3.8 Culturally Responsive Care
Open Resources for Nursing (Open RN)
After establishing a culturally sensitive environment and performing a cultural assessment, nurses and nursing students can continue to promote culturally responsive care. Culturally responsive care includes creating a culturally safe environment, using cultural negotiation, and considering the impact of culture on clients’ time orientation, space orientation, eye contact, and food choices.
Culturally Safe Environment
A primary responsibility of the nurse is to ensure the environment is culturally safe for the client. A culturally safe environment is a safe space for clients to interact with the nurse, without judgment or discrimination, where the client is free to express their cultural beliefs, values, and identity. This responsibility belongs to both the individual nurse and also to the larger health care organization.
Cultural Negotiation
Many aspects of nursing care are influenced by the client’s cultural beliefs, as well as the beliefs of the health care culture. For example, the health care culture in the United States places great importance on punctuality for medical appointments, yet a client may belong to a culture that views “being on time” as relative. In some cultures, time is determined simply by whether it is day or night or time to wake up, eat, or sleep. Making allowances or accommodations for these aspects of a client’s culture is instrumental in fostering the nurse-client relationship. This accommodation is referred to as cultural negotiation. See Figure 3.6[1] for an image illustrating cultural negotiation. During cultural negotiation, both the client and nurse seek a mutually acceptable way to deal with competing interests of nursing care, prescribed medical care, and the client’s cultural needs. Cultural negotiation is reciprocal and collaborative. When a client’s cultural needs do not significantly or adversely affect their treatment plan, their cultural needs should be accommodated when feasible.
As an example, think about the client previously discussed for whom a fixed schedule is at odds with their cultural views. Instead of teaching the client to take a daily medication at a scheduled time, the nurse could explain that the client should take the medication every day when he awakens rather than every morning at 0800. Another example of cultural negotiation is illustrated by a scenario in which the nurse is preparing a client for a surgical procedure. As the nurse goes over the preoperative checklist, the nurse asks the client to remove her head covering (hijab). The nurse is aware that personal items should be removed before surgery; however, the client wishes to keep on the hijab. As an act of cultural negotiation and respect for the client’s cultural beliefs, the nurse makes arrangements with the surgical team to keep the client’s hijab in place for the surgical procedure and covering the client’s hijab with a surgical cap.
Decision-Making
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