Nursing, health, and cultural competence

1. Inherent in nursing is respect for life, dignity and rights of man. It is unrestricted by considerations of nationality, race, creed, co lour, age, sex, politics or social status.

2. The nurse, in providing care, promotes an environment in which the values, customs and spiritual beliefs of the individual are respected.

3. Each registered nurse is accountable for his or her practice, and, in the exercise of professional accountability shall take account of the customs, values and spiritual beliefs of patients/ clients.

4. Individualized programs of nursing care are designed to accommodate the psychological, social, cultural and spiritual needs of clients, as well as their biological needs.

5. Providing culturally appropriate nursing care can be very challenging, requiring much thought and caring concern, and a willingness to learn from those we nurse.6. Not only must nurses be a ware of the clients cultural point of view his relation to the life , to realize his vision of his world, but be willing to look at health needs and problems in new ways, planning nursing interventions that are culturally acceptable and meaningful to the client.

7. Many nurses may find it difficult to change their ideas on how a patient should behave while in hospital, it can be all too easy to label patients as uncooperative or unpopular to them because they act or react in ways that are culturally different from what is expected of them. 8. In most cultures there are several forms of health care to which an individual or a family may turn. People who wish to be helped or healed will turn to practitioners whose care is considered efficacious, accessible and relevant to their cultural view and needs.

9. It is important for nurses to know what their patients consider to be the causation of ill-health and misfortunate, and what they see as appropriate measures for dealing with such events.

* Nurses need to be alert to signs and symptoms attributed to one particular illness and its complications in one culture being differently construed in another culture.

10. Identifying what is pertinent information about a clients culture in relation to a particular nursing situation and finding ways to make nursing care culturally acceptable is essential

11. Racial and economic factors compound many health situations that ethnic minority people face , and a nurse from another culture needs to feel his / her way, looking at each clients needs from the clients perspective, providing the appropriate support and care , or else referring the client, if he or she so wishes, to someone who can.

12.Nurses working in multicultural societies (from diverse cultural backgrounds) need to be proficient in

providing culturally relevant nursing care, there is also much merit in care being provided by nurses from the

clients own ethnic group e.g. style of teaching.

13. Using the same language and understanding the same symbolic meaning are obviously of enormous help when promoting client health, and what happens when nurses visit clients from their own culture , though social class differences can militate against intra- as well as intercultural understanding and empathy.

Culture and cultural competence

A model of cultural competence

*This model defines cultural competence as " the process in which the nurse continuously strives to achieve the ability and availability to effectively work within the cultural context of a client individual, family ,or community.

This process requires nurses to see themselves as becoming culturally competent, rather than being culturally competent. It includes consideration of cultural desires, cultural awareness, cultural knowledge, cultural skill (conducting culturally sensitive assessments) and culture encounters.

1 .Cultural desires

Defined as the motivation of the nurse to "want to" engaged in the process of becoming culturally aware, culturally knowledgeable, culturally skillful, and seeking culturally encounters. This desire must come from ones aspiration, and not out of ones desperation. It involves the concept of caring (it has been said that people don’t care how much you know, until they first know how much you care.

CONTINUE…….Desires

Cultural desires includes a genuine passion to be open and flexible with others, to accept differences and build on similarities, and willing to learn from others as cultural informants. This type of learning is a life-long process which has been referred to as cultural humility. One suggestion is to see the patient as a unique human being.

CONTINUE…….Desires

First; listen to the patients perception of the problem. This listening must be done in non-judgmental manner, using encouraging comments such as, "tell me more".

Second; to explain his / her perception of the problem.

CONTINUE…….Desires

Third ; to acknowledge not only the differences between the two perceptions of the problem, but to acknowledge the similarities.

Fourth; to make recommendations which involve the patient.

Fifth; to negotiate a treatment plan, considering that it is beneficial to incorporate selected aspects of the patients culture into the plan.

