Culturally Informed Nursing Care: Person and Environment

Introduction: The CNS Role and Cultural Care

As a clinical nurse specialist (CNS) — an advanced practice nurse "whose care focuses on a specific patient population" — the concept of multicultural care is integral to daily practice (CNS, 2011, career overview). "A CNS can specialize in certain types of diseases (such as diabetes or cardiovascular disease), can work in many different medical environments (such as operating room, emergency room, or critical care), and can focus on a variety of procedures (such as surgical or clinical)" (CNS, 2011, career overview). Regardless of the CNS's specialty, the care he or she provides must be culturally appropriate and take into consideration the patient's daily environment.

A CNS must often be more conscious of the social implications of nursing care than nurses in other subspecialties, because the individuals within a CNS's practice may be dominated by a particular social segment or a predominant ethnic group. Of the four core nursing metaparadigm concepts — person, environment, health, and nursing — the ideas of "person" and "environment" are especially relevant to the CNS role.

Person and Environment in Diabetes Management

For CNSs specializing in diabetes care, the nurse must be aware that individuals from poor and disadvantaged backgrounds are often more likely to manifest the condition, given their limited access to healthy food, opportunities for exercise, and knowledge about appropriate nutrition. According to the Centers for Disease Control and Prevention, more than half of women aged 45–64 with diabetes have an annual family income of less than $20,000, and 28.5 percent have less than $10,000 — compared with 30.5 percent and 11.3 percent, respectively, for women without diabetes (Diabetes and women's health, 2011, CDC).

The nurse must be able to provide culturally appropriate advice given the limits of the patient's environment and personal circumstances. Rather than simply recommending a low-calorie diet, the nurse must ensure that the prescribed diet is within the patient's likely food budget. Exercise recommendations should be made with the awareness that the patient may not have access to a gym. Suggesting walking more often and making daily tasks more aerobic would be more feasible alternatives. Understanding the stressors upon the "person" as not merely individualized — and locating that person within a context of culturally appropriate care — is essential to ensuring that the treatment plan is both feasible and likely to be followed.

Cultural Sensitivity in Dietary and Lifestyle Recommendations

According to the Centers for Disease Control, Latinos, African Americans, American Indians, and Pacific Islanders are 2–4 times more likely to develop diabetes than other populations, due to a combination of historical, economic, and genetic factors. Culturally appropriate care with regard to patient preferences is therefore vital when making dietary suggestions. The nurse must offer recommendations that are attractive to the patient, informed by an understanding of the patient's tastes and expectations regarding food and eating habits.

The concept of "person" extends beyond the individual's body or psychology and acknowledges the social influences that shape that person. This includes awareness of cultural attitudes toward exercise — for example, some cultures may be resistant to the idea of women and girls exercising in public — as well as the role of women in preparing food within the home. A patient may be reluctant to alter recipes traditionally prepared by her mother or grandmother, even when the prescribed diet for managing blood sugar contraindicates certain ingredients. Nurses must navigate these dynamics with sensitivity and respect, recognizing that social determinants of health profoundly shape patient behavior and treatment adherence.

Conclusion: Integrating Person, Environment, and Nursing Practice

Understanding the patient and environment means understanding what circumstances brought the individual to his or her particular state of health — the third critical component of nursing — and determining the type of nursing intervention warranted to improve the patient's wellness. One of the great strengths of the CNS role is the ability to devote more time to understanding the needs of a specific population likely to present within the nurse's framework of practice. Specializing in diabetes treatment or emergency care allows the nurse to develop deeper insight into the needs that extend well beyond treating the immediate, visible manifestations of an illness. Integrating all four nursing metaparadigm concepts — person, environment, health, and nursing — ensures that care is not only clinically sound but also socially responsive and culturally competent.