The Role of Cultural Sensitivity in Building Patient Relationships

The Role of Cultural Sensitivity in Building Patient Relationships

Culture is everywhere—and it defines almost every aspect of our lives in one way or another. That can be true across a variety of dynamics, including how someone functions within a family, relates to others, or responds to stress. Nurses encounter patients and families with myriad cultural influences every day. That’s why understanding and practicing cultural sensitivity is so important for building relationships and providing excellence in patient care.

The Importance of Building Relationships

In any setting, trusting relationships are important. However, some patients may hesitate to trust health care providers because of several factors—such as a history of discrimination, disparity in representations of diverse people as care providers, and lack of recognition of the particular challenges that some patients face.

According to a report from the American Psychological Association (APA), individuals with low incomes or those from racial or ethnic minority groups are more likely to experience severe stress than others, a dynamic that can lead to poorer mental and physical health outcomes. Unfortunately, such individuals may be less likely to pursue medical care because of financial concerns or fear of discrimination from a provider. However, if clinicians learn to build trusting relationships, then those who need care may feel more comfortable in accessing it.

The Role of Cultural Sensitivity

Previously referred to as “cultural competency,” cultural sensitivity requires that nurses possess the needed skills to affirm diversity and embrace the values of people from different social or cultural backgrounds. Practicing cultural sensitivity is essential to building relationships, since it helps nurses step outside of their own perspectives to better understand the unique needs of the patients and families for whom they provide care.

The shift in language from “competency” to “sensitivity” underscores the role of culture across an individual’s life and care continuum, and the need for clinicians to recognize the importance of this dynamic. Thus, when nurses become educated about different cultures, they are better equipped for building relationships with patients and families, which can help to improve outcomes of care.

Strategies for Building Trust

In addition to learning about different cultures, nurses can make use of empowering strategies to help patients and families feel understood and accepted; such strategies are included in The National Education Association’s Diversity Toolkit:

  • Use inclusive language in written and verbal discussions.
  • Ask each client for their preferred pronouns, even when you feel sure of their gender.
  • Take time to learn proper pronunciation of each person’s name.
  • Ask for permission before touching or hugging each person.
  • Learn cultural customs for any community or group with whom you are working closely.
  • Encourage patients to have a family member accompany them if privacy is needed.
  • Offer to translate information or rewrite it in more understandable terms if someone is having difficulty reading or understanding complex medical information.
  • Know the cultural or diversity-related resources in your community.

To learn more about the role of cultural sensitivity in building relationships, see “How To Be Culturally Sensitive Working with Clients with a Range of Identities.”

East Meets West in the Bathroom

East Meets West in the Bathroom

A patient needed assistance in the bathroom.  An elderly, obese, female with Lupus affecting her legs and hips needed help transferring from her electric wheelchair and some assistance with hygiene and buttoning her pants. It’s something I’ve done a million times and I didn’t think twice about it. What happened later made me think about the differences in cultures between India and the United States and how to approach these differences when they come up with someone in the workplace.

After the job was completed and the patient gone, the episode came up in conversation between the patient’s doctor, who is from India, and myself. While she didn’t exactly dress me down, she was very firm that clinic nurses were not supposed to help patients in the bathroom. She gave me several reasons:

“The patient takes care of herself at home. Why do you need to do it here?”

“If the patient has a caregiver at home, where is the caregiver now?”

“What if you get injured, who is going to take care of you?”

“If you help her in the bathroom this time, she will expect help every time she comes.”

I thought about this conversation for a long time. Without a doubt, I was correct to help the patient. This I know. It’s required by the nursing oath, and it’s required by my own moral code. Why did this doctor see things so differently?

Indian society is rigidly stratified by religious and socioeconomic class. At the bottom are the untouchables who work with waste. This stratification was formalized during British rule with some 60,000 different classifications. With this in mind, I realized that my doctor was actually trying to protect me from performing work outside my caste, which would be degrading to me. From my point of view, all people are created equally. As a nurse, when someone asks for help, I don’t have to decide if that person is worthy of my help or if performing a task is outside of what is permitted by my caste. I just do it.

From the doctor’s point of view, I was performing a task outside of what is permitted by my caste and performing it for a person who is of lower status than myself. I was breaking social norms, degrading myself, and degrading the clinic and other nurses whom she expected would not perform such duties. After doing some thinking, I can now appreciate her point of view, but it is not my point of view. The tricky part is how to address it in the future in a culturally sensitive manner. I don’t want to insult my doctor. She is in a position of power over me. I don’t want to break my nursing oath or my personal moral code to always offer assistance when someone asks. In this case, I’ve decided to simply not bring it up again. I will continue to perform my nursing duties as I always have without mentioning it. I will respect my doctor’s culture by simply avoiding the subject in the future. In a perfect world where I’m king, I would explain to the doctor my point of view and expect her to change her point of view to suit my own. However, the world is not perfect, and I’m not king. So respect, cultural sensitivity, and work relationships will win out over my personal feelings.

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