Fundamentals - Principles, part 9: Cultural Considerations, Complementary and Alternative Medicine

In this article, we cover what you need to know about how to give culturally competent care, religious and cultural considerations for your patients, how to use a medical interpreter, and we'll share some example religious and cultural considerations that could apply to Muslim patients, Jewish patients, Catholic patients and more! We'll also cover complementary and alternative medicine and what to look out for. Who shouldn't get acupuncture? Who shouldn't meditate? We'll answer these questions and more.

The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Cultural Considerations

The key points you need to know when it comes to cultural considerations in nursing are: what a culture is, culturally competent care, how to do a cultural assessment, what ethnocentrism is and how to avoid it, language differences and best practices for the use of an interpreter, and then some example religious and cultural considerations to be aware of in your practice.

Culture

What is a culture? A culture is a set of shared beliefs, values, and customs that are influenced by race, geographic location, ethnicity, and language.

Parts of culture may have religious origins, but have become more generalized to geographic location and social group. For example, per a 2013 Pew Research poll, 90% of Americans polled celebrated Christmas, but only half considered it a religious holiday.

Culturally competent care

Nurses must strive to provide culturally competent care. Culturally competent care is care that meets the religious, cultural, and social needs of the patient. Culturally competent care improves the quality of care and improves patient health outcomes.

Cultural competency begins with a nurse identifying their own beliefs and values so they understand where they are coming from and what beliefs they bring to the table.

In nursing, it is important to understand ourselves because it helps us better understand our patients. For example, in the phases of the nurse-client relationship, during the pre-orientation phase we examine our thoughts and feelings about working with a patient.

Why is culturally competent care important?

If you've studied Med-Surg, you may have noticed that race is listed as a risk factor for some diseases and disorders. As we have explained in our articles on these subjects, race virtually never plays a biologically predetermined role in a disease, but risks can be higher statistically for nonwhite and minority patients for a variety of reasons, including the social and environmental determinants of health — which includes access to adequate and nondiscriminatory health care.

Culturally competent care is an important way that nurses, as individuals, can provide adequate and nondiscriminatory health care. Culturally competent care leads to better health outcomes for your patients.

Cultural assessment

A cultural assessment is a key part of giving culturally competent care going to be essentially just identifying what your patient's cultural/religious/spiritual needs are. And the ways that we can cater to those, what our best practices may be.

Ethnocentrism

Ethnocentrism is the belief that one's own culture is superior to somebody else's. Nurses should not practice ethnocentrism, and should take care to assess their own beliefs and behaviors continually to assess for, and eradicate this.

Language differences and interpreter use

As a nurse, you will be caring for patients who speak many languages. Patients have a legal right to appropriate language services, like medical interpreters and printed material in their preferred language.

It is important that a patient's interpreter is an official medical interpreter, approved and hired by the facility. We do not want to use a patient's friends or family members to interpret, if at all possible.

Best practices for interpreter use

Speak directly to the patient, not to the interpreter. We're having the conversation with the patient, the interpreter is just assisting us.

Ask one question at a time, to allow the interpreter time to ask the patient, and then give you the response.

Try to limit your use of additional hand gestures.

Example religious/cultural considerations

There are different cultural practices and religions that may influence the care that you provide. Below, we've provided some examples that you may encounter.

NOTE: Regardless of what your patient's stated religious practice is, every person practices differently, so it is best never to assume. Instead, ask your patient directly about any religious practices that they may follow that would influence their care.

Islam

Islam is the world's second-largest religion, and followers of Islam are known as Muslims. Patients who follow Islam may not choose to eat pork products, alcohol, or shellfish.

Ramadan is a month-long holiday during which many Muslim adults fast (abstain from food), from dawn till sunset. You may have a patient who is fasting during Ramadan and you may need to accommodate for this.

You may need to make accommodations for your patient to be able to pray five times a day. And female patients may request female care providers.

Judaism

Some patients who are Jewish follow Kosher diets. If your patient does follow a Kosher diet, then they may not eat pork, shellfish, or meat combined with dairy.

For example, a hamburger would be considered Kosher, but a cheeseburger would not.

Mormonism

Patients who are Mormon may abstain from alcohol, tobacco, and caffeine products.

Catholicism

Patients who are Catholic may avoid meat on Fridays during the period of Lent (a religious observance period that lasts around 40 days and ends with Easter).

Jehovah’s Witnesses

Jehovah's Witnesses may refuse blood products, like blood transfusions. If they were having surgery, they may say that they do not wish to have a blood transfusion.

For more information on blood transfusions, check out our Medical-Surgical Nursing - Flashcards.

Complementary and Alternative Medicine (CAM)

Complementary and Alternative Medicine (CAM) is an umbrella term for practices and products that are not a typical part of conventional (allopathic) medical care.

Complementary means that the practice may be used alongside (as a complement to) traditional forms of medicine, and alternative may mean that it's being used instead of traditional medicine. It's very important to assess a patient's use of CAM during their initial intake assessment.

Acupuncture

Acupuncture is a technique in which practitioners stimulate specific points on the body, usually by inserting thin needles through the skin. Acupuncture procedures may be contraindicated if a patient has a bloodborne pathogen, because of the potential of exposure to blood.

Herbal supplements

If your patient is taking herbal supplements (like ginkgo biloba, St. John's wort, valerian root, or saw palmetto), you need to know exactly what they're taking and how much, because there is the potential for interactions with standard pharmacological therapies.

Massage

Massage is a great use of CAM for many patients. However, a patient with a deep-vein thrombosis should not receive a massage, as this could dislodge the clot.

Psychosis is another contraindication for massage, because touching may aggravate some conditions. To learn more, check out our Psychiatric Mental Health Nursing Flashcards.

Hypnosis & meditation

Hypnosis and meditation can be great tools for patients. Psychosis, either current or previous, may be a contraindication for hypnosis or meditation, as it may exacerbate some traits.

Chiropractic adjustments

Chiropractors use spinal manipulation and deep massage for the relief of chronic pain. Chiropractic adjustments may be contraindicated for patients with existing fractures, bone cancers, or spinal cord compression.