11 .Cultural awareness

Defined; as the self examination and in-depth exploration of ones own cultural background. This process involves the recognition of ones biases, prejudices, and assumptions about individuals who are different. Without being aware of the influence of ones own cultural values, there is risk that the nurse may engage in cultural imposition.

111 .Cultural knowledge

Defined; as the process of seeking and obtaining a sound educational foundation about diverse cultural and ethnic groups e.g. " knowing the cultural values of the deaf can help these clients use their usual coping response in the midst of illness.

Cultural knowledge….continue

Ethnic pharmacology is the study of variations in drug metabolism among ethnic groups. There are several factors that are involved in determine responses to a specific drug in ethnic groups. These factors include genetic, environmental, structural, and cultural variation in ethnic groups. Lin, Poland, and Lesser(1986) reported that the therapeutic range of lithium for manic patients in Japan and Taiwan to be 0.4 – 0.8 mEq/L, as compared to 0.6 – 1/2 mEq/L.

Four stages that a nurse goes through in seeking knowledge

S1; Unconscious incompetence; is not being aware that one is lacking cultural knowledge. This nurse has no awareness that cultural differences exist between themselves and the patient.

S2; Conscious incompetence; is the awareness that one is lacking knowledge about another culture.

They know that culture plays an important role in nursing, but do not know how to effectively use this knowledge.

S3; conscious competent; is the intentional act of learning about the patients culture, verifying generalizations and providing culturally responsive nursing interventions.

S4; Unconscious competence; is the ability of the nurse to spontaneously provide culturally responsive care to patients from diverse cultural backgrounds. The timing of an unconsciously competent nurse appears to be " a natural" when observing their interacting with patients from diverse cultures.

V1. Cultural skill

Is defined as the ability to collect relevant cultural data regarding the patients presenting problem as well as accurately performing a culturally based, physical assessment

Cultural skill……. continue

* Leininger (1978) defines a cultural assessment a as " systematic appraisal or examination of individuals, groups, and communities as to their cultural beliefs, values and practices to determine explicit needs and intervention practices within the context of the people being served.

V11.Cultural encounters

Defined as ; the process which encourages the nurse to directly engage in face to face interactions with patients from culturally diverse backgrounds. This will refine or modify ones existing beliefs about a cultural group and will prevent stereotyping.

Cultural encounters

Cultural encounters also involve an assessment of the patients linguistic needs. Using a formally trained medical interpreter is necessary to facilitate accurate communication during the encounters.

Standards for culturally competent and congruent care

Consumers of diverse cultures have a right to have Tran cultural care standards used to protect and respect their generic (folk) values, beliefs, and practices and to have health personnel incorporate.

nurses providing care to diverse culture or subcultures have a moral obligation to be prepared in Trans cultural nursing to provide knowledgeable, sensitive, and research-based care to the culturally different.

nurses as caregivers have an ethical, morale, professional obligation and responsibility to study, understand, and use relevant research-based Trans cultural care for safe, beneficial, and satisfying client or family outcomes.

Providing culturally competent and congruent care should reflect the caregivers ability to assess and use culture-specific data without biases, prejudices, discrimination, or related negative outcome

nurses caring for clients of diverse cultures should seek to provide holistic care that is comprehensive and takes into account the clients worldview and includes ethno history, religion (or spiritual), morale/ ethical values, specific cultural care beliefs and values, kinship ties.

nurses demonstrating cultural competence and congruent care maintain an open, learning, flexible attitude and desire to expand their knowledge of diverse cultures and caring life ways.

Nurses with Trans culture competencies show evidence of being able to use local, regional, and national resources for beneficial care outcomes.

nurses with Tran cultural competencies demonstrate leadership skills to work with other nurses and interdisciplinary colleagues who need help to provide culturally safe and congruent client practices, thus preventing cultural imposition, cultural pain offenses, cultural conflicts, and many other negative and destructive outcomes.

nurses with Trans cultural competencies are active to defend, uphold, and improve care to clients of diverse cultures and to share their research findings and competency experiences in public and professional arenas.