Transcultural Nursing: Cultural Competence, Evidence-Based Practice, And Patient Dignity

The Defining Features of Cultural Competence

Question:

Discuss about the Nursing Practice in Cases of Isolation.

Cultural competence can be defined as part of nursing skills to provide quality, safe and effective care to patients belonging to different cultural backgrounds. The defining features of cultural competence includes cultural knowledge, cultural awareness, cultural skill and cultural sensitivity and its associated dynamic processes (Loftin et al., 2013). Cultural diversity, cultural desire and cultural encounters are the predecessors of cultural awareness and as a result nurses, patients and healthcare organizations face the consequences. It is necessary for nurses to develop and continually hone their ability to practice cultural awareness. It is necessary for the nurses to be self-aware about their own culture, language, assumptions and biases in order to provide culture specific care to patients belonging to different cultural backgrounds (Douglas et al., 2014). Many times the nurses rely on uninformed approaches to provide patient care without any knowledge of the patient’s cultural and linguistic backgrounds.  A nurse’s cultural assumptions and biases can significantly affect the health of patients. It is important for nurses to determine the ethnicity of their patients. This is because disease manifestations, epidemiology and medication effects differ in the various ethnic groups. A study called “ethnopharmacology” deals with the differences of medication effects with respect to ethnic groups (Giger, 2016). Cultural beliefs affect the choice of medication and their use. It is necessary for nurses to understand the rules of communication with specific cultural groups, their customs and spirituality in order to determine the attitudes of the patient. Additionally if the nurse is aware of their own biases and attitudes to stereotype with respect to other cultural groups, will help them to provide suitable care to the patients. Speaking in the language of the patient will enable them to understand and participate in developing a genuine care plan. Negligence and malpractice is associated with cultural incompetence. Transcultural nursing helps to reduce relapses, decrease overall healthcare costs and provide an effective treatment plan. It is necessary to assess the patient’s perception of the medical condition, treatments, the social organization, preferred care and language. Misinterpretation of non-verbal communications can give rise to miscommunications. Thus, ignoring cultural diversity and providing culturally incompetent care can significantly affect patient outcomes and jeopardize the safety of the patients (Almutairi, 2015).

In order to remain objective while providing care the nurses should treat the patients as individuals and maintain their dignity. The nurses are meant to remain non-discriminatory and unprejudiced in providing care to patients. Nurses are required to challenge any poor or malpractice, discrimination or attitudes that affect quality of patient care. It is imperative for nurses to offer care based on facts and not assumptions. Nurses are meant to provide evidence based care rather than care that is based on financial or commercial gains. The nurses are to remain impartial and honest and act with integrity at all times. The care and interventions provided by the nurses should be fair and impartial and not biased by their own beliefs and assumptions. It is also necessary for the nurses to maintain a professional relationship with the patients and their families. The nurses are expected not to exploit the vulnerability of the patients and carry out intervention strategies that may be financially beneficial to them. Giving support to the patient’s family at the time of their need is also an objective of the nurses. The nurses who carry out this form of care are described as being objective in their care delivery (Musingsazpro.wordpress.com, 2017).

Importance of Nurses' Self-Awareness

In order to provide proper decision making, information and performing necessary skills, the nurses are required to gather evidence from research works related to this subject (Thompson et al., 2013). Patient safety based research carries out data analysis to identify patient related safety issues and provides evidence that the new practice or intervention will provide improved quality care keeping in mind the safety of the patient. Practice based on research can provide quality care to patients. Evidence based practice is the judicious use of current evidence in association with nursing expertise and patient preferences to guide in the decision making process (Melnyk et al., 2014).  The evidences are obtained from randomized clinical trials, qualitative and descriptive research methods, case reports, expert opinions and scientific principles. The steps required to carry out evidence based practice is obtaining new knowledge and identifying which ones are suitable for providing effective patient care, knowledge diffusion or dissemination among other care givers and adoption and subsequent implementation of the knowledge into practice by the healthcare organization. Quick reference guides can also be used to provide point of care and can be integrated into healthcare plans thereby necessitating its implementation.

