Cultural Competency in Nursing Care FINAL
amp20
Today, more than ever, culture is playing a leading role in the health care field. Nurses need to particularly pay attention to the culture factor when providing care. This is because it directly affects the care they give. The term culture has many different meanings. Some say it is dependent on a person’s race, ethnicity, language, or skin color. Others relate a person’s culture to geographic area and location. Elizabeth Crockett, director of REACH CNY defined culture as “a system of shared values, beliefs, ideas and learned patterns of behavior, explicit and implicit, which people use to interpret the world.” Throughout America as well as globally, culture is becoming an increasing important topic of discussion for health care providers (and for good reason).
What is Culture and How it Affects People?
Culture, chosen or inherited, shapes everything in a person’s world. Values, religion/spirituality, morality, literature, imagination, history, art, creativity, attitude, language, relationships to nature/the world, socials views, economic values, prejudices, behavior, emphasis on education, wisdom, time perception, self worth as well as importance of family relationships are all aspects influenced by the cultural orientation of any given person. Culture affects every aspect of a person’s life; it is intertwined within them and cannot be separate from them. Culture is significant to health care providers, especially nurses, because it concerns every facet of every person’s life. Nurses know that being able to connect with a patent, being able to understand them and to advocate for them, can make an immense difference it that person’s health care and intern their life. Understanding, respecting, and working with the cultural markers a person identifies with can vastly impact the care that health providers are able to give. For this reason, being culturally competent as a nurse is an aspect of care worth learning about.
According to Steve Wood, Resource Development Coordinator at REACH NY, cultural competence is:
• Accepting and respecting differences in culture
• Proficiently work with peoples that do not share “your culture”
• Taking part in ongoing self-evaluation and adjusting to change
• Expanding the knowledge of known cultural practices, beliefs, ideas, and issues
• Seeking advice or consultation when necessary
• Being dedicated to applying the knowledge known about culture into practice
Cultural Competence
The Cultural Competence Continuum
Cultural competence should be a goal for every nurse to obtain. In relation to the “Cultural Competence Continuum,” Cultural Competence falls just below the top (ideal) ranking on the continuum. The Continuum is defined as follows: (starting with the lowest level)
1. Cultural Destruction
2. Cultural Incapacity
3. Cultural Blindness
4. Cultural Pre-competence
5. Cultural Competence
6. Cultural Proficiency.
Unfortunately, many of today’s health care providers fall short of being culturally competent and are considered “Culturally Blind.” Cultural blindness is being culturally unaware and unconcerned about culture; and how it may affect a patient’s care. It is clumping everyone together, stereotyping, and thinking that culture is only based on race and ethnicity. The truth is everyone has a culture that is “individual and communal,” dynamic, and influenced by a variety of factors. To ignore a person’s culture is to ignore their individuality and essentially, to deny them care that is specific to their needs and identity. But how can it change? How can the jump from being “culturally blind” to being “culturally competent” be made by nurses/providers?
Consider this Case Study
A patient is not accepting treatment of cancer (not due to economic reasons). The uninformed and culturally inept nurse (culturally blind/incompetent nurse) may just write the patient off as “non-compliant” and stuck in denial. In the end, the patient is denied any further help because of the patient’s “poor attitude” on getting better.
Now, take the culturally competent nurse in this same scenario. This patient with cancer does not want treatment because they believe God will heal them through prayer. The nurse knows this about this patient and does not judge them. Being culturally aware helps the nurse find other ways to help the patient with the disease. The nurse, knowledgeable about the patient’s culture, can suggest alternative medicines and support groups. The nurse can also offer comfort measures and natural therapies that the nurse knows the patient might be interested in. This example is just one of many examples that can be given relating to the fact that being culturally knowledgeable is important and necessary for giving patient’s the best care they can receive from health providers.
A Way to Change
Understanding One’s Own Culture
