Unit 5 - Culture

Cultural impostion

placing own values onto patient

Ethnocentrism

view your way of life as superior

Discuss nursing interventions designed to promote spiritual health.

•Use assessment data about the spirituality and spiritual behaviors or practices from caregivers of family members with chronic illnesses to identify areas of strength and support. •When appropriate, encourage family caregivers to participate in spiritual behaviors or practices and encourage members from the caregivers' congregations to visit to enhance social support and reduce caregiver burden. •Consider cultural differences and explore personal preferences when determining nursing interventions to enhance spiritual well-being. •Inform caregivers of spiritual resources available in the community (e.g., parish nurses, community- or faith-based support groups, clergy, social services). •Arrange for respite care to allow caregivers to attend religious services if desired to enhance social support and reduce caregiver burden.

Cultural Desire

-Motivation + Commitment -Seek opportunities to "learn" -Accept differences -Build on similarities

Differentiate culturally congruent from culturally competent care.

- Culturally congruent care - (transcultural nursing) care that fits the person's life patterns, values, and a set of meanings. - Culturally competent care - process of acquiring specific knowledge, skills, and attitudes to ensure delivery of culturally congruent care.

Identify major components of cultural assessment.

-Census data (gather demographics of pts who come to health care setting, ethnic groups, education, occupations) -Asking questions (open-ended, focused, contrast questions, encourage pts to describe values, beliefs, and practices that are sig to their care) -Establishing Relationships

Describe social and cultural influences in health, illness and caring patterns.

-Cutural influences can range from religious practices, to grief and loss interventions, or the birth of a child. Providing culturally competet care can bridge cultural gaps and provide supportive care for patients. -Social and cultural influences on health, and caring patterns are evident through examining different ethnicities, being open to etic and emic worldviews, and understanding where possible cultural conflicts may exists.

Selected components of cultural assessment

-Family structure -Ethnic heritage and ethnohistory -Bicultural effects on health -Social organization -Religious and spiritual beliefs -Foods with cultural significance -Communication patterns

Describe steps toward developing cultural competence. (5) Campinha-Bacote

1. Cultural awareness 2. Cultural knowledge 3. Cultural skills: Being able to assess social, cultural, and biophysical factors influencing treatment and care of patients 4. Cultural encounters 5. Cultural desire: Motivation & commitment to caring that moves and individual to learn from others, accept the role as learner, be open and accepting of cultural differences, and build on cultural similarities.

The nurse is assigned to a patient who believes that wearing a copper bracelet will relieve arthritic pain. Which action would be most important for the nurse to incorporate into the plan of care?

A. Encourage the patient to use anti-inflammatory medications instead of the bracelet. B. Inform the patient that copper bracelets have no proven medical value. C. Address the pathophysiologic mechanisms associated with arthritis with the patient. D. Respect the beliefs associated with the copper bracelet by the patient.

The nurse is preparing to discuss with the alert elderly Hispanic female patient the bronchoscopy procedure scheduled for the next day. The patient tells the nurse that she wants to wait until her family arrives later. Which nursing action is most appropriate?

A. Provide the information to the patient and answer family question's later. B. Give the patient the bronchoscopy procedure information in Spanish. C. Tell the patient to call you when her family arrives. D. Inform the physician.

The nurse is taking care of a patient scheduled for surgery today. The patient asks the nurse to read a passage from the Bible to help her prepare herself for surgery. What is the most appropriate action for the nurse to take?

A. Read the Bible passage. B. Ask if someone on staff is the same religion as the patient. C. Kindly tell the patient that nurses cannot get involved in religious issues. D. Inquire whether the patient would prefer that a religious person be called.

Cultural repatterning

Work with patients to change cultural practices known to be harmful. Ex: use of fried foods

Analyze outcomes of culturally congruent care.

All three modes of professional decisions and actions assist, support, facilitate, or enable people of particular cultures. 1. Cultural care preservation or amintenance - retain and/or preserve relevant car calues so pts maintina their well-being, recover from illness, or face handicaps and/or death. 2. Cultural care accommodation or negotiation - adapt or negotiate with others for a beneficial or satisfying health outcome. 3. Cultural care repatterning or restructuring - reorder, change, or greatly modify pt's lifestyle for a new, different, and beneficial health care pattern. The intended outcome of these actions and decisions is meaningful, supportive, and facilitative care as judged by the patient.

Establish presence with patients.

Behaviors that establish the nurse's presence include paying attention, answering questions, listening, and having a positive and encouraging (but realistic) attitude. Establishing presence is part of the art of nursing. It is not simply being in the same room with a patient while performing procedures or sharing technical information with him or her. Presence involves "being with" a patient versus "doing for" a patient (Benner, 1984). It involves offering closeness with the patient physically, psychologically, and spiritually

Vocation

Many people express their spirituality through their vocation, which can include volunteer positions.

Cultural preservation

Nursing actions and decisions that help clients retain and preserve traditional values. ex: using acupuncture for chinese patients

Demonstrate interventions that achieve culturally congruent care.

Nursing interventions that achieve congruent care involve being sensitive to the patients beliefs and culture, assessing their culture to gain knowledge on how to accurately treat them, and communicating effectively.

DIscuss the influence of spiritual practices on the health status of patients.

People gain spiritual health by finding a balance between their values, goals, and beliefs and their relationships within themselves and others. Throughout life a person often grows more spiritual, becoming increasingly aware of the meaning, purpose, and values of life. In times of stress, illness, loss, or recovery, a person often uses previous ways of responding or adjusting to a situation. Often these coping styles lie within the person's spiritual beliefs.

Describe the relationship among faith, hope, and spiritual well-being.

Spirituality and faith bring hope. When a person has the attitude of something to live for and look forward to, hope is present. It is a multidimensional concept that provides comfort while people endure life-threatening situations, hardships, and other personal challenges. It is closely associated with faith and is energizing, giving individuals a motivation to achieve and the resources to use toward that achievement. People express hope in all aspects of their lives to help them deal with life stressors.

Use cultural assessment to identify significant values, beliefs, and practices critical to nursing care of individuals experiencing life transitions.

Use census data, ask questions, establish relationships inorder to exam values, beliefs, and practices

Compare and contrast the concepts of religion and spirituality.

When providing spiritual care to a patient, it is important to understand the differences between religion and spirituality. Many people tend to use the terms spirituality and religion interchangeably. Although closely associated, these terms are not synonymous. Religious practices encompass spirituality, but spirituality does not need to include religious practice. Religious care helps patients maintain their faithfulness to their belief systems and worship practices. Spiritual care helps people identify meaning and purpose in life, look beyond the present, and maintain personal relationships and a relationship with a higher being or life force.

Perform an assessment of a patient's spirituality.

You can assess a patient's spiritual health in several different ways. One way is to ask direct questions (Box 35-2). This approach requires you to feel comfortable asking others about their spirituality. Several assessment tools are available to help nurses clarify values and assess spirituality. For example, the spiritual well-being (SWB) scale has 20 items that assess the individual's view of life and relationship with a higher power (Gray, 2006). The B-E-L-I-E-F assessment tool helps nurses evaluate a child's and family's spiritual and religious needs (McEvoy, 2003). The acronym stands for the following: B—Belief system E—Ethics or values L—Lifestyle I—Involvement in a spiritual community E—Education F—Future events

Acculturation

acquire

Discrimination

act on biases

Cultural accommodation

allow cultural practices which scientific study has not been found to be harmful. ex: home burial of placenta

Etic world-view

an outsider perspective

Assimilation

give up & take on

Emic world-view

insider or native perspective

Enculturation

learn