Cultural Awareness and Sensitivity Research Paper

Introduction and Problem Identification

Having no other opportunity but to move as well as trying to make their dreams come true, people from different locations come to the USA. Some of them return home after a couple of months or years while others become residents of this country so that it turns into a melting pot that unites a diverse population. During the first ten years of the 21st century, the number of people who represented the Hispanic minority increased by more than 35% (Committee on Health Care for Underserved Women, 2011). In a similar way, the Asian population increased. Associated but less significant changes dealt with American Indians, Alaskan Natives, and African Americans. These alterations are critical, as there are more minorities than whites in some US communities. Needless to say that all these individuals require high-quality healthcare services. They consult providers in order to receive preventive care and to improve their health conditions when they are ill. Minorities cannot be ignored in this perspective because they can affect the rest of the population if they are ill. To avoid the possibility of such an issue, providers should reveal both cultural sensitivity and awareness because only understanding people’s values and beliefs they can develop positive patient-provider relationships and improve the quality of care.

In daily operations, the culture of a consumer and a medical establishment can come into opposition because of different major concepts, such as views on abortion or particular treatment options. Taking into consideration the fact that current services are patient-centered, it is not surprising that the client’s culture prevails in the majority of cases. Unfortunately, provider-patient relationships are often negatively affected by this discord. Enhancing their understanding of other cultures, physicians can become more open-minded, which will influence their performance positively.

According to the Committee on Health Care for Underserved Women (2011), cultural competency (awareness and sensitivity) is “the knowledge and interpersonal skills that allow providers to understand, appreciate, and work with individuals from cultures other than their own. It involves an awareness and acceptance of cultural differences, self-awareness, knowledge of a patient’s culture, and adaptation of skills” (p. 1). As many providers fail to develop it, many cultural groups avoid seeking a consultation even if they have severe health problems. As a result, the members of the LGBT community, individuals with disabilities and specific faiths, people with low income, ethnic minorities, and immigrants are underserved even though they are to be treated like other Americans. Poor cultural competence of healthcare providers is one of the main reasons these groups fail to obtain appropriate medical care.

Even though some interventions targeted at the improvement of this situation have already been implemented, the needs of many patients remain unsatisfied. The proposed research study is likely to benefit these populations, as it reveals the most important steps that should be made by healthcare management to enhance cultural diversity in the sphere and meet the needs of minorities.

The necessity of the development of cultural awareness and sensitivity among healthcare providers is theoretically supported, which proves that this topic is to be thoroughly discussed. First of all, nurses and physicians should improve their understanding of people’s everyday way of life, their health-related problems, and associated beliefs. In this way, according to Leininger’s culture care theory, professionals will improve patients’ health, meeting their needs and demands and focusing on “culture care preservation and or maintenance, culture care accommodation and or negotiation and culture care restructuring and or repatterning” (Russell, Brunero, & Lamont, 2014, p. 1). Moreover, Papadopoulos, Tilki, and Taylor’s model encourage focusing on all components of cultural competence, including

1. cultural awareness,
2. cultural knowledge,
3. cultural sensitivity and
4. cultural practice (Kouta, Vasiliou, & Raftopoulos, 2016, p. 2).

Thus, the necessity of providing culturally competent care and services to patients is theoretically supported.

Literature Review

The population of the USA becomes more diverse with the course of time, and its demographics continue altering even today. The number of non-white citizens who come from abroad constantly increases and the members of the U.S. Census Bureau consider that they will turn into majorities before 2060 (King, 2014). Hispanics, Africans, and Asians, etc. have their own views and believes that come from their cultures. They define the way these people act in particular situations and treat various things. In this way, it is not surprising that they also affect their decision-making associated with healthcare. Thus, it is vital for medical providers to understand and accept the opinions of their clients even if they do not agree with them. Otherwise, there will be no opportunity to provide patients with the best possible services. Practitioners should not make their clients follow those recommendations that oppose their beliefs. Instead of acting this way, they should ensure clients’ freedom to choose those interventions that do not interfere with their views. This adaptation to the culturally diverse patient population can enhance the quality of care and improve patient-provider relationships, as people will feel that they are respected. To facilitate this process, healthcare management teams should be involved, as they have enough power to implement associated changes.

