Culture in Advanced Nursing Practice
Abstract

Culturally competent nurses can assess the psychological, spiritual, physiological, social, environmental, and epidemiological data on a particular cultural group to provide culturally sensitive and patient-centered care. Since Madeleine Leininger first proposed that cultural competency was essential to nursing, various means of incorporating cultural learning and assessment have been incorporated into advanced nursing practice. Culture includes but is not limited to ethnic, linguistic, religious, and national heritage, and can also include subcultural domains, age, socioeconomic status, and political affiliations. Advanced practice nurses have a moral and legal obligation to provide culturally competent care, outlined in Standard 8 of the American Nurses Association (ANA) Standards of Practice. Cultural assessment strategies enable the advanced practice nurse to understand the complex intersections between health status, cultural needs, disease prevalence, spirituality, agency, and more.

Culturally Competent Advanced Nursing Practice

Since Madeleine Leininger first proposed that cultural competency was essential to nursing, various means of incorporating cultural learning and assessment have been incorporated into advanced nursing practice. Cultural competency is important in nursing because “culture affects people’s health and illness experiences as well as nursing care delivery,” (Wagner, 2019, p. 1). Cultural variables impact attitudes and social norms, values, beliefs, lifestyle habits, and more. Advanced practitioners need to remember that culture refers not only to ethnicity but also gender, religion, age, and other factors that impact healthcare attitudes, behaviors, beliefs, and expectations.

Cultural competency becomes relevant to advanced nursing practice on the individual level (such as nurses working with individual patients) and also on the organizational level (built into healthcare policy or institutional policies). For the advanced practice nurse, cultural competency involves self-efficacy along three primary dimensions: “cognitive, practical, and affective,” (Wagner, 2019, p. 1). The nurse practitioner asks the right questions, conducts research, and uses scholarly means to conduct cultural assessments of a particular patient population. Similarly, the advanced practice nurse reviews the literature for evidence-based practice models for working with specific patient populations in clinical care. Cultural competency also includes an affective domain, such as the cultivation of empathy, compassion, and understanding. For all nurse practitioners, cultural competency is an “ongoing process” that requires continual self-reflection (Wagner, 2019, p.1). Advanced practitioners need to formally assess cultural competency.

Cultural assessment strategies are used to detect biases or prejudices that might impact one’s ability to deliver clinical care, and also to know the best approaches to a given situation. Working with the patient, advanced practitioners can determine the patient’s need for familial and extra-familial social support and access to religious and spiritual practices. Cultural knowledge empowers the nurse to make recommendations and use communication styles conducive to patient satisfaction and quality of care. Rather than make...…would be to ask direct questions, making note of conflicts between the patient’s religious and spiritual practices versus those of family members.

Assessing social and environmental variables is also important for advanced practice nurses. It is possible to talk with the patient and caregivers, as well as review the empirical literature on the intersections between social norms and healthcare and also between environmental factors and healthcare risks. Similarly, social and environmental variables might affect health status and lifestyle habits that impact the patient’s prognosis and ability to comply with suggested lifestyle changes. Epidemiological data would include all statistics related to disease prevalence within the African American community, specifically within the sub-group identified by the patient such as age-related or gender-based differences. The advanced practitioner must rely on scholarly databases to acquire such data.

Demonstrating cultural competency includes assessment of culture, using strategies that incorporate, recognize, and validate client beliefs and practices (“Cultural Awareness and Influences on Health: NCLEX-RN,” 2020). The advanced nurse practitioner identifies singular means of aligning a treatment plan with patient goals and objectives, respectful of diversity while still providing advice as to evidence-based practices. Doing research, working with colleagues, and actively engaging the patient and family members in the process of elucidating cultural differences in healthcare will promote improved patient outcomes and elevate patient perceptions of the quality of care provided.…