The nursing landscape is probably more challenging and rewarding today than it has ever been. Patients face new illnesses, and there is a constant development of new treatments and sciences to aid medical staff in fighting off disease. Today, patients hope to be treated by nurses who are knowledgeable, culturally diverse, and empathetic.
Nursing is a rewarding but challenging occupation. A report by the Health Resource & Services Administration regarding satisfaction levels among nurses before the COVID-19 pandemic showed that 89% of nurses in the American healthcare system were extremely satisfied with their chosen healthcare career.
Despite this fact, the turnover rate for nurses remains high. Heightened expectations have been brought about by the shift towards patient-centered care. Patients expect to be involved in decisions regarding their treatment.
There are also a multitude of emerging social, ethical, and cultural factors that affect nursing. The nurse-patient dynamic has changed significantly from a few decades ago.
Why the shift?
The United States of America is more diverse than it has ever been. Today, communities are made up of people from different ethnicities, races, backgrounds, and countries.
Forty or fifty years ago, most nurses dealt with mainly Caucasian and mainly Christian patients. They may have been different in terms of their economic backgrounds, but most shared values based on their religion and their race.
Today’s nurses have to deal with a diversity of patients. They need to have a good understanding of people from different races, different countries, and a variety of religions and cultures.
Social factors also come into play. Economic and job opportunities vary from patient to patient, and nurses have to take this into account as they dispense care.
In keeping with these changes, many universities have tweaked their curricula to equip nurses with skills to enable them to cope in the challenging new environment. The basic nursing courses are the same, but nursing students also touch on themes like cultural competence, community health, and patient-centered care.
Nurses who enroll in higher education courses further explore the cultural, ethical, and social issues that affect nursing practice. Those who sign up for an online master’s nursing education program, for example, cover topics like evidence-based practice, nursing education leadership, and educational evaluation methods. The course is designed to equip educators with skills to teach nurses how to cope with many of the issues that they encounter as they practice. Those who qualify can become nurse educators or nurse managers.
As you climb the nursing career ladder, it is important to be aware of the cultural and social ethical issues that affect nursing in America and what is being done to tackle them. When you encounter them in your course, they will be familiar, and when you are employed as a nurse manager or educator, you will know what to anticipate.
Social factors that affect nursing practice
Imagine an ER in a large city like New York or Los Angeles. On any given day, nurses attend to patients from all social backgrounds.
Some are rich, and many are poor. Some are well-educated and aware, but many only have a basic education. Some of the people nurses care for come from the very best of neighborhoods, but many live in the projects, and some are homeless.
How is a nurse supposed to provide adequate care to such a diverse group of patients?
The social factors that affect the nursing profession are also called social determinants of health. These are economic and social conditions that affect health and healthcare. Money is probably the most powerful determinant of health. People with more money can afford the very best in healthcare.
Even when they attend an ER in a large hospital in New York or Los Angeles, they will get top-level treatment, be admitted in private rooms, be afforded access to the latest equipment, and be beneficiaries of the latest innovations in healthcare. The poor, on the other hand, are given the bare minimum, and it is not the fault of the nurses or the doctors. The blame lies with the structure of healthcare in America. Those who can afford to pay for it get the best, and those who cannot have to make do with the little that the system is willing to do for them.
As a nurse, you will encounter this situation time and time again. You are sworn to help all who are ailing, but that isn’t always possible.
The COVID-19 pandemic played a critical role in highlighting how different socio-economic classes are treated by the healthcare system. We saw poor people die because they couldn’t afford to pay for basic care.
Nurses rose to the task of advocating for those who couldn’t speak for themselves. They highlighted their plight and put these stories out, hoping that something would be done to increase equity in healthcare. It helped. Many hospitals were forced to review how they dealt with admissions, treatments, and care, and it helped save lives.
Other social determinants include education, income, and employment; access to good food; access to decent living conditions; and even incarceration.
Social factors are hard for nurses to deal with because they often fall outside their sphere of influence. If a community is poor and cannot afford good nutrition, for example, there is little that the nurse can do other than treat those who come in with various complaints.
Nurses do whatever they can to help. Many become advocates for the underprivileged in their communities, helping their voices be heard in the places that matter.
They collect data about the social factors that impact their patients and how they affect their health and present it to politicians and heads of organizations that can help improve healthcare equity.
Many nurses also take it upon themselves to educate their patients on how they can make a difference. They may teach young mothers about basics like good nutrition and child care. They may also teach the elderly about diet to help them manage chronic conditions.
Nurses can also do little things that make a big difference. Sending homeless people to shelters where they can get a hot meal and a place to sleep, especially when it turns cold, is a good example.
The important thing is not to give up. Things evolve, and social factors that impact health also change. Your community may have poor access to healthcare because of low income and other factors, but your efforts and the efforts of others who are determined to change things will pay off one day.
Cultural factors that affect nursing practice
Cultural factors have to do with our beliefs and attitudes. In some cultures, it is taboo for women to be treated by male doctors. In some religions, blood transfusions are a no-no. Patients sometimes die because their beliefs forbid them from undergoing organ transplants.
These are just two examples, but they touch on some of the most common cultural factors that nurses have to deal with as they care for patients.
Nurse have their own cultural beliefs. Growing up, they developed certain attitudes. What happens when these don’t match those of the patient?
Cultural competence has become a buzzword not just in healthcare but in many other professional spheres. As communities have become more diverse, understanding other people’s cultures helps us be more accommodating and patient.
For nurses and others in health care, cultural competence is an important skill that they must start to develop as soon as they start practicing.
