Nurses face yet another order: Cultural competence
May 1, 1999
Nurses face yet another order: Cultural competence
Ethnic sensitivity assumes priority among payers
Be careful. The direction in which your patient’s bed may be facing could determine whether your ICU wins high or low scores in patient-family satisfaction.
Federal and state health care officials are pushing providers to become more culturally sensitive in dealing with ethnic and cultural diversities among patients. Private health maintenance organizations and some large employers that pay for health insurance are asking for proof of heightened cultural competence from contracting medical providers.
In September, the Health Care Financing Administration proposed new regulations mandating states establish cultural competence guidelines for health plans that contract with the government under Medicaid. In turn, payers are likely to raise the issue in patient satisfaction questionnaires and hospital accreditation assessments.
"The Joint Commission on Accreditation of Healthcare Organizations is also looking into the subject," says Elaine Waidley, RN, MSN, a health care consultant and president of EKW & Associates in Laguna Beach, CA. The commission recently began including cultural competence factors in completing their site surveys for accreditation renewals.
Hospitals lag in ensuring cultural competence
The enormous diversity of patient populations in the health care system has given rise to a new mandate, says Waidley. Nurses, physicians, and allied health professionals need to understand how they affect their patients culturally during the patient-provider encounter, she adds.
Waidley is scheduled to present a six-hour workshop on cultural diversity at this month’s National Teaching Institute and Critical Care Exposition in New Orleans. The event is part of an annual conference sponsored by the American Association of Critical Care Nurses based in Aliso Viejo, CA.
Despite a growing awareness of cultural diversity, many hospitals have not taken adequate steps to ensure that staff competencies get translated into appropriate actions, Waidley says. "There is still a ways to go in doing these things."
In the ICU, where family input is usually welcome, nurses have a great opportunity to seek out cultural information about the patient. In the Muslim culture, for example, a patient’s family is likely to prefer that the hospital bed be pointed so the patient faces an easterly direction.
Ask about religious preferences ahead of time
The preference may seem silly to Westerners, but it conforms to Muslim religious beliefs, Waidley says. Ask the family ahead of time, she advises. And incorporate the topic in each patient’s care plan. Most requests, unless they interfere with medical necessity, will be easy to grant.
Diversity concerns don’t only apply to ethnic differences, the consultant says. The same sensitivity on the part of caregivers should apply to any group that is considered outside the mainstream such as the homeless.
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