NURSING AND CULTURAL WELLNESS

Definition of Culture and Subculture of Nursing

• Culture of nursing - the learned and transmitted lifeways, values, symbols, patterns, and normative practices of members of the nursing profession of a particular society.

• Subculture of nursing - a subgroup of nurses who show distinctive values and lifeways that differ from the dominant or mainstream culture of nursing.

• Nursing - a learned profession with a disciplined focus on care phenomena. Central purpose is to serve human beings in health, illness, and if dying.

Cultural Wellness

• cultural groups have their own culturally-defined ways of maintaining and promoting health

• health promoting behaviors can be understood only by considering persons within their social, cultural, and environmental contexts

• importance of cultural knowledge - promotion and maintenance of health occurs in the context of everyday lives rather than in the doctor’s office or in a hospital

• the range of cultural influences on health maintenance and promotion programs is implemented for culturally diverse groups

Culturally Competent Nursing Interventions to Help Maintain

Wellness

• involve local community leaders who are members of the cultural group being targeted - promote acceptance of health promotion programs

• family members, churches, employers, and community worksites need to be involved in supporting health education program.

• health messages are more readily accepted if they do not conflict with existing cultural beliefs

• language barriers and cultural differences - local volunteers should be used to disseminate messages in their own language and to help organize and present information that is culturally appropriate and understood by community members

• sensitivity is essential to meeting health needs that exist within diverse cultural groups.

CAUSES OF ILLNESS (CULTURAL BELIEFS AND

SCIENTIFIC)

Traditional Concepts of Health and Disease

• Health concepts held by many cultural groups may result in people choosing not to seek Western medical treatment procedures because they do not view the illness or disease as coming from within themselves

• The locus of control for disease causality often is centered outside the individual, whereas in Western cultures, the locus of control tends to be more internally oriented

• Individuals from other cultures might not follow through with health-promoting or treatment recommendations because they perceive the medical or other health - promoting encounter as a negative or perhaps even hostile experience.

• The need to be flexible in the design of programs, policies, and services to meet the needs and concerns of the culturally diverse population, groups that are likely to be encountered.

Traditional Concepts of Illness Causality

• Folk illnesses are generally learned syndromes that individuals from particular cultural groups claim to have and from which their culture defines the etiology, behaviors, diagnostic procedures, prevention methods, and traditional healing or curing practices.

• Most cases of lay illness have multiple causalities and may require several different approaches to diagnosis, treatment, and cure including folk and Western medical interventions

• Folk illnesses, which are perceived to arise from a variety of causes, often require the services of a folk healer who may be a local corianders, shaman, native healer, spiritualist, root doctor, or other specialized healer.

• The use of traditional or alternate models of health care delivery is widely varied and may come into conflict with Western models of health care practice.

Scientific Concepts of Health and Illness

• the newest and most removed from the interpersonal human arena of life

• according to the worldview, life is controlled by a series of physical and biochemical processes that can be studied and manipulated by humans

• 4 specific forms of symbolic thought processes characterize the scientific paradigm

- Determinism - Mechanism

- Reductionism - Objective Materialism

4 specific forms of symbolic thought processes

• Determinism - states that a cause-and-effect relationship exists for all natural phenomena

• Mechanism - relates life to the structure and function of machines

• Reductionism - according to which all life can be reduced or divided into smaller partsCartesian dualism - the mind and the body can be separated into two distinct entities

• Objective materialism - what is real can be observed and measured

• Disavows the metaphysical and ignores the holistic forces of the universe

• Western cultures (e.g. US and Canadian cultural groups) espouse this paradigm

• Biomedical model - scientific paradigm is applied to matters of health

Biomedical Model

• Biomedical beliefs and concepts dominate medical thought in Western societies; must be understood to appreciate the practice of modern health care

• All aspects of human health can be understood in physical and chemical terms

• Fosters the belief that psychological processes can be reduced to the study of biochemical exchanges

• Effective treatment consists of physical and chemical interventions

• In this model, disease is viewed metaphorically as the breakdown of the human machine as a result of:

– wear and tear (stress)– external trauma (injury, accident)– external invasion (pathogens)– internal damages (fluid and chemical imbalances

or structural changes)• Disease is held to cause illness – has more or

less specific cause; a predictable time course and set of treatment requirements

• Instead of supernatural forces as explained by the traditional concepts, the biomedical model supports that diseases are caused by infectious agents

