Assessment/Analysis
The United States is home to 337 million people, with 13.7% of this population being immigrants, making one in seven of United States residents being foreign-born (Batalova et al., 2020). With an increasingly diverse population, there is also an increasingly diverse set of cultures, ethnicities, religions, and languages. Healthcare systems need to adapt to such diversity to address the needs of various persons equally. Healthcare is culturally dependent due to personal values and beliefs about health and healing. Failed consideration of patients’ culture leads to inadequate diagnoses and care since nurses do not understand the actual health issue and interventions that the patient will accept. On the other hand, language differences affect diagnosis and care due to misunderstanding between nurses and patients. Nurses provide care according to their understanding of patients but not patients’ needs when there is a language barrier. The Quality and Safety Education for Nurses Institute (QSEN) developed a list of nurses’ competencies to address to practice quality patient care. Cultural and language issues in healthcare fall under patient-centered competencies since they affect understanding patients’ needs. In this literature review, issues surrounding cultural diversity in healthcare will be analyzed about patient-centered care following QSEN Institute.
Planning/Literature Review
Cultural and language block patient-centered care while risking safety and quality through limited sharing between nurses and patients. Belintxon et al. (2020) investigated parents’ experiences from diverse cultural backgrounds and nurses once they meet in primary healthcare to attend to children. The study shows that nurses are ethnocentric and impose their cultures on patients. Some of the signs for being ethnocentric and setting culture on patients as the study found includes distance nurse-parent relationship and failed mutual understanding. Distance relationships and failed mutual agreement due to language and cultural barriers prevent adequate sharing between patients and nurses. Results are wrong diagnoses and inadequate treatment that risks quality and safety. Researchers suggest nurse education on effective communication and cultural awareness training to adopt a constructivist approach to understanding patients.
Apart from blocking sharing, cultural and language differences impact inequality and limited access to healthcare. Adebayo et al. (2020) show that ethnocentrism and cultural imposition are expected in the US, blocking culturally centered care and hence, inequality, limited access, and poor outcomes. Following community socialization, nurses discriminate against some cultures, for example, African Americans. Failure to recognize the culture in healthcare leads to delays. Discrimination impacts patient safety through the development of other health issues through psychological responses. Other results are mistrusts and low-quality care that affects other health issues following psychological responses and improper diagnoses. Researchers suggest addressing discrimination and injustices in American institutions, especially in nursing practice and education.
Speaking the same language and engaging in patient culture, on the other hand, increases confidence towards nurses and other healthcare providers, leading to more understanding of each other. According to Ali and Johnson (2017), the absence of language concordant care impacts misunderstanding between nurses and patients and their families. Patients and their families end up complaining leading to further distance relationships with their providers. On the other hand, language concordant care raises patient confidence in care, strengthening relationships with nurses. Such relationships are barriers to accessing quality care and risk to safety. However, Ali and Johnson (2017) find that healthcare facilities in the US do not appreciate language skills among providers, and neither supports them through policies. Researchers recommend institutional support of language concordant care through policies.
In a study, Chen et al. (2017) show one way through which cultural and language barriers between patients and nurses block patient-centered care through failed psychosocial care. In the study, researchers found that nurses could not provide psychosocial care due to language differences and training and practice that focused on the task. Too much documentation that blocked interaction with patients and absent family members also obstructed psychosocial care. Cultural and language barriers, as the study shows, are a result of improper training to focus more on documentation and task blocking interaction with patients. Researchers suggest interprofessional care to interpret and reduce documentation to the most critical information that supports sufficient interaction.
Another impact of cultural and language barriers in accessing and benefiting from healthcare services such as emergency departments impacts safety and quality of care. Patients who speak a different language to that of nurses delay accessing care following a misunderstanding with providers (Poola et al., 2020). There are also fears that providers will not deliver needed care. The language barrier, in this case, blocks patients from expressing themselves and receiving information from nurses. Researchers suggest for professional interpreters or nurses who speak the same language as patients.
Existing literature shows that language and culture barriers are real in healthcare, following ethnocentric nurses with limited cultural competencies and imposing their cultures on patients (Belintxon et al., 2020; Adebayo et al., 2020). Racism in the US has extended in healthcare, where nurses discriminate against some cultures (Adebayo et al., 2020). However, other nurses do not have the cultural and communication skills to allow close relationships and interactions with patients. On the other hand, patients speak different languages that nurses cannot hear (Ali & Johnson, 2017). Nursing practices like excess documentation and task-oriented approaches are also preventing understating of patient cultures. The impact of language and cultural barriers is limited access, low quality, and risk to safety. Nurses, for example, are unable to provide psychosocial care that depends on patient understanding from the cultural perspective (Chen et al., 2017), Other patients, on the other hand, delays in accessing care due to a lack of understanding of differ communications such as billing (Poola et al., 2020). There is a need to reduce language and cultural barriers to enhance patient-centered care that is of high quality with less risk to safety.
Intervention
One of the interventions to reduce language and cultural barriers and enhance patient-centered care is through policies that support nurse-patient connectedness in healthcare facilities. Among the guidelines is one that restricts communications on that which the patient prefers and understands, including language, pace, and clarity. Healthcare facilities, especially nurse leaders, should provide communication restrictions to that which patients approves and understands. As a result, the facility should allow nurses to take any measures like accessing professional interpreters and family members when dealing with patients. As the literature notes, language, and cultural barriers in the US are institutional phenomena instead of a lack of cultural competencies in serving patients. However, addressing patients with a language they understand, including pace, would bring nurses and patients a common understanding. Sobel and Metzler Sawin (2016) find that using patient language increases interaction between patients and nurses, eliminates discrimination, and improves information clarity. Communication that appeals to patients would increase the relationship with nurses reducing fear and increasing sharing. Nurses can use patient language and culture because they can utilize families and other interpreters.
