Health Needs of a Changing Population

The landscape of healthcare is changing. The location for service is changing from hospital-based to alternative locations - home, rehabilitation center, subacute care center, and urgent care center. Clients cross international borders to receive healthcare. The age of the client is changing from younger clients to older clients. Healthcare personnel are changing from a common ethnic origin to a variety of ethnic origins. Clients come from many different ethnic backgrounds. All of this change creates the need for healthcare personnel to be familiar with transcultural or intercultural principles of care.

Transcultural nursing is a recognized specialty in nursing. Transcultural nurses focus on the similarities and differences among cultures order to provide appropriate healthcare based on the client's values, beliefs, and healthcare practices (Leininger, 1994). In addition to the client's cultural values, beliefs and healthcare practices affecting the healthcare provided and received, the healthcare provider's cultural values, beliefs and healthcare practices also impact the outcome of each care situation. Working together to provide the most appropriate care is difficult when cultural values are shared, it becomes much more difficult when cultural values differ or even clash.

Within a healthcare team, there might be multiple cultural backgrounds. In 1976, I shared a home with Vietnamese refugees. I could understand their English so when the youngest son became ill I became the translator (speaker of "American English") between the "Indian English" the physician used and the "Vietnamese English" the patient and his family used. Frustrating - Yes! Rewarding - Yes!

One cultural value that may differ is the value of time. Healthcare providers are habitual time conscious. When the client does not sense the same urgency for appointments or therapies, misunderstandings can occur. Adapting schedules, rearranging appointments and being sensitive to cultural variations to the meaning in time will promote better understanding between healthcare provide and client.

Another cultural pattern that varies between ethnic or cultural groups is who makes the decisions. Frequently, the healthcare providers expect the parents to make healthcare decisions for a child. In some cultures, it may be a group decision or the decision may be made by the 'elder' in the family. The insistence that only the parents be informed of the condition of the child can cause friction within the family.

Communication is critical to providing culturally appropriate healthcare. Speaking the same language does not guarantee comprehension between healthcare providers and between healthcare providers and the recipient of healthcare. English varies from country to country. Spanish varies between Spain and countries in Central and South America. Speaking different languages creates confusion and misunderstanding. A person that speaks a second language well may not know healthcare terminology in the second language. When I was learning French in Albertville, France, I became ill with severe headaches. After one particularly trying time in a doctor's office, I vowed never to speak French again! Illness decreases a client's ability to communicate in a second language. Translators, although necessary, may add another layer uncertainty to the communication between healthcare providers and care recipients. Both verbal and non-verbal listening skills are necessary for today's professional.

Education in cultural sensitive skills should be part of every health care program. Higher education institutions offer cultural anthropology, intercultural studies, foreign language, cross-cultural ministries, or similar courses. An objective of courses like these is to help a person gain an understanding of similarities and differences between groups of people. It would be impossible to learn specific similarities and differences for all groups of people. Instead, the goal would be to become more cultural sensitive and gain an ability to recognize potential culturally sensitive situations. Some institutions are requiring students to meet a minimum requirement for cultural competency. Specific programs of study require courses in cultural studies.

Nursing programs have added courses such as Intercultural Nursing, Transcultural Nursing, Cross-Cultural Nursing, and Cultural Diversity in Health Care. The objectives for these courses include demonstrating awareness of other cultures, identifying personal cultural biases, and integrating cultural care in professional practice settings. These courses have a didactic (lecture) component and some may have a practicum or clinical component.

Intercultural Nursing at Indiana Wesleyan University has both components. The didactic component (2 credits) is taken during a student's junior year. Upon completion of the junior year, the student arranges for a 42 practicum (1 credit) experience with a professional nurse. Students request a professional nurse they know to be their preceptor for their Intercultural Nursing Practicum or they request help in locating a preceptor. Students have spent time at hospitals in Gabon, Kenya, Russia, Zimbabwe and Haiti, as well as in a Mexican clinic, a Cambodian health center, Indian reservations in the United States, and at local providers of care for Mexican migrants. Students have chosen to go to Mary Breckinridge Hospital in Kentucky, and Hooverwood Nursing Home (Kosher Jewish) and Citizen's Health Corporation both in Indiana. Students research cultural phenomena for their chosen location in order to have a basic knowledge of the culture upon arrival. The experience is stretching and life changing. Students report on their experiences during the next school year.

Cultural care and sensitivity is required of healthcare professionals today. Each professional will encounter cultural similarities and differences in their clients and their co-workers. An ability of manage quality care in the changing landscape of healthcare today is a skill that can be learned and must be practiced. The landscape is changing but the need for culturally sensitive, excellent care will never change.

Author
Barbara a.Ihrke
Division of Nursing Education
Indiana Wesleyan University

Leininger, M. (1994). Transcultural nursing education: A worldwide imperative. Nursing and Healthcare