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Population Health for Nurses

24.3 The Nurse’s Role in Promoting Organizational Cultural and Linguistic Competency

Population Health for Nurses24.3 The Nurse’s Role in Promoting Organizational Cultural and Linguistic Competency

Learning Outcomes

By the end of this section, you should be able to:

  • 24.3.1 Advocate for policies of social justice and health equity that promote cultural and linguistic responsiveness.
  • 24.3.2 Implement sociocultural and linguistically responsive interventions.
  • 24.3.3 Develop partnerships to support organizational cultural and linguistic competence.

Nurses play an important role in promoting organizational cultural and linguistic competency. According to Cervený et al. (2022), nurses can integrate culturally competent behaviors into their daily interactions by putting their awareness, attitude, and knowledge into practice through effective and respectful communication and body language. Additionally, promoting ethnic diversity within the nursing workforce enhances the ability to provide culturally competent care to meet the needs of an increasingly diverse population. At the organizational level, cultural competence or responsiveness refers to a set of congruent behaviors, attitudes, and policies that enable a system, agency, or group of professionals, including nurses, to work effectively in multicultural environments. Nurses, along with other health care professionals, should have the capacity to value diversity, conduct self-assessment, manage the dynamics of difference, acquire and institutionalize cultural knowledge, and adapt to diversity and the cultural contexts of the communities they serve. By embodying cultural and linguistic competency in their daily practice, nurses can help promote the provisions of CLAS, which respond to the individual preferences and needs of each client, improve health outcomes, and decrease health disparities.

Nurse Advocacy for Policies That Support Cultural Responsiveness

According to the American Nurses Association (ANA) Standard 8 (2021), nurses play a vital role in advancing health care policy and ensuring equal access to health care for all individuals. Policy discussions often involve the effects of discrimination, oppression, and social and environmental determinants of health on cultural groups, leading to health disparities. As advocates, nurses promote policies that aim to improve the health and well-being of culturally diverse, underserved, or underrepresented individuals. This includes advocating for equal access to health care services, tests, interventions, and health promotion programs for all consumers, with a particular emphasis on those who are culturally diverse and underserved.

To achieve this goal, nurses must advocate for appropriate funding to support the planning, delivery, and sustainability of culturally congruent care. This means advocating for sufficient resources and funding to ensure that health care services are culturally sensitive and responsive to the needs of diverse populations.

Nursing schools should incorporate cultural content throughout all nursing curricula that place an emphasis on education about cultural norms, values, and health-related needs within diverse communities. This foundational knowledge enables nurses to identify policy areas that require attention and reform. Nurses can participate in policy-making processes at local, state, and national levels, where they can contribute to drafting policies that promote cultural training, adequate interpretation services, and equitable resource allocation. Nurses can also support policies that encourage a diverse nursing workforce and create welcoming spaces for clients and health care workers.

Direct involvement with communities is essential for nurses to understand specific cultural needs, preferences, and barriers to health care access. This grassroots-level insight can guide advocacy efforts in shaping policies that directly address community needs. Evidence-based practice is central to nursing, and the same applies to advocacy. Nurses must employ existing research and generate new evidence to support the need for policies promoting cultural competency.

Nurse researchers are encouraged to build substantial research programs beyond descriptive investigations. The essential next step is to design and test interventions that have meaning for populations from different cultures and improve their health and quality of life. Because this step requires sample sizes large enough to support meaningful conclusions, nurses and supporters need to advocate for more funding for these studies at the national level. Such research can help to eliminate the dismal inequities seen in diverse-consumer health outcomes.

Nurses can raise awareness about the importance of cultural competency and the specific policy changes needed to support it. Utilizing media, professional networks, and public speaking opportunities can help to reach wider audiences and generate support for cultural competency policies. Table 24.4 provides some strategies nurses can use to advocate for policies that support cultural competency.

Advocacy Explanation Examples
Engage with Health Care Organizations Nurses can collaborate with health care organizations to advocate for policies and initiatives that support cultural competency.
  • Participate in quality improvement projects and processes
  • Serve on diversity, equity, and inclusion committees
  • Provide input on the development of policies and guidelines that promote culturally competent care
Partner with Administrators Nurses can collaborate with administrators to promote cultural competency within health care institutions.
  • Advocate for the inclusion of cultural competency training in staff development processes and programs
  • Ensure that resources and support materials are available to health care providers
  • Promote the implementation of inclusive practices that address the cultural needs of diverse client populations
Get Involved with Policymakers Nurses can engage with policymakers at local, regional, and national levels to advocate for policies that support cultural competency.
  • Participate in policy development processes and programs
  • Provide evidence-based research on the impact of cultural competence on health care outcomes
  • Collaborate with policymakers to shape policies that address health care disparities and promote health equity
Collaborate with Community Leaders Nurses can actively collaborate with community leaders to gain insights into the specific cultural needs and preferences of diverse communities (Figure 24.5).
  • Build partnerships with community leaders to develop culturally tailored strategies and initiatives that address the unique needs of different populations
  • Work with community leaders to promote cultural competence and improve access to quality health care
Conduct Nursing Research Nurse researchers can design and test interventions.
  • Create interventions that have meaning for populations from different cultures and improve their health and quality of life
Table 24.4 Strategies for Advocacy (See Williams et al., 2018.)
Groups of African Americans sit together at round tables, talking and engaging with one another.
Figure 24.5 Members of the Baton Rouge, Louisiana, community participate in community engagement and listening sessions to discuss opportunities and challenges around food, nutrition, and health in Black communities. By participating in such community sessions, nurses learn firsthand about the needs of the communities they serve. (credit: Perry Rainosek/USDA/Flickr, Public Domain)

Nursing Practice That Is Congruent with Cultural Diversity

Nurses can practice with sociocultural and linguistically responsive interventions (Jongen et al., 2018). Cultural practices can vary widely between different ethnic, religious, and social groups, and it is important for nurses to be aware of and sensitive to these differences to provide appropriate care (Figure 24.6). Table 24.5 provides some examples of the types of cultural practices that nurses might encounter.

