The Need for Multi-Cultural Diversity in the Nursing Practice - Article Example

The need for multi-cultural diversity in the nursing practice An interesting incident occurred on one of my clinical postings. A middle-aged Chinese patient refused to consume post operative medicines which were routinely administered to patients after surgery. These are usually painkillers to help them overcome the pain of surgery. This brave patient claimed that he could bear the pain and go on without medication; his discomfort did not merit any medication and he would survive anyway. The nurse repeated the offer but the response remained the same. However the next strategy that the nurse employed in the harassed situation worked with the patient. Though the nurse was a little tough by insisting on the medication which would improve him and indicating that there was no reason for him not to take it, the patient obliged. She reminded him that this was the protocol in the post operative ward and the patient’s comfort was foremost in her mind. Her frustrated attitude was because she could not gauge why patients refuse necessary medications which could only benefit them. Deep down in my heart, I could understand why the patient refused to take the medication. The nurse was right in carrying out her duty but she could have utilized her knowledge of cultural diversity and respected the patient’s wishes. The Chinese believe that medications must be a last resort. Many in my country only take them when the pain is unbearable. This idea may seem old-fashioned to the modern world but they work for us. The emphasis on cultural diversity must be practiced. However old-fashioned they may sound, the patients are to be respected for their values, decisions and ideas on health care. Demographic changes have reflected an increasingly diverse population globally. The immigration of people of varying races, ethnicity and cultures into America has similarly changed the demography. This increasingly multicultural profile of the American population requires that nurses provide culturally competent care in nursing. Leininger (1999) defined transcultural nursing “as a formal area of study, research, and practice which focuses on care beliefs based on culture, values and practices to help cultures or subcultures, not just maintain or regain their health system but also help facing disabilities or death in culturally congruent and beneficial caring ways” (Leininger, 1999). Hospitalized patients and their families are subjected to numerous stresses. If nurses lack cultural awareness and fail to provide culturally competent care, patients are more likely to experience increased stress and inadequate care provided by nurses. The understanding and provision of culturally competent care by nurses will make a difference to the health outcomes of many cultural groups. If the nurse I was talking about had been culturally aware and practicing culturally competent care, she would have been informed about beliefs of other cultures on health. She would also have had a better understanding of how the patients from other cultural backgrounds desired to be treated according to their own health beliefs and values with respect and dignity. This patient’s level of stress could have been markedly decreased if awareness of his cultural beliefs had been incorporated into his care. Without just saying that it was her responsibility to keep her patients as comfortable as possible without pain, the nurse could have addressed this patient’s cultural beliefs on medical care with respect and introduced the western health beliefs by explaining pathophysiological benefit and effects the treatment has. The nurse should have said, “I understand and respect your view that human suffering is the plight of mankind and healing does not emphasize the absence of pain as it does in Western medicine. I know you have a higher level of pain tolerance but you don’t need to be in any pain, however slight. This pain medication your physician prescribed will relieve your pain and help you to sleep well, get enough rest, and feel less anxious so your healing process will be pain-free and faster.” Better outcomes would have been produced in that the patient would have obliged the nurse and felt that she really cared for him. The patient would have also felt that he had found a caring friend in the nurse who understood him well and be ready for her the next time she comes up to him. Chinese are taught self-restraint. The needs of the group are more important than those of the individual unlike the Western culture. Another factor that may have contributed to the Asians refusal of pain medication is courtesy. The Asians generally consider it impolite to accept something the first time they get an offer. Sometime it would be the best and safest approach for the nurse to anticipate the needs of Chinese patients for pain medication without waiting for their requests. Nurses should be aware of their rules of etiquette when offering pain medication, food or other services. But if the patients continue to refuse medication, needless to say, their wishes should be respected. Using herbal remedies (often brewed as tea), acupressure, acupuncture and conferring with a medium or spiritualist are acceptable traditional treatments in China. Depending on their exposure to Western medicine, some Chinese may be fearful of going to hospitals, getting surgery and needles. On the contrary, Chinese think that a medication given by injection is more potent and effective and which may be preferred over oral medication. They consider using Western medicine only when traditional remedies have failed or for severe symptoms that they cannot resolve. This may put them in a quandary and lead to delayed diagnosis and use of the emergency room. Treatment decisions are usually made by the family unit. Chinese patients may have a low tolerance for diagnostic tests, as they may expect medical professionals to be experts who can give treatment immediately. Blood tests may be avoided since they allow the “Chi” (the essence of one’s body energy) to leak out. They believe symptoms would be promptly eliminated by medication, and that an illness is cured if its symptoms are relieved. The concept of health maintenance may not be encouraged. Some patients may prefer to use both an American physician and a Chinese traditional practitioner simultaneously so that they get the best of both worlds. It is important for nurses to ask what other Chinese herbal medicines the patient is on to avoid drug interactions and adverse reactions. Patients may need education on drug and herb interactions. A generalized lack of well-being is how a Chinese views illness; it is an