Culture affects everything and every choice we make every day. It not only relates to cultural differences but also the dress, food and celebrations of a certain community. There needs to be a rethink of what constitutes care that is cultural as the effects of globalisation and worldwide economic changes affect us even further. To consider this issue, this article has adopted the term culturally appropriate care (CAC).
CAC, in this context, incorporates all of the cultural theoretical terminology that is used to deliver individualised care.
American nurse theorist and nurse anthropologist Madeleine Leininger in the late 1950s created the term ‘cultural competence’ and the concept of ‘transcultural nursing’. Championed by nurses internationally, subsequent cultural theorists developed a variety of terminology that uses culture to indicate a particular need or approach taken to deliver nursing care.
The NHS Constitution and the Nursing Midwifery Council also reinforce the need to consider the culture of a patient, as part of effective individualised care delivery.
The extensive nursing literature on cultural care agrees with these important fundamentals: there needs to be effective, sensitive, non-discriminatory communication, the positioning of the understanding of health from the patients’ experience, values or perspective, and a professional open to the creative application of services.
Limitations and challenges of providing effective CAC
It could be argued that the provision of CAC has a tendency to be seen as ensuring the provision of diet, prayer space, pamphlets in different languages and mainly, delivery of ‘extra’ care to those who appear different.
CAC is more than just identifying the needs of patients, it requires those needs to be user-centred and have the ability to adapt continuously to respond to either changing needs or the impact of differing life histories and events of all patients.
This is challenging because although health professionals are aware of the individualities of patients they are often constrained when caring for individuals in an unpredictable environment with a perceived lack of time.
The biggest challenge for the delivery of fair CAC is the motivation of the professional to “want to” engage in the process of becoming culturally aware, culturally knowledgeable, culturally skilful and seeking cultural encounters: not just that they “have to”.1
At a subconscious level, we naturally categorise people into different groups, hierarchies and levels of acceptances, and so as members of wider society, it can be challenging for health and social care professionals not to adopt the same attitude, despite the regulation of trying to provide non-discriminatory care to all patients.
What really should CAC consist of?
In 2012, the Nursing & Midwifery Council and the General Medical Council released a joint statement on professional values, responding to recent high profile failures, (although this was not the sole responsibility of the nurses and doctors who were there at the time).
The joint statement was a reminder to staff about what constituted professional values and about treating people as individuals and respecting their dignity. It doesn’t, however, pay attention to how much our personal values affect how we act professionally.
Firstly, CAC is for all communities: this includes not just the ethnic minorities of a country but also the ethnic majority.
An individual’s cultural identity is complex and multi-layered, it is sometimes overtly obvious but mainly it is subtle and unconscious. It changes, modifies and adapts over time by the external influences of history, politics and the media. It can also be subtly different between individuals in the same family, or visibly similar groups, communities or professions who identify themselves as a group.
Providing CAC is not about making an assumption about personal preferences or by pandering to the media-driven myth of political correctness, which makes people nervous about asking ‘culture’ questions in case they offend. It involves, at one level, asking questions about personal preferences from individuals rather than making assumptions.
CAC is also about the professional realising that they are equally a product of their own culture as much as the culturally different person they care for; by acknowledging that we are all made up of powerful personal experiences of learned, shared and transmitted values, beliefs and norms. This guides our thinking and decisions in familiar ways, once we recognise this we are more likely to understand that difference is a result of an alternate set of equally powerful shared values.
CAC should also be seen as the provision of humanised care.2 The healthcare professional and the patient, both being products of their own culture, bring with them into a professional relationship, pre-conceptions of what is right or wrong.
The cultural norms of the professional must encompass codes of conduct, the law and other confines within which they need to operate. It is not, however, about complete acceptance of practices that may be considered harmful to a patient, but is about an appreciation and compassion for the perspectives the patient has developed.
Promoting equal cultural care
There needs to be a re-adjustment of the presumption of discrimination made by the government and powerful bodies concentrating on arguments around the confines of race and ethnicity. As per the Equality Act set in 2010, there also needs to be a wider focus on people of all backgrounds in the UK.
There needs to be a clear and honest discussion around how our professional values affect our personal values in a non-confrontational and accusing environment. Professional values are the guiding beliefs and principles that influence work behaviour. Therefore, another way to instil cultural desire is to include the professional within the cultural equation.
By looking and discovering their cultural self-awareness, the professional will be able to recognise and articulate their own cultural values and principles, while understanding how these may differ in other communities. It also allows the identification of personal strengths or limitations and for the professional to note the impact of normal personal emotions or prejudices and the impact this may have on others.
A desire to care for any patient is conveyed by non-verbal behaviour and actions. Together with the tone of language expressed in non-judgemental communication, nurses are more likely to be successful in encouraging patients to share information. As professionals, we need to be able to see to the bigger picture and not rely on lay-definitions and generalised assumptions of those we will be caring for, be it personally or professionally. There are serious implications for health and social care professionals and more significantly, patients, if CAC is not seen.
1. Camphina-Bacote J. Cultural desire: caught or taught? Contemporary Nurse 2008; 28(1-2):141-8.
2. Todres L, Galvin K, Holloway I. The humanization of healthcare: A value framework for qualitative research. International Journal of Qualitative Studies on Health and Well-being 2009; 4 (2): 68-77.
You are currently leaving the Nursing in Practice site. Are you sure you want to proceed?