Registered Professional Nurse Responsibility

Cultural competence: Registered Professional Nurse Responsibility
Today, registered nurses offer public health care to populations from diverse cultures;
each with unique cultural and religious spirituality. Culture is defined as shared values and
character, transmitted from one generation to another, which distinguish individuals of one group
from another. Therefore, it is vital to understand patient cultural background because they
impact significantly on the patients’ health and illness (Astrid et al, 2010). Cultural diversity is
recognizes individual uniqueness in terms of their socio economic status, physical attributes,
ethnicity, political and religious beliefs. The cultural diversity concept entails respecting person’s
cultural background in order to relate with them i.e. cultural competence. According to The
Primary care Access Network (PCAN) of central Florida, culture competence refers to all
activities geared towards effective and sensitive delivery of quality health care. It entails a set of
attitudes and regulatory policies that work together in ensuring that health care practitioners
function effectively and sensitively across the board. Becoming culturally competent requires
self-awareness and commitment to give safe and quality health care services to everyone
irrespective of their backgrounds (CDC, 2014).To provide competent health care, the following
four guidelines are followed; a) Acknowledge and respect diverse cultural influence b) Cultural
care accommodation c) Widen knowledge on cultural diversity and d) Culture care preservation
To start with, the practitioner should acknowledge and respect the cultural influence in
personal and professional way of life. The guideline supports patient centered model; where the
nurse focuses on the patient rather than treating the illness. According to this guideline, illness is
interpretation of individual’s ailment interpreted by their sociocultural factors. For instance,
some cultures may associate mental disorder such as Schizophrenia as being inhabited by evil
spirit. It is the nurse’s obligation to listen the disease description according to the patient’s

perspective. Secondly, health practitioner should be vigilant regarding the dynamics of cross
cultural relations to enhance communication. Cross cultural interaction brings forth the
possibility of misjudging other people’s actions or intentions. More insights on patient’s cultural
background minimize stereotyping incidences; and develop mutual beneficial relationship
between the parties. The medical practitioner should Listen to patient’s description of the
problem; explain the perception into medical terms and prescribe the treatment (Norton &Marks-
Maran, 2014).
Thirdly, The practitioners should broaden their cultural diversity knowledge, and
incorporate it into their profession. The increased knowledge about the person’s sociocultural
concepts enhances the relationship especially during physical examination processes i.e.
facilitate in identifying what questions to ask, avoid, modify and how to put them across. For
instance, questioning sexual behavior among Hispanic community is disrespectful, and patients
may not collaborate. Some religion does not permit vaccination, and therefore, may exempt their
new born from getting immunization. Nurses should get acquainted on the relevant sociocultural
beliefs of the ethnographic local communities. Lastly, Nurses should develop and adapt to the
identified culturally sensitive interventions which will enhance better relation between patients’
needs and clinicians needs (Dudas, 2012).
An Islam Imam (spiritual leader) suffered mild dementia while visiting his son in
Toronto. He was physically examined, and all cultural questions posed were answered by his
son. The patient condition deteriorated and was transferred to the ICU. After several
interventions, the nurse in-charge decided to help the elderly man in grooming and personal
hygiene. The first step was to clean shave the long and unkempt beard. In the process, the nurse
let the man know that she was going to shave his beard; the man seemed to nod, and the nurse

concluded that he agreed with the entire hygiene Practices. The nurse went home very happy and
proud to have provided such good comfort and care for the elderly. When the son visited the
following morning, he was horrified at the sight of his father. He rushed out of the room and
reprimanded the nurse. Apparently, the father was a holy man so his beard had never been cut.
The family had to make new arrangements of how to sacrifice for this taboo. The nurse was
charged with negligence of cultural beliefs Therefore, it is important to identify all practices and
beliefs by designing assessment questions elicit to provide more information. The healthcare
institution should involve political, religious and non-religious experts when designing such
assessments. This will ensure that health care services are delivered in a way that respects and
values cultural practices. From this example, it is obvious that cultural competent care is very
important in providing quality and satisfying patients care (CNO, 2009).
Nursing scholars have debated on ways to ensure cultural competence in nursing.
Cultural assessment interview plays vital role when evaluating patient cultural needs. This is
done by asking relevant but open-ended questions to the patient, and giving them opportunities
to elaborate on them (Mareno & Hart, 2014). Patients become more co-operative if a nurse
shows interest in learning more their cultural back ground. The nurse should make the
comfortable enough to make the open up about everything they have done prior to seeking
medical attention. Georgetown University have established Cultural competence Health
practitioner Assessment program which can be downloaded from their website. Generally, The
nurse must listen and must not misjudge or stereotype the patient. Some of the questions that
could be integrated to gather clients culture include; asking the patient to explain what could
have caused the ailment; letting the patient explain what they think the disease does to them;
enquiring on the major problem the patient thinks could have been caused by the illness; what

steps or precautions they have taken since commencement of the illness; enquire what kind of
treatment they expect or their overall expectation; and asking for other information that seems
culturally important (Mcclimens et al, 2014).
Nursing profession is a caring profession. Nurses must reflect on cultural values of the
society especially in this era of globalization and massive international movement. The only
way to ensure that cultural competent services are offered is by acquiring more about
transcultural nursing practices, especially by conducting comparative analysis of various cultures
nursing care, values and beliefs. (Mareno & Hart, 2014). However, noting the broad differences
across culture is not enough, relying on data only risks generalization and stereotyping because
even two individuals from the same community or ethnic group, may have different experiences
and expectations from the same illness, influenced by their education and socio economic
background. Language barriers are the most common obstacle when delivering health care
services which impedes clear communication between patient and the health practitioner. Most
common law suits are miscommunication related cases. Understanding cultural diversity will
improve patient treatment and safeguard them from malpractice (Rily, Tish &Nancy, 2014). The
world is a global village. Citizens from any particular part of the world are from all sorts of
backgrounds. This presents challenges to the health sector during service delivery to patients.
Therefore, cultural competency and sensitivity program must be incorporated in medical schools.
Leaving cultural disparities in health care unattended could lead to high turnover rate, mortalities
and disease burden in certain geographic locations. This will directly or indirectly impact on
every person in the US. Therefore, every health practitioner has unique opportunity to take
leadership to improve quality of life through culturally competent health care (Mcclimens et al,
2014).

