Nursing Process to Deliver Culturally Competent Care

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The aim of this paper was to find an article discussing the application of a nursing process to deliver culturally competent care for Indian Americans. Articles have been found through a search on (ERIC), Cumulative Index of Nursing and Allied Health Literature, PubMed, FirstSearch, and EBSCO. The findings reveal that Indian Americans experience massive healthcare disparities and continue to pass through higher rates of prevalence of some diseases and mental conditions in comparison with other ethnic and racial groups. Such communities include white Americans, Black Americans, and Hispanic Americans. In the context of Indian Americans, the pillars of nursing care revolve around the knowledge of their healthcare needs and respect for their religion, beliefs, and medicine during interaction with nurses. Implications of this study on nursing practice include the development of new standards, as an emphasis on hiring and deployment of culturally competent nurses to specific ethnic groups; and it acts as a foundation for future research.

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Application of the Nursing Process to Deliver Culturally Competent Care among American Indians


Cultural competence is increasingly becoming quintessential in healthcare to meet the needs of a multicultural society. It refers to congruent policies, attitudes, and behaviors that integrate in an agency, a system or among professionals to enable professional discharge of duties with the highest degree of effectiveness in cross-cultural situations (Bainbridge et al., 2015). The term culture is employed in this context in reference to integrated patterns that characterizes human behavior such as communications, thoughts, customs, actions, beliefs, and institutions of social, racial, religious, and ethnic groups. The word competence entails having the required capacity as a professional, in case a nurse, to function effectively. A system of care is considered to be culturally competent at each level when it emphasizes the importance of culture, demonstrates vigilance from various cultural dynamics, continually assesses cross-cultural relations, expands cultural knowledge among employees, as well as services are adapted to cater for culturally unique needs (Bainbridge et al., 2015).

According to the US Census Bureau, American Indians are the individuals originating from North and South America who continue to maintain a tribal affiliation or attachment to their communities. For Indian Americans, medicine and religion are intertwined. They always prefer to use traditional Indian medicine to treat a number of ailments (Hodge & Wolosin, 2014). Some of these medicines have no proven scientific bass but it is important for a nurse to be trained on how to acknowledge and respect these beliefs. For many years, an access to healthcare has been a huge challenge for this cultural group due to a number of barriers such as isolated living, poor roads, the lack of providers of healthcare, and high poverty levels. The research shows that 56% of Native Americans have a higher likelihood of dying from the causes related to alcohol than non-Natives (Hodge & Wolosin, 2014). The 5 biggest public health problems that they face include diabetes (Pima Indians residing in Arizona experience the high rate of Diabetes in the world), Injuries (CDC reports that more Native Americans are killed by Injuries at the age of 44 than any other cause of death compared to white Americans; and violent crimes have also skyrocketed), sexual abuse (1 n 3 American Indian women experience rape in their lifetime), tuberculosis, and suicides (Young Native Americans have a higher likelihood of killing themselves compared to any other group) (Aronson et al., 2016). Thus, the health disparities among this community are alarming.

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Registered nurses account for the largest number of professionals in healthcare. However, the ethnic and racial diversity of today’s nursing workforce does not reflect the general population (Loftin et al., 2013). It has come to light that individuals from ethnically and racially diverse communities like native Americans suffer high rates of disability and illness and have experienced the lower level of stress in healthcare than the overall population. Whereas the healthcare industry has made a number of progresses in reducing disparities in healthcare, there are still ongoing problems and outright challenges in its delivery to indigenous communities like American Indians (Loftin et al., 2013). Some of these disparities include; the increased rates of diagnosis of new human immunodeficiency virus among ethnic and racial minorities, higher rates of infant mortality for black women’s babies and higher incidences on non-communicable illnesses such as stroke, cardiovascular sicknesses, asthma, diabetes and cancer among minority populations (Bainbridge et al., 2015). Even though the causes of existing disparities are multifaceted, improved education on cultural competence for nurses and other providers of healthcare are regarded as most vital and potentially useful interventions required to change these circumstances. Also, the need for cultural competence among healthcare professionals like nurses has emerged as an international concern considering the recent surge in migration.


Several studies have recognized the big health disparity that exists between indigenous and non-indigenous individuals. The leading causes of disproportionate elevated rates of diseases and illnesses among the Native American populations are influenced by social determinants of health of the community and embedded in the historical experiences such as grief and loss, the loss of culture and land, social exclusion, trans-generational trauma and racism. This proposal seeks to demonstrate the importance of applying nursing processes/ principles to deliver culturally competence care to Indian American patients with high respect for their culture.

