Psychology of Patient Culture - Essay Example

?Client Study: Patient's Culture (The Experience of Health and Illness) Client’s Background Mrs. C is a fifty-year-old Asian American. To preserve the confidentiality and anonymity of client, she will be referred as Mrs. C all throughout the study. Mrs. C suffered from recurrence of breast cancer and underwent treatment for bone metastasis. While complying with the treatment, she experienced nausea and vomiting. She was able to drink some fluids but her appetite continues to decrease and worsen.Mrs. C got diagnosed with breast cancer while she was working as an accountant in the company of her husband. Mrs. C was always accompanied by her husband (an engineer) and her two daughters (college students) in attending to bone metastasis treatment in the hospital because of her condition and the long distance of travelling from their house. Mrs. C insisted to have her family remain at her bedside and to have her eldest daughter attend to her basic needs instead of bothering the nurses. Meanwhile, Mrs. C’s husband only went home for shower while the two daughters stayed with Mrs. C. Mrs. C’s family constantly massage her back and legs, assist in changing position, and listen to her feelings, complains, and needs. They continuously support her and never voice out stress or discomfort in caring Mrs. C. However, I noticed that Mrs. C denies pain and difficulty in sleeping to the nurse instead, verbalized it to her family. Mrs. C requested to continue her treatment at home. I chose Mrs. C as the subject of my case study because she is the mother of a friend and I want to help their family in any way I could. In addition, Mrs. C is very cooperative because she thinks of me as a family caring for her. Delauneand Ladner (2006) described Asian American who highly value family and not verbally expressed criticism and disagreement (p. 392). Outline of Client’s Background In order to guide the study, the following data about the client’s background is outlined: The cultural group to which the client belongs is identified. The ethics of care is preserved and assigned a different name to refer to the client. The disease condition of the patient is described as well as presenting symptoms. The family background is described as well. The occupation of Mrs. C and her husband is identified and the educational status of her two daughters. Also, the effect of house distance to seeking treatment. The culture of the family in terms of health and caring was is described. Health needs are identified and client’s preferred treatment modalities are verbalized. The reason of the author for choosing the client is stated, as well as the attitude of Mrs. C to the interviewer. A literature is cited about client’s culture to relate the behavior to the existing culture. Outline of the Client’s Healthcare Need Mrs. C needed counseling in terms of her condition because based on her decision to go home, it is clearly demonstrated that she has difficulty coping with the present disease condition. Mrs. C also has body image disturbance. Health care professionals must work on increasing the self-esteem of the client. In order to improve Mrs. C’s well-being she will need to be seen by a multidisciplinary team involving the surgeon who will help her in possible surgical procedures related to cancer, a radiologist who specializes in x-rays and related scans, an oncologist doctorwho specialized in chemotherapy and radiotherapy, a palliative care doctor who specialized in easing or relieving the symptoms cancer, and a clinical nurse specialist. Other health professionals may also be involved, such as a physiotherapist to help Mrs. Ctreat the physical problems associated with breast cancer, an occupational therapist to help Mrs. C with the difficulty in moving around or doing everyday tasks such as dressing, washing or cooking, a psychologist for her psychological problems, a dietitian due to her poor appetite, and a pharmacist to provide medication she will probably need. Definition of Culture The definition of culture varies in different care setting. White (2005) defined culture as a unique and integrated dynamic structure of knowledge, attitudes, behaviors, beliefs, ideas, habits, customs, languages, values, symbols, rituals, and ceremonies of a particular group of people which provides them with a general design for living (p. 203). Meanwhile, Helman (1990) defined culture as the individuals’ inheritance of explicit and implicit set of guidelines as a member of a particular society which tells them how to view the world emotionally and behaviorally, as well as their relationship with other people, supernatural gods, and natural environment. Culture, with the use of symbols, language, art and ritual, provides a way of transmitting these guidelines (p. 2). Based on the two definitions of culture identified by two different authors, the following similarities were noted: White and Helman’s definitions of culture both pertains to a particular group of people or society; Both definitions identified culture as a guide for everyday living; and Both definitions identified behavior as one of the structures of culture. On the other