Caring for People with Cultural Diverse Needs - Essay Example

Caring for People with Cultural Diverse Needs Introduction This brief essay reflects back to a time that I offered care for a patient with culturally diverse needs form a critical point of view. Encourse the reflection, the paper analyzes critically the care that I and the institution in which I am a member provided for that female patient against the consensus of available recent literature as regards the appropriate nursing care for culturally diverse patients. The paper specifically elaborates and discusses the response of the Arab female to the care provided time and my colleagues, as well as the care support services that was available to me during that memorable moment of my nursing career. Now that I reflect back to the incident from an informed point of view and based on current research, I can review the incident in a balanced manner. For instance, the paper reflects on the availability of support and ideal care provision protocols in the institution, for their culturally diverse patients’ i.e. sympathetic care. Based on this balanced reflection, the paper then makes tenable recommendations that the institution can employ to enhance their ability to provide culturally competent care for such patients. This entire discussion is based in recent literature. To achieve the ends highlighted above, the paper is structured thus. It begins with an introduction into the numerous needs that a culturally diverse patient has and what they expect as part of their nursing care. In this section, the paper discusses cultural diversity and its manifestation, to establish what the needs of culturally diverse patients normally are. The next section summarizes on the incident that I reflect on from my earlier experiences. In this incident, the paper presents my experiences with a culturally diverse patients and how my institution and I went about providing care for her. This done, the paper then proceeds to review current literature on the nursing practice versus its applicability among culturally diverse patients. This section establishes the protocols of culturally competent nursing practices, its characteristics, components and requirements. Based on this consensus, the paper then proceeds to identify recommend the best ways in which my institution and I would have provided the ideal culturally competent nursing care to the patient, over and above what we did at the time. Upon that point, the paper then terminates with a tenable conclusions on the issues raised in the discussion and reflection, throughout. Care Needs in Cultural Diversity To begin with, the concept of culture has hundreds of offered definitions (Transcultural Nursing, 2008). For the purpose of this paper, the notion of culture shall refer to the sum total of a people’s way of life, including the values, the beliefs, the standards, the language, the thinking patterns, the behavioral norms, the communications styles, and such other variable practices of a people (Transcultural Nursing, 2008). Culture is what guides the decisions and even actions of a particular community or people through time (Transcultural Nursing, 2008). It is a fact every human being has a culture and a cultural heritage in which he or she was born in and or lives by (Gordon 2006, pp. 313 – 354). The most obvious manifestations of culture include religion, race/ethnicity, nationality, language and gender/gender roles (Devore and Schlesinger 1996, pp. 82). The less obvious but valid manifestation of culture include age, marital status, education, educational status and even mobility traits including handicaps (Devore and Schlesinger 1996, pp. 82). By calling a patient culturally diverse, we mean that such a patient has a cultural background or identity than that of the nurse offering care (McMahon and Allen-Meares 1992, pp. 533 – 538). The nurse will thus be a distinct culture from that he or she is familiar with (McMahon and Allen-Meares 1992, pp. 533 – 538). Currently, Australia, Europe and North America have all been experiencing a great shift in their demographic trends towards what can be referred to as cultural diversity ((Transcultural Nursing, 2008; Devore and Schlesinger 1996, pp. 82). Demographers are currently predicting that in about two decades, most of the racial and ethnic minorities will have attained numerical equity in these countries (Sue and Sue, 1999, 1133), and also given the entire globe a taste of each race, each culture. That means that nurses are more likely now and in the future, to encounter patients from any cultural background (Gordon 2006, pp. 313 – 354). Especially while working in urban areas, a nurse must necessarily be akin to the needs of the culturally diverse patients and be able to provide appropriate care despite the variance of cultural backgrounds (Gordon 2006, pp. 313 – 354). Nurses will have to be averse with the needs of African patients, African Americans patients, American Indians patients, Australian Aborigines patients, east and central Asian patients, Asian Americans, Irish patients, Dutch patients, Pacific Islanders patients, Hispanic patients etc (LaVeist, Diala and Jarrett 2000, pp. 194-208). While living and practicing in any part of the world today, a nurse must necessarily be able to offer diligent care to each of these differing patients (Gordon 2006, pp. 313 – 354). The nurse must