City University of New York
La Guardia Community College
Department of Natural and Applied Science
Practical Nursing Program
PN SCL 118- The Science and Art of Nursing II
Instructor: Associate Professor Iona Thomas-Connor, RN, MA CNE
Date: January 30, 2008
SMALL GROUP PRESENTATION: RESEARCH PROJECT
TOPIC
Practical Nursing Practice: Cultural Competency In The
Practice of Nursing Profession
GROUP MEMBERS:
Alvar, Crispo
Cox, Eva
Ilagan, Norman
Jimenez, Marie
Poltilov, Zoya
Utoh, Ifeyinwa
Yanchen, Tsering
Fall II, 2008
TOPIC
Practical Nursing Practice: Cultural Competency In The
Practice of Nursing Profession
TABLE OF CONTENTS
I. Introduction……………………………………………………..Crispo Alvar
§ Topic Overview
§ Purpose of the Group Project Presentation
§ Importance and Rationale of the Research Project
II. Cultural Competency Considerations, its Contributions to the Health and Health Beliefs of Clients and the Practice of Practical Nursing Profession.
§ Understanding Culture………………………………....…..Tsering Yanchen
§ The Impact of Ethnicity…………………………………….Ifeyinwa Utoh
§ The Influence of Religion…………………………………..Normal Ilagan
§ The Aspects of Socialization……………………………….Marie Jimenez
III. Problem Areas Related to Cultural Competency in Communicating and Working Across Cultures in Practical Nursing Practice………………….Eva Cox
IV. Legislations and Resolutions Related to Issues on Cultural
Competency…………………………………………………….Crispo Alvar
V. The Nurse’s Role in Developing Cultural Competency in the
Clinical Arena……………………………………………..……Zoya Poltilov
VI. Summary and Conclusion……………………………………....Marie Jimenez
VII. References
Introduction
As a concept, cultural competency in the nursing profession has evolved over time. Cultural Competency has been defined by The National Standards for Culturally and Linguistically Appropriate Services (CLAS) defined cultural competency as a “set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. Further it defines ‘Culture’ as an integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. And defined ‘Competence’ to imply as having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities” (Office of Minority Health, 2007).
In the United States, the presence and interests of different cultural constituencies have made provision of cultural competency health care imperative. This is true because many minority cultural groups have already experienced a disproportionate burden of health care disparities - particularly related to the access to health care, and quality of care. In many ways cultural and linguistic differences has compromises communication and jeopardize patient’s trust.
Since apparently every aspect of a person’s life is influenced by that person’s cultural background, each encounter with a healthcare provider must also be shaped by the cultural frameworks of both the client and the medical professional. In today’s increasingly diverse society, cultural competence becomes a critical skill in our personal, professional and social environment. But unfortunately, according to the Surgeon General Report of 2005, the U.S. healthcare profession is considered still not been very well-prepared to provide culturally competent care to our highly diversified population. Because nurses such as LPN’s provide direct health care to culturally diverse client populations in various settings, knowledge of culturally relevant information is essential for delivery of competent nursing care. It is for this reason, that as Student of Practical Nursing (SPN) must be made aware, be educated and provided with the initial knowledge about Cultural Competency in the Practice of Nursing Profession. Hence, this small group presentation.
UNDERSTANDING CULTURE
Culture is the accumulated learning for generational groups of individuals within structured or non-structured societies. Individuals experience a cultural heritage with others. It is a heritage that is learned through formal and informal experiences through the life cycle. Culture consists of the combined heritage of language and communication style, health beliefs and health practices, customs and rituals and religious beliefs and practices. Culture is influenced by environment, expectations of society, and national origin.
The changing demographics of the nation increase the cultural diversity of the United State population. Knowledge and skills related to cultural diversity can strengthen and broaden health care delivery systems. Concepts of health, wellness, and illness are part of the cultural belief. To provide better health care service to a client, nurse need to recognizing cultural diversity, their values, and their beliefs.
