Cultural Competence in Nursing Care for the Elderly

Introduction: Culturally Competent Care and Watson's Theory

Basic knowledge in nursing or medical studies is not sufficient on its own. As Watson argues, there is a need to instill the humanistic aspect into the profession. Watson believes that a nurse must establish a caring relationship with patients, display unconditional acceptance of the patient regardless of their condition, treat patients as holistic beings, treat patients with positive regard, and promote health through knowledge and intervention. She also emphasizes the importance of spending uninterrupted time with patients — moments she calls "caring moments" (Vanguard Health Systems, 2011).

In order to effectively achieve and implement the ideas in Watson's theory of culturally competent care, it is important to critically examine the cultural diversity among the aging American population. Cultural diversity among the elderly is considered to be one of the biggest challenges — alongside nutrition — that older people face. According to the American Speech-Language Hearing Association (ASHA) (2011), culture shock will not only affect the lifestyle of the elderly but will also affect the dining habits of those affected. This issue touches both nursing-home comfort and the nutrition of elderly people. There is therefore a need for a high level of interpersonal communication skills to enable effective transcultural interaction with the aging population.

The Aging American Population and Key Challenges

The elderly can be effectively considered a vulnerable group for several reasons. In 2008, there were 39 million people aged 65 and above in America, accounting for slightly over 13% of the population. It is estimated that by 2030, there will be around 72 million Americans in this age group — the point at which all baby boomers will have reached age 65 or older. This will represent a significant 20% of the entire American population. However, a longer life for this generation does not come easily or cheaply. Inflation and rising annual healthcare costs make it increasingly difficult for senior citizens to maintain a robust lifestyle. It is estimated that in 1992, the annual healthcare cost per elderly person was $9,224; this rose to $15,081 by 2006, and this trend is projected to continue rising each year (National Institute of Aging, 2008). This sizable and marginalized population deserves issues affecting them to be addressed immediately and effectively.

The two predominant issues facing aging Americans today are poor nutrition — and the resulting health conditions — and inadequate home care facilities that are not culturally sensitive. Regarding poor nutrition, heart disease remains the highest cause of death among the elderly and is even more serious among the very frail and old. One of the major known contributing factors is the type of nutrition to which elderly people are subjected. The Federal Interagency Forum on Aging-Related Statistics (2010, p. 17) indicates that the number of elderly people suffering from obesity has been increasing every year since 1988, and from 2000 onward has leveled off rather than declining.

Regarding cultural incompetence within nursing homes — and within the wider American population — most Americans are too busy to spare time for the elderly. Preoccupied by career and financial pursuits, they seek care homes where their elderly relatives can retire with dignity and live comfortably after their active years. Unfortunately, for the majority of Americans, this turns out to be ironic: their elderly relatives do not end up in the comfort or care they anticipated. The elderly are often placed in the hands of culturally incompetent nurses who mistreat them with little or no regard for their cultural backgrounds and needs. There is a pervasive assumption that one approach to elderly care fits all. No attention is given to race, previous place of residence, social background, psychological disposition, or the many other factors that constitute culturally competent nursing care.

The Purnell Model for Cultural Competence

One of the most renowned models for cultural competence is the Purnell Model for Cultural Competence. It is one of the most comprehensive models available, covering the global society, the community, the family, and the individual. It also explains various cultural domains — twelve in total — which do not stand alone but apply in tandem when caring for patients, including the elderly. The model also incorporates ideas drawn from administrative, organizational, family development, and communication theories. The twelve domains are: heritage; family roles and organization; communication; workforce issues; biocultural ecology; high-risk behaviors; pregnancy and childbearing practices; death rituals; spirituality; healthcare practices; and healthcare practitioners (Larry Purnell, 2005).

Given the breadth and diversity it encompasses, the Purnell Model is well suited to the care of frail and elderly Americans who require a comprehensive care system in order to live happy lives in care homes or in their own residences. It is worth noting, however, that these cultural standards exist within economic, political, and social systems. As a result, various health organizations hold different definitions of culturally competent care for their patients. Nevertheless, certain baseline considerations cut across most cultures. These are the focus here, in line with both the Purnell Model and the twelve standards outlined by the American Academy of Nursing Expert Panel (2009), which present interlaced standards of culturally competent practice.

Conclusion: Watson's Caring Moment and Its Significance

In some cases, insurmountable administrative obstacles stand in the way of implementing culturally competent care within nursing facilities, even when such practices have been validated by research (WHO Regional Office for South-East Asia, 2006). One significant role that culturally competent nursing plays among older people is the creation of what Watson calls a "caring moment" — a situation in which the nurse and patient make genuine contact. Through the attitude and competence of the nurse, the patient's world can become larger or smaller, brighter or drab, rich or dull, secure or threatening. These moments have been shown to meaningfully affect both nurse and patient, linking them together in a way that transcends routine clinical interaction.

Culturally competent nursing care is therefore not merely a professional standard but a moral imperative — one that determines the quality of life of one of America's most rapidly growing and most vulnerable populations.

References

American Speech-Language Hearing Association (ASHA). (2011). Culture change in nursing homes: Pioneer Network food and dining clinical standards task force summary. Retrieved July 6, 2013, from http://www.asha.org/SLP/clinical/dysphagia/Culture-Change-in-Nursing-Homes/

Larry Purnell. (2005). The Purnell Model for Cultural Competence. The Journal of Multicultural Nursing and Health, 11(2). Retrieved July 10, 2013, from

National Institute of Aging. (2008). Americans living longer, enjoying greater health and prosperity, but important disparities remain, says federal report. Retrieved July 6, 2013, from

The American Academy of Nursing Expert Panel. (2009). Standards of practice for culturally competent nursing care: A request for comments. Retrieved July 10, 2013, from

The Federal Interagency Forum on Aging-Related Statistics. (2010). Older Americans 2010: Key indicators of well-being. Retrieved July 6, 2013, from

Vanguard Health Systems. (2011). Overview of Jean Watson's theory. Retrieved July 6, 2013, from

WHO Regional Office for South-East Asia. (2006). Promoting the application of research findings in health development. Retrieved July 6, 2013, from http://www.searo.who.int/en/Section1243/Section1310/Section1343/Section1344/Section1350_5241.htm