Cultural competence in Healthcare

A

Using your own words, define culturally competent nursing care. Support the definition with a professional literature citation.

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 patients 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 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 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 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).

 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 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 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

Diaz, C., Clarke, P., & Gatua, M. (2015). Cultural Competence in Rural Nursing Education: Are We There Yet?. Nursing Education Perspectives, 36(1), 22-26. doi:10.5480/12-1066.1

Dudas, K. (2012). CULTURAL COMPETENCE: An Evolutionary Concept Analysis. Nursing Education Perspectives, 33(5), 317-321. doi:10.5480/1536-5026-33.5.317

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. doi:10.1093/sw/55.4.297

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. doi:10.1093/sw/56.3.213

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. doi:10.1186/1471-244x-14-181

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. doi:10.5480/12-834.1

McClimens, A., Brewster, J., & Lewis, R. (2014). Recognising and respecting patients’ cultural diversity. Nursing Standard, 28(28), 45-52. doi:10.7748/ns2014.03.28.28.45.e8148

Norton, D., & Marks-Maran, D. (2014). Developing cultural sensitivity and awareness in nursing overseas. Nursing Standard, 28(44), 39-43. doi:10.7748/ns.28.44.39.e8417

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