Racial concordance signifies the connection between the racial or ethnic backgrounds of patients and their healthcare providers, showcasing its profound impact on patient care, communication, trust, and overall health outcomes.

While racial concordance in Nursing offers various benefits, it's important to recognize it's not always feasible or practical to match every patient with a Nurse of the same racial or ethnic background. Emphasizing racial concordance should not overshadow the importance of Diversity, Equity, and Inclusion (DEI) within the Nursing workforce. 

Improved Communication 

This shared background fosters a sense of understanding and connection that goes beyond mere words - it's a deep-rooted familiarity with traditions, beliefs, and values that allows for seamless communication and empathy. Patients feel validated and heard when they can freely express their concerns and health needs in a language that resonates with their cultural identity. This bond of shared ethnicity or race creates a safe space for open dialogue and mutual respect, paving the way for a more holistic and personalized approach to healthcare.

Enhanced Trust 

Trust is a crucial component of the patient-provider relationship. Racial concordance can contribute to building trust between patients and Nurses, as patients may feel that their Nurse understands their unique experiences, challenges, and perspectives. This trust can lead to greater adherence to treatment plans and better health outcomes.

Cultural Competence

Nurses who share the same racial or ethnic background as their patients may possess a deeper understanding of cultural beliefs, practices, and health-seeking behaviors. This cultural competence enables Nurses to provide more personalized and culturally sensitive care, which can positively impact patient satisfaction and outcomes. Nurses of all backgrounds should receive training in cultural competence and communication skills to effectively care for patients from all backgrounds.

Reduced Health Disparities 

Racial and ethnic minorities often face disparities in healthcare access, quality, and outcomes. Racial concordance in Nursing can help mitigate these disparities by improving communication, trust, and cultural competence. Patients from marginalized communities may feel more empowered to seek care and engage in preventive health measures when they have Nurses who understand their unique needs and experiences.

Opportunity For Learning

Having a diverse workforce not only provides Nurses with the opportunity to learn from each other's unique life experiences and cultures but also fosters a rich environment for collaboration and growth. Nurses from different racial and ethnic backgrounds bring a wealth of knowledge and perspectives to the table, allowing for a dynamic exchange of ideas and practices. This diversity enriches the overall care provided to patients, as Nurses can draw upon a wide range of insights and approaches to address the needs of individuals from various backgrounds. Embracing diversity within the Nursing profession not only enhances the quality of care but also promotes a culture of inclusion and understanding that benefits both healthcare providers and patients alike.

Racial concordance in Nursing can play a significant role in improving patient care, communication, trust, and health outcomes, particularly for racial and ethnic minority populations. However, it's essential to address the broader issues of Diversity, Equity, and Inclusion within the healthcare workforce to ensure all patients receive high-quality, culturally sensitive care, regardless of the racial or ethnic background of their providers.

In our growing diverse society, health care workers need to understand that applying only traditional westernized medical practices isn't appropriate for many patients and families. Health professionals must have an awareness of different cultural practices and spiritual beliefs in order to reduce racial and ethnic disparities in health care.

According to the American Hospital Association, cultural competency in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet patients' social, cultural and linguistic needs.

There can be language barriers so make sure you know your patient’s preferred method of communication and arrange an interpreter. Non-verbal communication may differ across cultures. Don’t make any assumptions without knowing the person's customs.

Many cultures have special dietary considerations. Hospital staff should be educated about food culture, which is a term used to describe the non‐nutritive, yet nonetheless significant, aspects of food, such as when food is eaten and how it is served.

For example, Jewish patients do not eat pork or shellfish. Muslim patients also do not consume pork. Muslims will eat only permitted food (halal) and will not eat or drink anything that is considered forbidden (haram). Halal food requires that Allah's name is invoked at the time the animal is killed. Lamb, beef, goat and chicken, for example, are halal as long as a Muslim kills them and offers a prayer. Fish and eggs are also halal. Buddhist are mostly vegetarian, though Buddhists may eat meat if it has not been killed for them specifically.

