With a Better Health Through Better Understanding theme, Minority Health Month promotes the importance of providing information to diverse groups and populations that is both linguistically and culturally competent. When individuals and communities have access to health information, resources, and services that identifies and respects others’ formal and casual languages, religious and cultural behaviors and beliefs, and is provided with easy and convenient access to accurate health resources, the potential for better health outcomes is greatly improved.
Individuals who have accurate information that relates directly to how people in the community live are excellent ambassadors for promoting health information. As healthcare providers, nurses can help advocate for healthy lifestyle choices and activities. But if they aren’t taking into account a patient’s cultural beliefs and traditions, those recommendations have less chance of actually being put into effect.
Nurses are in an excellent position to help patients by being aware of their cultural norms around language and dietary choices and guidelines, activity choices, mental health approaches or stigmas, sexuality, and even how family decisions are made. Each of these areas can have a significant impact in a patient’s choices and so each decision is frequently made through several layers.
For Minority Health Month, the Office of Minority Health has several fact sheets and guidelines that can be downloaded for free. This Health Literacy and Limited English Proficiency: 2023 Reading List offers resources and links for nurses to find additional information that relates to communities in general and specific considerations for diverse populations. As a nurse, you may work with several populations and understanding those cultures will help you treat your patients more effectively. If they aren’t proficient in whatever the primary language of your practice is, work to help find a translator and to offer printed information that’s been translated to their primary language.
Building up a rapport is as important as letting people know the straight facts about minority health. You can do that in several ways, but having an open and curious approach to each patient’s life is a good beginning. Ask questions that are open and honest, and always ask permission first. Many people will be more willing to talk when someone asks permission to talk about a difficult or potentially embarrassing subject. If they decline to talk about something, respect that as difficult as it might be. It’s likely that under additional pressure, they might not give you a full and accurate answer anyhow.
If you can build trust, your patients will be more likely to open up to you about their concerns, about what’s bothering them, and about what’s not working for them. You’ll be in a better position to help them find an approach to long-term health that will be sustainable.
Ensuring that patient’s understand what you are relating to them and having information they can access or take home in a language they are proficient in, will put everyone ahead of the game. That linguistic and cultural competence is an essential piece of a comprehensive approach to minority health education and wellness.
On most days nursing is extremely rewarding. At the end of our shift, we feel we’ve done a good job caring for the needs of grateful patients. But occasionally, we encounter patients who test our patience and make it challenging to effectively care for them. So how can we improve the situation when caring for difficult patients?
1. Lend an Ear
No one is at their best when they’re in the hospital, a rehab center, or receiving medical care at home. They may have pain or nausea, or maybe they are still struggling with a change to their ordinary lives as a result of an accident or illness.
Provide them with an opportunity to talk about their situation if they feel comfortable, and make the effort to actively listen. Nurses can get caught up in the endless to-do list on any given day and aren’t always able to take the time to connect adequately with their patients. While listening closely to them, a nurse can learn what a patient’s expectations for recovery are as well as any concerns they may have about their care or prognosis.
2. Body Language Barrier
During a day’s work, our patients are often in a hospital, home bed, or sitting in a chair. When we are talking to them, we’re standing above them, which can make them feel uncomfortable. As often as possible, make the effort to put your body on the same plane as theirs. Avoid crossing your arms over your chest, putting your hands on your hips, or in your pockets, none of which communicates receptiveness and may further agitate someone who is already upset. Face them when speaking to them and modulate your voice appropriate to their hearing ability.
3. Culture Clash
Does your patient have a culture different from your own? Be respectful of any differences and try to learn what you can about their culture. You can learn either through resources available to you or by asking questions, but only if they’re receptive to educating you about their ways.
4. Build a Bridge to the Unknown
Alleviate any concerns they may have about what is unknown to them. Encourage discussion about their health condition, medications, or upcoming procedures. Welcome questions that will allow them to open up. Building a relationship with them can motivate the patient’s own investment in their care and help smooth a rough nurse-patient relationship.
5. Autonomy Can Be Helpful
Many patients express feelings of helplessness in the face of their illness, which can lead to difficult behaviors. Restoring some of their autonomy can go a long way to returning a sense of control within their lives when caring for difficult patients. Allow them control over that which can be allowed: bathing, medication times, meal times, and any other choice that can be accommodated without contradicting their physician’s orders.
Making the extra effort to reach out when caring for difficult patients can often smooth the path to a better nurse-patient relationship.
Nowadays, nurses are increasingly working with patients from different cultural backgrounds. This brings opportunities and challenges for nurses to deliver culturally competent services. Whether working at a hospital, in a nursing home, or within a school, nurses must have the ability to identify differences in others. It is expected that nurses understand patients’ differences in demographics, beliefs, norms, practices, and desires for medical care and take their perspectives into account when caring for them. Cultural competence is an important component of excellence in health care delivery and can contribute to the elimination of racial and ethnic health disparities.
