formulation of a plan of care for culturally diverse patients

International Journal of Nursing Terminologies and Classifications Volume 15, No. 1, January-March, 2004 17

Susan Walsh, MSN, RNC

PURPOSE. To formulate a plan of care for a

culturally diverse population and develop a

resource for the healthcare team in providing

culturally competent care.

DATA SOURCES. Books, journal articles.

DATA SYNTHESIS. Healthcare workers are

challenged to provide appropriate care for an

increasingly diverse population. A cluster of

nursing diagnoses were used to develop a plan of

care addressing the unique challenges of caring

for a diverse population served by a community

hospital.

CONCLUSION. A care plan was devised and

inserted into the nursing diagnosis�based

nursing documentation computer system for easy

access when needed.

PRACTICE IMPLICATIONS. A care plan for a

diverse population can promote respectful and

excellent care for every patient.

Search terms: Care plans, cultural competence,

diversity, nursing diagnosis

Elaboration d�un plan de soin pour des patientsde cultures différentes

BUT. Elaborer un plan de soin pour une

population de culture différente et développer une

ressource pour l�équipe de santé, qui doit

dispenser des soins culturels compétents.

SOURCES DE DONNÉES. Manuels, articles de

revues.

SYNTHÈSE DES DONNÉES. Dispenser des soins

appropriés à une population de cultures variées

représente un défi pour les soignants. Un groupe

de diagnostics infirmiers fut utilisé pour élaborer

un plan de soin destiné à une population

multiculturelle, fréquentant un hôpital

communautaire.

CONCLUSIONS. Un plan de soin fut élaboré et

inclus dans le système de soin informatisé, basé

sur les diagnostics infirmiers afin d�en faciliter

l�accès aux soignants.

IMPLICATIONS POUR LA PRATIQUE. Un plan de

soin destiné à une population multiculturelle

peut promouvoir des soins empreints de respect et

d�excellence pour tous les patients.

Mots-clés: Compétence culturelle, diversité

culturelle, diagnostics infirmiers, plan de soin

Formulation of a Plan of Care for Culturally DiversePatients

Translation by Cécile Boisvert, MSN, RN

18 International Journal of Nursing Terminologies and Classifications Volume 15, No. 1, January-March, 2004

Formulation of a Plan of Care for Culturally Diverse Patients

Elaboração de um plano de cuidados parapacientes culturalmente diversos

OBJETIVO. Formular um plano de cuidados parauma população culturalmente diversa edesenvolver um recurso para a equipe de saúdeoferecer um cuidado culturalmente competente.FONTE DE DADOS. Livros, artigos em periódicos.SÍNTESE DOS DADOS. Trabalhadores da saúdetêm o desafio de oferecer uma assistênciaapropriada para uma população cada vez maisdiversificada. Um agrupamento de diagnósticosde enfermagem foi utilizado para desenvolver umplano de cuidados abordando os desafios únicosde assistir uma população diversificada, servidapor um hospital comunitário.CONCLUSÃO. Um plano de cuidados foi criado e inserido no sistema informatizado de docu-mentação de enfermagem fundamentado emdiagnósticos de enfermagem, para fácil acessosempre que necessário.IMPLICAÇÕES PARA A PRÁTICA. Um plano decuidados para uma população diversificada podepromover uma assistência respeitosa e excelentepara cada paciente. Palavras para busca: Competência cultural,diversidade, diagnóstico de enfermagem, planosde cuidados

