“Culturally competent care includes knowledge, attitudes, and skills that support caring for people across different languages and cultures. Culture influences not only health practices but also how the healthcare provider and the patient perceive illness” (Murphy, 2011, para. 1). Murphy continues to state in her article regarding cultural competence, “becoming a culturally competent nurse… Acquire a knowledge base of cultures in your service area, especially in relation to healthcare practices and beliefs…Avoid making stereotypical assumptions about your patients' culture; become aware of your own biases and prejudices…Learn new communication skills to simplify language for any patient, regardless of primary language” (Murphy, 2011, para. 5).
Providing culturally competent nursing care along with that of culturally sensitive care is essential to obtaining the most successful results possible. In order to deliver the most effective and proactive care, providers must be willing and able to understand the basis of what their patients values are, what their religious beliefs stem from, and what their perception of the medical world is along with how they view potential treatment and/or prognosis, if any (Campinha-Bacote, 2011).
Three individuals were interviewed, all from different backgrounds. This project was performed to more clearly demonstrate the differences between those in which the medical world come into contact with on a regular basis.
Robert Herrera is native to the United States, as are his parents and grandparents. Even with deep roots in this country, he comes from a strong family background of Mexican heritage and Catholic beliefs. Herrera said that he and his family has a close connection with their extended family; they always have, and continue to do so. For as long as he can remember his family visited regularly with other family members, on a weekly basis if not more frequently. The Catholic religion was strongly practiced within the family; it was their livelihood. Herrera recalls going to Sunday mass regularly; his was not a family who only attended on religious occasions. All-in-all, Herrera emphasized the strong-family unit he is a part of. It was a difficult and trying time when he met his wife while off at college. He nervously brought her home to introduce to his family, his Caucasian fiancé who had a firm belief in the LDS church. This caused a temporary rift in the firm-bond of the family unit. As means to compromise and show respect to Herrera’s deep-rooted Catholic family, he and his wife married in a catholic cathedral with marriage venue to go accordingly. After the marriage he said he began to explore the LDS church, with his wife. He felt it had a strong and positive impact on him, and eventually was baptized. This caused yet another trial to come upon he and his family (R. Herrera, personal communication, February 5, 2014).
In 1990 Herrera and his wife welcomed into their home their first child, a baby boy. Catholic custom is to baptize children in their infancy. This was a huge deal to the practicing Catholic family, something they wouldn’t just “get over” if the infant was not baptized. The baptism had much greater significance to them. As devout LDS members, Herrera and his young bride came to the conclusion that they would allow their son to be baptized in the Catholic Church, for no other reason than to provide comfort in the hearts of the firm and strong believers in the family. This was a difficult decision, but one that he and his wife eventually came to terms with and felt good about (R. Herrera, personal communication, February 5, 2014).
The last major event that Herrera and his wife had to come to terms with was whether or not to circumcise their son. Being brought up in Catholic teachings it was only natural for Herrera to be against the medical practice; along with that his wanted his son to be like him, in a sense. His wife had always assumed that she would have her sons circumcised; it was a practice in her family, one in which was performed on her father and brothers, just one of those things that one typically doesn’t place much thought into until the time comes, yet they have a strong opinion about. Fortunately this discussion between the married couple went as well as could be. Being that her husband, and the father of her son was uncircumcised, it made it a bit easier to go without her son being circumcised (R. Herrera, personal communication, February 5, 2014).
Since the beginning of their dating relationship, Herrera said there were obvious bumpy-roads that he, his wife, and both sides of the family had to pull through. Since then, they have come a long way. They openly practice their [LDS] religion and celebrate family traditions that they have both created together and that they have incorporated into the family from their own past traditions. Herrera ended the conversation by making it clear that “the key to success with our family is to respect one-another. My wife and I are devout members of the LDS church, my parents and extended family come from a long line of firm Catholic beliefs. We may not have the same beliefs, but it doesn’t mean we have to be scared of those practices either. My wife and I have participated in catholic celebrations that are significant to my family, and vise-versa. This is an act of love and respect for one-another” (R. Herrera, personal communication, February 5, 2014).
William Howard is also a United States native, as are his parents and grandparents. Howard grew up in a close-knit African-American household. As an only child he enjoyed being raised in the same house as three of his cousins. Extended family always lived near-by and get-togethers were frequent. Howard was raised Jehovah’s Witness. To simplify this, he said that his family did not believe in celebrating the “typical” holidays that most Americans do. As a child he was somewhat curious as to what these “parties” were all about, especially as he was shipped from his regular classroom, to the library during such times as Christmas parties and valentines celebrations in school. He saw the excitement of surrounding children as certain holidays approached, but that was about the extent of his understanding (W. Howard, personal communication, February 6, 2014).
