Recent statistics show the U.S. is more diverse than ever before. The Hispanic and Asian populations, for instance, each grew by 43% between 2000 and 2010, according to U.S. Census Bureau figures. For nurses, a diverse society translates to a need to keep cultural sensitivity in mind during every encounter with patients.
The advocates
The National Coalition of Ethnic and Minority Nurse Associations was formed in 1998 by five separate organizations — the Asian American/Pacific Islander Nurses Association, the National Alaska Native American Indian Nurses Association, the National Association of Hispanic Nurses, the National Black Nurses Association and the Philippine Nurses Association of America — to be a voice for nurses, but also patients.
“Nurses recognized there was a strong need for a collective group to advocate on behalf of ethnic minority patients,” said Daisy L. Alford-Smith, RN, PhD, MSEd, FAAN, the current president of NCEMNA, who added the organization represents 350,000 minority nurses across America.
Nurse.com asked nurse members of these organizations what their colleagues should keep in mind when caring for patients with ethnically diverse backgrounds.
The advocates
The National Coalition of Ethnic and Minority Nurse Associations was formed in 1998 by five separate organizations — the Asian American/Pacific Islander Nurses Association, the National Alaska Native American Indian Nurses Association, the National Association of Hispanic Nurses, the National Black Nurses Association and the Philippine Nurses Association of America — to be a voice for nurses, but also patients.
“Nurses recognized there was a strong need for a collective group to advocate on behalf of ethnic minority patients,” said Daisy L. Alford-Smith, RN, PhD, MSEd, FAAN, the current president of NCEMNA, who added the organization represents 350,000 minority nurses across America.
Nurse.com asked nurse members of these organizations what their colleagues should keep in mind when caring for patients with ethnically diverse backgrounds.
Religion
Jomy Kunju, RN, BSN, a nurse clinician at Greenwich (Conn.) Hospital, was born in India and moved to the U.S. when she was 5. The oncology nurse said nurses should not allow stereotypes and preconceived notions to affect patient care. A country such as India is so diverse, she said, it’s as if every state has a different culture; but many people aren’t aware of the distinctions.
“People assume if you’re from India you’re Indian, and that’s it,” she said.
There are major differences between North and South India as far as religion is concerned, she said. Many Christians live in southern India, while northern India has a larger population of followers of Hinduism and a small population of Muslims, Kunju said. The best rule of thumb is for nurses always to ask. “It’s something you are going to have to establish in your conversation with the patient,” she said.
Being sensitive and responsive to patients’ religious beliefs can require flexibility and some creativity. Kunju recounts how after a Chinese patient’s death, the family requested the window be opened, so her spirit could be released properly, in accordance with their religious practices. The windows, however, did not open easily. The facility engineer was called in to unseal the window — much to the appreciation of the family.
Kunju also recalled the death of a patient who was a Hasidic Jew . To comply with his religious traditions, his body had to be cleaned and prepared for burial in a specific manner, so nurses were not allowed to touch him after died, according to Kunju. The nurses respected that tradition and other requests, she said.
Brenda Terrell, RN, MSEd, a retired nurse who spent 20 years in nursing administration and education in Indiana and a member of the the NBNA’s Northwest Indiana chapter, said, based on their religious beliefs, some African Americans will seek only God’s healing, as opposed to seeking medical treatment. Others will seek medical treatment, but may be hesitant to comply fully with treatment plans because of religious beliefs about healthcare.
“Religion plays an important part, so if you involve clergy with the care of the patient, you will probably get the patient to be more compliant,” she said.
Jomy Kunju, RN, BSN, a nurse clinician at Greenwich (Conn.) Hospital, was born in India and moved to the U.S. when she was 5. The oncology nurse said nurses should not allow stereotypes and preconceived notions to affect patient care. A country such as India is so diverse, she said, it’s as if every state has a different culture; but many people aren’t aware of the distinctions.
“People assume if you’re from India you’re Indian, and that’s it,” she said.
There are major differences between North and South India as far as religion is concerned, she said. Many Christians live in southern India, while northern India has a larger population of followers of Hinduism and a small population of Muslims, Kunju said. The best rule of thumb is for nurses always to ask. “It’s something you are going to have to establish in your conversation with the patient,” she said.
Being sensitive and responsive to patients’ religious beliefs can require flexibility and some creativity. Kunju recounts how after a Chinese patient’s death, the family requested the window be opened, so her spirit could be released properly, in accordance with their religious practices. The windows, however, did not open easily. The facility engineer was called in to unseal the window — much to the appreciation of the family.
