Chapter 14-2 - Fundamentals of nursing textbook notes PDF

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Chapter 14: Cultural and Spiritual Aspects of Patient Care •

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Transcultural Care o Transcultural nursing: patients unique cultural and spiritual needs significantly improves patient outcomes and overall quality of care o Leininger's theory: human caring is a universal aspect of every culture, present in all cultures What is culture o Culture: collection of beliefs, values, and assumptions about life that is shared and maintained by a group of people o Worldview: comprehensive system of beliefs used by individuals and groups to explain and interpret reability o Enculturation: cultural beliefs and norms are transferred from a group to the individual members of the group who adopt them and incorporate them into their personal views o Four features of culture ▪ Culture is learned and acquired in a social context through enculturation ▪ Shared by a group ▪ Incorporated into individuals identity ▪ Dynamic and changes under th influence of shared experience and evolves at a slow pace o Ethnicity and ethnic groups: used to define a group of people who share the common and distinct culture based on shared ancestry, social experience, regional or national history o Race: social classification that assigns a group based on physical characteristics o Subcultures: smaller groups within the culture whose members have similar views and goals in addition to or in place of those of the main culture Understanding spirituality o Spirituality: deeply subjective experience that ties to explain ones relationship to the wholeness of the physical and non physical world and the meaning of ones life o Religion: formalized system of belief and worship o Rituals: practices related to health, illness, birth and death and prescribed behaviors that are part of organized religion and sometimes spirituality o Religious beliefs: convictions or opinions derived from religious doctrine that one considers true o Faith: belief that cannot be proven or for which no material evidence exists o Atheist: a person who does not believe in god o Agnostic: a person who neither believes nor denies existence of god in religious sense because it cannot be completely proved or disproved o During illness, and especially in the face of death, religious and spiritual beliefs may be strengthened, questioned, or rejected Major religions o Christianity ▪ Roman catholic ▪ Eastern orthodox

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Middle east Allah Koran Religious officials calledimams Pork and alcohol and drugs prohibited Modesty for women Body washed at time of prayer 5 pillars • Proclaim Shahadah • 5 prayers • Fast during month of Ramadan from dawn to sunset • Pay zakat religious tithes to poor • Pilgrim age in meca • Women: no independence

Judaism ▪ Orthodox, conservative, reform, and reconstructionist ▪ Rabbi ▪ Synagogue ▪ Strict rules ▪ Torah ▪ Kosher ▪ Jewish laws followed during illness ▪ Circumcision: eighth day of boy's life o Hinduism, Buddhism, and Taoism ▪ Vegetarians ▪ Ayurvedic medicine: hot and cold balanced diets ▪ Buddhists believe spiritual peace and liberation from anxiety through buddhas teaching ▪ Asian: less meat and more vegetables ▪ Hot or cold foods consumed during illness or disease to regain balance Developing cultural competence o Begins with development of cultural awareness and cultural sensitivity o Cultural awareness: involves developing understanding that health is expressed differently across cultures, and that culture influences an individual's response to health, illness, disease, and death o Cultural sensitivity: ability to engage and communicate with an individual from another culture in a manner that demonstrates respect for their cultural norms and beliefs o

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Protestant • One god • Bible • Churches • Rituals

Cultural competence: involves knowing yourself, examining your own values, attitudes, beliefs and prejudices Barriers to cultural competence o Six barriers to cultural competence: stereotyping, prejudice and racism, ethnocentrism, cultural imposition, cultural conflict, and cultural shock o Stereotyping: applying certain beliefs and behaviors about a culture to an individual or group without assessing individual needs o Generalizations: which identify common trends, patterns, and beliefs of a group o Prejudice: emotional manifestation of negative stereotypes and deeply held beliefs about a group o Racism: form of prejudice that takes place when individuals, groups, or institutions exercise power against groups that are judged inferior o Ethnocentrism: belief that ones own cultural group determines the standards by which other groups behavior should be judged o Cultural blindness: inability to recognize the differences between ones own cultural beliefs, values, and practices and those of another culture o Cultural imposition: the act of imposing ones own cultural beliefs, values and practices on individuals and groups from another culture o Cultural relativism: ability to recognize that each cultural group has its own set of beliefs and that each culture should be evaluated on its own merit o Cultural conflict: perceived threat arising from misunderstanding of expectations when nurses are unable to respond appropriately to another individuals culture practice because they are unfamiliar with the practice o Cultural shock: the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are radically different from the individuals culture Cultural differences Communication o Language is the most obvious component of cultural identity o Dialect: variation of language o European American cultures: 18 inches normal o Asians, middle east, and Hispanics stand closer together o Interpreter on a pole IPOP device o Sometimes people find it inappropriate to disagree with someone in position of power View of time o Time varies from one culture to another o European culture: value time and tend be future oriented. Sense of time urgency and importance is placed on punctuality and schedules o Hispanic and African American do not have this same view of time. This applies to social occasions rather than business or health care appointments o Some cultures past oriented and attach considerable importance to traditions o It is important to know the patients view of time Family organization and structure o Male dominated, female dominated, or egalitarian (equal share between spouses) o

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o Determines how healthcare decisions are made Nutritional practices o Culture specific o Food has symbolic and social meaning o Asian, Hispanic and middle eastern as hot cold or cool based not on their temperature but their effects on the body Death and dying o Each culture has its own approach to death and dying o No correct way of expressing grief Health care beliefs o Culture based o Folk medicine Susceptibility of disease o More common in certain groups because of sociocultural factors or genetics o African or Mediterranean ancestry (regardless of culture) more prevalence of sickle cell trait or sickle cell anemia o Keloid formation and sarcoidosis: more common in patients of African American o Europe, Jewish: fatal neurologic disorder o Latino African Chinese Thai and American diabetes o Hypertension more prevalent among cultural groups that use salt Nursing Process in Transcultural Nursing o Assessment ▪ General aspects of patient's culture and spiritual orientation before beginning the assessment ▪ Spiritual assessment by a nurse o Nursing diagnosis ▪ Specific to cultural and spiritual problems • Impaired verbal communication • Decisional conflict • Spiritual distress o May be related to feelings of guilt and unworthiness if the patient views illness as punishment for wrongdoing or sin o Planning ▪ Consider patients family, social support system, and beliefs in culturally traditional health care practices • Express comfort, express needs and opinions, cope with cultural differences, develop, reestablish spiritual practices o Implementation ▪ Respect for patients cultural and spiritual practices, developing therapeutic caring relationship, religious objects o Evaluation ▪ Based on achievement of expected outcomes, not whether treatment is successful from the standpoint of nurses cultural orientation

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Transcultural nursing is successful when mutual understanding and trust develop between the patient of the nurse Must be sensitive...