Here are 5 ways to help you provide culturally competent nursing care.
1. Perform a cultural competence self-assessment.
Determining your own strengths and weaknesses when it comes to working with people who come from different cultures is probably one of the most important ways to help improve your cultural competence. Several organizations offer free cultural competence self-assessment tools and you can choose one that appropriate to your work.
2. Obtain a certificate in cultural competence.
You can increase your cultural awareness, knowledge, and skills through culturally competent training, a workshop, or a seminar. Journal articles, textbooks, and the internet also offer great information that can help you improve cultural competence.
3. Improve communication and language barriers.
The values, beliefs, and worldview of a particular cultural group are rooted within their language use; therefore, language is the key to accessing a culture. It is best if you can speak its language or find a translator (an individual providing language assistance) to help communicate with limited English proficiency patients. You also can use pictures, gestures, or written summaries to improve communication with your patients and reduce language barriers.
4. Directly engage in cross-cultural interactions with patients.
Understanding that each patient is a unique person can help nurses effectively interact with patients. Nurses need to have the ability to explore patients’ beliefs, values, and needs in order to build effective relationships with them.
5. Participate in online chats and networks.
Online networking and social media can have a great influence on improving nurses’ perceived cultural competency and cultural awareness and keeping them up-to-date on cultural competency issues.
It is an enviable opportunity to provide healing services to a country in need by combining a fairly large, diverse, multidisciplined medical team. Three nurses on missions did just that, and in the process, they saw that one person can make a difference. They share their experiences in the Dominican Republic (DR), Haiti, Kenya, and Uganda here in the hopes of inspiring others to do the same.
Dominican Republic
Marie Etienne, PhD, MSN, with Haitian children
The Haitian and Dominican cane cutters and their families in the Dominican Republic are spread over some 350 bateyes (cane-cutting communities). They were in dire need of access to health care—and Marie Etienne, PhD, MSN, a professor of nursing at Miami Dade College, responded.
Etienne, who was born in Haiti, came to the United States at the age of 14. From her youth, she has seen herself as a servant leader and believed a career in nursing would provide opportunities to fulfill her aspirations. She has been a member of the Haitian American Nurses Association of Florida (HANA) and served as president from 2005 to 2007.
Today, she serves as the chairperson of the International Nursing Committee of the Red Cross. In 2005, an attorney and member of the Miami Haitian community visited the bateyes in the DR, and when he returned, he told her that he had seen living conditions of the migrant workers and they were être traités comme des esclaves (being treated as slaves), with no access to health care. He suggested that HANA do something to shine a light on the conditions in the bateyes and devise ways to help the workers and their families. Etienne took the findings of the attorney to the Haitian American Professionals Coalition (HAPC) and obtained support to conduct a needs assessment of the situation. One of the objectives of the HAPC is to examine and address issues affecting Haitians in the United States and abroad.
“We went on the first mission trip to the DR in 2005 to assess the need and take care of the people in the bateyes,” recalls Etienne. The team saw over 1,000 patients in the week they were there and realized the level of need was so great that they decided to do two medical missions each year.
Haitian cane cutters in the DR are not recognized as citizens, and children born in the country do not receive birth certificates. The sugar cane farming sector of the DR depends fundamentally on Haitian migrants, who represent 90% of the labor force in sugar cane cutting and are paid $1 per day.
The team, once assembled, included a diverse blend of medical and health care competencies and others who offered their availability in a supporting role. “But in 2006, I decided that we needed to get nursing students involved because there are certain things you can teach students in the classroom and certain things you can’t,” explains Etienne.
She received the support and participation of the college’s administration and trustees, who quickly approved and funded the project. “As a professor, I inaugurated this project as part of the students’ learning activity to get them engaged and to give back to the community so they may become global citizens and in the process enhance their cultural competence,” she says.
Twelve nursing students from the associate’s degree program were added to the team. The team travelled to the DR to do a one-week mission trip twice each year from 2006 to 2009—each time serving some 1,200 patients ranging from children to the elderly with a wide spread of medical and health conditions.
Haiti
In 2010, an earthquake struck Haiti, killing over 200,000 people, and the mission’s focus shifted to Haiti. “Our attention turned to the needs in Haiti as relief efforts, and other nurses who were members of the [National Black Nurses Association] came together to share in the relief response treating wounds, stabilizing the injured, triaging patients according to symptoms, and whatever else was necessary,” says Etienne. “I went to Haiti about five times that year going back and forth. I also went to one of the universities to teach the nursing students basic skills and show how they can be empowered to take care of their own country.”
