The Analysis of the Multicultural Health - Essay Example

Human diversity is a complex issue for the nurse, that has many inter-linking facets providing novel situations, ethical dilemmas, and also a wealth of skills, knowledge and competencies to solving critical health and social care issues. Nursing is a social activity and so the range of patient, co-worker and the general public temperaments that personal will come into contact with is vast (Carillo, Green, & Betancourt, 1990). In order for these therapeutic relationships, however brief, to have an impact on the healing process, it is apparent to me that a nurse must develop their communication, caring, justice and fairness skills. This paper will briefly review the personal experiences of an American Indian patient with the health care system. Firstly, a description of the responsibilities of nurses (in the 21st century) to multicultural issues will be presented. Secondly, the needs and expectations of an American Indian with regard to health care delivery will be explored. A conclusion will synthesize the main points of the paper and place it in the larger context of clinical governance. Communication, care and justice and fairness within nursing are critical issues as staff must be able to engage with, and develop therapeutic relationships with a diverse range of individuals, cultures, communities and aggregate groups that comprise a community. In order to be sensitive to the human diversity of patients, it is evident to that a nurse must continually develop skills of sensitivity to other's ways of expressing their needs, expectations and responses to health care issues (Carillo, Green, & Betancourt, 1990). Further, the nurse must cultivate an awareness of the socio-political issues within her community which will impact on decision-making of patient care, such as gender roles, issues of multiculturalism, and social protection of the socially excluded (e.g., the elderly, disabled, the homeless and minority groups). These relationships are bound up in concepts of power, and the nurse must be aware that they are perceived as the one's who have the power (in the form of knowledge) by the patients (Carillo, Green, & Betancourt, 1990). The nurse must remain aware of the influence the power the role of the nurse brings with it, and so not unduly influence a patient deciding on their treatment, as this would infringe on the patient's right to not be coerced into any particular procedure. Turning now to the culture of an American Indian, concepts of beliefs, values and expectations of health care needs will be discussed. In contrast to the existing (although changing) biomedical model of health and well being, many indigenous patients attribute causes of their illness to factors very different to those considered by Western healthcare (Queensland Government, 2006). For example, it is not unusual for an American Indian to have an aversion to X-rays, which are not so different from photographs (often considered to be 'soul stealers' in indigenous belief systems). It is also not unusual for an American Indian to have a different concept of the course of an illness or ill health, such as the influence of natural forces, rather than subscribing to the germ theory of disease (Zucherman, Haley, Roubideaux, & Lillie-Blanton, 2004). Alternatively, an American Indian may feel hesitant about receiving an injection as it is introducing a foreign substance into their body, and their socio-cultural construction of life does not have a place for such an activity. It is important for a nurse to be educated about differences in perception of illness and well being, as these cultural forces influence belief systems that may explain why an indigenous patient does, or does not, choose to adhere to a treatment or health promoting activity. Family and the community also play a large role in American Indian health belief systems, as they belong to a collectivist culture. Hence, the individual in society is de-emphasized and the social group as a whole becomes the focus of importance when making decisions, even about one's own health (because one's health is indicative of the collective health) (Zucherman, et al., 2004). In communities where the broader social group is of more importance than the individual, family structures tend to differ radically to the nuclear norm of the West (e.g., extended families). Family roles can impact greatly on health care provision by nurses. For example, it may be necessary to receive permission from the grandmother to conduct a treatment on a child who presents with his mother. Often, within collectivist culture, it is the responsibility of the group to coordinate care for the one who is ill, rather than the Western concept of the individual taking on sole responsibility for their well being. Additionally, due to American Indians being a minority group presently in North America, and given the tendency for cultural groups to place causes of illness as external to their locus of control, many patients may wish to have friends and or relatives present when they attend consultation or treatment in a 'foreign' environment and belief system (Zucherman et al., 2004). The presence of these social others can provide support for the sick patient, and can aid in relieving anxiety which may impact negatively on delivery of care. Studies show that a patient who experiences hope, and anticipates healing, is more likely to find the therapeutic experience a beneficial one. The presence of the family, with regard to a collectivist culture, aids in the collection of more precise details and in the dissemination of information to ensure adequate care of the sick individual (Queensland Government, 2006). However, due to rapid changes in social systems of North America (e.g., advancing technology, spanning globalization, discourse and practices focused on multiculturalism, tolerance, and social justice and protection) it is not unlikely that many American Indians do not fully subscribe to 'traditional' belief systems about health care, and so the nurse should still inquire if they would like their family to be present (Zucherman et al., 2004). Also, there well be times when it is not feasible nor safe (for either the patient or their family) that social others be present, and in such cases the nurse must use tact and fully explain why it is necessary for the social group to be separated. A final critical issue for an American Indian attending Western health care complexes or staff is that of gender roles. In most cultures, gender will determine the role that person takes within their society, as well as how they respond to becoming ill and in turn how they will be affected for recovery to occur (Queensland Government, 2006). For example, a male American Indian may be unable to see a doctor or nurse who is not of the same gender, and vice versa for female indigenous patients. As such, it is normally best for woman to be attended to by females, and males by males, especially for procedures that require physical interaction with the lower portion of the body (e.g., for gynecological, urological, lower gastrointestinal and sexual health problems) (Zucherman et al., 2004). Should a female staff member is unavailable than an acceptable alternatives must be made available, such as having a social peer present. As most American Indian cultures are male dominated, and at times it is necessary that a female health professional interact with them, the service provider needs to use patience, and persistence, professionalism and firmness, as women may be considered to be subordinate to males. As such, the service provider should not take the cultural construction personally, although it may be necessary to have a male staff member present to communicate the importance of the patient interacting with the female nurse or doctor. Evidently it is critical that nurses develop cultural awareness to be able to interact effectively and efficiently with the diverse cultural groups that exist in world of expanding globalization. A health promoting therapeutic relationship is unable to occur without the ongoing professional development of nurses in areas of communication, multiculturalism and reflection on personal belief systems and values and how these impact on working with those from another culture. An American Indian patient may have an assortment of concepts about health and health care that do not correspond to Western practices and beliefs. However, this does not negate the legitimacy of their belief system; it merely indicates areas of health care provision that requires continuous debate and discourse to ensure cultural inclusiveness, and the best treatment for the indigenous patient. References Carillo, E. J., Green, R., A., & Betancourt, J. R. (1990). Cross-cultural primary care: A patient- based approach. Retrieved November 24, 2006 from http://www.annals.org/cgi/reprint/130/10/829.pdf Queensland Government. (2006). Multicultural Health. Retrieved November 24, 2006 from http://www.health.qld.gov.au/multicultural/guidelines/default.asp Zucherman, S., Haley, J., Roubideaux, Y., & Lillie-Blanton, M. (2004). Health service access, use and insurance coverage among American Indians/Alaska Natives and Whites: What role does the Indian health service play American Journal of Public Health, 94(1), 53-59. Read More