Patient Safety and Cultural Competence
Background
Personal identification, language, thoughts, communications, actions, customs, beliefs, values, and institutions often specific to ethnic, racial, religious, geographic, or social groups are cultural examples.
Healthcare is defined through a cultural lens for both patients and providers.
A person’s cultural affiliations can influence where and how they seek care, describe symptoms, choose treatment options, and follow care recommendations.
Similarly, providers bring their cultural orientations, including medical culture.
The ability of systems to provide care to patients with diverse values, beliefs, and behaviors, including tailoring healthcare delivery to meet patients’ social, cultural, and linguistic needs, is referred to as cultural competence in healthcare.
A culturally competent health system necessitates behaviors, attitudes, and policies that promote effective cross-cultural interactions.
Many cultural competence models have been developed, and these serve as the foundation for various cultural competence interventions, such as provider training and practical tools. While “cultural competence” has traditionally referred to the culture and language of racial and ethnic minority groups, it is increasingly used to include people with disabilities and the LGBTQ community, among other groups. These populations have been the primary focus of cultural competence intervention research. Cultural competence and health literacy have also become linked, indicating that mutual understanding between patients and providers necessitates integrating culturally and linguistically competent and health literate approaches. The updated National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care reflect this expansion of cultural competence.
The cultural competence movement has grown with the increased national focus on pervasive racial and ethnic disparities in healthcare.
Research has consistently shown disparities in health and healthcare between minority and majority populations.
The demographic shifts that have resulted in several minority-majority states and diversity in previously homogeneous areas have strengthened the case for cultural competence in healthcare.
Patient Safety and Cultural Competence
Disparities in healthcare extend to the realm of patient safety. For example, a study of hospitals across the country discovered that patients with limited English proficiency were more likely to be harmed than their English-proficient counterparts when adverse events occurred and that harm was more likely to be severe. These findings extend to pediatric populations, such as the study that discovered hospitalized Latino children are more likely than non-Latino white children to experience an adverse event.
Diagnostic errors, missed screenings, unexpected adverse reactions to medication, harmful treatment interactions from concurrent use of traditional medicines, healthcare-associated infections, adverse birth outcomes, inappropriate care transitions, and inadequate patient adherence to provider recommendations and follow-up visits are examples of patient safety events that can occur as a result of failing to address culture, language, and health literacy.
For example, a failure to recognize that a hospitalized Asian woman would only communicate when accompanied by a male family member resulted in a delay in obtaining consent for necessary surgery.
As patient populations across the country become more diverse, the risk of differences between patients and providers contributing to missed care opportunities and safety events grows.
In addition to directly influencing medical errors and harms, cultural competence can significantly impact another driver of patient safety outcomes – patient engagement. Cultural and linguistic competence strategies, such as language assistance and cultural brokers, can promote effective communication with diverse patients, essential for involving them as collaborative partners in their care. Other interventions, such as cultural competence training, can help providers bridge cultural differences and foster increased trust by increasing understanding of what the patient is going through.
QUESTION
Lack of cultural awareness and failure to provide culturally competent care can impact patients in a negative manner, adding more stress, and resulting in inadequate care provided by nurses. First answer: What makes a nurse culturally competent? Then explain a situation in your practice as a nurse where either cultural competence was at the forefront of care or was lacking.