Cultural competence in Healthcare

A

Identify four (4) guidelines the registered professional nurse may use to enhance the ability
to provide culturally competent nursing care. Provide one example the culturally
competent nurse applies to each of the four (4) selected guidelines. At least one example
must address care of patient(s) not occurring in an acute care hospital.
Describe how the registered professional nurse evaluates if the patient�s cultural needs
have been met.

Describe whether cultural practices must be accommodated in all aspects of health care.
Provide a specific example and rationale to support your response.
B
Select four (4) cultural features, associated with the selected cultures that influence the
provision of nursing care for patients with chronic illness and at the end of their lives.
Describe how the four (4) cultural features influence the provision of care to the patients.
Provide two (2) nursing interventions that demonstrate nursing care, which reflect the
respect for the dignity and uniqueness of those cultural features for patients experiencing
chronic illness and at the end of their lives.

Part A: Cultural competency in health and social care
The reforms in health care industry are focusing on ways to embrace diversity in
providing care. Cultural differences affect patient’s perceptions about sickness, their assessment

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2
and disease outcome. With the advancement in technology, it has become easy for people to
move from place to place making countries to be ethnically diverse than the nursing forces.
Thus, the nurses work with the patients from various cultural backgrounds. Therefore, the health
care facility must provide a culturally competent healthcare environment. Cultural refers to the
way of life of a population including shared values, skills and languages (McClimens, Brewster
& Lewis, 2014). It is the aspect of the society which defines person’s character due to the
conscious and unconscious beliefs that have been installed in them. In this context, cultural
competency refers to the ability to deliver quality care which is congruent with people’s social
background and cultural expectations. A culturally competent organization is one that
demonstrates that their organizations integrate awareness of the community health related
cultural beliefs and how they impact the disease prevalence and the mortality rates. The
healthcare settings must be established in a manner that acknowledges the value of culture and
the repercussions if the health care providers fail to respect the diversity (Legha Et al., 2014).
Four essential elements are necessary in ensuring that the institutions are culturally diverse
including a) valuing cultural diversity; b) valuing the cultural dynamics that makes the
community interact effectively; c) adapting and reflecting to the understanding of the existing
cultural diversity and d) possessing institutionalized cultural knowledge. From all levels, the
nurse must reflect on the diversity on the population the healthcare facility serves. This will
facilitate the nurses to push better for care for the underprivileged and the underserved
populations. Valuing the diversity in the community it facilitates their understandings of the
community perceptions about health. Everybody in the society or a nurse interacts with has a
cultural identity which in one way impact their perception about culture. Importantly, the nurse

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3
must understand that culture is not static. It evolves over and over again with time (Dudas,
2012).
A client from developing country was admitted in one of the healthcare facility in this country.
The person migrated into this country as an asylum seeker and all her life, she has believed and
worshipped in one religion in the country of origin. Fortunately, on migration, the patient found
other members in this country and fellowshipped together. Whenever a person is admitted in
hospital, there must be a ritual that has to be performed so as to scare away the evil spirits. The
ceremony involves chanting, burning of the incense stick and produces some smoke. When the
nurse in charge was requested, she was in a dilemma because she had never experienced these
cultural rituals in public places before (Mareno & Hart, 2014). However, understanding the value
of cultural competence she discussed the matter with the senior management who evaluated the
impact of disturbances to the other clients due to noise from chanting, risks for fire as the
burning of the things was being done and the effects of smoke to patients from these processes.
The administration provided a separate room for the ritual. They even went ahead in
incorporating the cultural concepts in their medication process. The patient was requested to
chant prayers three times while facing west before taking the medication. Within a week, the
patient condition had improved due to the increased cooperation with the medical providers
(Norton & Marks-Maran, 2014).
From the case scenario, valuing the cultural components in the community will help the nurse
reduce reactions and prejudices which could impact the patient-nurse relations. As a matter of
fact, nurse culture is influenced by professional values as are slightly influenced by nurses’
beliefs. Valuing cultural diversity is an important guideline because it the nurses responsibility
to assess the patient’s needs and expectations as established by the patient cultural values. For

