Many nurses might regard a patient who refuses to take a certain medication, constantly has a roomful of visitors or demands that a family member feed him as noncompliant. However, nurses who dig deeper may discover these behaviors are a product of the patient's cultural beliefs and values -- deep-rooted ideologies that nurses can preserve or accommodate.
"To be a true patient advocate, a nurse needs to be culturally aware," says Sue Hasenau, RN, MSN, a certified neonatal nurse practitioner and member of the TransCultural Nursing Society.
Providing effective, sensitive healthcare for patients of other cultures requires empathy, flexibility and a commitment to continuous learning. How can nurses successfully work with and care for the nation's increasingly diverse patient population? Here are some general guidelines:
Don't Make Assumptions
Patients from other parts of the world may experience entirely different medical issues than US patients. Gihan ElGindy, RN, MSN, executive director of the TransCultural Educational Center in McLean, Virginia, learned this firsthand when she developed a breast-cancer awareness program for recent immigrants from areas in Africa, the Middle East and Asia that are virtually cancer-free. While many of the 500 women in the program had never heard of breast cancer, their risk level increases the longer they live in the US. "Our American literature says these groups of women are ignorant or don't comply," ElGindy says. "But why [would] they have to know about cancer if it doesn't exist in their countries?"
Explain Every Detail
Healthcare jargon is especially difficult for people whose native language is not English. The women in the breast-cancer program, for instance, had "no clue about the American terminology we use but were too shy to say they didn't understand," ElGindy relates. For example, when one of the questions on ElGindy's initial survey asked, "Do you have Medicare or Medicaid?" some respondents assumed that Medicaid and Medicare were forms of cancer.
Ask About Alternative Approaches to Healing
Many people from other cultures seek herbal remedies from traditional healers, says medical anthropologist Geri-Ann Galanti, PhD, author of Caring for Patients from Different Cultures and founder of the Web site Cultural Diversity in Healthcare. Some herbal remedies may be harmful or interact poorly with Western medicine, so it's especially important that nurses ask about these alternative treatments.
The role of the family differs greatly by culture. Whereas Americans value the nuclear family, most Asians and Hispanics place more value on the extended family, Galanti notes. In those cultures, the patient's extended family members show their love -- or fulfill their duty -- by visiting. "This often creates problems for nurses who don't understand why so many visitors are there all the time," Galanti says. "Whenever possible, it is best to accommodate these visitors."
Another common cultural misunderstanding involves self-care. Believing that it is important for a patient to feed and bathe himself and perform other activities of daily living on his own "is merely a reflection of the American value of independence -- a value that is not shared by most other cultures," Galanti explains. "Instead, most cultures value interdependence, as demonstrated by family members taking care of each other when ill." For that reason, nurses should not insist on self-care unless it is crucial to the patient's physical recovery, she advises.
Accommodate and Educate
Whatever the patient's cultural background, the health provider and patient both want the patient to return to the best state of health possible. According to Hasenau, sometimes a nurse can help patients preserve their beliefs and values within the American medical model; other times, the nurse can teach patients why new techniques or technologies that are antithetical to their beliefs are required for their recovery.
ElGindy, who is Muslim, says devout Muslims may reject medications that contain alcohol (like cough syrup) or that are made with pork (like insulin). In nonemergency situations, health providers can usually find alternatives to treatments that contradict patients' beliefs, ElGindy says. Making these small accommodations can have big payoffs for patients' emotional well-being.
To deliver truly culturally competent care, "we have to look at where our patients are coming from and what their ideas of wellness and illness are," Hasenau says.