Influence of Culture and Social Determinants on Healthcare Practice

This reflective essay discusses the influence of community, culture and social determinants on healthcare practice. It also evaluates the distribution of healthcare resources and the impact of globalization on nursing workforce. A case study is used to demonstrate the cultural impact on healthcare process and how different social determinants can hamper the health status of the people.

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Title:
Student’s name:
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The concept of cultural safety is concerned with the power relationship between the
patients and the nurses. It is basically about accepting and valuing the culture and beliefs of
others. It has been included in the nursing code of conducts in order to involve the nurses in
the practices of culturally safe and appropriate care to the patients irrespective of their
cultures and beliefs. Cultural beliefs affect the healthcare delivery process. In this reflective
essay, the influence of community, culture and in healthcare practice will be thoroughly
discussed. Also, the distribution of various healthcare resources related to healthcare need
and concepts of health and wellbeing will be evaluated in the paper. It has been recognized in
many surveys and studies that due to globalization, the culture of nursing workforce is
affected and here, in the paper, the position of globalization on nursing workforce will be
justified with proper evidence and literature support. In the context of equity and cultural
safety, the social as well as ethnical wellbeing plays an important role and hence, the concept
of indigeneity and lifestyle of different cultural groups will be analyzed in this regard.
Exploring different health services and issues, the paper will finally conclude summarizing
all the important points found.
Culture is a particular pattern of ideas shared by a particular people of the society. The
diversity of religion and culture within the world’s population brings several challenges for
the healthcare providers. The Australian Institute of Health and Welfare reports that the
healthcare providers of Australia are highly concerned regarding the life expectancy rate of
all the Australians. However, the challenge for the healthcare professionals is in
understanding the religious beliefs of any patients while making any vital clinical decision.
Australia is known as one of the countries with largest number of immigrants and statistics
report found that 24% of Australians are the immigrants (Butler-Henderson, Dimitropoulos,
Katte, Mcpherson & Bennett, 2018). Also, there are 200 types of different cultures and
languages that exist in the diversified community of Australia. The gap in culture causes

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multiple barriers in the healthcare system (Schultz, Abbott, Yamaguchi & Cairney, 2018).
According to some literatures, communication barrier is one of the most obvious effects of
culture on the health outcome of the Australians. Even, the communication can cause wrong
diagnosis and treatment as well as reduce the probability of required follow-ups due to not
understanding the language. Again, while taking crucial decisions in the clinical settings
cultural beliefs might influence. The Australian health surveys revealed that cultural
differences and food choices might contribute to the poor nutritional status of some specific
group of people which indicates poor health outcome. Malnutrition or risk of malnourishment
is 20-30%, found in the older adults and 40% of them require hospital settings. Contributing
factors to poor nutrient intake causes different types of chronic diseases that include
dementia, depression, impaired vision and many others. Also, social influences, such as
isolation from the community involvement, loneliness, poverty and many other factors affect
the mental wellbeing which causes physical issues as well. Literatures from different authors
mentioned that poor mental condition may cause digestion issue and sleeping disturbance
which directly affects the physical wellbeing.
Healthcare system in developed countries like Australia is facing challenge of dealing
with different social structures and aging population. Different studies examined that access
to healthcare resources due to geographical distance is critical. Studies also indicated that
rural residents often encounter barriers of accessing healthcare resources. Transportation
barrier can be a cause in this regard. Also, some patients might not be that much educated
about different care sites and healthcare facilities available in the market. In a survey of
cityMD, conducted in the year 2017, it has been found that a large number of patients do not
know about the availability of different healthcare facilities in their nearby areas (Young &
Guo, 2016). Also, due to lack of opportunities and education, they cannot access the
healthcare sites available online. The older adults are more likely to suffer from such issues

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as they are not so much accustomed with the new technology and options available online.
High cost of care is another issue faced by some economically backward people is another
reason of not accessing healthcare facilities available in the market. Therefore, distributing
healthcare resources as per the needs and concepts of health and wellbeing is essential.
In this context, in order to highlight the health issues identified among the culturally
different older people, a case study of a patient will be considered. The patient is a 75 years
Indigenous old widower and living alone in his house with a very little amount of family and
social support. Mr. X (pseudonym) is a diabetic patient with a history of hypertension,
depression as well as symptoms of asthma. His nursing diagnosis includes malnutrition, high
blood pressure, and shortness of breathing. I personally identified, he is a smoker and the
poor lifestyle of Mr. X contributes to the poor health status. Also, his father had diabetes and
died due to ischemia stroke.
In order to conduct a cultural assessment a nurse should have sufficient understanding
of different cultural perspectives and its impact on the healthcare delivery. The Nursing and
Midwifery Board of Australia (NMBA) specifically outlines the commitments of nursing
profession towards the patients of different cultural beliefs and it also identifies the necessity
of respecting the diversity of different cultures and rights of every individual (Nursing and
Midwifery Boards of Australia, 2016). I also believe in developing a culturally appropriate
nursing assessment in order provide comfort to the patients of different cultures. In the
literatures, the authors indicated that should reflect on their own views and also acknowledge
that healthcare practice has its own cultural values, beliefs, and practices. Needless to say that
critical reflection is a vital practice of cultural care that can affect the health outcomes. I also
feel significant responsibility while assessing the cultural beliefs of the patient in order to
provide essential care. Cultural encounter is crucial and sensitive which requires intellectual
communication (McFarland & Wehbe-Alamah, 2017). In order to understand the cultural

