Nurses, Patients, & Families: Caring at the Intersection of Health, Illness, and Culture PDF

NURSES, PATIENTS, & FAMILIES: Caring at the Intersection of health, illness, and culture CHAPTER 13 & 14 DR. LINDA LEDET, DNS, APRN, PMHCNS-BC Outcomes  Upon completion of this topic, the student will be able to:  I. 2.71.1 Identifies the characteristics of culture.  2.71.2 Explains the...

NURSES, PATIENTS, & FAMILIES: Caring at the Intersection of health, illness, and culture CHAPTER 13 & 14 DR. LINDA LEDET, DNS, APRN, PMHCNS-BC Outcomes  Upon completion of this topic, the student will be able to:  I. 2.71.1 Identifies the characteristics of culture.  2.71.2 Explains the concepts of cultural diversity.  2.71.3 Discusses factors in the healthcare setting that affect the delivery of culturally competent nursing care.  II. 2.71.1 Recognizes the importance of understanding diversity in the healthcare setting. CULTURAL UNDERSTANDING & DIVERSITY MATTERS https://www.youtube.com/wat ch?v=qeD-s0tzGgQ What is family?  Systems Theory – a change in one part of the system results in changes in other parts   Example: Family as a system. A change in one member affects the other members. We are all inter-related! Nursing supports health, manages illness, addresses complex changes & human responses to illness. 4 5 https://www.youtube.com/watch?v=zSguDQRjZv0 6 https://nam.edu/publications/the-future-of-nursing-2020-2030/ Acute Illness  Illness is a personal experience.  Acute illness – characterized by severe, short-live symptoms  Examples:  Common cold – may not require medical attention  Acute appendicitis as potentially life threatening  Acute myocardial infarction leading to chronic conditions  Spinal cord injury & life changes – leads to long term medical needs 7 Chronic Illness  Chronic illness • develops gradually • • 8 requires ongoing medical attention may continue for the duration of an individual’s life  In 2012, almost one of every two adults – 117 million people -- had at least one chronic illness (Centers for Disease Control and Prevention, 2015).  Factors that contribute to continued increase in chronic illness – sedentary lifestyles, obesity, and aging population Chronic Illness 9  Chronic illnesses: • caused by permanent changes that leave residual disability • vary in severity & outcomes • periods of remission & exacerbation • Require long-term behavioral change & treatment Adjusting to an Illness DABDA  Denial  Anger  Bargaining  Depression  Acceptance Adjusting to Illness 11 Disbelief & Denial  People have difficulty believing signs & symptoms are caused by illness  Believe that symptoms will go away  Fear of illness often leads to delay of diagnosis & treatment  Denial - a psychological defense mechanism people use to avoid anxiety associated with illness Adjusting to Illness Irritability & Anger 12  Increases as functional ability declines  Prolonged irritability may indicate depression  Anger directed at caregivers or general – “mad at the world.”  Guilt for failure to prevent the illness during denial Adjusting to Illness Attempting to gain control/bargining  Consult their health care provider  Use over-the-counter medications, folk practices, or home remedies.  Illness awareness causing fear of outcomes  Fear stimulates treatment-seeking behavior to gain control over the illness, but  Fear may also lead to further denial & avoidance 13 Adjusting to Illness Depression, Grief, & Stress  Grief—normal & expected response to any loss, including one’s health  Depression – a treatable mental health condition  Stress - ability to work is altered, daily activities must be modified, and the sense of well-being and freedom from pain may be lost 14 Adjusting to Illness Acceptance & Participation  Patient acknowledges reality of illness  Participates in decisions about treatment  Active involvement & hope lead to increased coping  Long-term chronic illness pts become experts in their own care & management of their condition 15 EMOTIONS Cultural Illness Behaviors  Modeling – Children learn by observing adults respond to illness  Stoicism – “Sick” person is not comfortable sharing their feelings and discomfort.  “Sick role” expectations vary culturally 17 Parson’s 1964 outdated White postulations: OUTDATED! 1. 2. 3. 4. 5. 6. 