Cultural Diversity in Nursing: ANA's Position and Practice

ANA's Position on Cultural Diversity in Nursing Practice

In its official position statement, the American Nurses Association (ANA) recognizes the importance of cultural diversity at all levels of nursing practice (ANA Board of Directors, 2011). Approaches to practice will not be effective if the indigenous and diverse cultural health and nursing needs of patients are not addressed and met. This is today's reality for all nurses, whether in clinical settings, schools, research, or administration. Cultural diversity focuses on racial and ethnic differences, and each experience is unique. The very concepts of illness, wellness, and treatment derive from a cultural perspective or worldview. Culture is a concept on which nursing itself is founded and defined.

Nurses, therefore, need to learn how cultural groups understand life processes; how they perceive health and illness; what they believe to be the causes of illness; what they do to maintain health and wellness; how their healers extend care; and how the nurse's own cultural background influences the provision of care. Nurses must consider the specific cultural effects of their care on individual clients and recognize that each client must be assessed according to their cultural differences. Changing demographics have increased the level of cultural diversity in the United States, as predicted by census data. What were once considered minority groups are continuously becoming a national majority (ANA Board of Directors, 2011).

Nurses likewise incorporate their personal cultural values and philosophical views into the professional care they provide (ANA Board of Directors, 2011). Their interaction with patients involves the nurse's culture, the client's culture, and the culture of the care setting. Patients need to choose from available delivery systems, and access should therefore be improved by providing more culturally relevant and responsive services. In clinical practice, nurses can apply their knowledge of cultural diversity to extend culturally sensitive care. By recognizing cultural diversity, incorporating cultural knowledge, and acting in a culturally appropriate way, nurses can be more effective in assessing patients and serving as client advocates.

In pursuing this goal, all nursing curricula should be attuned to the provision of diverse health care, beliefs, values, and practices. Educational programs should demonstrate to nursing students how cultural beliefs and practices are an essential part of the nursing process and function as psychosocial factors in care. Nurse administrators should design policies and procedures that ensure access to care responsive to cultural beliefs, remaining sensitive to the level of cultural diversity among both providers and consumers. Nurse researchers, in turn, need to draw on cross-cultural data to answer pertinent questions in the field. They will find that, while cultures differ, meaningful similarities also exist among diverse groups. Overall, nurses are in a strong position to influence professional policies and practice in ways that better respond to cultural diversity (ANA Board of Directors, 2011).

Impact of Cultural Diversity on Professional Nursing Practice

Studies show that genetics is a major component in certain diseases and that these diseases develop at significantly higher rates among particular ethnic groups (Paniagua & Taylor, 2008). These diseases include sickle cell anemia among African Americans and Hispanic Americans; cystic fibrosis and phenylketonuria among white Americans; and Tay-Sachs disease among Ashkenazi Jews in the United States (Nussbaum, McInnes, & Willard, 2007, as cited in Paniagua & Taylor, 2008). Single-gene (Mendelian) disorders are found at high rates among specific racial and ethnic groups and develop from the mutation of individual genes. Healthcare providers and professionals must be aware of these connections among specific population groups as risk factors (Paniagua & Taylor, 2008).

The U.S. Census Bureau reported in 2007 that the largest minority groups in the United States are Hispanics, Black or African Americans, Asians, American Indians or Alaskan Natives, and Native Hawaiians or other Pacific Islanders (Paniagua & Taylor, 2008). Healthcare providers must, therefore, approach these patients through a cultural lens. Understanding cultural differences is necessary to provide sensitive and effective care. The Department of Health and Human Services (2007) defines cultural sensitivity as "the ability to adjust one's perceptions, behaviors, and practice styles to effectively meet the needs of different ethnic or racial groups." Acquiring baseline knowledge of different ethnic groups' beliefs about the genetic causes of disease will provide essential understanding of their widely varying perceptions and help healthcare professionals deliver culturally sensitive care (Paniagua & Taylor, 2008).

A lack of awareness or consideration of ethnically diverse health practices and beliefs — including beliefs about the causes of disease and birth defects — is likely to hamper effective patient care (Paniagua & Taylor, 2008). Ethnic and cultural beliefs directly influence the information patients share during counseling (Weil, 2001, as cited in Paniagua & Taylor, 2008). The effectiveness of care may also be limited by the patient's lack of basic knowledge of body structure and function, the use of non-standard community health practices, or certain expectations about medical treatment and practitioners. It is therefore important that care professionals learn and understand the connection between racial ancestry, culture, healthcare values, and behaviors when transmitting information about disease and treatment (Paniagua & Taylor, 2008).

The incorporation of foreign cultures into American society has been an ongoing process long before the United States became a nation (Lowe & Archibald, 2009). However, the significance of that cultural mingling has not always been widely recognized. Cultural diversity within health care is thus a complex issue that requires considerable time and effort to incorporate and implement effectively, and the process is expected to be challenging. In 1986, the ANA issued its official position statement and announced its intention to strengthen culturally diverse programs in the nursing curriculum. As a discipline, nursing has continued to be challenged as it incorporates and adapts to cultural diversity. The progressive changes in the cultural composition of the U.S. population challenge nurses daily in their provision of quality care to clients with diverse cultural needs. A concurrent shortage of qualified nursing staff adds further pressure. Research indicates that without adequate attention to cultural diversity, the volume and quality of healthcare practices will suffer, while health disparities will widen (Cook, 2003, as cited in Lowe & Archibald, 2009).

References

ANA Board of Directors. (2011). Position statement: Cultural diversity in nursing practice. American Nurses Association.

Lowe, J., & Archibald, C. (2009). Cultural diversity: The intention of nursing. Journal Compilation. Wiley Periodicals, Inc.

Paniagua, C. T., & Taylor, R. C. (2008). The cultural lens of genomics. The Online Journal of Issues in Nursing, 13(1). American Nurses Association.