Culture In Nursing
As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new infor- mation regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs Culture In Nursing
Goethe’s quote is considered a call to action by organ- izations as prestigious as the Institute of Medicine, and it remains one of my favorite quotes today. It has such incredible implications for health care, particu- larly as we struggle with the extended time it takes to translate research into practice. In fact, oftentimes, de- spite strong evidence, we are slow in enacting the changes we need to improve the health care and nurs- ing we deliver. In some cases we are waiting for the “indisputable” evidence, and in other cases we are sim- ply being resistant to change. But occasionally the need for change is thrust upon us, momentum builds, and the realization emerges that there isn’t a need to prove the obvious before acting but a need to act as the obvious is all around us. This has become the case with cultural competence in health care. Culture In Nursing
My knowing about the importance of cultural com- petence developed as I grew up in my bilingual, bicul- tural Puerto Rican family, where perspectives about health and health care were incredibly varied, and at times at odds with Western medicine. My knowing grew, as I trained to be a health-care professional in underserved and diverse settings such as Newark, New Jersey, and New York City, where we saw pa- tients from all cultures, classes, and racial/ethnic back- grounds. What became crystal clear to me was that while we were learning the best medications to treat hypertension or the most advanced algorithms for di- agnosing and treating disease, if we couldn’t commu- nicate effectively with our patients or get them to buy into, agree with, and cooperate with what we were try- ing to accomplish, then all that medical knowledge was worth nothing. Whether a doctor, a nurse, or other health professional, caring for patients required an understanding of the sociocultural factors that might impact their health beliefs and behaviors, rang- ing from how they presented their symptoms, to how they viewed disease and illness, to what informed their health care, diagnostic, and treatment choices. Cases where we couldn’t bring our knowledge to bear to ease suffering or cure disease because of “cultural differ- ences” with patients were the ones that kept us up at night and were the most frustrating and disappointing Culture In Nursing
of all. Along the way I also learned to appreciate that we all have culture and that the tools and skills I needed to learn to communicate clearly with patients wouldn’t just be helpful in the care of those who were culturally different from me, but to any patient with whom I interacted. For at the end of the day, there were always three cultures in the room—my culture; the patient’s culture; and the cultures of medicine, nursing, and other health professions—making every encounter cross-cultural in one way or another.
Despite these almost daily epiphanies during my training, there were few resources available that might provide me with guidance on how to become an effec- tive communicator and caregiver in this new world I was entering. Fortunately, this has changed. New models have been developed, leaders have emerged, and health-care professionals no longer need to go blindly into cross-cultural encounters without guid- ance, as there are real and practical approaches that facilitate improved understanding, communication, and care. Knowing is not enough, we must apply. Culture In Nursing
Transcultural Health Care: A Culturally Compe- tent Approach builds on a framework for cultural competence—which is essential in the care of the individual—by bringing together health-care providers of various backgrounds and disciplines to share their knowledge, expertise, and experiences in the field with particulars about different populations. This information is presented to provide details about the social and cultural fabric of different cultural groups, with the important caveat that it is not to be used to stereotype patients within these groups, as each pa- tient is an individual and diversity can be as extensive within groups as it is among groups. It is from this principle—that learning background information about cultural groups can help health-care providers both develop a “radar” for potential pitfalls when caring for them and serve as a springboard for in- quiry with the individual patient—that Transcultural Health Care emerges.
Why is this book, and this edition, so timely? In the past, arguments about the importance of cultural competence were based primarily on making the case that our nation was becoming increasingly diverse and that as health-care professionals we need to be pre- pared to care for patients of different sociocultural backgrounds. This is an important argument, no Culture In Nursing
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doubt. Shortly thereafter, research began to emerge demonstrating that being inattentive to cultural issues in the clinical setting leads to lower quality of care for specific populations, such as racial and ethnic minorities—a term that became known as disparities in health care. Yet what has evolved more recently is a burgeoning literature documenting the impact of cul- tural factors on health-care quality, cost, and safety. New research demonstrates that when we are not skilled or prepared to care for patients from diverse backgrounds, they may, when compared to their Cau- casian counterparts, suffer more medical errors with greater clinical consequences; have longer hospital stays for the same common clinical conditions; and may have more unnecessary tests ordered—all due to language or cultural barriers between health-care providers and patients. With health-care reform and payment reform on the horizon, we literally can no longer afford to be ill prepared to meet the needs of an increasingly diverse nation. Culture In Nursing
As we look toward the future, we see signs of a breakthrough occurring. More and more is being writ- ten about the topic of cultural competence. Students who years ago had to be convinced of the importance of this issue are now arriving more sensitized about cultural competence than ever before and are demand- ing to build their skills in the field. More research is being conducted on cultural competence and its im- pact on quality, safety, and cost. Additional areas are
being cross-linked to cultural competence, such as patient-centeredness and health literacy. New quality measures and accreditation standards are being devel- oped, and in some states cultural competence training has become a condition of health professional licen- sure. There is little doubt that the field of cultural competence is moving from the margin to the main- stream and from a luxury to a necessity. As individual providers, we must all do our part to ensure that we are delivering high-quality care to any patient we see, regardless of her or his race, ethnicity, culture, socio – economic class, or language proficiency. Transcultural Health Care: A Culturally Competent Approach helps us build the radar to identify and understand key cross-cultural issues among diverse populations and, when applied with the tools and skills that are essen- tial for exploring the sociocultural perspectives of the individual patient, positions us for success. Now it is time for us to learn the lessons and skills so gracefully shared with us in this book to make a difference in pa- tients’ lives. Willing is not enough, we must do. Culture In Nursing
Joseph R. Betancourt, MD, MPH Director, The Disparities Solutions Center and
Director of Multicultural Education, Massachusetts General Hospital Associate Professor of Medicine,
Harvard Medical School Cofounder, Manhattan Cross-Cultural Group Culture In Nursing
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