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Carol Reinhardt (left) and Sushma Das, a respiratory therapist, clean a patient's airway.

Salamanca added that one way to practice cultural sensitivity is to give patients your time and simply listen to them. She and other nurses say that Hispanic patients in particular like to spend time with their health care providers and that many of the older Hispanic people insist on expressing their own-often less than scientific-reasons for the onset of a particular ailment.

Salamanca, who is of Colombian and Chilean descent, recalled one elderly Hispanic patient who was certain that her cough was due to the large number of cockroaches that had temporarily infested her home.

"You have to be respectful of what they have to say," she said. "Obviously, you want to steer them to other ways of thinking, but you have to listen with a sympathetic ear because a lot of what they tell you stems from their beliefs. If you put them off, it only builds a wall."

Other examples of hospitals and clinics trying to accommodate the customs and beliefs of minority groups abound. One of the more dramatic examples comes from Zazworsky, who recalled that while working as a nurse at an Arizona hospital several years ago, she watched an elderly American Indian patient become extremely agitated in his bed. It turned out that the man's window faced a roof corner of the hospital on top of which sat a statue of an owl. According to the beliefs of his tribe, the owl signified death and thus the man believed he was going to die. Hospital officials eventually removed the statue.

One question that often arises is how can any nurse or doctor know all the customs and beliefs of the patients that come before them? It's not easy, say health care professionals. It takes years of interaction with members of different cultural groups as well as efforts on the part of hospitals and clinics to enlighten their employees about the ways of particular peoples.

At Sunset Park Family Health Center, for example, Tong oversees language and cultural training sessions, while Reinhardt said that the staff at Ohio State University Medical Center creates posters that describe the customs and beliefs of the many different groups that reside in the community.

Several books also address the subject. They analyze the health care beliefs of various cultural groups and, in essence, serve as a quick reference for all the dos and don'ts when providing care for foreign-born residents. Culture & Nursing Care: A Pocket Guide, for example, is a 300-plus-page pamphlet that describes everything from the death rituals of Haitians to the ways Russian women prefer to deliver babies. (Vaginal over cesarean-even if a baby is in breech position, physicians are expected to exhaust all measures to ensure a vaginal delivery.)

"It provides a way for nurses to approach patients from different cultures and help improve communication during what is often a time of great stress and transition," said Sue Dibble, DNSc, RN, professor of nursing at University of California, San Francisco, and co-author of the pamphlet.

Of course, many nurses add that there is more to properly treating patients from different cultures than just understanding their particular views on health care. It also helps to know aspects of their daily life.

"You want what you're doing to have an impact on these patients, and so you have to know a bit about how they live," Tong said.