Cultural competence: Registered Professional Nurse Responsibility
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linked item M6A3: Cultural Competence: Registered Professional Nurse Responsibility Paper
Using APA format, write a six (6) to ten (10) page paper (excludes cover and reference page) that examines culturally sensitive nursing care. The paper consists of two (2) parts and must be submitted by the close of week six (6).
A minimum of three (3) current professional references must be provided. Current references include professional publications and valid websites dated within five (5) years. Additionally, a textbook that is no more than one (1) edition old may be used.
Part 1 – Introduction
Address the following:
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 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.
Part 2- Demonstrating Culturally Competent Nursing Care
Address the following:
Select one of the following cultures:
- Asian
- Native American
- Hispanic
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) examples that demonstrate nursing care, which reflects the respect for the dignity and uniqueness of those cultural features for patients experiencing chronic illness and at the end of their lives.
Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format. Assistance with APA citations and references is available through the free resource Citation Machine™. Assistance with APA format, grammar, and avoiding plagiarism is available for free through the Excelsior College Online Writing Lab (OWL). Be sure to check your work and correct any spelling or grammatical errors before you submit your assignment
NB
This task is 7 pages.
SAMPLE ANSWER
Registered Professional Nurse Responsibility
Cultural competence: Registered Professional Nurse Responsibility
Today, registered nurses offer public health care to populations from diverse cultures; each with unique cultural and religious spirituality. Culture is defined as shared values and character, transmitted from one generation to another, which distinguish individuals of one group from another. Therefore, it is vital to understand patient cultural background because they impact significantly on the patients’ health and illness (Astrid et al, 2010). Cultural diversity is recognizes individual uniqueness in terms of their socio economic status, physical attributes, ethnicity, political and religious beliefs. The cultural diversity concept entails respecting person’s cultural background in order to relate with them i.e. cultural competence. According to The Primary care Access Network (PCAN) of central Florida, culture competence refers to all activities geared towards effective and sensitive delivery of quality health care. It entails a set of attitudes and regulatory policies that work together in ensuring that health care practitioners function effectively and sensitively across the board. Becoming culturally competent requires self-awareness and commitment to give safe and quality health care services to everyone irrespective of their backgrounds (CDC, 2014).To provide competent health care, the following four guidelines are followed; a) Acknowledge and respect diverse cultural influence b) Cultural care accommodation c) Widen knowledge on cultural diversity and d) Culture care preservation
To start with, the practitioner should acknowledge and respect the cultural influence in personal and professional way of life. The guideline supports patient centered model; where the nurse focuses on the patient rather than treating the illness. According to this guideline, illness is interpretation of individual’s ailment interpreted by their sociocultural factors. For instance, some cultures may associate mental disorder such as Schizophrenia as being inhabited by evil spirit. It is the nurse’s obligation to listen the disease description according to the patient’s perspective. Secondly, health practitioner should be vigilant regarding the dynamics of cross cultural relations to enhance communication. Cross cultural interaction brings forth the possibility of misjudging other people’s actions or intentions. More insights on patient’s cultural background minimize stereotyping incidences; and develop mutual beneficial relationship between the parties. The medical practitioner should Listen to patient’s description of the problem; explain the perception into medical terms and prescribe the treatment (Norton &Marks-Maran, 2014).
Thirdly, The practitioners should broaden their cultural diversity knowledge, and incorporate it into their profession. The increased knowledge about the person’s sociocultural concepts enhances the relationship especially during physical examination processes i.e. facilitate in identifying what questions to ask, avoid, modify and how to put them across. For instance, questioning sexual behavior among Hispanic community is disrespectful, and patients may not collaborate. Some religion does not permit vaccination, and therefore, may exempt their new born from getting immunization. Nurses should get acquainted on the relevant sociocultural beliefs of the ethnographic local communities. Lastly, Nurses should develop and adapt to the identified culturally sensitive interventions which will enhance better relation between patients’ needs and clinicians needs (Dudas, 2012).