Translation by Shigemi Kamitsuru, PhD, RN

Translation by Jeanne Michel, PhD, RN, and Alba de Barros, PhD, RN


Formulación de un plan de cuidados parapacientes de diversas culturas

PROPÓSITO. Formular un plan de cuidados parauna población culturalmente diversa ydesarrollar recursos para que el equipo decuidados de salud proporcione cuidadosculturalmente competentes.FUENTES DE DATOS. Libros, artículos.SÍNTESIS DE LOS DATOS. Los trabajadoressanitarios se enfrentan al reto de proporcionarcuidados apropiados a una población que cada vezes más diversa. Se ha utilizado un grupo dediagnósticos de enfermería, para desarrollar unplan de cuidados dirigido al desafío de cuidar auna población culturalmente diversa que esatendida en un medio hospitalario.CONCLUSIONES. Se desarrolló un plan decuidados basado en los diagnósticos deenfermería, para facilitar el acceso cuando fueranecesario y se insertó en un sistema informático,para documentar la atención enfermera.IMPLICACIONES PARA LA PRÁCTICA. Un plan decuidados para una población culturalmentediversa, puede promocionar cuidados excelentes yrespetuosos para cada paciente.Términos de búsqueda: Competencia cultural,diversidad, diagnósticos de enfermería, planes decuidados

Susan Walsh, MSN, RNC, is a staff nurse in the neonatalintensive care unit at Saint Elizabeth Regional MedicalCenter in Lincoln, NE.

Maintaining proficiency and competency in provid-ing health care to patients and their families has becomemore and more challenging. The ethnic populationwithin the continental United States has increased, andthe needs of these diverse groups are unique and unfa-miliar to many healthcare workers. According to the U.S.Census Bureau, the number of foreign-born residents inthe United States increased from 19.8 million to slightlymore than 28 million between 1990 and 2000. And by theyear 2050, whites will account for less than half the pop-ulation (Griffin, 2002).

In order to improve care for a wider range of diversepatient populations, a community hospital in the centralUnited States expanded its definition of cultural diver-sity to include religion, physical or mental challenges,and nontraditional family units as well as ethnicity. Thepopulation of individuals with physical and mental chal-lenges has increased as well. Recent estimates are that19.7% of the U.S. population has some level of disabilityand that 12.3% of the population has a severe disability,indicating a large population with diverse healthcareneeds (U.S. Department of Commerce [USDC], 2001).Often these healthcare needs contribute to differences incommunication ability as well as different perceptions ofhealth and illness. Healthcare workers care for patientsand their significant others from nontraditional familieson a daily basis. In 1990, there were more than 7 millionsingle-parent families in the United States, as well as 3.9million or 5.5% of American children living with agrandparent (USDC). With the increase of diversity oflanguages spoken, definitions of the family unit, andhealthcare practices, it is easy for healthcare facilities tobecome overwhelmed with developing appropriate re-sources and care plans for meeting the challenge. This ar-ticle discusses the formulation of a care plan to assisthealthcare providers in meeting the needs of a diversepopulation.Translation by Mercedes Ugalde, MHS, RN


Providing culturally competent care is assessed usingdirect observation of care, testing, and monitoring ofpatient/associate satisfaction surveys, and personalencounters.

The Office of Civil Rights within the USDHHS has ad-ditional policies (2001a). Title VI, the Civil Rights Act,prohibits discrimination toward individuals with limitedEnglish proficiency (LEP). This act not only addressesappropriate interpreter services and regulations but alsoprovides for equal access to federally assisted programs.Interpretation of this act, by the Office of Civil Rights,states that the �key to providing meaningful access forLEP persons is to ensure that the recipient/covered en-tity and LEP person can communicate effectively� (p. 8).Staff members need training so that they understand theorganization�s policy on provision of interpretation ser-vices and are able to implement it effectively.

The Magnet Nursing Services Recognition Programfor Excellence in Nursing Services of the AmericanNurses Credentialing Center (ANCC) awards �magnetstatus� to hospitals that display major attributes of excel-lence (McClure & Hinshaw, 2002). One of these major at-tributes is �attention to patient, family, and staff culturaland ethnic diversity� (Gasda, 2002, p. 45). Magnet appli-cation requirements include Standard XI: Ethics Mea-surement Criterion 11.4, which addresses �fostering anondiscriminatory climate in which care is delivered in amanner that is culturally sensitive and that is reflective ofthe cultural diversity that exists within the organization�(ANCC, 2003�2004, p. 115). Sources of evidence of com-pliance to this standard include assessment of the diver-sity of the patients cared for within the healthcare organi-zation, culturally sensitive policies affecting patients andstaff, as well as cultural education programs for staff.