First, recognizing where cultural blindness comes from may help in understanding where to start the shift to becoming culturally competent. A simple lack of experience or knowledge may be the reason for many people’s cultural blindness. This can be addressed by seeking knowledge, so that even though the actual experience has not been made-the knowledge is there for when an encounter is made with that specific situation. Fear is also a factor leading to cultural blindness. Having a fear of the differences held by other cultures can be intimidating. One way to address fear of other cultures is to learn about them! Knowledge is never wasted, and it certainly will not hurt! Learning about other cultures may expose pieces about that culture that are not only interesting but that can also help in providing better care! Self-assessment is another way to conquer that fear. Evaluating the knowledge about medical skills and how to perform them is just as important as evaluating the relationship and communication used to relate to patients. Assessing personal barriers can help in understanding how to bring them down. No one is separate from their own culture. Knowing one’s own culture and how it influences they way one thinks and acts can help understand how to delivers services more effectively.
Secondly, a person’s cultural experiences can vastly impact the care they give because it directly affects the way they view others. Someone who has had interaction with many cultures sees the world much differently than those who have only been around their own culture (or very few different cultures). People, most times, do not even know they are culturally blind because that is all they know.
Thirdly, once the cultural barriers are indentified, one can start to change them. Ways to change include listening to others about their culture, reading on the internet, or visiting a nearby Refugee Center. Also, following the “CLAS Standards” may help providers become more culturally sound as well. These standards stand for C-Culturally, L-Linguistically, A-Appropriate, and S-Services. This simple acronym actually encompasses the whole essence of cultural competence. A nurse delivering services in a way where the patient’s culture is incorporated helps the patient to feel that the nurse cares for them personally. This provides for a trusting relationship between the patient and nurse. Having a trusting relationship between the patient and nurse directly improves care for the patient because the patient is comfortable with the nurse and feels valued.
Privilege
Nonetheless, there are many factors affecting culture and how people view it in today’s society. There are, without doubt, privileges given to people of certain cultures. Conversely, there are stigmas surrounding certain cultures as well. Much of the problem comes from stereotypes and assumptions. Consider the “white man privilege.” There are many situations in life that the “white man” does not have to encounter. Steve Wood gave the example that many people assume things about him in a positive way, being that he is a “white guy.” However, when they discover that he is gay, they quickly change the perception they once had of him. Along with the change of perception comes a change in the privileges assigned to Mr. Wood as a “straight white man.” Other types of privilege include, but are not limited to, Gender, Skin Color, Sexual Orientation, Body Ability, and Class. Non-Transsexual, Heterosexual, Able-Bodied, Male, White, and High-Class or Economically Fortunate people are examples of peoples who have privilege in today’s society. Mr. Wood stated that “white, heterosexual, able-bodied, males typically have the most privilege” in American society.
How Cultural Competence Plays into Nursing
Lastly, cultural competence is not only significant but is valuable for nurses to strive for. This is because nurses work with “diverse and varied.” Cultural differences effect a broad range of practices involving pregnancy (contraception, abortion, spiritual blessings/curses, reasons for having children), birth (how, when, where the birth happens), child care (work ethics, values, schooling), medical procedures (wanting medicine or not, blood transfusion, special medals/pieces of faith in that culture, prayer times, alternative medicines, gender rules/specifications). All of these things are a part of a person’s culture and should be considered by the nurse. Nurses should also recognize that “not cultural group is homogeneous.” This means that one person of a certain culture is not representative of that culture as a whole. A nurse not practicing cultural competence if he or she makes assumptions and creates stereotypes based on an experience with one person of a given culture. Also, nurses should understand that to obtain cultural competence identifying one’s own culture and cultural beliefs is vital. Understanding one’s own cultural beliefs means recognizing ideas, perceptions, falsehoods, prejudices and stereotypes held about certain peoples, and learning how to break those stigmas down so that equal care can be given to every patient.
Being that culture affects such an immense range of issues in a person’s life, it is obvious that it is a major component in understanding them and how to provide the best care for them as an individual. Cultural competence is more important today than ever before-it is time for a change. Nurses (as well as the rest of the medical field) encounter different cultures every day. Being a culturally competent care provider is crucial in providing patient with equal care as well as the quality of care entitled to every person regardless of their culture.




