Cultural Perspectives on Nursing in Health Care - Research Paper Example

Cultural Perspectives on Nursing in Health Care Abstract The purpose of this paper is to focus on health care in Lithuania and determine how proper nursing care can be delivered to culturally diverse patients. Lithuania is ranked at 73 in overall health from a group of 191 participating countries. Their health care is currently progressing, although due to governmental issues since their independence in 1991, they have experienced many gaps in provision of services and care. The Ministry of Health of the Republic of Lithuania has worked diligently to upgrade the health care system there; however it still has a long way to go to meet the needs of its people. Nursing care to this population would need to be sensitive to many factors in order to ensure a positive outcome of the health care experience. While they no longer rely as much on traditional medicine, many of those former beliefs and practices still influence people today. Lithuania is an independent Baltic state which was once a part of the Soviet Union. It is a diverse culture with Russia, Poland, Latvia, and Belarus for neighbors, with its western border on the Baltic Sea coast at the edge of the Eastern European Plain. Although it struggled valiantly for independence throughout most of the twentieth century, it remained under Soviet control, until August, 1991, when it finally overcame Soviet occupation and set up its own government, gaining admittance to the United Nations as an independent Baltic state on September 16, 1991. It became a member of NATO on March, 29, 2004 and also of the European Union on May 1, 2004. (U.S. Department of State, 2011) Due to its proximity to the Soviet Union and the prevailing air currents, Lithuania is exposed to air pollution from the factories, including occasional nuclear fallout. There are many chemical plants dumping wastes into the rivers and streams, and as of yet, no water purification systems in some of the cities. The beaches along the Baltic coast are frequently closed for contamination. Although Lithuania, as a Soviet republic, was a leader in passing environmental regulations, it was not largely enforced due to Soviet concentration on the race for productivity and industrial supremacy. As a result, the environment of today has many challenges to overcome. (U.S. Department of State, 2011) With a current population of 3,239,032, Lithuania, despite colonization by Russia and Germany throughout the last century has remained fairly homogenous with ethnic Lithuanians comprising nearly 85 percent. They have retained their language, Lithuanian; although the mandatory Russian during the Soviet years is a second language for them, with a wide section of the population also speaking Polish. Of that population, approximately twenty percent are pensioners and senior citizens. Those from zero to age fifteen comprise about 23 percent, declining annually due to low birth rates; those in the working category, from age 16 until retirement, make up the remaining 57 percent. Life expectancy in 2007 for males was 66.3 years and for females was 77.57 years; infant mortality was around 7 per 1,000 live births. (U.S. Department of State, 2011) Government, trade, services, and industry account for approximately 30 percent of employment, with18 percent in agriculture, 14 percent in sciences, education, and culture, 12 percent in construction, and the remainder divided equally between health care, transportation and communications. Child labor is prohibited. There are provisions for occupational safety, labor unions, and protection from retribution for reporting of illegal business practices and employer activities. As well, there is a minimum wage standard. Education is free and compulsory until age 15; the literacy rate is more than 99 percent. (U.S. Department of State, 2011) Lithuania has a social insurance program to support health care, with provision of care from birth through death. There are sufficient facilities to provide health care; however, those facilities are not adequately prepared to handle every medical crisis. Most patients bring a gift for their health care provider to ensure they are given priority for the best treatment available and also to somewhat avoid the long lines at provider offices and clinics. Although the medical personnel are some of the best trained health care providers in the Soviet region, all aspects of health care suffer from shortages in equipment, medicine, supplies, and lack of public education regarding disease prevention, especially in the areas of dental care, pediatric and prenatal care. Administrative initiatives are lacking to help provide funding for updates in the health care infrastructure. Frequently, humanitarian assistance is required for vaccines and critically needed medicines. (U.S. State Department, 2011) On June 21, 2000, the World Health Organization (WHO) published a Health System Performance Report comparing the overall health ranking of its 191 members. Unfortunately, more current data isn't available due to this being the last report to be issued of this kind by the WHO. This report was based on five basic assessment criteria: the overall health level of the population, the disparities and inequalities, the system response to the patient satisfaction, the degree to which people of various income levels are able to have their needs met, and, the