Culture, End of Life, and Evidence-Based Practice - Assignment Example

? Culture, End of Life and Evidence Based Practice The essay aims to address the following questions about evidenced based practice, cultural care and end of life care. Culture, End of Life and Evidence Based Practice 1. Define evidence based practice. Schmidt & Brown (2011) define evidence based practice as the practice or nursing our patient using the best available evidence, patient preferences, and clinical judgment (4). When we speak of best available evidence, we are gathering research findings from the expert to solve our clinical problem. We also use scientific theories to support our hypothesis. Using their findings, we tend to explore and add evidences to tailor their needs or the clinical problem. It is not easy to find research findings that would be of clinical significance to your study. Critical thinking skill is very much essential in finding the best evidence that would support your study. In addition, the researcher in evidence based practice always work on what they think would be of the best interests of the patient. They also used their clinical judgment in applying evidence to patient care. 2. Discuss the process of how current evidence is used to make clinical decisions. In using current evidence to make clinical decisions, evidence based practice follows a distinct process which are different from nursing research process or research utilization. First, researchers observe, recognize, and identify clinical problem. After identification of the clinical problem, researchers will gather researches that are of clinical significance to the present situations. When we speak of clinical significance, we can say that related literatures or studies the researchers have gathered came from the experts and have used scientific theories. Using their critical thinking, the researcher will synthesize all the evidence and will integrate all the findings from the expert to the patient input or current situation. Unlike any other research, findings from the experts and researchers’ studies are immediately applied – not in the organizational level but at the bedside and specific to individual patient (Keele, 2011, 7). 3. Formulate a clinical question about clinical practice. The best guide in formulating a clinical question about clinical practice is the PICO question. PICO stands for Population, Intervention being tested, Comparison, and Outcome (Gerrish & Lacey, 2010, 69). PICO could be illustrated in the question that follows: “In an adult population, does taking virgin coconut oil (compared to not taking one) increase the level of good cholesterol?” The population is the adult population, taking virgin coconut oil is the intervention, comparison set-up are those adults who are not taking virgin coconut oil, while the projected outcome is the increased levels of good cholesterol. 4. Identify common complementary and alternative therapies used by clients based on culture. The use of complementary and alternative therapies has increased dramatically for the past decades. Complementary therapies refer to treatment approaches that can be used in conjunction with conventional medical therapies whereas; alternative therapies are treatment approaches that are not accepted by medical practice (Daniels, 2004, 812). The used of complementary-alternative modalities (CAM) depend upon the culture of an individual. Sometimes, those therapies of Western origin are called complementary while those who do not are called alternative. For instance, the Ancient Greek culture viewed health as the balance of in all the dimensions of life and healing is administered primarily by trained priest-healers. In Chinese, Japanese, and Indian culture, health is viewed as the balance between mind, body, and spirit. They have this concept called “energy force” which is deeply rooted on their religious beliefs; examples of which include the Tao healing in Chinese and the Ayurveda in Hindu culture. Aside from religious affiliations, one can observe the emergence of Shaman or a folk healer-priest who used herbs and spiritual inclinations for healing. 5. Describe special considerations related to complementary and alternative medicine (CAM) usage. When using complementary and alternative medicine, special considerations must be addressed in order to deliver a culturally-competent care. These special considerations include the following: Know your own culture. We have learned that CAM usage depends upon the culture of the individual. If the nurse who is rendering care assumed that all are alike in culture, he/she might have cultural blindness and may fail to deliver CAM that would meet the needs of the patient. Recognize the existence of cultural baggage. No matter how good your intentions are as a nurse, always remember that every members of the culture possess ethnocentrism. We have to respect and be guided accordingly to show cultural respect. Be open-minded. There are CAM that has no therapeutic claims or of medical basis; however, a nurse must be open-minded to accept these as part of their patient’s culture and in delivering holistic care. Always ask for the CAM being used by the patient. It may sometimes cause a reaction with the current drug or treatment the patient is receiving. Above all, educate the patient about these CAMs and not convince. Sometimes, convincing them that they believed at the wrong alternative medicines is viewed similarly to disrespect of their culture. 