affliction of the whole person. The dynamic system of opposing energy forces in the concept of yang and yin need to be balanced for harmony. Illness may be attributed to a losing of balance in Yin (a cold force) and Yang (a hot force), a curse by an offended spirit or a punishment for some previous wrong behavior. Internal and external factors are also believed to be behind the illnesses. Traditional division of the body into yang and yin is the basis of this thought. The yang is the symbol of surface organs and the yin represents internal organs. Diagnosing and treating selected illnesses and medical conditions is also possible by classifying illnesses into hot and cold. Skin eruptions, cold sores, fevers, and ear infection are excessive “heat” or yang illnesses which are from within the body itself. Coughing, headaches, muscle aches, and diarrhea from a “cold” stomach and infectious airborne disease as well as cancer are “cold” or yin maladies which are generated by intrusion of cold or “bad wind” into any part of the body. These may relate to symptoms caused by loss of blood and improper diet. Ensuring harmony between the yin and yang forces of the body, as well as their mind and emotions helps to maintain good health In Chinese culture, patients are often not informed of their life-threatening serious illness such as cancer that they are diagnosed with but the family is usually told. Family members often wish to care for their sick family members at home if it is possible. However, some people believe that if the patient dies at home, this may have bad effects on children in the home. Due to this reason, relatives may wish the patient to die in a hospice or hospital setting other than the home. However the family may wish to be at the bedside of their hospitalized dying patient. White is the color for mourning so wearing all-white or all-black may be regarded as bad luck by some Chinese. Families may not wish to allow autopsies to be performed on their deceased family members. They are also often reluctant to donate organs to someone who needs it because donors would be reborn incompletely without all their vital organs in the next life. Also, they believe their bodies are given from their parents and it may be disrespectful to their parents if they don’t preserve their bodies till the end. Death and dying practices are closely related to and can be affected by one’s religious beliefs. The Chinese Buddhist believe that death is not always a one-way passage. It is a two-way encounter in which the consciousness leaves from ones life and begins the journey for another new life. Another Chinese Buddhist belief is that human life is concurrent and inseparable from the two factors of consciousness and warmth. Dying is a gradual process in which the consciousness gradually separates from the body. Death occurs when the body is not conscious anymore and completely has lost warmth. In U.S. a person is declared dead when a persons pulse and brain waves have stopped. However, the Buddhist belief says that the person remains active in the process of dying and the consciousness is still in the process of separating from the body. During active dying, it is considered important to avoid any movement of the body or sudden environmental changes. Therefore interference of the body is not allowed until the body is cold all over for at least eight additional hours. Like any other Asian countries, the wearing of white is a symbol of death in China. White or off-white robes are traditionally worn to symbolize that someone has died and can be seen worn among relatives of the deceased during a funeral ceremony. They may also be required to wipe their faces with a white cloth. In Chinese culture, red is strictly forbidden to be worn because it is a traditionally symbolic color of happiness. However, contemporary Western culture influenced mourners to wear dark-colored or black attire and it is more often acceptable especially for those outside the family. When a coffin is lowered into the ground the mourners bow their heads and should not watch the coffin being lowered into the ground. A traditional Chinese gift for the attendees is usually a small sum of money which should not be brought home. The repetition of an act three times is practiced to prevent bad luck so people at the funeral may brush their hair three times or spit three times before leaving the funeral. Throughout centuries of isolation from the rest of the world, ancient China evolved a unique and extremely well-organized system of medicine that continues to dominate medical thinking up to now. This distinctive system has further influenced the medical concepts of people of Korea, Japan, and Southeast Asia. The Koreans have adopted Buddhism as a state religion from China in ancient times so they share their concepts of illness and practices of medicine based on ideas of Buddhism. The Chinese did not differentiate between psychological and physical problems. However, Koreans have a folk illness called Hwa-Byung. Hwa refers to “anger” and Byung means “sickness.” A person who has suffered from repressed or suppressed inner anger of long duration may have somatic symptoms such as loss of appetite, indigestion, pain, alternating diarrhea and constipation, dyspnoea, hypertension, headaches, dizziness, and fatigue. This is because the negative emotions that individuals are having can affect the body negatively and transfer to their physical condition as symptoms. Religion, health beliefs and practices, and social roles from different parts of Asia are very similar. Their present concepts and practices of medicine have been formed and shaped by their long history of interaction across the close international community in Asia and constantly moving toward Westernization of society. Fundamental or traditional Chinese medicine is the philosophy of Buddhism. The principle of cosmic forces of yin and yang with their concepts of health and disease are closely related. If an individual remains properly balanced in harmony with these two factors, it is believed that he can enjoy good health and longevity while imbalance may result in illness and death. The process of seeking and obtaining information based on different cultural and ethnic groups and utilization of this cultural knowledge by nurses can help the development of multicultural diversity in the care provided. Nurses need to be fully aware of their patients’ belief systems and medical practices of their patients’ cultures. Improved understanding of how the belief systems differ from one’s own and how these differences might influence their health care practices will further optimize care for diverse patients from different cultures. Read More