A recent report published by the National Academyof Sciences (2002) addressed racial and ethnic disparities.The Academy concluded that, based on an increasinglydiverse U.S. population, the initiation of training pro-grams for healthcare associates was a promising inter-vention strategy to reduce healthcare disparities. Diver-sity educational programs that begin with enhancementof healthcare associates� awareness of cultural and social


Literature Review

Requirements of Accrediting Agencies and Government Guidelines

Several accrediting agencies advocate for more cultur-ally sensitive workplaces. The Joint Commission on Ac-creditation of Health Care Organizations (JCAHO, 2003)addresses ethical issues related to providing care in its�Standard and Intent Statements for Patient Rights.� ThePatient Rights and Organizational Ethics Standard 1 di-rects hospital structure be based upon �the patient�s rightto care that is considerate and respectful of his or herpersonal values and beliefs� (p. 77). The Education Stan-dards state that the goals of effective patient and familyeducation are to be integrated with the patients� spiri-tual, psychosocial, and cultural values. Further elabora-tion of this concept can be found in the Education Stan-dards: �[D]esigning education processes includes . . . thephysical, cognitive, cultural, social, and economic charac-teristics of the patients being taught� and �The hospitalselects and makes available educational resources, in aform the patient can understand, based on patient learn-ing needs� (pp. 156�157). Various teaching methods andresources including interpretative services, special de-vices, videotapes, and other teaching materials are listedas potential necessary educational aids.

The Office of Minority Health within the U.S. Depart-ment of Health and Human Services (USDHHS) has setnational Culturally and Linguistically Appropriate Ser-vices (CLAS) standards for linguistically appropriate andculturally sensitive healthcare services (USDHHS,2001b). Standard 1 directs healthcare organizations toprovide patients and consumers with �effective, under-standable, and respectful care that is provided in a man-ner compatible with their healthcare beliefs and practicesand preferred language� (p. 7). Standard 3 articulates theexpectation that healthcare organizations provide staff atall levels with ongoing education and training in cultur-ally appropriate service delivery. Methods of implement-ing these standards include providing appropriate cul-tural education and training and assessment of skills.


and mental and physical characteristics, but also com-munication skills, educational background, religion, pri-mary language, work experience, income level, geo-graphic locale, experience in the military, and familystatus.

Dreher and MacNaughton (2002) agreed with previ-ous definitions of cultural competency in nursing, butdefined two major areas of competency. The first wasstructure and content related to clinical interaction be-tween the patient and nurse. The second focus requiredthe nurse to become knowledgeable about patients�lifestyles, behaviors, and health patterns and apply thisknowledge to providing care. The authors further cau-tioned the healthcare provider about making assump-tions and generalizations that individuals from the samecultural group are all the same. Ford (2003), a nationallyrecognized speaker on cultural diversity, supported thisbelief and encouraged healthcare providers to simplyask their patients about their specific cultural needs. Theclinical nurse needs to have a strong background con-cerning cultural norms, but needs to personalize and in-dividualize care for the patient and family. The MayoClinic in Rochester, MN, articulates a nursing philosophythat �meeting patient needs comes first and this meansproviding culturally competent care to all patients�(Leinonen & Smith, 2002, p. 260).

Nursing Diagnosis

Nursing diagnoses, particularly the NANDA (2001)taxonomy, have been accused of being insensitive withregard to cultural considerations. Leininger criticizedthe NANDA classifications because they are not basedon any international or transcultural data (Carpenito-Moyet, 2002). Leininger (1990) also believes that manydiseases and illnesses are directly related to specific cul-tures that need to be understood by nurses. These dis-eases and illnesses formulate different expressions ofhealth care, wellness, and illness. Leininger further be-lieves that experts or individuals from that cultureshould construct culturally specific nursing diagnosesbased on that culture.

factors that influence healthcare, as well as implementa-tion methods to apply information, are also valuableways to decrease this disparity.

