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Cultural Competence: Non-English-Speaking Home Health Patients Benefit from Same-Language Nurses—Part 2

Analysis  |  By Jasmyne Ray  
   August 29, 2023

When working with patients from different ethnic backgrounds, it's important that nurses be culturally competent.

Part two  of a two-part series. Read part one here.

HealthLeaders continues our conversation with Allison Squires, PhD, RN, FAAN, an associate professor with the New York University Rory Meyers College of Nursing who is lead author of a recent study that found that having a home health nurse who speaks the same language can help prevent hospital readmissions for non-English speaking patients.

The following transcript has been edited for clarity and brevity.

HealthLeaders: How do interactions in the same language affect the quality of care you're able to provide?

Allison Squires: I would get a lot of great information, but then I would also be playing catch-up because oftentimes there would need to be an additional referral, another consultation, a social worker, a mental health professional. You get so much more out of the patient when they know you speak their language.

On the other side, when you have an interpreter, if you become good at establishing relationships, people will share more with you. That consistent relationship certainly helps because people have had a variety of healthcare experiences in their lives.

If they have come from another country, their healthcare experiences will be informed by what their experiences were in their home country, which may or may not have had health services. There's a lot of different things that inform healthcare experience.

The more consistently you can engage with someone, the more likely you are to be able to help them and meet their healthcare needs whenever they happen to be.

HL: How do you navigate the cultural differences in your conversations and interactions with patients?

Squires: It's an approach that, over my professional career, was initially called trying to respond in a "culturally competent" way, then became a "culturally sensitive" way, and now it's phrased as "culturally humble."

The idea is that if you work in a place like New York City, there's no way you're going to be culturally competent in all of the cultures, backgrounds, and languages. Increasingly in the rest of the country, the populations are becoming more diverse in terms of the immigrant profile, so there's no way to be culturally competent for one single group.

To be culturally humble, you have to realize there are going to be  beliefs across cultures that are going to affect how people make decisions about their healthcare. These might be beliefs around food, around religious or spiritual practices, and certainly around their previous experiences with healthcare. You're meeting the person where they are in that healthcare encounter and not making judgments about their choices in terms of their health that may be culturally driven.

HL: How important is it that home-based healthcare professionals be knowledgeable of cultural competencies and meet patients where they are?

Squires: Good quality home care organizations will already be doing this and should have already been doing this for many  years, so that type of training should be in place already.

It needs to respond to whatever the changing local demographics are, and this is especially because the Medicare population will be getting more diverse as time goes on. The diversity of the market that home care agencies are going to be serving moving forward is going to increase.

Most people don't know you have to work 10 years in the U.S. to become eligible for Medicare and Social Security, so even if you're not a citizen, you can still receive Medicare as a green card holder if you've worked for the eligible amount of time. That's something that's going to also help contribute to shifting the demographics of who's being served by Medicare, who home care will be attending to, and who home health agencies will be serving now.

HL: How can younger generations of healthcare professionals understand the importance of cultural competency throughout the healthcare continuum?

Squires: Interestingly, nursing assistants are more likely to come from the same background as foreign patients. They may themselves be immigrants, and some of them may have even been trained as nurses in their home countries.

They're just not eligible to get credentialed here in the U.S. for a variety of reasons.

When we're looking at nursing aides, especially for home health care aides, you know that training has multiple nuances, and it really depends on who they're working with.

There's also an accountability on the patient part where nursing assistants may very well experience racism and discrimination because of their identity from the patients, and home care agencies also need to be prepared to respond to that, because that culturally humble approach to that patient provider relationship, no matter what the level is, needs to be productive for everyone to be effective.

Jasmyne Ray is the contributing editor for revenue cycle at HealthLeaders. 


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