Cultural and Social Determinants Related to Medication Administration
Open Resources for Nursing (Open RN)
In addition to the legal and ethical considerations, there are also cultural and social influences that the nurse must consider when administering medication. According to the 2018 U.S. Census report, by the year 2030, the nation’s population is projected to age considerably and become even more racially and ethnically diverse. Though health indicators such as life expectancy and infant mortality have improved for most Americans, some people from racial and ethnic minority groups experience a disproportionate burden of preventable disease, death, and disability compared with non-Hispanic white people.[1]
The American Nurses Association’s (ANA) Scope and Standards of Practice states the need for health care is universal and transcends differences with respect to the culture, values, and preferences of individuals, families, groups, and communities. Diversity characterizes today’s health care environment, and nursing is responsive to the changing needs of society. To effectively promote meaningful client outcomes that maximize quality of life across the life span, the ANA states that nurses must engage in cultural humility. Cultural humility is a humble and respectful attitude toward individuals of other cultures that pushes one to challenge their own cultural biases, realize they can’t possibly know everything about other cultures, and approach learning about other cultures as a lifelong goal and process.[2] As previously discussed in this chapter, culturally congruent practice is the application of evidence-based nursing that is in agreement with the preferred cultural values, beliefs, worldview, and practices of the health care client.
In addition to cultural beliefs, conditions in the places where people live, learn, work, and play can also affect their health, functioning, quality of life, and risks. These conditions are known as social determinants of health (SDOH). Differences in health can be significant in communities with poor SDOH such as unstable housing, low incomes, unsafe neighborhoods, or substandard education. These differences are referred to as health disparities. By applying what we know about SDOH, nurses can not only improve an individual’s health, but also improve health equity for communities and the population as a whole.
Healthy People is a government agency that provides science-based, ten-year national objectives for improving the health of all Americans. Healthy People 2030 highlights the importance of addressing SDOH with a goal to “create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.”[3],[4]
Read additional information about Social Determinants of Health on the Healthy People 2030 website.
The U.S. Department of Health and Human Services also sets national standards for Culturally and Linguistically Appropriate Services (CLAS) in health and health care. The national CLAS standards are intended to advance health equity, improve quality, and help eliminate health disparities by “providing effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.”[5]
The U.S. Department of Health and Human Services (HHS) defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.” Adequate health literacy may include being able to read and comprehend essential health-related materials such as information on a medication bottle or in a handout. Nurses promote health literacy by including interventions such as visual aids to increase client understanding and, thereby, improve client safety.[6]
View the National CLAS Standards PDF.
Examples of Culturally Congruent Practice Related to Medication Therapy
There are several instances when a nurse must assess and accommodate a client’s cultural beliefs and social determinants of health when administering medications or teaching about medications. For example, a nurse addresses health literacy and medication safety by assisting a client to read information on a medication bottle or on a handout.
Another example of culturally congruent practice is when a nurse considers cultural or religious beliefs, such as fasting, when administering medications. For example, a Muslim client may participate in Ramadan, which requires 12-hour fasting. A nurse can advocate for the client and assist in altering the scheduling of medication to accommodate the client’s beliefs in order to reduce the risk of treatment failure.
Read more about medication intake during Ramadan.[7]
A third example of culturally congruent practice is when a nurse considers how a client’s ethnic background may affect their ability to respond to medications. For example, African Americans often require combination therapy to treat hypertension, and Asian and Hispanic clients often respond better to lower doses of antidepressants.
View a free module from the U.S. Department of Health and Human Services: Culturally Competent Nursing Care: A Cornerstone of Caring.
Critical Thinking Activity 2.4
A nurse is providing health teaching to a mother regarding a liquid antibiotic prescribed for her child to take at home. The prescription states amoxicillin 250 mg, give 1 teaspoon (5 mL) every eight hours for seven days. After talking with the mother, the nurse realizes the family does not have measuring spoons in their home.
What is the nurse’s best response?
Note: Answers to the Critical Thinking activities can be found in the “Answer Key” section at the end of the book.
