Nurses are increasingly working with a diverse patient population. As a result, they are challenged by a wide variety of linguistic, cultural and health literacy barriers. To improve the delivery of care, nurses should understand the cultural and linguistic context of imparting health literacy skills.
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Nursing literature provides minimal coverage when it comes to integrating linguistic and cultural considerations into the nursing practice. The practitioners are well-placed to promote interconnections between patient culture, health literacy and language with the aim to improve health outcomes for culturally diverse patients.
Experts identified cultural barriers, limited English proficiency and low health literacy as threats to effective health communication. The evaluation of language and culture as determinants of patient health literacy has been minimal. The integration of these aspects requires a paradigm shift. In the past few years, healthcare organizations in the United States have begun addressing these barriers.
Nurses should understand that culture has a direct or indirect bearing on individual and collective care experiences. Some of the examples of factors that are shaped by patient health beliefs and behaviors include prioritization of needs, understanding of mental and physical illness, communication norms and preferences. The same applies to perceptions of locus of control.
For this reason, an individual’s interpretation of healthcare messages is influenced by culturally bound beliefs, preferences and values. Understanding a patient’s culture and language helps nursing practitioners establish health literacy levels in each situation.
Notably, the average health literacy scores for Hispanics, Alaska Natives/American Indians, Blacks and other multicultural adults are lower when compared to Asian/Pacific Islander and White adults. Additionally, non-native English speakers have lower average health literacy scores than native English speakers.
According to the Institute of Medicine, researchers recognized that health literacy disparities often contribute to ethnic and racial disparities. Experts are working hard to examine how language, culture and literacy affect health outcomes.
Patients need decision making and critical thinking skills to make correct health decisions. This includes selecting the ideal insurance plans, treatment options and care providers. In addition, they must decide when to seek care and the appropriate level of care. Patients are often faced with scenarios that require weighing risks and the benefits of health decisions. Another key area is deciding on end-of-life preferences.
These abilities are usually influenced by ethical systems, perceptions, norms and culturally driven values. This means that what is considered appropriate health decisions in the United States can differ from the values of culturally diverse patients.
For instance, familistic cultures encourage individuals to consult with the family structure to make appropriate health decisions. In America, these decisions are based on an individual’s choices. In some patriarchal cultures, it is common for males to make health decisions for all females.
Healthcare providers should provide resources and structures for purposes of evaluating and meeting the cultural needs of diverse patients. Hospital management is responsible for establishing and maintaining infrastructure for efficient delivery of care. On the other hand, the organization’s mission, values and vision should consider the needs of culturally diverse patients. The policies should be implemented throughout the organization.
Community engagement plays an essential role when it comes to the proper functioning of healthcare systems. This helps healthcare providers establish a critical level of trust and collaboration. It is vital to invite the participation of community members in such activities as education exchange, program development and organizational decision making. Doing so enables entities to develop culturally relevant interventions, which boost the potential for achieving positive health outcomes for patients.
Successful implementation requires the establishment of a system-wide, managerial-level task force. The team assumes responsibility for matters relating to diversity within the organization. An internal budget should be established with the aim to provide the necessary support for efficient delivery of culturally appropriate care. Some of the activities that need funding include the hiring of interpreters, adding signage in different languages and the production of multi-language patient education materials.
Cultural competence is a lifelong learning process that is highly dynamic. Over-generalization and stereotyping can be prevented by gaining a deeper understanding of processes involved in the assessment of cultural patterns and factors that determine group and individual differences.
Developing a deeper understanding of one’s own cultural beliefs and values and the culture of others is important when it comes to effective nursing care. Self-awareness provides a practical way to analyze personal feelings as a component of reflection. Critical reflection extends beyond awareness by examining assumptions of one’s values. It encompasses the evaluation of one’s cultural values and those of other cultures.
A balanced reflection enables nurses to establish therapeutic relationships with culturally diverse patients. As a result, it becomes easier to achieve favorable patient care outcomes. Reflective thinking involves critical inquiry, evaluation and actions. It has the capacity to increase personal cultural awareness.
The refusal to open to cultural diversity for purposes of protecting cultural identity can be detrimental to developing therapeutic relationships. Respect for all cultures is fundamental in the nursing profession and it should be demonstrated throughout one’s professional life.
Healthcare organizations should make an effort to hold small group sessions that discuss the application of critical reflection in culturally congruent nursing care practice. Cross-cultural practice in nursing encompasses a complex blend of reflective self-awareness, skills in cross-cultural assessment, world views and attitudes about cultural differences.
Cross-cultural practice requires a comprehensive assessment of the psychological, physical and cultural foci as the basis of care planning. The process also involves examining the ethical, sociopolitical and sociocultural aspects that define patient experiences within the health-illness continuum of diverse clients.
Cross-cultural communication skills provide a practical way to maximize a common understanding of the health-illness encounter of culturally diverse patients. However, it is not possible for nurses to achieve a certain degree of competence in all cultures. They can only do so in some diverse cultures.
Implementation of higher standards of care for culturally diverse patients is determined by nurses’ intentional reflection on their own attitudes and cross-cultural communication skills.