Despite the evidence that the most rapidly growing minority population in the United States is Spanish speaking, I do not believe that schools of nursing should require the study of elementary Spanish in the curriculum. Rather, I favor teaching nursing students how to be culturally sensitive, and how to work with a translator for the best outcome for each patient.

In my town of 230,000 there are approximately 75 first languages represented in the local school system. This is remarkable because we are not on a United States border, nor are we a port city, a state capital, or major transportation hub. Therefore, a focus on teaching Spanish alone would be a disservice to the other minority groups represented in this area. Some may argue, "Learning Spanish does not mean students would be taught to ignore the needs of patients speaking other languages!!" While true, the limited flexibility in most nursing curricula would favor including content and approaches that are more broad-based than requiring courses in Spanish.

For example, population groups in our area with over 1,000 individuals include natives of Viet Nam, Cambodia, tribes from the highlands of Vietnam known as Montagnards (Greensboro has the largest Montagnard community outside of southeast Asia, at approximately 2,000), Korea, Palestine, Nigeria, Sudan, Niger, Bosnia, as well as Hispanic/Latinos (Center for New North Carolinians, 2004). Many other countries are represented as well, with smaller numbers. With this diverse list of non-English-speaking groups it seems nonsensical to focus on Spanish alone. Better alternatives would be to: help students to become sensitive to cultural differences, effectively use translators, and find translators or other sources of assistance in communicating with non-English-speaking individuals.

Just as most curricula include content that covers the lifespan, so should curricula include content about the cultures that students will encounter in the practice settings of their community. Examples of content to be covered include: the typical dietary preferences or foods not usually permitted; beliefs about health, disease, medications, and surgical procedures; common health problems; religions; the role of the extended family in decision making; or other aspects that have been identified as significant in promoting or blocking health in these populations. Some would suggest that this ideal is impossible, but I believe that students should at least recognize that individuals from other cultures may differ from them in significant ways, and thus may have dissimilar perspectives on health. An excellent book that illustrates this was written by Fadiman (1997). The book describes the failure of the healthcare system to find common goals with the family of a Hmong child who suffered from seizures. Had the healthcare system better understood the family's view of their child's problem, and had communication with the family been more culturally sensitive, the final outcome may have been different.

The study of any foreign language requires many semesters before students can speak easily and fluently. Two years ago our faculty consulted with faculty in our foreign language department who agreed that even with four semesters of a single foreign language, most of our students would be unable to converse adequately with a native speaker of that language. Four courses (12 semester hours) is a considerable amount of credit and time devoted to the study of any topic in a nursing school curriculum, especially when students may not achieve the desired outcome.

If we assume that we will continue to have immigrant populations representing many countries and languages in the future, then we must develop in our students the ability to work with translators who can help nurses. Working effectively with a translator is not a natural skill, and students need role modeling and practice to learn how to do it. In addition, we must teach students about translation resources available in the community. In summary, the goal of nursing must be to provide the best care to patients of all backgrounds. To do this, nurses must learn how to individualize their assessment and care of patients, regardless of patient background. For non-English-speaking patients this challenge can best be met by nurses learning how to be culturally sensitive and to use translators to their best advantage.

References