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

CNS Action in Patient/Client Sphere of Influence

Discussion with Mr. Young revealed that he perceived the hospital environment to be threatening and "noncompliant" with his cultural feelings. He withdrew from the nurse in an effort to protect him from further cultural pain. The nurse had never asked him about his cultural background, identity, values, beliefs, practices, or traditional foods. Based on his physical appearance, the nurse assumed that Mr. Young was African-American and followed a "traditional soul-food" diet. Mr. Young stated that he was a "Black Indian" (Katz, 1997; Rich-Heape Films, 2000) and while he embraced his African-American heritage and Navajo heritage, his values, beliefs, practices, and traditional foods were mainly consistent with the Navajo culture. He added that he had resided in the Navajo nation until age 30. He had been experiencing emotional stress and discomfort due to the lack of awareness, sensitivity, and understanding by the nurse, other health care professionals, and the organization. In this case, stereotyping based on physical appearance led to cultural imposition and cultural pain. Furthermore, he expressed distress over the hospital admission form that asked for the selection of one "ethnic/racial group". The forced choice of one category makes the unique culture of the multiracial or multiethnic individuals "invisible" (Jeffreys & Zoucha, 2001). These culturally insensitive and incongruent incidents caused cultural pain and adversely affected Mr. Young's well-being and health outcomes. For example, elevated glucose levels during hospitalization may have been influenced by stress.

As a cultural broker, the CNS identified areas of action and change in all three spheres of influence. The next step as cultural broker would require action or intervention, with the patient/client sphere of influence as the immediate priority.

After expressing regret and sincere concern over the factors that had caused Mr. Young cultural pain, the CNS assured Mr. Young that every effort would be made to provide culturally specific and congruent care. Mr. Young responded favorably to the CNS's suggestion for consultation and collaboration with a transcultural nurse specialist familiar with the traditional Navajo culture. He also responded positively towards the further proposed consultation with a transcultural nurse generalist to help nursing and other health personnel become more culturally aware, sensitive, and develop cultural competence for culturally diverse populations.

Consultation and collaboration with a transcultural nurse specialist permitted quick access to the information and expertise necessary to provide high quality and cultural specific care for Mr. Young. Next, a detailed and systematic cultural assessment provided valuable information for designing a culturally specific care plan. In addition to the obvious mistakes made by the nurses previously, the transcultural nurse specialist pointed out several other barriers to achieving positive client outcomes with this client. One barrier to effective communication was the nurse's misinterpretation of Mr. Young's periods of silence in conversation and avoidance of eye contact as indicating lack of interest. Actually, among many traditional Native American groups, silence is expected to enhance understanding and exemplifies respect for the other person. Avoidance of eye contact also indicates respect and that the person is paying close attention to what is being said (Andrews & Boyle, 1999).