Forensic Nursing Chronicles

Cultural competence has been a responsibility addressed in nursing programs since before I became a student and I have noticed a steadily increasing amount of focus placed on the topic throughout the years. As with all aspects of nursing (including forensic nursing), there will always be room for improvement in how we conduct our profession in a culturally sensitive manner. It seems to be a basic understanding that any nurse be acutely aware of his or her own cultural beliefs, practices and biases. I also notice universal agreement that health care professionals need to attempt to learn about all clients’ cultural attitudes towards healthcare and allow for specific integration of these attitudes when at all possible. As this is a responsibility of the health care professional, is documentation of the practice necessary as well? Cultural competence can be applied in forensic nursing and all aspects of nursing care; so documenting the practice is very complicated. Much discussion will be needed to determine how it can be applied to daily documentation without taking excessive time from other nursing responsibilities. A basic need of clients is to have their healthcare options given to them in their first language to maximize the potential for full understanding. Hospitals have addressed this need in a variety of ways including written translation of informed consent and having native speaking interpreters present during any medical explanation before “informed consent” is given. The practice of providing culturally sensitive care is then “documented” by the presence of the signed translated copy of the consent or the presence of the interpreter’s signature on the English version of the consent. The cost to health care providers in both the areas of finance and time is great to accommodate these needs. Therefore, the value of our current practice should be continuously evaluated in order to assure we meet the needs of the client without excessive cost. Value is the key word in this sentence. In the case of the written translated consent form, I have seen consents get signed without being read and this has forced me to think about the various reasons this might occur. Could the client read the consent? Although the consent was in the language self-identified by the client, was the terminology not familiar to the client? Were the opinion and “desires” of the healthcare professional deemed sufficient and therefore explanation not required? The signed consent, however, is placed in the client’s chart and acts as documentation that the client was explained the procedure in a manner facilitating understanding. Healthcare facilities are also managing costs by trying to minimize the amount of paper used in documenting. I have seen consents presented to clients in the form of laptop computers with electronic writing devices. Does this technology intimidate the patient and further compromise their comfort during their healthcare experience? I am sure the answers to the questions posed above are as varied as are the cultures and people of those cultures seeking healthcare in this country. Is it really of value, then, to “document” all of our efforts in providing culturally competent care? Or rather, should we seek to create an environment in healthcare settings where continued education and discussion enhances the healthcare professional’s awareness of the need for culturally competent care? This in turn might increase our accountability to this responsibility without further straining the healthcare system with the financial and emotional stress of balancing the application of good care with the documentation of the process.

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