An Islam Imam (spiritual leader) suffered mild dementia while visiting his son in Toronto. He was physically examined, and all cultural questions posed were answered by his son. The patient condition deteriorated and was transferred to the ICU. After several interventions, the nurse in-charge decided to help the elderly man in grooming and personal hygiene. The first step was to clean shave the long and unkempt beard. In the process, the nurse let the man know that she was going to shave his beard; the man seemed to nod, and the nurse concluded that he agreed with the entire hygiene Practices. The nurse went home very happy and proud to have provided such good comfort and care for the elderly. When the son visited the following morning, he was horrified at the sight of his father. He rushed out of the room and reprimanded the nurse. Apparently, the father was a holy man so his beard had never been cut. The family had to make new arrangements of how to sacrifice for this taboo. The nurse was charged with negligence of cultural beliefs Therefore, it is important to identify all practices and beliefs by designing assessment questions elicit to provide more information. The healthcare institution should involve political, religious and non-religious experts when designing such assessments. This will ensure that health care services are delivered in a way that respects and values cultural practices. From this example, it is obvious that cultural competent care is very important in providing quality and satisfying patients care (CNO, 2009).
Nursing scholars have debated on ways to ensure cultural competence in nursing. Cultural assessment interview plays vital role when evaluating patient cultural needs. This is done by asking relevant but open-ended questions to the patient, and giving them opportunities to elaborate on them (Mareno & Hart, 2014). Patients become more co-operative if a nurse shows interest in learning more their cultural back ground. The nurse should make the comfortable enough to make the open up about everything they have done prior to seeking medical attention. Georgetown University have established Cultural competence Health practitioner Assessment program which can be downloaded from their website. Generally, The nurse must listen and must not misjudge or stereotype the patient. Some of the questions that could be integrated to gather clients culture include; asking the patient to explain what could have caused the ailment; letting the patient explain what they think the disease does to them; enquiring on the major problem the patient thinks could have been caused by the illness; what steps or precautions they have taken since commencement of the illness; enquire what kind of treatment they expect or their overall expectation; and asking for other information that seems culturally important (Mcclimens et al, 2014).
Nursing profession is a caring profession. Nurses must reflect on cultural values of the society especially in this era of globalization and massive international movement. The only way to ensure that cultural competent services are offered is by acquiring more about transcultural nursing practices, especially by conducting comparative analysis of various cultures nursing care, values and beliefs. (Mareno & Hart, 2014). However, noting the broad differences across culture is not enough, relying on data only risks generalization and stereotyping because even two individuals from the same community or ethnic group, may have different experiences and expectations from the same illness, influenced by their education and socio economic background. Language barriers are the most common obstacle when delivering health care services which impedes clear communication between patient and the health practitioner. Most common law suits are miscommunication related cases. Understanding cultural diversity will improve patient treatment and safeguard them from malpractice (Rily, Tish &Nancy, 2014). The world is a global village. Citizens from any particular part of the world are from all sorts of backgrounds. This presents challenges to the health sector during service delivery to patients. Therefore, cultural competency and sensitivity program must be incorporated in medical schools. Leaving cultural disparities in health care unattended could lead to high turnover rate, mortalities and disease burden in certain geographic locations. This will directly or indirectly impact on every person in the US. Therefore, every health practitioner has unique opportunity to take leadership to improve quality of life through culturally competent health care (Mcclimens et al, 2014).
Part 2
Good health care practices entail the provision of quality care through changing risky behavior that hallmarks cultural miscommunications and misunderstandings. These misunderstandings are obstacles in responding to the growing health care demands for Hispanics. Hispanics represents approximately 55% of US total population. Hispanic culture upholds family institution, and it comprises of the extended relatives including grandparents, uncles, aunts, cousins, god parents and family’s siblings. When ill, Hispanic person mostly consult with their family members, and frequently ask the members to accompany them to the hospital. Hispanic culture entails provision of love and support to the ill; which could be opposed by institutional rules such as limit of patient’s visitors (Antonio, 2014).
Additionally, Hispanic culture emphasizes on interdependence and cooperation. Therefore, the patient’s relatives will be actively involved in decision making and treatment processes which may not be entertained by most health institutions. Hispanic culture is mediated by respect. Respect involves appropriate behavior based on individual’s age, gender, and socio economic status. Thus, the elderly demands respect from the young, men demands respect from women and so on. Hispanics show respect by avoiding eye contact to the authority which could be misinterpreted as lack of interest. Due to their medical expertise, health practitioners are afforded great respect; most Hispanic patient will regard the physician advice. Respect is highly valued in this culture and a patient may terminate treatment if any signs of disrespect are perceived. Family information remains confidential and must remain within the family. Therefore, questions on health related problems such as sexual practices, alcoholism and mental disorders are perceived as embarrassing and disrespectful. To gather this kind of information, registered nurse should ask them indirectly (CNO, 2009).
