Transcultural Concepts in Nursing Care

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Chapter 11 Culture, Family, and Community

up as early as 4 a.m. by a shuttle van that takes them into Tuba City, AZ, for renal dialysis; the van takes them home later in the afternoon. Depending on the route and weather conditions, some individuals may arrive home as late as 5 or 6 p.m. having spent up to 8 hours per day in travel time plus the time required for dialysis. This arduous routine may take place as often as 3 days each week. Other factors that may also limit access and use of healthcare services include the following: ●● Clients from may be hesitant to seek the services of healthcare professionals who do not speak their language. ●● Undocumented persons may be reluctant to seek healthcare because they are afraid of revealing their immigration status. ●● Women from traditional Muslim cultures may be reluctant to seek care from male healthcare providers. ●● Lack of understanding by clients of how to use health resources may deter them from seeking care. Nurses can develop sensitivity to diverse groups within communities and reach out to them with culturally specific health programs. Box 11-3 lists some important factors that nurses 6. Inconvenient locations or hours of health and social services that preclude clients from accessing care. 7. Lack of understanding, trust, and commitment on the part of healthcare providers. 8. The Social Determinants of Health as defined by Healthy People 2030 . They are economic stability, educational access and quality, healthcare access and quality, neighborhood and built environment, and social and community context (Office of Disease Prevention and Health Promotion (gov), n.d.).

Access to Health and Nursing Care for Diverse Cultural Groups Members of diverse cultural groups, especially those with low incomes and without health insur ance, face special problems in accessing health and nursing care. Access to care is often determined by economic and geographic factors. Certain cultural groups have faced discrimination and poverty, and their ability to access care has been compromised. Sensitivity to cultural factors has often been lacking in the healthcare of traditional communities and identified minority groups. In addition to economic status and discrimina tory factors that limit access to care, geographic location plays an important role in healthcare. Many medically underserved areas lack medical personnel and the variety of health facilities and services that are available to urban populations. For example, Native Americans living in sparsely set tled and isolated reservations in the western part of the United States must travel long distances, some times over primitive roads, to obtain healthcare services. Individuals who live on the Navajo or Hopi reservations in northern Arizona and have type 2 diabetes or kidney failure requiring dialysis must travel long distances for care. They may be picked 1. Employment opportunities and insurance coverage or the financial ability to pay for healthcare services. 2. Different traditional belief systems as well as different norms and values. 3. Lack of understanding, provider bias, and lack of trust on the part of social service and healthcare workers. 4. Lack of bilingual personnel or staff members or the lack of interpreters to assist clients and care providers. 5. Rapid changes in the U.S. healthcare system, where clients are “lost” in the gaps between agencies and services. BOX 11-3

Factors to Consider in the Nursing Care of Culturally Diverse Groups

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