Posted: September 4th, 2023

An elderly Native American man was brought to the emergency room

An elderly Native American man was brought to the emergency room by his wife, sons, and daughters. He had a history of 2 previous myocardial infarctions, and his current clinical findings suggested he was having another. During the patient’s assessment, he calmly informed the emergency room staff and physician that, other than coming to the hospital, he was following the ‘old ways’ of dying. He had ‘made peace with God and was ready to die’ and ‘wanted his family with him.’”
The emergency room physician ordered intravenous fluids, a dopamine infusion, a Foley catheter, and transfer to the intensive care unit of a regional hospital 3 hours away. The patient died 2 weeks later. No family members were present when he died except for his wife. The rest of his family members were unable to afford the cost of traveling to the healthcare facility.
Adapted from: Culturally Competent Nursing Care: A Challenge for the 21st Century written by Deborah Flowers RN, PhD.
Crit Care Nurse (2004) 24 (4): 48–52.
QUESTIONS
1. What does the term “culture” mean to you personally?
2. Define the term “culturally competent nursing care”. How do you deliver this care is delivered in your nursing practice
3. Name at least three cultural considerations that were omitted in the care of this patient. Support each opinion with a different reference/evidence.
APA format
250-300 words

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Personally, the term “culture” encompasses the shared beliefs, values, traditions, customs, and practices that shape the identity and way of life of a particular group of people. It includes aspects such as language, religion, social norms, art, and cuisine. Culture provides individuals with a sense of belonging, influences their behavior and perceptions, and contributes to the diversity and richness of our society.

Culturally competent nursing care refers to the ability of healthcare providers to deliver services that are respectful, sensitive, and responsive to the cultural beliefs, values, and needs of patients and their families. It involves understanding and acknowledging the influence of culture on health beliefs and behaviors, and tailoring care accordingly. In my nursing practice, I strive to deliver culturally competent care by:

a) Developing cultural awareness and knowledge: I continuously educate myself about various cultures, their health practices, and beliefs through research, attending cultural competence workshops, and engaging in discussions with diverse individuals and communities. This knowledge helps me better understand the perspectives and needs of my patients.

b) Communicating effectively: I make efforts to bridge language and communication barriers by utilizing interpreters or language services when necessary. I also employ active listening and open-ended questioning techniques to elicit patients’ cultural perspectives, beliefs, and concerns related to their health.

c) Individualizing care plans: Recognizing that each patient is unique, I collaborate with patients and their families to develop care plans that respect their cultural preferences and incorporate their beliefs and practices. This may involve integrating traditional healing methods, accommodating dietary restrictions, and involving family members in decision-making processes.

Three cultural considerations that were omitted in the care of this patient are as follows:
a) Failure to involve the patient’s family: In Native American culture, family plays a crucial role in the care and support of individuals, particularly during critical times such as end-of-life situations. The patient expressed his desire to have his family with him, yet no efforts were made to accommodate this request. This oversight not only disregarded the patient’s cultural values but also denied him the comfort and emotional support he desired from his loved ones during his final moments.

b) Lack of understanding about the “old ways” of dying: The patient mentioned following the “old ways” of dying, indicating his adherence to traditional Native American beliefs and practices surrounding death and dying. This cultural aspect should have been explored further to gain a better understanding of his preferences and ensure that his spiritual and cultural needs were addressed appropriately during his end-of-life care.

c) Limited consideration of financial constraints: The inability of the patient’s family members to afford the cost of traveling to the healthcare facility was not taken into account when making decisions about his care. Cultural competence includes recognizing the socioeconomic factors that can affect access to healthcare and striving to provide equitable care that considers the financial limitations of patients and their families.

References:
Flowers, D. (2004). Culturally Competent Nursing Care: A Challenge for the 21st Century. Crit Care Nurse, 24(4), 48-52.
Leininger, M. (1991). Transcultural nursing: Concepts, theories, research, and practice. McGraw-Hill.

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