Promoting Cultural Health Competence in Nursing

By Lani Hollenbeck

Part One: Situation and Background

Situation

According to the August 2003 Kaiser Commission on Medicaid and the Uninsured, more than 46 million people - more than 17 percent of the U.S. population - speaks a language other than English at home. The Kaiser Commission report provides many examples of how lack of language access negatively affects access to and quality of health care.

As a registered nurse (RN) in the Special Diagnostic Center at Children’s, many of my interactions with limited English proficient (LEP) patients and families have been frustrating, leaving me feeling that my communication and teaching were inadequate and wondering how I could improve my skills and interactions. Many of my nurse colleagues have shared with me that they experience similar feelings. The results of Children’s 2005 employee satisfaction survey as well as the Special Diagnostic Center’s problem scores confirm that lack of cultural health competence is seen as a barrier to providing excellence in patient care. Cultural health competence is defined as understanding the values and views of those in other social classes and ethnic groups.

Background

“Providing culturally safe care is necessary for excellent nursing care. The nurse/patient interaction is the core of such excellence; it enables openness, trust, and acceptance so that nursing care is facilitated” (Pasco, Morse and Olson, 2004). Consequences of inadequate health competence include poor health status, lack of knowledge, lack of understanding, and underused of preventative services.

Coffman, Shellman and Bernal (2004) evaluated the effectiveness of the Cultural Self-Efficacy Scale (CSES) for assessing nurses’ confidence and skills in caring for patients from culturally diverse backgrounds. They used literature searches and questionnaires to evaluate the uses, methods, and findings of the CSES. According the authors, “The . . . CSES is an important assessment tool as today’s nurses need to be increasingly sensitive as a result of the growing diversity of the population. Research indicates that nurses lack cultural self-efficacy, cultural information, and cultural experience. This lack of experience often results in nurses subjecting their clients to ethnocentric attitudes, inappropriate communication, inaccurate diagnoses, and ineffective interventions.” Their study supports ethnicity exposure, coursework, and educational experiences to increase nurses’ self-efficacy in delivering culturally competent care.

Comerford-Freda (2004) identifies patient education as one of the most important responsibilities of nurses and nurse midwives but acknowledges that appropriate and comprehensive patient education has become increasingly difficult to provide. She suggests that the challenges may be the result of the influx of clients from various cultures, confounded by lack of time, a dearth of educational materials at appropriate readability levels and/or in languages other than English, and lack of reimbursement for patient education. The author discusses cultural competence as affecting patient education, principles of education, methods of teaching, readability, ethical issues, and informed consent.

Majumdar, Browne, Roberts and Carpio (2004) conducted a randomized controlled study assessing the effectiveness of cultural sensitivity training on knowledge and attitudes of health care providers as well as satisfaction and health outcomes of patients from minority groups with health care providers who received training. They concluded that a cultural sensitivity program improved knowledge and attitudes among health care providers as well as health care outcomes for their patients.

The above literature identifies that cultural competence is integral to providing safe and excellent nursing care and reinforces the importance of recognizing our own limits and biases as nurses when caring for patients. It is imperative that we appreciate the need for cultural understanding and the nuances of cultural health in order to work effectively with families. The literature summaries identify that nursing participation in education about cultural health competence will enhance communication and patient interaction.

In Part II of this article, coming soon, I will present my assessment of and recommendations for education for RNs on caring for LEP patients and their families.

Lani Hollenbeck, RN, BSN,C, is a staff nurse in Special Diagnostics at Children’s.

Coffman, J, Shellman, J., Bernal, H. (2004). An integrative view of American nurses’ perceived cultural self-efficacy. Journal of Nursing Scholarship 36(2), 180-185.

Comerford-Freda, M. (2004). Issues in patient education. Journal of Midwifery Women's Health 49(3). Retrieved May 3, 2005 from http://www.medscape.com/viewarticle/478283

Kalanj, B. Director, Cultural Care and Interpreter Services, Children’s Hospitals and Clinics of Minnesota. Personal communication, May 17, 2005.

Majumdar, B., Browne, G., Roberts, J., Carpio, B. (2004). Effects of cultural sensitivity training on health care provider attitudes and patient outcomes. Journal of Nursing Scholarship 36(2), 161-166.

Pasco, C., Morse, J., Olson, J. (2004) Cross-cultural relationships between nurses and Filipino Canadian patients. Journal of Nursing Scholarship 36(3), 239-246.

Perkins, J. (2003) Kaiser Commission on Medicaid and the Uninsured. 1-31.