3.6 Culturally Sensitive Care
Open Resources for Nursing (Open RN)
Providing culturally responsive care integrates an individual’s cultural beliefs into their health care. Begin by conveying cultural sensitivity to patients and their family members with these suggestions[1]:
- Set the stage by introducing yourself by name and role when meeting the patient and their family for the first time. Until you know differently, address the patient formally by using their title and last name. Ask the patient how they wish to be addressed and record this in the patient’s chart. Respectfully acknowledge any family members and visitors at the patient’s bedside.
- Begin by standing or sitting at least arm’s length from the patient.
- Observe the patient and family members in regards to eye contact, space orientation, touch, and other nonverbal communication behaviors and follow their lead.
- Make note of the language the patient prefers to use and record this in the patient’s chart. If English is not the patient’s primary language, determine if a medical interpreter is required before proceeding with interview questions. See the box below for guidelines in using a medical interpreter.
- Use inclusive language that is culturally sensitive and appropriate. For example, do not refer to someone as “wheelchair bound”; instead say “a person who uses a wheelchair.”[2]
- Be open and honest about the extent of your knowledge of their culture. It is acceptable to politely ask questions about their beliefs and seek clarification to avoid misunderstandings.
- Adopt a nonjudgmental approach and show respect for the patient’s cultural beliefs, values, and practices. It is possible that you may not agree with a patient’s cultural expressions, but it is imperative that the patient’s rights are upheld. As long as the expressions are not unsafe for the patient or others, the nurse should attempt to integrate them into their care.
- Assure the patient that their cultural considerations are a priority their care.
Using Medical Interpreters
When caring for clients whose primary language is not English and they have a limited ability to speak, read, write, or understand the English language, seek the services of a trained medical interpreter. Health care facilities are mandated by The Joint Commission to provide qualified medical interpreters. Use of a trained medical interpreter is linked to fewer communication errors, shorter hospital stays, reduced 30-day readmission rates, and improved patient satisfaction.
Refrain from asking a family member to act as an interpreter. The patient may withhold sensitive information from them, or family members may possibly edit or change the information provided. Unfamiliarity with medical terminology can also cause misunderstanding and errors.
Medical interpreters may be on-site or available by videoconferencing or telephone. The nurse should also consider coordinating patient and family member conversations with other health care team members to streamline communication, while being aware of cultural implications such who can discuss what health care topics and who makes the decisions. When possible, obtain a medical interpreter of the same gender as the patient to prevent potential embarrassment if a sensitive matter is being discussed.
Guidelines for Using a Medical Interpreter[3]
- Allow extra time for the interview or conversation with the patient.
- Whenever possible, meet with the interpreter beforehand to provide background.
- Document the name of the medical interpreter in the progress note.
- Always face and address the patient directly, using a normal tone of voice. Do not direct questions or conversation to the interpreter.
- Speak in the first person (using “I”).
- Avoid using idioms, such as, “Are you feeling under the weather today?” Avoid abbreviations, slang, jokes, and jargon.
- Speak in short paragraphs or sentences. Ask only one question at a time. Allow sufficient time for the interpreter to finish interpreting before beginning another statement or topic.
- Ask the patient to repeat any instructions and explanations given to verify that they understood.
Discussing Sexuality
It is common for nurses to encounter patients who wish to have discussions pertaining to their sexuality. Sexuality encompasses sex, sexual orientation, gender identity, gender roles, among other topics. The need for sexuality discussions may be a result of medication sexual side effects, disease processes that may affect a person’s sexuality, surgical procedures affecting sexuality, sexually transmitted infections, sexual trauma, or other health needs of LGBTQAI+ and straight patients. Sexual topics can be uncomfortable for both the nurse and the patient. The patient may feel embarrassed or as if they cannot initiate the conversation due to social stigmas about certain topics. For this reason, nurses should let patients know they can talk about sexual concerns in a non-judgmental environment by using the following guidelines.[4]
Guidelines for Discussing Sexuality in a Sensitive Manner[5]
- Provide a private area free of interruptions for use during the conversation
- Do not appear hurried and give the patient your undivided attention. Patients may be reluctant to open up if they feel the nurse is too busy to engage with them.
- Provide a sense of normalcy with what the patient may be feeling without minimizing their concerns and ask permission before further discussing sexuality. For example, if a male patient is taking medications with the sexual side effect of erectile dysfunction, the nurse could state, “Some patients taking this medication experience erectile dysfunction. Is this something that you would like to talk about?
- Be aware of certain situations that may warrant using additional resources such as other staff nurses. For example, if a female has experienced sexual trauma by a male perpetrator, she likely will not be comfortable with a male RN performing her assessment. It may be necessary to confer with the charge RN to change patient assignments to allow this patient to be cared for by female staff.
- Remain nonjudgmental and respectful in your interaction even if you may not agree with your patient’s sexuality.
- It’s ok not to have all the answers for your patient. It is acceptable and advised to recognize your limitations as a nurse and seek additional referrals and information as necessary.
- Brooks, L., Manias, E., & Bloomer, M. (2019). Culturally sensitive communication in healthcare: A concept analysis. Collegian, 26(3), 383-391. https://doi.org/10.1016/j.colegn.2018.09.007 ↵
- UK Office for Disability Issues. (2018, December 13). Inclusive language: Words to use and avoid when writing about disability. https://www.gov.uk/government/publications/inclusive-communication/inclusive-language-words-to-use-and-avoid-when-writing-about-disability. ↵
- Juckett, G., & Unger, K. (2014). Appropriate use of medical interpreters. American Family Physician, 90(7), 476-80. https://pubmed.ncbi.nlm.nih.gov/25369625/ ↵
- Southard, N.Z., Keller, J. (2009). The importance of assessing sexuality: A patient perspective. Clinical Journal of Oncology Nursing, 13(2), 213-7. https://doi.org/10.1188/09.CJON.213-217. ↵
- Southard, N. Z., & Keller, J. (2009). The importance of assessing sexuality: A patient perspective. Clinical Journal of Oncology Nursing, 13(2), 213-7. https://doi.org/10.1188/09.CJON.213-217. ↵
