2.4 Cultural and Social Determinants Related to Medication Administration

In addition to the legal and ethical considerations, there are also cultural and social influences that the nurse must consider when administering medication. According to the 2018 U.S. Census report, by the year 2030, the nation’s population is projected to age considerably and become even more racially and ethnically diverse. Though health indicators such as life expectancy and infant mortality have improved for most Americans, some people from racial and ethnic minority groups experience a disproportionate burden of preventable disease, death, and disability compared with non-Hispanic white people.^[1]

The American Nurses Association’s (ANA) Scope and Standards of Practice states the need for health care is universal and transcends differences with respect to the culture, values, and preferences of individuals, families, groups, and communities. Diversity characterizes today’s health care environment, and nursing is responsive to the changing needs of society. To effectively promote meaningful client outcomes that maximize quality of life across the life span, the ANA states that nurses must engage in cultural humility. Cultural humility is a humble and respectful attitude toward individuals of other cultures that pushes one to challenge their own cultural biases, realize they can’t possibly know everything about other cultures, and approach learning about other cultures as a lifelong goal and process.^[2] As previously discussed in this chapter, culturally congruent practice is the application of evidence-based nursing that is in agreement with the preferred cultural values, beliefs, worldview, and practices of the health care client.

In addition to cultural beliefs, conditions in the places where people live, learn, work, and play can also affect their health, functioning, quality of life, and risks. These conditions are known as social determinants of health (SDOH). Differences in health can be significant in communities with poor SDOH such as unstable housing, low incomes, unsafe neighborhoods, or substandard education. These differences are referred to as health disparities. By applying what we know about SDOH, nurses can not only improve an individual’s health, but also improve health equity for communities and the population as a whole.

Healthy People is a government agency that provides science-based, ten-year national objectives for improving the health of all Americans. Healthy People 2030 highlights the importance of addressing SDOH with a goal to “create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.”^[3],[4]

The U.S. Department of Health and Human Services also sets national standards for Culturally and Linguistically Appropriate Services (CLAS) in health and health care. The national CLAS standards are intended to advance health equity, improve quality, and help eliminate health disparities by “providing effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.”^[5]

The U.S. Department of Health and Human Services (HHS) defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.” Adequate health literacy may include being able to read and comprehend essential health-related materials such as information on a medication bottle or in a handout. Nurses promote health literacy by including interventions such as visual aids to increase client understanding and, thereby, improve client safety.^[6]

Examples of Culturally Congruent Practice Related to Medication Therapy

There are several instances when a nurse must assess and accommodate a client’s cultural beliefs and social determinants of health when administering medications or teaching about medications. For example, a nurse addresses health literacy and medication safety by assisting a client to read information on a medication bottle or on a handout.

Another example of culturally congruent practice is when a nurse considers cultural or religious beliefs, such as fasting, when administering medications. For example, a Muslim client may participate in Ramadan, which requires 12-hour fasting. A nurse can advocate for the client and assist in altering the scheduling of medication to accommodate the client’s beliefs in order to reduce the risk of treatment failure.

A third example of culturally congruent practice is when a nurse considers how a client’s ethnic background may affect their ability to respond to medications. For example, African Americans often require combination therapy to treat hypertension, and Asian and Hispanic clients often respond better to lower doses of antidepressants.