Providing Culturally Sensitive Care: It Takes More Than KnowledgeJune 25, 2014
By Karen Roush, AJN clinical managing editor. Photos by the author.
One Saturday a few weeks ago I grabbed my camera and headed out to spend the afternoon taking photographs around the city. I ended up wandering around the streets of Chinatown, photographing the street life—the rows of fresh fish on piles of ice, the colorful patterns of vegetables in crates outside shops, old women in variations of plaid and flowered housedresses lined up on a bench, children scattering clusters of pigeons.
Eventually I happened upon a vigorous and highly skilled game of handball in a park. The competitors were predominately young Asian men, though there were a few Hispanic men playing too. Standing next to me, a young man was telling his friend about a clever way a mutual friend had devised to get out of paying a parking ticket. If you live in New York, or almost any big city, you will earn yourself a parking ticket or two at some point. Intrigued by this man’s idea, I asked him if it actually worked and he assured me it did. Then he rolled his eyes and said, “Oh no, I shouldn’t have said anything. Once the white people know, that’s the end of it!”
I think of myself as having good cultural and ethnic awareness and sensitivity. But that phrase, once the white people know, was startling to hear. I laughed at the time, and so did he, but it got me thinking about all the assumptions I make about my place in the world as one of the “white people.” I know I come armed with a lot of privilege—white, educated, living in a good neighborhood in a great city in a rich nation; even my primary language, English, affords me privilege. I know that people of color are still considered “other” to the standard of white in this country.
And color is only one of the many ways people are made to feel like the “other”—there’s also ethnicity or religion or class or sexuality or disability. I have spent time being the other, as a white woman during a month in a rural area of Uganda and then again during a month teaching at a rural college in Ghana. I wondered then how I was perceived by the local people, who would nod and smile or stare with serious curiosity. I knew I was an outsider, a visitor to their country, their community. Being the “other” made sense.
But it was so unexpected to be the “other” in my hometown. To be the subject of stereotyping, while not even quite sure what the stereotype is or why it exists. Are we white people blabbermouths? Do we tell all, tattle? Or is it that we co-opt everything as our own, claim it, gentrify it, own it? I wanted to protest, to assure him I was not that stereotype—in some odd, ironic way I wanted to tell him I wasn’t a typical white person, whatever that meant. In a matter of moments I had already bought the bias and was looking to disengage myself from it.
But it also hit me for another reason. Two of my children are Asian. I don’t think of them as nonwhite—I just think of them as my son and daughter, though I have always realized that as a minority they receive the world from a place that is different than mine. Standing there, labeled as one of those “white people” and categorized with preconceived ideas, I was experiencing what it must be like for them. The difference though . . . I was only a short subway ride away from being the standard once again.
Diversity is one of the great things about this city and this country. Hopefully we are moving closer to the day when differences exist without a hierarchy that sets one group up as the standard. But until that day, I wish every nurse—actually, every person—could have an “other” experience.
We learn cultural competence, differences in the meaning of family, illness, healing, and death among ethnic and cultural groups. We are taught to respect and provide care congruent with the beliefs and traditions of all of our patients. I think we do a pretty good job of that. But we can do better. Knowledge will only take us so far; to provide truly culturally sensitive care, we also need empathy. And there is nothing like experiencing something firsthand to develop the deeper, even if never complete, understanding that is the foundation for empathy.