Cultural competence which is the process of working effectively within the cultural context of another person is so important to achieve best health care and satisfaction to your client. The U.S. Bureau of the Census predicts that by the year 2050, about 47% of the total population will be made up of racial minority groups.
Cultural contributions in health care system are:
§ Being experienced in different culture group may lead nurse to understand the complexity of culture. By adapting different culture beliefs and practices, nurse will obtain cultural information and be knowledgeable in treating a client. Like their beliefs and practices in times of illness such as scientific or biomedical, holistic medicine, Yin-yang, and hot-cold theories. Knowing about a client’s culture and their impact on interactions with health care is crucial for nurses and leading quality of care and better outcomes.
§ Skills related to cultural diversity can strengthen and broaden health care delivery. By understanding their Personal Space could lead to therapeutic communication and the client will open up and response truthfully without hesitation.
§ Personal cultural heritage of the nurse can maximize the care of the client.
Many nurses can provide a valuable service to the public by providing information and servicing in many areas where there are shortage of nurses.
Some barriers to culturally competent care are prejudice, ethnocentrism, and stereotyping. The ways as future nurse to overcome these barriers would be to develop cultural sensitivity. Cultural sensitivity is the understanding and tolerance of all cultures and lifestyles. It allows the nurse to understand and accept the behavior of others in terms of the client’s health and or illness.
Moreover, exposing to different people of different ethnic backgrounds can also prevent or reduce the likelihood of stereotypes, prejudices, and ethnocentrism. Cultural exposure can facilitate learning interactions with different types of people. Having knowledge of cultural diversity is vital at all levels of nursing practice.
IMPACT OF ETHNICITY
The word Ethnicity and culture are some times used interchangeably but in the main perspective, they are different. Ethnicity is a social construction which indicates identification with a particular group which is often descended from common ancestors. Its members share common cultural traits for example; they share (same language, religion and dress) and they are an identifiable minority within the larger nation.
It’s Impact to the Health care
The health care systems have changed drastically accommodating people from various aspects of life. In this present dispensation, nurses and other health care providers have been trained to give maximum care to all patients that walk into any health care facility regardless of what ethnic group or culture there are from. Nursing practice has expanded even more and thereby embracing all varieties of people in order to give care, thus, nurses needs to understand the impact of ethnicity as it relates to individual.
The diversity of ethnicity has made it possible that even when patients are told to fill out the admission forms, there is a portion where one’s ethnic group is required. Most times, it is necessary just to use in order to know how to better treat the patient.
INFLUENCE OF RELIGION
Religious and spiritual beliefs are important in many individuals’ lives. These beliefs can influence attitudes, lifestyle, and feelings about life, pain and death. Some religions specify practices about diet, birth control, and appropriate medical care. Often, spiritual beliefs assume a greater significance at the time of illness than at other times in a person’s life. These beliefs assist some people in accepting their illnesses and help explain illness for others. Religion can both help people live fuller lives and console or strengthen people during suffering and in preparation for death. According to Rosdahl, “in the United States, 35,000 churches with 1,500 different identified sects exist. Because the nurse will be caring for people of different faiths, he should learn about major religious differences. By doing so, he will be better equipped to determine, with the help of his clients, sources of spiritual and religious support” (Rosdahl, 2003, p. 94).
IT’S CONTRIBUTION TO THE HEALTH CARE
When caring for clients, nurses need to know that cultural and religious practices are often connected. Many people eat specific foods in certain combinations or refrain from eating certain foods because of their religious beliefs. Particularly when ill, individuals are often unwilling to deviate from their religious dietary customs.
Furthermore, those who are injured or ill need reassurance, and they may talk to a nurse about their illness and spiritual beliefs. As nurses you must, respect their confidences and maintain a nonjudgmental attitude. Suggest a visit from a spiritual leader, but do not contact such a person without first asking if the client wants such counsel.