Cultural Competence

Cultural competence has been discussed extensively inthe nursing literature. In order to formulate either a diver-sity diagnosis or a nursing care plan, cultural competenceneeded to be defined. Leininger (1999) stated that cultur-ally competent care is using knowledge that has beenlearned about a specific culture and applying it in sensi-tive, creative, and meaningful ways when providing careto individuals from diverse backgrounds. The goal is todeliver culturally competent care to patients and theirfamilies, in other words, excellent nursing care in the con-text of the patient�s cultural and or religious beliefs.

Alexander (2002) defined cultural competence as �aset of congruent behaviors, attitudes and polices thatcome together in a system, agency, or among profession-als and enables that system, agency, or those profession-als to work effectively in cross-cultural situations� (p. 30).Alexander stated that one cannot manage diversity with-out valuing diversity. Employees at every level within ahealthcare organization, regardless of age, sexual orienta-tion, race, ethnic background, or religion, have the pri-mary goal to care for patients and their needs. This ne-cessitates cultural competence education for employeesat every level within the organization.

Burchum (2002) described cultural competence as anongoing developmental process that is based on in-creased knowledge and skills specific to cultural sensitiv-ity, understanding, interaction, and awareness. Fornurses providing competence in cultural care, it meansthat care is individualized and appropriate in regard tothe patient�s cultural values, beliefs, and practices. Pa-tients are empowered by providers� commitment to de-veloping cultural competence. Frusti, Niesen, and Cam-pion (2003) stated that diversity competence is �anindividual�s ability to respect each person�s uniqueness�(p. 31). They believe that diversity not only includes sex-ual orientation, age, gender, ethnic backgrounds, race,


Plan of Care

Saint Elizabeth Regional Medical Center recognizedthe need to provide a structured resource for nurses car-ing for the growing number of diverse patients. An ex-tensive literature review focused on diversity, culture,and cultural competency. Development of a care planthat contained a cluster of pertinent nursing diagnosesfor culturally diverse patients evolved as the best option(Table 1). Relevant nursing diagnoses were identified,and expected outcomes and nursing interventions de-fined for each nursing diagnosis. This structured re-source/care plan became a positive and proactive re-sponse to the needs of the diverse patient population. Bydeveloping such care plans, we sought to avoid the neg-ative stereotypes such as use of nursing diagnoses ofnoncompliance or �nonadherence� that may be a result ofcultural barriers to understanding or acceptance.

The facility for which this care plan was designedelected to include not only diversity of culture but alsoreligion, physical, or mental challenges and nontradi-tional family units. The cultural diversity care plan be-came an adjunct to the general admission care plan forall patients. This care plan addresses the unique chal-lenges in caring for a diverse population and serves as aresource for the healthcare team in providing culturallycompetent care. Following the nursing process and usingthe NANDA diagnoses, this care plan was easily incor-porated into the hospital�s clinical documentation sys-tem. The care plan is prefaced with the premise thatevery patient evidences some level of cultural and reli-gious diversity, but when the level of diversity hampershealth promotion and disease recovery, special strategiesneed to be implemented (Lipson, Dibble, & Minarik,2000; NANDA, 2001; Sparks & Taylor, 2001).

