Emerging Standards for Culturally Competent Care - Research Paper Example

? Emerging Standards for Culturally Competent Care Introduction The past two-three decades witnessed tremendouschanges in healthcare system as a whole that has intensified the challenge of meeting cultural competence in nursing practices. The emergence of culturally competent care approach is mainly attributed to the increasingly diverse populations across the globe especially in multi-cultural nations like the United States and UK. Cultural competence is not a set of assessment practices based on patients’ activities of living but a comprehensive approach to patients’ care incorporating the skillful use of one’s cultural knowledge and interpersonal aptitudes. This is possible only if health professionals are sensitive enough to demonstrate respect toward the different values, beliefs, and practices of one’s counterparts (Cherry & Jacob, 2005, p.246). The writers also insist on the need of taking responsibility ‘to inquire, learn about, and integrate beliefs and values of others in professional encounters’ so that it would change one’s negative prejudicial behavior. This paper will evaluate the significance of developing cultural competence in nursing care especially in critical care settings like Intensive care units (ICU) where proficient care is highly crucial. What is Culturally Competent Care? Health care is a very sensitive area of service where people often confront with long standing disparities on the basis of culture, tradition, nationality, ethnicity, language, and socio-economic status. ‘Culturally Competent Care’ is the modern perception that has been developed to address health and human service issues in a multicultural social environment. In other words, the modern world requires collective responses of doctors, nurses, and other care givers to patient’s varying attitudes, values, verbal indications, and many more; which is possible only by initiating cultural sensitivity as a new dimension of clinical specialization like age and gender. In order to be culturally competent, nurse needs to obtain cultural information with intent to apply that knowledge into practice while they encounter various sorts of ethnic and cultural differences. The major objective of this knowledge acquisition is to avoid stereotyping patients on the basis of their race, culture, or any external appearance. The logic behind this approach is that high-quality outcome can be derived from culturally competent care. When doctors and nurses familiarize themselves with the cultural perceptions and practices of patient, normally it would make a positive impact on treatment results and patient satisfaction. Why cultural competence in nursing? As mentioned in the introduction, cultural diversity has become the major facet of almost every developed nation. Therefore, in order to meet the specific needs of people with different cultural background, the nursing care given should be culturally competent. Health care industry reform has been a hot button issue for several decades in the United Sates. Although several attempts have been made to equalize care delivery across the nation, as critics comment, all were defeated by unethical medical-political coalition. Culture influences people’s perception of illness and their causes, the way they seek health care, their approaches to medical treatments, and how they respond to health care providers. Therefore, health providers especially nurses need to obtain skills to act according to the health behaviors of the clients. Infant death and pregnancy loss is an ongoing problem in the United States of America. Studies show the noticeable racial and community based disparities in infant death rates. This situation points to the need of equal delivery of health care services to everyone regardless the race, culture, or community. According to the AAN Expert Panel Report (1992) culturally competent nursing care should follow mainly four principles; 1) care is designed for the specific client 2) based on the uniqueness of the person’s culture 3) care would facilitate client’s decision making 4) and care is provided with cultural sensitivity of the client (Cited in Cherry & Jacob, 2005, p.246). Since the cultural perceptions of the client would vary from that of the nurse, it is essential for a nurse to have culturally competent skill to avert any possibility of conflict. This skill involves the nurse’s ability to learn and integrate the patient’s beliefs and practices into the treatment and further intervention plans. For this purpose as Mitchell, Wilson, and Wade (2007) purport, a nurse must undergo a process of education that involves ‘self-examination of own cultural beliefs and practices and the possible influence these may have on the practice’ (p.167). Cultural competence in critical care (ICU) The facility to provide culturally competent care is the most important factor that determines the effectiveness of critical care areas of nursing like Intensive Care Units (ICU). The healthcare industry as a whole has been highly influenced by the rapid changes in science and technology. According to Catalano (2003, pp.393-411), The population trends in the United States indicates that by the year 2080 the white population might become a minority group that constitutes around 48.9% of the total population. The ever changing social conditions require critical care nurses to develop cultural competency in their work places in a way that would