References
Ross, Terry. “Cultural Competence Continuum.” National Indian Child Welfare Association, Portland, Oregon. University of Minnesota, Department of Social Work. <http://www.d.umn.edu/sw/culturalcomp/cultural%20competence%20conti.htm>

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amp20
Thank you to everyone who commented on my draft, it really helped!
Also, thank you to everyone who gave me suggestions on fun, inexpensive stuff to do!

THANKS GUYS AND HAVE AN AWESOME SUMMER!

maternity
amp20
 Yesterday I had my last clinical for my Maternity rotation.
IT WAS AMAZING...
I had always thought I might want to be involved with that kind of nursing care (well since I started nursing), however I never knew how much I liked it until I did the rotation for the past couple of weeks.

But before I get to the amazing part.... I started off the morning making brownies because it was our last day. Unfortunately they were not ready by the time I had to leave for the hospital to go to clinical (I have to leave by 6:20 to get there by 6:45 a.m.) Anyway, so I wait until 6:40 to leave anyway because I really wanted to bring the brownies... they weren't done. So I just left... I am half way there and realize I left my name tag, stethoscope, etc. at home in my other bag!

So I had to turn around and go back home... I found my stuff and was able to get the brownies too. (BTW if you are late without a good excuse or do not have an assignment or your name tag, materials that you need- you get a clinical jepardy... what that is, is a mark on you, kinda like three strikes and you're out of the program... except for this nursing program you are only allowed two strikes for the whole two years you are there!-So needless to say, I DID NOT WANT A CLINICAL JEPARDY! Plus my teacher for clinical is known to be a stickler for giving them out when necessary or not!)

Okay, so I call my friend and tell her to tell my teacher I am having car trouble... because I was! I could not get my car to start!!!!!!!!!!!!!! I finally get it to start and end up being 20 minutes late.. and my friend informs me on the way there that my patient is in LABOR! I was like... Man the one day I am late is the day my patient is in labor! Fortunately for me, this was her first baby so it takes longer (most times) than women who have had 2+ babies. 

So I get in the hospital and get everything ready and realize I DON"T HAVE MYNAME TAG!!!!!!!!!!!!!!!!!!!! So I tried my best to not let my teacher notice and she didn't!!!!!!!!!!!! So when everyone went down stairs for a break at the cafeteria I went to my car and found it! It must have fallen out of my bag (that I went back home to get). 
Anywhooo, that's when things started turning around. My patient delivered shortly after that and canceled out any negative feelings I had for the day!

After waiting week after week, I finally got to see a delivery! Nothing could make the day better!

And I don't mean that I just got to watch! I was right up there with the woman in labor helping her with the process and even holding her leg. 

The midwife was so nice! She showed me all these awesome things... the whole process was just incredible...
It was one of the best experiences of my life (right up there with getting engaged!)

This experience was definitely the icing on the cake for me! I absolutely know I want to be in maternity nursing-actually I am sure I want become a midwife! I just need to figure out when.... now, two years from now, 10 years from now... I don't know
I am not sure if I should get some experience first as a nurse and then go on to get my degree or if I should just go for it!

In any case, yesterday was one of the most exciting and life-changing days of my life!


graduation
amp20
 I am singing for this year's Nursing graduation/pinning and I have not been able to practice once with the pianist or dancer! 
We finally have rehearsal on monday but it is during a final (1 of 3 I have that day I might add!) so I have to now take the final later in the day!
The actual ceremony is on thursday and I am pretty excited... but very nervous! 
Anyway, I don't know I just thought I would throw that out there because it is something that is kind of stressing me out right now...
I haven't really been able to practice because I am taking over 20 credits and for some reason I think all my teachers decided to pile on work these past few weeks- plus preparing for finals! 
... I feel like all my blogs are AHHHH blogs!

