Definition of Cultural Competent Care
Cultural competence in nursing suggests that nurses must be sensitive to matters related to culture, race, economic situation, social class, and gender (Huber, 2006). These imply that nurses are aware and sensitive and have the capacity to intervene appropriately and effectively in matters relating to diverse populations. Home care nurses are increasingly confronted by challenges posed by the complexity of the health care environment as a result of diverse factors they must consider in caring for patients from ethnically diverse communities. Culturally competent care is necessary to enhance efficiency and effectiveness in nursing practice since world society has become increasingly diverse. This diversity in world society has accelerated the necessity of a nurse being sensitive to individual needs in nursing standards. A nurse must consider a patient’s individual lifestyle, value systems, and religious beliefs in planning nursing care (Rowland, 1997).
Populations served by cultural competence and issues of population vulnerability
The movement of diverse populations of multicultural nature due to globalization across boundaries affects not only national economies, but also strains societal resources and contributes to unrest in societies. As a result of mobilization, dislocation, and migration, these populations are vulnerable to problems that are unique with potential trauma, and psychopathologies that are specific. Globally, these multicultural populations include; racial or ethnic minorities who are long-term residents, underprivileged class of people surviving below poverty levels, workers who migrate, refugees, and international biculturally educated business people, students, tourist elites, and others. These diverse populations have different requirements, especially for mental health and social care services (Dana, 2008).
The minority population that is resident enjoys some status in host nations quite often. This population is not necessarily subjected to segregation, however, they may have been subjected to intergenerational oppressions that expose them to vulnerability to mainstream psychopathologies and problems that are culture-specific in living that affects their health and well-being. The underclass population on the other hand is deficient in infrastructural benefits of security, education, housing, social support, and other amenities. Populations that are migratory are regarded as stateless and segregated by occupational status, international racism, and acculturation deficiencies. Migrant workers with specific skills that are marketable are transient, marginal in their bicultural capabilities, and vulnerable to exploitation by affluent host cultures. Populations of refugee status carry with them the emotional residues of former lives and experiences that may constitute incursions on their humanity needing abroad range of additional special services. Populations that are skilled, educated, and affluent bring with them required expertise and desired occupational skills that make them more generally welcomed by host countries. These populations typically retain their original cultural identities and languages; however, they may also become comfortably integrated as international technocrats, professionals, and political workforces. These people experience differential pressures from national governments and transnational corporations (Dana, 2008).
The majority of these populations are vulnerable to stressful cultural shocks and other ongoing opportunities for specific sources of distress of the population during the acculturation process. Interpersonal interactions between populations of different ethnic and racial backgrounds can cause reactions that are averse and give evidence for active participation with a cultural environment that is unfamiliar (Dana, 2008).
When working with populations that are diverse, health care practitioners must understand that their personal backgrounds, knowledge and beliefs may vary significantly from those exhibited by patients or consumers of health care. For instance, the issue of language barriers may distort efforts to offer assistance to culturally diverse populations. Therefore, the health care practitioners must engage community members as excellent resources especially as translators not only of actual words but also of cultural beliefs, expectations, and possible utilization of non-traditional health care practices. Nurses and health care professionals need to know if there are risk factors that are specific for a given population, for instance, a migrant population from South East Asia are often at risk for Hepatitis B, and tuberculosis among others. These conditions are treatable and preventable as well if managed correctly (Huber, 2006).
Nurses and health care practitioners need to engage their clients to understand especially the non-traditional healing practices applicable to patients. A closer examination of these treatments reveals that many have proved effective and can be blended with modern medicine. The essence is for health care practitioners to know cultural practices that patients are used to so that blending can be incorporated knowledgeably. For this to be a success, health care practitioners must utilize community members as excellent sources of this information. The techniques they may employ to achieve these include; community assessment, family, and group work. Children and adolescents adapt easily to the new cultures they are exposed to than their elders do. This can be a potential recipe for family conflict and, at times can lead to violence. Nurses and other health care professionals must be keen on the warning signs of family stress and tension. They can use family members to assist in translating their culture, religion, beliefs, practices, support systems, and risk factors. Family members can also aid in making decisions and providing support to enable the person or groups seeking care to change behavior to become more health-conscious. Nurses and health care providers need to understand the role of the family in these vulnerable populations and to treat patients in the context of the family from which they come. The role of the larger community in care provision is equally essential. Larger communities can assist patients and providers of health care with communication, intervention in the crisis, emotional support, housing, explanations, and other forms of support. Nurses and other medical practitioners need to carefully assess the community and learn what strengths, resources, and talents they possess (Huber, 2006).