way the financial burden of health care is distributed throughout the population. Lithuania placed overall at number 73, while the United States placed at number 37. (WHO, 2000) The overall health of the population in the U.S. in 2,000 was ranked at 24, while Lithuanian overall health was ranked at 63. The health distribution available to the population in the U.S. was at number 32, while Lithuanian distribution was rated at 48. The U.S. rated number one in responsiveness to patient satisfaction, while Lithuania was ranked at nearly half the countries poled at place number 80 to 81. The degree of representation across economic levels for patient satisfaction ranked 3 to 38 in the U.S., while Lithuania was ranked at 45-47. The fairness of distribution for the health care burden was ranked at 54-55 for the U.S., while Lithuania placed 131-133. In overall health care goal attainment, the U.S. ranked number 15 while Lithuania ranked 52. The final measure of overall health involving the health expenditure per capita ranked the U.S. as number 1 while Lithuania placed at 71. (WHO, 2000) Traditionally, Lithuanian health concepts are steeped in paganism with many superstitions surrounding what is health or lack of it. They believed that health was a second part of the soul, therefore anything that disturbs health, also causes the soul to either leave the body or become deeply disturbed. Headaches were attributed to a person combing and cutting their hair; once the hair is thrown out, the birds take it and make a nest from it causing the headache from all the activity involved. It was also believed that moonlight causes illness and to avoid moonlight coming through the window at night in children's rooms, a doll was placed in the window to catch that light and protect the children. Evil spirits were thought to be responsible for illness, as well as God. In order not to fear death, people were taught that God created illness in order to produce death to bring people back to Him; people dreaming of two moons are dreaming about death. Various sounds of nature, such as dog barking or birds chirping and hooting, particularly owls, also signify impending death. (Balkute, Nd.) Healing information was passed by oral tradition among the village elders and senior family members.. Caretakers were usually family members, particularly women. Usually there were special people in the village who were more adept at caring for the ill because they had the gift of some kind of folk magic. When caring for ill people, the personality, morals, and physical attributes of the person were the strongest indicators of what cure was needed. Folk medicine and potions, charms, and spells were kept secret by the healers and used to treat illness. Women healers were more involved with using herbs and casting lots while curing women and children, whereas men were involved more with incantations and bleeding patients to rid them of impurities; they also were more involved with treating fractures and bone dislocations, battle injuries, and curing sick animals. (Balkute, Nd.) Various herbs, animal parts, and products of nature, such as stones and clay were used to produce the cures. A special item, such as the mother’s wedding sash or wedding band was used to bind wounds because it had special powers. The umbilical cord and placenta of childbirth were dried and used to produce a tea which increased fertility. Head wounds and sores were washed with alum or lead water, as well as the silver and mercury used in the incantations. Water, such as window dew, and holy water also played a significant role in healing. Bathhouses were common places for healing to occur, with patients being whipped with brushed wood, massaged, steamed and bled by leaches or cupped with glass cups to release illness from the body. A patient with a fever had ice applied to the forehead, while a person with chills was given a hot brick to put his feet on. Heat and fire had a significant role, in that rickets was treated by putting the patient in the sun; patients with scabies were put in a hot oven. Candles were believed to hold magic. There were many rituals and beliefs associated with the number of times something was performed, the position of the patient, if animals were present or not, the place the ritual was performed, etc. Illness, itself, had a soul and personality; many of the While illness and health today is more progressive, the folk beliefs still persist, especially in the rural areas and among the elderly. (Balkute, Nd.) The current statistics on health in Lithuania indicate that circulatory system disease the leading cause of death by 52 percent; mainly the result of a diet rich in animal products. Environmental factors and chemicals in the food and water supply create malignant neoplasms as the second major cause of death involving 19 percent of the population. Respiratory disease follows that, resulting from air pollution not only originating in Lithuania, but also from neighboring Russia. Digestive system diseases, especially chronic liver disease and cirrhosis due to alcoholism, vehicle accidents and accidental drowning as well as suicide also play a significant role in causes of death in Lithuania; however, there is a very low incidence of HIV. (WHO, 2006) The current focus of the Ministry of Health initiatives is on health care becoming more preventive through public education, monitoring the population