Culturally Competent Nursing in Homecare
Submitted by Meghan Crivello, BS, RN, BSN
Homecare nurses must be culturally aware in order to appropriately care for homecare patients. Culture plays a part in the care of all types of patients but it plays a more important role in homecare. The care is being completed in the home where the patient controls the care. The nurse has to assess the cultural background of the patient in order to implement an appropriate plan of care.
Every day the population of the United States is becoming more and more diverse. It is important for nursing to becoming culturally competent to take care of the patients effectively. It is especially important in home care due to the fact the care is taking place in the patient’s home. The nurse is essentially a guest in the patient’s home. In traditional health care setting, the patient is the one who could be seen as the guest; in home care it is reversed. Patients have the right to refuse care from the nurse, they control whether they are compliant with the nurses instructions or not. Although this can also happen in a hospital, a homecare patient is able to completely refuse any time of care. A hospitalized patient is at least able to hear what the nurse has to say before deciding not to follow the recommended plan of care. A homecare patient can refuse to even speak or allow a nurse to come into their home. A home care nurse has to be culturally competent in order to be an effective care taker. A patient who may be seen as noncompliant may just have different health care practices based on their cultural. These differences need to be recognized and embraced for the patient to effectively participate in their plan of care. The homecare nurses have to be able to adjust their care accordingly. Prior to becoming culturally competent, the nurse must first look at their own beliefs. The nurse has to understand their own cultural needs before they can take of others.
Registered nurses are primarily Caucasian, 90% compared to 2% of Hispanic registered nurses.(Maier-Lorenz, 2008) Hispanics are the fastest growing minority in the United States, according to the 2010 United State census the Hispanic population grew 43% from 2000 to 2010. The Caucasian population grew only 5.3% in those same ten years.(U.S. Census Bureau, 2011)Homecare nurses have to be culturally competent in their daily care. They have to adjust their plan of care for each patient identifying particular cultural characteristics to meet the healthcare goals for the patient. (Maier-Lorenz, 2008)Madeleine Leininger defines cultural based care in nursing as “the most comprehensive, holistic, and particularistic means to know, explain, interpret, and predict beneficial congruent care practices. Culturally based caring is essential to curing and healing, as there can be no curing without caring, although caring can occur without curing.” (Leininger, 2002) A homecare nurse needs to look at the whole picture of the patient, beyond the medical diagnosis to be an effective caregiver.
To be an effective nurse leader in home care, one has to be aware of what is going on behind the nursing care and especially when the nurse is not there. The nurse needs to be able to determine why a patient may not be receptive to teaching, taking their medications or going to the doctor. The nurse needs to be culturally competent and this can be done by having an open mind. To address the cultural issues up front and ask what can be done differently and what is culturally acceptable.
Language barriers can present a problem. An official translator needs to be available via phone to communicate effectively with the patient. Family members should not be used as translators because they may not translate exactly what is being said. The family member may also include their personal and cultural preferences in the translation causing a miscommunication between the patient and the nurse.
Madeline Maier-Lorentz identified three steps to provide culturally competent care, adopting an attitude that promotes transcultural nursing care, developing an awareness of cultural differences and performing a cultural assessment.(Maier-Lorenz, 2008) To develop an attitude to accept transcultural nursing care, there are four major components; caring, empathy, openness and flexibility. A nurse is able to demonstrate caring by her approach to each patient and the time she takes to listen to a patient’s specific needs. By taking the time to discuss cultural preferences the patients will become confident in the care they are receiving. Therefore creating better health outcomes. The nurse needs to view the patient’s problems from their cultural perspective to show empathy. This allows the patient to know their cultural beliefs are respected and considered in their care. Openness of the nurse allows the patient to see the acceptance and understanding by the nurse of different cultural practices. Lastly, the nurse needs to be flexible and able to accommodate the specific cultural needs of the patient into the plan of care. These four characteristics show patients their care is individualistic. (Maier-Lorenz, 2008) The nurse needs to develop awareness of cultural differences by understanding that even patients within the same culture may have different opinions and expectations. No two patients are the same; each case needs to be handled individually. While completing a medical assessment on a patient, the nurse also has to complete a cultural assessment. The nurse needs to understand what foods are considered healthy, ones that are eaten in times of illness, whether the patients believes in traditional or alternative medicine, their perception and definition of pain and pain control. It is also important for the nurse to understand the family structure and how that impacts the patient’s plan of care. (Maier-Lorenz, 2008)
While taking care of homecare patients, the nurse has to take into consideration the setting in which they are providing their care. Patients who receive care in their homes need special and different attention than traditional hospital patients. Patients will be receiving most of their care from their family members and primary caregivers, not nurses, doctors and patient care assistants. The nurse only has control during the time in which he or she visits and even then, the patients commands the control. The nurses needs to first understand her own beliefs and views of his or her own culture. After the nurse completes a personal cultural assessment, it is important to complete the patient’s control assessment as part of the admission process to home care. The nurse needs to ask if there are any specific considerations to be aware of, things that will impact the plan of care for the patient. If the nurse is up front with these questions, the nurse will then be able to create an individual plan of care for each patient so each one gets the best possible care. If the nurse does not share the same views, he or she needs to be accepting, respectful and adjust accordingly. Ultimately, it is up to the patient if they want to receive the home care services so it is the nurse’s responsibility to meet their needs to continue the service.
Family members and primary care givers are essential the health and recovery of the homecare patient. They need to be acknowledged and accepted as part of the plan of care. If they do not agree with the plan of care, the chances they will enforce it for the patient goes down significantly. It is a team effort to achieve the goals of the patient in home care; everyone has to be in agreement. It is the nurse’s job to make sure he or she understands the role the family members play and why.The primary caregiver may not be viewed as someone the nurse would pick as the primary caregiver but it the nurse’s job to accept and plan accordingly.
The homecare nurses need to look at their own personal and cultural beliefs before taking care of homecare patients. Then he or she will be able to accurately assess and accept the patient’s cultural beliefs into the plan of care. The homecare nurse will have to continue to reexamine his or her cultural beliefs as it is an ongoing process. Cultural practices are a very important aspect of healing for patients and are essential for positive homecare outcomes.
Leininger, M. (2002) Culture Care Theory: A Major Contribution to Advance Transcultural
Nursing Knowledge and Practices.Transcultural Nursing. 189-194Maier-Lorentz, M. (2008)
Transcultural nursing: its importance in nursing practice.
Journal of Cultural Diversity, 15(1), 37-43. Retrieved from EBSCOhost.
U.S. Census Bureau. (2011).2010 Census Data.Washington, DC : U.S. Census Bureau.