The goal of culturally sensitive gerontological care

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In nursing, and certainly in Western world nursing textbooks, privacy is held up as one of the fundamental principles of gerontolgical care. Hence, we would not consider it to be acceptable that a resident of a care home for senior citizens should be expected to share a room with ten other people, especially without the provision of bed curtains to afford at least some level of personal privacy. Yet, in the process of researching how Chinese older people adjust to life in a residential home, I found that many of the barriers to adjustment suggested in the literature, such as living with rules and regulations, and the communal nature of residential home life, were not in fact regarded as important by Chinese elders (Lee et al. 2002). One told me: ‘I don't need a curtain around my bed-unit. What's the point? Although ten of us are living together in this room, they (the other residents) are my brothers and sisters. We are a big family now. Why should I need a curtain to provide for privacy here?’ My research has led me to understand that Chinese older people's conceptions of residential living are more socio-centric than ego-centric, and this insight provides an opportunity to reconsider our beliefs about residential care which, for the most part, have been constructed by research and writing from the Western world.

Understanding how socio-cultural settings and values define and shape the beliefs and experiences of older people in our care is becoming increasingly important, and particularly in this era of population ageing and globalization. As a result of globalization the socio-cultural profile of our elders is rapidly changing and the importance of addressing socio-cultural influences on the provision of care for older people is becoming more widely acknowledged. But despite the profession's growing attention to issues of cultural diversity, there remains a concern that the culturally-determined health care needs and preferences of older people within indigenous populations and minority ethnic groups are not being adequately met. The goal of culturally-sensitive nursing care remains a somewhat distant ideal.

Meeting the needs of a growing population of older people from diverse cultures who, in the last phase of their lives, strongly reaffirm their cultural identity is both complex and challenging. In any encounter, both the nurse and the older person bring to the clinical situation their own distinctive socio-cultural values and beliefs. As well as focusing our attention on these characteristics of the older client, we must not ignore that the nurse, too, is a culturally-grounded individual with expectations, values and beliefs that may contrast sharply with those of the older client with a different ethnic background. The nurse–patient/client relationship can be further compounded by the often unrecognized ‘generation gap’ between the older client and the nurse who, usually, is very often younger. Until we acknowledge all the different socio-cultural values that shape interactions and relationships between health care professionals and patients, we will neither recognize nor accommodate successfully the cultural differences that inevitably exist.

When it comes to the actual delivery of care to culturally diverse groups, we have to consider not only individual nurse and client factors, but also contextual influences. Many a time, individual factors interact with contextual or environmental factors, for example in terms of the availability of resources, the policies of the institution, and the community setting that influences the provision of care. I firmly believe that the successful provision of culturally-sensitive health care requires not only individual effort on the part of individual professionals, but also organizational reform. Unfortunately, the infrastructure that nurses need in order to provide culturally-sensitive care is usually not yet in place.

A final cautionary word is in order. While culture shapes an individual's values and beliefs, those values and beliefs will also be modified by life experience. This effect is particularly pronounced in older people since they have lived through the many different stages of life. Therefore, while it is important to address the socio-cultural needs of our older clients, the provision of care should not be determined simply on the basis of differentiation across cultural groups. Rather, we have to acknowledge older persons as individuals, each with their own distinct life history, and each making choices within socio-culturally determined norms and boundaries. To achieve this will demand a shift from the institutional focus inherent in present-day practice to a modality of care that focuses on older people as unique individuals, with their own distinct socio-cultural background and their own distinctive life history.

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