Media Attributions
- ORN-Icons_internet-copy_internet-copy-300×300
- Centers for Disease Control and Prevention. (2023). Minority health and health equity. https://www.cdc.gov/minorityhealth/index.html ↵
- American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
- Social Determinants of Health: Know What Affects Health by Centers for Disease Control and Prevention is available in the Public Domain. ↵
- Social Determinants of Health by Healthy People 2030 is available in the Public Domain. ↵
- U.S. Department of Health and Human Services, Office of Minority Health. (n.d.). National standards for culturally and linguistically appropriate services (CLAS) in health and health care. https://thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf ↵
- Health Literacy by Health People 2030 is available in the Public Domain. ↵
- Aadil, N., Houti, I. E., & Moussamih, S. (2004). Drug intake during Ramadan. BMJ (Clinical Research Ed.), 329, 778–782. https://doi.org/10.1136/bmj.329.7469.778 ↵
The second IPEC competency relates to the roles and responsibilities of health care professionals and states, “Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations.”[1]
See the following box for the components of this competency. It is important to understand the roles and responsibilities of the other health care team members; recognize one’s limitations in skills, knowledge, and abilities; and ask for assistance when needed to provide quality, patient-centered care.
Components of IPEC’s Roles/Responsibilities Competency[2]
- Communicate one’s roles and responsibilities clearly to patients, families, community members, and other professionals.
- Recognize one’s limitations in skills, knowledge, and abilities.
- Engage with diverse professionals who complement one’s own professional expertise, as well as associated resources, to develop strategies to meet specific health and health care needs of patients and populations.
- Explain the roles and responsibilities of other providers and the manner in which the team works together to provide care, promote health, and prevent disease.
- Use the full scope of knowledge, skills, and abilities of professionals from health and other fields to provide care that is safe, timely, efficient, effective, and equitable.
- Communicate with team members to clarify each member’s responsibility in executing components of a treatment plan or public health intervention.
- Forge interdependent relationships with other professions within and outside of the health system to improve care and advance learning.
- Engage in continuous professional and interprofessional development to enhance team performance and collaboration.
- Use unique and complementary abilities of all members of the team to optimize health and patient care.
- Describe how professionals in health and other fields can collaborate and integrate clinical care and public health interventions to optimize population health.
Nurses communicate with several individuals during a typical shift. For example, during inpatient care, nurses may communicate with patients and their family members; pharmacists and pharmacy technicians; providers from different specialties; physical, speech, and occupational therapists; dietary aides; respiratory therapists; chaplains; social workers; case managers; nursing supervisors, charge nurses, and other staff nurses; assistive personnel; nursing students; nursing instructors; security guards; laboratory personnel; radiology and ultrasound technicians; and surgical team members. Providing holistic, quality, safe, and effective care means every team member taking care of patients must work collaboratively and understand the knowledge, skills, and scope of practice of the other team members. Table 7.4 provides examples of the roles and responsibilities of common health care team members that nurses frequently work with when providing patient care. To fully understand the roles and responsibilities of the multiple members of the complex health care delivery system, it is beneficial to spend time shadowing those within these roles.