The first nursing diagnosis identified on the care planis impaired verbal communication. This diagnosis encom-passes not only inability to speak, but also hearingdeficits and difficulty in expressing thoughts. Interven-tions include interpreter services, alternative communi-cation methods, providing health information resourcesin the familiar language, and recognition of importance


Carpenito-Moyet (2002) pointed out that a nursing di-agnosis cannot be a judgment that nurses make with re-gard to their client and family�s responses to illness basedon the nurse�s own values, responses, or cultural perspec-tive. Errors in nursing diagnosis, however, can occur if thenurse is unfamiliar with a specific culture and their beliefs.This presents two major challenges to the nurse. One isthat the nurse needs to be familiar with numerous cul-tures, beliefs, practices, and responses to illness, wellness,and stress. The greater challenge is to avoid culturalstereotypes and be open-minded and nonjudgmental inidentifying and implementing nursing diagnoses and careplans. Every patient has personal values, perspectives, andinterpretations of wellness and disease. Lack of familiaritywith the diverse patient�s unique customs may create bar-riers to provision of respectful and excellent care.

Culture can be present in all domains of life, and thisposes an additional complication to developing a careplan specific to diversity (Tripp-Reimer, Brink, &Pinkham, 1999). Any nursing diagnosis that deals withbehavior has the potential to have a cultural cause andneed. A number of nursing diagnoses can be directlylinked to differences in cultural values. Primary exam-ples are nursing diagnoses such as ineffective coping, non-compliance, knowledge deficit, impaired verbal communica-tion, altered parenting, anxiety, and social isolation.Removing the consideration of diversity from any ofthese nursing diagnoses opens the possibility of missingthe influence of diversity issues on the diagnosis and ul-timately successful intervention strategies.

The option of using alternative nursing interventionsor outcome classification systems was explored by agroup of professional nurses within the organization aspart of the care planning process. The Nursing Interven-tions Classification (NIC) and Nursing Outcomes Classi-fication (NOC) presented similar dilemmas when at-tempting development of a specific diversity diagnosis(McCloskey & Bulechek, 2000; Tripp-Reimer et al., 1999).Using either the NIC or NOC classification systems pre-sented an additional conflict for our facility in that ourclinical documentation system was formatted on nurs-ing diagnoses alone.


Table 1. Nursing Care Plan for Culturally Diverse Patients

Definition Every patient evidences cultural and religious diversity. However, when the level of diversity hampers health promotionand disease recovery, altering strategies need to be implemented.

Clinical Problem/Nursing Diagnosis Expected Outcome Nursing Intervention

Impaired verbal communication related to ■ Patient will communicate needs ■ Assess need for interpreter.■ Inability to speak dominant language and ability to understand ■ Assist in intervention with alternative commu-■ Hearing deficit instructions effectively. nication methods such as sign language, inter-■ Difficulty in expressing thought ■ Patient is satisfied with staff�s preter services, and hearing enhancement de-

verbally or recognition of differences. vices.■ Inability to speak ■ Use health-information resources in patient�s

familiar language if possible.■ Recognize importance of variations in personal

space, nonverbal communication, and touch for specific individuals.

■ Use resources to enhance communications withthe verbally impaired.

Ineffective health maintenance related to ■ Evidence and behavior of ■ Determine discrepancy factors between pa-■ Cultural patterns nonsupportive of improving health measures. tient�s health needs and religious and cultural

wellness patterns.■ History of non-health-seeking behaviors ■ Provide support and logic for necessary change

in health practices: contact religious or cultural leaders as needed.

■ Supply resource information that is specific andsensitive to patient�s heritage.

Knowledge deficit related to ■ Patient will demonstrate specific ■ Select teaching strategies that are best suited for ■ Lack of familiarity with information knowledge application. the patient�s learning needs and heritage.

resources ■ Utilize resources/interpreter services that ac-■ Communication barriers commodate the patient and family appropriately.■ Cultural and religious practices that are ■ Have patient/family give return verbalization

incongruent with wellness and/or demonstration of newly learned skills.■ Emphasize importance of new knowledge to

disease recovery and health promotion.■ Acknowledge efforts.■ Provide resources and support for maintaining

new healthcare knowledge and practice in community setting.

