Culture Competence in Nursing Shannon Karlsson California State University, Chico Introduction According to the United States Census Bureau (2010), over 30% of the total population in the United States is comprised of various ethnicities other than non-Hispanic Whites. This statistic highlights that the United States (US) has a significant multicultural population today. These diverse cultures bring with them new languages, religious beliefs and practices, social structures, and health care beliefs and practices.
These cultural differences can create barriers in the healthcare industry and can be challenging to those healthcare providers who are caring for these individuals. As a result, these ethnic minorities often experience poorer access to care and lower quality of preventive, primary, and specialty care. The Hmong are one of the ethnic minority groups listed in the U. S. population. Currently there are more than 170,000 Hmong living in the United States. The majority of Hmong in the U.
S. currently reside in California, Minnesota, Wisconsin, North Carolina, and Michigan. In order to care for these individuals in a more effective manner, nurses must provide culturally competent care to their patients. By providing care that is based on patients’ cultural beliefs, values, and practices, the patient is more likely to adhere to the plan of care outlined by the nurse. History of the Hmong Among those who have immigrated to the United States are the Hmong.
The Hmong are a population of people who live in China, Burma, Thailand, and northern Laos. The Hmong of northern Laos were recruited and trained by the Central Intelligence Agency during the Vietnam Conflict to help prevent the North Vietnamese form invading Laos and South Vietnam through the Ho chi Min Trail. Though they played an important role during this conflict, they were not protected by the US when troops withdrew from the region in 1975. This resulted in many Hmong people being killed by the new communist regime in Laos.
Those who did survive fled to refugee camps in Thailand. This population of Hmong form northern Laos were given preferred refugee status by the US in the 1980’s, resulting in a large immigration influx of Hmong into the United States. Hmong Culture The cultural and ethnic backgrounds of patients can shape their views of health, wellness, and illness. When caring for a patient from another culture, it is important to explore their cultural background, taking into consideration their beliefs, values, daily practices, spirituality.
Having a better understanding of how a patient understands illness, perceives treatment plans, and makes healthcare decisions are all significant to the nurse when assessing a patient and creating an appropriate plan of care for them. The Hmong are among those minority groups that continue to be challenge healthcare due to the barriers of language, medical and religious beliefs, medical practices, cultural beliefs, and social organization. Language The Hmong have their own language called Hmoob; translated as Hmong in English.
The Hmong language consists of many dialects, which creates difficulty in providing a quality interpreter when necessary. Also, a written form of the Hmong language did not exist until the 1960’s, creating another complication with communication. Many older Hmong are unable to read or write their own language and the language does not contain many medical terms that are needed for interpretation. Cultural Health Beliefs Different cultural groups have diverse belief systems with regard to health and healing compared to Western beliefs of medicine and health.
Westerners tend to attribute the cause of illness to the individual or the natural world, whereas non-Western peoples explain illness as a result of social and supernatural causes. The Hmong believe in Animism, a belief where the spirit world is connected to all living things. If the body is not in balance with the spirit, the Hmong believe that they could incur illness. Evil spirits as well as offended ancestors are also believed to cause illness. They believe that the body contains several souls that need to remain whole in order for the individual to remain healthy.
Shamans are often brought in to identify which spirit is causing the illness and to communicate with the spirit world in order to restore the wandering souls of the body. A variety of traditional treatments including herbal medications, folk remedies, and feeding practices are used to treat illness; for example the use of hot and cold food and the practice of spooning, cupping, or wearing of religious symbols in order to care for sick individuals. The Hmong also believe that birth defects and even disabilities are a form of punishment for past or present offenses.
This often times makes it difficult to convince them to engage in preventative measures that could prevent these problems. Another issue has to do with surgical treatment of disease and illness. The Hmong fear surgery because, (1) it could result in the soul leaving the body through the surgical opening, leaving them unwhole and endangering the reincarnation of the soul, (2) the fear of being stigmatized as disabled by their clan and losing the support of their community. They are skeptical of blood draws and blood transfusions, as well as immunizations.
These cultural differences can affect how people react to illness, respond to symptoms, how they seek medical care, and how they perceive members of the healthcare team. Although many Hmong Americans believe in the use of Western medicine, the use of their own cultural treatments are often times simultaneously utilized. So it is important for those who are treating these patients to understand their culture in order to provide the best possible care. By implementing cultural competence in care, nurses will be able to provide more effective care.
Social Organization of the Family Another barrier to providing quality care to Hmong populations is their social structure and the roles within them. The Hmong live in clan societies, which include extended family members. They observe a patriarchal clan system in which the males are dominant and make all the major decisions. Each clan has a clan leader, to whom members of the clan must consult on any major medical decisions. Nurses are held to a code of ethics by which helps guide them in their care. The ethical principle of utonomy refers to the commitment by the nurse to include patients in decisions about all aspects of care. If a Hmong patient were not allowed to make decisions for themselves, this would create a difficult situation for the nurse. Cultural Competence The development of cultural competence requires the nurse to most importantly have the interest in becoming culturally competent and next to take the necessary steps to attain it. If nurses are to give the most effective and appropriate care possible, they must take into account the diverse backgrounds of the patients they are working with.
Nurses are not likely to know about culturally based, health-related beliefs and practices of all people they come into contact with. However, they can gain knowledge and skills in cross-cultural communication to better equip them to provide culturally competent care. Cross-cultural communication involves examining the ways in which people from diversified cultures communicate. Non-verbal cues play a vital role in conveying messages among people, so understanding these communication cues and their meanings is necessary in order for a nurse to attain cultural competence.
These communications cues include eye contact, touch, silence, as well as space and distance. Cultural competence in nursing is the continual process of striving to become increasingly self-aware, to value diversity, and to become knowledgeable about cultural strengths. Having knowledge of a patient’s culture enables a nurse to provide effective and appropriate care. Nurses can also use the model of cultural competency developed my Josepha Campinha-Bacote in 1998. This model blended the world of nursing and anthropology in order to create the field of transcultural nursing.
The major concepts of the model include cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. Nurses need to maintain cultural competency in their daily practice, in order to instill in their patients a felling of being known and cared for as individuals. This is vital in our ever changing, complex healthcare system and culturally diverse society. Currently, there are inadequate numbers of health care providers worldwide who are prepared to provide culturally congruent care.
Many providers neither recognize nor acknowledge the existence of the variety of healing and caring paradigms that are widely valued and used. In addition, healthcare providers are frequently unwilling or unable to accommodate ways of knowing and healing that does not fit into their own cultural frameworks of knowledge and experience. Instead, they impose practices of care on people that are ineffective or harmful, rather than working collaboratively across paradigms and care systems. Actions related to ethnocentrism, lack of awareness and moral blindness perpetuates and exacerbate healthcare inequities.