help promote interpersonal bond with patients. As Flowers (2004) states, “as patient’s advocates, critical care nurses are required to support decisions made by patients or patients’ families that may reflect a cultural perspective that conflicts with mainstream healthcare practices”. In order to be culturally competent, a nurse in critical care service must avoid estimating a patient on the basis of outward appearance. In the same way, all other aspects including race, nationality, religion, sex, language, and education should not be of any constraint to the standard of care offered. Instead, health care professionals should discourage labeling patients on any basis other than determining the extent to which the individuals concerned have ‘assimilated or cultured into US society’ (Flowers, 2004). The major challenge critical care nurses are to meet today is to acquire adequate knowledge on various cultural practices and perceptions so that they can ensure effective interaction with the patients to develop cultural competence in work place. Culture, as the most dominant factor of an individual will have great influence on one’s health concerns and practices; therefore, critical care nurses must heed genuine concern to obtain knowledge about the cultural background of the patient. The question how one could obtain cultural knowledge is irrelevant to the context as we have today access to numerous sources of information that vary from print to electronic means. However, a critical care nurse must go beyond that acquired information to be highly competent with care offered in a multi-cultural setting. According to Campinha-Bacote and Munoz (2001), the best model for cultural competence includes five components such as cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. These components range from nurses’ understanding of their own cultural and professional background to the deep understanding of the patients’ cultural perceptions and practices. Successful areas of care & impacts The National Center for Cultural Competence (NCCC) functions in US with the objective of increasing the efficiency in health care and mental health by eliminating health disparities on culture and ethnicity. NCCC has met some of the basic standards of cultural competence in nursing and health care field with the help of medical practitioners, especially of professionals in critical care nursing. The NCCC provides wide range or workshop programs for nurses in order to make them efficient for the successful performance of competent care. The following part describes the successful areas of cultural competence. The NCCC could design a special project for the health care improvement of children and youth. This project offers a high quality system for the assessment of current youth care systems and forms timely polices for bridging the gaps (NCCC). They also frame continuous research program with intent to increase the efficiency of family centered and community based health care plan for children; it mainly includes the application of efficient nursing. Similarly, NCCC provides adequate resources for the early intervention programs and gives effective advices to promote good health habits among the youth. In addition, they undertake leadership for the rehabilitation of people from different communities. This project promotes the growth of a healthy future generation and adds value to the nation’s healthcare. Since NCCC builds early intervention programs, it is possible to prevent various severe diseases at an earlier stage. As part of a critically competent health care initiative, the NCCC has developed the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center which provides family support and consultancy services in pregnancy period without any discrimination (NCCC). These assistances are provided with the help of nurses in the respective regions. This program helps the nation to improve its manpower requirements as it prevents unexpected child deaths and pregnancy losses. If continuous pregnancy loss occurs couples might be compelled to rely on contraception which would adversely affect the population stability of the nation as a whole; it is successfully prevented by the development of National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center project. The Division of Research, Training and Education is another NCCC program implemented with intent to increase the cultural and linguistic competency among healthcare practitioners like nurses (NCCC). The indiscriminate services of nurses contribute to successful implementation of a competent healthcare, which are discussed below. Child and Adolescent Mental Health is another effective program formulated by NCCC. It has a contemporary significance in the US society since gang and gun crimes have been creating severe problems among the youth of USA. This program provides very effective mental health programs for the children and adolescents. In addition to this, US department of Health and Human Services have designed some cultural and linguistic competence programs with the help of nursing practitioners. Weaker areas of cultural competence & impacts A large number of US nurses include immigrant groups from other countries who are not accustomed with the diverse cultures and ethnic groups of US. This paucity of cultural knowledge becomes a barrier in providing competent nursing services. In the same way, immigrant nurses are not familiar with the conventional believes of US’s communities and