Culture as Attributes of Learner That Influences Nursing What Are Cultural Characteristics?

The cultural landscape of the United States has been evolving rapidly, especially in terms of racial and ethnic diversity. At the turn of the 21st century, the population was approximately 71.3% white and 28.7% minority. By 2012, minority representation increased to 37%, and projections indicate that by 2043, no single racial or ethnic group will form a majority in the U.S. population. By 2060, it is expected that 57% of the U.S. population will consist of minority groups (U.S. Census Bureau, 2012).

Given this increasing diversity, nurses and healthcare professionals must adapt their practices to include culturally sensitive care that respects the values, beliefs, and customs of various ethnic subgroups. Transcultural nursing involves recognizing these differences and incorporating them into healthcare practices. A lack of cultural sensitivity can lead to misdiagnosis, ineffective care, and the alienation of patients from different backgrounds (Nguyen & Mills, 2014).

Historically, the healthcare system in the United States has operated under a Western, biomedical paradigm, which often conflicts with the healthcare beliefs of many ethnic and cultural groups. The challenge for nurses today is to incorporate cultural understanding into their care delivery, ensuring that all patients feel respected and understood.

Assessment Models for the Delivery of Culturally Sensitive Care

The growth in immigration, higher birth rates among minority populations, and greater geographic mobility have made it essential for the U.S. healthcare system to shift from a monocultural focus to a multicultural and transcultural perspective. This shift is crucial for the effective delivery of culturally competent healthcare and for preparing professionals who are sensitive to the diverse needs of their patients (Narayan, 2003).

Various models have been developed to guide healthcare professionals in delivering culturally competent care. One popular model is Purnell’s model for cultural competence, which provides a systematic and comprehensive approach to understanding culture and ethnicity. This model helps healthcare providers offer holistic and culturally competent care in diverse settings (Purnell, 2013).

Purnell’s model identifies primary and secondary characteristics of culture. Primary characteristics include nationality, race, gender, age, and religious affiliation, while secondary characteristics include socioeconomic status (SES), physical characteristics, educational background, and occupation. Both sets of characteristics influence a person’s beliefs and worldview, which in turn shape their healthcare preferences and needs.

The Purnell model is structured as a circle with several layers representing different cultural concepts:

1. Global society: The outermost layer represents the global environment and how cultures interact on a worldwide level.
2. Community: The second layer focuses on the influence of the community or local environment on cultural beliefs.
3. Family: The third layer highlights the role of family and familial structures in shaping an individual’s cultural values.
4. Individual: The innermost layer represents the individual and their unique cultural identity.

Within these layers, Purnell’s model outlines 12 cultural domains that should be considered when providing care:

1. Communication (dominant language, nonverbal expressions)
2. Family roles and organization (head of household, gender roles)
3. Workforce issues (language barriers, acculturation)
4. Biocultural ecology (heredity, biological variations)
5. High-risk behaviors (smoking, alcohol use)
6. Nutrition (common foods, dietary restrictions)
7. Pregnancy (fertility practices, birthing rituals)
8. Death rituals (views on death, burial practices)
9. Spirituality (religious practices, prayer)
10. Healthcare practices (traditions, medication use)
11. Healthcare practitioners (folk medicine, gender issues)
12. Overview/heritage (origins, socioeconomic background)

These domains provide a comprehensive framework for understanding how culture influences an individual’s health beliefs and behaviors, ensuring that care is delivered in a culturally sensitive and effective manner.

Assumptions of the Purnell Model

Purnell (2013) identified several key assumptions that form the foundation of the model. The most relevant assumptions for nursing education include:

• One culture is not superior to another: Each culture is unique and should be respected.
• Culture affects one’s interpretation of and response to healthcare: Understanding cultural influences can lead to more effective care.
• Cultural competence improves healthcare outcomes: Nurses who respect and accommodate cultural differences can improve the quality of care and health outcomes.
• Prejudices and biases can be minimized: By fostering cultural understanding, nurses can reduce prejudices and biases that may exist in healthcare settings.

