Today’s multicultural society has led to the need to have nurses provide culturally congruent care to the many patients from diverse cultural backgrounds. This presents a challenge to the nurses’ and the nursing profession because they have to incorporate the cultural needs of the patients to ensure quality and adequate care. Multicultural issues involve a range of cultural differences factors that exist between the nurses and patients and which affects the ability of nurses to deliver the best care. To improve the health outcomes within a cultural context, nurses require specific skills and knowledge in cross-cultural nursing. The nursing practice is currently recognizing the importance of understanding the beliefs, values, and health care for different cultures to provide appropriate and relevant care. The various cultural factors are essential in understanding the specific requirements within the health care setting. Because people from different cultural backgrounds have different expectations during health care, the nursing practice is currently reinforcing the skills and knowledge of nurses regarding cultural diversity. Even though the issue of multiculturalism within the nursing practice is still a challenge to the nurses, progress has been made over the last decade as more nurses are becoming more experienced on how to handle patients from different cultural backgrounds. This paper reviews various literature concerning the issue of multiculturalism in the nursing profession and how the nursing profession is currently responding to this challenge.
Literature Review
The concept of multiculturalism has dominated discussions for the past one decade with a key focus being on the health care sector. Due to the rising number of immigrants, minority groups and other people from different cultural backgrounds, there is a growing concern over the need to provide nursing care that is sensitive to cultural diversity. The recent influx of immigrants and the rising number of people from other regions of the world, the United States health care sector has been providing care for patients across all the cultural dimensions. According to the recent statistics, at least 3.3% of the global population reside out of their country of origin ( Holland, 2017 ). This population though having been included in their new country, they retain their cultural practices. The population of the United States of America is made up of members from different racial and ethnic groups. According to Holland (2017), communication barriers continue to exist between patients and nurses due to cultural differences. This puts the nurses in a difficult situation because, despite the language barrier, they have to continue providing quality care for the patients despite their cultural backgrounds. To break these barriers and ensure quality care for the patients, there is a need to have nurses who are culturally competent and who understand the needs of people from diverse cultural backgrounds. There is, therefore, a justification for the practice of transcultural nursing because of the importance it has within the nursing profession.
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Different cultures have different practices, and this can significantly affect the way nurses provide health care services to patients. Specific practices that could be considered unethical in America may be acceptable in other cultures. Similarly, certain practices that are acceptable in the United States may be seen by patients from other cultural backgrounds as disrespectful and unethical. This presents the nurses and the nursing profession with the need to have a culturally competent team that can understand the variation in the needs of patients from diverse cultural backgrounds. According to the National Institute of Heath, nurses must respond to ever-changing patients' demographics to provide culturally sensitive care ( Shen, 2015 ). The explanations of the culturally competent nursing care focus on the need to recognize the individual needs of the patients which include the customs, beliefs, language, and perspectives. According to the American Nurses Association, “the nurse practice with compassion and respect for the inherent dignity, worth and unique attributes of every person” ( Shen, 2015 ). Due to the ever-growing cultural diversity, nurses must respond by providing care that respects and support the cultures of the patients as this will ensure that there is a definite health outcome within the care setting.
The first step to the development of cultural competence is to have the nurses become aware that many beliefs and cultures are different. Cultural awareness is the degree to which nurses believe and accept that people from different backgrounds have different cultural practices and beliefs which must be respected ( Shen, 2015 ). Without first becoming aware of this fact, then nurses can have a challenge of becoming culturally competent. Cultural knowledge is important as it seeks to understand the information about various cultural and ethnic groups. Nurses have to access the cultural knowledge through various articles and books that contain information regarding a variety of cultures. Transcultural nursing is an essential area of study and the practice usually focus on cultural beliefs, values, and perspectives of different people ( Shen, 2015 ). Majorly, transcultural nursing emphasizes an understanding of the cultures and the specific needs so that the nurses can understand how to provide care for patients with different cultural backgrounds. Understanding the beliefs and perspectives of different cultures can help nurses know and apply what is best for the particular culture. The cultural competence model views cultural competence as a process that nurses usually strive to realize and to ensure that they provide care as of the expectation of different cultural backgrounds. This involves taking into consideration cultural knowledge, skills, awareness, and encounters. The cultural competence is an ongoing process and nurses has to continually learn and respond to the ever-changing cultural diversity to effectively work within any cultural context of the patients and their families.
