By Debra Anscombe Wood, RN
With Lady Liberty’s welcoming torch in New York Harbor, people from all over the world have streamed into the metropolitan area, many seeking greater opportunities or freedom from oppression or discrimination. Diverse populations have enriched the fabric of New York and New Jersey, and when ill or injured, these patients require culturally competent care to best answer their unique individual needs.
“When you look at our hospital, we are virtually a melting pot of all different religions and cultures,” said Susan Olson, RN, a staff nurse and coordinator of service excellence at Holy Name Medical Center in Teaneck, N.J.
Maimonides Medical Center in Brooklyn, N.Y., also cares for a diverse patient population. Ruth Sharf, RN, nurse manager at Maimonides, said nurses try to “be sensitive to their cultural needs.” Some cultures are stoic; others look for family input. In addition, religious or sexual preferences give the patient population uniqueness and diversity.
“I enjoy working with different cultures,” said Seana Mohammed, RN, a staff nurse with the Visiting Nurse Service of New York. Nurses from around the region include questions about language and cultural preferences during the admission assessment.
Aware of the need for more cultural education, Olson spearheaded a Diversity Awareness Day event May 6 at Holy Name to raise colleagues’ understanding of the most frequently admitted cultural groups, including Hispanic, Korean, Jamaican, Jewish, Hindu and Philippine. More than 400 staff members attended. Dietary services prepared foods from each of the cultures. Nurses from various departments, including home care, researched and presented information about a culture’s general healthcare attitudes, family involvement, rituals surrounding birth and death, and beliefs about the causes of and responses to illness.
“If that culture believes it might be punitive to be sick, the nurse going in needs to be aware of that,” Olson said. “That learning was helpful to nurses.”
From the information gathered, the committee has prepared a resource guide to be posted on the hospital’s intranet. The guide informs nurses that Muslim women will likely prefer a female nurse or aide, so assignments can be adjusted. It mentions that Koreans tend to be stoic, so a nurse may need to ask about the patient’s pain status in a different way.
“[Being culturally sensitive] improves care and outcomes,” Olson said. “You are not treating everyone as the same package deal. Because you are aware of similarities, you’re more attune to the differences.” Holy Name has established an Asian Medical Program and a Hispanic Outreach Program. The Asian program began as a Korean program, in 2008, and has been expanded to include the Chinese population. Both programs focus on outreach, health education and screenings in their respective communities. The program also provides bilingual drivers to transport patients to medical appointments.
“When you make the care ethnically or culturally specific, people are more comfortable and tend to respond better,” said Linda B. Lohsen, BSN, RN, a nurse who has worked in the Asian program.
The programs also offer inpatient services, such as interpreting, navigating and finding referrals. Nurses have worked with the dietary department to add ethnic foods preferred by these patients, such as seaweed soup for postpartum Korean women.
“We helped to change the menu to make the palates of some of our patients happier,” said Nina-Marie Alvarez, BSN, RN, coordinator of the Hispanic Outreach Program.
Holy Name also participates in Bloomfield (N.J.) College’s Global Internship program. Students rotate through clinical areas, observing U.S. care, while Holy Name nurses learn about Korean culture.
Overcoming language hurdles
Language often presents a barrier to communication. Maimonides has created a book listing staff members who speak languages in addition to English. The hospital has translated the Patient’s Bill of Rights and educational materials into a variety of languages. Additionally, patient representatives can speak multiple languages.
“It’s reassuring to the patients when there is someone who speaks their dialect,” said Sharf, adding that sensitivity improves outcomes and patient satisfaction.
Holy Name will use Language Line, which offers non-English speaking families interpretation of more than 170 languages via telephone or video. It has invested in iPads and a video-interpreter service that includes American Sign Language. “The patients are speaking with someone who not only understands their language but looks like them as well,” Olson said. “There is a certain comfort to that.”
Broadening diversity perspective
Traditionally, nurses tend to think about diversity of ethnicity or religious groups. It also can include sexual orientation and gender identification. The 2013 National Health Interview Survey, from the CDC, found significant differences in health status, healthcare access and utilization, and health-related behaviors among adults who identified as straight, gay, lesbian or bisexual.
Jersey City (N.J.) Medical Center recognized the hospital serves a large population of lesbian, gay, bisexual and transgender patients and launched the PRIDE Promise: A Commitment to LGBT Healthcare Initiative to update policies, present classes and hold special events, including an open house for members of the community.
“It’s developing a comfort level about how you approach people who are different than you,” said Rita Smith, DNP, RN, senior vice president of patient care services and CNO at Jersey City. Smith said these educational opportunities have led to more open communication, resulting in better care.
Transitioning to home
Many resources exist to ensure culturally competent care in a hospital. As patients transition home, nurses enter those homes and must respect the patients’ and families’ beliefs. That includes nurses covering their shoes as a show of respect or talking with the oldest son per the patient’s request.
Being in the home also offers nurses insight into cultural practices that may contribute to illness and an opportunity to educate patients about ways to modify cultural preferences to be healthier. This can include baking rather than frying foods or using wheat rather than white flour. Nurses from the home care agencies train home health aides on how to cook and modify ethnic dishes.
Mohammed greets patients in their native language and said such communication improves outcomes. Her greatest rewards come from patients who make the adjustments and no longer need blood pressure or other medications because of healthy lifestyle changes.
“New York City is a true melting pot of cultures,” Mohammed said. “It’s all about clinicians understanding and learning about each culture and how they live day by day (to provide better care).”
Debra Anscombe Wood, RN, is a freelance writer.