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Unit 1
Contemporary concepts in nursing
their food items (e.g. specialty food markets). Religious
practices may include fasting (e.g. of Catholics, Buddhists,
Muslims) or abstaining from selected foods at particular times
(e.g. Catholics may abstain from meat on Ash Wednesday),
and may be implicated in the considerations of medications,
especially with regard to the source of biological medications
such as insulin.
Religious practices may also include the ritualistic use of
food and beverages (e.g. Passover dinner, consumption of
bread and wine during religious ceremonies). Many groups
tend to feast, often in the company of family and friends, on
selected holidays. These culturally based dietary practices are
especially significant in the care of patients with diabetes,
hypertension, gastrointestinal disorders, and other conditions
in which diet plays a key role in the treatment and health
maintenance regimen.
Treatments
Data have been collected for many years regarding differences
in the effects of certain medications on people of different
ethnic and/or cultural groups. For example, research has indi-
cated that genetic predispositions to different rates of metab-
olism cause some patients to experience overdose reactions to
the ‘normal dose’ of a medication, whereas other patients are
likely to experience a greatly reduced benefit from the standard
dose of the medication. General polymorphism—variation in
response to medications resulting from patient age, gender,
size, and body composition—has long been acknowledged by
the healthcare community. Careful consideration needs to be
given in interpreting such findings, and racial and cultural
factors must be differentiated. Clearly, culturally competent
medication administration requires that consideration be
given to ethnicity and related factors, such as values and beliefs
regarding the use of herbal supplements and dietary intake,
that affect the effectiveness of treatment and compliance with
the treatment regimen. Interventions for achieving alterations
in health and wellness
vary among cultures. Australia’s and
New Zealand’s Indigenous people also have traditional medical
practices. Traditional Ma¯ori healing employs a range of healing
practices performed by
tohunga
(Ma¯ori healers) and spiritual
healers. Healing focuses on the person’s presenting signs and
symptoms and has ritualistic and spiritual dimensions. Healing
activities include
ritenga
and
karakia
(incantations and rituals),
rongoa
(remedies derived from trees, leaves, berries, fruits, bark
and moss),
mirimiri
(a form of massage) and
wai
(the use of
water) (Wilson, 2009).
Many alternative therapies are becoming widely accepted as
treatment options. Therapies such as acupuncture and herbal
treatments may be recommended by a doctor to address aspects
of a condition that are unresponsive to mainstream medical
treatment or to minimise its side effects. In New Zealand,
doctors and advanced practice nurses may work in collabo-
ration with a herbalist, spiritualist, or
tohunga
to develop a
comprehensive treatment plan for a patient. In such situations,
healers and healthcare providers must respect the strengths
of each approach. The use of complementary therapies is
becoming more common as healthcare consumers become
aware of the types available.
The nurse needs to assess each patient’s use of comple-
mentary and alternative therapies, remain alert to potentially
conflicting treatments, and be prepared to inform the patient
about possibly harmful treatments. The nurse must, however,
accept the patient’s beliefs and right to control his or her own
care. As a patient advocate, the nurse facilitates the integra-
tion of mainstream medical, complementary, and alternative
medical therapies.
Cultural nursing assessment
Cultural nursing assessment
refers to a systematic appraisal or
examination of individuals, families, groups, and communities
in terms of their cultural beliefs, values, and practices.
Data gathering should be guided by the questions in
Chart 2-6. Nurses should consider their own cultural orien-
tation when conducting an assessment of the patient and the
patient’s family and friends (Wilson, 2009). The following
guidelines should be taken into account:
•
Know your own cultural attitudes, values, beliefs, and
practices.
•
Identify the myths and misconceptions held about
someone from a different culture.
•
Maintain a broad, open attitude. Expect the unexpected.
•
Avoid seeing all people as alike; that is, avoid cultural
stereotypes such as ‘all Ma¯ori like
kai moana
(seafood)’ or
‘all Australians eat Vegemite.’
•
Try to understand the reasons for any behaviour by
discussing commonalities
and
differences. Ask for
clarification. Be a good listener.
•
If possible, speak the patient’s language. Listen and gauge
the person’s fluency in English before offering detailed
information.
Culturally competent and ethical decision making are
important influences in reasoning and reflecting. When deci-
sions are informed by evidence, ethics and cultural safety this
Assessing for cultural beliefs
CHART
2-6
• What is the patient’s country of origin? How long has the
patient lived in this country? What is the patient’s primary
language and literacy level?
• What is the patient’s ethnic background? Does he or
she identify strongly with others from the same cultural
background?
• What is the patient’s religion, and how important is it to
his or her daily life?
• Does the patient participate in cultural activities such as
dressing in traditional clothing and observing traditional
holidays and festivals?
• Are there any food preferences or restrictions?
• What are the patient’s communication styles? Is
eye contact avoided? How much physical distance
is maintained? Is the patient open and verbal about
symptoms?
• Who is the head of the family, and is he or she involved in
decision making about the patient?
• What does the patient do to maintain his or her health?
• What does the patient think caused the current problem?
• Has the advice of traditional healers been sought?
• Have complementary and alternative therapies been used?
• What kind of treatment does the patient think will help?
What are the most important results he or she hopes to
get from this treatment?
• Are there cultural or religious rituals related to health,
sickness, or death that the patient observes?
