Cultural Competence in Nursing

Most healthcare organizations have incorporated cultural competence in their staff orientation training program in order to promote individual centered care and by assessing patient’s cultural, social and linguistics needs. Cultural competent organizations invest in diversity training and promote cultural oriented activities. It is important for healthcare staff and specifically nurses to obtain information about patient’s cultural heritage and modify environment when deemed safe and appropriate. Madeleine Leininger is the pioneer of transcultural nursing and challenges nursing to be culturally competent when caring for their patients. She also states “inadequate knowledge of cultural factors represented a missing link in her ability to provide care” (Leininger, 2002).

The Heritage assessment provides a guide to culturally oriented questionnaire during assessment and enables staff to learn about patient’s’ ethnic, socio-economic and cultural background. Learning about different cultures can be challenging but fascinating. I would like to discuss some health tradition amongst Haitians, Nigerian, and Ethiopians.

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Caribbean- Haiti

During an interview with three different families from Haiti, I realized that health practices and traditions are different across the world. Among the families were Caribbean (island), Ethiopia and Nigeria.We discussed the principles used during health maintenance which is personal or public health services offered in the promotion and restoration of health (world health organization). Health maintenance in an island in the Caribbean (Haiti) is a constant struggle considering the socio-economic status of the population and scarce resources. The health care system is not regulated and patient’s rights are often ignored and violated. It is very common to experience substandard care and adverse outcomes in Haiti. There is limited or restricted insurance system that only a few privileged groups have access to. The majority of the population have minimal to no access to health care and are treated differently based on their financial status. Family members or significant others are expected to be available during hospitalization in case medical staff need to acquire additional medical supplies. Patient’s family often brings food from home because they prefer home made meals and assist with most of the activities of daily living.

The Haitian culture is blended with African, Spanish and French considering its history. The culture is rich in tradition and yet remains very unique and fascinating. Despite the constant economic instability, Haitians remain resilient and very proud of their culture and health traditions. Some of them believe in treating their body like a temple which means eat the right food, avoid smoking, alcohol and promiscuous lifestyles, engage in some type of physical activities and be spiritually engaged with God. Children are encouraged to play outdoor sports regardless of their family background. They often play soccer, basketball, volleyball and tennis in school, on the streets or at a sport club. Most Haitians walk at least two to three miles daily involuntarily due to expensive transportation system and lack of infrastructure. It is considered normal to walk to a store and they believe in fresh (organic food) or home grown products. Most Haitians do not use microwave often since meals are prepared daily. Therefore, most of them do not like to eat left over foods. Honey, palm oil, castor oil and herbs are considered miracle remedies to almost every disease or illness. They use a lot of natural remedies and do not always believe in prescription drug. Meat is brought and cooked daily and deep freezing is not common practice among Haitians.

They protect themselves against diseases by constantly drinking herbal tea specific to the geographic region of the country. Others believe strongly in castor oil and use it for cold relief, to treat cuts, burns, bruises, fever and joint disease such as arthritis, swelling, minor sports injury. About 90% of the population will have a bottle of that oil in their medicine cabinet and use it wisely since supply is sometimes limited. Honey is also very common and they are persuaded that it is the best because it is raw and unrefined. Honey rhum Barbancourt, tea and local lime juice are the remedies to treat a cold, fever and other body aches. They also use other rituals such as carrying their rosemary around their neck for protection or sometimes a special made items or a protective symbol of some sort with them all the times. Helmet, braces and other protective gear are expensive there, so it is not common practice for young children to protect their head and other joints. Health restoration usually happens at home with family members taking turn during the process. Family is the support system there and is very important to them. Family members will travel across the country to support each other and will bring natural remedies from the country side to assist with the recovery process. Most of the families can not afford restoration in health care setting, so they prefer to take the patient home to avoid medical cost. They also pray a lot during the process or will do ritual dances and ceremonies by “Voodoo” priest, a pastor or chaplain. Some catholic, will hope for a quick response from Virgin Mary and often pray the Saints to ask for forgiveness and mercy. Those who are protestant will pray God and let it be up to his power to heal the ill. Finally, family members will make soup and tea daily to promote wellness and assist in the recovery process.

