What is ethnogeriatric nursing practice?

When a health care provider meets a health care recipient, there are at least two cultures operating in the interaction and there can be vast differences between the two. Nurses need to find and know the available information about cultural values, belief systems and the prevalence of disease in cultures dissimilar to their own. Using this valuable information [is] ethnogeriatric nursing practice.

So many of our immigrants have post-traumatic stress disorder buried under their medical problems. They've gone through things we could never imagine such as a war, Chernobyl or the Holocaust. Having knowledge of a patient's history facilitates communication and, ultimately, their treatment.

For example, we have an elderly black female, age 87, raised in the South, a civil rights activist, now blind, with dementia. She needed a quad cane. The supplier called her home for her Medicare number by mistake. She hit the roof and accused us all of getting into her business, expressing a lot of suspiciousness around the call.

At first, it all seemed unnecessary and could easily be labeled as paranoia and treated with medication and other therapies. However, when the nurse looked at her history and life experience, which occurred during the time of lynching and segregation, the nurse understood the patient's suspicions.

Also, one of the tools that I'm working on is a cohort analysis and integrating historical events with a patient's age into nursing practice.

How did you get interested in this specialized nursing area?

I worked as a geriatric nurse practitioner for more than 25 years in Miami and we had some patients who-no matter what we did-didn't improve. We found, in this instance, that it was part of their culture to have family take care of them in old age. Unfortunately, their family was geographically separated and no one was available to function as a caretaker. Their depression needed a different approach that included cultural beliefs.

What is the importance of intercultural competence?

The way to approach patients is the key to providing help or not. Health care occurs at the intersection of aging with different cultures. Whatever we do health care-wise, it has to be acceptable and relevant to that particular individual. Any plan has to be satisfactory to the patient and their family; otherwise, it's not going to work.

For myself, I learned the importance of communication style from the American Indian community in San Jose. This is important because assertiveness and confrontation are Western constructs considered rude in other cultures.

There are now voluntary federal guidelines from the Centers for Medicare & Medicaid Services addressing cultural differences. Other regulatory bodies, such as JCAHO, require interpretive services such as staff members or telephone services and family members for non-English-speaking patients.

How is ethnogeriatric competency addressed in nursing education?

This issue is increasingly being addressed in nursing curricula. I travel around the country to bring home its importance to nursing practice. Culture affects just about everything: response to pain, medication compliance, health care decision-making and especially end-of-life decisions.

The best way to teach about different cultures is to integrate the information with the existing curriculum. I work with nurses to integrate elements of ethnogeriatric assessments into their established practices.

In the '80s, Madeline Leininger developed a transcultural nursing framework. The information gained put nursing ahead of this game. We're still building on those constructs.

How do you bring home your message for ethnogeriatric nursing?

I'm part of an innovative collaboration at the UCSF School of Nursing with a faculty appointment at Laguna Honda Hospital. This opens up all kinds of ways to educate and interact with providers. I do lectures, seminars and one-on-one, grass-roots teaching with the staff. This latter approach works best over a longer term, for that's where change takes place.

I'm having the most fun working on a daily basis with the Adult Day Health Center. I consult with the inpatient part of the hospital and work with interdisciplinary teams that include nurse managers, nursing staff and patients.

I did a study and found that in the main hospital, the largest patient population is Caucasian, the second-largest is black, followed by Asian.

The nursing staff is 48 percent Filipino, which presents a truly multicultural workplace. Every patient interaction is going to be intercultural. This includes not only between the patient and the caregiver, but also between patients themselves.

Anything you'd like to add?

The art of what we're doing every day in nursing is taking a huge amount of information and bringing it down to one interpersonal interaction. That one point of contact is where we have a chance to make an impact on the health of that individual and their family. That's what ethnogeriatric nursing practice is all about.