The promotion of cultural awareness and sensitivity in healthcare systems presupposes the necessity to involve its management in the development and implementation of specific education and training programs that can improve the knowledge and skills of healthcare practitioners, including both physicians and nurses. These programs should be targeted at the acquisition of the most significant information related to US minorities, at least the most populous ones (Health Research & Educational Trust, 2013). In addition to that, it is significant to provide education that is targeted at patients. In particular, they should acknowledge the way the healthcare system works. As a result, it will be easier for them to receive care and associated services. Nevertheless, the focus should not transfer to patients because physicians and nurses are to be the ones who should alter the way they perform their duties. It will be advantageous for them to be able to work with diverse clients because they are not able to choose the population they want to serve. Moreover, if some clients remain unsatisfied, it will have an adverse influence on providers’ performance.

Along with the development of cultural awareness and sensitivity, professionals should improve their knowledge of foreign languages. Rather often the representatives of the minorities do not have good knowledge of English, which affects their ability to communicate with healthcare providers. These people may not contact professionals because they are afraid to be ignored or poorly treated by others. Moreover, they may think that they will not be understood anyway, so there is no sense in trying to contact practitioners. If healthcare workers know at least the basics of those languages used by the most populous minorities, they will be able to serve these people better because they will understand what issues they have. However, this problem can also be managed in another way. For instance, the management of a healthcare facility can hire an interpreter who will provide services when needed. This can be a full-time employee or just a person who comes when being called. In addition to that, healthcare systems should have patient navigators who assist clients while they are in a hospital (Truong, Paradies, & Priest, 2014). As a result, those individuals who do now know how the US healthcare works will still be able to benefit from it.

It will also be advantageous to hire diverse medical staff so that its members represent minorities. As a result, there will be providers who understand different cultures and languages as well. Reconsideration of recruiting strategies is likely to be advantageous because it can encourage a diverse student population to start their career in the sphere of healthcare. Fantacone (2017) states that currently, more than 90% of practitioners are European Americans, which means that people with different cultural backgrounds comprise less than 10% of these professionals. In an ideal situation, the number of practitioners should be representative of the population. In this way, there should be many more professionals from other cultures. In this way, it will be much easier for healthcare systems to address the needs of the diverse client population. The management should focus on the changes connected with recruiting more because this initiative will give them a chance to minimalize spending associated with the necessity to provide specific education targeted at the development of cultural awareness and sensitivity. Even though this training cannot be ignored at all, its simplification can be rather advantageous for providers.

Thus, the necessity for the representatives of the healthcare systems to be culturally competent cannot be neglected. The population they are expected to serve is very diverse, and they are to be able to build positive and trust-based relationships with each patient, regardless of one’s background. The management should focus on the implementation of the most advantageous changes, considering this issue, such as training of practitioners, interpreter’s and navigator’s services, and new recruiting approaches. Patient education is likely to be beneficial as well because it will improve clients’ understanding of practitioners’ decisions.

Study Methods

As the USA is a country that turned into a home for numerous immigrants who have diverse cultural backgrounds, it is significant for it to ensure that its population can understand each other. The number of people who represent minorities increases constantly, but this fact does not make Americans acknowledge other cultures. As a result, the gap in cultural awareness and sensitivity keeps growing. In the framework of healthcare services, all patients are usually treated in the same way regardless of their origin because practitioners start operating in a robotic manner, failing to adopt various approaches depending on those patients they serve. Nevertheless, patient recovery is tightly connected with their health-related decisions and individual background. For professionals to streamline this process and ensure that it is properly managed, they need to be aware of clients’ cultural beliefs and align recommended interventions with them. As a result, patients will have an opportunity to find comfort in those rituals that return them to good health. Therefore, a qualitative research study aimed at the improvement of patient-provider relationships, and the quality of provided care through the development of cultural awareness and sensitivity should be conducted.

To reach its purpose, this research will answer the following major research questions:

1. Why can the lack of cultural awareness and sensitivity lead to critical problems associated with patient-provider relationships?
2. Is understanding patients’ background a key to the delivery of high-quality care and improvement patient-provider interactions?
3. What should be done to reduce the gap associated with cultural diversity between patients/families and healthcare providers?