Implication for Nurses

If you are a nurse caring for Haitians, you should expect a lot visitors from church, temple or from the family. They will also bring home made meals because the hospital food is bland according to many Haitians. Nurses should also expect prayers and scripture reading, so modify the environment to meet the patient’s needs. Nurses should educate patients, family and visitors about hospital protocol to avoid misunderstandings. They might need a cross, rosemary or items specific to their beliefs. Lastly, most Haitians speak Creole not French, so translator might be needed.

Ethiopian Culture

Ethiopian’s culture does not differ much from Haitian’s culture. After interviewing a family who lives next door, I noticed some similarities in health traditions such as herbal and fresh food. In that culture, the family mentioned that their body was very important to them and treats it well. The family mentioned that health maintenance includes living a good life without drinking, clubbing, eating process food, microwave food and smoking. They also mentioned the importance of physical activities and stated that most Ethiopian will walk three to four miles daily. They eat mostly fresh fruits and legumes and a lot of them do not eat pork for religious reason. The family talked about the importance of fasting to cleanse the body and promote healthy lifestyle. They will fast almost every two to three months according to the same family. They walk to places and drink herbal tea as cleanser and remedy. They are very involved in outdoor activities and encourage children to play sports. They use religion as their main protection and use bees and special bracelets to protect themselves against certain diseases. They avoid late night partying and drinking to promote healthier body and one should avoid contact with the ill to prevent disease transmission. They believe in early bedtime to promote optimal health. When sick, family members or friends will make home remedies prior to seeking physicians’ advice. If long term recovery is needed, the family will care for the patients at home to avoid medical bills. They believe in home remedies and family members provide direct care to their relatives.

Implication for Nurses

The care approach should be individualized to meet the cultural needed in addition to what is mentioned above.

The last culture is Nigerian which is again not very different from the other two. The Nigerian family wanted to talk about pregnancy, giving birth and post partum care. When a woman is pregnant, she is still actively involved in households‘ activities and outside work as before. Prenatal vitamin is not very common; therefore, families will make healthy meals to the mother and encourage the mother to eat extra since she is eating for two. Most of them will not see a physician for prenatal care, but they will instead visit local midwife and plan a home birth delivery. The woman will avoid direct contact with most people to protect the fetus. They will increase their calories and fluid intake and will eat mostly legumes and meat stew to promote healthy development of fetus. During delivery, the woman family must arrange to be present and bring grocery items to prepare meals for the next month post partum. The woman will choose medicine free birth and will deliver either at home or a birth center. Midwives will make necessary arrangements and prepare the family for the delivery process. Shortly after birth, the new mother will remain inside the house for a minimum of 30 days. Her immediate family will make fresh healthy meals and will encourage her to eat a lot to replace energy lost during labor. The new mother will only allowed hot meals and drink and nothing cold will be given until a month later. The new mother will perform warmth sitzbath for several days to promote healing after birth. The new mother will also wear an abdominal binder very tight to shape up abdomen post partum. The family could not provided care after c-section since she said it was not common practice in their tribes. The baby will remain inside for at least 30 days as well and depending on the family financial status, newborn babies do not always have access to a private pediatrician. The neonate are mostly breast fed since formula is expensive and there is no government subsidized program like the United States. When the mother is fully recovered, family will go back to their villages and the husband will reward his in laws with monetary compensation, cattle, clothing and much more.

Nurses should expect large group of visitors and home rituals perform while in the hospital during birth and postpartum. The new mother will need more blankets and additional gowns compare to other patients.

It was very interesting learning about all the different cultures and comparing some of their traditions. One can conclude there is no good or bad culture,and it is all about education and acknowledgement of each other’s culture. If healthcare professionals fail to assess cultural needs and background, they will not be able to fully understand patients’ behaviors and beliefs during nursing care. It is beneficial for nursing staff to assess their patient’s ethnic, socio-economic and cultural background when caring for patients. The Heritage assessment is one of the helpful tools used in regard to that. However, one should further assess patients’ beliefs and culture based on patients report.