Research Method

It would be a case study involving the search information from the online databases. Data will be searched on the Educational Resources Information Center (ERIC), Cumulative Index of Nursing and Allied Health Literature, PubMed, FirstSearch, and EBSCO. The search terms included in the search are cultural competence, measuring cultural competence, nursing care process, culture competence, and cultural sensitivity. After identification of an instrument, it has been included in further searches. Exclusion criteria during the search have included the literature published before 2013, sources from other disciplines not related to nursing, and the literature with little information. The research prioritized literature that had been considered relevant (contains the information related to the topic), valid (contains up to date data on nursing care processes and cultural competence), and reliable (authored by reputable authors).

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Review of Literature

This review banks on a professional article by Ross et al. (2015) on health care services for American Indians and Alaska Native people. The authors have found that this group has a long history of experiencing poorer health status and continually reports adverse outcomes than any other ethnic community in America. The leading causes of death include; heart diseases, unintentional injuries, and diabetes. Their overall life expectancy when compared to other races across populations in the US is 4.2 years (Ross et al., 2015). The Indian Health Service (IHS) has reported that individuals from Indian tribes have a higher rate than any other racial and ethnic group in the US of mortality because of several conditions namely; chronic liver disease (368% higher), Type I and Type II diabetes (177 percent higher), unplanned injuries (138 percent), homicide (82 percent), and suicide (65 percent higher) (Ross et al., 2015). Additionally, there are significant cases of mental health disorders that affect the quality of life of Indian American individuals. According to the study conducted among the youth living on a reservation, 28 percent were diagnosed by at least a psychiatric disorder, 60 percent with a depressive disorder plus substance abuse disorder, and 13 percent had multiple mental health conditions (Ross et al., 2015). Also, Indian Americans have higher rates of dependence on drugs and alcohol and high death rates related to alcohol compared to any other community in the US. In fact, Indian Americans are associated with the highest rate of prevalence of daily to weekly limits of drinking with 53% exceeding the two limits compared to the whites at 52.5%, blacks at 29%, and Hispanics at 37.3% (Ross et al., 2015). These findings are alarming.

The first nursing care process that applies to this cause is knowledge of the needs of Native American patients. It is important to understand their very long and troubled history in the country. A nurse must also comprehend their inter-generational and historical trauma. Even without understanding their language, it is imperative to identify their source of trauma by learning their story. It can be achieved by conducting listening sessions with the help of an interpreter. Secondly, a nurse must show respect to their medicine and religion and, in some cases, employ a model of spiritual care for older American Indians under inpatient care. It will improve the patient overall satisfaction with the service (Hodge & Wolosin, 2014). Thus, competent care among nurses is characterized by knowledge and respect to the healthcare needs, religion, and beliefs of Native Americans.

Implications for Nursing Practice

Developing new standards in the nursing process and care

The findings from this study will reveal some strengths and weaknesses in current nursing care processes in relation to meeting the multicultural needs of Native Americans. Identification of various shortcomings in the healthcare work flow will lead to necessary adjustments in curriculum taught to nursing students and used to train nurses to increase their competency levels to anticipate and manage complex cases. For instance, the nursing practice can measure cultural competence of a nurse before certification.

Justification for hiring culturally competent nurses

The proposed study will illustrate the significance of emphasis on cultural competence as a part of emotional intelligence in the nursing profession. For instance, the profession can prioritize hiring competence nurses with the roots in Native America where most clients come from ahead of competent nurses with no knowledge of cultural issues affecting the clients.

Foundation for further nursing research

The study is broad as it tackles a nursing process and cultural competence, in general. It means that the findings will not provide answers to specific cultural issues affecting patients. However, it will create a need for the additional research on how the healthcare work flow in specific specialties. Such ones as theater, oncology, mental health, maternity, and orthopedic just to mention a few ones to apply in certain cultural issues, i.e. traditions, religious beliefs, and gender roles just to mention a few ones.

In conclusion, the society has become more diverse and multicultural because of globalization and immigration. As a result, it is important to study and identify the required improvements in nursing practice to overcome the hindrances imposed by cultures to provide quality care and improve health outcomes in patients. This proposed qualitative case study will reveal the significant findings that can be applied in nursing practice to advance the quality of service delivery in care facilities.

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