Quality Nursing Care in a Trans-cultural Setting - Essay Example

Quality Nursing Care In A Transcultural Setting: Myth Or Reality Nursing has been one of the noblest professions which have its roots deep down in humanity. Even though profound credit is always specified to doctors but nursing is what without which even medicine and doctors' efforts all are in vain because taking care of the patient, giving medicine on time and keeping check of patient's vital metabolic activities are not the only support that is provided by nurses, they provide moral, emotional and psychological support to the patient which if provided in proper mannerism can accelerate patient recovery. Generally speaking nursing is all about taking care of the patients. But in 1950's one nurse thought that caring taught in nursing training and applied in practice is general for all, irrespective of their ethnic background, religious beliefs, Norms, life ways and environment. She was Madeleine Leininger who was among the first graduate to gain doctorate degree in anthropology and she thought to add new dimension to nursing by introducing culture relevant caring technique which was introduced as a concept and later mature into a specialized domain in nursing and known to be as transcultural nursing. Sharon C. Murphy quotes Leininger definition of transcultural nursing as "A substantive area of study and practice focused on comparative cultural care (caring) values, beliefs and practices of individuals or groups of similar or different cultures. Transcultural nursling's goal is to provide culture specific and universal nursing care practices for the health and well-being of people or to help them face unfavorable human conditions, illness or death in culturally meaningful ways" Culture and care has been associated in nursing in transcultural setting where care is provided with accordance to person's culture. Care according to Leininger is termed as a powerful and dynamic force to understand the totality of human behavior in health and sickness (p 2). According to Leininger "Caring is also attributed to actions, attitudes and practices to assist or help others toward healing and wellbeing" (p 5) Culture on the other hand is the "broadest, most comprehensive, holistic and universal feature of human being which comprises of the learned, shared, and transmitted values, beliefs, norms, and life ways of a particular culture that guides thinking, decisions, and actions in patterned ways and often intergenerationally" (Leininger, p 6). Leininger thought that having no cultural knowledge was affecting the quality of nursing actions and decisions. So nursing in transcultural setting is reliant on the knowledge about the patient's culture and cultural attributes. Transcultural nurses are train to work in diverse culture and to identify unknown or misunderstood cultures factors and influencers which affect caring actions and decisions. Sharon Murphy quotes that transcultural studies comprises of care symbol, expressions and meanings and their research is basically studying cultural care and health concern. Leininger also presented a theory called as "The Culture Care Theory". This theory presented the interdependency between culture and care and emphasized that culture relevant care helps to improve the helping technique use to facilitate patient in the course of their recovery. Some major construct of Leininger's theory are firstly the interdependency between culture and care, secondly the theories and models are unknown blurred truth and expressions in a culture and are pictorial diagram showing some concept but lack the relationship among them respectively. Thirdly the theory is open to discovery of unknown ideas previously unknown or indistinctive related to cultural care experience of human health and welfare. Fourthly the theory encourages ascertaining various aspect of culture and care in naturalistic manner in similar or different environmental context. Fifth is a new technique of discovery such cultural values and expressions which is Ethnonursing method and it is define by Leininger as "an open, natural, and qualitative inquiry mode seeking informants' ideas, perspectives, and knowledge, and did not control, reduce, or manipulate culture and care as with quantitative methods(p 2-3). Now if we consider whether the quality nursing in transcultural setting is a myth or it has some reality behind it then we have to bring into consideration that human diversity and its impact upon health issue and human wellbeing are very profound and there exist succeeding challenges to alter education and practice in nursing which are cultural congruent and with respect to different belief and values (Ludwick, Silva 2000). It is obvious that every culture has its own cultural values and ethics which may be conflicting with other cultures and thus giving rise to ethical conflict. In nursing these things gain importance as world progress through globalization and nurses were faced with challenge of nursing patient from alien culture. Some cultures are based on "individualism" which according to Ludwick and Silva is defined to be as the capability of an individual to pull themselves up to their bootstraps and some are consider to be depending upon collectivism where trustworthiness of a person is vested in his family and friends. So any health decisions and action taken in either culture will be different from the other. According to Ludwick and Silva any misunderstanding can result into lack of trust in treatment as well as it can potentially damage patient emotionally, physically or psychologically. The way to impede such a situation to occur the nursing should be provided in transcultural settings. Now we must look at some real life case studies which will throw light on whether transcultural nursing is substantial and it is a demand of the time thus a reality that can't be ignored. Some Studies are pin pointed by Cultural Diversity in Nursing Organization on their website, I am quoting here two of them Chinese Culture Example: In Chinese according to the website it is believe that health is a state where spiritual and physical synchronization with nature exists. If this balance is disturbed then illness occurs. The Asian patient was found to be rarely complaining about their illness and nurses have to reply on responsive cues to understand them. Case I: According to the website "A Vietnamese woman was rushed to the hospital by her adult children. The emergency room personnel discovered dark red