In order to gather all the required information, professionals conducted an interview. The sample needed for this research study included nurses who performed their duties in individual private practices. In particular, 4 professionals participated. Initially, the sampling method was opportunistic, as those nurses who are easy to reach were approached. Further, it also became volunteer sampling, as all participants agreed to take part in this research due to their free will and desire to assist the researcher. The setting took place in an area that is full of minorities. These decisions can be explained by the fact that nurses are those professionals who interact with patients and their families more than all other healthcare employees. They note everything that should be considered by a physician and shape the way patients communicate with other professionals. That is why if some improvement considering these interactions is needed, nurses are those parties whose involvement is to be initially discussed. Thus, cultural awareness training/education should be targeted at them. Interviews allow gathering the most explicit information, as they provide an opportunity to ask additional questions and clarify something. Finally, a recording device is needed to ensure that all information is gathered and nothing is overlooked during analysis.

Interview questions were the following:

• Can you just provide me with some background of your professional career and end with what it is you do here along with the timeframe you have been here?
• How would you describe the patient population here in terms of their backgrounds?
• What resources would you say are available to patients/families to help them understand and communicate better with the providers here?
  • If resources mentioned then ask, “Do you believe that those resources are enough to provide quality care, or is there something you would like to see offered?”
  • If answered with barely any services available or not sure then ask, “What is your professional view should be available for providers and patients to help communicate and understand better?
• As a professional working in the field, what are your thoughts on the standardizing care approach for all?
  • If yes then ask, “Please elaborate on why?”
    • At this time after explanation, provided a scenario from the literature review as an example to contradict that.
  • If no then ask, “Why and what would you propose then?”
• Do you or your colleagues that you know ever change the way you approach and communicate with patient/family members differently because of their cultural background?
  • If so, why?
    • Was it because you did not want to offend them or step over any cultural boundaries?
    • Were you aware of what cultural limitations might there be in the first place?
    • If you were in that situation that your colleague was in or the one you were in again, what would you do differently?
    • What resources would you have liked or the approach you would take?
    • How was the situation handled?
  • If no, then provide another example to depict a scenario where cultural awareness would avoid a significant problem and improve the patient-provider relationship.
• What considerations does the current practice you work at now from your knowledge have made in the past to better fit their patient demographics in the area?
  • Ask if anything needs to be added/changed to the practice so quality of care can improve between patient-providers?
    • If response is none then ask, “Why they believe that?”
    • Follow up by asking, “If hypothetically speaking, a situation or two does arise where lack of sensitivity and cultural awareness leads to a problem, would there be an acceptance and effort to educate staff via a training program by the practice?”

Findings

Those 7 interview questions that nurses answered provided enough data for analysis of what their response means in terms of the outlined 3 main research questions. They revealed information on patient demographics, available resources, nurses’ experiences, their attitudes towards cultural competence.

All participants stated that they serve a diverse population with varied backgrounds. 4 out of 7 nurses stated that standardize care approach is needed because it ensures that all patients are treated equally, and no one is discriminated. In this way, professionals highlighted that interactions with patients should not be biased. They added that nurses could not reveal their unwillingness to work with particular clients because of their nationality or beliefs. However, they clarification aligned with the response of the rest 3 participants, as they stated that specific needs of their clients are to be addressed.

Nurses 1, 2, and 6 admitted that the lack of cultural awareness and sensitivity had negative effects on their relations with clients in the past. For instance, a male nurse insisted on the necessity for a woman with Islamic background to work with him, as other professionals were too busy. These actions offended her, and she addressed the management. The nurse thought that she was arrogant and did not realize that her behavior was triggered by her culture. This case allows answering the first research question, revealing that the lack of cultural awareness and sensitivity can ruin patient-provider relationships.

In this way, participants managed to realize that understanding patients’ background improves patient-provider interactions and answer the second research question. 5 nurses claimed that it is the key element that should be considered while 2 of them stated that it is among the most important ones. This decision was supported by personal experience. Nurse 2 tried to work with all patients, in the same way, ensuring the absence of personal bias. However, when a Hispanic woman needed a cesarean delivery, she did not just insist on the necessity to sign the surgical consent form because it is needed for better health outcomes but explained to her and her family members all risks of avoiding this intervention. As Hispanic families have a great impact on medical decisions, this approach allowed overcoming associated issues. The nurse admitted that she would have addressed the patient directly if she had not known about relatives’ influence. In this situation, the women might have refused to sign a form, which would lead to further issues.

