Nursing Culturally Competent Care: Analysis of Department of Veterans Affairs - Essay Example

? Nursing Culturally Competent Care Nursing Culturally Competent Care Analysis of Department of Veterans Affairs Richmond VA Introduction The department of Veterans Affairs is a government authorized establishment that has traditionally served soldiers enrolled in the United States army after completing their period of service for the nation. Like all other organizations, the department of Veterans Affairs has experienced various changes as well as challenges. This has particularly happened due to the many veterans that require professional care after completing their term of service. In the past ten years, the United States has been at war in Afghanistan as well as Iraq. This means that the department of veteran affairs is forced to meet with the needs of many soldiers over a prolonged time period- something which has forced it to expand in order to cater for the needs of various ex-soldiers from different ethnic backgrounds. There is a reason why army veterans require specialized care. Military service members do not face the same challenges as other members of the society. Their very job requires them to put their lives in danger constantly whenever the country is engaged in a conflict with a different nation. Many times, the challenges that soldiers face are life-threatening and require immediate specialized care. Some of these injuries include gunshot wounds, lost limbs, wounds caused by shrapnel and head injuries that affect a soldier’s daily functions or even speech and thought patterns. Military service members may also be exposed to environmental pollutants like harmful chemicals used by the opposing army, contaminated water and biological weapons. There are also the mental stresses of being in a war. Being separated from one’s family and friends for an extended period of time is a difficult thing for any ordinary human being. It becomes harder for both the soldier and his or her family when both parties are aware that the soldier might never return home. Many times, the families of soldiers have sought counseling services to help them to cope with such possibilities. Another cause of mental anguish is the act of war. Killing and maiming other human beings is a difficult undertaking for even the most hard-hearted individual. Soldiers are required to do it repeatedly and automatically when ordered to do so by their commanding officers. They are also expected to ignore their fears and constantly put themselves in the way of danger. This causes mental problems such as post traumatic stress disorder and depression- which are conditions that the soldiers carry home with them even after the war is over (Jakupcak, Luterek, Hunt, Conbeare and McFall, 2008). According to (Erbes, Westermeyer, Engdahl and Johnsen (2007), more than ten war veterans commit suicide every day due to their inability to handle mental states of depressions and post traumatic stress disorder. There have also recently been reports of war veterans who took their own lives after eliminating their whole families. When they return from war situations, soldiers require healthcare benefits that will enable them to live with some measure of peace and comfort. They also usually require a lot of mental support so that they can process through the horrifying things that they may have witnessed during the war. The department of Veteran Affairs has successfully established a 24-hour suicide hot-line that helps soldiers to deal with issues they may be experiencing but feel unable to tell even family members. Standards of cultural competence that appear to be met and any that are not met The Department of Veteran Affairs defines minority veterans as ex-soldiers who are of Asian American, African Americans, Pacific Islander, Native American, Hispanic, Native Hawaiian, or Alaska Native origin. According to the Department of Veterans Affairs (VA), roughly 20% of the country’s 23.5 million veterans are from these ethnic backgrounds (National Alliance on Mental Illness, 2013). Similar to other racial minority populations in nations all over the world, American minority veterans are confronted with a variety of distinctive health care challenges such as higher levels of post-traumatic stress disorder (PTSD) and disease disparities, as well as difficulty in procuring the medical treatment that they require. All over the nation, Veteran Affairs medical facilities are trying to implement strategies that ensure that minority veterans are able to access culturally sensitive healthcare which is more likely to affect them positively. For instance, every Veteran Affairs treatment facility has an MVPC (Minority Veterans Program Coordinator) who works as an activist for minority patients. In addition, Veteran Affairs medical practitioners have began to develop inventive ways of closing the gap in terms of health disparities between minority veterans and those of the mainstream. This is accomplished through outreach programs created to encourage minority veterans to take advantage of available healthcare services, as well as diversity training courses meant to increase the numbers of staff members who specialize in understanding the