While working in his early adult years he met and eventually married his Caucasian, Christian wife. Though his wife was “Christian”, she was not at all active as far as attending a religious institution. Prior to marriage it was thoroughly discussed how they planned to live out their beliefs. Howard, at this point, did not attend a religious institution either, however his childhood beliefs remained with him and the idea of actively taking a part in pagan celebrations was not comfortable to him. His wife was adamant that she was going to celebrate ALL holidays, and would raise their children the same. They did get married with this understanding (W. Howard, personal communication, February 6, 2014).
It’s been 9 years since Howard and his wife were married. They have two children and every holiday is celebrated full-force. Though Howard plays no part in the festivities (doesn’t decorate, won’t buy gifts, etc.) he doesn’t place any limits on how his wife choses to celebrate or what she teachers their children in that regards. Howard is present for the celebrations, but his presence is about as far as his participation goes (W. Howard, personal communication, February 6, 2014).
Unfortunately the understanding of respecting and embracing familial differences has not been a success for them. Howard’s mother didn’t attend their wedding because she disapproved of his choice to marry a white woman. Though she has since over-come the racial-barrier, she has yet to overcome the religious differences. His mother won’t even come to their home if decorated with Christmas lights. Howard describes his mother as a caring, loving individual, but feels immense guilt if she is in any way intertwined with activities that are contradictive to her beliefs; she is unable to find a balance between her religion and family (W. Howard, personal communication, February 6, 2014).
Lastly Robert Burgess was interviewed. Both he and his wife are US natives, along with their parents and grandparents. Burgess was sent to church weekly as a child. He remembers his parents sending him and his siblings outdoors to be picked up by a bus that transported them to church. He can’t recall the denomination, but remembers leaving church terrified each week, as the topics preached were always “hell and damnation.” His parents had no religious preference; Burgess believes it was more of a convenience to ship the kids off to church (R. Burgess, personal communication, January 31, 2014).
As Burgess became an adult and met his wife, there were no difficulties of struggles to overcome between the two of them or their families. Both families were pretty Americanized, visited with extended family, though perhaps not near as frequently as those in other cultures. They were taught that they needed to provide for themselves, and to give a loving home to the children they would have. Aside from this, Burgess and his wife began the journey of starting their own family, as they pushed away from the families they were raised in, in the sense of reliance. Their health beliefs center on those of most Americans, with little to no stray from the ordinary (R. Burgess, personal communication, January 31, 2014). This appeared to be the easiest blend of culture/heritage, but at the same time it seemed as though extended family remained at a distance in comparison to the other two interviewees.
As these three individuals were interviewed it was noted that Herrera came from a background that had more of a “if it’s not broke, don’t fix it” attitude. Though not all religious based, circumcision wasn’t seen as a necessity. Vaccines were looked at as placing poisons into an otherwise healthy individual. Breast feeding was the only form of nutrition for infants; formula wasn’t even to be a consideration. When it came to childbirth it was to be done naturally without pain medication, as the belief was that the unborn child would become ill from the medication given to the mother.
After Howard’s interview the impression left was that things are meant to remain as they are. Races shouldn’t be mixed, marriage should remain within the religion of origin, and that families are the center-stone of their life. Medically, the family’s central belief is maintaining good, healthy eating and lifestyle habits. Minimal objections come into play within the medical community, however they do not believe in blood transfusions. With this knowledge, all is done to prevent and minimize placing them in the predicament of requiring one.
Burgess came across pretty main-stream with his beliefs on medical services. Prevention is the key, in his opinion. All should be done to prevent disease and illness, from healthy living, to vaccinations, to regular doctor checks to receiving prompt medical care and treatment when conditions do arise.
Three very different people; three ways of thinking and living. Amazingly it doesn’t appear it be that different when looking at the individuals themselves. Understanding that each person is unique and comes from a different walk-of-life and communicating openly with these people is what will make the difference between successful medical care or not. Individuals want to be “seen”, they want to be heard, and they want to know that THEIR best interest is the goal of the provider caring for them. When this is accomplished, patients will begin to feel as though their needs are being met and feel less like just another name for the provider to cash-out on.

References
Campinha-Bacote, J. (2011, May). Delivering patient-centered care in the midst of cultural conflict: the role of cultural competence. ANA Periodicals, 16(2). Retrieved from www.nursingworld.org
Murphy, K. (2011, March/April). The importance of cultural competence. Nursing Made Incredibly Easy!, 9(2), 5. http://dx.doi.org/10.1097/01.NME.0000394039.35217.12