In order to understand the level of cultural incompetence found in today’s world of healthcare, one must first understand the term ethnocentrism and the many ways it impacts society. William Graham Sumner used the term ethnocentrism to define the tendency to believe that one’s own culture and way of life signify the norm or are superior to all other beliefs. An ethnocentric person sees his or her “group” as the defining point of culture and views all other cultures as deviations from what is “normal,” (Schaefer 2017). Nursing programs as well as healthcare institutions teach curriculum and offer training courses for nurses and students to gain a better understanding of cultural sensitivity and how to apply it through patient care. Yet in healthcare, especially nursing departments, ethnocentrism prevents staff from offering the quality of care patients deserve in a multitude of ways; creating insurmountable barriers between nurses and patients.
Cultural competence is a difficult combination of cultural awareness, knowledge, and skill that can take a lifetime to master. Purnell and Paulanka (2001) describe cultural competence as having three core elements: cultural awareness, cultural knowledge, and cultural skills. Cultural awareness, the focus for this paper, is the process in which a person becomes receptive to an individual’s cultural differences. It is a type of self-awareness that means one is attempting to understand how another is influenced by their own culture. “A part of awareness is the knowledge that similarities as well as differences exist,” (Zander, 2007). It is about respecting the differences within society and eradicating ethnocentrism. Cultural awareness is a stepping stone to obtaining cultural knowledge and skill; knowing specifics about various cultures and mastering cultural assessment. Most nursing programs, nowadays, have courses or modules that focus on cultural issues and teach students how to approach and treat cultural differences. There are also workshops and courses for registered nurses to attend that are focused on cultural sensitivity. But, this is an endless and ever-evolving process and, unfortunately, there is no official cultural diversity training handbook. Douglas et. al. (2011) composed a set of ten universally applicable guidelines to serve as a resource for nurses providing culturally competent care. They are as follows: (1) Knowledge of Cultures, (2) Education and Training in Culturally Competent Care, (3) Critical Reflection, (4) Cross-Cultural Communication, (5) Culturally Competent Practice, (6) Cultural Competence in Health Care Systems and Organizations, (7) Patient Advocacy and Empowerment, (8) Multicultural Workforce, (9) Cross-Cultural Leadership, and (10) Evidence-Based Practice and Research. These standards of care, I believe, will help nurses and nursing staff to be culturally competent individuals which will lead to a better quality of care given to patients.
Though such resources, classes, and ongoing professional development programs exist for nurses and nursing students, ethnocentrism is still present nursing departments. Throughout my experiences through clinicals and even my day-to-day job on the labor and delivery unit, I have seen and heard the most caring and qualified nurses fall short in terms of cultural sensitivity. Unfortunately, I have overheard comments such as, “that is just weird,” or “honestly, it’s just gross.” In talking with nurses, they have followed up instructions with, “she probably won’t understand you anyways.” I have heard hospital staff say, “surprisingly, they aren’t being disruptive,” and “you know how Hispanic families are.” Is our interpretation of the world so manipulated by the culture in which we are raised? Khalid Almutairi (2015) discusses that despite the fact that the government provides programs for cultural competency, there is still a clear communication barrier between patients and health care workers. Effective communication and understanding of various cultural beliefs and practices are key to providing the kind of safe and quality care that every patient deserves.
Cultural misunderstandings and miscommunication between healthcare workers and patients contribute greatly to patient unhappiness and poor quality of care. These shortcomings not only put the patient at risk, but also the health care employee. Communication barriers, as well as cultural incompetence, and poor clinical management are some of the causes behind the various forms of ethnocentrism seen within nursing departments. As a people, we are judgmental and afraid of things we do not understand. But as a society, we are quick to assume that because things are different means that they are wrong. Eliminating ethnocentrism starts with instilling new norms and values within society. It involves understanding the concept of cultural relativism. Instead of evaluating foreign cultures using the culture of the observer as a standard of correct behavior, cultural relativism means viewing people’s behavior from the perspective of their own culture, (Shaefer 2017). This way of thinking places a priority on understanding other cultures, rather than rejecting them. Cultural relativism emphasizes that different social circumstances give rise to altered norms and values. It doesn’t mean that we must indisputably accept every cultural difference, but it does require an impartial effort to evaluate said norms, values, and customs in light of the cultural differences. It is important to understand that all societies have developed cultural universals; adaptations to meet essential human needs. And that while some of these practices are also universal, the manner in which they are practiced might differ from culture to culture and even change over time within a single culture. Understanding this and being open-minded to beliefs that might not align with your own will increase your cultural competence and, if you are going to be a nurse or work in healthcare, it will make you better at your job.
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