with their slang; it creates communication gap between nurses and patients. Nurse’s sympathetic attitude, compassionate caring, and strong encouragement are the effective techniques to fasten patient’s recovery (Gloria, 2004, p. 191). It is possible only if nurse maintain a good relationship with the patient. However, if nursing profession is considered as a mere source of income we must be skeptical about the moral perception of nurses. Nurses with such inferior conception would only add to patients’ pain rather than motivating them toward recovery. Psychological studies have proven that a person’s body does not respond to medicines if he is he/she possesses a distracted mind. Lack of experience is another problem associated with nursing that would also impede competent care. Health care departments are forced to recruit more nurses every year; and it eliminates the possibility of long service of experienced practitioners. On the other hand, the newly recruited nursing staff may take much time to get familiar with her duties and responsibilities. Similarly lack of up to date education is another problem associated with nursing field. Nurses cannot give better treatment to their clients unless they get up to date training in accordance with the changing medical environment. As mentioned earlier, individuals who are driven by money motives always tend to affect the code of conduct of the profession, which in long term would impede meeting competent care. Population served and population vulnerability The culturally competent care in nursing especially in ICU covers all areas of the population without any discrimination. The US population mainly includes Native Americans, African Americans, and European Americans. In olden days, the blacks were deprived of proper health care due to the dominance of the White in all areas of social life. As a result of the emergence of culturally competent care concept, the health care disparities in United States have been eliminated to a large extent. Although critical care nursing services systems serves all people of the area, they give priority to infants and mothers with intent to reduce mortality rates. The Intensive Care Unit systems under health care institutions also frame plans to ensure better healthcare to low class people of the society who cannot meet the escalating medical expenses. In addition, they also provide ambulance service facilities in all areas of cities to ensure immediate access to medical service for seriously injured persons. The unpredictable climate changes have become the major threat to the vulnerable populations across the United States (Human vulnerability to environmental change). The cyclones, storms and earthquakes are the most frequent natural disasters in US which can wipe out a large geographical area. Similarly heat wave in Southern California is another insoluble problem which extremely contributes to population vulnerability. California constitutes major part of the foreign-born population of US such as Latin Americans and Asians. The atmospheric heat of California reaches in triple digits in the middle of the summer. This horrible temperature causes wildfire that normally kills hundreds of people. The researches have found that age, community, and poverty factors play a significant role in determining the number of deaths as a result this heat-related difficulty. Generally, the low class people of the society including the Blacks and other poor cultural groups are forced to work even in the times of this intense heat while the high class enjoys a more comfortable life. Therefore, the concept of culturally competent care envisages the safety of all ethnic and cultural communities regardless their standard of living in the society. The heat waves and thereby community-related deaths are also becoming a problem in cities like Chicago and Missouri. Similarly premature deaths and increased infant mortality rates are the reflective areas of US population vulnerability and it is attributed to their unhealthy life habits. Many of the cultural groups of the US have no idea about the necessity of health care and related diseases since the US’s healthcare departments cannot implement equal distribution of improved healthcare facilities. The increased population concentration in the coastal regions of United States affects the vulnerable population more. Similarly it is argued that women face more difficulties while confronting with the demographic changes. The culturally competent care system in ICU has designed a comprehensive structure for the mitigation of impacts of these difficulties especially in the case of struggling people. Suggestions for improving standards Culturally competent care in critical nursing field is essential in order to address the problems of population vulnerability and other health care issues. Scientific approach to culturally competitive concept guides nurses with certain standards which would help them better understand the mode of delivering effective nursing in critical situations. Nurses must ensure the applicability of social justice as it is the most effective way to meet critically competent care in nursing. The value of social justice emerges from the other elements like impartiality, dignity and tolerance. The nurses have to possess leadership skills in order to promote the result-oriented social policies. The nurses should transfer their concept of caring from individuals to a large population and concentrate on the whole