hand, the following differences were noted: White’s definition of culture specifically stated that culture is uniqueto a particular group of people while Helman only stated that culture is inherited as a member of a particular society and no specifications entailed whether this culture inheritance is the same with the ancestors; White’s definition is specific ranging from knowledge, attitudes, behaviors, beliefs, ideas, habits, customs, languages, values, symbols, rituals, and ceremonies of a particular group of people while Helman’s definition is general and includes emotions, behaviors, and relationship with other people and supernatural gods; and Helman stated that culture is transmitted through the use of symbols, language, art while White referred these as part of the structure of culture. Relevance of Culture to Health and Well-Being Nursing has a long history of striving to provide skillful health and illness care to all human beings (Oermann and Heinrich, 2005, p. 250). Through history, it has been identified that perceptions of health and illness, beliefs, and values about achieving wellness and health care are all significantly related and influenced by culture (Bonder, Martin and Miracle, 2002, p. 61). Cultural variations such as social roles, status, values and rituals, and personal feelings about health and well-being affects how a nurse deliver a culturally-competent care. For instance, there is a “loss of face” among Asian women for causing conflict with the nurse who is viewed as a social superior. In return, Asian women avoids future contact with health professionals (Simpson and Creehan, 2008, p. 46). In the case of Mrs. C, not bothering the nurses for her basic needs and the verbalization of going home was mainly because of cultural preference. Data Collection of Client’s Culture Prior to data collection, I had reviewed literatures about the topic culture in nursing or transcultural nursing, the health care culture in the United States, the culture of Asian American, the different case studies and care issues about culture, and the cultural assessment guide used in data collection. After thorough review of the related case study materials, a consent letter was sent to Mrs. C indicating a request for scheduled interview.Upon approval from Mrs. C, the interview was set and conducted. The interview was gathered using the structuredinterview questions guide adapted from Daniels (2004) Cultural Assessment Interview Guide (p. 106). Interview was conducted by gathering psychosocial assessments related to the cultural context of health problems and health care needs (Tjale and Villiers, 2004, p. 160).This includes Mrs. C’s personal information, language, ethnicity, cultural group, customs and beliefs, personal food preferences, religious affiliations, and living arrangements utilizing effective communication(Smeltzer, Bare, Jhinkle and Cheever, 2009, p. 111). The settings of the interview are the hospital to where Mrs. C was treated and to her house. The two-part interview was conducted in order to determine Mrs. C’s behavior towards health care settings and family care settings as well as to assess multicultural variations (Andrews and Boyle, 2008, p. 196). I had noticed that aside from behavioral changes related to care setting, Mrs. C’s responsiveness during the interview was also affected. Mrs. C was very hesitant to answer questions related to her conditions while at the hospital which is in contrary to the cooperative Mrs. C during the house interview.During the interview, I asked Mrs. C “describe the cultural customs or beliefs you have in terms of health”? Mrs answered, “Health for us is the gift from our ancestors.” (The rest of the interview questions are found in the Appendix A). Important Cultural Issues from Client’s Perspective Cultural influences affect a person’s perspective with regards to health (Elliott, Aitken, and Chaboyer, 2007, p. 166). Based on the data gathered during the interview with Mrs. C, some of the cultural issuesfrom the clients perspective and summarized as follows: I noticed that Mrs. C seldomly verbalized her feelings to the nurse. When I asked her why, she stated that it is because of her language ability. Mrs. C cannot speak English fluently and stated that she don’t want to bother the nurses to care for her basic needs when she has her family on her side to take care of it. During the interview, Mrs. C emphasized that as Asian Americans, they value the unity of the family especially when difficulties arises. As a family, they view themselves as a group rather than an individual. In my literature review, I learned that Asian Americans used medicine in treating illnesses. I had verified it to Mrs. C during the interview. Mrs. C added that she was still using herbs as an alternative therapy for her cancer. Mrs. C also had encountered some forms of labelling from people about her illness. When she was first diagnosed with cancer, people associated it from a deadly disease. Her fellow Asian Americans believed that her condition is contagious. She stated that because of her hair loss and metastasis of her cancer, Mrs. C believed what other people are saying – that she will