: )
amp20
 My faince is here!
I am so excited but it has been hard to spend time with him because of school!
And he's getting pretty bummed about it...
Anyone have any ideas on fun stuff to do around here that is inexpensive????????????

A movie and dinner can get kinda pricey! 
Especially since we both really aren't working because of school!
But we really want to spend some quality time together that is fun and is cheap!
Any ideas???


ut oh!
amp20
I am taking sociology, and because it is a general course I figured it would be easy.... not true!
Although it is not super brain challenging and hard mathmatical equations-it is a lot of work! We always have to write things, work in groups outside of class, and do take home exams (that take forever)....

I recently took my third A&P 2 hourly test and thought I got an A.... turn out the next week when we got out tests back that i only got a C!
I was so mad!
The same day I took the A&P test I had my second Maternity nursing test. I was so confident when I walked in the room-I thought "There won't be a single question they can throw at me that I won't know the answer to!"
Soon to find out... there were  A LOT of questions I didn't know the answers to! I was so crushed!
And for nursing you have to get a 75 to be considered passing! I got my test results back yesterday.... I didn't pass- I got a 74.3... Needless to say,  I am pretty upset!

what happened...
amp20
So I am really dissapointed in myself ... I recently did something to someone that really hurt them an really hurt my relationship with them. Now, by many people's standards what I did would be not a problem but to this person-it hurt them deeply and ruined the trust they had in me... I did not cheat or lie or kill anyone but I did something small that broke that fragile trust we had...

I feel awful and because that person loves me-that person has forgiven me... but I just cannot get past the guilt.
I know guilt is a good thing sometimes because it helps you to grow and realize what you have done is wrong and how to change but I just hate feeling this way. I feel like dirt on the ground....

It has been so long since I have actually broken trust with someone and felt like this because I generally strive to make all of my relationships great... I kind of actually have a problem with it because I desire so much for people to be pleased with me and for me to do the right thing in their eyes that I often end up hurting myself and running out of energy...

I think this is what actually got me into this problem... I was with a group of people and I wanted to feel like I was approving of them and i wanted to feel liked so I did something that ended up hurting someone that I really love...

I guess you can call this peer pressure in a way but no one made me do this... I always take responsibility for my actions and this case is no different... I just wish I would have been more conscious of what I was doing and the consequences of it...

trip
amp20
So I went on a nursing trip to Nashville, Tennessee! It was awesome! The trip itself was great-the hotel was beautiful, (I think 48 acres under one roof!), the seminars were informative and interesting, the expo was cool 'cause we got free stuff and lots of neat information about future plans, everything was just really awesome! The only bad thing was that I dropped my laptop the first day after we got there and it wouldn't turn on! I planned on doing blogs and assignments but I had no way to get on! I was so relieved when I found out that last week was a catch-up week! (I still missed out on blogs and commenting so I am going to try to make up for it this week)

I am really glad I went because it was a great experience but I feel so behind on school work now! I missed sociology, a whole week of blogs and comments, A&P class, and 2 maternity classes... I have two tests tomorrow ( A&P and maternity) and I feel so overwhelmed!

I have to sing for the pinning for the nursing graduation this year in 3 weeks... plus I am the Chair for decorations for graduation committee- and graduation is so SOON! Plus finals and the HAPS exam! I just feel really overwhelmed...
and on top of all that I got sick saturday and had to fly home on sunday so I was sick all weeked and all of yesterday (and still al little bit today) and couldn't study at all for my tests....

When I went to go do manditory work in the LAB for my clinical (case studies) it was closed so now by thursday I have to find a way to get all my stuff done for that too!

Does anyone else feel overwhelmed this time of year? It just feels like thigs are out of controll and not changing any time soon!

learning units? and easter
amp20
Does anyone know when the learning units end? Is is like a week from when they are put out? And when exactly our blog entries are supposed to be in? Anyway that was just a quick few questions before I "officially" start my blog...