Standards of cultural competence
Cultural competence in our health care working environment is a priority due to the adoption of National standards for culturally and linguistically appropriate Services (CLAS) in health care at the end of the year 2000 by the U.S Department of Health and Human Services. There are several standards of cultural competence that appear to be met, and these include the standards provided to attain a stated purpose. The stated purposes are explicit and relate directly to target standards of cultural competence care. This purpose applies to the quality of nursing services, nursing education and training programs, and the overall performance of health care professionals in the institution; the scope of professional nursing practice and accountability standard has been catered for effectively. They have been based upon clear definitions. Nurses and other health care professionals have been able to account for their actions taken in the provision of health care. Standards have made their responsibilities explicit and move in line with the legal, ethical and professional accountability of all those to whom they apply; additionally, the standards adopted have promoted levels of performance that are universal and encourage professional identities and mobility. Variations between institutions from country to the country do happen and therefore this standard meets the needs in specific contexts; last but not least, the standards adopted are explicit to achieve the institution’s objectives while allowing flexibility to conform to the local context. These standards allow for flexibility that facilitates the applicability at both national or local levels, and adaptation to changes in health care systems. There is room to express in line with local needs without affecting the consistency between different levels (Huber, 2006).
In addition, other standards that appear to have been met include; relevance, collaboration, consumer rights, access and equity, coherence and consistency, convergence, reliability, and cultural competent standards themselves. The standards available address cultural competent areas that are seen to be important, applicable, and pertinent. This relevance is attributed to the processes applied in all aspects involving nursing and other health care professionals for practice for effective and efficient achievement of results. The adopted standards foster collaboration among health care professionals who provide essential services. These standards acknowledge the need for integrated health care systems that concentrate on consumer services that meet the needs of patients. The available standards promote cultural competencies as it has built nursing and health care personnel that is sensitive to cultural needs necessary for meeting health care obligations to all groups safely and competently. The standards available also recognize the realistic expectations of consumers of health care. Nurses and other health care professionals acknowledge that the delivery system of health care is consistent with realistic expectations of patients (Huber, 2006).
Potential Impacts of Delivery of Nursing where Standards are Being Met
The potential impact of the delivery of nursing where standards are being met involves evaluation of indicators that are intermediate and making the necessary changes to meet these indicators helps to ensure that the patient is progressing towards the desired outcome in a manner that is timely. The desired outcome arises whenever the desired outcome is not met. Whenever this outcome is not met, the Nurse or the health care practitioner concerned must determine why the problem arose and attempt to correct it (Rowland, 1997).
Nursing practice standards are meant to set minimum levels of agreeable performance. Nursing standards in health care institutions strive to provide patients with a means of measuring the quality of nursing care received. The institution has installed guidelines and conditions that are applied to determine whether a standard has been met. These conditions are frequently used by institution’s lawyers to assess the appropriateness of patient care and find out whether the standards of nursing care are met in a specific situation. For instance, these standards involve the documentation of care and describe the collection of data about the health status of patients as a systematic and ongoing practice. There is appropriate communication of information to relevant people, and this information is recorded and kept in a retrievable and acceptable system (Rowland, 1997).
Comment on the Solutions that could be implemented where Standards are not met
In situations where the adopted standards could not be met, the institution should put in place mechanisms of defining and isolating the problem, and making plans to solve them on the basis of priority. Those problems that are critical or essential must be addressed as a matter of priority and plans made and implemented immediately to resolve them. In particular, those associated with the safety and welfare of culturally diverse patients take initial priority.
Solutions to health and health care challenges that are not met are complex. These solutions involve enhancing the diversity of nurses and health care providers by ensuring that all people have access to affordable health care in the process of promoting wellness and a healthy lifestyle. Another solution that could be implemented where standards are not met is to eliminate disparities that exist in health care. Disparities in health care could be in form of disease morbidity and mortality in sections or segments of the population. These disparities come about due to differences in race or ethnicity. Income and educational inequalities form the root basis of many health care disparities. Populations with adverse health care variations have the worst health care status coupled with the highest poverty rates and least education. Low income and education levels are associated with differences in rates of illness and mortality (Bonder, 2002).
It is essential to note that efforts to recognize and respect culture in health care settings are complicated by organizational and practical considerations. Health organizations are faced with cost pressures to minimize time spent with each client and to concentrate on intervention goals that are pre-selected to reflect institutional rather than individual goals. The solution for cultural competence in such a setting requires recognition of both individual goals and institutional goals. Cultural factors play a significant role in health care outcomes that requires health care practitioners and their institutions to solve the complexities of culturally sensitive care (Huber, 2006).
Bonder, B., Martin, L., & Miracle, A. (2002). Culture in Clinical Care. Sydney: Elsevier Health Sciences.
Dana, R., Allen, J. (2008). Cultural Competency Training in A Global Society. New York: Springer.
Huber, D. (2006). Leadership in Nursing Care Management. Sydney: Elsevier Health Sciences.
Rowland, B. (1997). Nursing Administration Handbook. Sydney: Jones and Bartlett Publishers.