region. Similarly, the persons engaged in nursing field must critically analyze various bases of their attitudes which would largely affect the ethics of culturally competent care. This reflective thinking consists of actions, evaluation and critical-inquiry (Teekman, 2000). It is better to conduct education campaigns and workshop programs so as to make nurses aware of the importance of keeping high mental attitudes. It is also recommended that nurses must be given proper training classes on the cultural features of various communities they serve for; it helps them to know traditional perspectives of different ethnic groups and thereby they can adopt suitable nursing practices. Similarly health care service providing systems and organizations should take maximum efforts to give better services to its clients. It is better to make provisions for separate budgets which can meet the resource needs of culturally competent health care (U.S Department of Health & human Services, 2007). At the same time, a panel of experts must be formed so as to develop appropriate health policies in time. Moreover, the health care organizations should conduct regular surveys which would reveal the deficiencies of current policies. The nurses must be always careful about the mental empowerment of patients as it is the most powerful aspect of treatment. In addition, the nurses may try to realize causes of patients’ stress and advocate them with regard to their cultural beliefs. The World Health Organization indicates that the process of advocacy can affect various levels and ranges of outcomes (Health Evidence Network, 2006). The health care recruiting agencies must give great emphasis on the selection of nurses from diverse cultural backgrounds in order to serve multicultural populations efficiently. It will also be beneficial to rotate nurses among various departments so as to mitigate health care disparities on the basis of culture and ethnicity. Likewise health care departments must ensure the mandatory formal education and clinical training for nurses which would enable them to contribute to culturally competent care. It is necessary for nurses to study the verbal and nonverbal aspects of patients’ language as it is important for better patient-nurse communication. In order to verify nurses’ communication skills toward diverse cultures, it is advisable to design some special interviews as part of nurses’ orientation program. Nurses must also learn from patients from diverse cultures, and can apply their previous experiences in regular nursing practices. Conclusion Culturally competent care is one of the major strategic concerns of modern nursing practices across the world. The concept has become inevitable part of health care service so as to meet the multiple requirements of increasingly diverse population of modern societies. Unlike the past, the new trend has opened up rather wide arena for nursing services along with the increased level of responsibilities. In order to meet the expected level of competency, nurses involved in critical care nursing must acquire wide range of cultural knowledge; and must incorporate their awareness and experiences into the care provided to patients. Critical care nursing is the most sensitive area of practice where patients require intensive care at the utmost level of quality. One of the most important benefits the cultural competent approach would bring about is that it would avert incorrect diagnosis and prescriptions caused by cultural barriers. Culturally competent care will become increasingly important in future nursing practices as modern health care organizations have considered it as one of the competitive advantages of successful business operation. References Catalano J. (2003). Nursing now: Today’s issues, tomorrow’s trends. 3rd Edition. Philadelphia, Pa: Fa Davis.. Cherry, B & Jacob, S. R. (2005). Contemporary Nursing: Issues, trends, & management. US: Elsevier Mosby. Campinha-Bacote, J & Munoz, C. (2001). A guiding framework for delivering culturally competent services in case management. Case Manager. 12 (2) 48–52. Flowers, D. L. (2004). Culturally competent nursing care; A challenge for the 21st century. Critical Care Nurse. American Association of Critical-Care Nurses. Retrieved from http://ccn.aacnjournals.org/content/24/4/48.full.pdf+html Gloria, W. (2004). Basic geriatric nursing, Edition-3, Missouri: Westline Industrial Drive. Health Evidence Network. (2006). What is the evidence on effectiveness of empowerment to improve health? World Health Organization Regional Office for Europe. Retrieved from http://www.euro.who.int/HEN/syntheses/empowerment/20060119_10 ‘Human Vulnerability to environmental change’. (n.d.). retrieved from http://www.unep.org/geo/geo3/english/pdfs/chapter3_vulnerability.pdf Mitchell, M., Wilson, D. & Wade, V. Psychological and cultural care of the critically ill. In ACCCN’s Critical care nursing. D. Elliott, L. Aitken & W. Chaboyer. Australia: Elsevier 2007. Projects and initiatives. (n.d.). National Centre for Cultural Competence. NCCC. Retrieved from http://www11.georgetown.edu/research/gucchd/nccc/projects/index.html Teekman, B. (2000). Exploring reflective thinking in nursing practice. Journal of Advanced Nursing, 31, 1125-1135 U.S Department of Health & human Services, Office of Minority Affairs. (2007). National standards on culturally and linguistically appropriate services (CLAS). Retrieved from http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15 Read More