Another intervention recommendation is to employ nurses with diverse cultures in the same institution, especially those immigrant cultures with a high flow rate. Nurse leaders and facility managers should make it a policy to have at least one representative of significant cultures such as African Americans and Hispanics in the facility. Such diversity will overcome cultural barriers by training fellow nurses about various cultures during collaboration and other meetings. Interpreters have proved useful in healthcare since they allow nurses to understand patients’ cultures (Belintxon et al., 2020; Squires, 2018). However, the same interpreters create a barrier in communication because nurses concentrate on what they are saying instead of patients (Belintxon et al., 2020). A nurse from the patient culture would solve the interpreter barrier by listening to the patient and providing the nurse in charge of relevant information instead of a direct communication interpretation. However, the diversity of nurses in culture would impact cultural competencies and understanding among all nurses and providers, making it easy to interact with patients from any cultures.
On the other hand, healthcare facilities should demand in-depth training and communication skills and cultural competencies during nurse recruitment. Although nurses learn communication skills, facilities should offer more training while demanding higher grades in the unit from the various nursing education institutions. The demand should follow a thorough test on communicating with people across different and new cultures. Sobel and Metzler Sawin (2016) found that connectedness with patients that allows culturally based care does not depend on the ability to speak patients’ language but getting patients engaged through communication skills such as careful listening. Nurses’ communication skills can make them understand patients’ cultures by, for example, being keen on their facial expressions and choice of words. However, such abilities to read culture through cues as opposed to language requires strong communication skills. The facility, as a result, should demand such high-level communication skills while holding regular workshops to improve on cultural cues
Evaluation
Outcomes from the interventions should include an increase in patient satisfaction, especially those from other cultures. Increasing understanding of patients from their culture, especially using their language, increases satisfaction due to providers’ trust. The care that is free from discrimination based on culture, on the other hand, increases satisfaction due to attended needs with safety and quality. Literature shows that African Americans and Hispanics expressed dissatisfaction with the American healthcare system due to discrimination on culture and lack of trust with provides since they do not speak their language (Sobel & Metzler Sawin, 2016). Increased satisfaction among other cultures will, as a result, imply solved cultural and language barriers in nursing. Measurement for patient satisfaction with healthcare will include two items, clinician communication, and nurse responsiveness.
Another way to determine the resolution of cultural and language barriers is through a change in the number of patients who seek healthcare from other cultures other than Americans. Literature shows that cultural and language barriers discourage different cultures, such as African Americans and Hispanics, from seeking healthcare, with some quitting while waiting in queue (Adebayo et al., 2020). An improvement in addressing patient cultures will, as a result, motivate more people to seek healthcare. Facilities will provide data on patients flow from specific cultures, primarily Hispanic and African Americans, and compare between sometime before and after interventions. The level of increase in number will indicate intervention success.
Readmissions and complications after treatment will also help assess the effectiveness of the interventions and resolve the issue. Among the outcomes of care that bypasses patient culture and connectedness with nurses are poor diagnoses and patients who do not adhere to the treatment. The care fails to address patient health and needs leading to complications due to delays. For instance, chronic illnesses among African Americans have persisted due to delays and discrimination in healthcare (Adebayo et al., 2020). Reduced complications and readmissions among members of specific cultures will, as a result, indicate intervention success. Healthcare facilities will provide data for a particular culture or two before and intervention to assess improvement in readmission and complications.
References
Squires, A. (2018). Strategies for overcoming language barriers in healthcare. Nursing management, 49(4), 20-27.
Belintxon, M., Dogra, N., McGee, P., Pumar‐Mendez, M. J., & Lopez‐Dicastillo, O. (2020). Encounters between children’s nurses and culturally diverse parents in primary health care. Nursing & Health Sciences, 22(2), 273–282. https://doi.org/10.1111/nhs.12683
Chen, C. S., Chan, S. W. C., Chan, M. F., Yap, S. F., Wang, W., & Kowitlawakul, Y. (2017). Nurses’ perceptions of psychosocial care and barriers to its provision: A qualitative study. journal of nursing research, 25(6), 411-418. https://doi.org/10.1097/JNR.0000000000000185
Adebayo,C. T., Walker, K., Hawkins, M., Olukotun, O., Shaw, L., Sahlstein Parcell, E., … & Mkandawire-Valhmu, L. (2020). Race and Blackness: A Thematic Review of Communication Challenges Confronting the Black Community Within the US Health Care System. Journal of Transcultural Nursing, 31(4), 397-405.
Poola, N., Koul, R., Sharma, S., Ng, A., Hayasaka, E., Borba, C. P., … & Piwowarczyk, L. (2020). Self-Reported Barriers to Healthcare and Interpreter Preferences for Patients with Limited-English-Proficiency in an Urban Emergency Department. Medical Research Archives, 8(8).
Ali, P. A., & Johnson, S. (2017). Speaking my patient’s language: bilingual nurses’ perspective about provision of language concordant care to patients with limited English proficiency. Journal of advanced nursing, 73(2), 421-432.
Batalova, J., Blizzard B., & Bolter J. (2020). Frequently requested statistics on immigrants and immigration in the United States. Retrieved from https://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states#:~:text=Immigrants%20and%20their%20U.S.%2Dborn,about%2036%20percent%20by%202065).
Sobel, L. L., & Metzler Sawin, E. (2016). Guiding the process of culturally competent care with Hispanic patients: A grounded theory study. Journal of Transcultural Nursing, 27(3), 226-232.