Well, I was up early this morning (not by choice-my body just woke me up) and I was thinking about what to blog about... I came up with a few thing- I am going on a nursing convention next week-so I thought I maybe could blog about that or school or home life right now or my fiance or easter... I couldn't decide so i am just going to pick one... Eanie meanie miney.... easter!

I am really excited about easter! I used to love it as a kid because we got candy and all that stuff.. easter egg hunts, good family food, etc. My mom totally took it too far and used to get us gifts-like play stations, i-pods, and just stuff. At the time we wanted it, I was spoiled and I just wanted more.. I didn;t even care about why we celebrated easter or Christmas.. I jsut want the toys and gifts! Now I see that my family (as I am sure many other families are like this too) has turned a celebration of the events of Christ's birth and death into something about consumerism and alcohol. I know it started a while ago with the Pagen stuff-intertwining christian holidays with pagen holidays to "keep the peace" in Rome. But today I think we have taken it too far-none of the kid's in my family even know why we celebrate easter or Christmas.
Now I know this is a preferrence because of what I believe in. But even if I didn;t believe in Christianity and for some reason i still celebrated the Holidays because of tradition or something- I would still want my kids to know why and let them decide for themselves.
I don't have kids but when i do I plan on telling them why I am a Christian but I will not force them to be anything they don't want to be. I want them to choose... it wouldn't be their real choice of I made them pick soemthing... Love is not love if it is forced...
anyway that was just a little bit on what I think about religion and holidays... Have an awesome weekend and if you celebrate Easter-have an awesome one and remember we only have this holiday because Jesus died and rose again!

this is... an elaboration of fwestcott002's blog... kind of
amp20


I hate when I hear students give teachers lame excuses and then joke about it later... I mean I guess it's just not fair-I mean they are expecting you to take responsibility, etc. I mean we all are grown ups... why do we feel tthe need to lie so much?
It's more noble and definitely harder to tell the truth-but I mean why? No matter the consequences of telling the truth-isn't it worth it to get it off your chest?
I guess it is really a moral/value choice. I mean some people become so desensitized to the guilt that they just don't feel it anymore so lies are nothing to them. At least that was how it was for me-I grew up thinking lies were just normal-not really realizing the stuff that comes along with them. I am proud and happy to say that I have come to understand life better through truth and honoring honesty, trust and responsibility as values in my life!
Life is so short-why should we waste it lying all the time!
Why should we have to lie to make others happy or give them excuses-they are people too-hopefully they can understand we are human like they are and forgive us for making a mistake. Maybe that's why we lie so much-to not hurt others. We do things for our own agendas and when we realize it could hurt someone else we lie to cover our butts 'cause we don't want to hurt people or look like we want to hurt people(or we might not care and then you are just plain mean! lol) The weight of the burden carried by a lie affects you more than the person being lied to-they can forgive you-but can you forgive yourself?
.. I don't really know why I am thinking about this now-I guess I am jsut think about the majority of people I know and wondering why lying is so occasional for us walking this earth.

I guess part of the reason peopel lie it so not get in "trouble" or whatever but I mean what is really important to you? Character, reputation, career, money, family, happiness-All of those things can make you an honest person or a liar... it just depends on your perspective-whether or not "saving" your reputation (from people who may or may not care one bit about you) is worth a few knocks at your character...
Why do we care so much about what people think? Why do we as people just want more? Why are we so greedy sometimes?
Are we good or bad; grey or black and white; or just a little bit of everything? And why are we? Why are we who we are-why are we affected by the things we are affected by? Why do we choose ot be affected by some things/people and not others?
Wow... I really don't think I can even begin to scratch the surface of these things ( at least not in this blog! lol)
I guess we just only know what we know until we know more... and then we know that too lol
Am I crazy, does anyone else think these things?
I say I guess a lot...
"You can (are free to) choose your actions but you cannot choose(are not free from) the consquences you reap from those actions." Pastor Walt and Mrs. Sawyer-White


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