18 Are exempt from social responsibilities Cannot be expected to care for themselves Should want to get well Should seek medical advice Should cooperate with the medical experts Should return to normal as soon as possible 19 Dorothea Orem Theory of Nursing & Self-care Self-care • focuses individual activities & actions to maintain one’s healthy life or correct a condition. Self-care deficit • nursing required because a person is limited or incapable of providing self-care & needs help Theory of nursing systems • Focuses on relationship between nurses & clients • Wholly or partial compensatory care, support, & education taking place between nurse & patient Internal & External Influences on Illness Behavior INTERNAL INFLUENCES EXTERNAL INFLUENCES Dependence/independence needs Past experiences Coping ability Culture Hardiness Communication patterns Learned resourcefulness Personal space norms Resilience Role expectations Spirituality religion Values Reaction to prescribed medications Ethnocentrism 20 21   Spiritual distress – “impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself” (Doenges, Moorhouse, and Murr, 2014) Meeting the Spiritual Needs Nurses sometimes reluctant to provide spiritual nursing care because: • • • • • • • • Feelings of inadequacy Lack of knowledge Embarrassment Spiritual uncertainty Lack of preparation Lack of privacy Lack of time Failure to see it as a nursing role (McEwen, 2005) 22 23 1. Disposition or temperament, 2. personality, overall health and appearance, and cognitive style) 3. Influenced by family support (e.g. warmth, support, and organization) 4. Caring network 5. Can be taught, modeled, and learned. CULTURAL COMPETENCE Cultural Competence  25 Having the attitudes, knowledge, & skills necessary for providing quality care to diverse populations (AACN, 2008).  Focuses on patient-specific needs shaped by culture.  Culturally competent nurses more likely attuned to health disparities  “Non-compliant” patients need culturally compentent nurses to understand patient’s perception of illness Which brings us back to diversity, equity & inclusion! 26 Why a Culturally Competent Nurse? 28  Nation more racially diverse than the nursing workforce  The Joint Commission  NASEM Future of Nursing 2030: Charting a path toward equity  The California Endowment: One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations  Cultural competence – guides the nurse in understanding behaviors and planning appropriate approaches to patient needs.  Conversely, culture will guide the patient’s response to health care providers and their interventions. Issues of not doing it?  Nurses lack these guidelines for predicting behavior in diverse clientele  Anxiety, frustration, & feelings of distrust in both patient and nurse  Stereotyping,  Communication difficulties  Misperceptions about personal space d  Differing values & role expectations  Ethno-pharmacologic considerations  29 Ethnocentrism Health Disparities !!!! Cultural Assessment 30  Begins with self-assessment.  Used to identify beliefs, values, & health practices that help or hinder nursing interventions  The patient is “a stranger in a strange land” just by entering the health care system. Quadruple Aim in Healthcare Goals  Enhance patient experience  Improve population health  Reduce costs  Improve the work life of health care providers Widely accepted as a compass to optimize health system performance Understanding the payor system to comprehend equity  Medicare o 65+  Medicaid  Private Insurance Barriers to Patient Education  Anxiety  Physiologic factors – visual & hearing deficits, unmet needs, and pain  Culture & meaning of illness  Lack of motivation & readiness  Ideal Setting: private, comfortable, & free-of-distractions 33 Impact of Caregiving on Nurses  Caring for self while caring for others  Compassion  Caregiver fatigue role strain  Watson’s theory on caring and non-caring nurses  AACN’s Six Essentials of a Health Work Environment 34 The Impact of Nursing https://www.youtube.com/watch?v=a7saob7NJ5Y NCLEX PRACTICE 38 A patient asks, “Would you read some passages from the Holy book for me?” What nursing action best promotes spiritual care? 1. Delegate to the unlicensed assistive personnel 2. Grant the patient’s request 3. Initiate pastoral services consult 4. Notify physician A nurse is preparing a plan of care for a Jehovah’s witness requiring surgery. In developing the plan of care, the nurse knows:  A. surgery is prohibited in this religious group  B. Medication administration is not permitted  C. Faith heaing is primarily practiced  D. Blood and blood products are forbidden During an education on diabetes, an Asian client turns away from the nurse continuously. Which action is most appropriate by the nurse?  A. Continue with the instructions, verifying client understanding  B. Tell the client about the importance of the instructions to maintain health  C. Walk around the client so that the nurse is facing the client at all times  D. Give the client a dietary booklet and return later to verify knowledge