Health care workers should use effective communication to increase their understanding about the patient's spiritual beliefs and practices. Your workplace should offer spiritual counselors like a chaplain or a rabbi. It is a good idea to have a non-denominational prayer and meditation room which can serve as an inclusive sacred space for staff and patients of all religious backgrounds.

Management should take an active role in promoting culturally competent workplace training courses and resources.

Our calendar of cultural dates is a great tool to assist staff with respectful scheduling and diversity celebrations.

The U.S. population is growing increasingly diverse. By 2020, the U.S. Census Bureau projects less than 50% of the children in the U.S. will be non-Hispanic and Caucasian. With demographics shifting, health care professionals trained in cultural competence will meet the needs of community health more effectively.  Nurse practitioners earning their Master of Science in Nursing can gain exposure to cultural competency in nursing practice. Trained NPs can help reduce disparities minorities experience, such as lower quality care, through improved awareness.

Culture’s Influence on Health Beliefs and Perception

Culture includes the knowledge, beliefs, and behavior of different groups of people. Elements of culture influence health knowledge and beliefs, as well as behaviors and measures that are taken to promote health. Understanding and respecting different cultures is a critical aspect of providing holistic, effective care.

Nurse practitioners must be culturally competent to be able to effectively listen to their patients’ health concerns, treat their health conditions in ways that are acceptable to the patient, and communicate in ways that are responsive and respectful of the patient’s culture. Here are a few ways that culture and ethnicity influence the care patients receive:

Body Language

Cultural norms highly influence body language. One example is the degree of eye contact with which individuals are comfortable varies. Some cultures express respect by not making eye contact, which can lead health care providers to view the patient as withdrawn, and suspect depression or anxiety if not informed of this difference. Eye contact may also be viewed in some cultures as flirtatious, or even disrespectful.

Experience of Pain and Illness

Different cultures have different ways of coping with illness and pain. These differences influence how, when, and whether individuals seek care. Cultures with an acceptance of pain as part of life may not report their pain to health care providers, and may not consider it a health problem.

Emotional responses to pain are also influenced by culture. Cultures that value stoicism may warrant less outward expression of pain, leading uninformed providers to believe that the individual isn’t suffering. Other cultures expect individuals in pain to react emotionally. Nurse practitioners must be mindful of differences in how cultures view, express and accept pain.

Decision-Making

Decision-making regarding health is also approached differently among ethnic groups. Some cultures value making health decisions as a family, or the individual receiving care will make the decision themselves, or the patient may appoint another family member to make decisions regarding their care. Nurse practitioners must be mindful that the patient may want to discuss options with their loved ones before accepting or declining a health care treatment plan.

Linguistic Barriers

Identifying linguistic barriers is another important aspect of cultural competence. Individuals may be able to communicate basic health needs to the provider, but have difficulty understanding the terminology used in the practitioner's response. NPs must be mindful of this, and also that some patients are not comfortable indicating that they don’t understand. Linguistic barriers can lead to the provider either missing or misinterpreting some of the nuances of the patient’s symptoms.

One way to help identify a linguistic or learning style barrier is through using the teach-back method. After explaining a health condition or treatment to the patient, the nurse practitioner then asks the patient to return the teaching. If they’re unable to do so or demonstrate some difficulty, interpretation services or a different teaching style, such as the use of audio or visual aids, may be necessary. Interpretation services should always be made available to those who speak English as a second language. Interpreters can also help providers better understand cultural differences.

Treatment Tailored to the Patient

Receptivity to cultural differences also influences treatment accepted by the patient. If a provider is not sensitive to or respectful of cultural differences, patients from diverse backgrounds may experience confusion or frustration. This may lead to them initially accepting treatment, but once home they may not follow through because they don’t trust the provider, don’t understand the purpose of the prescribed treatment, or the care plan conflicts with cultural values.

Taking Initiative as a Nurse Practitioner

Improved awareness helps eliminates assumptions made during care and gives voice to patients, so they can adequately express their concerns. Understanding cultural diversity in nursing also helps close the gap in health equity, reducing health disparities affecting minority populations such as higher morbidity rates and lower quality care.

