Fundamentals of Nursing 2: lesson 2

Cultural blindness:

Occurs when a person refuses to recognize the cultural needs of another person.

Cultural shock:

Occurs when you are immersed into a culture and are literally emotionally shocked by it.

Cultural conflict:

Occurs when you enter a power struggle with another person (the patient).

The patient may believe that illness is caused by an imbalance between inanimate forces. Members of certain cultures believe that illness is caused by an imbalance between "hot" and "cold." As a result, a member of these cultures may:

Only drink or eat hot foods when ill in an effort to restore balance and health. Because of fears that cold temperatures can cause illness, members of some cultures make efforts to stay warm at all times. For example, a patient holding this belief might refuse to use an ice pack to treat an injured ankle; another patient who is ill may refuse to shampoo her hair because of fear of developing a headache or catching a cold.

Cultural awareness:

The knowledge of various cultural beliefs and values.

According to traditional Chinese medicinal practices, illness is caused when:

There is an imbalance of the energy forms known as yin (cold) and yang (hot). In this belief system, the terms hot and cold do not refer to actual temperatures but serve as descriptors of these energy forms, which exist not only in the individual's body but also in foods, actions, and behaviors. India's practice of Ayurvedic medicine, which uses herbs, nutrition, cleansings, acupressure, massage, and yoga, is based on similar beliefs.

The categorization of a group of people by a distinctive trait is called ethnicity.

True

Cultural sensitivity:

Means that you provide care to the patient and show respect for and incorporate the patient's specific cultural beliefs and values into your nursing care. Cultural sensitivity also requires that you recognize and respect the accepted patterns of communication.

Factors that determine the cultural diversity of a group might include the different:

Ethnic groups, races, languages spoken, and religions within the larger group. Anything that is specific to the group that distinguishes it from all other groups of people defines the culture of the group.

The greatest barrier to cultural competency is:

Ethnocentrism. This is a concept that indicates that one person's culture is "the best." The most devastating examples of ethnocentricity are the "ethical cleansings" that occurred in Germany during the Holocaust.

Which of the following organizations helped establish standards that promote the rights of patients to receive spiritually sensitive care?

The Joint Commission

If the patient feels he or she is being attacked or feels totally out of control of the situation, the patient may refuse care, become combative, or leave without the needed health care. In an effort to prevent these problems from arising, try the following approaches:

- Allow the patient time to get his or her thoughts together. - The use of a trained interpreter is preferred if available. If an interpreter is needed but one is not available, use the interpreter phone line, if the facility has one, or use prompts such as pictures or vocabulary cue cards. - Be aware of the patient's nonverbal body language. It may alert the nurse to escalating tension and the need for a calm and quiet approach. - Be aware that hand gestures mean different things in different cultures. For example, the "okay" sign used by many people in the United States may mean consciousness or deliberation to individuals in India. - Understand that the patient may be able to speak English but that it may be broken or difficult to understand.

Scientifically Based Beliefs, Biomedical:

- Based on scientific research leading to best practices Basic Tenets of the Beliefs: - If it can be proven scientifically, then it is accepted as truth and law. - If it cannot be proven scientifically by research, it is an unfounded belief and myth. Examples: - Brushing teeth prevents tooth decay. - Hand washing prevents the spread of disease. - Immunization prevents disease.

Transcultural nursing addresses the following:

- Cultural differences among patients - Cultural differences among health-care providers - Culture of the individual nurse

Several barriers to health care are specific to the individual. Some of the issues that may lead to lack of care or to the provision of inappropriate care include the following:

- Economics - Education - Geography - Language - Stereotyping - Prejudice and discrimination - Misunderstandings

If it is determined that the patient has spiritual distress, you can then determine the appropriate nursing care to provide. Nursing interventions will nearly always include the following:

- Offering presence, which means to give the patient time and attention - Providing opportunities for the patient to express his or her feelings - Using therapeutic communication techniques to promote the expression of feelings - Contacting the religious or spiritual advisor of the patient's choice (only with the patient's permission) - Providing for religious rituals as the patient desires, such as the practice of communion or the opportunity to pray

The nurse does not need to have expert knowledge of every culture or cultural group to be culturally competent. However, the culturally competent nurse chooses to be aware of the cultural differences and to become familiar with aspects of the patient's culture that affect and influence the patient's health and care. The nurse strives to understand anything that might influence the patient's health, including the patient's:

- Perceptions - Expectations - Behavior - Decision-making processes

The 5 steps in cultural awareness:

- cultural desire - cultural awareness - cultural knowledge - cultural skill - cultural encounter

Basic cultural assessment questions:

1. What language do you speak? 2. What makes you sick? 3. What do you think made you sick this time? 4. What do you think made it start? 5. Are there any particular concerns or fears you have about it? 6. What has this sickness changed about your daily living? 7. What do you do when you are sick? 8. What usually makes you better? 9. What have you done about it this time? 10. Are there special foods you need to assist you in getting better? 11. Tell me about your family and how they can help you to feel better. 12. What are your spiritual beliefs as they relate to your illness? 13. What treatment do you expect to receive? 14. What do you expect to be the result of this treatment?

