Patient-Nurse Culture Matching

[perfexion]

I'd like feedback from current nurses only, please no students. Do you think that the cultural make up of the nurse population at your hospital should match that of the patients? In other words, if you work with a predominantly Hispanic population, should the majority of the nurses in that hospital be Hispanic? Do you think having the majority of nurses from a different cultural background than the patients poses a problem with cultural competence? Personally I do. I work at a hospital now with a large Bangladeshi population but very few, if any, Bangladeshi nurses. The nurses are very ignorant of that culture, particularly their views on pain, despite numerous annual in-services on cultural competence. There is just no getting through to the nurses. They just think those patients can't handle pain, and they are treated as drug seekers, but it's a cultural thing. Do you think having more Bangladeshi nurses would solve that particular problem?

[Emergent, RN]

Personally, I think some of this cultural competence stuff is perpetuating stereotypes.

If a hillbilly from the backwoods doesn't believe in hygiene and wants to eat soda pop and tater tots for lunch, we as professionals should not say, "well, that's their culture ". An extreme example is the tradition of mutilating the genitals of little girls.

We as professionals need to gently educate.

[TriciaJ, RN]

Nobody is blaming the nurse for anything. But I think if there is a cultural explanation for certain behavior, maybe having a nurse of that same culture would help. Think about what you just said: you'd assume the patient was emotionally unbalanced. What if they weren't? What if they were just taught to exaggerate pain response for whatever reason. You are just like the nurses im talking about. You think the patient's cultural nuances makes them crazy. That's exactly the lack of cultural competence that im referring to.

If a patient has to wait an inordinate length of time for a pain med, that is most likely a staffing issue. A lot of current hospital-speak (Cultural Competence, Service Excellence and whatever the new bandwagon is) are really just ways to try to avoid dealing with staffing issues.

A patient screaming in pain from emptying the Foley? That's a patient with emotional issues. If a whole culture does it, then it's an educational issue. And it's not the nurses who need educating.

It is of course to be desired that healthcare workers respect the cultures of others. But that is a two-way street, especially if one finds oneself hospitalized in a new country.

[JKL33]

Having diversity within a staff is good for a lot of reasons, including perhaps the ability to serve as a reference in the scenario you pose. This benefits everyone. It can easily become "Bangladeshi nurse is needed to care for Bangladeshi patients," and that's something different and is a theory that can't be followed through to its logical conclusion. After all, for whom will the Bangladeshi nurse care if there happen to be no Bangladeshi patients on the unit at a given time? And, while this discussion concerns ethnic cultural identities, there are multiple types of cultures with which patients may identify, and innumerable combinations of cultural identities, at that.

When learning about transcultural nursing, we learn about many particular cultural differences of which we may not have been aware, and we learn various ways we can try to bridge an apparent gap. It occurs to me while reading this, that we don't really learn anything about how mainstream medicine/nursing in the culture of origin would address a particular issue at hand. For example, assuming everything else were equal for the moment, how would one expect that emptying a foley is handled in cultures where, according to the example we're discussing, it may be perceived as 10/10 pain? How is this task undertaken? Pre-medication? Distraction? Sedation? Local anesthetic? Whether it is verbalized in the same way, the ultimate question I'm asking is probably what nurses who are perceived as refusing to care are also thinking: In what mutually acceptable way shall I address this?

Nurses not engaging, not addressing the pain complaint is not appropriate. But, in your example, there is a discrepancy that has to be addressed which goes beyond general cultural sensitivity training. How has that been addressed on the unit other than telling nurses that they are judging and are not appropriately understanding culture? We do not heavily medicate or sedate patients in order to perform a task that, when performed with any minimal bit of care, is rarely noticed by the large majority of patients.

So do the nurses know how to handle this in a culturally appropriate way and they're just refusing to do so? Out of genuine curiosity, what specific way is that?

[BedsideNurse]

Yeah, so, the answer would be to...what?. From the suburbs--not allowed to work in inner city hospitals, German immigrant--automatically unfit for practice in the U.S., Chinese--to work in predominately Chinese areas only. There is an endless list of ways we could divide people up. Talk about discrimination! Trying to match culture to patient population is a very bad idea in my opinion. Anyone can give good care, anyone can give bad care. It depends on the individual nurse.

[brownbook]

The elephant in the room is a patient screaming in pain when a Foley is emptied.

Either the nurse is incompetent or something else is wrong with the patient. Emptying a Foley should not cause any pain. Should not be felt at all. Working nights I've emptied 100's of Foley's, the lightly sleeping patients don't notice.

The patient needs a thorough head to toe assessment to find out what is causing the pain.

Perhaps you have a better example of cultural bias than that.

[KalipsoRed21, BSN, RN]

In all honesty if doing such a thing didn't increase cultural ignorance and intolerance I would agree with you. I generally prefer to be able to understand and have a common background to my caregivers because it decreases the burden of communication for both me and the caregiver. And as we know, medicine is already fraught with inadequate communication in the first place, which just makes this issue more pronounced in today's medical landscape. But the less a population has to practice a skill, the more intolerant they become to the variance of manners of others. That is the beginning of racism. So while I understand what you are saying, and that you are actually not wrong in your observation, it would really be a disservice to the United States I wish to continue to live in if we allowed ourselves the 'easy' route of huddling in masses similar to ourselves. It would put us back about 70 years culturally if we did that. So keep up the good attempts at educational programs for your staff, because they will eventually get it.

Also, several on here are focused on the example of exaggerated pain that you gave. I do get exhausted with people focusing on example and not what you meant. Let's for one F-ing second believe the person is a competent caregiver when they pose a question. An reduced ability to cope with hospitalization and culturally different ideas on what caregivers in a facility should be doing, do exist. Once one has ruled out all medical reasons for this inflated reaction, it would be awesome to have some culturally relevant tools to try to reduce the patients' stress. That is plainly what the OP is asking. And s/he is having issues with the culture in question because of limited information from those in that culture. What maybe helpful is to go to a religious center for this patient population and start asking women there what they do when caring for their family and what expectations they would have given the various scenarios you may have.

[GoodNP]

They just think those patients can't handle pain, and they are treated as drug seekers, but it's a cultural thing.

You say "it's a cultural thing" rather than drug seeking. Would you mind elaborating on what "it" is. I'm genuinely curious as to how Bangladeshi culture affects pain tolerance and pain expression. Thanks!

[CharleeFoxtrot, BSN, RN]

You say "it's a cultural thing" rather than drug seeking. Would you mind elaborating on what "it" is. I'm genuinely curious as to how Bangladeshi culture affects pain tolerance and pain expression. Thanks!

I've scanned (briefly as I am on my way of the door) and didn't see a lot in the literature about that culture as it relates to pain. Any cites or articles you've read OP? Or is this just your observations?