• uses specialists to take care of the “parts”, “fixing” a part enables the machine to function – Western medicine

• discuss health and disease reflect the North American cultural values of aggression and mastery: microorganisms attack the body, war is raged against these invaders, money is donated for the campaign against cancer, and illness is a

struggle in which the patient must put up a good defense

• defines health as the absence of disease or the signs and symptoms of disease; to be healthy, one must be free of all disease

NURSING CARE

Purposes of Knowing the Patient’s Culture and Religion for Health Care

Personnel

• To heighten awareness of ways in which their own faith system. Provides resources for encounters with illness, suffering and death.

• To foster understanding, respect and appreciation for the individuality and diversity of patients beliefs, values, spirituality and culture regarding illness, its meaning, cause, treatment, and outcome.

• To strengthen in their commitment to relationship-centered medicine that emphasizes care of the suffering person rather than attention simply more to the pathophysiology of disease, and recognizes the physician as a dynamic component of that relationship.

• To facilitate in recognizing the role of the hospital chaplain and the patient's clergy as partners in the health care team in providing care for the patient.

• To encourage in developing and maintaining a program of physical, emotional and spiritual self-care introduce therapies from the East

Culturally Congruent care

• Care that fits the people's valued life patterns and set of meanings - generated from the people themselves

• Discovering client's culture care values, meanings, beliefs and practices as they relate to nursing and health care and requires nurses to assumes the roles of learners of client’s culture and co-partners with client's and families in defining the characteristics of meaningful and beneficial care

Culturally Competent Care

• It is the ability of the practitioner to bridge cultural gaps in caring, work with cultural differences and enable clients and families to achieve meaningful and supportive caring.

• Requires specific knowledge, skills, and attitudes in the delivery of culturally congruent care and awareness.

• A culturally competent nurse is someone who:• consciously addresses the fact that culture

affects nurse-client exchanges• with compassion and clarity, asks each client

what their cultural practices and preferences are• incorporates the client’s personal, social,

environmental and cultural needs/beliefs into the plan of care wherever possible

• respects and appreciates cultural diversity, and strives to increase knowledge and sensitivity associated with this essential nursing concern

• Nurses who understand and value the practice of culturally competent care are able to effect positive changes in healthcare practices for clients of designated cultures

• Sharing a cultural identity requires a knowledge transcultural nursing and principles, along with an awareness of current research findings.

• Culturally competent nursing care can only occur when client beliefs and values are thoughtfully and skillfully incorporated into nursing care plans.

• Culturally competent nursing guides the nurse to provide optimal wholistic, culturally based care. These practices also help the client to care for himself and others within a familiar, supportive, and meaningful cultural context.

• Today, nurses are faced daily with unprecedented cultural diversity because of the increasing number of immigrants and refugees. Commitment to learning and practicing culturally competent care offers great satisfaction and many other rewards to those who can provide wholistic supportive care to all patients

Nursing Decisions

• Leininger (1991) identified three nursing decision and action modes to achieve culturally congruent care

• All three modes of professional decisions and actions are aimed to assist, support, facilitate, or enable people of particular cultures

• predicted to lead to health and well being, or to face illness and death.

The THREE modes:• 1. Cultural preservation or maintenance:

Retain and or preserve relevant care values so that clients can maintain their well-being, recover from illness, or face handicaps and/or death.

• 2. Cultural care accommodation or negotiation - Adapt or negotiate with the others for a beneficial or satisfying health outcome

• 3. Cultural care repatterning or restructuring: Records, change, or greatly modify client’s life ways for a new, different and beneficial health care pattern

Purpose and Goal of the Theory

• The central purpose of the theory - discover and explain diverse and universal culturally based care factors influencing the health, well-being, illness, or death of individuals or groups.

• The purpose and goal of the theory - to use research findings to provide culturally congruent, safe, and meaningful care to clients of diverse or similar cultures.

