Clinical Nurse Specialists as Cultural Brokers, Change Agents, and Partners in Meeting the Needs of Culturally Diverse Populations

Journal of Multicultural Nursing & Health, Summer 2005 by Jeffreys, Marianne R

Census results document the growing diverse populations residing within the United States and predict an ever-increasing trend in cultural diversity. Healthcare professionals now and in the future are challenged to promote culturally congruent care. The clinical nurse specialist (CNS) is in a key position to effect positive change as a visionary leader. The CNS has the potential to promote culturally congruent care and multicultural workplace harmony in a variety of settings. The purpose of this article is to describe the process of cultural competency and suggest strategies for meeting the needs of culturally diverse populations within the CNS role. The article will include a brief review of the literature, identify relevant conceptual models, define key terms, highlight specific applications for clinical nurse specialists, and provide an illustrative exemplar of the CNS as cultural broker, change agent, and collaborative partner within the three spheres of influence: patient/client, nursing personnel, and organization/network.

KEY WORDS: Black Indians; Clinical Nurse Specialist; Cultural Broker; Cultural Competence; Cultural Diversity, Multicultural Workplace Harmony; Partnerships.

Census results document the growing diverse populations residing within the United States and predict an ever-increasing trend in cultural diversity (US Bureau of the Census, 2000). Part of this trend is the growing numbers of immigrants, refugees, and multiple heritage individuals that comprise the client population and the workforce population (Jeffreys & Zoucha, 2001). Approximately one in four people living in the United States is a member of a racial or ethnic minority group, surpassing 75 million in total. With over one million immigrants entering the United States each year, the United States will become even more culturally diverse (Westphal, 1999).

Ethical principles declare the necessity to consider culture when providing health care and when interacting with culturally diverse health care workforce (AAN, 1992; ANA, 2001; Donnelly, 2000; Leininger, 1991a; Leininger & McFarland, 2002). Furthermore, the two overarching goals of Healthy People 2010, (US DHHS, 2000) demand cultural considerations when providing health care. The first goal, to increase quality and years of healthy life for all, can only be achieved when examining "quality of life" and the meaning of "health and well-being" within a cultural context. The second goal seeks to eliminate health disparities among different segments of the population, necessitating culture-specific actions designed to eliminate disparities. Consequently, healthcare professionals now and in the future are challenged to promote culturally congruent care.

The clinical nurse specialist (CNS) is in a key position to effect positive change as a visionary leader. Within the three spheres of influence (patient/client, nursing personnel, and organization/network), the CNS has the potential to promote culturally congruent care and multicultural workplace harmony in a variety of settings. The CNS statement (NACNS, 1998; 2004) attests to the various roles of influence in clinical practice, workplace settings, organizations, and networks. Population-specific care demands cultural congruent care. The CNS statement (NACNS, 1998; 2004) describes the role of the CNS to include cultural considerations and competency. Since cultural competency is a process (Campinha-Bacote, 1991; Campinha-Bacote & Padgett, 1995; Jeffreys, 2000; Leininger, 1994a; Leininger, 1991b; Purnell & Paulanka, 2003), the CNS of the present and of the future will need to be an active participant in the process of achieving cultural competency and will need a repertoire of strategies towards meeting this goal.

The purpose of this article is to describe the process of cultural competency and suggest strategies for meeting the needs of culturally diverse populations within the CNS role. The article will include a brief review of the literature, identify relevant conceptual models, define key terms, highlight specific applications for clinical nurse specialists, and provide an illustrative exemplar of the CNS as cultural broker, change agent, and collaborative partner within the three spheres of influence. Visionary implications for the future will be addressed.

CULTURAL CONGRUENT CARE AND CULTURAL COMPETENCY

Leininger defined cultural congruent nursing care as "those cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are tailor-made to fit with an individual's, group's, or institution's cultural values, beliefs, and lifeways in order to provide meaningful, beneficial, and satisfying health care, or well-being services" (Leininger, 1991b, p.49). This definition fits well with the CNS role within the three spheres of influence of client (individual or group), nursing personnel (individual or group), and organization/network (institution) and the desired CNS goal of achieving positive nursing care outcomes. Leininger's theory of cultural care diversity and universality and her illustrative sunrise model (Leininger, 1991b; 1994a; 2002) can provide a valuable resource and guide to CNS role development with culturally diverse populations. The desired outcome of the model is cultural congruent nursing care. This involves the systematic assessment of the dynamic patterns and cultural dimensions of a particular culture (subculture or society), including religious, kinship (social), political (and legal), economic, educational, technologic, and cultural values, and how these factors may be interrelated and function to influence behavior in various environmental contexts. Universalities (or similarities) and diversities (differences) within and between groups are examined (Leininger, 1991b; 1994a; 2002).