Nursing Care for Culturally and Linguistically Diverse Populations: A Case Study
Introduction
Every nurse in Australia is bound to a common international Code of Ethics when providing
healthcare but encounters special cases at some point when handling immigrants who find it hard
to adapt to the socio-cultural norms of their new home country. Providing care to culturally and
linguistically diverse (ACALD) populations presents unique challenges and opportunities which
are reflected in my case involving a 35-year-old Afghan refugee who presented with complex
health needs during my practice. The said patient sought care for chronic pain and anxiety which
was exacerbated by her recent resettlement in a regional area of South Australia and was finding
it hard to access medical care due to many disparities.
I chose this patient because her case highlighted the complexities of delivering culturally
competent care in a healthcare system that often overlooks the specific needs of diverse
populations making it hard to offer tailored medical care. Her case required not only clinical
skills but also cultural sensitivity and effective communication strategies since language barriers,
cultural differences, and a lack of familiarity with the Australian healthcare system had made her
care particularly challenging. During my interactions with the patient, I realized that I needed to
access the interpreting services to ensure effective communication before proceeding to provide
comprehensive nursing assessments of her condition and coordinated care with multidisciplinary
teams. Through the interpreter, I was able to understand the health beliefs and practices of the
patient based on her Muslim cultural background before I embarked on educating her on the
management of her condition and guiding on how to address her anxiety. This experience is a
reflection on the importance of cultural safety and person-centered care, which aligns with the
Nursing and Midwifery Board of Australia (NMBA) Registered Nurse Standards for Practice.
Understanding the Diverse Population
Social Determinants of Health
The uneven distribution of social factors and conditions, such as education, income, power, and
social support, contributes to the overall health inequalities of a given population (Najafizada et
al., 2017). The cultural identity and mental health of the Afghan and Arab refugee population,
which are the largest part of the ACAD population in Australia manifest in their well-being
because of their diversity in factors like language, culture, and socioeconomic status (Groen et
al., 2017). The study by Peprah et al. (2023) reveals many refugees that arrive in Australia with
limited English proficiency and varying levels of education, hindering their ability to
communicate and navigate the healthcare system effectively. Additionally, (Torlinska et al.,
2020) show that individuals from ACALD backgrounds are likely to experience barriers to
accessing healthcare due to language difficulties, lack of familiarity with the healthcare system,
and financial constraints, compared to the general population.
Health Inequalities
According to McCartney et al. (2019), health inequalities in a given population are a result of the
social circumstances that people are exposed to during their lifetime and reflect the overall
welfare of different population groups. In most cases, Afghan refugees often experience higher
rates of chronic diseases, mental health issues, and lower overall well-being compared to the
general population of their new country (Matsangos et al., 2022). This inequality in the ACALD
group is mainly caused by limited access to preventive care and health education, the cultural
stigma surrounding mental health and treating Muslims as terrorists, and the stress associated
with resettlement. For instance, the findings from the study by Mahmood et al. (2019) show that
refugees who flee from violence-hit countries like Afghanistan are at an increased risk of
developing post-traumatic stress disorder (PTSD) and depression due to their experiences of
conflict and displacement. In the case of my patient, she faced several health inequalities,
including a higher risk of anxiety-related complications and mental health disorders like
depression, which needed a collaborative effort to handle.
Health Inequities
The differences in health status manifested in my patient through her limited access to culturally
appropriate healthcare services where she struggled to find healthcare providers who understood
her cultural and religious background and found a way to communicate with her. Nair and
Adetayo (2019) contend that lack of access to culturally competent care is a significant barrier
that contributes to ongoing health issues, something that the ACALD population often faces due
to the lack of multilingual health resources and culturally competent healthcare providers. These
inequities can lead to misunderstandings and inadequate care and can be compounded by
systemic issues such as discrimination and social exclusion that make. There is a need for the
appropriate government policies to be put in place to mitigate these inequities which makes it
difficult for people like the Afghan refugees to seek and receive appropriate care.