The participants of the research study shared their ideas regarding the ways the gap of cultural diversity between patient/families and healthcare providers can be reduced. 5 nurses stated that those resources that are currently available are not enough for them to improve their cultural competence. The rest 2 nurses claimed that they needed to look for everything themselves because their management does not pay attention to cultural competence as a part of high-quality care even though it requires all professionals to reach their potential. Nevertheless, all of them try to search for information about different cultures. 4 nurses surf the Internet from time to time, 6 share information with their colleagues, 2 read periodicals. 3 nurses believe that their healthcare facility should have an interpreter, 4 believe that patient navigators are needed, and 7 want to participate in a training program that does not affect their workload. In this way, the third research question is also answered.

Conclusions and Recommendations

Thus, it can be concluded that nurses often work with diverse populations, which requires them to be able to meet the needs of different clients. Even though patient-centered care makes professionals treat all clients equally in order to avoid personal biases, it is also vital to ensure that provided services are aligned with a personal background. Unfortunately, the research study reveals that nurses do not have appropriate access to those resources that can enhance their understanding of other cultures. As a result, those professionals who do not have much experience in the sphere face issues associated with the lack of this knowledge. They try to use a standardized approach when working with diverse clients, which leads to problems that worsen their relationships with patients. Nurses fail to understand what shapes patients’ decision-making and make them face discomfort. With the course of time, they usually realize that they cannot build positive patient-provider relationships without knowing their background. That is why nurses start changing their behavior to reduce the gap associated with cultural diversity. Nevertheless, this process is often time-consuming, which means that those clients who are served by an inexperienced provider are not treated appropriately. They suffer from the nurses’ mistakes and face increased risks of complications because of this issue.

Even though healthcare providers have an opportunity to learn on the basis of their personal experience and self-education, it will definitely be better if their management addresses the observed issue as well. In particular, they should implement programs that increase cultural awareness and sensitivity of professionals. Being targeted at nurses, these programs should include information related to the peculiarities at least of the most populous groups of minorities. Professionals should acknowledge the way they treat their own health and medical services in addition to some general elements, such as interactions between opposite genders, etc. It can also be advantageous to provide some basic education for patients to find out how the US healthcare system works. This information can be summarized and printed so that people who come to a hospital can access it without any difficulties.

Except for education, the management can think of hiring an interpreter and patient navigator to make it easier for the newcomers to interact with providers and receive required care. However, it is also significant to motivate nurses to search for some information themselves. They can have a forum that they can use to share their experience of working with minorities. Moreover, it is significant to ensure that during their education, even those nurses who prefer using standardized approach are encouraged to develop their cultural competence. In particular, they should become curious about the way people differ due to their cultural background. They should visit various cultural events and try to speak with people who use different languages. Nurses need to educate themselves at home, they can read books, watch movies, interact with people, or just surf the Internet, noticing related information. Using their own practice, professionals should notice how people with different backgrounds behave, what they think about health-related elements, what are their habits, etc. They need to find a common language with all clients that is why it is significant for them to know several ways to connect with patients that can be appropriate in a particular situation. Thus, only a complex approach that includes practitioners’ and management’s efforts to develop cultural awareness and sensitivity can lead to positive results.

References

Committee on Health Care for Underserved Women. (2011). Cultural sensitivity and awareness in the delivery of health care. The American College of Obstetricians and Gynecologists: Women’s Health Care Physicians, 493, 1-4.

Fantacone, J. (2017). Looking to the future: Improving the diversity of the health care workforce. Web.

Health Research & Educational Trust. (2013). Becoming a culturally competent health care organization. Web.

King, M. (2014). The importance of cultural diversity in health care. Web.

Kouta, C., Vasiliou, M., & Raftopoulos, V. (2016). Improving the cultural competence level of community nurses through an intervention. Journal of Family Medicine, 3(9), 1088-1093.

Russell, R., Brunero, S., & Lamont, S. (2014). Reflecting on transcultural care; culture care theory and mental health nursing. Austin Journal of Nursing & Health Care, 1(2), 1-4.

Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research, 14(1), 99-116.