But what is cultural competence in healthcare? It is the ability to deliver healthcare without regard to the patient’s race, beliefs, religion, or culture.
In America, statistics show that minorities are disproportionately burdened by disease and yet have less access to healthcare than Caucasians.
African Americans and Native Americans are more likely to suffer from chronic illnesses like heart disease, cancer, and diabetes. They are also less likely to get adequate healthcare. These can be challenging issues for any nurse to think about. How do they go about changing a system that is burdened by such endemic problems?
You may not be able to change the whole system, but you can play your small part by making sure that you care for every patient to the best of your ability without regard for race, ethnicity, attitude, or beliefs.
Learning about other cultures is not easy, but you should make time to understand them. Good communication can go a long way toward making your job easier.
If a patient refuses to be attended by a male nurse, the nurse should ask the right questions to try and understand why. If it is because of their religion or their culture, the best thing to do would be to get a female nurse to care for the patient.
Immigrants are particularly at risk because of the language barrier. If a patient cannot converse in a familiar tongue, they may not be able to adequately explain their symptoms, they may not be able to provide a comprehensive history, and they will not be able to express their preferences during treatment. It affects their treatments and care.
It is the job of the nurse to do whatever they can in such a situation. They may look for a translator, or they can use a translation app to try and understand what the patient is saying. The nurse can also look for relatives or friends who speak English to help the patient communicate.
Developing cultural competence is not easy, but people do it all the time. Nurses are busy, but if they want to serve their patients better, this is one of the things they have to make time for.
They should make time to mix with people from other cultures and countries so that when they encounter them as patients, they can serve them with ease.
Below are some of the areas that nurses should strive to understand if they want to be culturally competent:
- The role of individuals in the family: Some cultures are rather hierarchical, and certain individuals are expected to undertake certain roles. In some cultures, for example, the mother is the caregiver, and it is viewed as shameful for fathers to care for children.
- The role of the community: What do you do if ten or fifteen visitors arrive to see a patient during visiting hours? It may be cultural for everyone in the community to provide support and prayers to the sick, and trying to stop them from visiting would only cause problems.
- Religion: Religion can have an impact on diet, how patients view certain treatments, what beliefs they hold about their illness, and even how they believe they will be healed. There are stories told of native Americans who insisted on shamans visiting them in the hospital to help them heal. Rather than alienating a patient because of their religion, accommodating them will yield better results.
- Views on death: In some religions, death is not something to be afraid of. It is something to be welcomed. They believe they are going to a better place. If a patient doesn’t want to be resuscitated or for doctors to take life-saving measures, it is best to obey their wishes.
- Beliefs in alternative medicine: Alternative medicine has become mainstream, and millions of Americans seek alternative cures every month. It is pointless to try and stop them; they firmly believe that these treatments are helpful. The nurse must find a way to accommodate a patient who insists on using Eastern or Chinese medicine.
- Sexuality and fertility: Beliefs about sexuality and fertility are varied, and while some may look ridiculous to an American, they are firmly entrenched in some cultures.
- Beliefs about food and diet: Every culture has beliefs about certain foods. A patient may refuse to eat a particular meal because it contains a certain ingredient. Catholics will not eat meat at certain times of the year. Fighting with such beliefs is a losing battle. The sooner you understand them, the better.
Ethical factors that affect nursing practice
These are factors that arise when decisions have to be made. Unfortunately, healthcare is an area that calls for decisions to be made all the time. Nurses and doctors often face complex issues, and they have to act quickly to save lives.
Common ethical issues include informed consent, protecting patient privacy, the right to die, and advanced care planning. Nurses also deal with refusal to take medications, decision-making for terminal patients, DNR orders, and child protection.
What happens when the ethics of the nurse do not match those of the patient or those of other professionals within the healthcare team?
What should a nurse do, for example, if a parent refuses to allow their child to get life-saving treatment? Should they let the child die? Should they fight for the right of the child to live without regard for the parent’s wishes?
The nurse’s code of ethics can be helpful when making ethical decisions. It deals with issues like human dignity, moral virtue, confidentiality, and healthcare as a right. It serves as an excellent guide for nurses when they are dealing with fundamental issues.
However, things can get complex, and the code of ethics sometimes doesn’t seem to help. What should a nurse do, then?
The most important thing is to make sure that all their actions are guided by state and federal law. If need be, they can ask for a consultation from the legal department. Nurses must also observe hospital protocol.
It is important to consult when confronted with an ethical dilemma. What may seem to you like helping a patient may go against the rules and get you into a lot of trouble.
Ask older, more experienced nurses who have served in managerial positions for an opinion. They can provide eye-opening insights.
If all else fails, leave it to the hospital administration to make the necessary decisions. They will consult with whoever they need to and then tell you what action you ought to take.
How can nurses become more culturally, socially, and ethically competent?
There are no hard-and-fast answers. There is no single book you can read that tells you how to act in any given situation.
Over time, as you become a more experienced nurse, you will become a better decision-maker. You will learn about other people and their cultures, and you will become more tolerant of those who are different from you.
Don’t be afraid to ask questions; it is the fastest way to learn. If you show a genuine interest in other people, they will be happy to share their cultures and beliefs with you.
Interacting with different types of people is a great way to learn about others. Seek out social settings that expose you to people from different countries and cultures.
Nursing practice is evolving, and many of the changes are driven by the cultural, social, and ethical factors that nurses have to take into account when caring for patients. There is no doubt that these are complex issues, but every nurse can play their part in making sure that each patient is treated with respect, compassion, and empathy.