Cultural Competency in Patient Care

At New York Hospital Medical Center of Queens (NYHMCQ), whose area of service includes the third largest Asian population in the US, demonstrating cultural competency to patients is second nature. According to Greta Antonik, RN, MSN, CNA, clinical director of nursing, cultural competency means nursing care that demonstrates the belief that culture affects health. Nurses need to know what health and illness means to their patients. They need to acquire a set of academic and interpersonal skills that allows them to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups and act accordingly.

On NYHMCQ maternity units, for example, Yunxuan Zhang, RN, staff nurse and former midwife in China, understands why some Asian patients may be reluctant to shower postoperatively. The cultural beliefs of these patients subscribe to the philosophy of staying warm to remain healthy. An illness contracted during postpartum is believed to have a negative impact on their lives in the future.

To provide culturally competent care, Zhang upholds her patients’ wishes to stay warm. She instructs them to dry off immediately while sponge bathing and teaches them the basics of pericare. “Nurses find a compromise with patients, encouraging good health practices while upholding cultural values,” Zhang says.

“To accommodate patients’ cultures,” says Antonik, “there are interdisciplinary meetings to identify unique needs of the culturally diverse patient population. One outcome, for example, is the grocery shopping done by nutritional services with nurses from the Asian community to provide nutritionally sound and culturally-based meals for Asian patients.”

Cultural Competency and Coworkers

American Nurses Association (ANA) Presi-dent Beverly L. Malone, RN, Phd, FAAN, maintains that issues of culture, economic class, ethnicity, language, race, sexual and gender orientation, and age all play into the mix of attitudes and decisions that determine cultural competence. “These attitudes influence nurse behavior, not just toward patients, but toward one another, ” Malone says.

Cultural competency accentuates respect for, not just tolerance of, cultures other than one’s own. It obviates ethnocentrism, the belief that one’s own culture is superior to all others. The ANA position statement says that while ethnocentrism is common to all cultural groups, it is this pervasive, often unconscious, attitude that creates problems between nurses and those of diverse cultural groups.

Team Approach to Cultural Competency

At Saint Peter’s University Hospital in New Brunswick, NJ, the population of patients and staff is a kaleidoscope of ethnic backgrounds. The goal of the Transcultural Committee is to achieve cultural competency of staff for patients and coworkers through dialogue and the presentation of educational programs such as seminars, continuing educational packets, a video regarding cultural diversity with follow-up quiz for new employees, and the establishment of a mini-library about diverse cultures.

Alicia Felicia, RNC, MEd, CNOR, patient education coordinator/instructor, describes the Transcultural Committee as interdisciplinary. It is chaired by Ellen Shuzman, RNC, PhD, director of education and development, in collaboration with Robert Like, MD, director of the Healthy Families and Cultural Diversity department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School. The Transcultural Committee is composed of nurses, members of the medical staff, pastoral care, physical medicine and rehabilitation, the wound care center, food and nutrition, the medical library, and planning and community affairs.

“Currently the Transcultural Committee is in the beginning phase of cultural competency, that is, formulating needs assessments of employees regarding sensitivity to, and awareness of, different cultures and providing educational programs based on these needs,” says Felicia. “The next step will be to validate cultural competencies through a soon-to-be-devised checklist evaluation whereby staff can demonstrate culturally competent behavior in certain situations.”

Management’s Cultural Competency Challenge

Management encounters its own challenges when it comes to promoting cultural competency and facilitating harmony and productivity within a multiculturally diverse workforce.

“When nurses manage staff, they have the difficult task of keeping in perspective the many facets of culture, that is, the culture of the organization, the clients, the coworkers, and of their own culture as well,” says Cheryl Saffer, RN, MSN, CAN, oncology nurse manager, Saint Peter’s University Hospital. “Each are key pieces that must blend together to create a successful climate that will enable healthcare goals to be met.”

At NYHMCQ, Antonik says that nursing management meets the challenge by fostering multicultural teams to work together and to understand each others cultures. Often members of the same culture are paired with a resource person, another staff member who is available to assist in navigating the system. “There is an element of being able to rely on each other for translation, for learning, and for understanding the differences that each culture represents,” she says. “By doing so, barriers for misunderstanding tend to be minimized or removed,” adds Antonik.

Saffer believes that being aware of cultural differences, listening to, talking with, and assisting staff to be aware of and deal with these differences all play a large part of nurse managers’ roles in promoting cultural competency among coworkers. “It is important to cultivate nonjudgmental attitudes among staff,” says Saffer. “When it comes to culture, there is no right or wrong, there are differences that need to be understood, accepted, and appreciated.”

Claudia Carron, RN, MSN, CNA, nurse manager, adult ambulatory care services and the mobil health unit, Saint Peter’s University Hospital, agrees with Saffer and says that managers must rise to the challenge of helping staff look objectively at cultural differences and realize that while we all come from different perspectives, we are working for the same healthcare goals.

“Looking at things from the perspectives of others is an educational opportunity for managers which opens up the world to us and enables us not only to manage better but to live in our diverse society. This open-mindedness is an essential attitude for a nurse leader today,” says Carron.

Continual dialogue encourages an attitude of acceptance. At staff meetings, Saffer encourages discussions of journal articles about cultural competency as well as real-life incidents that occur on the unit with clients and staff.

Antonik says that the ongoing assessment of new and present NYHMCQ staff members’ needs relevant to cultural competency includes assisting staff to acclimate to the always changing cultural environment. “This enables them to function in a culturally competent manner,” she says.

“Rather than a status to be achieved, cultural competency is an on-going process, one that will enable employees to work effectively in cross-cultural situations, improve employee and patient relations, and exert an impact on healthcare,” says Felicia. For information regarding Diversity in Communication: Bridging the Gap, call Saint Peter’s University Hospital at (732) 745-8664.