Nurse practitioners are responsible for improving their own cultural competency to ensure that all patients receive effective care. The Agency for Healthcare Research and Quality offers many ideas to improve cultural awareness-one way is by respectfully asking patients about their beliefs in the context of health and treatment.

Nurse practitioners can also benefit from attending courses on cultural diversity in practice, participate in community organizations, and research the norms of different cultural and ethnic groups. Broadening one’s own understanding of culture and how people interact improves the professional ability to make meaningful connections with patients.

References:

Agency for Healthcare Research and Quality. (2015). Consider culture, customs, and beliefs: Tool #10. https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool10.html

National Institute of Health. (N.d.). NIH fact sheets - Health disparities. https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=124

Peacock, S., Patel, S. (2008). Cultural influences on pain. Reviews in Pain: British Pain Society, 1(2), 6-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589930/.

United States Census Bureau. (2018). Older people projected to outnumber children for first time in U.S. history. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html

Holly Rinehart, RN, BSN, is a registered nurse and writer for the Carson-Newman University blog. She specializes in emergency and perioperative nursing and cherishes the opportunity as a nurse to help serve and comfort those in vulnerable positions. In her free time, she enjoys traveling and telling nurse stories to anyone who will listen.

First article written by Frontier Nursing University
Second article Written by Marissa Silver

Frontier Nursing University believes in increasing awareness of the importance of cultural competency and decreasing health disparities. This article is about their 7th annual Diversity Impact Event. FNU states “Diversity Impact is designed to open the door for nurses to foster and strengthen collaborative discussions to address health disparities to improve minority health among underrepresented and marginalized groups.” Enjoy this informative article.

In a rapidly-changing, sometimes divided world, Frontier Nursing University (FNU) emphasizes the value of respecting and honoring diversity.

In the United States, there is a wide gap in health outcomes. Several populations face greater obstacles in obtaining good health based on their racial or ethnic group, religion, socioeconomic status, gender, age, mental health, sexual orientation, physical or mental disability, or geographic location. These disparities may exist because of social and economic inequality, inadequate health care providers or systems, and bias on the part of health care providers or patients.

The gap forming in the health of women before and during pregnancies is also a source of concern. Determinants of a mother’s health may include social factors, ethnic or racial group, or her previous health status. An infant child is also impacted by factors such as nutrition, family income, and the geographic location of their homes and neighborhoods.

Additionally, consider this: women living in rural areas have less access to health care than women living in urban areas. Where 22.8% of women live in what is defined as a “rural” area in the U.S.¹, there is a significant disparity between the health care they receive and the health care received by the “urban” population of women.

Although health care needs around the nation are diverse, health care providers do not reflect the population. In 2008, only 16.8% of Registered Nurses residing in the United States represented diverse racial and ethnic backgrounds². Additionally, underrepresented groups make up less than 10% of nursing school faculty³. The nursing profession faces the challenge of recruiting and retaining a culturally diverse workforce that mirrors the nation's demographics.

With these challenges in mind, it is important that our education system equips nurse practitioners, nurse-midwives and other healthcare professionals with the resources they need to eliminate these disparities, and ultimately achieve health equity.FNU would like to see the Frontier community impact health equity and move forward by uniting through diversity.

On June 1- 4, 2017, Frontier Nursing University held the 7th annual Diversity Impact Student Conference. Diversity Impact is designed to open the door for nurses to foster and strengthen collaborative discussions to address health disparities to improve minority health among underrepresented and marginalized groups. Students will engage in cross-cultural and intercultural workshop activities, along with leadership strategies on current diversity healthcare trends as it relates to patient-provider care.

This year’s Diversity Impact theme is Moving Forward: Uniting Through Diversity. Students will attend sessions hosted by nationally recognized nursing leaders; participate in teambuilding activities, cultural competency awareness training, and open dialogues; network with available FNU students, community leaders, faculty and staff; and learn more about the world with FNU’s International Food Menu.