Imbalanced nutrition related to ■ Patient is satisfied with nutritional ■ Assess and acknowledge specific dietary requests.■ Specific cultural and religious patterns choices and culturally sensitive ■ Refer to nutritionist as needed.

and restrictions information. ■ Integrate specific cultural requests with healthy ■ Unavailability of usual preference of ■ Patient weight is within normal diet and health improvement.

food because of hospital setting limits within necessary time ■ Provide diet choices based on religious rules ■ Conflict with specific disease/diet/ frame. and cultural preferences. (Consult Culture and

health improvement and cultural and ■ Patient�s lab work is within normal Nursing Care: A Pocket Guide [Lipson, Dibble, &religious restrictions limits within necessary time Minarik, 2000] regarding hot/cold balance,

frame. fasting, and typical foods.)

Compromised family coping related to ■ Family will increase participation ■ Assess effects that illness has had on the family.■ Lack of familiar ethnic and religious in patient�s care. ■ Integrate typical culture-specific family com-

resources in the healthcare setting, ■ Patient/family will indicate munication patterns.■ Nontraditional family units verbally or behaviorally better ■ Encourage family participation in health care ■ Lack of privacy understanding and acceptance. for the patient.■ Specific religious or cultural beliefs ■ Incorporate religious and cultural requests ■ Disease severity whenever possible.■ Role disparity brought on by communi- ■ Be sensitive to unique cultural family patterns.

cation deficits or disease ■ Encourage support system for family.■ Use specific resources within hospital (e.g.. pas-

toral care, social services, case managers) and within community (Asian Community Center, Faces of Middle East, Catholic Social Services, Lincoln Action Program).

This plan of care may be reproduced for noncommercial purposes without permission from the author.

of personal space, nonverbal communication, and touchfor specific individuals (Andrews, Boyle, & Carr, 2003;Cox et. al., 2002; Joyce & Villanueva, 2000; Lipson et al.,2000). A specific clinical example might be not only hav-ing a competent interpreter for a Hispanic couple withan infant in the neonatal intensive care unit, but alsoposting at the infant�s bedside in Spanish milestoneweight gains according to age. Additional resources inSpanish that review the infant�s care and treatment planshould be available to reinforce and enhance communi-cation for these parents.

The next nursing diagnosis, ineffective health mainte-nance, includes cultural patterns that may not be sup-portive of wellness and a history of poor health-seekingbehaviors. Interventions include determining discrepan-cies between the patient�s health needs and religious andcultural patterns. Additional interventions include provi-sion of support and logic necessary for change of behav-iors and supplying resource information specific to thepatient�s heritage (Andrews et al., 2003; NANDA, 2001;Tucker, Canobbio, Paquette, & Wells, 2000). An exampleof discrepancy in health-seeking behaviors was seen in aVietnamese family who brought their toddler to theemergency department with a persistent high fever. Thechild had numerous bruises. The healthcare worker de-termined that the parents had been using coin rubbing(cao gio) as a home remedy to treat the child�s fever. Aculturally competent provider would be sensitive to thispractice, but would provide support and explain thelogic behind a healthcare regimen that may include an-tibiotics, lab screening, and earlier access to health care(Davis, 2000; Lipson et al., 2000).

The third nursing diagnosis is knowledge deficit. Lackof familiarity with informational resources, communica-tion barriers, and cultural and religious practices that areincongruent with wellness are all related to having adeficit in knowledge. Nursing interventions must be cen-tered on provision of teaching strategies best suited tothe patient�s learning needs and heritage. Use of re-sources and teaching tactics that accommodate patientsand their families appropriately, provision of resources,and support for maintenance of new healthcare knowl-


edge and practice in the community setting (Carpenito-Moyet, 2002; Lipson et al., 2000; NANDA, 2001) are in-corporated into the care plan. An example of interven-tions to address this nursing diagnosis would beincluding the mother, sister, and mother-in-law in activeparticipation and support for an Arab-American womanwho is in labor. Since in this tradition fathers do not par-ticipate in the birth process, teaching strategies and com-fort measures need to be directed at those who can sup-port the patient in labor. Healthcare providers mustrealize that lack of participation by a Arab-American fa-ther in the birth process does not constitute neglect orlack of interest. If no female family members are avail-able, Arab-American women may require the encour-agement and support of alternative individuals, andnurses must provide education for the support systemthat is present (Kridli, 2002; Lipson et al., 2000).