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beliefs nurses need to go beyond their comfort zone to make the patient more comfortable.
According to studies, verbal and nonverbal communication is essential in assessing the
cultural beliefs of the patients (Pekerti & Thomas, 2015).
The patient in this case is diabetic and it is a common threat to all the healthcare
professionals around the world. Uncontrolled diabetes can deteriorate the condition of the
patient and hence the clinical intervention is highly necessary. It has been found in the studies
that may damage the large blood vessels of the heart which is quite dangerous and may
threaten the lives of the patients. Hypertension as well as high blood pressure is also
concerning in this regard. Here, Mr. X is suffering from growing symptoms of asthma. His
diseases require multiple interventions and strategies to control.
Moran developed cultural knowing framework in order to support the cultural
experience. Attaining data means gathering specific knowledge about the cultural information
of Mr. X that includes language, practice, and perspectives. In this regard, while assessing the
patient I will be careful about the language and culture of patient and I will change my
actions of speaking and touching the patient. At the same time, I will also focus in developing
trust between us in order to ensure holistic care. Apart from this, communication gap is
another issue which might create misunderstanding between the patient and the nurse
(Greenwood, Lindsay, King & Loewen, 2017). Also, due to not understanding the follow up
practices, the patient might skip those which will directly hamper his health status. Therefore,
being a nurse, I will try to speak in his language or I will show some visual content to explain
my words more. Some steps are there to compare their cultural beliefs as well as to
understand the emic and epic perspectives. Emic is the insider opinion which means how
people explain their own culture (Wallace, 2019). Whereas, epic is the outsider view which
means the outsiders’ interpretation about the culture. I will ask questions to Mr. X about his
culture and find a common ground to impose the care delivery process. Also, Kolb’s

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experimental learning cycle can be used as a framework to understand the stages of
participation, description, interpretation, and response to understand the cultural thoughts and
perspective of the patient before delivering the care (Tomkins & Ulus, 2016).
There is influence of various social determinants like economical condition,
education, environment, and others on the health status of people (Adler, Glymour &
Fielding, 2016). Several literatures in this regard explained that poorer people are more likely
to suffer from various health issues due to lack of opportunity of accessing costly healthcare
facilities and poor nutritional status (Garg, Toy, Tripodis, Silverstein & Freeman, 2015).
Again, some other researchers found that older people, who are living alone in their house,
are less likely to maintain a healthy lifestyle (Thornton et al., 2016). Poor nutrition and
improper lifestyle may cause various health issues. In case of Mr. X, he lives alone and is a
diabetic patient along with multiple adverse health issues. One of the main health issue
identified is his diabetes due to improper eating habits and poor lifestyle. Here, I will gain
understanding about his culture and develop care plan according to that. Also, according to
the food choices in their culture, I will develop a diet plan in order to bring him in the good
lifestyle. However, understanding his perception on diet might be critical but, individualized
care plan will help in promoting patient rapport in the shared decision making.
Health inequity is one of the biggest concerns for the healthcare providers from all
over the world and the Indigenous older adults are more likely to suffer from the inequality
related issues in healthcare due to various reasons such as transportation issue, racial issue
and others which creates ethical issues (Ray, 2015). However, in many literatures, the authors
discussed the importance of cultural safety and respecting a person’s values and dignity over
their culture while establishing a therapeutic relationship with the patient (Cai, 2016). Here,
Mr. X has lack of opportunity to achieve a good health status due to his unhealthy eating
habits, and isolation from the society that reduces the number of hospital visits. Using both

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the epic and emic perspectives, I will explain the causes of illness and different ways to
prevent further harming. I will let the patient know about different healthcare facilities as
well. As per his belief system I will interpret and process the way of developing care plan.
Again, in some studies it has been found that culturally safe practices require continuous re-
evaluation as well as assessment. However, this practice will help me to gain a lifelong
learning experience and knowledge. I will be stronger in developing intercultural relationship
while establishing the therapeutic relationship with the client.
Culture is a sensitive point and involvement of culture in the healthcare process
makes it extremely challenging for the healthcare providers which requires additional
supports (Cox, 2016). In this purpose, nurses are meant to follow specific standards of
nursing that depicts the way of valuing cultures and maintaining a culturally-appropriate care.
Patients from different cultural perspectives might not easily accept the follow ups and
restrictions but it is essential to explain the patient about the necessity of it and here, building
a trustful relationship becomes mandatory. Here, in this paper, the cultural and social
influence upon the healthcare industry and its impact on the health of the patients has been
clearly discussed. Here, in this paper, a case study was considered to demonstrate the cultural
impact on the healthcare process and how different social determinants can hamper the health
status of the people. Also, two different theoretical frameworks have been used in the paper
to establish the connection between the stated ideas and structure of the argument. Therefore,
to conclude, it can be said that using a cultural perspective in the healthcare delivery process
requires the development of new and deep knowledge through a cycle of action as well as
reflection. Nursing as a profession always values a culturally appropriate practice and a
leadership in describing the values of protecting the rights of every individual in this regard is
essential. I also realized that I should be skilful enough to implement new set of actions and
use different resources to achieve a culturally safe environment for me as well as the patient.

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