practice setting.
  • The historical one size fits all approach in healthcare resulted in negative health disparities, mistrust of the healthcare system, and poor health outcomes amongst minorities and other marginalized groups. 
  • With nurses providing high-quality care to an increasingly diverse population, it’s vital for nurses to effectively communicate, build trust, and reach patients across barriers. This may include cultural, socio-economic, gender, race, ethnic, or language barriers.
 
Culture
  • Groups use shared customs, beliefs, rules, and values as a means of interpreting their experiences, as well as directing their behavior patterns. 
  • An individual’s identified culture shapes their health-related beliefs and impacts their experience of the health-care system.
 
Misconceptions
  • Traditionally, teaching cultural competency in nursing focused on understanding the norms of a particular culture, as a means to provide culturally sensitive care. This was both impractical and misguided. 
  • The concept of cultural competency over-simplifies large cultures by not taking into account the great variation that exists within cultural groups such as Americans, Europeans, or Latin-Americans.
 
Encounter dynamics
  • Three unique cultural perspectives intersect during every healthcare encounter:
    1. The culture of medicine (i.e., belief in scientific evidence and respect for patient autonomy)
    2. The culture of the bedside caregiver ( i.e., inherent bias and communication style)
    3. The culture of the patient ( i.e., language, norms, beliefs, family support structure)
  • To effectively manage this intersection, caregivers must exhibit respect, empathy, and curiosity as they seek to understand the patient’s individual perspective and experience.
  • Sociocultural differences between bedside caregivers and patients influence communication and decision-making, with evidence suggesting good communication between patients and caregivers can improve satisfaction, adherence, and health outcomes (Betancourt, Green, Carrillo, 2018). 

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Best Practices

Contemporary methods

  • Perspective-taking encourages caregivers to take the patient’s unique sociocultural background into consideration, as it may affect:
    • How they present their symptoms (stoic versus emotive)
    • Their threshold for when to seek care (proactive versus reactive)
    • Comprehension of care strategies (limited versus deep health literacy)
    • Expected outcomes of care (holistic/therapeutic versus medical/diagnostic)
    • Likelihood of adherence or compliance with preventive measures, medication regimens, follow-up, and inclusion of alternative modalities
  • There is no single superior paradigm for providing appropriate and meaningful culturally- sensitive care to patients.
  • Available research supports the education of bedside caregivers in cross-cultural care to maximize patient outcomes.
  • Caregivers that acknowledge and respect sociocultural differences show improved attitudes toward patients, with more respectful and effective communication patterns. 
  • Acknowledging the historical racial, gender, social, and ethnic disparities endemic in the healthcare system can lead to more meaningful and effective clinical encounters for both clinicians and patients.

Communication Pearls

  • Current research supports a balanced approach to communication, building trust with patients, and acknowledging differences in order to transcend them.
  • The following are core cross-cultural issues to address with patients navigating the healthcare system:
    • Communication styles
    • Prejudices and mistrust
    • Family dynamics and decision-making
    • Traditions, customs, and spirituality
    • Gender and sexuality issues
  • Time constraints are often a barrier to effective cross-cultural nursing, as it takes time to fully assess and establish a trusting relationship with new patients.
  • Use interpreters to assist patients with limited English-language proficiency.  
    • Remember to make eye contact with the patient and address the patient, not the interpreter.
    • Position the interpreter so that everyone can see one another.
    • Avoid medical terminology and acronyms.
    • Instruct the interpreter to alert you if they perceive any communication issues.
    • Keep questions short and ask one at a time.
  • Routinely assess for understanding, utilizing a teach-back technique.
  • Ask patient about their desired level of family involvement in their decision-making, respecting their autonomy as well as their possible desire to include family members or defer to their choices.
  • Use open-ended questions to elicit patient and family input and be willing to incorporate preferred modalities and treatments as appropriate.
  • Alternative therapies and treatments should be considered as adjuncts to care and included whenever possible in accordance with patient and family wishes.
References:
Betancourt, J.R., Green, A.R., & Carrillo, J.E. (2018). Cross-cultural care and communication. UpToDate. Retrieved from https://www.uptodate.com/contents/cross-cultural-care-and-communication
 
Utley-Smith, Q. (2017). Meeting a growing need: an online approach to cultural competence education for healthcare professionals. Nursing Education Perspectives, 38(3), 159-161. doi: 10.1097/01.NEP.0000000000000120.  Retrieved from https://journals.lww.com/neponline/Abstract/2017/05000/Meeting_a_Growing_Need__An_Online_Approach_to.14.aspx