To gain insight into a patient's beliefs about his or her health, you need to ask these 3 questions:

1. What makes you sick? 2. What do you do when you are sick? 3. What makes you better?

Naturalistically or Holistically based beliefs:

A healthy state is one of balance and harmony. Examples include beliefs in yin and yang, or "hot" and "cold." Basic Tenets of the Beliefs: - The balance between yin and yang is what maintains and restores health. Yin and yang are compared with the sympathetic and parasympathetic nervous systems and the way they maintain balance in the body. - Balance is maintained between hot and cold in order to maintain health. Some cultures believe that certain conditions are cold if they are manifested by vasoconstriction and decreased metabolism. Hot conditions or diseases are manifested by a high metabolic rate and vasodilation. The goal of treatment is to restore balance. Examples: Cold diseases or states: menstrual cramps, rhinitis, colic Hot diseases or states: hypertension, diabetes mellitus, pregnancy

Which of the following is the best way to provide culturally sensitive care?

Ask the patient their wishes

Cultural Competence:

Awareness and competence of social differences.

Jewish religion prohibits pork but not:

Beef

Spiritual care:

Begins with an understanding of the differences between spirituality and religion, in addition to an understanding of one's own spirituality, beliefs, and values. Nurses who provide spiritual care must understand their own purposes and goals related to providing spiritual care to the patient. The relationship of body, mind, and spirit is so closely interactive that an alteration in the body affects the mind and spirit, an alteration in the mind affects the body and spirit, and an alteration in the spirit affects the mind and body.

Polytheistic:

Belief in many gods

Monotheistic:

Belief in one God

Folk Healing:

Beliefs in practitioners of specific alternative therapies Basic Tenets of the Beliefs: There are practitioners who promote the treatment and healing of disease who are not licensed as health-care providers or nurses or recognized by any certifying organization of higher learning. Many people seek assistance from herbalists, spiritualists, naturalists, and more. Other alternative practitioners provide therapeutic touch, iridology, naturopathic medicine, and reflexology. Examples: The patient seeks a reflexologist, who performs massage of the sole of the foot to relieve the pain of a migraine headache.

It is also important to be aware of the different beliefs about illness and wellness that may affect a patient's health and prognosis. Several cultures believe that:

Health is the balance of the internal and external environments of the individual, incorporating the whole of the person, including his or her physical, mental, social, and spiritual components. Some believe that the imbalance of these environments is the cause of illness. Traditional Chinese medicine is based on this belief.

Religiously Based Beliefs:

Called magico-religious, the principle of these beliefs is that disease is caused by supernatural forces and health can be restored by supernatural forces. Basic Tenets of the Beliefs: - Although many religions believe in prayer and the laying on of hands for healing, magico-religious beliefs indicate there is an added realm, the realm of magic. Magic can both heal the illness and be the cause of illness. - Others who practice magico-religion believe that illness is caused by some sinful act or by an actual demon spirit who is working against the individual. These patients may also believe that God is punishing them for sinful behaviors or lack of faith. Examples: - Depression is thought by some to be the result of sins. - There is belief in the "evil eye," which is a term that means a look or an eye that can cast spells on individuals. - Amulets, talismans, and rites are used to chase away bad spirits. - Many herbs are used to heal

The way of life that distinguishes a particular group of people from other groups is called:

Culture

Ethnic:

Defined as concerning a group of people within a cultural system who desire or are given a distinct classification based on traits such as religion, culture, language, or appearance.

Culture:

Defined as the way of life that distinguishes a particular group of people from other groups. It is the whole of the learned behaviors of individuals within a specific group. It includes the beliefs; values; symbols; art; music; morals; laws; customs; experiences; attitudes; religions; roles; concepts of space, time, and the universe; belongings; communications; races; and ethnicities of an individual or group. Additional aspects included in the definition of culture are traditions, holidays, and specific celebrations and practic

Cultural accommodation and negotiation

Definition: Actions or decisions that facilitate adaptation to or negotiation with others to promote culturally congruent, safe, and effective care; improve lifestyle habits; or deal with illness or dying. Example: The nurse is caring for a patient who uses a faith-based treatment for an illness. Instead of criticizing the patient, the nurse asks the patient whether the treatment is working.

Cultural preservation and maintenance

Definition: Professional acts or decisions that help cultures retain, preserve, or maintain beneficial care beliefs and values or face disabilities and death. Example: A nurse is caring for a patient who uses a therapeutic oil chest rub to soothe chest congestion and cough. The nurse should not judge or criticize the patient for using the chest rub.

