Providing Patients with Cultural Care Protection Status
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by Karen Zulkowski DNS, RN, CWS

All medical personnel strive to provide care based on the strongest available evidence. Yet how many of us provide culturally competent care? Culturally competent care is defined as having specific cognitive and effective skills that are essential for building culturally-relevant relationships between patients and providers.1 We may know about local customs but in today’s global world our patients may be from a different area of the world. So how would you react if your Asian patient wanted to use non-traditional medicine or your patient of the Sikh faith refused to remove their underpants prior to surgery?

Different faiths and different cultures have practices that are important to those individuals. Interfering with them could cause distress. Therefore it is important for us to know more about our patient than just their medical history. Cultural assessment includes knowing the language for communication, and understanding the patients comfort level regarding proximity to others or need for/avoidance of eye contact. Other factors to consider include: what are the patient's beliefs about health and illness, what are the ramifications of the illness to their religious beliefs, and does the patient use/how important are any non-traditional medical practices.

In the United States, Native American tribes have varied beliefs and rituals. For example, many tribal members wear a sacred bundle. This bundle is filled with herbs and may not look important to the staff, but should never be touched without permission. Medicinal herbs may also be used for treatment and it is important to know what is being taken to look for potential interactions with prescription medications.

For Muslim patients it is important to understand the religious implications of care. For example, Muslim fatwa for ostomy patients. A fatwa is a religious/legal pronouncement in Islam, issued by a religious law specialist on a specific issue. Since ablutions (cleansings) must be performed before prayer, the existence of an ostomy bag is problematic. In the ostomy, Muslim patients are able to perform the traditional ablution before prayer (five times a day) and may enter the mosque. Possessing this information would be important for pre-surgical education and to allay concerns for these patients.

Other religions such as Judaism and Sikhism have specific issues. Certain geographic regions also have health beliefs that affect care. Some of these issues will be discussed next month.


1. Alexander, GR (2008) Cultural competence models in nursing, Nursing Clinics of North America, 20(4): 415-421.

About The Author
Karen Zulkowski DNS, RN, CWS is an Associate Professor with Montana State University-Bozeman, teaches an online wound course for Excelsior College, and is a consultant for Mountain Pacific Quality Improvement Organization. She has served as a Research Consultant with Billings Clinic Center on Aging, and was the Associate Director for Yale University’s Program for the Advancement of Chronic Wound Care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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