Week 6: Providing Culturally Competent Nursing Care (graded)
Purpose
This week's graded topics relate to the following Course Outcomes (COs).
• CO
... [Show More] 1 - Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)
• CO 2 - Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO 1)
• CO 3 - Utilize effective communication when performing a health assessment. (PO 3)
The Assignment
This week you have your choice of three discussion topics! Select the one that most interests you and answer the corresponding questions completely.
Remember to reference both the book or lesson, and an outside scholarly source.
Option #1:
You are the nurse assessing an Orthodox Jewish client with peptic ulcer. The client is strictly religious and refuses to eat the food provided at the health care facility.
1. Describe how you would further assess and provide care for this client.
2. What steps could you take to increase your cultural competence, if you were not familiar with this faith?
Option #2:
You are the nurse caring for a client with Crohn's disease. The client believes he is being punished by God. The client is spiritually distressed and cannot come to terms with the illness.
1. How would you respond to this client?
2. What are some identified risk factors for spiritual distress, and recommended interventions?
Option #3:
Describe a time in your clinical nursing practice when you have cared for a client of cultural, religious, or spiritual practices different from your own.
1. What were some of the challenges you faced caring for this client?
2. What steps did you take (or could you have taken) to ensure the patient received culturally/spiritually competent care?
Lesson
Why do Nurses Need to Understand Culture?
The U.S. population is made up of many cultural groups. Nurses interact with clients and co-workers every day who have varied cultural backgrounds, and hold differing beliefs about sickness and health. An individual's culture may influence how they communicate, celebrate life events, or express their spirituality. A holistic nursing assessment must include an understanding of a client's cultural background, and to what extent their culture affects their personal view of health.
The purposes of including culture in a holistic nursing assessment are:
• To gain an understanding of the client's beliefs related to sickness and health, including why disease occurs, caregiving, hygiene, dietary restrictions or needs, hygiene practices, and religious beliefs associated with healthcare.
• To compare the client's cultural health practices and beliefs to traditional Western medicine.
• To compare the client's beliefs to the beliefs of others with the same cultural background.
• To be able to screen the client for diseases that are prevalent in the identified culture.
Adapted from: Weber, J.R. & Kelley, J.H. (2018).
Cultural Competence
Culturally competent healthcare providers are aware of their own biases toward people who are different from them. They are knowledgeable about the beliefs, rituals and genetic differences among ethnic groups. They are able to assess clients from various cultures in a sensitive way, and communicate effectively with them. In addition, culturally competent individuals take a sincere interest in learning more about cultural similarities and differences, and interacting with people of various cultures and ethnicities (Weber & Kelley, 2018).
Cultural Competence Self-Assessment
What are some steps you can take to enhance your cultural competence? Begin with a self-assessment identify your own biases and areas for growth. A self-assessment if offered at http://www.clchpa.org. (Links to an external site.)Links to an external site.
Using the Right Words to Talk About Culture
Culture is defined in the Weber & Kelley (2018) as "the totality of socially transmitted behavior patterns, arts, beliefs, values, customs, lifeways, and all other products of human work and thought characteristic of a population or people that guide their worldview and decision making." Just reading this definition helps one realize how essential cultural assessment is to a holistic nursing assessment. There are a variety of terms used by healthcare professionals when discussing culture. Match the terms below to their corresponding definitions.
Cultural Assessment in Nursing Practice
Achieving cultural competency is an ongoing process for nurses. As nurses interact with individuals of varying cultures, their level of expertise in this area grows. The Weber and Kelley text (2018) covers some of the common cultural and biologic factors variations that can affect health. Often, basic questions related to cultural values and beliefs are included on the health history form. Cultural assessment can provide the nurse with important subjective and objective data. Based on the answers provided by the client, nurses must determine whether a more in-depth cultural assessment would be appropriate. The degree in which a cultural assessment is performed, often depends on the nurse's level of knowledge about the preferences and beliefs of the identified culture. Nurses are encouraged to build their knowledge base by referring to the literature and educating themselves about common cultural practices of the populations in their care.
Examples of information that may be learned in a cultural assessment include:
• Generational status and family roles
• Religion and spiritual beliefs
• Communication needs and preferences
• Nutrition and dietary habits
• High-risk behaviors
• Pregnancy and birth practices
• Health care beliefs (i.e., death rituals, causes of illness, pain, organ donation)
• Disease susceptibility and developmental variations based on ethnicity
Religion and Spirituality in Nursing Assessment
Questions related to religious and spiritual preferences are typically included in a cultural assessment. Nurses should understand that religion and spirituality, though related, are separate concepts. Religion is considered the formal practice of rituals or experiences within an organized group, all seeking a sacred power (i.e., God, Allah, etc.). More abstract than religion; spirituality is described as a less-formal search for meaning in life, and is often focused on self-reflection and spiritual well-being. Religious beliefs and spirituality are related to one's personal philosophies of health.
When nurses assess the spiritual practices of their clients, they gain an understanding of their clients beliefs related to illness, end of life, and nutrition. This assessment data provides valuable insight when developing holistic nursing care plans. For example, if a client identifies with Islamic faith, he or she may practice the ritual of praying in an east-
facing window five times per day. In this religion, sickness is considered to be a test sent to an individual from God. Islamic believers are less likely to question healthcare providers, since they believe the outcome of their ailments to be predetermined, and do not want to appear distrusting. It is important in the Islamic faith to be facing eastward at end of life. Also, pork and alcohol are restricted from their diet, and there are specific eating rituals related to the holy days of Ramadan. Nurses are encouraged to have a basic understanding of the common religious and spiritual practices of the populations they care for, and to seek out
Adapted from: Weber, J.R. & Kelley, J.H. (2018).
Spiritual Assessment Tools
The goal of a spiritual assessment is to gain a better understanding of a client's spiritual perceptions of health. By briefly addressing the religious and spiritual needs in an initial health history, the nurse can evaluate for the need for further exploration into rituals and practices that may be important aspects of nursing care (Hodge, 2013). Nurses must be careful to remain objective, and not allow their own personal beliefs and spiritual practices to interfere with this assessment. Experienced nurses are able to pick up on phrases and emotions shared by the client that indicate religion and spirituality are important to the individual (Hodge, 2013).
There are a variety of more formal spiritual assessment instruments. The SPIRIT Acronym, described in the Weber & Kelly textbook, provides a list of open-ended questions, and is a way for nurses to remember the basics of an informal spiritual assessment. Self-assessment instruments exist that ask the clients to rate or describe the importance of certain spiritual practices to their daily routine. These assessments help healthcare providers understand the role religion and spirituality have in assisting the client in difficulty times. The FICA Spiritual History tool (Links to an external site.)Links to an external site. was developed by Dr. Cristina Pulchalski (1996) and a group of physicians as an organized way for healthcare providers to address the spiritual needs of patients.
Analysis of Cultural and Spiritual Assessments
Data collected in cultural and spiritual assessments can help the nurse identify how this information relates to the general health of the client. Is the client full of hope and motivated to care for self? Or is the client having difficulty coping, and perhaps feeling like their illness is a punishment from God? Analysis may result in a nursing diagnosis such as "Readiness for enhanced hope" or "Risk for spiritual distress," Interdisciplinary referrals to counselors, religious leaders, or other healthcare providers, may be necessary. [Show Less]