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4
instance, some community beliefs that giving birth to disabled children is a curse; and is often
associated with evil spirits. In such a case, it is more likely that the infant’s mother could feel
distressed and confused. The nurse must listen to the patient to understand her concerns; and it is
their responsibility to ensure that the mother overcomes the fear. These impacts the whole
society as the woman could be bold to speak out for her child, empowering other women who are
under similar circumstances (Legha Et al., 2014).
Additionally, the ability to recognize the cultural dynamics within the society is important.
This is because it acts as a guide on how the community uses the dynamics to make sure that
they live in harmony and that their health is protected or promoted. The cultural dynamics and
potential interactions among the community increase the probability for stereotyping and
misjudging. For instance, a nurse can associate certain ailments with cultural practices which
seem unhygienic. In other cases, the nurse can discuss topics which are identified as bad omen to
the society such as discussing issues of unborn child. In this case, the nurse must listen to the
patient’s description of their health conditions, the reason the patient thinks the disease is
manifesting its symptoms and their perception on treatment (Norton & Marks-Maran, 2014).
Adapting and reflecting to the understanding of the existing cultural diversity is the third
guideline that facilitates the nurses provide culturally competent care. Every patient has a set
values and beliefs that affect the way they view life and how they react to the world. The best
way to ensure that the nurse provides culturally competent care is through self-reflection on the
values and barriers that could underscore his/her strategy to provide quality care to the patient. It
is important for a nurse to reassess their interventions to various situations so as to identify issues
that hinder or introduce cultural biasness; and where necessary seek assistance from other peers
to establish the best intervention for a particular objective (Diaz, Clarke & Gatua, 2015).

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5
Possessing institutionalized cultural knowledge is very vital in all sectors of health care systems.
Nursing profession has cultural values too. These values include truthfulness, empathy, caring
respect to patient preferences and promotion of health and autonomy. This nurse culture
determines how a nurse interacts with the clients. For instance, a nurse who values patient
empowerment and autonomy meets a patient whose cultural values does not allow them to make
healthcare decisions for themselves, but the decision making process integrates the entire
extended family could be in a dilemma, especially if the decision involves a health care therapy
that must be performed quickly to save the patient’s life. Therefore, the nurses must be
empowered adequately so that they can make the right decision when faced by an ethical
dilemma. If the concept of cultural competency is ignored in medical schools, there will be
increased mortalities, disease burden nurse burn out and increased turnover rates; especially in
underprivileged societies in this nation (McClimens, Brewster & Lewis, 2014).
Part B: Culturally competent nursing care
The cultural belief is that illness is caused by ghosts, a punishment for not following taboos or
loss of equilibrium between the body and the environment. The sick will often be stoic and quiet
because the culture demands so. The sick person is more likely to request alternative therapy.
The nurse must devise strategies that will integrate the patient culture when providing care. The
culture does demands that terminal illness must not be discussed directly to the patient or in open
discussion because it may hasten death events. The Native American like many other cultures
emphasizes on cooperation and mutual aid. In this context, the patient’s relatives will be mostly
involved in decision making processes. The head of the family is the spokesperson of the person
who is ill; and in most cases it is this person that will be used to communicate the family
decisions. Therefore, the nurse should consider integrating the community and the family in