Imbalanced nutrition can be the result of specific cul-tural and religious patterns and restrictions, but also ofunavailability of usual food preferences during hospital-ization. Food preferences may be in conflict with a spe-cific disease, diet or health improvement needs, and cul-tural or religious restrictions. Referral to a culturallysensitive nutritionist is an important component and re-source for the intervention for this diagnosis. Additionalinterventions include integration of specific cultural re-quests into a healthy dietary plan, as well as health im-provement and diet choices based on religious rules andcultural preferences (Andrews et al., 2003; Lipson et al.,2000; NANDA, 2001). The following example demon-strates how specific cultural patterns can be integratedinto a specific disease care regimen. A middle-age maleof Middle-Eastern descent who practiced traditional eth-nic patterns presented to the clinic with newly diagnoseddiabetes. The healthcare provider in conjunction with adietician integrated insulin and blood sugar monitoringaround the patient�s traditional meal pattern of havingthe largest meal around 2 P.M. (Lipson et al., 2000).

Compromised family coping is the final nursing diagno-sis in the care plan. This diagnosis is related to lack of fa-miliar ethnic and religious resources in the healthcaresetting, nontraditional family units, lack of privacy, spe-


cific religious or cultural beliefs, disease severity, and roledisparity brought on by communication deficits or dis-ease. Nursing interventions include assessment and inte-gration of the illness beliefs and the specific family cul-tural patterns. Religious and culturally related requestsare implemented whenever possible. Encouragementand sensitivity to family values are emphasized. Use of�within the walls� as well as community resources areidentified (Andrews et al., 2003; Cox et al., 1995; Lipsonet al., 2000; NANDA, 2001).

There are numerous opportunities for incorporating re-ligious and cultural requests within the healthcare setting.A Native American family�s wish to see their terminallyill, ventilator-dependent infant on a traditional papooseboard with a large family tribal ceremony demonstrated aunique challenge. Culturally sensitive healthcare workersworking with neonatologists, primary nursing staff, respi-ratory therapists, and family members enabled the familyto safely position the infant on a papoose board and trans-port the infant to an area where all tribal members couldbe present for the ceremony. Nursing interventions mayinclude sensitivity to unique cultural family patterns. Forexample, grandparents who are assuming the role of par-ents may need additional updated health information onchild care and support for their expanded role. Single par-ents may need additional resources for accessing respitecare options. Family units that have a family memberphysically unavailable (e.g., deployed overseas, incarcer-ated) may need innovative nursing interventions. Digitalcameras, e-mail, Red Cross communications, and supportgroups may need to be used.

Additional Practice Implications

This nursing care plan has been integrated into thegeneral admission care plans for all patients at our facil-ity. It is available online via Intranet resource manuals atall times for easy access and referral. The intent is thatthis plan of care will guide healthcare workers in target-ing the needs and resources for any patient with diver-sity. The ultimate goal is to promote respect and provideexcellent patient care for every individual, including


those with unique diversities. Compliance with govern-ment guidelines is evidenced within the clinical docu-mentation system that integrates care plans and nursingdocumentation. This care plan also provides a promptfor referral to multidisciplinary team members to orga-nize their care and prioritize resources for these patients.

Conclusion

Expanding the definition of culture to include diver-sity of culture, plus religion, physical, or mental chal-lenges and nontraditional family units allowed us to im-prove care for the increasing number of patients withdiversity. This care plan focuses on the uniqueness andpositive opportunities and challenges of working withdiverse populations.

Author contact: [email protected], with a copy to the Editor:[email protected]

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formulation of a plan of care for culturally diverse patients

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