cultural needs of minority veteran patients. Challenges In spite of all these improvements in the provision of healthcare for minority veterans, there are still issues that are yet to be satisfactorily addressed. Some of these include substance abuse, homelessness, unemployment and the treatment of mental health issues. For minority veterans, institutionalized racism can affect the extent to which they are susceptible to PTSD (Hoge, Castro, Messer, McGurk, Cotting and Koffman, 2004). For example, in the Vietnam War, Native American soldiers were sometimes treated as if they had instinctual capabilities in the battlefield. This meant that some of them were often assigned to hazardous combat duties which made them become more exposed to enemy fire than other soldiers serving in the unit. This resulted in such veterans experiencing greater levels of post-traumatic stress. On their return to America, the fact that there were no culturally sensitive methods of treating PTSD available to them caused many of them to turn to substance abuse to treat the symptoms of PTSD. How are VA hospitals meeting these or not meeting these? The (MVPC) Minority Veterans Program Coordinators usually work in concert with hospitals to make sure that they initiate and support activities that teach and sensitize internal workers about the special needs that minority veterans have. They also promote the use of available programs, benefits and services availed by the Veterans Department for minority veterans. VA hospitals are also actively involved in targeting minority veterans with outreach efforts that are channeled through their ethnic community’s’ network. VA hospitals also campaign on behalf of minority veterans by recognizing gaps that allow for disparities in terms of healthcare and also make recommendations to enhance service delivery. Problems not being addressed There are veterans who feel that only culturally sensitive methods of treatment can help them to recover from mental issues. This is because they feel that their individual needs are not being addressed. In a recent study, it was also revealed that a Veteran’s ethnicity could affect the probability of their PTSD-related claim being accepted by the Veterans Administration (National Alliance on Mental Illness, 2013). When veterans do not feel that their concerns are being adequately addressed, they are more likely to turn to substance abuse to cope with their illnesses. There are also discrepancies in the number of homeless veterans that appear to indicate that there are disparities in the provision of medical healthcare for veterans of different ethnicities. According to (National Alliance on Mental Illness, 2013), 56% of the homeless veterans in the United States are Hispanic or African American. In addition, 40% of all these homeless veterans suffer from some form of mental disorder. According to (National Alliance on Mental Illness, 2013), Native American veterans also tend to display higher levels of alcohol abuse than other veterans. Identify how delivery of nursing care could be affected where standards are being met and where they are not being met The culture care theory, which was developed by Madeleine Leininger gives a system that can be used to meet patients’ healthcare needs in a culturally sensitive approach (Leininger and McFarland, 2006). This is accomplished through preservation, accommodation, maintenance, negotiation and restructuring or re-patterning. Cultural maintenance in the culture care theory addresses nursing care interventions that aid patients of particular cultures to preserve their intrinsic values through the healthcare they receive. Cultural care negotiation or accommodation refers to innovative nursing activities that help the patient to negotiate or adapt in order to reach the goal of the most favorable health outcomes as defined by the patient’s culture- whether the patient be a person, a family, or a community (Georgetown University Centre for Child and Human Development, 2007). Cultural care restructuring or re-patterning has to do with the therapeutic activities undertaken by a culturally competent medical practitioner that allows the patient to change personal health behavior s in order to attain beneficial outcomes. While the VA hospitals have successfully reached out to veteran minorities in as far as informing them of the existence of medical services and seeking to address disparities in the provision of medical treatment, they have not been able to develop culturally sensitive treatment plans that address the concerns, particularly mental disorders such as PTSD, of these veterans (Erbes, Westermeyer, Engdahl and Johnsen, 2007). Creating a program based on the culture care theory is more likely to improve the mental conditions of minority veterans because it seeks to address mental illness through treatment factors that are specific to their communities. For instance, a nurse trained in the implementation of the culture care theory when treating a war veteran will, upon recognizing the patient’s ethnic background, deduce formerly learned preferences or characteristics of this particular ethnic group. According to (De Landa, 2010), during a practical session, nurses trained to use cultural