Heath education has always been a vital part of nursing practice,
but it has become increasingly more difficult to accomplish as
numerous factors beyond our control threaten its quality and value.
Margaret Comerford Freda, writing in the Journal of Midwifery &
Women's Health (2004), cites the influx of clients of varying
cultures into an overburdened health care system, the lack of time
for patient education, the amount of patient educational materials,
and the lack of reimbursement for time spent on patient education
as significant barriers to effective patient education.
Looking at cultural generalities can help educators tailor
materials to different people, thus making education more
The U.S. Census Bureau delineates four major cultural groups in the
United States: Hispanics, blacks, Asian/Pacific Islanders, and
American Indians. The term "culture" has been given many different
definitions, but for the purposes of this discussion culture is
described as learned and shared beliefs and values of a particular
group, which are generally passed on intergenerationally and affect
one's thinking and actions.
The largest and fastest growing of the minority populations is that
of Hispanic Americans. Ideas for implementing patient education for
Hispanic patients include utilizing mass media for outreach
programs, including family members in the plan of care, providing
appropriate interpreters for the patient's preferred language, and
providing written and/or audiovisual materials in Spanish to
America's black population has traditionally been the largest
minority population, and much has been written about beliefs and
themes prevalent in this culture. L.D. Purnell and B.J. Paulanka
have written that black Americans may be suspicious of the health
care system and may rely more heavily on folk healers and home
remedies. Similar to the Hispanic culture, family is valued and
elders are respected, many times making health care decisions for
extended family. Finally, black Americans tend to have strong
religious beliefs and may believe that regardless of what happens
in their life, it must be God's will. This attitude may cause
individuals unfamiliar with this culture to assume that they have a
pessimistic view of life.
Another of the four major cultural groups in the United States is
Asian/Pacific Islanders. Despite the fact that this population has
been classified as one ethnic group, there are actually many
different cultures, religions and languages represented. The term
"culture" has been given many different definitions for people from
Asian countries and the Pacific Islands. There are, however, some
common values central to this group, including male authority,
"saving face"-based on pride, strong family relationships, and
respect for ones elders and authority figures.
The final major cultural group is that of the Native American
population, which includes American Indians and Alaskan natives.
For this population, spiritual connection with the land, nature,
religion, and health are all closely related. Some Native American
tribes use the medicine man or "shaman" to help with the care of
sick tribe members. The Native American culture also feels strongly
about family and tribe, has a more casual perception of time, and
respect older adult members of this community.
The U.S. government, in an effort to improve the well being of
people from diverse backgrounds, directed the Office of Minority
Affairs to create the National Standards for Culturally and
Linguistically Appropriate Services (CLAS) 2001, which were
designed for health care organizations who receive federal funding.
These 14 standards, some of which are mandatory, guide health care
providers in creating a welcoming, informative, and effective
medical care environment. Three of the guidelines refer to
culturally competent care.
Cultural competence requires an awareness of one's own existence,
thoughts, and environment without letting them have unnecessary
influence on individuals from other backgrounds. In addition, the
culturally competent demonstrate understanding of a client's
culture, accept and respect cultural differences, and adapt care to
accommodate a client's culture. One step toward an organization's
collective cultural competence is training. Health care
organizations can and should provide ongoing educational
opportunities for staff members around cultural issues.
Becoming culturally competent takes time and patience from all
staff, including nursing personnel. But as we move forward and ride
the wave of our country's shifting demographics, it is imperative
that we as nursing professionals evaluate our personal beliefs and
value systems in regard to other cultural groups. Nursing
professionals can be a tremendous catalyst for positive change and
can serve as ambassadors of equality and respect for the diverse
populations we care for. The first step is our own awareness.
Bastable, Susan. Nurse as Educator: Principles of Teaching and
Learning for Nursing Practice, Second Edition, 2003
Leininger, M. & McFarland, M. R. Transcultural Nursing:
Concepts, Theories, Research, and Practice (3rd ed.). New
York: McGraw-Hill, 2002
Purnell, L.D., & Paulanka, B.J. Transcultural healthcare: a
culturally competent approach. Philadelphia: F.A. Davis, 1998
2006 ASTD, Alexandria, VA. All rights reserved.