In an increasingly globalised world, such skill as cultural competence becomes valuable in parallel. For a considerable time, the notion that society is supposed to be homogenous was prevalent; at present, it is replaced by appreciation and respect for individual cultural differences (1). Consequently, the need for cultural competence in nursing practice is also accentuated. The sizable body of literature dedicated to the subject fortifies the value of attentiveness to diversity and inclusion in all types of medical institutions. Yet, the discussion around cultural sensitivity and healthcare mostly concerns patients and their beliefs (2). Nurses’ ethnicity and social heritage are sometimes overlooked despite its equivalent significance for establishing appropriate and efficient relationships. In this regard, ethnocentrism is a notion that is primarily applied not to patients but healthcare providers. Its inclusion in medical discourse helps shift the focus from patients’ cultural backgrounds to nurses’ ideas and biases regarding their own or patients’ ethnicity or cultural group. The paper aims to clarify how ethnocentrism affects nursing practice, establish the scope of its influence, its connection to cultural competence, and examine medical discourse regarding the issue.
To understand how ethnocentrism impacts cultural competence and contributes to its understanding in nursing practice, the notions should be clarified at the outset. The related literature contains many definitions of cultural competence, which is sometimes used interchangeably with cultural sensitivity. The array of notions may accentuate different facets of cultural competence in nursing. Nonetheless, it is commonly understood as “demonstrating knowledge and understanding of the patient’s culture, health-related needs, and culturally specific meanings of health and illness; continuing to learn about cultures of patients to whom one provides care” (3 p. 4). Currently, this competence is considered a critical element in the provision of efficient and relevant care for a population that becomes more diverse (4). Culturally congruent care is a deriving theory that strives to meet the patients’ desire to preserve their heritage. For instance, knowledge regarding Mexican American beliefs about the postnatal period could be necessary for forming nursing care plan in the theory’s framework (5). It can be stated that in given conditions, healthcare systems in multiple developed countries strive to be culturally responsive.
World perception, to an extent, depends on one’s cultural background, potentially leading to ethnocentrism, which entails understanding and judging other cultures by the standards of one’s own. In some cases, it could also be described as nurses’ perception of their home culture as the only one adequate and thus superior (6). In its origin, an anthropological notion, ethnocentrism became incorporated in medical discourse, partially due to Leininger’s theory of culture care diversity, which strives to narrow the gap in providing care for patients from diverse cultural backgrounds (5). Leininger’s approach emphasises the need to review the understanding of efficient care provision and for nurses to be culturally educated when dealing with a diverse population (5). Given the scope of ethnocentrism and its prevalence in medical settings, the idea of institutional ethnocentrism also emerged. Institutional ethnocentrism enforces the home culture’s methods to achieve goals, effectuate tasks, and specific behavioural patterns, even when dealing with diverse patients (7). Hence, ethnocentrism is a notion contrary to cultural competence, as it reduces the understanding of other cultures.
Institutional ethnocentrism has numerous adverse effects on nurses’ cultural competence and healthcare provision in general. According to Alizadeh and Chavan, “institutional ethnocentrism and cultural distance can deter an individual from using his/her cultural knowledge and skills to achieve favorable outcomes” (7 p. 128). Furthermore, institutions can facilitate or obstruct the acceptance and development of cultural competence among their employees (8). Organizational support is one of the most crucial factors determining the extent to which transcultural care is adopted. Ethnocentrism expressed in organizational practices has a greater power to affect the health outcomes of patients who belong to out‑groups. More specifically, nurse-patient relationships suffer because of it: patients may experience alienation, doubts, and suspicion, which can be prevented if medical personnel possess cultural competence. On the contrary, trustful relationships between patients and nurses, for example, could ensure that more quality information about a patient’s state is provided, and ultimately better health outcomes (9). It could be stated that cultural competence and ethnocentrism are in a negative correlation, and when the level of cultural competence increases, ethnocentrism becomes less prominent.
As it has been established, the main harmful impact of ethnocentrism on cultural knowledge and skills is that it commonly reduces them. In addition to the mentioned issue, ethnocentrism serves to reinforce Western medical practices and impose its standards on practices of other traditions – acupuncture could be an exemplary case in this regard (10). The treatment is characterized as a form of alternative medicine, and several studies on pain management strived to measure its effectiveness, but based on Western norms (11). For instance, a relatively recent study showed that acupuncture is rather efficient in mitigating the effects of carpal tunnel syndrome (12). A lot of medical practices are constructed for specific cultural frameworks. From the perspective of healthcare provision, it is important to recognize “how deeply professional practice is embedded with a Western worldview, especially when working across cultures and diverse communities” (13 p. 106). Generally, a widespread opinion is that ethnocentrism limits the capacity of nurses to understand how approaches regarding treatment of different cultures representatives should adjust accordingly.
Nonetheless, the perception of what causes ethnocentrism and what constitutes cultural competence in nursing practice may vary. For instance, Henderson et al. state that “healthcare providers perceive that by emphasizing cultural differences, they are showing respect for culturally diverse health consumers, which can lead to the promotion of ethnocentrism and not necessarily cultural competence ” (14 p. 593). Additionally, some healthcare workers, nurses specifically, may find it challenging to incorporate patients’ cultural differences in their professional practice (14). Although nurses’ cultural competence has been widely acknowledged as indispensable and ethnocentrism has been denounced, some level of ambiguity related to transcultural, culturally sensitive, and inclusive care remains (14). According to Rohrbach Viadas, cultural relativism in opposition to ethnocentrism complicates the establishment of the hierarchy of values needed even in transcultural nursing (15). Thus, the perception of ethnocentrism as detrimental and cultural competence as beneficial is not universal and occasional opinions that differ from those that seem to be generally accepted still appear.
In conclusion, western medicine can be broadly characterized as ethnocentric. Even though healthcare systems tend to be perceived as scientific and neutral, they are not invulnerable to societal influences. The notion contributes to understanding the importance of cultural competence by accentuating the adverse effects that it entails – the worsening of nurse-patient relationships, primarily. Nurses’ cultural competence signifies that they can understand, respect, and consider in their practice the health beliefs that people belonging to different cultures may hold. Despite the considerable shift that societies continue to undergo, from being homogenous to diverse, medical care still seems to require greater levels of transculturalism and cultural competence that ethnocentrism of individual workers and whole institutions decreases.
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