The community health nurse needs to be open to different cultures. We have all heard this statement, "They are in the U.S. and so they should learn to conform". In our interactions with people, their health is of upmost importance. To be able to provide care, the nurse must be able to provide culturally consistent, suitable, and meaningful nursing and health care.

This will help to eliminate misunderstandings and miscommunications (Maurer & Smith, 2013, p. 268) . We will not know everything about all cultures, however, over time we will add more and more to our cultural competence suitcase.

Cultural preservation maintains the importance of the specific culture. In the Native American culture, the placenta is often saved and used in ritual planting of a tree. In looking at the placenta, you can see the symbolic tree of life in the veins and arteries of the placenta. By asking about this preservation ritual before throwing the placenta away, you show a cultural competence and respect for the patient's culture.

Cultural accommodation is including aspects of culture into western practice if it is not harmful. In the Gypsy culture, childbirth is viewed as unclean. Many of their women will receive prenatal care through their midwives in their village and only go to the hospital for the birth so as not to make their home unclean. They believe in the support of the village.

When we had a patient come in to give birth, she arrived with no less than 15 people to attend the birth. The OB was not happy with this and tried to empty the room until the nurse took charge. The number of people was reduced but the majority remained with an understanding that if an emergency came up they would need to exit the room. Once the OB understood the cultural relevance, he could take a step back and allow for this ritual.

Cultural repatterning is changing a harmful health practice while still respecting the culture. In L&D, we see the practice of female genital cutting. This is practiced in 28 African countries as well as other areas. Genital cutting is the excision of part or all the female external genitalia for non-medical reasons. This takes place around the age of 14. The negative outcomes are many. Women's groups and human rights activist have placed this as a high priority to stop this harmful practice. Community education is key to increase public awareness. Harmful traditions seem impossible to change. Through policy makers, community leaders, and education the message will get out there (Hersh, 1998) .

Cultural brokering is the intervening for the patient, providing the appropriate care. An example of this would be the young Hispanic girl that comes to the hospital to have a baby, her family refuses to sign for the epidural. They believe that the epidural could have negative long lasting effects on her back. They also believed that this young girl needed to be taught a lesson, through the pain, maybe she would not have sex again before marriage. This type of withholding medication is not allowed, the patient could sign for her own epidural even though she was a minor. We could provide the best care for her. The barrier is the families wishes were not observed.

References

Hersh, L. (1998). Giving up harmful practices, not culture. Retrieved from

http://www.advocatesforyouth.org/publications/publications-a-z/521-giving-up-harmful-practices-not-culture

Maurer, F. A., & Smith, C. M. (2013). Community/public health nursing practice (5th ed.). [Elsevier]. Retrieved from Elsevier eBooks