Cultural repatterning or restructuring:

Definition: The professional actions and mutual decisions that help people to reorder, change, modify, or restructure their lifeways and institutions for better (or beneficial) health-care patterns, practices, or outcomes. Example: A patient is taking an herbal supplement that the health-care provider did not prescribe. The nurse reeducates the patient on the benefits of taking the prescribed medication.

Misunderstanding:

Is a barrier that is caused by a mistake of meaning or intention.

Culture:

Is a way of life that involves unique characteristics of human beings, wheren they share a pattern of learned behavior's such as patterns and moral conduct.

Prejudice:

Is an attitude, a determination, or a judgment about a person or group based on irrational suspicion or hatred of a particular group, race, sexual orientation or identity, or religion.

Transcultural nursing:

Is care that crosses cultural boundaries or combines the elements of more than one culture.

Cultural diversity:

Is defined as the differences between groups of people in a certain geographical area, such as a city, state, or country; a specific place, such as a church or factory; or a conceptual community, such as the medical community.

Discrimination:

Is the action of unfair treatment of one or more persons or groups. The discrimination is usually the result of misguided and unfounded beliefs about the race, ethnicity, age, gender, sexual orientation or identity, or religion of the person or group.

Ethnicity:

Is the categorization of a group of people by a distinctive trait, such as the line of genealogy or ancestry, race, or nationality.

Spirituality:

Is the descriptive term that explains the spirit and the relationship of the spirit to the body, mind, and environment, including the patient's relationship to others.

Religion:

Is the formal structured system of beliefs, values, rituals, and practices of a person or group, usually based on the teachings of a god or other spiritual leader.

Members of which religious group traditionally do not believe in receiving blood transfusions?

Jehovah's Witness

Stereotyping:

Means that a person or group is looked at by another person or group through preconceived ideas and fixed impressions; it can also be defined as ideas or beliefs that lead to prejudice and possibly mistreatment. These preconceived ideas may be based solely on a person's physical characteristics.

Patients who practice Hinduism may:

Refrain from eating pork.

Cultural competence:

Requires that the nurse makes a commitment to consider the cultural background of each patient and to provide appropriate care specific to that individual.

Often tea and coffee are served in the hospital with meal trays. However, it is important to be aware that:

Some cultures and religions prohibit caffeine intake, so decaffeinated beverages would be preferred for these patients.

Diet restrictions can even affect the medications a patient may take; for example:

Some patients may refuse to take medication that is packaged in a capsule because the capsule might be made from gelatin derived from either beef or pork.

Looking at a person or a group with preconceived ideas and fixed impressions is called:

Stereotyping

Unconscious bias:

When an individual unconsciously stereotypes, judges, or discriminates against an individual or a group of people. Such bias can affect how health-care professionals care for their patients, even though the health-care provider is not consciously trying to stereotype or discriminate.

Cultural imposition:

When one person imposes his or her beliefs, values, and practices on another because he or she believe his or her ideals are superior.

Atheistic:

denying the existence of God

Race:

refers to a set of distinct characteristics such as skin color that are genetically and biologically transmitted.

A specific plan to maintain diversity and inclusion should include several of the following points:

• Each nurse manager plays a key role in sustaining diversity and, although individual commitment is necessary, a team approach to diversity and inclusion will help ensure this as a sustainable policy within the organization. • Diversity strategies are most successful when they are implemented both at the organizational and departmental levels. • The focus on process and outcomes is best managed in smaller settings such as individual units in which hands-on managers can have an immediate impact. • Efforts to maintain and monitor the commitment to diversity should be discussed and evaluated frequently. • Organizations may utilize minority programs such as affirmative action or minority scholarship resources to increase diversity among nurses and to develop a foundation for inclu-sion. Diversity must be embraced thoroughly by management and should be practiced by both clinical and administrative staff.

Eight descriptors are used to define cultural competence:

• Integration of your nursing knowledge with the cultural needs of the patient results in the patient being better informed and, it is hoped, more cooperative with the health-care regimen. • Understanding that meeting cultural needs assists in improving health and health-related outcomes is important for every nurse. • Respect for another person's cultural needs inspires the trust two people can have for each other and fosters cooperation. • Communication, based on cultural understand-ing, provides a strong bridge to identifying the overall needs of a patient. • Sensitivity to another's cultural needs provides a mechanism for health-related needs to be met more successfully. • Dignity is a crucial aspect of holistic care and does not exist without an understanding of culture.Respect for another person's cultural needs inspires the trust two people can have for each other and fosters cooperation. • Knowledge about culture comes only with effort. A benefit to having that knowledge is the opportunity to meet the overall needs of the patient. • Acceptance of the beliefs and characteristics of another person is essential for culturally competent care to be given.