Part 2
Good health care practices entail the provision of quality care through changing risky
behavior that hallmarks cultural miscommunications and misunderstandings. These
misunderstandings are obstacles in responding to the growing health care demands for Hispanics.
Hispanics represents approximately 55% of US total population. Hispanic culture upholds family
institution, and it comprises of the extended relatives including grandparents, uncles, aunts,
cousins, god parents and family’s siblings. When ill, Hispanic person mostly consult with their
family members, and frequently ask the members to accompany them to the hospital. Hispanic
culture entails provision of love and support to the ill; which could be opposed by institutional
rules such as limit of patient’s visitors (Antonio, 2014).
Additionally, Hispanic culture emphasizes on interdependence and cooperation.
Therefore, the patient’s relatives will be actively involved in decision making and treatment
processes which may not be entertained by most health institutions. Hispanic culture is mediated
by respect. Respect involves appropriate behavior based on individual’s age, gender, and socio
economic status. Thus, the elderly demands respect from the young, men demands respect from
women and so on. Hispanics show respect by avoiding eye contact to the authority which could
be misinterpreted as lack of interest. Due to their medical expertise, health practitioners are
afforded great respect; most Hispanic patient will regard the physician advice. Respect is highly
valued in this culture and a patient may terminate treatment if any signs of disrespect are
perceived. Family information remains confidential and must remain within the family.
Therefore, questions on health related problems such as sexual practices, alcoholism and mental
disorders are perceived as embarrassing and disrespectful. To gather this kind of information,
registered nurse should ask them indirectly (CNO, 2009).

As a registered nurse, having some culture insights facilitate communication. Therefore,
working in ethnographic regions whose larger local population is Hispanics; the health
practitioner should retrieve secondary data analyzed by CDC databases. Due to their
collectivistic tendency, registered nurse should allow collective responsibility during decision
making. Most Hispanics are group oriented. The family has a right to make decisions regarding
health care interventions necessary and in most cases, they are actively involved in decision
process in order to allow the patient to rest and recover peacefully. The nurse can request the
patient to identify the family’s spokesman. If they are out of country, the nurse should be patient
and wait to get consent for the therapy. To accord respect to the patient, the nurse can address
them using their language formal titles such as, Mr., Mrs., Miss, Senöra or Senör. In most cases,
Hispanics nod out of respect to the authority (health practitioner), that does not necessarily imply
that they agree with the nurse. In this case, the registered nurse should pay attention to the non-
verbal communication, and attempt to clarify further if required. In most cases, silence is a sign
of respect; the nurse should be patient for a response. If need be, the nurse can ask for an
interpreter. Additionally, most Hispanic is religious and beliefs that illness and death are natural
life processes. Because of this belief, the patient tends to neglect health acre attention until their
health worsens significantly. In some cases, the family may want the patient spend end of life at
home. The patient may associate the setting impersonal and disrupts their family relationship
(CDC, 2014).
Nurses are privileged to meet people during the period of crisis in their lives when they
are required to provide their expertise. People attitude toward death and bereaved are influenced
by their cultural, religious and socioeconomic background. The nurse should always remember
that there are aspects within every cultural grouping which could be solved through competent

cultural care and comprehensive communication. For instance, a client from Hispanic
community requests for sweet-grass ceremony as her last wish. The ceremony is a part of
cultural treatment, which involves burning of incense stick and prayer chanting, and will be
conducted in the hospital. Heeding to the patient’s request implies that the nurse will break the
institutional policy. What is the solution to this case scenario? In this case, other options should
be explored by consulting the relevant authorities in other departments. If the activity is
determined as risky to other patients, then the client can be transferred to private room where the
ceremony can be conducted. Inexperience’s and fear are the most common obstacles to
providing cultural competence care. Through consultation with higher authorities, the nurse is
able to address the issue (CNO, 2009).
References
Antonio, MA. 2014. Latin American culture: A deconstruction of stereotypes. Studies in Latin
American Popular Culture Vol 32, 73-100
APA. (2012) “Culturally diverse communities and end of life care.”
Astrid, W., Et al. (2010) A londitudinal study of cultural competence among health science
faculty. Journal of cultural diversity, Vol 17; 2, p68-72
CDC. 2014. “Building our understanding: culture insights communicating with
Hispanics/latinos.”
Norton, D. & Marks- Maran, D (2014) Developing cultural sensitivity and awareness in nursing
overseas. Nursing standards, 28, 44, 39-44
Mareno, N. & Hart, PL (2014) Cultural competency among nurses with undergraduate and
graduate degrees: Implications for nursing education. Nursing education perspective 35,
2, 83-90

Mcclimens, A. Et al (2014) Recognizing and respecting patient’s cultural diversity. Nursing
standard, 28; 28, 45-52
Riley, D., Tish, S., & Nancy, Y. (2012) Cultural competence of practicing nurses entering an
RN-BSN program. Nursing education perspective 33, 6, 381-385

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