The dignity of a patient is an important issue in the field of nursing. Promotion and preservation of patient’s dignity make them feel satisfied and valued by the healthcare organization. Human dignity is an intrinsic value and is a basic right of all individuals. Various illnesses, disabilities, lack of privacy, hospitalization and subsequent isolation can affect a patient’s intrinsic value. Various medical conditions take a toll on the daily lives of patients. Some of these medical conditions like cardiovascular diseases cause social isolation, reduces quality of life and influences the patient, their families and society in general. Maintenance of patient dignity can be carried out by determining and gaining knowledge of the factors that affect or influence it. There are six factors that influence the dignity of patients in isolation. These are confidentiality of information, privacy, selection, information and communication, interference and control in providing care and respect. Other studies reveal that understanding context, beliefs, cultural and social backgrounds of the patient can help to maintain the dignity of the individual in isolation. Proper awareness among nurses of the factors that help in the promotion of patient dignity can enable in the proper dissemination of the message to other personnel in carrying out practices that maintain the dignity of the patients. Proper communication attitudes, persona and staff conduct also help in the maintenance of patient dignity (Borhani,  Abbaszadeh & Rabori, 2016).

Importance of Evidence-Based Practice

Isolation, sensory deprivation and solitary confinement is associated with diminishing levels of social and physical stimuli. Sensory deprivation results in loss of visual, tactile and auditory stimulations. Sensory deprivation occurs among individuals living in isolated settings in the hospitals. Due to sensory deprivation in isolated hospital settings, various adverse psychological effects are found among patients. These include irritability, anxiety, aggression, apathy, hallucinations, psychotic reactions and lack of concentration. Nursing diagnosis related to sensory deprivation involves determination of sensory overload in relation to changes in environment  and or hearing loss. It can be determined by the patient’s inability to determine the time and place, presence of altered behavior and restlessness (Gilmartin, Grota & Sousa, 2013). The nursing interventions that can be carried out to prevent sensory deprivation in patients living in isolation involves

Providing a daily routine and physical environment that helps to reduce overstimulation and element of surprise.

Access to familiar objects to reduce confusion.

Adequate rest and sleep helps to reduce overstimulation and fatigue, resulting in confusion.

Promotion of a calming environment and soothing approach to communication to enhance sense of dignity.

Engage in activities that help the patient to differentiate between reality and one’s thoughts.

Facilitation of the use of hearing aids as it will enhance the ability to hear that will enable the patient to remain connected to the real world.

Attentive listening helps to improve the relationship between the nurse and the client, thereby establishing trust and help to carry out any therapeutic intervention.

Use of simple and short sentences during communication facilitates easy understanding and minimizes the anxiety of the patients (Nicholson, 2012).

Thus, it can be concluded that transcultural nursing practice, remaining impartial, honest, unbiased, carrying out evidence based practice, maintaining the dignity of patients and providing interventions to prevent sensory deprivation for patient’s in isolation can help to provide comprehensive and effective care for patients with severe medical conditions.

Reference list

Almutairi, K. M. (2015). Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia. Saudi medical journal, 36(4), 425.

Borhani, F., Abbaszadeh, A., & Rabori, R. M. (2016). Facilitators and threats to the patient dignity in hospitalized patients with heart diseases: a qualitative study. International journal of community based nursing and midwifery, 4(1), 36.

Douglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M., Lauderdale, J., & Purnell, L. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing, 25(2), 109-121.

Giger, J. N. (2016). Transcultural Nursing-E-Book: Assessment and Intervention. Elsevier Health Sciences.

Gilmartin, H. M., Grota, P. G., & Sousa, K. (2013, January). Isolation: A concept analysis. In Nursing forum (Vol. 48, No. 1, pp. 54-60).

Loftin, C., Hartin, V., Branson, M., & Reyes, H. (2013). Measures of cultural competence in nurses: an integrative review. The Scientific World Journal, 2013.

Melnyk, B. M., Gallagher?Ford, L., Long, L. E., & Fineout?Overholt, E. (2014). The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence?Based Nursing, 11(1), 5-15.

Musingsazpro.wordpress.com. (2017). Objective. A-Z professional nurse. Retrieved 16 November 2017, from https://musingsazpro.wordpress.com/2017/02/20/objective/

Nicholson, N. R. (2012). A review of social isolation: an important but underassessed condition in older adults. The journal of primary prevention, 33(2-3), 137-152.

Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013). An agenda for clinical decision making and judgement in nursing research and education. International journal of nursing studies, 50(12), 1720-1726.