Cultural Differences That Affect Health Care

The United States is a melting pot of ethnic and cultural diversity. In a health care setting, this can cause a nightmare for the patient as well as the health care team. Imagine a young woman being brought in by paramedics from an automobile accident. She is bleeding from somewhere under her clothing and the first thoughts of the emergency workers is to cut away her clothing so that they can examine her. She speaks very little English and is extremely distraught that a male nurse and EMT are in the room as she is being exposed.

This could describe almost any young woman who is vitally concerned with her own modesty, but suppose it is a young Muslim woman who has recently emigrated here. That changes the situation and it becomes more apparent that her cultural values can adversely affect her health care situation as she struggles to remain covered and delays diagnosis and treatment.

A young child of Jehovah's Witness faith is critically injured in an accident and has lost a significant amount of blood. His religious beliefs prohibit transfusion of any form of blood products. This very scenario has become the issue of court battles over and over.

Just as you wouldn't classify all diabetics into one category and expect that they will all react to a specific diabetic regimen in the same manner, you cannot lump all people of one culture, race, or religious belief into one category. Health care needs to be individualized for each patient and in doing so you need to take into account all aspects of whom this person is.

Transcultural health care models have emerged over the past thirty years, but as far as nursing care is concerned, the nursing process still drives how the care is provided. You need to assess all patients, diagnose their nursing health care needs, plan for their care, and implement and evaluate the care. In implementing the care plan, you always need to consider who this person is, what they believe and what their background is.

Cultural differences affect how people react to illness, respond to symptoms, how they seek medical care, and how they perceive the health care team members. All this affects how they will react to and respond to treatment.

You will also encounter cultural differences in your health care team. The team members will have varied beliefs and strategies for handling situations and patient care issues. Nurses need to listen and be tolerant. Being understanding of differences will not only broaden your own horizons, but also will help you to become a better nurse. Ask questions, listen to the answers, be sensitive, show respect, and build trust.

Another emerging aspect of providing culturally competent care is that of ethnopharmocology. Research has shown that ethnic makeup can affect the response and effectiveness of drugs. For instance, African-Americans have a greater risk for developing delirium from tricyclic medications than whites. Asians have different reactions to some medications than other races. This opens a whole new realm to understanding drugs.

One approach being emphasized by these researchers is to ask two important questions and listen carefully to the answers in order to better understand the cultural diversity issues in health care that affect your patient. These two questions are: “What do you think caused your illness?” and “What do you think will help you the most?”

This approach not only helps to cut through the layers of diversity, but also adheres to the premise of putting the patient at the center of the health care delivery model. It also emphasizes the patient's role in promoting his wellness and in his responsibility for his own care.

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