Healthcare is something we all need from time to time even in the healthiest of lives, from the cradle to the grave. Illness and injury occur to us all, regardless of age, sex, race, religion, disability, sexuality or gender identity.
However, it is not always that simple. Illnesses do not always manifest in the same way, particularly between the sexes or across age ranges. Ethnic origin can also impact health, with some conditions being more common in particular ethnic groups. In addition to the different ways an illness can have an impact, there are also cultural implications, which means that care may need to be adapted to suit the patient. The different dietary requirements of various religions can be an important consideration. Rather than saying that every patient deserves the same care, it is better to say that every patient deserves the same standard of care, which should also be adapted as appropriate.
Guidance around the tailoring of healthcare to fit diverse patient profiles is something that applies to all healthcare professionals, however it is often nurses who provide the greatest continuity of care, so they may need to be particularly aware and sensitive to differing needs and beliefs. Nurses are also very accustomed to providing holistic care, where they consider the entire patient rather than simply a collection of symptoms. As a result of this, it is often second nature for nurses to adjust their care plan according to patients’ cultural beliefs. This means they are well positioned to ensure that care plans are adapted to diverse patient profiles.
Learning about diversity
Nurses come from all backgrounds. Some will be accustomed to diversity, while others may come from areas where most people have the same skin color and religion. Learning how to adapt care plans according to diversity starts when nurses are in training. Courses that cover topics such as building competencies in patient care for patients of all ages and diversities and understanding health factors in different communities and vulnerable populations are key to this.
There are numerous training options to begin a career in nursing. One of the most common is the Bachelor of Science in Nursing (BSN) as most nursing positions now require at least a BSN. If you already hold a bachelor’s degree in another field, you may be able to enroll in an Accelerated Bachelor of Science in Nursing (ABSN), which will allow you to complete your studies in less time. If you’re wondering “What is ABSN capable of covering?”, reputable institutions such as Elmhurst University offer online ABSN programs that include online study, on-campus residencies and clinical placements in your own locality to prepare you for the National Council Licensure Examination (NCLEX-RN) in as little as 16 months.
You will learn how to adjust care plans for diverse patient groups, but education for nurses does not end there. New discoveries and practices are being made all the time, and it is important for nurses to keep on top of the latest developments. These may include new insights into how different conditions manifest or affect different populations, which can impact care plans.
In diverse populations, illnesses can be more common in some groups than others. Symptoms can also manifest differently. In considering the differences whether in the physiology or at the genetic level, it is easy to see how complex treatment and diagnosis can be. Nurses who specialize in specific conditions will need to be particularly aware of how this relates to their specialty. Taking a patient’s history is often key to determining the right treatment plan from the beginning as it may provide some insight during the diagnosis.
Age is one of the most obvious examples that even non-medical professionals can see will impact on diagnosis and treatment. During the COVID-19 pandemic, we all saw how the elderly were more at risk of fatality from the virus than children and young adults. However, if disability or a chronic condition was also a factor, a young person could have the same or higher risk as a much older person. This resulted in a different care plan, particularly with the vaccination program with the elderly protected first. Similarly, with injuries, the same fall can have a very different result. A child may cry for a few minutes but soon be running around again, quite proud of their scabbed knees. An adult is more likely to feel shaken by the fall and perhaps a bit embarrassed. For the elderly, it can be a far more serious problem, and is more likely to result in fractures and may leave them feeling nervous and vulnerable.
There are also conditions that become more common with age. Heart disease, strokes and cancers all become more common, as do cognitive disorders such as dementia. Although none of these conditions can be ruled out in a younger patient, there may be more common conditions that the medical professionals will consider first, while in an elderly patient these conditions may be the ones to first rule out.
There are some very obvious differences between males and females that are likely to affect treatment, namely with their reproductive organs. When taking a medical history, it is important to find out if there is any possibility that a female patient is pregnant. This may impact on a diagnosis. For example, a female patient presenting with severe abdominal pain might be suffering from a miscarriage or an ectopic pregnancy. An ectopic pregnancy is an emergency and would need to be diagnosed quickly. There are also some medications and treatments that are best avoided during pregnancy. A CT scan or an abdominal X-ray for example would only be carried out on a pregnant woman if the benefits will truly outweigh the risks. Part of the care plan of a female of childbearing age might include a pregnancy test to rule out this condition before providing treatment.
Heart disease is just one condition that can manifest differently in males and females. Males usually report chest pressure and although women will also report this, they are more likely to also report other symptoms, such as nausea, sweating and pain elsewhere on the body. Understanding the difference in symptoms will help providers reach a quicker diagnosis.
However, it is also important not to make assumptions. Gender identity can make the differences less obvious. This further underlines the importance of obtaining a complete medical history. For example, someone who identifies as a man may have reproductive organs that mean a pregnancy is possible.
Some genetic conditions are more prevalent in a particular race. Sickle-cell anemia for example is most common in those of sub-Saharan African descent, while thalassemia is most prevalent in those with Mediterranean ancestry. This may mean that in diagnostics these conditions are more likely to be considered in patients of that ethnic origin. It can also influence genetic testing carried out in pregnancy. However, prevalence does not mean these conditions cannot arise in another population. Making assumptions about race should be avoided, particularly today when many people have a diverse ancestry.