Table 7.4. Roles and Responsibilities of Members of the Health Care Team
| Member | Role/Responsibilities |
|---|---|
| Assistive Personnel (e.g., certified nursing assistants [CNA], patient-care technicians [PCT], certified medical assistants [CMA], certified medication aides, and home health aides) | Work under the direct supervision of the RN. (Read more about Assistive Personnel (AP) in the “Delegation and Supervision” chapter.) |
| Licensed Practical/Vocational Nurses (LPN/VN) | Assist the RN by performing routine, basic nursing care with predictable outcomes. (Read more details in the “Delegation and Supervision” chapter.) |
| Registered Nurses (RN) | Use the nursing process to assess, diagnose, identify expected outcomes, plan and implement interventions, and evaluate care according to the Nurse Practice Act of the state they are employed. |
| Charge Nurses or Nursing Supervisors | Supervise members of the nursing team and overall patient care on the unit (or organization) to ensure quality, safe care is delivered. |
| Directors of Nursing (DON), Chief Nursing Officer (CNO), or Vice President of Patient Services | Ensure federal and state regulations and standards are being followed and are accountable for all aspects of patient care. |
| Clinical Nurse Specialist (CNS) | Practice in a variety of health care environments and participate in mentoring other nurses, case management, research, designing and conducting quality improvement programs, and serving as educators and consultants. |
| Nurse Practitioners (NP) or Advanced Practice Registered Nurses (APRN) | Work in a variety of settings and complete physical examinations, diagnose and treat common acute illness, manage chronic illness, order laboratory and diagnostic tests, prescribe medications and other therapies, provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance, and refer clients to other health professionals and specialists as needed. NPs have advanced knowledge with a graduate degree and national certification. |
| Certified Registered Nurse Anesthetists (CRNA) | Administer anesthesia and related care before, during, and after surgical, therapeutic, diagnostic, and obstetrical procedures, as well as provide airway management during medical emergencies. |
| Certified Nurse Midwives (CNM) | Provide gynecological exams, family planning guidance, prenatal care, management of low-risk labor and delivery, and neonatal care. |
| Medical Doctors (MD) | Licensed providers who diagnose, treat, and direct medical care. There are many types of physician specialists such as surgeons, pulmonologists, neurologists, cardiologists, nephrologists, pediatricians, and ophthalmologists. |
| Physician Assistants (PA) | Work under the direct supervision of a medical doctor as licensed and certified professionals following protocols based on the state in which they practice. |
| Doctors of Osteopathy (DO) | Licensed providers similar to medical physicians but with different educational preparation and licensing exams. They provide care, prescribe, and can perform surgeries. |
| Dieticians | Assess, plan, implement, and evaluate interventions related to specific dietary needs of clients, including regular or therapeutic diets. Formulate diets for clients with dysphagia or other physical disorders and provide dietary education such as diabetes education. |
| Physical Therapists (PT) | Develop and implement a plan of care as a licensed professional for clients with dysfunctional physical abilities, including joints, strength, mobility, gait, balance, and coordination. |
| Occupational Therapists (OT) | Plan, provide, and evaluate care for clients with dysfunction affecting their independence and ability to complete activities of daily living (ADLs). Assist clients in using adaptive devices to reach optimal levels of functioning and provide home safety assessments. |
| Speech Therapists (ST) | Develop and initiate a plan of care for clients diagnosed with communication and swallowing disorders. |
| Respiratory Therapists (RT) | Specialize in treating clients with respiratory disorders or conditions in collaboration with providers. Provide treatments such as CPAP, BiPAP, respiratory treatments and medications like aerosol nebulizers, chest physiotherapy, and postural drainage. They also intubate clients, assist with bronchoscopies, manage mechanical ventilation, and perform pulmonary function tests. |
| Social Workers (SW) | Provide a liaison between the community and the health care setting to ensure continuity of care after discharge. Assist clients with establishing community resources, health insurance, and advance directives. |
| Psychologists and Psychiatrists | Provide mental health services to clients in both acute and long-term settings. As physician specialists, psychiatrists prescribe medications and perform other medical treatments for mental health disorders. Psychologists focus on counseling. |
| Nurse Case Managers or Discharge Planners | Ensure clients are provided with effective and efficient medical care and services, during inpatient care and post-discharge, while also managing the cost of these services. |
The coordination and delivery of safe, quality patient care demands reliable teamwork and collaboration across the organizational and community boundaries. Clients often have multiple visits across multiple providers working in different organizations. Communication failures between health care settings, departments, and team members is the leading cause of patient harm.[3] The health care system is becoming increasingly complex requiring collaboration among diverse health care team members.
The goal of good interprofessional collaboration is improved patient outcomes, as well as increased job satisfaction of health care team professionals. Patients receiving care with poor teamwork are almost five times as likely to experience complications or death. Hospitals in which staff report higher levels of teamwork have lower rates of workplace injuries and illness, fewer incidents of workplace harassment and violence, and lower turnover.[4]
Valuing and understanding the roles of team members are important steps toward establishing good interprofessional teamwork. Another step is learning how to effectively communicate with interprofessional team members.