In 2012, the team was asked back to the DR because the health care needs persisted and the living conditions were deplorable. The people in the bateyes were doing their level best by any means necessary to survive, but the team decided not to go back in 2013 because the DR Supreme Court had ruled that the government could proceed to deport all persons who are in the country illegally, and that put a lot of fear into the workers needing health care.
Many Haitians arrive in the DR through open borders without legal documents and stay in the country this way. The living conditions of these communities are extremely poor, and immigrants generally live in impoverished barracks that have no electricity, no basic sewage services, and no potable water. There are no health services, recreational spaces, or schools. The workers work 12 hours per day on average and face the threat of deportation when they attempt to organize to obtain basic rights. “As the impact of the Supreme Court’s decision began to be felt, violence subsequently broke out and, for the sake of the students, I could not take them there that year,” Etienne explains.
On their visits, the U.S. team partnered with the Universidad Central del Este, which assigned 50 medical students for a week. They gave one rotation in the morning and one in the evening to work with Miami Dade College students. “We were assigned a primary school in one of the towns outside Santo Domingo, the capital, where we set up the clinic,” says Etienne. “We had registration in one area, a room for triage, and vital signs in another area. Then we sent the patients to see the primary care doctor, or the PA, and then they went to pharmacy, where all the medications were donated by U.S. Catholic charities and others. We designed a pediatric area, and it had balloons, coloring books, toys, and games just to make the children comfortable where we did play therapy. And for the elderly, we would triage them by themselves, keeping them hydrated so they can see the primary.
“Some have asked us if we feel like we are putting a Band-Aid on the conditions of people’s lives in the bateyes. I would explain that our purpose of going there was so we could save lives. One of the patients had a seizure, and if we were not there he would have died. Another had an asthma attack, and because of the ventilator machine we brought along with the administration of some albuterol and follow-up care, that patient recovered. We feel we are saving lives and making an impact. The people know that someone cares about them and that they are not forgotten,” says Etienne.
“God puts us here to serve other people, and if we can put a smile on someone else’s face—if we can change someone’s life—we should not think twice about it,” she says emphatically.
Kenya
Sharon Smith, PhD, with Maasai tribesman
At the tender age of eight, Sharon Smith, PhD, believed that one day she would be a missionary. She knew she would go to Africa and serve in some capacity, but she never really knew how that would happen. “I just figured it would somehow come through my interest in health care,” she explains. As a young person, her aspiration was to be an oral surgeon, but she knew she would not like some of the situations she would see, so she chose nursing. She is currently a nurse practitioner at the Family Health Centers of San Diego.
“Nursing offered me more career flexibility. My roles as a nurse just fit my personality, so I am glad I chose nursing instead,” says Smith. “I didn’t know I would go to Kenya, but that is where I landed, and I have really enjoyed the connections and my experience working with the people there. That is what kept me going back.”
Smith’s first trip to Kenya was in 2006 with 12 members of a Pentecostal church group out of Carlsbad, California. A physician friend was unable to go and suggested that she go instead. Since then, she has been back twice on her own. Nairobi served as the primary hub on each visit, but on her first visit she went to the town of North Kinangop, about a two-hour drive from Nairobi, the capital.
She also visited the town of Tumutumu and spent time doing crafts with the children in a home for the deaf and hearing impaired. This was possible because the group from California included a young woman who could sign. The home for the deaf was adjacent to the Tumutumu Hospital, which provides care to approximately 3,000 inpatients and more than 16,000 outpatients each year. Tumutumu Hospital is one of the three mission hospitals in Kenya sponsored by the Presbyterian Church of East Africa (PCEA). Smith and her team came with hospital supplies that they delivered to the staff. The hospital had a large HIV clinic, and while the children waited on their parents, they were provided with school supplies and toys as gifts from Smith and her team.
As the visitors toured the hospital wards (floors), they were exposed to the differences between nursing practices in Kenya and the United States. They saw how much was lacking by way of resources and training. In a ward, there would be a patient with pneumonia next to a surgical patient with an open wound, who may be next to a patient with HIV. There was no segregation based on medical condition. In the pediatric ward, however, three or four rooms were set aside for preemies or small children who were intubated or on ventilators. Smith says that at this hospital there were one or two experienced nurses, but all the work was done by student nurses from the PCEA Tumutumu Nursing School. “They ran the hospital with the number of beds at about almost 200, inclusive of the maternity ward. There was no ICU, however,” she explains.
On her third trip to Kenya in 2010, Smith, who was at that time one of two nurse practitioners in the U.S. team of eight, visited an orphanage of 250 children and did physicals on over 100 of them, from newborns up through teenagers. This provided the orphanage with the children’s first medical records. While on this trip, Smith also had an opportunity to work with some of the nurses of Kenya on a very large, day-long health expo in the Maasai village. They performed health screenings, vaccinations, physicals, oral examinations and extractions, working alongside physicians and dentists from Kenya.