Sociocultural Factors and the Nursing Process

Religious belief that affect the nursing care:

• Belief about birth & death.• Belief about diet and food practices.• Belief regarding medical care

Role of Nurse• begin the assessment by attempting to

determine the client's cultural heritage and language skills

• should evaluate their attitudes toward ethnic nursing care

• inexperienced nurses are so self-conscious about cultural differences and so afraid of making a mistake - they impede the nursing process by not asking questions about areas of difference or by asking so many questions that they seem to try into the client' personal life

Roles of Nurses on the Cultural Aspect of a Community

• Nurses have a responsibility to understand the influence of culture, race &ethnicity on the development of social emotional relationship child rearing practices &attitude toward health.

• A child's self concepts evolves from ideas about his or her social roles

• Primary groups are characterized by intimate contact mutual support and pressure for conformity.

• Important sub culture influences on children include ethnicity social class, occupation school peers and mass culture

• Socioeconomic influences play major role in ability to seek opportunity for health promotion for wellness

• Religious practices greatly influence health promotion belief in families.

• Many ethnic and cultural groups in country retain the cultural heritage of their original culture

• How culture influences behaviors, attitudes, and values depends on many factors and thus is not the same for different members of a cultural group.

• Ethnocentrism can impede the delivery of care to ethnic minority clients and, when per vasive, can become cultural racism.

• Stereotyping ethnic group members can lead to mistaken assumptions about a client.

• The nurse should have an understanding of the general characteristics of the major ethnic groups, but should always individualize care rather than generalize about all clients in these groups.

• Before assessing the cultural background of a client, nurses should assess how they are influenced by their own culture.

• The nursing diagnosis for clients should include potential problems in their interaction with the health care system and problems involving the effects of culture.

• The planning and implementation of nursing interventions should be adapted as much as possible to the client's cultural background.

• Evaluation should include the nurse's self-evaluation of attitudes and emotions toward providing nursing care to clients from diverse sociocultural backgrounds.

• When nurses provide care to clients from a background other than their own:

they must be aware of and sensitive to the clients' sociocultural background,

assess and listen carefully to health and illness beliefs and practices,

and respect and not challenge cultural, ethnic, or religious values and health care beliefs.

• The nursing process enables the nurse to provide individualized care

Culturally Congruent Nursing Process

The nurse should begin the assessment by attempting to determine the client's cultural heritage and language skills.

The client should be asked if any of his health beliefs relate to the cause of the illness or to the problem.

The nurse should then determine if any home remedies the person is taking to treat the symptoms

Assessment enables the nurse to cluster relevant data and develop actual or potential nursing diagnoses related to the cultural or ethnic need of the client.

The nursing diagnosis should state the probable cause .The identification of the cause of the problem further individualizes the nursing care plan and encourages selection of appropriate interventions - cultural variables as they relate to the client.

The extended family should be involved in the care the client's strongest support group. Cultural beliefs and practices can be incorporate into therapy.

• Educational level and language skills should be considered when planning teaching activities.

• Explanations of and practices into nursing therapies - aspects of care usually not questioned by acculturated clients may be required for non-English speaking or non-acculturated clients to avoid confusion, misunderstanding, or cultural conflict.

• The nurse may have to alter her usual ways of interacting with clients to avoid offend ignore alienating a client with different attitudes toward social interaction and etiquette. A client who is modest and self-conscious about the body may need psychological preparation before some procedures and tests.

• The nurse can find out what care the client considers appropriate by involving him and his family in planning care and asking about their expectations. This should be done in every case, even if the nursing care cannot be modified. Because both the nurse and the client are likely to take many aspects of their cultures for granted, questions should be clear and explanations should be explicit.

• Discussing cultural questions related to care with the client and family during the planning stage helps the nurse understand how cultural variables are related to the client's health beliefs

and practices, so that interventions can be individualized for the client.

• The nurse evaluates the results of nursing care for ethnic clients as for all clients, determining the extent to which the goals of care have been met.

Evaluation continues throughout the nursing process and should include feedback from the client and family. With an ethnic minority client, self-evaluation by the nurse is crucial as he or she increases skills for interaction.

Conclusion

• Nurses need to be aware of and sensitive to the cultural needs of clients.

• The body of knowledge relevant to this sensitive area is growing, and it is imperative that nurses from all cultural backgrounds be aware of nursing implications in this area.

• The practice of nursing today demands that the nurse identify and meet the cultural needs of diverse groups, understand the social and cultural reality of the client, family, and community, develop expertise to implement culturally acceptable strategies to provide nursing care, and identify and use resources acceptable to the client (Boyle, 1987).