treatment methods revealed that citizens from Guam tend to be easy-to-please and friendly while European citizens tend to be more self-contained. From that alone, the nurse knew whether to approach prospective patients in a direct manner or through a lively chat. In teaching the veterans how to care for their wounds, the nurses would then anchor their instructions on the patient’s community’s beliefs, personal preferences and cultural or religious considerations. By using this technique, the patients felt empowered by the fact that nurses actively involved them in their own treatment and the nurses also began to appreciate the importance of using this method due to the impact that they saw it had on patients and their families. Comment on solutions that could be implemented where standards are not being met  Trans-cultural nursing helps in increasing the awareness of the nurses or other medical practitioners on how to integrate modern treatment methods with culturally approved methods of treatment (Leininger and McFarland, 2006). For instance, in some African American communities, the church plays a central role in the lives of all community members. Helping African American war veterans to process their emotions through PTSD would be more successful if they were encouraged to voice their concerns about the Church’s stand on how to deal with such problems and what the church recommends for patients with mental issues (Erbes, Westermeyer, Engdahl and Johnsen, 2007). This pattern allows the nurse to emphasize on finding the best way of caring for the patient and not the pathophysiology of disease. According to a study conducted by the Institute of Medicine, war veterans from Racial minorities get lower quality care. This is not because they cannot access better care but because there is a dearth of culturally competent care. One way in which this can be addressed is by actively recruiting nurses from minority communities to help in treating minority war veterans. This will be cost effective in some ways because such nurses do not have to be trained on the important cultural aspects of the veteran’s community. The veterans may also feel more comfortable in speaking or confiding in care givers who understand them when talking about the experiences that they have gone through and the things they saw in the war. Conclusion War veterans are courageous and dedicated persons who are motivated to make sacrifices for the nation’s freedom at great cost. It is important for their contributions to be recognized and for practical treatment facilities to be created for their rehabilitation when they live the battlefield. War takes a big toll on both the families of soldiers as well as the soldiers themselves. Most soldiers are not able to meet the expenses of the treatment needed for the wounds that they incurred on the battlefield. It can be extremely disappointing for soldiers who fought valiantly for their country to find that they are not considered as important enough to warrant the creation of special programs to deal with their issues once they return from the battlefield. This is one of the reasons why veterans sometimes take matters into their own hands or become violent towards their family members as they are filled with frustrations that they have no way of dealing with. It is not uncommon for the families of returning soldiers to go through divorces or temporary separations as even other family members feel unable to deal with disturbed veterans. The Department of Veteran Affairs has tried to deal with this issue for the most part by establishing programs that are more suited to veterans of Caucasian ancestry. While good treatment programs have been implemented where the mainstream ethnic group is concerned, minority veterans still require services that are more suited to their particular ethnicities. References De Landa, B. (2010). Vulnerable Populations and Human Subjects Review. Research Compliance Office. Retrieved from http://humansubjects.stanford.edu/education/2010_10_Vulnerable_Populations.pdf Erbes, C., Westermeyer, J., Engdahl, B., & Johnsen, E. (2007). Post-traumatic stress disorder and service utilization in a sample of service members from Iraq and Afghanistan. Military Medicine, 172, 359-363. Georgetown University Centre for Child and Human Development. (2007). National Centre for Cultural Competence. Retrieved from http://www11.georgetown.edu/research/gucchd/nccc/ Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I., & Koffman, R.L. (2004). Combat duty in Iraq and Afghanistan, mental health problems and barriers to care. New England Journal of Medicine, 351, 13-22. Jakupcak, M., Luterek, J., Hunt, S., Conbeare, D., & McFall, M. (2008). Posttraumatic stress and its relationship to physical health functioning in a sample of Iraq and Afghanistan War veterans seeking postdeployment VA health care. Journal of Nervous and Mental Disease, 196, 425-428. Leininger, M., & McFarland, M. (2006). Culture Care Diversity and Universality: A Worldwide Nursing Theory 2nd Illustrated Edition. New York: Jones & Barlette Learning. National Alliance on Mental Illness. (2013). Veterans of Culturally Diverse Populations. 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