understand that these are all patients, alike in their reliance on the nurse and differing only in their cultural background (Gordon 2006, pp. 313 – 354). The ability of the nurse to adapt to and accommodate the diverse needs of all these peoples is vital in current nursing practices ((Transcultural Nursing, 2008; Minarik 1996, pp. 212 – 264; Lum 1996, pp. 56). Among the needs that such patients have, is a nurse and or care giver who understands their medical needs first. They will have come to the health care facility primarily because they need medical care. Secondly, the need help and assistance in overcoming their medical problems (LaVeist, Diala and Jarrett 2000, pp. 194-208). Up to that point, the needs are identical to all the patients a nurse can handle (LaVeist, Diala and Jarrett 2000, pp. 194-208). The difference starts emerging on the thirds need which is the patients wish to understand the nurse during the care giving procedures (LaVeist, Diala and Jarrett 2000, pp. 194-208). This is usually solved by use of an interpreter in cases where the nurse and the patient do not share a common language (LaVeist, Diala and Jarrett 2000, pp. 194-208). Fourthly, the patient always requires that the nurse understand, recognize, accept and the cultural diversity (Fellin 2000, pp. 261 – 278). A Muslim patient for instance always requires the nurse to recognize their religious identity and to respect it even in the administration of care (Fellin 2000, pp. 261 – 278). Finally, the culturally diverse patients require that the nurse be able to find care options and practices that compliment rather that contradict their cultural identity (Fellin 2000, pp. 261 – 278). Rarely is a patient in a position of telling the nurse what to do in order to accommodate the cultural diversity between them (Fellin 2000, pp. 261 – 278). It is the burden and mandate of the nurse to fashion out his or her care giving antics to the needs of the culturally diverse patient (Fellin 2000, pp. 261 – 278). A Reflection on Caring for a Culturally Diverse Patient A while ago, I was in assigned a patient admitted to our institution with an advanced case of a serious venereal disease (Syphilis). While I had seen many similar cases prior to that one, that particular patient remains an isolated island since she was unlike any other patient I had ever cared for. To begin with, the patient was a woman and secondly she was from the Middle East and had come visiting to Australian. Her infection had advanced to extents that the doctors feared that it had already affected her reproductive system severely. It took several days to administer all the relevant tests and arrive at a prognosis before the eight days of treatment started. By that time, the patient had antagonized the entire institution and challenged our cultural competency than any other patient we had ever treated. To understand the context, certain highlights are important. Having come from UAE, the 23-year-old woman was a devout Muslim and married. That means that she was brought up and practiced the beliefs and values of the Arab culture. Her religion was Islam. Muslim women are very conservative in their interaction with non-Muslims (McMahon and Allen-Meares 1992, pp. 533 – 538). They wear scarves and long dresses to cover their bodies completely and are very sensitive to touch. We allowed her to remain fully dressed during treatment and any uncovering of her body was kept at the barest minimal. Fortunately, she had a relatively passable knowledge of English although at the beginning I and my colleagues relied highly on a translator who was also a member of staff and proficient in Arabic. By the time she left, in could understand her without the need of a translator. Like other devout Muslims, she observed prayer 5 times daily and had to pray facing Mecca. Having to make allowances for that, that she be able to pray without interruptions while kneeling and bowing down on the floor, was itself a challenge in busy and large scale institution as ours. We however placed her in an isolated ward and provided a mat that she could use as a prayer mat. All checkups and consultation was done in those hours she did not to pray and during prayer time, the door was locked to avoid interruptions. More importantly however, was her reluctance to disclose any detailed information about herself, her husband and her family to a stranger (our medical team and me). She had a habit of giving as little and inconsequential information as possible, such that diagnosing her condition was a real problem. It would have been better if she had just been conservative, but the woman was downright embarrassed by any questions regarding her sexual relationships and partner(s). Almost every personal question was regarded with suspicion. Even worse, having contracted a sexually transmitted disease made it almost impossible to talk to her. It was totally out of line from a Muslim woman perspective and we understood her fears, concerns and worries. Having a venereal disease was very difficult for her psychologically, emotionally and even physiologically. We however learnt that the disease had also infected the husband and he was called in for check up and treatment too. Only later did we learn that it was the husband who had infected her, probably after some indiscretion on his part. This explained why contrary to our expectation, he did