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Carol Reinhardt, RN (right), reviews a poster presentation with colleagues Brenda Vermillian, RN (left), and Sheila Smith.

As Carol Reinhardt, RN, recently entered the room of a new patient in the intensive care unit at Ohio State University Medical Center, the longtime nurse assumed the discussion she was about to have with family members would be like most others.

It wasn't. The patient was an Iranian man, and as Reinhardt began explaining his ailment to the loved ones gathered around his bed, she quickly encountered the unexpected. When she tried directing her discussion toward the man's wife and daughter, they lowered their heads and turned away.

It eventually dawned on Reinhardt that she was supposed to speak only to the man in the room-who in this case happened to be the patient's son-in-law.

Reinhardt then mentioned the hospital's visiting hours-and received a look from family members like she'd just asked them all to jump out of the nearest window. The son-in-law requested to see the nurse manager and explained that leaving sick loved ones alone for any amount of time was akin to abandoning them. "They had no comprehension of visiting hours," Reinhardt said. "It was something that was abhorrent to them."

The nursing team met with the family and quickly worked out a compromise: The visiting hours would stand, but be extended each day for family members of this particular patient. The impasse was solved, but not before it provided Reinhardt with yet another example of what she sees as a growing trend in her hospital and many others: an increasingly diverse patient population-with increasingly diverse needs.

Most researchers agree that the United States, long a destination of immigrants, continues to grow more culturally diverse. According to the U.S. Census Bureau, the number of foreign-born residents in the country jumped from roughly 19.8 million to a little more than 28 million between 1990 and 2000. What's more, experts predict that Caucasians, who now represent about 70 percent of the U.S. population, will account for barely more than 50 percent by the year 2050.

The country's growing number of newcomers, many of whom migrate from Latin America and Asia and in smaller numbers from throughout the world, come from all walks of life.

However, they share at least one thing in common with everyone else: They, too, need health care.

"This is something that every nurse needs to be aware of," Reinhardt said. "Our country is growing more and more diverse, and the people from these different cultures are finding their way to our doors."

When they get there, the going is often rough. Nurses around the country say that from language differences to divergent viewpoints and beliefs, providing medical help to patients from different cultures can be a mighty challenge. Nonetheless, it is a challenge that many hospitals and nursing staffs are attempting to meet as the populations they serve take on an increasingly international appearance.

"In years past, the medical community has largely just paid lip service to this matter," said Karen Aroian, Ph.D., RN, a professor with the college of nursing at Wayne State University in Detroit. "But it has now become a most pressing issue for health care providers."

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