Research Paper on "Culturally Competent Communication in Professional Nursing"

Research Paper 9 pages (2751 words) Sources: 3

[EXCERPT] . . . .

Culturally Competent Communication in Professional Nursing

Demographic Shift

Culturally Competent Communication

(Why it Matters)

Nurse Patient Communication

(Quality of Interpreters)

Nursing Care

(Developing Cultural Communication)

Cross Cultural Communication

(LEARN and RESPECT Models)

Improving Cultural communication

(Nursing Perspectives)

Culturally Competent Communication in Professional Nursing

As the population demographics change, the need for culture sensitive care provision becomes more prominent. Culturally sensitive communication is the key to effective interaction with patients from different cultures and subcultures and to develop timely interventions. Quality interpreter services is also a key component of caring for patients from diverse backgrounds and it is the responsibility of the health institutions to provide these services. There is an urgent need to address the cultural component of nursing at the academic level, as this would better prepare the graduating nursing force for delivering quality care across the entire spectrum of patient population.

Introduction

The nursing profession is continuously evolving with advancements in technology, discovery of new and sophisticated interventions, evidence-based nursing, etc. The rapidly aging population of the U.S. And the increasing healthcare demands has also placed increasing strain on the already overworked nursing force. However, one of the significant contemporary nursing issues is the increasing stress on culturally competent nursing. The U.S. population demographics is continuously changing and there is a clear shift in the ethnic and race ratios. Increase in patient diversity has important implications for the healthcare industry. Particularly for critical care nurses, the ability to provide culturally competent care is crucial as they not only have to develop interventions based on quick assessment of the patient's needs but also have to deal with cultural requests which may often contradict with mainstream healthcare practice. Culturally competent communication is crucial for the nurses involved in caregiving of an increasingly multicultural patient profile. Developing this cultural competency is the most pressing challenge faced by the Professional Nurse. A brief overview of the emerging demand for culturally competent care, and the nursing focus on developing transcultural competency would provide more insight into this important healthcare topic.

Demographic Shift

The population demographics is definitely shifting. Not only is the U.S. slowly changing into an aging nation but also there is a significant change in the racial mix contributed by the continuous influx of immigrants predominantly from South American, and Asian countries. Data pertaining to the ethnic population trends between 1980 and 2000 showed that a population increase is pronounced for the Hispanic race at 141.7% increase compared to 1980 while there was only a 12.3% increase in the population count for the Whites. In the same period both African-American and Native American population surged by 30.8% and 74.4% respectively. [Deborah L. Flowers (2004)] The more recent data released by the Government Census report of 2009 confirms this growing diversity in race and ethnicity in the national population. The Hispanic-American population, which was just 5% of the national population in 1970 has increased to 16% in 2010 and is projected to constitute 29% of the American population by 2050 representing one of the fastest growing population segments in America. [Philip Martin, (2010)]

Source: U.S. Census Projections With Constant Net International Migration, 2009

These demographic shifts have propelled new healthcare policy initiatives including culturally and linguistically pertinent services. Year 2000 saw the first major policy initiative in response to the changes in composition of the national population in the form of 'Culturally and Linguistically Appropriate Services' (CLAS). The CLAS standards were drafted with active input from the 'Health and Human Services' (HHS) and 'Office of Minority Health' (OMH) with guidelines for implementing the new initiatives into both public and private sector healthcare setups. Since then the OMH has made significant strides in promoting cultural competence in the healthcare sector in the form of providing grants for 'Centers of Excellence Bilingual and Bicultural Minority Pre-Faculty Fellowship program', conducting local health department surveys to assess the degree of compliance with the CLAS standards, research into the use of interpreter services and developing cultural competency models in partnership with universities to include such programs as part of curriculum for medical and nursing school students. [HHS, 2001]

Culturally Competent Communication (Why it Matters)

Good communication between the patient and the health care providers is essential for accurate assessment, appropriate treatment and for obtaining optimal outcome for the patient. Having competent cultural communication helps in reducing the racial disparities in terms of quality of health care provision. In some cultures patients may be very hesitant to seek clarifying information from their physicians and this could even result in nonadherence to treatment plan and even medication errors. Patients from diverse backgrounds have different perspectives of health, illness and healing that requires appropriate cultural knowledge from the nurses and other direct care providers in order to optimize the quality of care delivered to them. Furthermore patients from some cultures may recourse to alternative or traditional medicines that may conflict with their main treatment plan, often without the knowledge of the medical care provider, resulting in a high risk for developing adverse complications. However, if the nurse or other care- providers understand the language and are able to communicate better with the patients such complications can be averted. [Stephanie L. Taylor, (2004)]

Also it has been found that lack of English language proficiency may adversely affect the quality of care received by the patient. Even in cases where the immediate relatives of the patient act as the interpreters, several studies have reported the problems involved in such an approach ranging from wrong translation to patients' inhibitions pertaining to sharing certain sensitive information, preventing them from disclosing the information to the care providers in the presence of their relatives.

Nurse Patient Communication (Quality of Interpreters)

A University of Pennsylvania Study focused on nursing concerns of using interpreters with Latino patients in the emergency department. For the study 4 county hospitals within northwestern states with a population comprising atleast 25% of Latinos were chosen. In all a total of 15 nurses participated in the study and most of them had limited or moderate Spanish speaking ability while 5 nurses had no Spanish ability. The researchers also found that only 2 of the four hospitals employed qualified medical interpreters and even they were doing multiple administrative duties and worked only for a limited period of time in the ICU. All the nurses availed the services of interpreters or bilingual staff when communicating with the patient. A common consensus among the nurses participating in the study was the lack of adequate and qualified interpreters at their disposal in the ICU setting. As one nurse put it, "I feel like they [patients] are gonna explain the story with an interpreter to the physician. So unless I have an urgent need to know, I don't waste the resources and have the interpreter go in with me." Also some nurses expressed their concerns about the quality interpretation "They'll be interpreting for me, then all of a sudden they have this little interchange without me involved at all. And I'm like, 'Okay, wait a minute. Back up. Did I just miss an important piece of information?'" [Regina E. Nailon, (2006)] This study clearly highlights that the availability and the quality of interpreter services are a crucial aspect of nursing care provision in the emergency department.

Nursing Care (Developing Cultural Communication)

As discussed above appreciating the cultural and linguistic differences and developing culturally competent communication skills are very vital for providing high standards of medical care in a transcultural healthcare setting. Culture has a profound effect on how the patient perceives his illness, how he/she interacts with the physician or the nurse and therefore may impact optimal care delivery. One recent research, an extensive literature review by Narayan and Mary Curry (2010), focused on the effect of culture on pain assessment and management in clinical settings. The authors found that for providing optimal pain care nurses must understand how the patient thinks about pain. It is observed that the patients' reaction to pain is not uniform. Cultural influence on pain perceptions and behaviors have to be properly discerned by nurses who are in charge of the patients. Failure to understand the cultural cues may result in sub-optimal pain care for the patient.

For instance, patients from cultures which value stoicism tend to be less reactive to pain than those who grew up in cultures where outward expression of emotions is encouraged as a better way to deal with it. Also the description of pain may vary for people belonging to different cultures. In one of the studies reviewed by the authors they found that when native Americans were asked to rate their pain on a linear numeric scale of numbers they tended to select their 'favorite or sacred' numbers rather than choosing the number to appropriately indicate the degree of their pain. Similarly, it was also found that presenting a numerical rating scale as a measure of pain in a horizontal format to Chinese patients could leave them confused as they are used to reading vertically from top to… READ MORE

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