Culturally sensitive care: Perceptions, challenges, and educational strategies

This dissertation explores the theme of culturally sensitive care, studying it from the
perspectives of both healthcare providers and informal carers. The exploration of these
viewpoints leads to the development, implementation, and evaluation of an educational module
designed to increase cultural awareness among nursing students.
Several demographic and societal trends (e.g., ageing population with increased age-related
conditions, a changed patient position, and increased diversity among patients) have reshaped
the profile of those needing care in Belgium, presenting new challenges and opportunities for
healthcare (Torres, 2019). Current fragmented and uniform care models have reached its
limitations, advocating for more integrated and culturally sensitive care solutions (Wickramage
et al., 2018). Culturally sensitive care can be proposed as a solution to address challenges and
inequalities in healthcare. However, its implementation is challenged (Markey et al., 2018).
Culturally sensitive care is an approach used when patient and healthcare provider from
different ethnic and cultural backgrounds interact, seeking to build a quality care relationship
(Uzun & Sevinç, 2015; Young & Guo, 2020). However, research shows that healthcare
professionals feel insecure and have hesitations concerning the concept of culturally sensitive
care (Markey et al., 2018; Roberts et al., 2007; Suurmond et al., 2010). In addition, implementing
culturally sensitive care faces various challenges across individual, interpersonal,
organisational, and systemic levels (Eleri Jones et al., 2017; Scheppers et al., 2006; Suurmond et
al., 2016).
Three research gaps were identified and translated in three research questions:
1. How do healthcare providers define, perceive, and deliver culturally sensitive care?
2. How do informal carers of patients with a migration background experience the
professional care they receive?
3. How can future healthcare providers be trained in becoming culturally competent and
sensitive healthcare providers?
This dissertation used different qualitative research methods to address the research questions.
For the first question, data collection involved in total 8 focus group interviews (n = 46) and 15
individual in-depth interviews with professional and student healthcare providers (e.g. nurses,
physicians). For the second question, 17 individual in-depth interviews were conducted with
informal carers of Italian and Turkish backgrounds (11 women and 6 men). The third question
involved developing, implementing, and evaluating a 4-hour intervention in a bachelor nursing
program, involving 34 second-year nursing students through curriculum mapping, focus group
interviews, and post-intervention surveys.
The findings of the first research question (chapters 3 and 4) indicate that most healthcare
providers have a narrow, stereotypical understanding of culturally sensitive care, seeing it as a
checklist of practical actions rather than an empathetic approach. This perspective, shaped by a
static interpretation of 'culture,' often reduces it to religious practices, particularly those of
Muslim patients, highlighting a concept of othering and a lack of awareness about implicit
biases and providers' own cultural frames of reference. Consequently, culturally insensitive care
and discriminatory behaviour can arise. Healthcare providers view culturally sensitive care as
challenging, requiring more effort and time, and while they recognize the need for greater
cultural knowledge, they make little effort to gain it, leading to uncertainty and reliance on
assumptions. Although some healthcare providers approach culturally sensitive care from a
relationship-oriented perspective and see it as enriching, most individual providers and
organizations treat it as unimportant and optional. Initiatives towards culturally sensitive care
are often personal rather than organizational mandates, with a noticeable lack of leadership
from management in its implementation.
The findings of the second research question (chapter 5) show that informal carers of older
persons with dementia and a migration background are seeking professional help to provide the
best possible care. Being an informal carer today involves many tasks. Informal carers seek to
create a sense of home, using familiar meals, language, and environment to offer personalized
care, especially since standard care often lacks cultural sensitivity. Despite some healthcare
providers offering tailored care, it is not structural. Moreover, cold-hearted and substandard care
is experienced. These negative encounters, marked by disinterest and insensitivity, reflect
broader issues in the healthcare system, including inadequate support for providers. Informal
carers experience an increasing burden as they try to bridge these gaps, making their role even
more challenging.
The third research question (chapter 6) builds on previous insights, showing that healthcare
education can increase nursing students' cultural and self-awareness. Findings demonstrate the
positive impact of a developed educational module, suggesting it as a basis for further training.
Current and future cultural competency training needs to focus on self-reflection, self-
awareness, and understanding inequalities and discrimination. The model of caring and
uncaring encounters, discussed previously, is not integrated into healthcare education, which
emphasizes technical skills. Education needs to address these and their impact on patients.
Simulation education, emphasizing relational aspects, can enhance student awareness.
Four themes occur across all studies in this dissertation: caring and uncaring encounters in
healthcare, othering and racial discrimination, the optional character of culturally sensitive care
and structural gaps in the healthcare system.
These findings have implications for both policy and practice. First, it is necessary to tackle
othering, racial discrimination, and structural exclusion in healthcare. The findings show
behaviours like implicit biases and cultural incompetence that enhance exclusion in healthcare,
emphasizing the need for increased self-awareness and critical awareness among healthcare
providers. Developing cultural competence through comprehensive training and fostering an
open environment for discussing discrimination at all organizational levels are necessary steps.
Integrating cultural competence education throughout healthcare curricula is essential to
reflect on societal diversity and promote lifelong learning for both students and healthcare
providers. Second, there must be aimed for caring encounters in a proficient healthcare system.
Providing high-quality personalized care must remain the aim for healthcare providers, but the
findings point out that this is not always achieved, with reports of culturally insensitive and
substandard care. To improve, healthcare organizations can prioritize the relational aspect of
care and support healthcare providers in delivering culturally sensitive, tailored care, ensuring
the management creates conditions for effective coordination and collaboration. In addition,
policy needs to guarantee inclusive, high-quality care by addressing structural exclusion,
ensuring healthcare policies evolve along with patient profiles, and supporting informal carers
through interventions.
To conclude, it can be stated that culturally sensitive care is essential. It is not optional, but it is
a basic a basic principle in health care provision, and it needs to be the standard practice in
healthcare and healthcare education. In the current superdiverse society, a diverse sensitive
approach is necessary to tackle exclusion at every level, including various identities like ethno-
cultural backgrounds, gender and LGBTQ+ diversity, diversity in ability and socio-economic
status. Addressing uncaring encounters in healthcare, especially at the management level of
care organizations and in healthcare education, is necessary. Implementation of sensitive care
must occur at all levels, with the management taking responsibility to increase awareness and
make culturally sensitive care the most obvious choice for healthcare providers. Finally, policy
needs to address gaps in healthcare services by providing tailored services for diverse groups
and support for informal carers, as the current approach is insufficient for meeting diverse and
complex care needs.