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Cultural diversity: Getting to a viewing point
FROM OUR COLUMNISTS Cultural Diversity Cultural Diversity: Getting to a Viewing Point
H
ISTORICALLY, CULTURAL DIVERSITY has been discussed as an issue primarily occurring in urban areas such as New York City, Chicago, Los Angeles, Miami, Washington, and Detroit. However, with globalization and the significant demographic shifts, few areas of the United States remain unaffected. More shifts are predicted. The Census Bureau estimates that, by 2040, more than half the United States population will be ethnic minorities. Governments, schools, and health care organizations must be ready to meet the needs of new populations who bring different expectations and problems to the forefront. In large urban areas, health care organizations have been pressured to bring about significant changes to meet the basic needs of those being served. New York City hospitals staff emergency rooms with health care providers who speak several languages and understand, through experience or culture competence training, the perspective and culture of the patients being served. Written materials, including patient handbooks, patient teaching materials, consents, and signage, have been translated into several languages for patient understanding and convenience. Serving culturally diverse populations is a complex yet exciting challenge because it allows health care providers and organizations the opportunity for new and different partnerships to improve health. If the goal is to achieve culturally sensitive and cost-effective outcomes, then substantial changes must occur. More than language training is needed, because the contacts that most Americans have with other cultural groups is oftentimes limited in breadth and scope, resulting in stereotyping rather than enlightened thinking or understanding. This new type of care and services to populations with special language or cultural needs requires additional funds to educate and train staff in languages and in intercultural communication and practices. From my experiences in the United States and overseas, communication breakdowns are the primary reason given by both the patient and provider for poor outcomes, dissatisfaction, or lack of compliance with the treatment regimen. Several months ago, I had the opportunity to shadow several physicians from various cultural groups as they did patient rounds at two acute care hospitals. This brief but powerful experience reinforced my belief that every patient wants and deserves the same things: respect, competent care, and cultural awareness. We visited over 50 patients representing a
ANN MARIE BROOKS, DNSC, RN, FACHE, FAAN Dean, The Catholic University School of Nursing Copyright © 2001 by W.B. Saunders Company 8755-7223/01/1701-0003$10.00/0 doi:10.1053/jpnu.2001.22116 4
number of cultures that are common to the DC metropolitan area. One striking difference about which we learned during the experience was the amount and type of information requested by patients and offered by the physician during the bedside visit. It is not surprising that patients born and raised in the United States requested and expected specific information about their diagnosis and condition and consistently asked about dates and times of discharge. Patients representing other cultures seemed less inquisitive, and physicians were more vague and global about their treatment regimen. Although not the reason for the observations, my appreciation for the need for intercultural training for all health care providers grew by leaps and bounds. Awareness that informed consent might be regarded in a different way by patients raised outside the United States is helpful when applying our Western approach of wanting to give as much information as possible. Being sensitive to the need for privacy and formality by some cultures will help to avoid embarrassment and patient dissatisfaction with healthcare providers. Compounding all of this is the striking decrease in ethnic minorities choosing the health professions. The problem of minority underrepresentation is serious and affects both medical and nursing education. The number of minority applicants to medical schools dropped by 6.8% in 1999. Of the 1999 first-year students, 65.1% were white compared with 19.4% Asian-American, 7.9% African-American, 6.9 Hispanic, and 0.7% Native American students. This decrease is also mirrored in contemporary nursing school applications. Where do we start? Anywhere, anytime, and any place. We leave our judgments of the past behind and acknowledge that we are not doing as much as we can. Do our nursing curriculums provide a training ground for respect, understanding, and advocating for cultural sensitivity and awareness in health care? Do we encourage the acquisition of another language within our programs? Do we reach out to minorities to recruit and retain them within our programs? Are we seen as culturally rich environments of learning, and what are we doing to improve our image? Are we preparing nurses for a culturally diverse world in which nurses will be able to bridge the differences across cultures? If nurses, physicians, and social workers are going to provide high-quality and cost-effective care, they must be able to apply the same strategies in treatment planning and evaluation. Are we collaborating with other interdisciplinary groups in developing cultural competence? These questions can start us and should help us to create a common viewing point for action. We pride ourselves on our flexibility, willingness to try new things, and future orientation. Let’s apply our critical thinking skills to recruiting, retaining, and building the nursing workforce for the culturally diverse world of healthcare ahead.