Cause and effect
When considering whether a particular characteristic may have caused a condition, it is important to check for other factors rather than assuming it is inherent in the patient’s biology as this will impact how the patient is treated. For example, it might be noticed that a particular immigrant population has a lower-than-average life expectancy. However, rather than looking solely at whether they have a genetic disadvantage, the problem may be linguistic. Communication difficulties may mean they are less likely to seek healthcare and struggle to follow the advice given. Advice freely available in the community on aspects of health and diet may only be available in English, making the information harder to understand. In this case, the correct treatment would be to improve accessibility to healthcare, with nurses and physicians drawn from the same cultural group or who speak the same language. Healthcare information can be printed in multiple languages common to the community.
It should also be noted that poverty is one of the main drivers of ill health, both physical and mental. In the US, poverty rates among Black and Hispanic people are much higher than among the White population. This can mean they are less likely to have medical insurance, have reduced access to healthcare, struggle to afford nutritious food and suffer from the stress inherent in living in poverty.
In addition to the physical differences of age, sex, disability and ethnicity, there can also be cultural reasons why nurses should adapt their care plans.
It is a sad truth of society that discrimination continues to be an issue, and this can make it harder for patients to access medical care. While the way LGBTQ+ people were treated during the AIDS pandemic of the 1980s has changed, there are still many within the LGBTQ+ community facing discrimination and judgment. Nurses need to be able to treat people without prejudice and should regard all people as equally deserving of the very best healthcare they can offer.
Nurses often have patients who have been victims of discrimination and abuse which can make it hard to trust anyone, even medical professionals. Simply accessing medical care can make patients feel anxious and vulnerable, so any additional steps nurses can take to demonstrate respect for their patients will help. For instance, a male nurse should make sure a female patient is comfortable receiving treatment from them, particularly if it requires any intimate care such as help with showering or toileting or treatment that requires the patient to be exposed, such as an internal examination or a mammogram. If the patient is uncomfortable, the nurse should not take it personally but arrange for a female colleague to take over those aspects of care. The very act of stepping back is an important part of the care plan in helping the patient feel more comfortable accessing medical treatment.
If offering dietary advice, putting together a dietary program or treating someone as an in-patient where they will require meals, finding out their religion is essential as this may affect the foods they are able to eat. A person of the Jewish faith will require food to be kosher. This means not eating meat and dairy together and having meat slaughtered in a particular way. Certain meats, including pork, some seafood and cuts of meat from the hindquarters, are also not allowed in the diets of some religious communities. For Muslims, the rule is halal and they too will not eat pork or pork derivatives, which may mean that gelatin-based medicine cannot be used. They will also not consume alcohol, so if an alcohol-free medicine is available, it should be offered. Hindus do not eat beef, and many Buddhists are vegetarian. If in doubt, a nurse involved in drawing up dietary plans should check with the patient or their family.
Religious and cultural traditions
Nurses should be aware of any rules related to a patient’s religion and how they may affect healthcare. A family nurse practitioner (FNP) providing advice to women of the Islamic or Jewish faith should be aware that there are rules for them being in the company of non-related males. Suggesting swimming as a form of exercise might be good advice, but unless you can also inform them of a women-only session, the advice is unlikely to be taken. For FNPs, knowledge of their local communities is highly valuable in knowing what health support is both available and appropriate.
You should also recognize and respect items of religious or cultural dress. A mangalsutra is a thread worn around the necks of Hindu women and must never be removed without their permission. For Sikhs, the hair is a gift from God and should not be cut without permission. The only exception to this is if a patient is unable to consent, such as being unconscious and in a life-threatening situation where emergency treatment is essential. Also be aware the Sikh men may not wish to remove their turban and if they do, they may wish to wear an alternative head covering. If the turban does need to be removed, explaining the reasoning to the patient and/or their family will help to establish nurse-patient trust rather than just expecting them to remove it in the same way that you would expect any other patient to remove their baseball cap. If items of religious significance are removed, they should be treated with respect and kept either with the patient’s own belongings or entrusted to their family for safe keeping.
Elderly and end-of-life care
There are many cultural and religious differences in how the elderly and end-of-life care is handled. In Western culture, it is becoming increasingly common for the elderly, once they can no longer manage independently, to move into a care home or residential facility. While never an easy decision, nurses can offer families support in finding the right home for their loved one and provide advice on how to settle them in. However, for some cultures, the idea of ‘putting elderly parents in a home’ is out of the question. For them, support is needed on how to best care for their loved one at home.
When the end does come, be respectful regarding the traditions different families have for the dead. If appropriate, a nurse can arrange for the dying patient or their family to receive support from their spiritual leader. Having conversations about this before the end is imminent can help a patient have a more peaceful death and give the family the chance to say their goodbyes and grieve.
Providing the appropriate care
While it may seem like there is a lot to remember, the reality is that no one can remember every rule of every religion or culture or fully understand what it means to live a culture or lifestyle different from their own. When adjusting care plans, the most important rule to remember is to be respectful and avoid making assumptions. Collecting information from patients and their families will provide a good place to start, and as the ones providing continuity of care, nurses will often learn more as they get to know their patients and can use this knowledge to advise other medical staff working with that patient. As long as the nurse is respectful, patients and families will not usually object if you ask questions to clarify whether a treatment plan is appropriate. By being polite and respectful, nurses can ensure the patient is being treated in the way all humans deserve.