Cultural cues important in home health care

Come armed with cultural knowledge

When a home care patient is from another culture it is a good idea to learn as much as possible about his or her cultural beliefs before the visit, says Jeanne M. Martinez, RN, MPH, CHPN, former quality and education specialist at Northwestern Memorial Home Health Care in Chicago and now a quality specialist with palliative care and home hospice at Northwestern Memorial.

"Find out as much about the general cultural values and beliefs as you can, but then be very cautious you don't assume each patient and family member ascribe to all of those values and beliefs because often they don't," says Martinez.

People are acculturated at different rates. There may be a lot of differences in the same family between who is acculturated and who has more core values and beliefs of the culture from which they came, particularly between generations, says Martinez.

"It is very important to always do an individual assessment and not assume because the culture at large believes that your individual patient believes that as well. But if you observe some customs in the home at least you have some background information of where the patient might be coming from," says Martinez.

For example, the home may have several religious artifacts that signal a person's faith is important to them. Or the female patient may be wearing a traditional, floor-length dress that signals privacy issues are important. A nurse raised in the United States may think nothing about exposing the lower leg to examine a wound with a male in the room, however in other cultures that action may not be acceptable. Therefore, it is wise to ask first, says Martinez.

Cues to appropriate behavior can also be spotted with careful observation. For example, if everyone has their shoes lined up at the door the home care visitor should take his or her shoes off, too.

Sometimes it is a good idea to curtail certain behavioral habits if it is uncertain how a person from another culture will react to them. "You may be the type of person who puts your arm around a patient and hugs them routinely; however, in a culture you are not familiar with, that might not be the thing to do," says Martinez. "You need to be careful about how you touch people."

Another obstacle to teaching a patient from another culture could be a language barrier. Interpreters sometimes accompany home health nurses to the home of a patient but when this is not possible telephone interpreter services can be used instead.

Pictures come in handy as well, says Martinez. She likes to have pictures to help reinforce education in any home but for patients who do not speak English or have low literacy skills, they are vital teaching aids.

When two people do not share the same cultural expectations and do not know what to expect from each other the home visit can be tense; it is important to come armed with as much knowledge of the culture as possible. It also is a good idea to bring teaching sheets in the patient's native language as well, Martinez explains.