Health Outcomes
The ACALD populations are at high risk of developing chronic diseases, mental health
disorders, and injuries compared to the general population due to a combination of interacting
social factors and health conditions (Khatri & Assefa, 2022). These groups often face barriers
such as poor health literacy, limited access to culturally appropriate health services, and
socioeconomic disadvantages, which can exacerbate their health vulnerabilities. The health risk
in the AACALD population is also compounded by the prevalence of multimorbidity, where
individuals suffer from multiple health issues simultaneously leading to poorer health outcomes
Friis et al. (2019). In the case of my patient, her chronic pain was poorly managed and her
anxiety was exacerbated by her struggles to navigate the healthcare system and communicate her
needs effectively due to language barriers and cultural differences. Her chronic pain condition
was getting worse and she showed signs of increased disability, reduced mobility, and the
development of secondary conditions such as musculoskeletal disorders or chronic fatigue
syndrome. The research by Dydyk and Conermann (2024) links chronic pain to the physical and
psychological stressors my patient experienced during her resettlement while mental health
issues are rooted in the trauma associated with her past experiences before seeking refuge.
Care Considerations when handling individuals from ACALD populations
For cases like that of an Afghan refugee patient, it is crucial to conduct a thorough cultural
assessment to understand the beliefs, values, and health practices of the patient to ensure that
health care is tailored to their needs and are engaged in their health management (Azizi et al.,
2021). Effective communication is a key consideration that can involve the use of interpreters
and culturally appropriate educational materials to enhance the comprehension of health
information and adherence to treatment plans by the patient (Kwame & Petrucka, 2021).
Sharkiya (2023) asserts that Healthcare givers also need to foster a therapeutic relationship built
on trust and respect to encourage open dialogue with the patient about health concerns.
Finally, nurses should advocate for the availability of culturally appropriate resources, such as
multilingual health materials and culturally competent training for healthcare providers to help
connect patients with resources that address their unique needs (Nair & Adetayo, 2019).
Critical Reflection and Evaluation
My practice, particularly the experience of caring for an Afghan refugee patient helped me to
identify my strengths and areas I need to work on to develop into an all-around nurse. My main
strength was my ability to establish rapport and trust with the patient, which facilitated open
communication that created a safe space for her to express her anxieties about her health
concerns. I was also able to recognize the importance of cultural competence and arrange for an
Arabic interpreter to ensure effective communication, an initiative that enabled me to learn about
Islamic practices and Afghan cultural norms and provide culturally appropriate care. I utilized
active listening skills and demonstrated empathy to make the patient feel valued and understood
and then I effectively coordinated care with other healthcare professionals, ensuring that the
patient received comprehensive support.
However, I recognized gaps in my knowledge about the specific health beliefs and practices of
Afghan women due to the limited availability of culturally appropriate resources and training in
cultural competence. While I made efforts to respect the patient's cultural beliefs, I recognized
that I could benefit from additional training in cultural safety and sensitivity to enhance my
understanding of the cultural beliefs and practices of ACALD populations to provide more
tailored care. I also recognized that the challenge of the language barrier at times hindered
effective communication forcing me to utilize an interpreter and I felt that I could have done
more to ensure that the patient fully understood her treatment plan.
In the future, I plan to implement several changes to my practice by seeking additional training
in cultural competence to better understand the unique needs of ACALD populations to be able
to provide more effective care and advocate for the resources necessary to support these patients.
In addition, I plan to enhance my skills in using visual aids and simplified language to improve
communication with patients from diverse backgrounds to ensure clear communication and
understanding.
Linking to NMBA Standards
My practice was aligned with several NMBA Registered Nurse Standards for Practice. For
instance, I upheld Standard 2 which emphasizes the importance of engaging in therapeutic and
professional relationships by establishing trust and rapport with the patient to create a safe
environment for her to discuss her health concerns while respecting her dignity and cultural
values (Shahriari et al., 2017). According to Cooper et al.(2021). Standard 3 highlights the need
for nurses to provide safe and effective care, which I adhered to by advocating for culturally
appropriate resources and coordinating care to ensure that the patient received the best possible
support. Finally, Standard 4 which focuses on the importance of professional development and
lifelong learning was important in recognizing my areas for improvement and seeking additional
training to enhance my practice and provide high-quality care to ACALD populations (White et
al., 2019)
Conclusion
Caring for culturally and linguistically diverse populations, such as Afghan refugees, presents
unique challenges that require a comprehensive understanding of social determinants of health,
health inequalities, and culturally appropriate care practices. Through my experience with the
Afghan refugee patient, I gained valuable insights into the complexities of providing care to
ACALD populations. By reflecting on my practice and identifying areas for improvement, I am
better equipped to deliver person-centered care that meets the diverse needs of my patients. As
the healthcare landscape continues to evolve, nurses need to embrace cultural competence and
advocate for equitable access to care for all individuals, regardless of their background.
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