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6
patient education. However, it is important for the nurse to observe the professional values
including autonomy and independence (Hodge & Limb, 2010).
The most important issues in Native American culture are the spiritual; healing and that vary
considerably from one tribe to another. The community is stratified into ranks, and member of
each rank can be differentiated from the type of dress they wear. The dresses also indicate person
rank in the society. Everything worn has a symbolic meaning on either prayer or healing. In this
context, the healthcare must be vigilant when removing any clothes or ornament from the patient.
If patient is not conscious to make decision if the cloth or the ornaments have to be removed, the
items must be put very close to the patient and should be replaced back as soon as the medical
operation is done. Some practices that are congruent with the health is burning sage, therefore,
the nurse can spray sage as it is considered as a method of purification (McClimens, Brewster &
Lewis, 2014).
The Native American culture has set standards for means and modes of communication. The
person with higher authority is respected. Religious people are accorded the highest respect and
must be addressed with respect. Respect is shown by avoiding eye contact, keeping distance and
having as little body contact as possible. In fact, the nurse should avoid hand shake. When the
patient is speaking, he/she should not be disrupted as it is perceived as sign of disrespect. In
most cases, the client could make long pauses which are considered as a means of conversation,
which implies that the patient is not in agreement with whatever the nurse is suggesting.
Speaking loudly to Native American indicates aggression, and it must be avoided. Where there is
need to make an imperative command, the nurse must be emphatic and direct. If there is more
healthcare recommendation or requests to be made, the nurse must give succinct explanation

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7
why the recommended process is important in a personable and polite way (Hodge & Limb,
2011).
Cultural assessment is one of the nursing interventions that is important in ensuring that quality
healthcare is provides. This involves asking open-ended questions to the patient if he/she is
conscious or a family member. This will improve the relationships between the nurse and the
patient; making the patient becomes more cooperative. There are several cultural competence
health assessment programs online which can be used to perform the process. However, it would
even be more appropriately if the health care facility designs their own tailor made cultural
assessment program, one that fits the diverse people in the community. The nurse must also
perform transcultural studies to understand the geographic region and values, beliefs and of the
community living in the neighborhoods (Hodge & Limb, 2010).
Communication barriers are other challenges that enhance health disparities. Effective
communication between the patient and the nurse facilitates better partnership. The patient is
able to express about how he/she feels and his/her perceptions about the disease. The nurse can
interact with the patient’s thought process which in turn facilitates the designing and
implementation of the action plan. Health citizens will require establishing of a culture that
embraces cultural competencies and reduces misunderstandings. This way, the patients get
empowered on ways to self-manage their health condition to meet their health care demands and
to improve the quality of life. Effective communication between the patient and the nurse
implies that the patient will be well informed and can be integrated in decision making processes.
This in turn will facilitate provision of quality care, increase patient self-esteem and autonomy
and improve their quality of life (Norton & Marks-Maran, 2014).
References

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Diaz, C., Clarke, P., & Gatua, M. (2015). Cultural Competence in Rural Nursing Education: Are
We There Yet?. Nursing Education Perspectives, 36(1), 22-26.
Dudas, K. (2012). CULTURAL COMPETENCE: An Evolutionary Concept Analysis. Nursing
Education Perspectives, 33(5), 317-321.
Hodge, D., & Limb, G. (2010). Native Americans and Brief Spiritual Assessment: Examining
and Operationalizing the Joint Commission’s Assessment Framework. Social Work, 55(4),
297-307.
Hodge, D., & Limb, G. (2011). Spiritual Assessment and Native Americans: Establishing the
Social Validity of a Complementary Set of Assessment Tools. Social Work, 56(3), 213-223.

Legha, R., Raleigh-Cohn, A., Fickenscher, A., & Novins, D. (2014). Challenges to providing
quality substance abuse treatment services for American Indian and Alaska native
communities: perspectives of staff from 18 treatment centers. BMC Psychiatry, 14(1), 181.

Mareno, N., & Hart, P. (2014). Cultural Competency Among Nurses with Undergraduate and
Graduate Degrees: Implications for Nursing Education. Nursing Education Perspectives,
35(2), 83-88.
McClimens, A., Brewster, J., & Lewis, R. (2014). Recognising and respecting patients’
cultural diversity. Nursing Standard, 28(28), 45-52.
Norton, D., & Marks-Maran, D. (2014). Developing cultural sensitivity and awareness in nursing
overseas. Nursing Standard, 28(44), 39-43.

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