Frontier Nursing University conference discusses healthcare diversity

Factors such as someone's age, race, gender and ethnicity can all play a role in their healthcare.

This weekend, Frontier Nursing University students attended a conference, to learn how those factors and other differences between populations may impact a patient's health and treatment. One factor, which may impact patients in Eastern Kentucky is living in rural communities.

"It's like a totally different population than what you see in urban areas," Vaishu Jawahar who attended the conference said. "Even though we think that sometimes urban populations have it bad, the sheer lack of resources that's out here makes being in a rural area that much harder."

Another topic discussed during the conference was caring for those in the Lesbian, Gay, Bisexual and Transgender (LGBT) community.

"As healthcare providers, no matter what your political views are you have to be able to take care of everyone or at least make them feel comfortable enough to seek out your care," said Jawahar.

As part of the discussion on serving the LGBT community, two Frontier Nursing University students talked about their experience treating patients during last year's mass shooting, at Pulse, a Gay nightclub in Orlando, Florida.

Overall, those who attended the conference said taking the time to get to know the patient and their background can make a difference.

"It's so easy for us to get caught up in our way of life, we forget there's very different realities for everyone," Wilvena Bernard, Diversity Pride Program Coordinator, Frontier Nursing University said.

More than 50 students and faculty attended the conference from across the country.

Last month, University officials announced they are moving student activities from the Hyden campus to Versailles by Fall of 2018.

Interested in learning more about Frontier Nursing University? Check out their Employer Profile! Just Click Here.

Growing up, we were taught to be modest. As we became adults and more comfortable with who we are as a person, modesty may have become more important in our lives, or perhaps, less important. It depends on our personal circumstances and beliefs.

Whatever our personal feelings are, as a Nurse, you must always be vigilant and respect your patient’s privacy. You already know this, but are you aware in some cultures, modesty truly is a virtue? For others, there could be a personal trauma, physical disfigurement, or psychological reason that produces tremendous anxiety when disrobing or showing any part of their body.

This article stresses the importance of being sensitive to each patient’s needs in delivering culturally competent care.

Many cultures and religions place a high value on modesty, particularly for women, associating it with honor and virtue. Often modesty is linked to styles of dress and circumstances under which an individual might feel comfortable being uncovered or touched. Yet, there are personal reasons for modesty too, so you’re likely to come across patients, both male and female, who have firm boundaries of privacy—including survivors of sexual assault and transgender patients.

Modesty can be so important to some patients that medical visits cause them a great deal of stress and anxiety. Some will shop around for a clinician of a particular gender or one who makes them feel comfortable—or even forego care completely. As a nurse, your ethical commitment to patient advocacy and patient dignity requires you to demonstrate cultural sensitivity to patients who value modesty. Making accommodations for a patient who values modesty is a form of holistic care, because it recognizes the individual’s emotional well-being.

In general, nurses should always preserve patient privacy, by providing gowns and cover-ups, pulling drapes closed, knocking before entering an exam room, etc. Whenever possible, go the extra mile, by providing scrub pants if a gown doesn’t close in the back or double-gowning a patient who will be leaving his room. Patients may know intellectually that healthcare providers “have seen it all,” but that doesn’t stem their embarrassment. You can also urge your employer to build an environment where patients feel safe, by speaking up about gowns that don’t close all the way or other modesty issues.

Cross-cultural patient encounters can often be challenging in terms of modesty. Muslim women are likely to request female providers only, and these requests might be hard to honor in small facilities or rural areas. They may also prefer to have their husband present during an exam or procedure, and may resist disrobing entirely—or uncovering their hair—for an exam. Women from certain Asian cultures also have a strong preference for female obstetrics staff. Ideally, nurses should be able to anticipate cultural requirements for modesty and make accommodations before patients become anxious or uncomfortable.

