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‘Quality care for me has to have culture embedded in it’

Rani Srivastava is a leading voice for expanding cultural competency

By Laura Eggertson
July 11, 2022
Courtesy of Rani Srivastava
For Rani Srivastava, being culturally competent requires understanding your own cultural biases, as she explains in her book, The Healthcare Professional’s Guide to Clinical Cultural Competence. This requires learning about a patient or client’s cultural beliefs and practices, especially as they pertain to health and illness.

Before she had the words to describe it, Rani Srivastava knew cultural competency mattered if she wanted to provide excellent health care for her patients.

“I knew that because of who I am — not because I learned it in school,” says Srivastava, an associate professor and dean of nursing at Thompson Rivers University in Kamloops, B.C.

Culture and the way it affects people’s philosophies about wellness and health were not on the curriculum when Srivastava graduated from Dalhousie University’s School of Nursing in 1981.

More than 40 years later, she makes sure the students under her leadership do learn about cultural competency — as much from what she models, as what she teaches.

“Quality care for me has to have culture embedded in it — because how can you provide patient-centred care without understanding who the person is?”

Role model

To understand who Srivastava is, is to appreciate her importance as a role model and mentor for other nurses.

A South Asian Hindu woman, Srivastava has a PhD and decades of experience as a nurse leader. Prior to joining the Thompson Rivers’ faculty, she was the deputy chief of nursing and then vice-president and chief of nursing and professional practice at the Centre for Addiction and Mental Health in Toronto.

She’s taught nursing at Memorial University, the University of Toronto, and York University, and is the author of The Healthcare Professional’s Guide to Clinical Cultural Competence. The textbook consolidates her extensive research and knowledge about the importance of practising appropriately when interacting with patients of a different culture.

She’s a wife and mother who loves to read, walk, and cook for her family.

She’s also a mentor, determined to illuminate and burst the barriers that exist for marginalized patients and nurses in the health-care system.

As an immigrant — her family arrived in Halifax from India when she was 13, via a two-year sojourn in the United States — Srivastava has experienced racism and discrimination first-hand.

She counts herself among a too-small number of racialized women in academic leadership roles in Canada.

All of those experiences sharpen the lens she brings to bear on cultural competency, mentorship, and equity, issues on which she is a leading voice.

“Keep pushing”

In 2017, the Canadian Nurses Association named her one of 150 nurse advocates and leaders in advancing patient-centred approaches to high-quality health care.

Her current position is a privilege she does not take for granted. “I see who’s not here,” Srivastava says, referring to the lack of women of colour, especially Black women, in leadership positions. She sees it as her responsibility to “keep pushing” to change that.

One of the values she’s pushing is to increase formal training in cultural competency for health-care practitioners. She wants to broaden the conversations about why that expertise is important.

‘How can you provide patient-centred care without understanding who the person is?’

For Srivastava, being culturally competent requires understanding your own cultural biases, as she explains in her book. This requires learning about a patient or client’s cultural beliefs and practices, especially as they pertain to health and illness.

Demonstrating cultural competency also requires understanding the roles that equity, power, and race play in health-care outcomes.

The importance of listening, understanding, and incorporating different values and traditions is something Srivastava came to understand not just as a nurse, but as a patient.

“Primitive” practice

Early in her career, when she was pregnant with her daughter, Ratika, Srivastava explained to her nurse colleagues that many cultures have rituals and beliefs about protecting mothers and babies by wearing particular stones or participating in ceremonies.

Her colleagues responded not just with skepticism, but dismissal.

“Oh, Rani — you really believe in that? That sounds so primitive,” she remembers them saying. “And I thought: ‘why is that primitive?’”

When health-care practitioners fail to acknowledge or dismiss their patients’ beliefs, that failure can lead to non-compliance with treatment, Srivastava says.

For example, a dietitian prescribed a diet for one of her renal patients that did not conform to the vegetarianism and fasting he was adopting to meet his spiritual goal of becoming a better Hindu.

Acknowledge beliefs

Only through extended negotiations with the dietitian was Srivastava able to arrive at a compromise that enabled the patient to accede to a modified diet.

“It’s how we work with people to acknowledge their beliefs [that’s important],” she says. “If we don’t even acknowledge them … there’s no trust.”

Trust is also a vital component of mentorship, Srivastava says. It was Jean Trimnell, chief nurse at the former Wellesley Hospital in Toronto when Srivastava was a clinical nurse specialist in nephrology there, who encouraged her to trust her interest in cultural competency as a potential research program and an area of specialty.

Trimnell’s faith in her is something Srivastava passes on to other nurses. She observes what they are interested in, validates those interests, and asks what she can do to help.

That mentorship is particularly important for nurses from marginalized or racialized communities who may not have the role models they need, she says.

It’s been gratifying for Srivastava when nursing students tell her what seeing her in leadership positions means to them, she says.

One student told her that “Rani is the dean — and just seeing her in that role means I could be that one day,” Srivastava recalls.

In the last two years, since beginning her work as dean, Srivastava has co-chaired the university’s anti-racism task force. She is listening to the experience of racialized students and colleagues at the university, building supports for them, and recruiting faculty members who are diverse not only in ethnicity but also in gender

Most of all, she’s creating space to hold the courageous conversations at the university and in the broader community that will make racism visible.

Make racism visible

“If we don’t make racism and the barriers to equity visible, we don’t understand them and we don’t know how to deal with them,” she says. “Making them visible makes it uncomfortable, but it now gives us a way to proceed.”

As she advanced in her career, Srivastava, like other racialized leaders, had to deal with the perception that she got her leadership positions because of her skin colour, not her qualifications.

At times, colleagues patronized her, questioning her authority or expertise, suggesting she needed additional help “because maybe I didn’t quite understand” an issue.

That type of racism is important to make visible, she says.

She no longer worries about criticism that she did not earn her position.

“What I do speaks for itself,” she says. “The number of times I didn’t even get in the door because of my brown skin and my name — if my brown skin and my name are now seen as positive to ‘diversify’ a team, I’m not going to apologize for that. I still wouldn’t get beyond Step 1 if I didn’t have the qualifications and the experience.”

She encourages other nurses and students to adopt a similar attitude.

Her best advice? Get comfortable with the fact that not everyone will be comfortable with you.

“Don’t put yourself down,” she advises. “It’s OK to be humble, but too much of that will make other people look for your weaknesses and not recognize your strengths. You have to learn to talk about your strengths.”

Laura Eggertson is a freelance journalist based in Wolfville, N.S.