CONSULT PRN

60 Volume 36 | Number 1 www.homehealthcarenow.org

How to Provide “Culturally Competent Care” MARY CURRY NARAYAN, MSN, RN, HHCNS-BC, CTN-A

You have already taken the first step to being a culturally com- petent home healthcare clinician by recognizing that you need to adapt care to meet the needs of your culturally diverse patients. Research indicates that racially/ ethnically diverse patients are at risk for health disparities (Agency for Healthcare Research and Quality, 2015). A recent system- atic review of the home health- care literature found that racially/ ethnically diverse home care pa- tients have poorer clinical, func- tional, and patient satisfaction outcomes compared with White home care patients (Narayan & Scafide, 2017). Culturally com- petent care is basically “patient- centered care” (meeting patient needs and preferences as defined by the patient) for culturally/lin- guistically diverse patients.

One of the challenges in pro- viding care across cultures is that “good health” and “good care” are defined differently by different cultural groups. Eti- quette norms (the way we show respect for one another) and ethical norms (the way we do the “right” thing) vary across cultures. The kinds of foods one eats and the kinds of treatments one believes promote health also vary by culture. Although it is impossible to be an expert in the norms of all cultures, you

My agency is accepting more referrals for immigrants and patients who do not speak English. I know that I should provide “culturally competent care,” but exactly how do I do this?

Q: can learn about the beliefs, val- ues, and practices of the patient populations you most frequently encounter through Internet re- sources and other sources of knowledge, including cultural community leaders. However, relying solely on cultural knowl- edge, without asking patients about their preferences, can lead to stereotyping, imposing on patients’ beliefs, values, or practices they do not hold.

Here are some principles I keep in mind: 1) If the patient does not speak English well, work with a medical interpreter when performing comprehensive as- sessments or providing educa- tion. 2) Perform culturally sen- sitive assessments, identifying how the patient’s culture affects their care preferences. Ask how their health problems affect them, what they think is wrong, and how the problem is most likely to be helped. What kind of diet would be helpful? What do they think of the medications/treatments the physician has recommended? 3) Adapt the care plan to the pa- tient’s cultural preferences iden- tified during your assessment. I recommend an Encourage-Ac- commodate-Negotiate framework for developing the care plan. You will discover that many cultural norms, based on current evi- dence, are more health-promot- ing than many Western/American norms. You will also discover that many cultural norms are “neu- tral,” neither helpful or harmful from a Western biomedical per- spective. Accommodate them and include them in the care plan. When cultural norms are harm- ful (e.g., a high-fat, high-salt diet),

negotiate with your patients to change behaviors, using health- coaching techniques.

One last recommendation. En- courage your agency to support your efforts at providing culturally competent care by implementing the National Standards for Cultur- ally and Linguistically Appropri- ate Services in Health Care (Office of Minority Health, Department of Health and Human Services, 2013). Strategies for implementing these standards specifically within home care agencies are available in the home healthcare literature (Narayan, 2016, 2017).

Mary Curry Narayan, MSN, RN, HHCNS- BC, CTN-A, is a Home Health Clinical Nurse Specialist, Advanced Certified Transcultural Nurse, and Education/Quality Care Consul- tant, Narayan Associates, Vienna, Virginia.

The author declares no conflicts of interest.

Address for correspondence: Mary Curry Narayan, MSN, RN, HHCNS-BC, CTN-A, 10340 Brittenford Drive, Vienna, VA 22182 ([email protected]).

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

DOI:10.1097/NHH.0000000000000639

REFERENCES Agency for Healthcare Research and Qual-

ity. (2015). National Healthcare Quality and Disparities Reports. Retrieved from http://www.ahrq.gov/research/findings/ nhqrdr/index.html

Narayan, M. C. (2016). Culturally and lin- guistically appropriate services. In M. Harris (Ed.), Handbook of Home Health Care Administration (6th ed.). Sudbury, MA: Jones & Bartlett.

Narayan, M. C. (2017). Strategies for imple- menting the national standards for cultur- ally and linguistically appropriate services in home health care. Home Health Care Management & Practice, 29(3), 168-175.

Narayan, M. C., & Scafide, K. N. (2017). Systematic review of racial/ethnic outcome disparities in home health care. Journal of Transcultural Nursing, 28(6), 598-607. doi:10.1177/1043659617700710.

Office of Minority Health, Department of Health and Human Services. (2013, April). National standards for culturally and lin- guistically appropriate services in health and health care. Retrieved from https:// www.thinkculturalhealth.hhs.gov/clas/ standards. Accessed August 3, 2017.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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