Textbook of Medical-Surgical Nursing 3e

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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 • 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? Assessing for cultural beliefs CHART 2-6