Cultural Adaptations

Cultural adaptations in healthcare often require professionals to modify their standard practices to accommodate the cultural beliefs and preferences of their patients. Giger and Davidhizar (2004) developed the transcultural assessment model, which includes six cultural phenomena to guide healthcare providers in delivering culturally appropriate care:

1. Communication: Understanding language barriers and nonverbal communication.
2. Personal space: Recognizing different cultural preferences for personal space.
3. Social organization: Acknowledging the importance of family, community, and social structures.
4. Time orientation: Considering whether patients are past, present, or future-oriented.
5. Environmental control: Understanding patients’ perceptions of how they can control their environment and health.
6. Biological variations: Being aware of genetic differences that affect health outcomes.

By incorporating these phenomena into nursing care, healthcare providers can better understand their patients and deliver care that is respectful of cultural differences.

Client-Nurse Negotiation Model

The nurse-client negotiations model was developed in the mid-1980s to provide a framework for understanding and addressing cultural differences between nurses and patients. This model emphasizes the need for negotiation between the scientific knowledge of the nurse and the cultural beliefs of the patient (Anderson, 1990). It recognizes that both the nurse and the patient bring their own cultural perspectives to the healthcare interaction, and these perspectives may differ.

This model is especially relevant for situations in which cultural beliefs about illness, treatment, and healthcare practices differ from the biomedical views held by healthcare providers. For example, a family may believe that their child should not receive a blood transfusion due to religious reasons, while the healthcare team sees the transfusion as essential for saving the child’s life. The nurse-client negotiations model helps open lines of communication, allowing both parties to understand each other’s perspectives and work toward a mutually acceptable solution.

Negotiation involves the exchange of information, and it is essential for the nurse to learn from the patient about their beliefs, values, and perceptions of illness and treatment. This collaborative approach helps patients feel more involved in their care and promotes a sense of empowerment.

Questions that nurses can ask to gain insight into the patient’s cultural perspective include:

1. What do you believe caused your health problem?
2. How severe do you think your illness is?
3. What treatments do you think are necessary?
4. What are your fears about your illness or treatment?

By addressing these questions, nurses can gain a better understanding of the patient’s cultural beliefs and work together to create a care plan that respects these beliefs while achieving healthcare goals.

Cultural Assessment and the Nursing Profession

Cultural assessment is a critical skill for nurses to develop. Nurses who are culturally competent can design and implement more effective patient education and care plans. They can also help colleagues understand and work with patients who may be perceived as noncompliant or uncooperative due to cultural misunderstandings.

Cultural competence requires active listening, empathy, and rapport-building skills. These skills help nurses identify potential areas of cultural conflict and select interventions that minimize misunderstandings and respect the patient’s beliefs (Campinha-Bacote, 2011). It is essential for nurses to avoid stereotyping patients based on their cultural or ethnic background. Just because a patient belongs to a particular cultural group does not mean they adhere to all the beliefs and practices associated with that group.

Cultural knowledge should serve as a guide, not a set of assumptions. Every patient is unique, and nurses must conduct thorough assessments to understand each individual’s specific needs and preferences.

Conclusion

In an increasingly diverse society, cultural competence is essential for nursing professionals. Understanding cultural characteristics and using models like the Purnell model, the Giger and Davidhizar model, and the nurse-client negotiations model can help nurses provide culturally sensitive care that respects patients’ beliefs and practices. By engaging in active listening, open communication, and negotiation, nurses can build strong relationships with their patients, leading to better health outcomes and greater patient satisfaction.

It is crucial for nurses to avoid making assumptions based on a patient’s ethnicity or cultural background. Instead, they should conduct individualized assessments to determine the specific needs and preferences of each patient. By incorporating cultural competence into nursing education and practice, healthcare professionals can ensure that all patients receive the highest quality of care, regardless of their cultural background.