Transcultural nursing

In the multicultural landscape that is the United States, providing individualized patient care often consists of more than clinical knowledge. Cultural competency training exists for various healthcare professions. The U.S. Department of Health and Human Services defines cultural competency as “the level of knowledge-based skills required to provide effective clinical care to patients from a particular ethnic or racial group.” Many states mandate cultural competency training for medical schools as well as a similar component for continued medical education.

Transcultural nursing is a specialty that focuses on worldwide cultures and incorporates cultural and religious values into nursing care and patient health. Transcultural nurses often treat patients who are migrants, immigrants, or refugees, integrating their knowledge of clinical care with culturally sensitive approaches.

Everyday transcultural nurse practice

Patients seeking care come from various walks of life and have differing views on healthcare than a healthcare provider may have been routinely exposed to. A few of the daily activities of a transcultural nurse include:

• communicating with foreign patients and their loved ones
• acting as a bridge between a patient’s culture and medical practice
• determining the patient’s cultural heritage, language skills, and if any of their health beliefs relate to their illness
• collecting information on any home remedies a patient may have taken to treat their symptoms
• understanding the influence of culture, race, and ethnicity on the development of social and emotional relationships, child rearing practices, and attitudes toward health
• collecting information about the socioeconomic status of a patient’s family and its influence on their health and wellness
• educating patients about medical practices

Patients with beliefs rooted in different traditions may not be inclined to accept western medicine. Some patients can be strongly opposed to blood transfusions or pork-based products on the basis of religious practices, while others may prefer same-sex practitioners. Providers who are unfamiliar with traditions may be unable to connect with patients or see eye-to-eye on approaches to care. In turn, patients may not feel heard, safe, or respected, resulting in inadequate patient care.

As a transcultural nurse, it is important to ensure patients understand their medical state and options, and to provide resources available to ensure this

As a transcultural nurse, it is important to ensure patients understand their medical state and options, and to provide resources available to ensure this. This may mean seeking interpretative support, taking time to build rapport with patients, and taking steps to learn about other cultures to further build awareness of culturally competent care.

The challenge of language barriers is not only faced during in-person interactions, but also in instructions of care for patients and caregivers. Materials, care instructions, and medication with complex regimens need to be appropriately relayed to patients and the importance of fulfilling these requirements conveyed in a manner they understand. For example, these may be written in a language they understand or pictures may be used for further simplicity.

Many cultures emphasize traditional or herbal medicines in their healthcare practice. As a transcultural nurse, it is essential to not dismiss these practices, but to understand them and to explain to patients how these practices may be impacting their health. Various cultural foods, beverages, and traditional medicines such as teas may interact with medications, disease states, or laboratory readings, and have negative consequences in treatment goals. Knowledge of common cultural practices helps transcultural nurses understand how these may be impacting patients’ health outcomes.

Transcultural nursing education

Typically, it takes between 2 and 5 years to become a transcultural nurse. The 2 primary educational routes are completing an associate degree in nursing (ADN) or a bachelor of science in nursing (BSN).

An associate degree is the minimum academic requirement for becoming a registered nurse (RN) and beginning work as a transcultural nurse. ADN degrees are offered at community colleges and some universities and include on-site clinical training. Upon earning this 2-year degree, you are prepared to assist physicians, dress wounds, run diagnostic tests, review treatment plans, and provide patients information on self-care.

A BSN is a 4-year degree path that combines classes in nursing education with clinical experience guided by a practicing nurse. There are also options for accelerated 15-month bachelor’s degrees in nursing science. A bachelor’s degree requires in-person clinical rotations at a hospital affiliated with your chosen nursing school.

Those wanting to become a transcultural nurse should seek further certification under a graduate study or track program offered by the Transcultural Nursing Society.

After completing an associate or bachelor’s degree, you are required to pass the National Council Licensure Exam (NCLEX) to become a registered nurse. Those wanting to become a transcultural nurse should seek further certification under a graduate study or track program offered by the Transcultural Nursing Society.

Professional certificate program can typically be completed in 12 months. Many programs also offer online curriculums. Coursework for these programs usually includes:

• social, political, and cultural barriers to healthcare
• medical conditions and diseases common to specific populations and cultures
• issues facing healthcare professionals administering care to diverse peoples

Along with the clinical focus, there is also an emphasis on how to develop appropriate care plans and interventions when working with patients from other cultures.

“It’s important to understand why patients are seeking care, and being a transcultural nurse may help you understand far beyond the clinical aspect of healthcare.”

Taz Williams, transcultural nurse in Long Island, NY

Who is this career best suited for?

A career in transcultural nursing is best suited for those with interest in and empathy towards different cultures. Transcultural nurses are able to recognize and appreciate cultural differences in healthcare values, beliefs, and customs. They are familiar with the religious customs, values, and beliefs of patients. In addition, they understand how someone’s way of life and unique habits can impact how they deal with illness, healing, disease, and death.

Transcultural nurses are able to work in a number of clinical settings, from large hospitals to small rural clinics, enabling them to assist patients from all walks of life. In addition to various domestic clinical roles, including travel nursing, transcultural nurses are also well-suited for positions in military healthcare or overseas medical volunteer programs.

A day in the life of a transcultural nurse

Taz Williams is a transcultural nurse based in Long Island, NY. She spoke to us about working as a healthcare provider in NYC and interacting with patients of many different cultural backgrounds on a daily basis. When asked what the greatest challenges are when treating patients of different backgrounds, Ms Williams mentioned language barriers, but also cultural values:

“Not all patients believe that taking 5 medications a day is a good quality of life, or that limiting certain foods or drinks is going to help their medical conditions. Many older patients who have had a routine their entire life may not be inclined to see your point of view or why at this point in their life they have to change their habits. [The] age of providers may also be a factor. In many cultures, you do not question the elderly, as they have more wisdom and life experience and therefore know more about health and curative factors than a young healthcare provider. As much as you may want to explain your qualifications, its best to try to see the patient’s point of view and together come to an understanding of their current health and goals where they will not have to omit all aspects of their culture.”

Ms Williams shared this memorable experience of a time when connecting with a patient and making an effort to understand their culture made all the difference:

“I once had a patient who had many comorbidities, high blood pressure, depression, high cholesterol, and atrial fibrillation. She was on numerous medications and presented with fever, diarrhea, and muscle stiffness. She was an older woman with limited English. I asked about her medications and she had a list prepared with doses and frequency. Nothing was out of the ordinary. I wanted to ask more but had to seek an interpreter to allow for deeper conversation about her daily habits, what she eats, had she traveled, and exercise habits. The interpreter was able to guide our conversation. [The patient] took a walk every morning and stopped at a local restaurant for breakfast. She had porridge, and a cup of tea. Nothing out of the ordinary it seems. But to many cultures, tea is composed of herbal elements. I asked what kind of tea, and this may have saved her life. St. John’s Wort is an herb used for centuries by many cultures; it’s thought to treat depression and heal wounds due to antimicrobial properties. However, it also interacts with a number of medications, including the medications my patient was taking. My patient was drinking St. John’s Wort tea twice a day and was presenting with serotonin syndrome, which can lead to death if not treated. A patients lifestyle, especially cultural, has everything to do with their healthcare, and as transcultural nurses and healthcare providers, we have to make the effort [to understand where they’re coming from].”

Final thoughts

In the melting pot that is the United States, the diversity of modern healthcare requires an appreciation and willingness to understand other religions, customs, and beliefs. As a result of this diversity, healthcare providers are almost guaranteed to be exposed to and treat patients from cultural backgrounds different than their own. The need for transcultural nursing will continue to be an important aspect of patient care.