There is a long-standing and well-documented pattern of health inequalities in the US, evident in both health care outcomes and in utilization of health services, while the gap between health needs and the provision of health services to meet them continues to widen. Inequalities in health particularly affect minority ethnic groups because of, among other reasons, disproportionate poverty, discrimination and failure of health service organizations to provide culturally competent care.
This work explores issues pertaining to race, race relations, health care equity, and the nature of attitudes and beliefs and their relationships with human behavior. It describes prejudice and discusses its expressions and consequences. It delineates the need for rehabilitation professionals to learn more about their own prejudices and possible manifestations of these prejudices.
Culture is an extremely complex concept, and one that has been defined, interpreted and analyzed from a variety of disciplinary perspectives. Not surprisingly, this has seen the emergence of a number of rival theories and viewpoints on what culture is, and on what its relationship to and role in human affairs is or should be. Unfortunately, it is beyond the scope of this work to discuss the concept of culture at the level and depth it warrants.
Nevertheless, regardless of the competing theories on what culture is, it is clear that it (culture) plays a fundamental and critical role in shaping people’s values, beliefs, perceptions and knowledge about the world within which they live, that it influences people’s behavior and generally gives logic and meaning to a whole way of life in that world, and that it ultimately provides the ‘blueprint’ for their survival in that world (Andrews & Boyle 1999). There are several compelling reasons why nurses need to be informed about culture. First of all, care is central to the concept of nursing.
If care is to be delivered in a consistent way, it must include assisting the client and family to achieve the goals that they have set up. Goals are strikingly cultural. They vary from culture to culture because of values (for example, maximizing the family versus maximizing the individual). Furthermore, nursing argues that it delivers holistic care. However, all too often, this means using only biophysical and psychosocial data. True holism must include the sociocultural aspect as well. If nurses intend to take care of whole clients, the sociocultural domain is essential.
This is particularly true of contemporary nursing in which nurses are on the person’s turf—in the household and community. Under these circumstances, to avoid the sociocultural is to truly miss the point of holistic care. The issues of working with elders and with the chronically ill are of immense importance. Fawcett (1983) suggests that there is an increasing number of cases in which health care workers need to work in community settings and with whole families in which the outcomes will not (cannot) be the standard medical outcome of cure.
It is clear that nursing outcomes will require working with (versus working on) human beings in settings in which the nurse has less control. Consequently, the client and family have more control than does the nurse; and culture has a strong effect on how people act. A person-centered, individualistic approach is important in providing culturally appropriate care. This approach avoids making assumptions about individual needs on the basis of any categorization or ascribed characteristics of the individual concerned.
Taking ethnicity as a marker of cultural identity, Callister (2001) assert that specific ethnic identities must be located ‘within their own particular social, political, economic and material contexts’, as there is such a wide range within ethnic groups of ‘access to and control over resources’ that people with equally strong ethnic identities may differ widely in their ability to participate in the social life associated with forms of identity in a meaningful way. Practitioners need to be constantly vigilant to guard against the influence of stereotypes, which often takes away individuality from the care given to clients.
A willingness to change one’s own attitudes and demonstrate genuine interest in and appreciation of cultural differences, coupled with readiness to seek increased knowledge about the complex dimensions of culture, is essential to the provision of culturally competent care (Louie 1985). It is very clear that nurses like other health care professionals cannot escape the tensions that are being caused by the radically opposing and competing moral viewpoints that are presently pulling the health care arena and indeed the world apart (Christiansen 1990).
An important question to arise here is: how can the nursing profession best respond to this predicament? There is, of course, no simple ‘final answer’ to this question. Nevertheless there is at least one crucial point that needs to be made, and it is this: it is vitally important that nurses learn to recognize the cyclical processes cultural change, and realize that they themselves are participants in this change. It is important that health care provision is regularly reviewed, monitored and evaluated to identify strengths and weaknesses in relation to cultural competence and proficiency.
It is essential that this be done against clearly identified indicators, targets and outcomes within identified timescales using a sophisticated framework: to establish what it is about the provision that works, and for whom; and to understand how and why it works. More cross-cultural studies would enrich and expand the factors considered in studies of nursing and weaning. References Andrews, M. M. and Boyle, J. S. (1999) Transcultural Concepts in Nursing Care, New York: Lippincott.
Callister, L. C. (2001) ‘Culturally competent care of women and newborns: knowledge, attitudes and skills’, Journal of Gynaecology and Neonatal Nursing, vol. 30. Christiansen, J. (1990). Nursing Partnership: A Model for Nursing Practice. Daphne Brasell Associates Press. Fawcett, J. (1983). Contemporary nursing research: its relevance to nursing practice. New York: McGraw-Hill. Louie, K. B. (1985). ‘Transcending cultural bias: The literature speaks. ’ Topics in Clinical Nursing, 7.