As nurses we will come across individuals from many different cultures and regions of the world. Some may have things in common with us and some may have differences that we are not familiar with or understand.
Yes, our patients will have different cultural values, beliefs and practices from our own, but we must still show them respect. In the following case study we will look at the best ways to provide care based up the Giger and Davidhizar Model and Dr. Campinha-Bacote Model of transcultural nursing.Giger and Davidhizar believe that each individual is culturally unique and should be assessed according to the six cultural phenomena (Giger and Davidhizar, 1991). 1. Communication Communication embraces the entire world of human interaction and behavior. Communication is the means by which culture is transmitted and preserved. Both verbal and non-verbal communication are learned in one’s culture phenomena (Giger and Davidhizar, 1991).
2. Space Space refers to the distance between individuals when they interact. Rules concerning personal distance vary from culture to culture phenomena (Giger and Davidhizar, 1991). . Social Organization Social organization refers to the manner in which a cultural group organizes itself around the family group phenomena (Giger and Davidhizar, 1991). 4. Time Time is an important aspect of interpersonal communication.
Cultural groups can be past, present, or future oriented. Past oriented groups, enjoy doing things the way they have always been done. Present oriented groups; focus on the here and now. These cultures that fall into this group may neglect preventive health care measures or they may show-up late or not at all for appointments.Future oriented groups are the exact opposite; they are looking at preventive health care measures for their cultural group phenomena (Giger and Davidhizar, 1991).
5. Environmental Control Environmental control refers to the ability of the person to control nature and to plan and direct factors in the environment that affect them phenomena (Giger and Davidhizar, 1991). 6. Biological variations Biological differences exist between individuals in different racial groups phenomena (Giger and Davidhizar, 1991).According to Giger and Davidhizar the following questions should be included in my cultural assessment of Ms. Jihad. 1. What country are you from? 2.
What is the patient’s religion and how important is it to her daily life? 3. Are there any food preferences or restrictions? 4. What are Ms. Jihad’s communication styles (does she make eye contact when spoken to, does she appear to keep a distance between you when speaking with her, is she very verbal about herself or does she appear to be holding back)? 5.
What does the patient think caused the current problem? 6. Have alternative therapies been utilized? . Are there religious rituals related to health, sickness, or death that the patient observes? 8. How long have you heard voices or seen things that others state they do not hear or see? 9. Does she identify strongly with others from the same cultural background? 10. What language do you speak? The next model is the Campinha-Bacote theory which consists of five components (Campinha-Bacote, 1999). 1. Cultural Awareness: The ability for health care providers to appreciate and understand their patients’ “values, beliefs, life ways, practices, and problem solving strategies.
Self-awareness is also a vital part of this. This allows health care providers to analyze their own beliefs to avoid bias and prejudice when working with clients (Campinha-Bacote, 1999). 2. Cultural Knowledge: The ability for health care providers to have an educated knowledge base about various cultures to better understand their clients. It also requires health care providers to be knowledgeable about “physical, biological, and physiological variations” among cultural groups (Campinha-Bacote, 1999).
3. Cultural Skill:The ability for health care providers to conduct an accurate and culturally competent history and physical examination (Campinha-Bacote, 1999). 4. Cultural Encounters: The ability for health care providers to competently work directly with clients of culturally diverse backgrounds. This is demonstrated by verbal and non-verbal messages by the health care provider and the client (Campinha-Bacote, 1999).
5. Cultural Desire: This is the ability for the health care provider to possess a drive to achieve cultural competence (Campinha-Bacote, 1999).Following the Campinha-Bacote Model I should be asking the following ten questions to my patient, Ms. Jihad. 1. Do I appear to project to my patient any negative feelings I may have about Iraq and its people? 2.
Am I guilty of ethnocentrism when dealing with my patient? 3. Do you prefer a male or female healthcare provider for your care? 4. Can you please tell me about how you take care of yourself daily (this would include your diet, exercise or any other pertinent cultural information that you wish to include). 5.Is there anything that you care to discuss with me that you have not been able to talk with your friends or family about? 6. Have you been taking your medication and if not why? 7. Is there anything about your social customs that you can teach me to help me better take care of you? 8. Are you religious and do you need time and privacy for prayer? 9.
Would you prefer to have the doctor speak with you? 10. Do you prefer that I do your assessment alone or would you prefer to have a family member or friend present? I should recognize that my patient probably practices Islam and does not eat pork or drink alcohol.If she is an actively religious woman of this faith then it is important that I understand that she must observe prayer 5 times a day. Islamic religion emphasizes maintaining good health, especially through personal hygiene practices and a healthy diet. They view Western medicine with much confidence and are generally compliant with taking their prescribed medications. The negative is that they will stop taking their medications when they feel the symptoms have improved and will not return for follow up appointments.Doctors are viewed with high esteem and nurses are viewed as “helpers”.
Reading from the Al Quran may help to give Ms. Jihad comfort also. She may look to an elder in the family for advice since they are viewed with prestigious status. She will turn to this elder first for comfort and advice. She may be reluctant to speak with me because I am a stranger so trust is something that I will have to build with her if I want to get an accurate health history and be able to apply a proper nursing diagnosis.
In Iraq mental illness is looked down upon so she may not be willing to share this information with friends and relatives in the room. Seeing that she is an immigrant she probably does not have health insurance and since coming to this country has not been compliant with her medication regimen for her cardiac issues. She probably had never sought out help for her schizophrenia since mental illness comes with a stigmatism in her country.Many patients who suffer from schizophrenia also have seizure disorders and this “language that her family doesn’t recognize” could actually be scrambled speech that occurs during seizure activity. The voices she is hearing and the things she sees that no one else sees are symptoms of her schizophrenia and can be easily treated with medication as long as the patient remains compliant. Educated the family about her mental illness would be the best approach. People to tend to fear what they do not understand and this will alleviate their fears.
Things have taken a turn for the worse and Ms. Jihad has had a heart attack and died. The five things that I want to include in my nursing care plan concerning death and dying are as follows: 1.
Allow the family to clean, scent and cover the body for burial. 2. Allow privacy for the family for prayer during this time. 3. Respect the family’s wishes that body be buried within twenty four hours.
4. Close the patient’s eyes upon death. 5. Provide any grieving support that is needed to loved ones. More frequently we are being required as nurses to provide culturally competent are for our patients. This is something this will continue to be of great importance as we head into the future and continue to have a mix of so many different cultures in this country.
We as nurses must remember to be open to differences, even those we may not understand or agree with. The more we learn about those we do not know about the better we will become in our field. Education is and always will be a continuing aspect of the nursing field.
References Giger, J. N. & Davidhizar, R. E.
(1991). Transcultural Nursing: Assessment and Intervention. St. Louis: Mosby, 1991.