trends in illness to provide information aimed at helping citizens become more pro-active in their approach to guarding their own healthcare, and community involvement with disease identification and prevention. They have initiated reform in compliance with the legal acts of the EU as well. More funding and attention is being given to psychosocial illnesses, especially for the youth, to prevent alcoholism, drug addiction, and suicide. Educational programs in the schools will focus on health initiatives, prevention and maintenance; throughout the lifespan. They have adopted a trauma prevention program modeled after the one in the United States, hoping to reduce fatalities and disabilities. Smoking Cessation was introduced in 2007, and a nutrition counseling program was initiated. Lithuania is working with the EURATOM initiatives to reduce environmental dangers and contamination to its people, food, air, and water supply. Technology is being updated to connect to the EU database in the detection and prevention of communicable diseases. Initiatives to reduce noise and environmental stress have been implemented. These health initiatives are all citizen oriented. (Ministry of Health of the Republic of Lithuania, 2010) While Lithuania doesn't spend as much money per capita as the United States, Lithuanians still have access to health care through socialized medicine funded by its citizens. The incidence of heart disease in the U.S. is about half of that in Lithuania, however, our incidence of HIV is much higher than theirs. We have lower infant and child mortality rates than Lithuania. Some of that may be due to better health care access, technology, and disease prevention, but it may also have more to with the fact that there are more governmental social monitoring programs in America than in Lithuania. Our health care is very patient centered, where the individual has a chance to make choices and those choices determine the outcomes of health, whereas the people of Lithuania are just now starting to focus in that direction. U.S. health care also focuses more on quality of health care with a customer service orientation. Beore attempting to assess the ethnic patient, the nurse must examine his or her own cultural biases and expectations, becoming aware of cultural filters. Recognition of and respect for a patient's cultural diversity is a key element in providing patient centered quality care. Providing excellent health care for culturally diverse patients requires that nurses be trained to note and work with the different cultural aspects of their patients. While it may not be possible to understand another's culture entirely, respect for a patient's beliefs and personal dignity is essential in promoting a positive health care outcome. (Anderson, Nd.) There are many factors to consider in providing culturally sensitive and appropriate care for culturally diverse patients. One of the best ways to find out the patient's expectations for health care and comfort is to communicate with the person. Find out what is done in their culture or what their traditions are. When people are ill, they are in their most vulnerable state; it's not the time for them to learn to accept new ideas. They are afraid, uncomfortable, and often separated from all they have control over; often there is a language barrier as well. The nurse should become informed about the patient's culture and traditions, the concepts of health, illness, medical intervention and the healing or dying process. If there is a language barrier with the patient, arrange for a medical interpreter or helpful family member to assist in gathering important information both medically and culturally. If possible, arrange for items that would normally be involved in health care rituals to be brought in for the patient, including foods if permitted. (Nursing Theories, 2010) Prepare patients as much as possible for procedures, giving them easy to understand and helpful information and instructions; include patient support systems and an interpreter, if necessary. This will help the patient to feel supported and encourage trust of caregivers, facilitating the healing process. Often, fear is the barrier that prevents successful outcomes of health care for culturally diverse patients. Allow for personal space, time orientation, and personal beliefs and traditions of the patient wherever possible. It may be that a traditional healer can also be involved with the patient's care in order to promote the healing process. (Hudelson, 2005) When planning for the care of ethnically diverse patients, the nurse should include traditional beliefs and comfort measures. Be aware of how health care is delivered and funded in their cultural setting; if necessary, arrange with social services to help patients in need. Be open to rituals involving traditional health care whenever possible. Teaching plans should focus on involving the patient’s support system and traditions as well. All patients have the right to receive high quality health care. Often, it is a challenge to care for culturally diverse patients. The best way to prepare for and work through these challenges is to become informed of what the patient needs through clear and compassionate communication, and, to be aware of your own cultural filters. The health care outcome depends on the nurse's response to the patient's needs. 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