While the majority of nurses are female, many mistakenly believe that male patients really don’t care about modesty, but that often is not true. Many hospitals don’t have nearly enough male nurses or technicians on staff, but you should try your best to honor requests for same-gender providers for baths, catheterizations, or other intimate procedures. Always try to be sensitive to modesty concerns—even when it creates an extra step for you or takes more time.

How can you properly care for a patient if you don’t understand their personal needs? Communication is key. Making a patient comfortable goes far beyond providing warm blankets. It is about the patient trusting you and knowing you have things in common that show them you understand how they feel and what they need. 

Many healthcare providers are seeing how important diversity and inclusion is to delivering quality patient care. Hospitals are providing language services by hiring a diverse staff, many of whom are bilingual or multilingual. Culturally appropriate care strategies are also key. Religious views may alter the way staff would normally provide care. That means you might assist a patient who needs to move in order to pray or work out special blood testing times to allow the patient to fast. The population is rapidly changing and by 2050, the white population will no longer be the majority.

Cultural respect is vital to reduce health disparities and improve access to high-quality healthcare that is responsive to patients’ needs, according to the National Institutes of Health (NIH). Nurses must respond to changing patient demographics to provide culturally sensitive care. This need is strikingly evident in critical care units.

“As an emergency room nurse in a small rural hospital, I was present when an elderly Native American man was brought to the emergency room by his wife, sons, and daughters,” Deborah Flowers says in Critical Care Nurse. “He had a history of 2 previous myocardial infarctions, and his current clinical findings suggested he was having another. During the patient’s assessment, he calmly informed the emergency room staff and physician that, other than coming to the hospital, he was following the ‘old ways’ of dying. He had ‘made peace with God and was ready to die’ and ‘wanted his family with him.’”

“The emergency room physician ordered intravenous fluids, a dopamine infusion, a Foley catheter, and transfer to the intensive care unit of a regional hospital 3 hours away. The patient died 2 weeks and 2 code blues later, and was intubated and receiving mechanical ventilation for most of that time. No family members were present when he died except for his wife. The rest of his family members were unable to afford the cost of traveling to a healthcare facility that far from home. This man’s cultural values and preferences in relation to dying were disregarded.”

In contrast, promoting culturally competent nursing care helps nurses function effectively with other professionals and understand the needs of groups accessing health information and healthcare.

Examining Culturally Competent Nursing Care

Definitions

Cultural competence can be defined as “developing an awareness of one’s own existence, sensations, thoughts, and environment without letting it have an undue influence on those from other backgrounds; demonstrating knowledge and understanding of the client’s culture; accepting and respecting cultural differences; adapting care to be congruent with the client’s culture,” according to Larry Purnell in his book Transcultural Health Care: A Culturally Competent Approach (1998).

Another definition states that cultural competence “describes how to best meet the needs of an increasingly diverse patient population and how to effectively advocate for them,” says Barbara L. Nichols, former CEO of the Commission on Graduates of Foreign Nursing Schools, in NSNA Imprint.

Explanations of culturally competent nursing care focus on recognizing a patient’s individual needs, including language, customs, beliefs and perspectives. Cultural sensitivity is foundational to all nurses. “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person,” states the American Nurses Association’s Code of Ethics for Nurses.

Relevance

More than one-third (37 percent) of the U.S. population consists of individuals from ethnic and racial minority groups, and by 2043, minority groups will become the majority, according to research from the American Association of Colleges of Nursing. However, nurses from minority backgrounds represent 19 percent of the registered nursing (RN) workforce. Men account for 9.6 percent of the RN workforce.

There is a “challenge presented by the health care needs of a growing number of diverse racial and ethnic communities and linguistic groups, each with its own cultural traits and health challenges,” the NIH says. Nurses and other healthcare providers must account for these differences through cultural respect to support positive health outcomes and provide accuracy in medical research.

“The development of cultural competence in the nursing practice first requires us to have an awareness of the fact that many belief systems exist,” says Lanette Anderson, executive director of the West Virginia State Board of Examiners for Licensed Practical Nurses. “The beliefs that others have about medical care in this country, and sometimes their aversion to it, may be difficult for us to understand. We must remember that we don’t need to understand these beliefs completely, but we do need to respect them.”

