Cultural competence in the real world

I would bet money that every single one of the nursing books I own mentions something somewhere about cultural competence. It’s one of those “key words” in nursing, like “evidence based practice.” By now, when we’re reviewing it in class, I start to think, “Really, this again?” And sometimes I feel like saying, “If I have to hear about cupping and coining and herbal remedies ONE MORE TIME….!”
Maybe it’s because I live in LA. I grew up here and cultural diversity is kind of just another part of life. I don’t really think about it, but I think I am pretty culturally sensitive and learning about practices and traditions of other ethnicities has been a part of my “life education” growing up. So when I came across those cultural chapters for the fourth, fifth, and sixth times, I skimmed through it, gleaning only the material that stuck out. Not anymore.

It’s not about the parts of the text that talk about what the traditions are that should be focused on; once you learn them, seen them, or heard stories about them, you will remember. The part that should be discussed, and is surprisingly less present in the text books is the part about what you should do when you encounter them. Text books tend to read something similar to this: “Many Asian cultures believe in the balance of hot and cold within the body. While Western medicine and nursing practice teach us to unwrap a patient with a fever and provide cooling measures, people from these cultures may bundle up with many blankets and request only hot liquids to ‘burn off’ the fever.”

That’s it. They just want to let you know that this is something that happens. Well, our family has always practiced this, and I can tell you that it’s always worked to burn off fevers by bundling up, so if I were in the hospital and someone put a cooling blanket on me, I would probably kick it off and go on the hunt for the blanket warmer myself! But the text always stops there. Few books give a good measure of what to do when our nursing practices conflict with culture beliefs.

I had an incident occur at work a few months back that showed me what it was like to really deal with cultural differences and that even if you try to be “therapeutic” there are some things that are just going to hurt their feelings. I was taking care of a baby one day when I noticed the mother was giving him plain water separate from his formula. At first I didn’t think too much of it, thinking “well, she’s in the hospital, someone must have said this was ok.” But then I noticed he had more diapers than he had the previous day, and so I questioned the nurse about it, and she had no idea about the extra water. We had to go talk to the mom.

She explained to us that she knew she shouldn’t give water outside of what was mixed with the formula, but her family kept calling from back home and telling her that he must be sick because he is “too dry” inside, that he needs water. She was getting so much pressure placed on her from her family, that she was giving him small amounts. The nurse was culturally sensitive and fantastic about talking with the mom about it, even when she started crying and explaining that the pressure was too much.

It was a very eye-opening moment for me. Looking back, it was more than any therapeutic discussion and cultural sensitivity lecture could have taught me. The books can’t really tell you how to deal with it, every patient is different. But I understand the importance now, I know what it means to be culturally competent in the real world, and I am sure this was just the first of many more lessons to come.