Cultural Considerations in Healthcare
Published on the 22 July 2019
Published on the 22 July 2019
This relies on healthcare professionals understanding that each patient is an individual with distinct, beliefs, behaviours and requirements.
It is vital you adapt your practice to address the wants and reasonable expectations of the patient (Medical Board of Australia 2014).
Cultural awareness is interlinked with this – healthcare professionals must be conscious of their own culture and beliefs, and ensure that they are respectful of the beliefs and cultures of others.
It is also worth remembering, however, that these differences can all-too-often have the potential to complicate the nurse-patient relationship and, henceforth, the provision of health services (Medical Board of Australia 2014).
Learning to nurture cultural respect and inclusion is vital to reducing health disparities and to facilitate and improve access to high-quality healthcare that is directly responsive to a patient’s needs (Zamanzadeh et al. 2015).
Statistics from the most recent national census reveal how truly diverse Australia is as a nation.
Only two thirds (67%) of the Australian population were born in Australia. Of the 6,163,667 overseas-born persons, nearly one in five (18%) arrived since the start of 2012 (ABS 2016).
As of 2016, there were over 300 separately identified languages spoken in Australian homes. More than one-fifth (21%) of Australians spoke a language other than English at home (ABS 2016).
In 2016, nearly half (49%) of Australians had either been born overseas (first generation Australian) or one or both parents had been born overseas (second generation Australian) (ABS 2016).
Culture is the values, customs, social structures, beliefs and patterns of human activity and the symbolic structures that provide meaning and significance to human behaviour (Engebretson 2016).
It is the combination of these as well as ideas, skills, arts, and other capabilities of a people or a group as a whole – and it is more than any of these elements and constantly in flux (Engebretson 2016).
Culture is influenced by political and economic conditions and varies with factors including age, gender, class, education and personality (Engebretson 2016).
Culture is largely tactic, which is to say, it is not generally expressed or discussed at a conscious level – most culturally derived actions are based on implicit cues (Engebretson 2016). This is one reason why healthcare professionals are wise to avoid making assumptions and should work toward understanding a patient’s culture beyond what may seem obvious to them.
We take for granted the way in which the following can differ between cultures and regions: eye contact, touch, decision-making, compliments, health-beliefs, healthcare practices, personal space, and modesty (Ferwerda 2016).
Cultural awareness and sensitivity is vital to nursing. While we like to believe in the ideal that all Australians have access to a high standard of healthcare, this is not always the case.
Patients from diverse cultural backgrounds (including First-Nation Peoples) experience almost twice as many adverse effects as English-speaking patients (Multicultural Health Communication 2013).
People of a non-English speaking background are more likely to experience medication errors, misdiagnosis, incorrect treatment, poorer pain management and poorer outcomes in general (Ferwerda 2016).
The potential of error in the absence of culturally-aware nursing is vast. Misunderstandings, miscommunication, and culturally-unsafe care by healthcare professionals are often reported (Johnstone and Kanitisaki 2006). Patients of a non-Anglo-Saxon background have cited feelings of powerlessness, vulnerability, loneliness and fear (Garrett et al. 2008).
It is worth keeping in mind that there is a variance in the prevalence of illnesses between cultural groups. This is due to genetic differences, dietary, cultural, environmental, socioeconomic or a combination of all of these factors (Collins 2003 quoted by Engebretson 2016).
Key determinants of health include but are not limited to: education and income, adequate and healthy housing, air quality, and health insurance (Centre for Disease Control of Prevention 2011 quoted by Engebretson 2016).
There may be situations in your job when cultural-beliefs and wishes clash with best practice. This is where culturally-safe practice is crucial.
Culturally safe and sensitive practice is defined by the Medical Board of Australian as:
(Medical Board of Australia 2014)
Transcultural nursing is a term that seems to be gaining traction in recent years.
In essence, it is nursing that seeks to provide care that acknowledges and is congruent with a patient’s culture, values, beliefs and practices – the crux of which is good communication between the healthcare professional, the patient and their family.
To ensure that they are able to provide culturally-considerate nursing, an individual must first consider their own cultural biases and how these may impact their practice.
In addition, it requires:
(Care Search 2018).
A - Assessment
C - Communication
C - Cultural negotiation and compromise
E - Establishing respect and rapport
S - Sensitivity
S - Safety
Learn and remember the ABCD model of Kagawa-Singer & Backhall (2001), and make it part of your routine to take time to discuss the following with your patient and their family:
A - Attitudes
C - Context
D - Decision-making style
E - Environment
(Kagawa-Singer & Backhall 2001)
There will be times in which you may find differing cultural practices and beliefs at odds with your practice and therefore hard to navigate. You may offend the patient or you might witness something that differs from your beliefs/moral codes. Sensitivity and communication should be the tools you rely on in these situations.
If in doubt, simply ask patients:
“Are there any religious or cultural practices that affect the way you wish to be cared for?”
- as opposed to making assumptions (Care Search 2018).
The primary consequences of cultural neglect are poorer outcomes for people of diverse or marginalised backgrounds and, on a more general level, distrust for the healthcare industry (Ferwerda 2016).
Ultimately, keeping these frameworks in mind and undertaking cultural assessments will help healthcare professionals provide safe and person-centred care to all people regardless of their race, ethnicity, culture or language.
(Correct answers below.)
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