Journal of Professional Nursing, Vol 17, No 1 (January–February), 2001: p 4
H
ISTORICALLY, CULTURAL DIVERSITY has been discussed as an issue primarily occurring in urban areas such as New York City, Chicago, Los Angeles, Miami, Washington, and Detroit. However, with globalization and the significant demographic shifts, few areas of the United States remain unaffected. More shifts are predicted. The Census Bureau estimates that, by 2040, more than half the United States population will be ethnic minorities. Governments, schools, and health care organizations must be ready to meet the needs of new populations who bring different expectations and problems to the forefront. In large urban areas, health care organizations have been pressured to bring about significant changes to meet the basic needs of those being served. New York City hospitals staff emergency rooms with health care providers who speak several languages and understand, through experience or culture competence training, the perspective and culture of the patients being served. Written materials, including patient handbooks, patient teaching materials, consents, and signage, have been translated into several languages for patient understanding and convenience. Serving culturally diverse populations is a complex yet exciting challenge because it allows health care providers and organizations the opportunity for new and different partnerships to improve health. If the goal is to achieve culturally sensitive and cost-effective outcomes, then substantial changes must occur. More than language training is needed, because the contacts that most Americans have with other cultural groups is oftentimes limited in breadth and scope, resulting in stereotyping rather than enlightened thinking or understanding. This new type of care and services to populations with special language or cultural needs requires additional funds to educate and train staff in languages and in intercultural communication and practices. From my experiences in the United States and overseas, communication breakdowns are the primary reason given by both the patient and provider for poor outcomes, dissatisfaction, or lack of compliance with the treatment regimen. Several months ago, I had the opportunity to shadow several physicians from various cultural groups as they did patient rounds at two acute care hospitals. This brief but powerful experience reinforced my belief that every patient wants and deserves the same things: respect, competent care, and cultural awareness. We visited over 50 patients representing a
ANN MARIE BROOKS, DNSC, RN, FACHE, FAAN Dean, The Catholic University School of Nursing Copyright © 2001 by W.B. Saunders Company 8755-7223/01/1701-0003$10.00/0 doi:10.1053/jpnu.2001.22116 4
number of cultures that are common to the DC metropolitan area. One striking difference about which we learned during the experience was the amount and type of information requested by patients and offered by the physician during the bedside visit. It is not surprising that patients born and raised in the United States requested and expected specific information about their diagnosis and condition and consistently asked about dates and times of discharge. Patients representing other cultures seemed less inquisitive, and physicians were more vague and global about their treatment regimen. Although not the reason for the observations, my appreciation for the need for intercultural training for all health care providers grew by leaps and bounds. Awareness that informed consent might be regarded in a different way by patients raised outside the United States is helpful when applying our Western approach of wanting to give as much information as possible. Being sensitive to the need for privacy and formality by some cultures will help to avoid embarrassment and patient dissatisfaction with healthcare providers. Compounding all of this is the striking decrease in ethnic minorities choosing the health professions. The problem of minority underrepresentation is serious and affects both medical and nursing education. The number of minority applicants to medical schools dropped by 6.8% in 1999. Of the 1999 first-year students, 65.1% were white compared with 19.4% Asian-American, 7.9% African-American, 6.9 Hispanic, and 0.7% Native American students. This decrease is also mirrored in contemporary nursing school applications. Where do we start? Anywhere, anytime, and any place. We leave our judgments of the past behind and acknowledge that we are not doing as much as we can. Do our nursing curriculums provide a training ground for respect, understanding, and advocating for cultural sensitivity and awareness in health care? Do we encourage the acquisition of another language within our programs? Do we reach out to minorities to recruit and retain them within our programs? Are we seen as culturally rich environments of learning, and what are we doing to improve our image? Are we preparing nurses for a culturally diverse world in which nurses will be able to bridge the differences across cultures? If nurses, physicians, and social workers are going to provide high-quality and cost-effective care, they must be able to apply the same strategies in treatment planning and evaluation. Are we collaborating with other interdisciplinary groups in developing cultural competence? These questions can start us and should help us to create a common viewing point for action. We pride ourselves on our flexibility, willingness to try new things, and future orientation. Let’s apply our critical thinking skills to recruiting, retaining, and building the nursing workforce for the culturally diverse world of healthcare ahead.
Journal of Professional Nursing, Vol 17, No 1 (January–February), 2001: p 4