Inclusion of a patient’s cultural preferences into the plan of care when at the same time the correctional setting demands that we be “firm, fair and consistent” in all our interactions with offenders is a distinguishing feature of correctional nursing. Weiskopf describes this feature as nurses negotiating the boundaries between custody and caring (2005). Incorporating the patient’s cultural preferences into nursing care has been part of the ANA’s Corrections Nursing: Scope and Standards of Practice since the first edition in 1995 (2007, pg. 74).
Failure to address ethnicity, culture and language has been found to exacerbate health disparities and lower health care quality according to a recent Cochrane Review (Horvath 2011). Cultural and racial minorities are disproportionately represented in the corrections population. The health needs of these groups are discussed at length in the Essentials of Correctional Nursing. In correctional settings inmates do not get to choose their health care provider and likewise nurses cannot pick their patients, therefore it is inevitable that challenges, misunderstandings and conflict resulting from diverse cultures will occur.
Cultural competence is the ability to effectively provide nursing care to patients from different cultures. Take moment to think about your experiences addressing patients’ cultural preferences when providing nursing care in the correctional setting. What successes would you like to share? Please write us in the comments section of this post? The paragraphs below describe how to build cultural competency.
Self-Awareness: First we must become aware of how our own views may differ from others. Mark Fleming, PhD., with the Missouri Department of Corrections, described this as “being willing to take a step on a journey of transformation…” in a recent interview with Lorry Schoenly at http://correctionalnurse.net/2012/09/07/multicultural-awareness-for-correctional-nurses-podcast/. A starting place for this journey is to assess our cultural competence. One great resource was specifically developed for primary health care providers and can be accessed at www.nccc.georgetown.edu/features/CCHPA.html.
Communication: As we experience more diversity, the potential for conflict and misunderstanding increases and the ability to communicate effectively becomes even more important (Pearson, 2007). Effective patient-centered communication is characterized by:
- an absence of assumptions
- use of open-ended questions
- active listening
- expression of empathy
- non judgmental words and behavior
What are the tools within the organization that support diversity? How do policies, procedures and clinical protocols support cultural differences and preferences for care? Are qualified interpreters available for communication with patients? Have staff been taught how to conduct an effective patient encounter when using an interpreter? Are patient information materials culturally relevant? Communication tools that support culturally sensitive healthcare delivery can be accessed at https://www.thinkculturalhealth.hhs.gov/Content/communication_tools.asp.
Knowledge: Cultural competence is a dynamic rather than static process so one class in cultural diversity isn’t enough. Understanding how illness is experienced by different cultural groups enables nurses to better tailor care for individual patients. We may be able to leverage help from the ethnic and cultural resources at our facility and within the community to deliver health care that is more relevant and effective with particular patients. These resources may also be able to provide meaningful emotional and social support for the patient. A free online course in culturally competent care specifically developed for nurses is available at https://ccnm.thinkculturalhealth.hhs.gov/ and offers 9 CE credits.
Summary: My favorite tool is a list of 37 concrete things that demonstrate cultural competency in providing primary health care services. The list can be posted in the clinical area as a handy reference. It also can be used to compare against actual practice and then to build an improvement plan. This resource may be obtained at http://nccc.georgetown.edu/documents/checklist_PHC.html. Read more about the cultural diversity and related health care needs of our patient population in the Essentials of Correctional Nursing. Order your copy of the book directly from the publisher and use promotional code AF1209 for $15 off and free shipping at http://www.springerpub.com/product/9780826109514#.UDqoiNZlQf4
American Nurses Association. (2007). Corrections Nursing: Scope & Standards of Practice. Silver Spring, MD: American Nurses Association.
Horvath, L. (2011) Cultural competence education for health professionals. Cochrane Database of Systematic Reviews, (10)
Pearson, A. (2007). Systematic review on embracing cultural diversity for developing and sustaining a healthy work environment in healthcare. International Journal of Evidence Based Healthcare. (5), 54-91.
Registered Nurses’ Association of Ontario (2007). Embracing Cultural Diversity in Health Care: Developing Cultural Competence. Toronto, Canada
Weiskopf, C. S. (2005). Nurses experience of caring for inmate-patients. Journal of Advanced Nursing, 49, 336-343.
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