Providing
Culturally Competent Care
Laura
Heim
University
of South Florida College of Nursing
Providing
Culturally Competent Care
In the
context of the family that will be focused on, regarding the topic of cultural
care and awareness of health care needs, there tends to be much emphasis put on
the entire extended family, with members working together to promote and
maintain each other’s health within that culture (Clark, 2003). In this family
unit, one person may not feel comfortable taking on the role of health care
liaison for the entire household, so it is important that the nurse values each
person’s role in the family. If the entire family’s culture is addressed, as
Dr. Leininger’s research suggests, and understood from the onset of nursing
care, then everyone will hopefully benefit from the resources presented to them
within the bounds of their culture and perhaps ones that are introduced, if
open, from the health care provider (Leininger, 2009).
Preservation
The idea of
preservation is important to keep in mind when treating patients, as in the
case that has been experienced of the culture of a woman in her 30’s, living in
the United States, who is of Indian descent, and was raised in South Africa. In
providing her care, as she is the primary provider for all of her family’s
needs, it would be logical to take only her care into consideration, but within
her culture it is the family unit that collectively makes decisions. The nurse,
then, must take her/his own biases out of the equation when assisting in the
recovery of family member(s), recognizing that the family’s culture’s “health
and illness and disease causation” will provide the framework for the care that
she/he will provide (Clark, 2003, p. 115).
Theories of what cause
diseases and their accompanying treatment may have been practiced by the family
for generations, so the care model the nurse utilizes must be dictated by the
cultural bounds and norms of the group in treatment for the best outcome. It is
hard to broaden the view of her culture when providing treatment, as care
providers may not always be in agreement with her health care model. In order
to provide her with the best possible care, health care professionals must look
into the resources her culture has provided her in the past to deal with
similar health issues. This woman may be living in the United States, but she
allowed her cultural role to override her own health issues when she had pain
last year and neglected it as she put her family’s needs ahead of hers before
considering whether or not she had time to seek treatment.
It is difficult to encourage traditional
health care practices because biases exist, as do the preferences of what care
may or may not work most effectively.
There is also a knowledge deficit for providers as her culture is one
that is unique to the area and individuals. Empathy must be used to realize
that the health care provider may not be Hindu, as she is, so the approach for
treatment for her illness could come from someone who does not practice that
religion. It should also be included
that people who practice Hinduism do so distinct to their upbringing and know
that it is based primarily on rites and customs (Czerenda, 2010). Indians who
are Hindu use Ayurveda and faith-based medicinal practices along with organic
remedies (Stratis Health, 2010). Kitchen and Weber (2010) describe how the
spiritual approach involves using natural spices and food items to treat
physical diseases of the hot and cold nature, while mental health issues are
often not addressed (the patient’s emotional health may not have been mentioned
within her household as it is customary for the women to stay in a passive role
at home). In the Indian culture the man
of the house makes decisions, and arranged marriages are common, just as this
woman’s was. Karma, one’s actions
influencing the next life and the interaction between physical and spiritual
forces, make up the backbone of mental health definitions in the Hindu
community, so treatment of problems includes eliminating imbalances utilizing
Ayurveda (method) which means “life and knowledge” (Swornalakshmi, 2010). The Indian
populace has also taken to adopting Western-based medical practices as people
seek the full mind-body connection (Stratis Health, 2010).
Accommodation
Clark (2003) details that
client-oriented community health nurses, with the goal of patient accommodation
in mind, can include utilizing a provider who refers resources well-known to
those in need. This female patient could
greatly benefit from someone who knows how to access resources for her and
makes sure that the patient can actually get to these health care providers.
Since this woman had back pain, she would benefit from a low-cost provider who
could treat that pain effectively without worrying the patient about fees and
worrisome bills. She/he may be someone who also brings a spiritual healing
background to their session(s). Her son,
as a teenager, may not feel comfortable verbalizing his bodily concerns, so a
health care provider, who builds a rapport with him, could serve as a
trustworthy confidante. The provider could schedule routine screenings without
passing judgment on him. The in-laws, who may be around 65 years of age or
older, probably would benefit from a coordinator in the delivery-oriented
community health nursing role (Clark, 2003). They are non-native English
speakers and would require someone who could plan and communicate care with
providers while assessing their concerns and level of health. That person
should also be able to work within their religion and see what has worked for
them in the past. The practitioner may
want to integrate native natural treatments and remedies with modern medicine.
Both the patient and her in-laws would probably like to maintain their health
while preventing future problems, so an intervention-type approach from a
community health nurse could be a great asset to them.
Repatterning
The idea of
repatterning would be used to help the family realize that their sole caretaker
in and outside of the home needs more physical and emotional assistance at her
apartment and at her place of work. She is in a state of constant fatigue and
as a result she is having difficulty staying focused and awake while performing
her activities of daily living (ADLs). This woman is suffering emotionally and
physically, but due to her culturally-based obligations at work and at home,
her health is progressively getting worse, and she is only in her 30’s. At this
rate, if her family does not help her, she may suffer a permanent disability
and not be able to care for anyone, including herself.
As uncomfortable as it may
be, it would be of great benefit to everyone if the family could slowly, but
surely, take on roles to support her at the family’s apartment and her place of
work. A health care provider could help the family by modeling effective
communication techniques with them (Clark, 2003). She has her own business but
she also attends college, so her family may have to break custom and help earn
their way in the household, at least while she attends school. There would be
an adjustment period, but with almost all change, resistance can be overcome
and change will become habit. If her family, including her husband, teenage
son, and in-laws who live with her truly realize that she is shouldering the
burden of their work, then perhaps they will contribute to the family unit,
especially if they can fully comprehend that her health and wellness is at
stake.
Conclusion
The concept of embracing and
providing culturally competent care (understanding it within the nursing
context) is a relatively new idea for some nursing students, as empathy is a
strong suit, but looking at care from a cultural viewpoint is a worthwhile
venture. It is definitely a relevant topic of care when approaching any patient
to keep their culture in mind, even with someone (a provider) who appears to
share the patient’s culture’s norms, mores, religious affiliation, values, and
other themes. In terms of theory, Dr. Leininger did realize that outcomes were
better when both traditional and textbook forms of treatment were employed in
combination therapy, as is evidenced through results that have been tested and
proven, for the most part, effective (Huber, 2009). In good practice,
culturally competent care will be utilized in future practice, because of the
importance of cultural sensitivity, and the fact that imposing only the
provider’s aspect of culture on patients may result in non-effective treatment. It is therefore imperative that patients
receive care that complies with their culture to ensure the best outcomes.
References
Clark,
M. J. (2003). Community health nursing.
(4th ed.) Upper
Saddle River, NJ: Pearson Prentice Hall.
Czerenda,
J. A. (2010.) The Meaning of Widowhood and Health to Older Middle
Class Hindu Widows
Living in a South Indian Community. Journal of Transcultural
Huber, L. M. (2009).
Making community health care culturally correct. E-Journal of
American Nurse today, 4(5). Retrieved from from
http://www.americannurse
Kitchen, A., &
Weber, S. Cross-Cultural Health Care Resource Guide. (2010).
Children’s
Mercy Hospitals and Clinics and
Children’s Mercy Family Health Partner Resource Guide,
pdf file. Retrieved from http://www.fhp.or/fhpdocs/CrossCulturalResource
Leininger, M. (2009). It
is Time to Celebrate, Reflect, & Look into the Future. Transcultural
Nursing Society. Retrieved from www.tcns.org
Stratis Health. (2010). Asian Indian Cultural Group Guide. Dimensions of Culture, Cross-
Cultural Communications for Healthcare
Professionals. Retrieved from
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