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 Some cultures express respect by not making eye contact, which can lead health care providers to view the patient as withdrawn, and suspect depression or anxiety if not informed of this difference.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.

Healthcare organizations strive to provide culturally competent care for individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). Recent changes in society, including the legalization of gay marriage have raised public awareness of LGBTQ issues. Yet many healthcare professionals lack knowledge in some areas when caring for LGBTQ patients.

Michael Johnson, PhD, RN, understands the barriers faced by LGBTQ patients and the assumption often made by healthcare professionals that all patients are heterosexual. 

According to a Nurse.com article, Johnson said, “Some members of the LGBTQ community avoid seeking healthcare services because of previous negative experiences in which they faced discrimination. Studies have shown most LGBTQ patients want to be able to share their sexual orientation or gender identity with their healthcare provider, but are often reluctant to open up because they fear they may be treated badly or even refused care."

LGBTQ individuals have a long history of discrimination at the individual and institutional levels, including the healthcare system. They may check to see if the environment is a safe place to reveal personal information, especially about sexuality. Some things an individual may take note of during their time in your waiting room area include:

• Your organization’s nondiscrimination policy: Is it in a visible location?
• A rainbow flag, pink triangle, or other symbol of inclusiveness
• Availability of unisex restrooms
• Health education literature with diverse images and inclusive language, including information about LGBTQ health
• Posters announcing days of observance such as World AIDS Day, Pride, and National Transgender Day of Remembrance

To understand LGBTQ populations and their health needs, it is important to first define the distinct core concepts of sexual orientation and gender identity. You can read about key LGBTQ terms here.

LGBTQ health requires specific attention from health care and public health professionals to address a number of disparities, including:

• LGBT youth are 2 to 3 times more likely to attempt suicide.
• LGBT youth are more likely to be homeless.
• Lesbians are less likely to get preventive services for cancer.
• Gay men are at higher risk of HIV and other STDs, especially among communities of color.
• Lesbians and bisexual females are more likely to be overweight or obese.
• Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGB individuals.
• Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.
• LGBT populations have the highest rates of tobacco, alcohol, and other drug use.

 

Nurses should avoid asking any unnecessary questions. People are sometimes curious about LGBTQ people and their lives, which can lead them to want to learn more by asking the patient questions. However, like everyone else, LGBTQ people want to keep their medical and personal lives private. Before asking any personal questions, first ask yourself: “Is my question necessary for the patient’s care, or am I asking it for my own curiosity?" If for your own curiosity, it is not appropriate to ask. Think instead about: “What do I know? What do I need to know? How can I ask for the information I need to know in a sensitive way?"

Effectively serving LGBTQ patients requires you to understand the cultural context of their lives, and to modify your procedures, behavior, and language to be inclusive, non-judgmental, and helpful at all times. By doing this, healthcare staff can help ensure that LGBTQ patients receive the level of care that everyone deserves. What helpful information can you add regarding this topic?

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.