Smith did have an opportunity to see up close the delivery of care inside a hospital in Nairobi after a dog bit a member of the U.S. team and required medical attention. Her assessment is that the hospital provided care comparable to that found in most U.S. hospitals. “My focus and concern was, however, the care delivered by the rural hospitals,” she says.
For Kenyans, Smith is the sister returning home, so they go through the villages and alert the community that “our sister is coming home.” “They plan for my arrival ahead of time,” she says, “and I am planning my return in 2016.”
Uganda
Angela Allen, PhD, with the head nurse at a Uganda hospital
Raised by her community-minded grandmother, Angela Allen, PhD, took her mission trips to Uganda with concern for both the physical and spiritual well-being of the people of Uganda. The Detroit native received her doctorate from Arizona State University with a focus on geriatric and dementia patients, and now she is the clinical research program director with the Banner Alzheimer’s Institute in Phoenix, Arizona.
Allen visited Uganda in 2010 and 2012 for periods up to three weeks each visit. Her visits allowed her to interact with the elderly who might have some form of cognitive impairment. What she uncovered was that cognitive impairment was less of a concern than physical impairment, which prevented the people in the community from caring for themselves. Even though she had gone with a religious purpose sponsored by the Church of God in Christ, Allen did have an opportunity to do research in an area of interest to her. Virtually all of the team’s time was spent in towns like Jinja, a town of approximately 70,000 people and a two and half hour’s drive from the capital, Kampala.
The team fully identified themselves with the Ugandans they sought to reach by sleeping in their huts and immersing themselves into the life and rhythm of the communities. “The people were hungry for knowledge more so than food, so I taught them, spending time with the women to help them develop a sense of community and even preached to them,” Allen says. “I was well received because, after my first visit to the hospital in Hoima, I was invited back by the hospital. So, I took what I had learned from the qualitative observations I had conducted and returned in 2012 as part of a team of 25 people and a fully developed plan, including a full curriculum for the nursing students.”
Allen’s plan included addressing the needs of adolescents, especially girls, who needed to hear that they were appreciated and acknowledged as persons of value. With the help of town officials, she recruited young girls and, using an interpreter, exposed exposed them to two days of instruction on self-esteem and self-pride.
She also worked on securing hospital supplies through Project C.U.R.E. (Commission on Urgent Relief and Equipment) in Phoenix, as well as surplus supplies from hospitals where she had worked in the past. These filled several crates that were presented to the hospital in Hoima.
Lastly, Allen sought to teach a two-day class to the nurses, but in the process she realized that the level of training the nurses had received was comparable to the training provided to nursing assistants in the United States. Her observations of the accommodations provided to the patients was comparable to those Smith observed in Kenya (e.g., patients were not segregated by medical condition in the wards).
“This was a life-changing experience for me,” says Allen. “I never imagined that this visit to the continent of Africa would affect me so much. It was a very emotional experience because the need is so great. I reaffirmed that my purpose in life is to help others.”
As a nurse practitioner student, I completed my clinical rotation in a rural and underserved clinic in the southeastern United States. Overwhelmingly, I treated patients that suffered from chronic diseases such as type II diabetes, hypertension, and obesity. Initially, the volume of patients that suffered from mostly preventable conditions perplexed me because many of the patients verbalized the potential adverse effects and complications. Yet, they continued to eat an unhealthy diet. Infamously, the South is known for higher rates of obesity, diabetes, and hypertension. Certainly, I can attest to that statement since a majority of the patients that presented to the clinic experienced at least one of those conditions. So one day, I finally mustered up some courage and asked an older African American gentleman why he snubbed the idea of implementing healthier food choices. Amazingly, he admitted that he had no desire to change his diet because the food symbolized his heritage and doing away with soul food denounced his upbringing.
Because of his sentiments, I decided to research food and its subsequent influence on culture in African American communities. Through my investigation, I stumbled across a dynamic and enlightening documentary entitled Soul Food Junkies, and it explored the significance of traditional food within the African American community. Byron Hurt, director and principal actor, eloquently merged a multi-layered story that explored the significance of traditional food in the African American community and most importantly his family. After watching this short film, I gained incredible knowledge regarding the traditions of family and togetherness that are embodied in the preparation and consumption of soul food. So, as a clinician, I have expanded my cultural competence; as a result, I will cultivate and encourage new recipes that symbolize the traditions but utilizes healthier ingredients. If you are interested in discovering modified soul food recipes, click on the links below.
Also for your viewing pleasure, I have included a link to the full documentary Soul Food Junkies. Click the link below. Thanks for checking out this post! Check us out every day to gain the newest scoop in the nursing world. Please share your thoughts in the comment section below. I am looking forward to hearing from you!