die soon. Mrs. C also stated that this was also the reason why she insisted to be cared at home rather than the hospital. The overflowing of emotions has led Mrs. C to thank their ancestors for giving her a supportive family whereas other Asian Americans sufferred from violence from their own family.. Based on Mrs. C’s perspectives, stigma and labelling, role play, body image, communication, and violence are some of the identified cultural issues associated with health and illness. The most prevalent issue in terms of screening and treatment of Asian American women for breast cancer is communication. Asian Americans are not assertive and may not make their needs known clearly (Dow, 2004, p. 306). At times, Asian Americans feel intimadated with the Western health care system that they tend not to repeat the experience and lean on traditional medicines instead. Aside from language barrier, the traditional culture and attitude of Asian Americans explains why Mrs. C did not disclose feelings of discomfort to the nurse practitioner. Nurse professionals need to convey trust from Asian Americans in order to deliver a culturally-competent care. The most affective cultural issue is social stigma or cultural shame. Most of the Asian Americans lack awareness and education about breast cancer, leading to increase rate of cancer among Asian American. Since being healthy is a gift from god or ancestors, Asian Americans link cancer to a disease from god or a sign of weakness(Chen, 2010, p. 279). Once diagnosed, they delay seeking treatment because of the cultural shame attached to the illness and the embarassment that a client could get because of distortion in body image. Often times, Asian Americans view cancer as a deadly and contagious disease. In the case od Mrs. C, refusing further treatments is probably related to social stigma of breast cancer. Mrs. C also describes relationship with her family as a source of strength during illness or stress. In Asian Americans, the family is the most important social institution and source of functional and psychological support. Asian Americans have extensive-family involvement in health-seeking behaviors (Edelman and Mandle, 2006, p. 34) Mrs. C also stated violence among Asian Americans. Shevrin, Islam and Rey (2009) states that the cultural factors prevent Asian Americans from seeking help against violence. Culture of the Client vs. the Culture of the Care Setting To delineate similarities and differences between the culture of the client and the culture of the health care setting, as well as if the culture of the client matches the culture of the health care setting, a careful analysis of each culture is needed. Let us take a look on the culture of Mrs. C – the culture of Asian Americans. Mrs. C’s main medium of communication is Mandarin Chinese and can speak a little of English. Mrs. C avoids eye contact because the Asian American culture considered it rude. Asian Americans also do not expressed criticism or disagreement verbally, avoids no to show respect for others, and views up-turned palm as offensive. Through understanding culture, one can interpret that Mrs. C’s behavior towards nurse practitioner reflects her culture. In addition, Asian Americans considered touching one’s head as disrespectful because the head is sacred (Delaune and Ladner, 2006, p. 392). Mrs. C puts high value to her family and a strong family tie and loyalty was observed . This is also in accordance with the Asian American culture. They also believe in in gender roles where men have the power and authority and women are expected to be obedient. She also viewed education as extremely important. In terms of health, Asian Americans define being healthy as a state of harmony with nature, a balance between yin and yang, and a gift from their ancestors. Cancer of the stomach and liver is often associated with Asian Americans (Delaune and Ladner, 2006, p. 393). Mrs. C. received her treatment for cancer in the U.K. health care setting. The culture of the U.K. health care system change over time and variations in cultural beliefs, values, amd practices exist. Cultural variations occur when the ethnic group applies the inherited cultural norms from their ancestors and from the society they live in (Moonie and Walsh, 2003, p. 126). Moore and Woodrow (2004) stated that 7.9 percent of the U.K. population is from minority ethnic groups (p. 78). It has been observed that these people sufferred from poorer health, increase incidence of heart disease, stroke, diabetes, and mental health, difficulty accessing health care services, and lower rates for surgery. Multiculturalism plays a vital role in dealing with minority group in U.K. care setting. The U.K. care setting tend to think of issues of race, culture, and ethnicity in terms of skin color. Increasing numbers of people born in U.K. considers dual identity from parent’s culture and the British culture(Moore and Woodrow, 2004, p. 79). This is the reason why families who migrated and raised their children in U.K. often preserved their cultural heritage. Cultural labelling such as African or Asian does not exist as U.K. has diversified minority ethnic groups. Minority ethnic