6. Define culture, cultural diversity, cultural sensitivity, and cultural competence. O’Connell Smeltzer et al. (2010) define culture as set of norms and practices (knowledge, beliefs, arts, morals, laws, customs) that is learned and shared by members of the society (108). On the other hand, cultural diversity refers to the variability of culture, cultural sensitivity refers to awareness, respect, and recognition of the differences between cultures; and cultural competence refers to the effective integration of one’s cultural perspective to the culture of other without losing respect. 7. Identify specific cultural practices, which should be considered when planning nursing care. When planning nursing care, some specific cultural practices are being addressed and adopted to deliver a quality and holistic care. When rendering care to Chinese, cold foods are given to patients with hot illness such as fever and infection and hot foods are given to patients with cold illness such as cancer. In addition, nurses must also ask first the permission of the Chinese patients when rendering care involving the head as they believe that it is disrespectful for an individual to touch the head of a person without permission. Likewise, it is also viewed as intrusive and disrespectful to have eye contact among Native Americans and Asian Americans unlike the U.S. cultural groups which interpret this as a sign of trustworthiness. In terms of religion, one must avoid giving Judaism or Islam patients pork in their meal as this is prohibited in their culture. 8. List 5 End of Life considerations for a patient with End Stage Renal disease. In a patient with end stage renal disease, the following end of life considerations must be considered: Avoidance of invasive procedures to prevent further introduction of microorganisms, trauma, and excessive bleeding. Administer pain medications as needed in consideration of preservation of human dignity. Provide the options of advance directives about medical care. Prepare the patient and family for the prognosis and survival outcome. Address the spiritual need of the patient as requested. 9. Provide 5 nursing intervention for the patient with End of Life considerations with Congestive Heart Failure. Meanwhile, in a patient with congestive heart failure, the following end of life considerations must be initiated by the nurse: Educate continuously the patient and the family about the prognosis and survival. Inform them of options of advance directives and existing palliative care in the hospital setting. Discuss with the family the option of inactivating the implantable device. Ensure continuous medical care both in the inpatient and outpatient settings. Administer medications to ease pain and complications such as inotropes, opiates, and intravenous diuretics. 10. Identify some differences between a patient who is Catholic, Southern Baptist, Scientologist and Jehovah Witness. While all a patient who is Catholic, Southern Baptist, Scientologist and Jehovah Witness may have the same belief about marriage, they also differ in a number of ways – particularly in their view of health and the interaction between mind, body, and spirit. In terms of religious practices, Catholics believed that praying to Mary or Saint means praying also to God while Southern Baptists believe prayer should be addressed to God only. Instead of praying, Scientologists have what they called “auditing” while Jehovah’s Witnesses have meetings for worship instead. In terms of health practices, Jehovah’s Witnesses do not accept blood transfusion; Scientologists have techniques called "assists" that alleviate trauma, injury, or discomfort; Catholics highly valued life and do not allow abortion of embryo or fetus; and Southern Baptists are more liberal and believe that abortion should be allowed in cases of rape or incest. Reference Daniels, R. (2004). Alternative and Complementary Therapies. In Nursing Fundamentals: Caring and Clinical Decision Making (pp. 812-840). Philadelphia: Lippincott Williams & Wilkins. Gerrish, K. & Lacey, A. (2010). Finding the Evidence. In The Research Process in Nursing (6th ed.) (pp. 65-78). Iowa: Blackwell Publishing Ltd. Keele, R. (2011). Beginning Tips on Surviving Nursing Research and Evidence-Based Nursing Practice. In Nursing Research and Evidence-Based Practice: Ten Steps to Success (pp. 1-16). Massachusetts: Jones & Bartlett Publishers, LLC. O'Connell Smeltzer, Suzanne C. et al. (2010). Perspectives in Transcultural Nursing. In Brunner & Suddarth's Textbook of Medical-surgical Nursing (12th ed.) (pp. 108-120). Philadelphia: Lippincott Williams & Wilkins. Schmidt, N.A. & Brown, J.M. (2011). What Is Evidence-Based Practice? In Evidence-Based Practice for Nurses: Appraisal and Application of Research (2nd ed.) (pp. 3-30). Massachusetts: Jones & Bartlett Publishers. Read More