Finally, you will want to consider your personal values when seeking a nursing position after graduation. Nursing offers a wide variety of job opportunities to the new graduate. In choosing a job, you certainly cannot expect to avoid all conflict or problem situations, but you will want to avoid working in an area where there is constant conflict.
Before you accept a position, you may want to consider whether it has the potential to conflict with your basic beliefs. For example, if you are ethically opposed to abortion, it would be wise to avoid employment on an obstetric unit or in a community clinic where therapeutic abortions are performed routinely. In this situation, making your views known and refusing certain assignments after you begin employment might result in termination because the employer may justifiably assert that you agreed to fulfill all the responsibilities of the position when you accepted employment. If you strongly value your own ethnic or cultural approach to health care, you might choose to work in a health care setting where that approach is part of the philosophy.
ASPECTS OF SOCIALIZATION
As with many other professional disciplines, nursing is a profession where socialization is a part of everyday nursing care. According to Blais et. al., “professional socialization is associated with the specialized knowledge, skills, attitudes, values, and norms needed to perform the Professional role” (Blais et. al, 2005, p. 13). Therefore, as future nurses, we should consider the socialized aspect of nursing because it creates an impact on the delivery of nursing care for the patient. The two major aspects of how socialization contributes to health and health beliefs of patients and nursing practice are the following: current nursing shortage and public image of nursing.
The shortage of nursing has become a current trend within the past couple of years where there are not enough nurses in the workforce. Because of the shortage, attempts to relieve this trend by creating more accelerated nursing programs and hiring nurses outside the United States are not enough interventions to relieve the burden of the shortage (Chitty & Black, 2007). In addition, the shortage of nurses plays a role in providing patient care. According to Chitty & Black, recent studies have indicated that “the impact of the nursing shortage on patient outcomes affects quality of care...[and found that] the ability of nurses to maintain patient safety was a problem…[while] the shortage had impacted the amount of time the nurse could spend with patients”(Chitty & Black, 2007, p. 64). Therefore, it is imperative to think about ways in which we, as future nurses, can overcome this problem so that we can efficiently provide the best care that our patients deserve.
One of the unique characteristics of the nursing profession is the privilege to wear uniforms. However, over the past couple of years, there have been unlicensed assistive personnel that also use similar uniforms as nurses which make it difficult for patients to differentiate one who is a nurse and one who is not. According to Chitty & Black, “…a part of nursing’s identity problem is attributable to the disappearance of the traditional dress mode” (Chitty & Black, 2007, p. 49). In other words, currently is not a universal dress code for nurses which create a problem because not everyone who wears scrubs to work is a licensed professional. Therefore, it is important to reestablish a universal dress code for nurses so that patients can easily identify nurses and make nursing what is should be: a recognizable profession.
Identifying the Potential Problems Areas in Communicating and Working Across Cultures
The number one potential problem in communicating is the language barrier. They are also other factors, including age, attention, gender, prejudice, stereotyping, and ethnocentrism that influence communication as well.
§ Age, the very young or old clients may be unable to communicate fully because of physical or intellectual development. Attention, a lack of concentration can occur.
§ Gender, a male or female client may feel uncomfortable speaking to a member of the opposite sex.
§ Prejudice, stereotyping, and ethnocentrism are based on the person feelings and beliefs at the time of communication.
The nurse and the client may speak a different language. In addition, many clients regressed to their primary language when they are ill, and even though they speak a second language, they feel more comfortable communicating in their primary language. They are many ways of facilitating communication and breeching this barrier. The most common is the use of a professional interpreter.
The interpreter should have several qualities. The interpreter should.
§ Know and understand medical language.
§ Should know the formal slang, and conversational levels of the language that he/she is interpreting.
§ Should be able to communicate without inferring judgment, bias, or personal opinions. A family member can act as an interpreter as well. However, the nurse must realize that having a family member interpret, compromises the client confidentiality. For this reason, a bilingual nurse who is familiar with the client’s cultures and practices can also act as an interpreter.