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Culturally Sensitive Care
Providing culturally sensitive care is an important component of patient centered-care. Nurses must strive to enhance their ability to provide patient-centered care by reflecting on how their and the patient’s culture’s, values, and beliefs impact the nurse-patient relationship. The nurse also must understand how bio-psychosocial needs and cultural background relate to health care needs.
The following scenarios address questions nurses have about providing culturally sensitive care.
My patient decided on a treatment to be performed by his spiritual healer. I believe my patient’s choice of treatment poses a risk to his well-being. What is my role as a nurse in this situation and how do I facilitate patient choice?
There are certain values considered most important in providing nursing care, these include patient well-being and patient choice. You are accountable to listen to, understand, and respect patients’ values, opinions, needs, and ethno-cultural beliefs. By integrating these elements into the care plan, you are supporting patients’ by meeting their specific health goals.
You also are accountable for obtaining informed consent for any proposed treatment. It is your responsibility to determine the patient’s understanding of the treatment, ensure that they have the necessary information to make an informed decision, and ensure that their questions about the proposed treatment are answered.
When there are concerns that a patient’s care decision negatively affects the patient, you work with the patient to explain the choice’s associated risks, enabling the patient to make an informed decision.
You also are encouraged to consult with the broader health care team including colleagues, the leadership team, and the treatment provider about concerns related to a proposed treatment or care plan. Establishing collaborative relationships with other health care providers assists in the provision of patient-centred care.
What are some strategies I can use to reflect on my own cultural beliefs and values?
You are encouraged to reflect continually on your and your patients’ cultural beliefs and values to determine if or how they impact the care you provide. Such reflection assist in providing patient-centred, culturally sensitive care.
Here are some reflective questions to consider:
- How would you describe your culture? How would you rank the following in order of importance: ethnicity, family, work, the future, diet, and religion? Do you believe your patients have the same priorities? How do these values impact your relationships with patients?
- Consider possible areas where cultural variations in beliefs and values frequently occur. In your role as a nurse, would the choices you make be different for yourself or someone you care about?
- What does your body language say about you? How might a patient from another culture interpret your body language? Could your body language be communicating something different from your words?
These reflective questions are found in the accountabilities stated in CNO practice standards, Therapeutic Nurse-Client Relationship, Revised 2006, and Ethics.
I work in a large metropolitan hospital’s emergency department. We receive patients from multicultural and multilingual backgrounds. How can I promote effective communication with these patients and ensure they receive the best possible care?
A therapeutic nurse-patient relationship is based on meaningful communication. When communication barriers exist, you are responsible for using communication strategies and skills so the patient is an informed partner in the care provision.
Interpreters are essential when a nurse-patient language barrier exists. When using interpreters to communicate with patients, you need to obtain patient consent, be sensitive to the issues surrounding interpretation and ascertain the interpreter’s appropriateness for the particular patient situation. You also are encouraged to consult with your employer regarding organizational policies on using interpreters and work with your employer to develop policies if none are in place.
You are obliged to maintain confidentiality and protect personal health information as outlined in the practice standard Confidentiality and Privacy: Personal Health Information. Interpreters, by virtue of their role, gain access to personal health information and also are bound by confidentiality. To help the patient feel comfortable with the interpreter, you should inform the patient that confidential information is shared only within the health care team.
Non-verbal communication can be useful in conveying and receiving information. Techniques such as demonstration, gestures, using pictures or symbols, and written translations of information assists in communicating with the patient.
You must appear open, receptive, and interested in the patient. For example, speaking clearly, making eye contact and paying attention when the patient is speaking demonstrates respect for the patient. Achieving a common understanding requires considering how the patient perceives you or the situation and making attempts to correct any misperceptions.
I work in an Indigenous community in northern Ontario. How can I support my patients and what resources are available to address the unique health needs of the Indigenous community?
Partnering with patients and providing culturally sensitive care are important components of patient centered-care. You are accountable for discussing with your patients, your and your patient’s roles in achieving the care plan’s desired goal. You also must ensure you are sharing nursing knowledge with patients and promoting the best care possible.
The federal government has recognized the unique health needs of First Nations and Inuit communities in Canada. You can find more information and helpful resources on the Government of Canada’s Indigenous Health page.
CNO has developed the following scenarios to provide guidance to nurses in providing culturally sensitive care.
A nurse is providing direct care to an elderly Indigenous woman newly diagnosed with angina. She was prescribed nitroglycerine to manage her angina attacks. The patient reveals to the nurse that her illness is caused by the “evil eye,” and that a glance cast upon her by another caused the condition. She shows the nurse her own treatment, a drink, high in sodium, which she claims will lift the curse of the evil eye and cure her.
The goal in this situation, is a care plan that incorporates the patient’s wishes, including treatment for the “evil eye” and also the appropriate use of nitroglycerine. The nurse provides patient-centred care as outlined in the practice standard, Therapeutic Nurse-Client Relationship, Revised 2006 by discussing with the patient both the nurse’s and the patient’s roles in achieving the desired care plan goal. The nurse also must assess the patient’s treatment for possible health risks, provide information about the nitroglycerine treatment, and share nursing knowledge with the patient. In doing so, the nurse adheres to the accountabilities in Professional Standards, Revised 2002. In this situation, the nurse explores ways to accommodate the request while negotiating with the patient to undertake the actions or interventions the nurse thinks are necessary for a positive health outcome.
A patient, who is Hindu, requests a prayer ceremony be performed in the hospital as part of her treatment. The ceremony involves chanting and burning incense, which results in small amounts of smoke. The nurse’s initial reaction is that this has never been done, and is against hospital policy. However, she also understands this ritual’s significance for the patient. The nurse raises the issue with the unit administrator and, with colleagues’ support, explores the potential impact on other patients. The nurse also reviews relevant fire policies and consults with appropriate staff in other departments. They determined that transferring the patient to a private room removes any risk to other patients. This is done, and the ceremony is performed.
The nurse’s commitment to patient-centred care as outlined in the practice standard, Therapeutic Nurse-Client Relationship, Revised 2006, outlines ways of meeting the patient’s needs within the hospital setting limits. The nurse meets the practice standard, Professional Standards, Revised 2002 by collaborating with their manager and other colleagues, and determining how to fulfill the patient’s needs without exposing other patients to discomfort or risk.
CNO Practice Standards
- Therapeutic Nurse-Client Relationship, Revised 2006
- Confidentiality and Privacy: Personal Health Information
- Professional Standards, Revised 2002
- Health Canada’s Indigenous Health
- RNAO Best Practice Guideline Embracing Cultural Diversity in Health Care: Developing Cultural Competence
- Truth and Reconciliation Commission of Canada