Developing Cultural Competence

Framework for Delivering Culturally Competent Services

Campinha-Bacote and Munoz (2001) proposed a five-component model for developing cultural competence in The Case Manager.

1. Cultural awareness involves self-examination of in-depth exploration of one’s cultural and professional background. This component begins with insight into one’s cultural healthcare beliefs and values. A cultural awareness assessment tool can be used to assess a person’s level of cultural awareness.
2. Cultural knowledge involves seeking and obtaining an information base on different cultural and ethnic groups. This component is expanded by accessing information offered through sources such as journal articles, seminars, textbooks, internet resources, workshop presentations and university courses.
3. Cultural skill involves the nurse’s ability to collect relevant cultural data regarding the patient’s presenting problem and accurately perform a culturally specific assessment. The Giger and Davidhizar model offers a framework for assessing cultural, racial and ethnic differences in patients.
4. Cultural encounter is defined as the process that encourages nurses to directly engage in cross-cultural interactions with patients from culturally diverse backgrounds. Nurses increase cultural competence by directly interacting with patients from different cultural backgrounds. This is an ongoing process; developing cultural competence cannot be mastered.
5. Cultural desire refers to the motivation to become culturally aware and to seek cultural encounters. This component involves the willingness to be open to others, to accept and respect cultural differences and to be willing to learn from others.

Tips

Nurses should explain healthcare jargon to patients whose native language is not English, according to Monster contributing writer Megan Malugani. A breast cancer awareness program for U.S. immigrants demonstrated that women were too shy to say they didn’t understood certain terms. Some assumed that Medicare and Medicaid were forms of cancer.

Many people from other cultures seek herbal remedies from traditional healers — and they can be harmful or interact poorly with Western medicine. Nurses should ask patients about any alternative approaches to healing they are using. Another example of cultural sensitivity involves nurses understanding the roles of men and women in the patient’s society. “In some cultures, the oldest male is the decision-maker for the rest of the family, even with regards to treatment decisions,” Anderson says.

The most important way for nurses to achieve cultural competency and promote respect, according to Anderson, is to gain the patient’s trust for a stronger nurse-patient relationship. This requires sensitivity and effective verbal and non-verbal communication.

Pitfalls

Nurses should never make assumptions or judgments about other individuals or their beliefs. Instead, nurses can ask questions about cultural practices in a professional and thoughtful manner.

Common pitfalls to avoid involve stereotyping and labeling patients, according to Flowers.

• Nurses should avoid unintentionally stereotyping a patient into a specific cultural or ethnic group based on characteristics like outward appearance, race, country of origin or stated religious preference. Stereotyping refers to an “oversimplified conception, opinion, or belief about some aspect of an individual or group of people,” she says. Additionally, many subcultures and variations can exist within a cultural or ethnic group. For instance, the term Asian-American includes cultures such as Chinese, Japanese, Taiwanese, Filipino, Korean and Vietnamese, and within these cultures, there are variations in geographic region, religion, language, family structure and more.
• Nurses should be careful about labeling patients. For instance, citizens in the United States may refer to themselves as Americans, but that term can also apply to individuals from Central and South America. Flowers recommends referring to a person from the United States as a U.S. citizen.

Responding to Higher Standards in Nursing

More hospitals across the United States now require that nurses have a bachelor’s degree. Rising educational standards are emphasized to increase the quality of care that patients receive. Alvernia University’s online RN to BSN Completion Program is designed to improve patient outcomes and help nurses meet each patient’s needs, including those unique to the patient’s cultural background. The degree program takes place in a convenient online learning environment that accommodates students’ work and personal schedules.

The RN to BSN Completion Program includes a class — NUR 318 Developing Cultural Competency & Global Awareness — which offers students “an opportunity to begin their lifelong journey to becoming culturally engaged.” This course has existed at Alvernia University for more than a decade, and demonstrates how Alvernia is leading the way in preparing culturally competent nurses.