The transcultural theory is an area that focuses on the need to seek and understand cultural variation among different groups with the aim of promoting cultural awareness and competence. Though the theory was derived from anthropology, it has made great importance within the nursing profession as the need to have a different care setting continue to rise. The focus of transcultural nursing is to seek a comparative study, analyze different cultures with regard to caring behavior and then understand the values, beliefs, and pattern of the behavior. The aim is to have nurses gain more understanding of the different cultures and then develop a care model that best fits that culture. The transcultural theory is built on the fact that people from different cultures have the best ability to determine the kind of care that they need from the care professionals and thus by understanding their culture, they can provide the most appropriate and quality care. According to Clayton, Isaacs and Ellender (2016 ), nursing involves a transcultural phenomenon with both the patient and the nurse having different cultural backgrounds. By having knowledge about the patients’ beliefs, values and practices, nurses are in the best position to provide holistic nursing care for the patients. The major objective of the transcultural theory is therefore to provide culture-specific care that would be congruent to the patients’ cultures and that which will benefit the patient.
Culture and care are two concepts tightly embedded into each other. Because care involves a supportive approach that enables the behavior of individuals, one must understand the cultural background before providing the best care for the patients. Nursing care is supportive and requires much understanding of the behavior and perspectives of individuals. What makes the nursing profession different from other disciplines is care which requires an understanding of cultural diversity and practices. The nursing care pattern is developed to be assistive, supportive, facilitative and enabling ( Clayton, Isaacs & Ellender, 2016 ). To realize all these, cultural competence is required as it is the basic foundation for providing a quality and supportive care to the patients. Culture involves values, beliefs, and practices that are learned and transmitted from one person to the other. Culture defines the behavior and expectations of individuals which also involves choosing how to receive quality. Culture defines the perception of people about receiving care, remaining healthy and making other life decisions. Because people come from different cultural backgrounds, their perceptions and perspectives about how they receive care are different. The exiting difference between the professional nursing care and the patients’ generic care can always be challenging to the patients. Recognizing these differences and making appropriate changes can help the nurses to provide quality and effective care that is culturally congruent. The combination of generic and professional care in a way that offers effective care can always lead to better and quality care for all patients irrespective of their cultural backgrounds. On the other hand, failing to align the generic and professional nursing care can lead to the culture conflict, noncompliance behavior and demonstration of various behaviors that are unfavorable and the result will be lack of quality care for the patients ( Clayton, Isaacs & Ellender , 2016).
Compare and Contrast
The most relevant information from the literature review is the importance of cultural competence. Cultural competence provides the best and most appropriate way to deal with the multicultural challenges that nurses face in the care setting. Cultural competence is the cornerstone to provide superior care for patients from all cultures. As patients get into the cares setting, they need a lot of comfort and care and at such a time, understanding their beliefs and values can be most essential. Different cultural practices can have a great influence on the care plan and determine how the patients perceive their illnesses. After many years of progressive research and education, the nursing profession has come up with various techniques to help improve the cultural competence of the nurses. Three major pillars form the basis of cultural competence in nursing. The three pillars include knowledge, attitude, and skills. Knowledge involves learning about the culture base of other people to gain much understanding of their beliefs and values ( Clayton, Isaacs & Ellender , 2016). Depending on the location, the number of cultures that nurses encounter usually varies and seeking much information to gain an understanding of these cultures can help improve cultural competence. Keeping a high level of awareness of the cultures can play a great role in understanding the generic elements of the patients. Culture determines whether people will seek help, where they seek help and the kind of care they expect to receive.