A pharmacist weighs dried plants on a scale while standing in front of a wall of small, square, wooden drawers. Other pharmacists work in the background.
Figure 24.6 Providing care that is congruent with cultural diversity requires nurses to be aware of clients’ health beliefs and practices. For example, some clients may integrate traditional Chinese medicine into their health care practices. (credit: “Apothecary mixing traditional Chinese medicine at Jiangsu Chinese Medical Hospital in Nanjing, China” by Kristoffer Trolle/Flickr, CC BY 2.0)
Communication Styles
  • Nonverbal communication: gestures, eye contact, and physical touch might have different meanings across various cultures.
  • Language barriers: understanding the client’s preferred language and possibly using medical interpreters if necessary
Health Beliefs and Practices
  • Traditional healing practices: use of herbal remedies, acupuncture, or spiritual healing
  • Perceptions of illness: different cultures might have varying beliefs about the causes and appropriate treatments for illness.
Dietary Practices
  • Religious dietary restrictions: such as halal or kosher diets, vegetarianism in Hinduism, or fasting during Ramadan for Muslims
  • Cultural food preferences: preferences and taboos about foods and preparation methods
Family Roles and Dynamics
  • Decision-making: in some cultures, family members or community elders might be deeply involved in medical decisions.
  • Gender roles: understanding the appropriate interactions between genders in different cultures
Modesty and Personal Space
  • Dress requirements: preferences for covering certain parts of the body
  • Examination etiquette: respecting preferences for a same-sex health care provider or having a family member present during physical examinations
End-of-Life Care and Death Rituals
  • Advance directives: understanding cultural perspectives on life-sustaining treatment
  • Death rituals: respecting cultural rituals related to death and grieving, such as handling of the body or mourning practices
Mental Health Perspectives Stigmatization: recognizing cultural stigmas related to mental health conditions and adapting communication and treatment accordingly
Childbirth Practices Birthing customs: preferences for birthing positions, people present at birth, post-birth rituals, etc.
Disability and Long-Term Illness Cultural attitudes: understanding how different cultures perceive and manage disability and long-term illnesses
Alternative and Complementary Therapies Acceptance or rejection: different attitudes toward conventional medicine versus alternative therapies
Trust in Health Care Providers Historical or cultural mistrust: recognizing potential mistrust due to historical or cultural factors and building rapport accordingly
Substance Use and Addiction Cultural perspectives: understanding how various cultures perceive and respond to substance use and addiction
Sexual Health and Orientation Cultural norms: respecting cultural norms related to sexuality and sexual orientation
Table 24.5 Examples of Cultural Practices

Being aware of these cultural practices requires ongoing education, openness to learning, and a willingness to ask clients about their preferences and beliefs. Individualized care that respects cultural diversity will generally lead to better client satisfaction and outcomes. It is important to approach cultural practices with curiosity rather than judgment, recognizing that each client’s cultural context is unique and multifaceted.

Developing Partnerships to Support Organizational Cultural and Linguistic Competence

Cultural and linguistic competence within health care organizations is essential for delivering effective and equitable care to diverse populations. Community health nurses play a pivotal role in this endeavor by developing partnerships with various concerned parties (Handtke et al., 2019) and can use the following strategies:

  1. Assessing Community Needs
    • Engaging with the community: understand the unique cultural and linguistic needs of the community through direct engagement.
    • Using existing research: analyze data and existing studies that identify cultural and linguistic gaps in care.
    • See Assessment, Analysis, and Diagnosis for more details on conducting a community needs assessment.
  2. Collaboration with Key Community Partners
    • Identifying partners: engage with community leaders, cultural organizations, educational institutions, and other health care providers.
    • Defining shared goals: develop common objectives aligned to the community’s cultural and linguistic needs.
    • See Assessment, Analysis, and Diagnosis for more details on collaborating with community partners.
  3. Implementing Cultural and Linguistic Training:
    • Developing curricula: create training programs that enhance cultural awareness and linguistic skills.
    • Promoting ongoing education: encourage continuous learning through workshops, seminars, literature, and online resources.
    • See Planning Community Health Education for more details on planning community education programs.
  4. Leveraging Technology:
    • Using language assistance tools: implement technology that facilitates effective language translation and interpretation.
    • Promoting telehealth services: ensure that virtual health care platforms accommodate individuals with diverse linguistic needs.
  5. Policy Advocacy:
    • Supporting legislative initiatives: advocate for policies that promote cultural and linguistic competence at local, state, and national levels.
    • Aligning with accreditation standards: ensure that practices align with standards set by accrediting bodies.
  6. Evaluating and Adapting Strategies:
    • Monitoring outcomes: regularly assess partnership initiative effectiveness via feedback and data analysis.
    • Iterating strategies: continuously refine and adapt strategies to meet evolving community needs.
    • See Implementation and Evaluation Considerations for more details on evaluating program effectiveness.

Developing partnerships to support organizational cultural and linguistic competence is a dynamic and multifaceted process. Community health nurses, in collaboration with various community partners, can spearhead efforts to ensure that health care delivery aligns with the diverse needs of the communities they serve. Through thoughtful engagement, education, advocacy, technology utilization, and continuous evaluation, health care organizations can create an environment that truly resonates with all members of the community.

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