Cultural Competency and Honesty in a Professional Nurse’s Practice

By Hannah L. Head RN, PHN, MSN

The challenge of writing about the topic of “cultural competency and honesty” among professional nurses is intriguing, overwhelming, and timely. Not only is the topic very complex/complicated, but it is often avoided when addressing the serious issues that are faced daily. This topic is overwhelming for the obvious reason that a one-shot discussion is not enough. All the training that I have participated in ranged from 3 full days to 1 week or a full course = 1 semester. Finally, the target group of this article is in the midst of facing a cultural revolution in our country.  The delivery of healthcare by culturally competent professional nurses and the delivery of healthcare by diverse culturally competent nurses to a very diverse population are in high demand.

Nursing is my passion and I am fascinated with every aspect of the professional nursing culture. From the mysterious tales of origins to the ongoing science that stimulates the support that gives a foundation and framework to our nursing theories that validate our evidence-based practice. Nurses are everywhere! Hospitals, clinics, home care, colleges, war zones, military, secondary schools, political arenas, public health, disaster teams, first responders, mental health, and even parish faith-based institutions. This is only a small list of the very diverse communities we are needed to serve. The work is intense and never boring for this writer.

In the unique world of professional nurses the culture is always changing, but for the purpose of this discussion, let’s explore some familiar definitions. What is culture? According to Webster, “the customary beliefs, social forms and material traits of a racial, religious or social group.” What is cultural competence? “A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professional and enables that system, agency, or those professionals to work effectively in cross-cultural situations.” Professional nurses, no matter where their practices are in effect must have the ability to adapt to the needs of the target group. Some commonly known facts about cultures are that they are not ALL homogenous. Becoming culturally competent professional nurses will not mean that nurses will know everything about every single culture. However, that fact should not discourage us from the worthwhile goal of becoming culturally competent as a career-long process. Research has shown that individuals are unique and have unique needs. For example, it has been discovered that families or friends would share their leftover medications with each other. This cost-saving act carried some dangerous consequences (i.e. allergic responses, overdoses, and even the development of resistance to certain antibiotics from the cultural practice of sharing meds without the supervision of the doctor).

Professional nurses will have some very positive consequences of becoming culturally competent. The instinct of cultural sensitivity will start to emerge. The professional nurse will find the desire to listen to verbal and non-verbal messages. For example, assessing the level of pain in an individual comes from a physical evaluation combined with asking appropriate questions. Culturally competent and sensitive nurses will begin to pick up on subtle clues like smell, grimaces, lack of eye contact, tears, absence of hearing, answers to questions that don’t fit the question. For example, while in a team, decision-making meeting, one of our members bothered to look under the table and noted the severe bruises that the mother was trying to hide on her wrists and ankles. Her verbal narrative in the meeting was not consistent with the physical and emotional pain that was right there in front of our eyes. All members of this team had been through intense specialized training for dealing with multi-cultural clients and sub-culture practices when dealing with systems of care that they often did not trust with the life-threatening issues in their life. It took skill for us to develop the community trust so we could navigate successful interventions immediately. The stressors of today’s culture have created some very dangerous cultural social norms. Unresolved racial relations are an example of a culture that is dysfunctional because of language barriers, economic deficits, and ill-health. The integration of technology, locally and globally, has added a very complicated element to the need for professional nurses to be culturally competent: To be able to access, store and transmit records electronically while protecting privacy and preventing loss of files.

Another need for being culturally competent is that health care is changing so rapidly and demanding that professional nurses have diversified skills that enable them to adapt to rapid social change expeditiously. Imagine what the challenges were for Martin Luther King, Jr, and his civil rights team when they found themselves seriously injured in strange environments. They had to access care often from their adversaries. Often those adversaries had different cultural norms and belief systems than the people seeking their professional help. Many of those stories exist that explain how professional nurse’s hearts were changed because their cultural awareness and sensitivity had been developed to see suffering human beings in need. Harriet Tubman used the same theory as she developed a very effective underground railroad team to save lives and free slaves. She also found herself in the unexpected position of rendering nursing care to individuals who were culturally unfamiliar but the system of social norms, governments, attitudes, and laws were changing. Harriet risked her life to save one life at a time. Humans adapt or they die, she was extremely culturally competent and sensitive and demonstrated it under extreme circumstances. We have to co-exist in circumstances that are rigorous and demanding. Professional nurses are often a bridge to opening the dialogue that lays the foundation for ethics and honesty to stay alive in health care. Our cultures no longer have borders when it comes to common needs like language, economics, social, political, and faith issues. Our differences cannot be ignored and it requires courage to speak up and be part of the change.

How timely is this discussion when nurses are not normally found in secondary schools? When the lack of culturally competent professionals are not in the role of prevention due to dwindling funds for healthcare? When the cost of lives lost cannot be quantified? When professional nurses are not able to recruit and train replacements for the aging retirees? And finally, when there is no priority to address any of the above issues from critically important policymakers?

This situation is not hopeless. We have a young generation that believes they can turn the tide. Our youth are technology savvy and they can impact the global response to youth their age dying from unnatural causes. They can change how their parents change. They have leadership skills. Every single life matters and has the potential to be a change agent, including the younger generation. Our youth can contribute to social change agents by impacting and changing their parents’ attitudes and actions.

The social norms are developed from societies. People make up social systems and therefore hope is always the wild card that inspires professional nurses to see the need and address it. We can volunteer to go to schools and help recruit future nurses. We can write our political representatives and layout the critical healthcare needs for our unique communities. We can hold them accountable by recruiting members of our communities to assist us. Technology is a wonderful tool, but we still need to communicate face to face and re-establish the human factor that is the backbone of our profession. We can continue to use our magazines and journals to communicate our ideas, concerns, and possible solutions. We must never forget those professional nurses that came before us: Florence Nightingale 1859; Mary Eliza Mahoney 1879; Clara Barton 1882; Lillian D. Wald 1891; Clara Louise Maass 1876-1901; The Vietnam War 1963-1975 more than 5,000 nurses served in Vietnam; The NIH – Ada Sue Hinshaw 1993 –The National Center for Research just to name a few.

One comment on Cultural Competency and Honesty in a Professional Nurse’s Practice

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Cultural Competency and Honesty in a Professional Nurse’s Practice

The challenge of writing about the topic of “cultural competency and honesty” among professional nurses is intriguing, overwhelming and timely. Not only is the topic very complex/complicated, but it is often avoided when addressing the serious issues that are faced daily. This topic is overwhelming for the obvious reason that a one-shot discussion is not enough. Read on to learn more about INA Member Hannah Head’s discussion on the need of cultural competence and honesty in the nursing practice.

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