Culturally Competent Nursing in
Homecare
Meghan Crivello, BS, RN, BSN
Abstract:
Homecare nurses must be culturally aware in order to appropriately care for
homecare patients. Culture plays a part in the care of all types of patients but it plays a more important role in
homecare. The care is being completed in the home where the patient controls the care. The nurse has to assess the
cultural background of the patient in order to implement an appropriate plan of care.
Every day the population of the United States is becoming more and more diverse.
It is important for nursing to becoming culturally competent to take care of the patients effectively. It is
especially important in home care due to the fact the care is taking place in the patient’s home. The nurse is
essentially a guest in the patient’s home. In traditional health care setting, the patient is the one who could be
seen as the guest; in home care it is reversed. Patients have the right to refuse care from the nurse, they control
whether they are compliant with the nurses instructions or not. Although this can also happen in a hospital, a
homecare patient is able to completely refuse any time of care. A hospitalized patient is at least able to hear
what the nurse has to say before deciding not to follow the recommended plan of care. A homecare patient can refuse
to even speak or allow a nurse to come into their home. A home care nurse has to be culturally competent in order
to be an effective care taker. A patient who may be seen as noncompliant may just have different health care
practices based on their cultural. These differences need to be recognized and embraced for the patient to
effectively participate in their plan of care. The homecare nurses have to be able to adjust their care
accordingly. Prior to becoming culturally competent, the nurse must first look at their own beliefs. The nurse has
to understand their own cultural needs before they can take of others.
Registered nurses are primarily Caucasian, 90% compared to 2% of Hispanic
registered nurses.(Maier-Lorenz, 2008) Hispanics are the fastest growing minority in the United States, according
to the 2010 United State census the Hispanic population grew 43% from 2000 to 2010. The Caucasian population grew
only 5.3% in those same ten years.(U.S. Census Bureau, 2011)Homecare nurses have to be culturally competent in
their daily care. They have to adjust their plan of care for each patient identifying particular cultural
characteristics to meet the healthcare goals for the patient. (Maier-Lorenz, 2008)Madeleine Leininger defines
cultural based care in nursing as “the most comprehensive, holistic, and particularistic means to know, explain,
interpret, and predict beneficial congruent care practices. Culturally based caring is essential to curing and
healing, as there can be no curing without caring, although caring can occur without curing.” (Leininger, 2002) A
homecare nurse needs to look at the whole picture of the patient, beyond the medical diagnosis to be an effective
caregiver.
To be an effective nurse leader in home care, one has to be aware of what is going
on behind the nursing care and especially when the nurse is not there. The nurse needs to be able to determine why
a patient may not be receptive to teaching, taking their medications or going to the doctor. The nurse needs to be
culturally competent and this can be done by having an open mind. To address the cultural issues up front and ask
what can be done differently and what is culturally acceptable.
Language barriers can present a problem. An official translator needs to be
available via phone to communicate effectively with the patient. Family members should not be used as translators
because they may not translate exactly what is being said. The family member may also include their personal and
cultural preferences in the translation causing a miscommunication between the patient and the
nurse.
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