Kunju also recalled the death of a patient who was a Hasidic Jew . To comply with his religious traditions, his body had to be cleaned and prepared for burial in a specific manner, so nurses were not allowed to touch him after died, according to Kunju. The nurses respected that tradition and other requests, she said.
Brenda Terrell, RN, MSEd, a retired nurse who spent 20 years in nursing administration and education in Indiana and a member of the the NBNA’s Northwest Indiana chapter, said, based on their religious beliefs, some African Americans will seek only God’s healing, as opposed to seeking medical treatment. Others will seek medical treatment, but may be hesitant to comply fully with treatment plans because of religious beliefs about healthcare.
“Religion plays an important part, so if you involve clergy with the care of the patient, you will probably get the patient to be more compliant,” she said.
Family
Norma Martinez Rogers, RN, PhD, FAAN, a professor at the University of Texas Health Science Center at San Antonio School of Nursing and past president of NAHN, said family members are one of the top considerations for nurses to keep in mind when caring for Hispanic patients. Nurses should not be surprised if patients listen to their family before their healthcare providers, Rogers added. “Family is where we get support from,” she said. “It’s who we trust the most.”
Kunju said often in the hospital immediate and extended families, as well as religious mentors and friends, will come to be with the patient. “It’s hard to say no, but if the number of visitors compromises patient safety, you have to,” she said. “If it is possible to allow more people to visit, however, try to accommodate it.”
She recalled a time in which the staff was able to move a patient to a family lounge to accommodate 30 visitors. On another occasion a patient in the CCU, who was comatose and nearing the end of life, had more than the standard two visitors. Because the nurses understood the dynamics of the family’s Indian culture, they allowed more family members in to say their final goodbyes.
With the patient’s permission, family also should be included in the discussion of the patient’s care plan, Terrell said, especially those who will be involved in the patient’s care after discharge. Family members will be able to assist the patient more effectively if they understand not only their care, she said, but also the rationale behind the care.
Norma Martinez Rogers, RN, PhD, FAAN, a professor at the University of Texas Health Science Center at San Antonio School of Nursing and past president of NAHN, said family members are one of the top considerations for nurses to keep in mind when caring for Hispanic patients. Nurses should not be surprised if patients listen to their family before their healthcare providers, Rogers added. “Family is where we get support from,” she said. “It’s who we trust the most.”
Kunju said often in the hospital immediate and extended families, as well as religious mentors and friends, will come to be with the patient. “It’s hard to say no, but if the number of visitors compromises patient safety, you have to,” she said. “If it is possible to allow more people to visit, however, try to accommodate it.”
She recalled a time in which the staff was able to move a patient to a family lounge to accommodate 30 visitors. On another occasion a patient in the CCU, who was comatose and nearing the end of life, had more than the standard two visitors. Because the nurses understood the dynamics of the family’s Indian culture, they allowed more family members in to say their final goodbyes.
With the patient’s permission, family also should be included in the discussion of the patient’s care plan, Terrell said, especially those who will be involved in the patient’s care after discharge. Family members will be able to assist the patient more effectively if they understand not only their care, she said, but also the rationale behind the care.
Language
U.S. Census data shows the number of Americans who speak a language other than English at home has increased steadily for the past three decades. In a healthcare setting communication is vital, and language barriers must be eradicated quickly.
Rogers, who did not learn English until she was in the third grade, said many Hispanics are aware their nurses may not speak Spanish. “The bottom line is there are 3 million RNs in the U.S., and 2.8 million are white, non-Hispanic,” she said. “So, we know that most nurses are going to need to think out of their comfort zone.”
She said it’s the hospital’s obligation to provide professional translators — family members or other staff members should not serve as substitutes. And nurses have an obligation to tell hospital administrators if the patient needs a translator, she said.
No matter who is translating, Terrell said, healthcare providers need to make sure they are speaking to their patients in a manner they understand, considering word choices based on the patient’s age and culture and speaking on the patient’s level of understanding of medical terminology.
U.S. Census data shows the number of Americans who speak a language other than English at home has increased steadily for the past three decades. In a healthcare setting communication is vital, and language barriers must be eradicated quickly.
Rogers, who did not learn English until she was in the third grade, said many Hispanics are aware their nurses may not speak Spanish. “The bottom line is there are 3 million RNs in the U.S., and 2.8 million are white, non-Hispanic,” she said. “So, we know that most nurses are going to need to think out of their comfort zone.”
