Imagine for a moment that you are a patient in a hospital that is unable to meet your special dietary needs. What are you going to do? Would you sign out against medical advice and go to another health care facility that can accommodate your requirements, even if its medical care is not known as the best?
The health care profession, like any other profession, has been forced to adopt customer-oriented service models. Logically, the best customer service model is to provide whatever is necessary to please every customer. In reality, of course, this model presents many challenges within the health care environment because of the many restrictions and contingencies, such as time, hospital policies, patient privacy and legal factors.
One of the biggest “customer service” challenges for nurses and other care providers is being able to meet the unique needs of patients from a wide variety of cultural, ethnic and religious backgrounds. Applying the adopted customer-oriented model within the context of nursing requires advanced assessment and validation skills whenever caring for our “customers” (patients). With this notion in mind, care providers are expected to be sensitive, open, flexible and able to meet these unique “customer” needs as appropriately as possible and at all times. Remember, cultural needs are not a luxury; they are a necessity and a part of the basic patient’s bill of rights.
Performing dietary assessments is one key area where nurses must develop cultural competency skills. Being knowledgeable about the dietary needs of different cultures and religions—including preferences, customs and restrictions—and how they may impact a patient’s care plan is essential to providing customer-oriented patient care. The following recommendations for conducting a dietary cultural assessment can guide nurses in reaching the desirable level of cultural sensitivity.
The art of asking the right questions—rather than making assumptions based on preconceived notions or stereotypes about various cultural, ethnic or religious groups—is the key to conducting a culturally competent dietary assessment. Here are some considerations to keep in mind.
Asking about the prescribed pharmacological/herbal treatments and visits to the folk practitioners need to be an essential part of our assessments. Being aware of the existing combination is a safety issue for both the patient and the care providers. In fact, we need to acknowledge the hidden competition of the Folk Practitioners existence in almost every culture, including the US. He/she is an experienced person in prescribing effective herbal treatments, home remedies, dietary management, etc. that are easy to follow and are quite inexpensive. The folk practitioner has almost a treatment for every illness, sickness, and/or all different kinds of health problems. Their repeated home visits for the sick are one of their key strategies for gaining great success among the poor, elderly, lonely, and the disabled population.
For example, physicians prescribe expensive nitroglycerin sublingual tablets for Anginal pain that usually expires within 6 month contrasting the Corandero/Folk Practitioners who prescribe peppermint oil that never expires and costs only a few dollars. Applying a few peppermint oil drops in the mouth has a very close vasodilatation effect on the body. Of course the elderly, no insurance, and limited income populations will select the peppermint regime especially if it can manage their condition effectively. Another factor for the folk practitioner’s success is teaching their patients effective complementary dietary practices such as drinking very light tea with plenty of natural mint leaves. The constant effect of the mint leaves on the blood vessels may easily keep some patient populations free from chest pain.
Whenever discovering the mix of the non-traditional and pharmacological medications, that are widely spread lately, it is very serious to ask the patients to continue or stop taking this combination. Especially if we do not know that much about these practices for the following reasons:
Conducting further physical and psychological assessment evaluating the effect of each therapy on the current health condition is a must before altering or stopping any of these therapies. Logically and scientifically, if assessment reveals a healthy condition, regardless of what is being used currently, it means that it must be working right for that patient or illness and why not keeping it and wisely ask for more frequent assessment visits as needed.
The best approach in similar cases is to continue dietary/herbal cultural assessment focusing on the following issues to reach a safe, sound, and legal decision:
Because there is no equivalent of FDA approval for most of these folk remedies, ask the patients for any documents or sources of information to gain in depth of information for any unfamiliar herbs, un-known therapies, and/or non-traditional ones. If nothing is available in English, there are many herbal and non-traditional books available in the public libraries, different bookstores, and university’s libraries that teach cross cultural programs. Internet searches may also be performed to reach countless English websites. Also, we need to accept that the patient is a source of such information whether documented or not. He/she is the one who knows most about these therapies and why he/she decided to try it/them.
Editor’s Note: Minority Nurse’s cultural competence expert, Gihan ElGindy, RN, MSN, is an internationally recognized authority on cross-cultural issues in nursing. Her advice column is designed to answer your questions about incorporating cultural competence into your nursing practice and resolving cultural conflicts in today’s diverse health care workplace.