Cultural competency is an increasingly important practice within the healthcare industry as the populations of industrialized nations become more and more diverse. 

 

According to a thought-provoking report on National Public Radio's Marketplace program (just click the link to listen), the need for registered nurses will increase by 23% over the next eight years, and that as the population of the United States becomes more and more culturally diverse, the need for culturally competent nurses will also expand exponentially.

 

Wikipedia states that cultural competency "refers to an ability to interact effectively with people of different cultures. Cultural competence is comprised of four components: (a) Awareness of one's own cultural worldview, (b) Attitude towards cultural differences, (c) Knowledge of different cultural practices and worldviews, and (d) cross-cultural skills. Developing cultural competence results in an ability to understand, communicate with, and effectively interact with people across cultures."

 

The National Center for Cultural Competence in Washington, DC states that organizations must "sanction, and in some cases mandate, the incorporation of cultural knowledge into policy making, infrastructure and practice." The Office of Minority Health of the U.S. Department of Health and Human Services offers National Standards on Culturally and Linguistically Appropriate Services (CLAS) which detail fourteen standards under the rubric of three overarching themes, including "Culturally Competent Care, Language Access Services, and Organizational Supports for Cultural Competence". 

 

As the cultural make-up of the United States and other Western countries becomes more diverse, the challanges of a multicultural and pluralistic society will only grow. According to the Pew Hispanic Center , white Americans will become a minority of the population around 2050 based on current population projections, and the percentage of elderly Americans will also continue to climb as the Baby Boom generation ages and retires. These and other indicators all point to the fact that the industrialized nations must accept the growth of various cultures within the larger society, and we must adapt to these changes as challenges of communication and cultural integration mount.

 

As healthcare workers providing care, we must take into consideration patients' language, cultural practices, dietary needs, cultural norms regarding communication, and family structures. Illness can stress families and patients, often bringing families into contact with the healthcare system for prolonged periods of time, and it is our moral and ethical responsibility to meet patients' cultural needs with a high level of sensitivity and knowledge. 

 

While standards and protocols call attention to cultural and language-based differences, it is often glaringly apparent that same-sex couples often receive a great deal less sensitivity than they deserve. As same-sex couples begin to win more legal rights across the country, healthcare workers must be aware of the needs of these families and be sensitive to the nuances of visitation and spousal privilege that traditional married couples take for granted, regardless of any personal bias on the part of the healthcare worker involved in the care of the patient. 

 

Similarly, transgendered patients also have needs which are often overlooked by the healthcare industry. For example, gender-specific restrooms are often great cause for concern for transgendered individuals who may be one gender biologically but present themselves to the world as the opposite gender. The establishment of gender-neutral restrooms removes this barrier and creates a less stressful environment for the transgendered individual. Healthcare workers must also take into account that a patient who presents outwardly as male could very well be coming to the office for gynecological care, and it is the responsibility of the front-line and clinical staff to make sure that the individual is treated with the same respect, courtesy and privacy as any other consumer. 

 

The issues surrounding cultural competency and healthcare are varied and multifaceted, and it is not the intention of this article to capture every nuance and detail of this broad subject. Rather, the intention is to call the reader's attention to the issue of cultural competency, and perhaps spark conversations and patterns of thinking which may, in turn, impact the quality of care delivered on the ground. Many policy changes within large institutions begin as individual workers identifty areas of care delivery in need of closer scrutiny, and it is this writer's hope that some readers will take it upon themselves to begin examining the practices of the institutions where they are employed, asking questions and challenging the status quo when appropriate. 

 

While some may blithely say that "they all should speak English", it must be accepted that there will always be new immigrants who, for one reason or another, never master the difficuties of English to the extent that would allow clear and concise communication during the delivery of healthcare services. Also, when under stress, individuals will frequently revert to the language that is most familiar and comfortable, and we must understand that some individuals simply will not be able to verbalize their symptoms in English, a difficult and nuanced language that even native speakers can have difficulty mastering. 

 

Cultural competency as a concept is one which should be embraced by healthcare institutions with the same fervor as we see vis-a-vis environmental awareness, smoking cessation, quality assurance, green energy practices, and infection control. In this writer's experience, many institutions perform very well in some of these popular areas, but fall far short in many others. In terms of customer service and the delivery of high quality healthcare, cultural competency and senstivity should be one of the highest priorities of every healthcare institution throughout the industrialized world. This level of increased sensitivity and awareness begins with each and every one of us, and it is up to us to hold our institutions and employers accountable to the needs of the diverse people whom we serve.

 

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NurseKeith is a writer, blogger, nurse and consultant. Feel free to visit his blog, Digital Doorway .  

 

 

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