Attitude is another pillar that plays a key role in determining the ability to become a culturally competent nurse. Attitude involves the level of awareness of the self and the patients concerning cultural differences. Becoming positive of the other cultures is the key step to gaining an understanding of those cultures. While most caregivers are most likely to identify with the cultures where they were raised, seeking to understand the basics of all cultures will increase the chance of a nurse becoming culturally competent ( Douglas et al., 2014 ). Nurses are currently developing their skills by increasing their cultural competence. The rising need to have clear communication skills to promote interaction with the patients. Nurses can gauge their level of cultural competence by doing a self-assessment and understand how well they are in terms of cultural competence. This can be done by determining the strengths and weaknesses when working and interacting with people from other cultures. Improving communication and language barriers can also play a key role in increasing the cultural competence of the nurse. The values and beliefs of a certain cultural group are usually rooted within their language, and by eliminating the language barriers, care providers are at a better position to deal with multicultural challenges. It is important that care providers understand that each patient is a unique person different from the other and should, therefore, be given such a unique treatment.
Multicultural issues continue to impose serious challenges within the nursing profession. With the call to have quality care for the patients and improve the health outcome, there is a growing concern over the ability of the nurses to deal with the challenge of cultural diversity. In many instances, nurses are forced to use interpreters to solve the problem of the language barrier which is one of the multicultural issues. Even though interpreters are useful in helping understand the problem of the language barrier, this can always be misinterpreted. The nurses who have developed cultural competence can overcome the misunderstandings and provide better and quality care ( Douglas et al., 2014 ). One way to ensure that nurses are culturally competent is to have a diverse workforce where nurses from a variety of cultures are all present within the care setting
The currently held image of the multicultural issues within the nursing profession depicts what the literature holds. It is undoubtedly true that multicultural issues continue to remain a great challenge within the nursing profession. Nurses currently in the care facilities deal with a diverse population from different cultural backgrounds, and this continues to cause serious challenges within the nursing practice. As noted in the literature review, lack of cultural diversity and competence among the nurses can interfere with their ability to provide quality care. Even though many health care centers currently have a diverse workforce, many nurses still struggle to develop cultural competence and this has consistently affected the way patients receive care.
Conclusion and Implications
Nursing profession continues to face the challenges of developing and maintaining a culturally diverse workplace and to increase cultural competence amongst nurses. Even though efforts have been made to ensure that nurses become competence culturally as a way of dealing with multicultural issues within the nursing profession, nurses have remained relatively low with regards to cultural competence. The current and future practice of the nursing profession requires that nurses are trained and developed on how to effectively deal with multicultural issues as this can impact the quality of care. As more people from different cultural backgrounds continue to seek care services, the quality of the care that nurses will provide both today and in the future rely on the ability of the nurses to understand and respond to the cultural differences amongst patients.
Lack of cultural competence can put the safety of patients at risk, and this affects the quality of care. Barriers to communication are one of the major causes of medical errors. Increasing the quality of care that is provided at the care facilities today and in the future require that the nurses develop and acquire skills that can make them more effective in working with every culture ( Douglas et al., 2014 ). Elimination of communication barriers and enhancing culturally congruent care can promise the future of the care services quality. By directly engaging them in the cross-cultural interaction with the patients and improving communication, nurses increase their cultural competence and help eliminate the challenges of working with patients from diverse cultures. The future of the nursing profession can involve the inclusion of cultural competency training within the nurse education and training so that they are well equipped with knowledge and skills to handle patients from across all cultures. This is what will eliminate the multicultural challenges that continue to affect the nursing profession.
References
Clayton, J., Isaacs, A. N., & Ellender, I. (2016). Perioperative nurses’ experiences of communication in a multicultural operating theatre: A qualitative study. International journal of nursing studies , 54 , 7-15.
Douglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M., Lauderdale, J., ... & Purnell, L. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing , 25 (2), 109-121.
Holland, K. (2017). Cultural awareness in nursing and health care: an introductory text . Routledge.
Shen, Z. (2015). Cultural competence models and cultural competence assessment instruments in nursing: a literature review. Journal of Transcultural Nursing , 26 (3), 308-321.