welts running up her arms, shoulders and chest, yet the only presenting complaint was dizziness. When questioned, her son explained that he had rubbed her body with a quarter. A nurse becomes concerned when she finds an elderly Chinese patient rubbing him self with a quarter (she thought he was trying to hurt himself). When she took the coin away from the patient, he became very upset, grabbed it back from her and continued to rub his arms and legs, leaving dark red scratches ". Now here there is a need to understand that coin rubbing is used for healing purpose in Chinese culture which is not an abuse. In the process of coin rubbing some red welts do appear on the patient's body which distracted the medical staff. The need here is to know that what coin rubbing is in cultural context as the patient is emotionally and morally connected with these kinds of beliefs, so impede them for it can cause even heightened stress for patient. Case II: In another example in Cultural diversity organization's website is "A Vietnamese woman, after giving birth to a son, refuses to cuddle him but she willingly provided minimal care such as feeding and changing his diaper. The nurse feeling sorry for the baby, picked him up, cuddled him and stroked the top of his head. Both the mother and the husband became visibly upset". Such confusion occurs because in Vietnam's rural areas believe in spirits and these spirit can get attracted to babies and can steal them (by causing death).So cuddling and loving the infant is considered to dram attention toward them of spirit so parents avoid this and it is also not thought that head is a taboo area which should no be touched. In these examples the confusion between patient's cultural norms and beliefs and care provided by nurses has created a discomfort level which hinders the process of benevolent nursing. Hence when nursing is provided in transcultural setting then they have to consider both their and patient view about any particular phenomenon, this require understanding and respect for other cultural views and have patience to listen and work through their health and illness beliefs and this is the real challenge in transcultural nursing. Coffman Maren J highlighted six phases of providing quality nursing in transcultural setting which are (a) connecting with the client, (b) cultural discovery, (c) the patient in context, (d) in their world, not mine, (e) road blocks, and (f) the cultural lens (P 2) Connecting with client is of utmost importance and it include communication through spoken language, interpreters, using body language and sign language (Coffman, Maren J p 3).Language barrier is considered to be the most tougher barrier to provide quality health care. According to Boi (2000) quoted by Coffman, only superficial nurse-patient relationship is developed when effective communication is absent (p3). One language barrier example quoted in Coffman article is "A student nurse reported an experience she had with a non-English speaking client stating, Language barriers are difficult. I was discharging a Vietnamese woman who spoke very little English. She wanted to be taught how to change the dressing over her breast which was from what she thought was a biopsy When the dressing was removed, she was shocked to find out that she had a mastectomy "(p 4). Second phase was cultural discovery which enable the nurse to gain knowledge about the various cultures and provide effective care to cultural diverse patient (Coffman p 4). Few nurses were very happy and enthusiastic to learn about other culture and showed cultural openness where as some were reluctant or having discomfort when caring for the patient who has conflicting religious or moral values (Coffman p 4). Thirdly, "Patient in context" deals with Families and relatives who are considered to be both positively and negatively affecting the health care activities and patient health. According to Coffman care relationship can only be build by learning about the importance of family in patient's live (p 4) .Fourthly nurses have to adopt, understand and accommodate to non-medical treatment, spiritual rituals ,home remedies and religious practice which are consider on high esteem in many cultures. These provide moral uplift and some satisfaction to patient (p 7).Fifthly Socioeconomic diversity in patient also affect their concept of health care system where some may be too proud to take any subsidy provided to them by government some fear to pay them back one day. Many such kinds of emotions are witness in patients. Lastly "cultural lens" is considered to be the way the nurses, institutes, colleges and health care system envision patient's culture (Coffman p 8). In the end it is now obvious that quality nursing in transcultural setting is not a myth, it is a reality and as globalization takes place and people from diverse culture move beyond their cultural boundary for health care, quality nursing in such environment posts a colossal challenge in front of nurses. This challenge is however can be efficiently handle by following transcultural theory of Leininger and other literature studies whose major points have been formerly mentioned. Transcultural nursing is a new interactive method of budding patient-nurse bilateral relationship which has more trust , care , love and humanity vested in it so it is definitely a reality in fact it is a future of nursing. REFERENCES: 1. Madeleine Leininger: Overview of Leininger's Theory of cultural care diversity and universality. Available on http:// www.madeleine_leininger.com/eng/documents/cct_overview.pdf 2. Sharon C.Murphy Mapping the literature of transcultural nursing: Journal Medical Library Association 2006 April; 94(2 Suppl):E143-E151 Retrieve on 18 April 2007 http://www.pubmedcentral.nih.gov/articlerender.fcgiartid=1463039#id2643557 3 Ludwick, Ruth and Silva, Mary Cipriano (August 14, 2000). Nursing around the World: Cultural Values and Ethical Conflicts: Online Journal of Issues in Nursing Retrieve on 19 April'07 Available on http://www.nursingworld.org/ojin/ethicol/ethics_4.htm 4. Maren J.Coffman: Cultural caring in nursing practice: a meta-synthesis of qualitative research: Journal Of cultural Diversity, fall 2004 Retrieve on 19 April '07 Available on http://findarticles.com/p/articles/mi_m0MJU/is_3_11/ai_n8585216/pg_1 5. Victor Fernandez and Kathy Fernandez Cultural diversity in Nursing: Basic Concepts and Case studies: Asian Community; Retrieve on 18 April'07 Available on http://www.culturediversity.org/asia.htm Read More