groups seek meical treatment but tend to have low levels of satisfaction in terms of health services offerred thus, critically ill people feel discriminated but unable to comprehend because of limited language ability. Nurses in U.K. oftenly interact with people of different cultures enabling them to learn the difeerent cultures and become culturally-intelligent (Cox and Hill, 2010, p. 297) Based on the above descriptions of the client’s culture and the health care’s culture, the following similarities were noted: Both of the settings considers English as the medium of health communication and both of the cultures put emphasis on family and respect for cultural heritage. Meanwhile, the only differences cited was the language incompatibility between the U.K. care setting and the client’s ethnic group. Since U.K. does not consider labelling and respect the cultural diversity of their countries,the culture of Mrs. C being an Asian American match the U.K. health care setting. However, Because of increasing low levels of dissatisfaction experienced by minority ethnic groups in terms of health services offerred, changes in health care system of U.K. has been advocated. Strengths and Weaknesses of Care Provision Related to Culture The application of culture to the care provision has its strengths and weaknesses, majority of which are strengths. Among the strengths of care provision related to culture are: Culture care provision has been extremely helpful in recognizing similarities and differences among clients with diversified cultures; Nurses developed a high quality culturally congruent health care; Allow nurses to explore various cultural areas in terms of technology, religious beliefs, care expressions and meanings, economic factors, cultural history, and environment; Cultural care assess diverse employment issues in clinical setting such as discrimination in the health care settings; The application of culture to the care provision serves as a guide in learning to understand others work and build a harmonious relationships with culturally diverse co-workers and clients in the health care arena, resulting to positive staff relationships, positive therapeutic outcomes, and decrease discomforts among clients(Leininger and McFarland, 2006, p. 159-162). Despite the numerous strengths of culture applied in care provision, there are also some weaknesses identified among care provision which includes the difficulties faced by health care professionalsin dealing with cultural assessments leading to inaccurate assessments and delivery of low-quality care. Leininger and McFarland (2006) identified some of the weaknesses of a culturally-provided care such as: lack of administrators understanding, involvement, and support in cultural care; absence or if not low numbers of a culturally-oriented working professionals; lack of evidence and career advancement in different cultural orientations; and absence of polices regarding the cultural application of care in the health care settings (p. 163). Caring for clients with different culture is a challenging task for a student nurse. To deal with this client, nurses need to utilize their strengths, respect their values, and used appropriate questions cultural assessments. Likewise, a nurse should also understand how a client explains and understands health and illness as an important part of cultural assessment. Health professionals put their shoes in the clients perspectives to develop a culture-sensitive care plans which includes their thoughts, values, and feelings about health and illness. As nursing professionals, developing a culturally competent care lead to the provision of respectful and meaningful care. It has been identified that the need to acquire a cultural knowledge and competence is essential to all health professionals, thus self-awareness is an imperative. Knowing one’s biases will develop an understanding of different cultures and will appreciate more of the challenges imposed by cultural issues. The importance of demonstrating caring behaviors rather than tolerating cultural variations in clients behavior fosters effective health interventions. Aside from self-awareness,accepting and appreciating the impact of culture on health care as well as cultural similarities and variations allow health professionals to care in a nonjudgmental manner. Appendix A: Cultural Assessment Interview Guide (Adapted from Rick Daniels) References: Andrews, M.M. and Boyle, J.S. (2008). Nursing in Multicultural Health Care Settings. Transcultural Concepts in Nursing Care 5th ed.Philadelphia: Lippincott Williams & Wilkins, pp. 196-225. Bonder, B., Martin, L. and Miracle, A.W. (2002). The Role of Culture in Health and Health Care. Culture in Clinical Care. New Jersey: SLACK Incorporated, pp. 59-82 Chen, E. (2010). Health. Encyclopedia of Asian American Issues Today. California: ABC-CLIO, LLC, pp. 261-394. Cox, C. and Hill, M. (2010). Cultural Diversity within the General Practice and Walk-in Center Settings. Professional Issues in Primary Care Settings. West Sussex: Blackwell Publishing Ltd., pp. 297-304. Daniels, R. (2004). Culture and Ethnicity. 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