not get angry when we asked that he be tested for the disease. His only request was that we do not discuss the issue with his wife, based on the strict religious beliefs they shared. It was also important to protect the wife from any adverse repercussions for having revealed the information to us. We therefore informed the husband that it was our diagnosis that helped predict the source of the disease and not his wife. Luckily for us, he seemed to believe our protracted theory completely without question. The success of the care we provided is largely owed to our impressive team of Allied Health Social Workers. Among them was a woman called Anne, who managed to speak through a translator and convince the female patient of the need to give information. She explained the risks of letting the condition progress, the need to treat her and her husband, the need to inspect her before making a prognosis and also the need to communicate her fears and needs to us. The patient actually told Anne that the disease must have come from her ‘errant’ husband, something that no other member of the team could dare ask. Having the team of highly qualified Allied Health Social Workers worked to our benefit in this incident as in many others. We relied completely on their multi-dimensional social skills. Even after the patient was on treatment and enroute to recovery, the team of Allied Health Social Workers played a central role in offering therapeutic care and counseling. The hospital had also to make arrangements for different dietary requirements for the patient such as avoiding any pork product in the food served to her. As I look back, I am glad that we adapted to and were able to help the woman despite the great cultural ridge between us. Nursing for the Culturally Diverse To adapt to and provide for the care needs of culturally diverse patients as identified in an earlier section of the paper, nurses and health care institutions need to develop what has been called cultural competence (Galanti 2003, pp. 165 – 187; McPhatter 1997, pp. 255 – 278). Cultural competence has been defines as a set of learnt congruent behaviors, attitudes, practices and policies of practicing care, which collate into a system, an agency and or profession, to enable effective work in cross-cultural settings (Cross, Bazron, Dennis and Isaacs 2007, pp. 64 – 78). Cultural competence is in opposition to cultural destructiveness, a practice that has been in practice until recently, where people undergo forced assimilation, domination and subjugation of their rights and privileges in favor of more dominant groups (Galanti 2003, pp. 165 – 187). If a practitioner or an organization does not build onto their cultural competence, they are said to have cultural incapacity (Galanti 2003, pp. 165 – 187). It is in such institutions that one can easily find racism, abounding stereotypes, segregationist practices, unfair hiring practices, unequal employment policies etc (Devore and Schlesinger 1996, pp. 82). Some health care organizations remain in cultural destructiveness and they have refused to build their cultural competence capacity (McPhatter 1997, pp. 255 – 278). Other have only eliminated the cultural destructiveness due to legal, social and business demands but have not fully embraces cultural competence. Such organizations are said to have cultural blindness (Galanti 2003, pp. 165 – 187). Culturally blind organizations and care givers usually ignore any existing cultural differences in their patients and insist on treating everyone in the same way (McPhatter 1997, pp. 255 – 278). In most cases, that ‘same way’ only meets the need of the dominant groups at the expense of minorities (Galanti 2003, pp. 165 – 187). In modern practice, health care organizations that are pursuing cultural competence strive to explore the cultural issues of their patients in their diversity (Meyer 1996, pp. 5 – 11). The organizations are committed to assess the needs to change both the organization and the staff in accordance to the requirements of their diverse patients (Galanti 2003, pp. 165 – 187). The ability of caregivers and their organizations to implement necessarily changes that help improve care giving practices based on the cultural needs of their patients as well as on research, is what has been called the process of cultural proficiency (Galanti 2003, pp. 165 – 187). The process must however be ongoing on a perpetual self-improvement manner (Galanti 2003, pp. 165 – 187). Cultural competence begins with a recognition that individual patients have cultural differences none of which is superior or more ideal than the other (Gordon 2006, pp. 313 – 354). It begins with realization that each patient deserves the best care regardless of the cultural diversity in play (Cross, Bazron, Dennis and Isaacs 2007, pp. 64 – 78). Once an organization realizes this, it seeks the advice of diverse cultural groups on how they can offer care that respects each cultural background of their patients (Meyer 1996, pp. 5 – 11). They will hire only the culturally unbiased staff and insist on a cross-cultural approach to care where every patient is regarded equal but with unique cultural needs during care (Cross, Bazron, Dennis and Isaacs 2007, pp. 64 – 78). The process of acquiring cultural competence in health care provision starts with the care givers and their organizations gaining awareness on the diversity