As a registered nurse, having some culture insights facilitate communication. Therefore, working in ethnographic regions whose larger local population is Hispanics; the health practitioner should retrieve secondary data analyzed by CDC databases. Due to their collectivistic tendency, registered nurse should allow collective responsibility during decision making. Most Hispanics are group oriented. The family has a right to make decisions regarding health care interventions necessary and in most cases, they are actively involved in decision process in order to allow the patient to rest and recover peacefully. The nurse can request the patient to identify the family’s spokesman. If they are out of country, the nurse should be patient and wait to get consent for the therapy. To accord respect to the patient, the nurse can address them using their language formal titles such as, Mr., Mrs., Miss, Senöra or Senör. In most cases, Hispanics nod out of respect to the authority (health practitioner), that does not necessarily imply that they agree with the nurse. In this case, the registered nurse should pay attention to the non- verbal communication, and attempt to clarify further if required. In most cases, silence is a sign of respect; the nurse should be patient for a response. If need be, the nurse can ask for an interpreter. Additionally, most Hispanic is religious and beliefs that illness and death are natural life processes. Because of this belief, the patient tends to neglect health acre attention until their health worsens significantly. In some cases, the family may want the patient spend end of life at home. The patient may associate the setting impersonal and disrupts their family relationship (CDC, 2014).
Nurses are privileged to meet people during the period of crisis in their lives when they are required to provide their expertise. People attitude toward death and bereaved are influenced by their cultural, religious and socioeconomic background. The nurse should always remember that there are aspects within every cultural grouping which could be solved through competent cultural care and comprehensive communication. For instance, a client from Hispanic community requests for sweet-grass ceremony as her last wish. The ceremony is a part of cultural treatment, which involves burning of incense stick and prayer chanting, and will be conducted in the hospital. Heeding to the patient’s request implies that the nurse will break the institutional policy. What is the solution to this case scenario? In this case, other options should be explored by consulting the relevant authorities in other departments. If the activity is determined as risky to other patients, then the client can be transferred to private room where the ceremony can be conducted. Inexperience’s and fear are the most common obstacles to providing cultural competence care. Through consultation with higher authorities, the nurse is able to address the issue (CNO, 2009).
References
Antonio, MA. 2014. Latin American culture: A deconstruction of stereotypes. Studies in Latin American Popular Culture Vol 32, 73-100
APA. (2012) “Culturally diverse communities and end of life care.” Retrieved on January 16th, 2015 from [http://www.apa.org/pi/aids/programs/eol/end-of-life-diversity.pdf]
Astrid, W., Et al. (2010) A londitudinal study of cultural competence among health science faculty. Journal of cultural diversity, Vol 17; 2, p68-72
CDC. 2014. “Building our understanding: culture insights communicating with Hispanics/latinos.” Retrieved on January 16th, 2015 from [http://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/hispanic_latinos_insight.pdf]
CNO. 2009. “Practice guideline: Culturally sensitive care.” Retrieved on January 16th, 2015 from [http://www.cno.org/Global/docs/prac/41040_CulturallySens.pdf]
Dudas, K. (2012) Cultural competence: An evolutionary concept analysis. Nursing Education Perspectives 33; 5,317-321
Norton, D. & Marks- Maran, D (2014) Developing cultural sensitivity and awareness in nursing overseas. Nursing standards, 28, 44, 39-44
Mareno, N. & Hart, PL (2014) Cultural competency among nurses with undergraduate and graduate degrees: Implications for nursing education. Nursing education perspective 35, 2, 83-90
Mcclimens, A. Et al (2014) Recognizing and respecting patient’s cultural diversity. Nursing standard, 28; 28, 45-52
Riley, D., Tish, S., & Nancy, Y. (2012) Cultural competence of practicing nurses entering an RN-BSN program. Nursing education perspective 33, 6, 381-385
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