She said it’s the hospital’s obligation to provide professional translators — family members or other staff members should not serve as substitutes. And nurses have an obligation to tell hospital administrators if the patient needs a translator, she said.
No matter who is translating, Terrell said, healthcare providers need to make sure they are speaking to their patients in a manner they understand, considering word choices based on the patient’s age and culture and speaking on the patient’s level of understanding of medical terminology.
The trust factor
Mistrust of healthcare professionals or the effectiveness or need for medical treatments can be a problem across the patient spectrum. In many instances, Kunju said, mistrust is the result of poor communication. A patient shouldn’t be left to wonder why his or her gown is being lifted or what is happening during a procedure, she said. She suggests nurses always explain what is about to happen before it happens.
Terrell agreed and said clear communication is vital to overcoming mistrust. She often witnessed cases of mistrust in older patients and considered that, for some African Americans, this may stem back to the days of segregation, she said.
Some elderly patients are very cautious about new treatment modalities, Terrell said. If they know someone who underwent a treatment that did not go well or had unsettling side effects, such as hair loss caused by chemotherapy, they may be reluctant to try it themselves, she said.
But honesty and compassion can diminish distrust. “Any time you’re open and honest, it decreases feelings of distrust,” she said. “If individuals feel you’re telling them the truth and you have their best interests at heart, they’ll probably be more trusting.”
Mistrust of healthcare professionals or the effectiveness or need for medical treatments can be a problem across the patient spectrum. In many instances, Kunju said, mistrust is the result of poor communication. A patient shouldn’t be left to wonder why his or her gown is being lifted or what is happening during a procedure, she said. She suggests nurses always explain what is about to happen before it happens.
Terrell agreed and said clear communication is vital to overcoming mistrust. She often witnessed cases of mistrust in older patients and considered that, for some African Americans, this may stem back to the days of segregation, she said.
Some elderly patients are very cautious about new treatment modalities, Terrell said. If they know someone who underwent a treatment that did not go well or had unsettling side effects, such as hair loss caused by chemotherapy, they may be reluctant to try it themselves, she said.
But honesty and compassion can diminish distrust. “Any time you’re open and honest, it decreases feelings of distrust,” she said. “If individuals feel you’re telling them the truth and you have their best interests at heart, they’ll probably be more trusting.”
Moving forward
There are many details to keep in mind — such as diet, age, gender issues — when caring for patients. Luckily, many of the solutions usually are simple and come from common nursing practice. Beverly Patchell, RN, PhD, APRN, PMH-BC, APRN-BC, president of NANAINA, recommends focusing on the question, “Are there any special considerations?” during the initial meeting with a patient and his or her family. She said she approaches each patient as she would approach one of the 550-plus recognized Native American tribes: as unique and different.
Practices for Native Americans vary from tribe to tribe. Some tribes may not allow nurses who are menstruating to prepare food, whereas other tribes may require a nurse of a specific gender to care for them, Patchell said. On the other hand, she said, some Native Americans have no special requirements.
Although seemingly obvious, it’s important for nurses to remember to look at patients simply as individuals, rather than focusing on their nationalities. The way nurses are trained to approach each patient as a distinctive person is the way nurses should approach dealing with diversity, Patchell said.
“It’s all basic nursing, but we get so in a hurry sometimes we forget that,” Patchell said. •
There are many details to keep in mind — such as diet, age, gender issues — when caring for patients. Luckily, many of the solutions usually are simple and come from common nursing practice. Beverly Patchell, RN, PhD, APRN, PMH-BC, APRN-BC, president of NANAINA, recommends focusing on the question, “Are there any special considerations?” during the initial meeting with a patient and his or her family. She said she approaches each patient as she would approach one of the 550-plus recognized Native American tribes: as unique and different.
Practices for Native Americans vary from tribe to tribe. Some tribes may not allow nurses who are menstruating to prepare food, whereas other tribes may require a nurse of a specific gender to care for them, Patchell said. On the other hand, she said, some Native Americans have no special requirements.
Although seemingly obvious, it’s important for nurses to remember to look at patients simply as individuals, rather than focusing on their nationalities. The way nurses are trained to approach each patient as a distinctive person is the way nurses should approach dealing with diversity, Patchell said.
“It’s all basic nursing, but we get so in a hurry sometimes we forget that,” Patchell said. •
Andrea Scott is a freelance writer. Post a comment below or email specialty@Nurse.com.