of culture and peoples, then developing their knowledge through research and consultation and finally enhancing that knowledge with specific, cultural competence skills (Transcultural Nursing, 2008). This process has been called cultural proficiency as described earlier (Fellin 2000, pp. 261 – 278). The process is usually initiated and polished by having cross-cultural encounters during the provision of care, just like the one I had with the Muslim woman. Ideal Nursing Practices for the Culturally Diverse I am convinced that my encounter with the Arab woman was successful. We managed to assist the woman and her husband despite having appalling odds. The advantage was that my colleagues and I accepted that the woman was culturally different and were willing to change our approach in a way that could accommodate her and facilitate effective care without contravening on her faith, values and religion (Gordon 2006, pp. 313 – 354). We engaged predominantly female staff members with her and male staff members with her husband. We also ensured that we were sensitive to the sex questions we asked and framed them in a way that made it easy for both of them to give appropriate answers. That was commendable. While she was handled adequately, the process of acquiring cultural competence is a perpetual process of self-improvement and should thus be embraced continually. Five essential components or elements of a health care organization’s cultural competency ability have been proposed and I recommend these, as the best way in which such patients as the Arab woman are given adequate and appropriate care. The institution can better improve its cultural competency and proficiency rate by initiating the following five elements. The institution needs to value diversity in its patients (Lum 1996, pp. 56). It is because of our diversity that we are all unique and as important (Lum 1996, pp. 56). Once diversity is appreciated, the organization should then conduct regular self-assessment to evaluate their capacity and that of their staff for cultural competence. Based on the self-assessment, the organization should then and implement a consciousness among its care givers, of the numerous dynamics inherent in instances where cultures interact, such as religion, gender etc (Cross, Bazron, Dennis and Isaacs 2007, pp. 64 – 78). Fourthly, the organization should institutionalize cultural competence and knowledge as part of the mandated qualifications and practice of its care givers (Cross, Bazron, Dennis and Isaacs 2007, pp. 64 – 78). Organization policies should help standardize protocols of implementing and practicing cultural competence (Cross, Bazron, Dennis and Isaacs 2007, pp. 64 – 78). Finally, the organizations should use these standard protocols to develop and implement adaptations of care giving service delivery in a way that reflects a deep understanding of ideal nursing in cultural diverse scenarios (Cross, Bazron, Dennis and Isaacs 2007, pp. 64 – 78). The five recommendations will require a collaborative effort in policy development, institutional administration and the care giving practice on a perpetual manner such that, cultural competence is reflected in the organization structures, attitudes, policies and practices of the organization (Cross, Bazron, Dennis and Isaacs 2007, pp. 64 – 78). References Cross, T, Bazron, B, Dennis, K, and Isaacs, M 2007, Toward a Culturally Competent System of Care, Volume 3, Georgetown University, Washington, D.C., pp. 64 – 78. Devore, W and Schlesinger, E 1996, Ethnic sensitive social work practice, Fourth Edition, Ally & Bacon, Boston, pp. 82. Fellin, P 2000, Revisiting multiculturalism in social work, Journal of Social Work Education, Vol. 36 (2), pp. 261 - 278. Galanti, GA, 2003, Caring for Patients from Different Cultures, University of   Pennsylvania Press, Philadelphia, pp. 165 – 187. Gordon, Suzanne, 2006, Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, And Medical Hubris Undermine Nurses And Patient Care: The Culture and Politics of Health Care Work, Cornell University Press, New York, pp. 313 – 354. LaVeist, T, Diala, C and Jarrett, N 2000, Social status and perceived discrimination: Who experiences discrimination in the health care system, how and why? In Hogue, C, Hargraves, and Scott-Collins, Eds, Minority health in America, Johns Hopkins University Press, Baltimore, pp. pp. 194-208. Lum, D 1996, Social work practice and people of color, Third Edition, Pacific Grove, California, pp. 56. McMahon, A and Allen-Meares, P 1992, Is social work racist? A content analysis of recent literature, Social Work, Vol. 37 (1), pp. 533 - 538. McPhatter, A 1997, Cultural competence in child welfare: What is it? How do we achieve it? What happens without it?, Child Welfare, Vol. 76 (2), pp. 255 - 278. Meyer, CR 1996, Medicine's melting pot, Minn Medicine, Vol. 79 (5), pp. 5 – 11.  Minarik, Pamela, 1996, Culture & Nursing Care: A Pocket Guide, University of California, San Francisco, pp. 212 - 264. Soest, Van, 1995, Multiculturalism and social work education: The non-debate about competing perspectives, Journal of Social Work Education, Vol. 31 (2), pp. 55-65. Sue, D and Sue, D 1999, Counseling the culturally different, Third Edition, John Wiley & Sons, New York, pp. 78. Transcultural Nursing, 2008, Cultural Competence, Viewed on 24 July 2010, < http://www.culturediversity.org/cultcomp.htm>. Read More