Transcultural Nursing Implications, Research Paper Example

Culturally diverse nursing is defined as “an optimal mode of health care delivery, referring to the variability of nursing approaches to provide culturally appropriate care that incorporates the individual’s cultural values, beliefs, and practices, including sensitivity to the environment from which the individual may come, and to which the individual may ultimately return” (Leninger, 1991, p.55).   It is becoming, as the United States grows ever more diverse, more important than ever that nurses be training in culturally competent nursing and that the plan of care does take into account the patient’s culture and beliefs, and as much as possible works within the framework of those beliefs to deliver sensitive care.  This is not only true for patients from other ethnic or cultural backgrounds, but also patients right here in the United States whose religious beliefs might lead them to healthcare practices that are outside mainstream Western tradition.

For this paper, a family of Jehovah’s Witnesses in a small, isolated, rural community in the mountains of Northwest Arkansas chosen.  Although this family is American, their religious beliefs lead them to some health care practices that are outside the norm of Western medicine. Because of this, the same concepts of transcultural nursing care should be applied as would be used, for example, to care for a family of immigrants from a culture very different from the United States.

This paper will outline some of the field work that was done in the course of caring for this family, as well as discussing some of the differences and similarities in this family in comparison with that of a more mainstream group and about what considerations had to be made to be sensitive to this family’s religious beliefs.  It will also discuss the role of the nurse in the care of these patients and what implications this kind of care has for nursing practice in general.

Summary and Interpretation of Field Work

The family in this paper lived in the small town of Deer, Arkansas, with a population of about 150, and a community which was largely comprised of Jehovah’s Witnesses.  The member of the family in question was the grandfather, a man in his seventies with a medical history of severe osteoarthritis in both knees, chronic pain, a history of falls, and impaired mobility, these last three diagnoses all related to his joint problems.  The patient lived with his daughter and her husband and five children in a small house outside of town, about half an hour away from the clinic of their primary care physician and about an hour from the nearest hospital.  The family had a low socioeconomic status and low education levels in general and were wary of having too much to do with the healthcare system outside of basic check-ups.  Their physician had recommended knee replacements for the patient but because of their beliefs about blood transfusions, both the patient and the family were very reluctant to commit to this.  It was at this point that the physician prescribed home health visits.

The family, somewhat reluctantly, agreed to the home health visits and the nurse was dispatched to perform an admission. The patient was seen twice a week for the first two weeks of his certification period, then once a week after that.  On the home health visits, the patient and family were educated about arthritis itself, as well as nonsurgical interventions to help cope with the condition, as the family had no religious objection to such interventions.  These interventions

Included in-home physical therapy as well as occupational therapy to help with fall prevention and activities of daily living such as transfers, bathing, and ambulation.  The home health nurse worked with the doctor to help create a plan of care for the patient’s chronic joint pain and although the patient’s pain was not completely eradicated, his day to day pain levels did decrease and the number of falls was reduced during his certification period.  As the patient’s overall quality of life improved, the home health nurse and therapy staff were able to gain the trust of the both the patient and his family.

It was at this point that the topic of knee replacement surgery was brought up again.  The nurse listened to the concerns of the family and patient regarding surgery: it was not the surgery in particular that they were concerned about, but about the possibility of a blood transfusion, which is diametrically opposed to their religious beliefs.  Among the fears was that the patient would be forced to have a transfusion while on the operating table in the case of some sort of emergency situation.  The nurse then spoke again to the doctor, communicating the concerns of the patient and family about the possibility of a blood transfusion if the patient agreed to surgery.  The doctor, as well the orthopedic surgeon to whom the patient had been referred, was notified of this concern and the possibility of the patient auto-donating a certain amount of blood — to be used if needed– was mooted.  The surgeon and primary care physician were amenable to this, and the possibility was then discussed with patient’s family, in the presence of their minister.  The patient and family were comfortable with the idea of auto-donation and the patient eventually had the surgery. He recuperated well from the surgery and several months later had the other knee replaced, continuing to have home health and home-based therapy services during the course of his recovery.  

The Use of the Transcultural Theoretical Model in Nursing this Group

The United States has always been a nation of immigrants, and in an increasingly global society, where even smaller and more rural areas are experiencing a growth in ethnic diversity, nursing care with which is culturally sensitive is more important than ever.  According to the Philosophy/Mission Statement of the Transcultural Nursing Society, this kind of nursing is “a theory-based, humanistic discipline, designed to serve individuals, organizations, communities and societies…culturally competent care can only occur when culture care values are known and serve as a foundation for meaningful care” (Transcultural Nursing Society, 2013, p.1).  This applied equally not only to different ethnic groups but also to groups, such as the Jehovah’s Witnesses, which have historically been somewhat isolated from the mainstream. So a good knowledge of the background of Jehovah’s Witnesses was important in the care of this family.

The beliefs of Jehovah’s Witnesses do not lie quite so far out of the mainstream as the public at large can sometimes perceive them to.  They do seek traditional medical care from doctors and other clinicians and reject the concept of “faith healing”, or trying to cure themselves of illnesses through prayer alone with little or no traditional medical intervention (Jehovah’s Witness website, 2012, p. 6).  In many of their religious beliefs, they are more or less in line with many conservative American religious groups.  They are against abortion and do not approve of contraception methods that terminate pregnancy; in vitro fertilization of an unmarried couple is considered adulterous, as is surrogacy. (Middleton, 2002, p. 36).

One of the major deviations from traditional Western medical practice, however, is their rejection of blood transfusions, believing that several passages in both the Old and New Testament order them to “abstain from blood” and that God views blood as representing life.  Therefore, as their website explains, “we avoid taking blood not only in obedience to God but also out of respect for him as the Giver of Life” (Jehovah’s Witness website, 2012, p. 7). However, with modern medical technology, things are not quite so simple.  While there are many cases of Jehovah’s Witnesses refusing blood or blood components such as white or red blood cells or platelets, there are many instances of members of this group who are willing, for instance, to have an organ transplant as long as the organ has been drained of blood prior to the surgery, and to accept products such as “albumin, clotting factors, immunoglobulin, interferon, and hemoglobin-based oxygen carriers” (Middleton, 2002, p. 36).  There is also a movement afoot within the Jehovah’s Witnesses to redefine and modernize the position on blood; it is called the Associated Jehovah’s Witnesses for Reformation on Blood (Middleton, 2002, p. 36).  This is why asking a patient directly about their religious beliefs is so important, because even within the same religious group, beliefs and interpretations of correct conduct can, and do, vary greatly.

The Role of the Nurse

The role of the nurse in transcultural care is of paramount importance.  The population of the United States is becoming ever more diverse, and this can bring challenges to nurses trying to care for their patients.  However, it has been clinically proved than improved cultural competence in regards to nursing care can greatly improve patient satisfaction and outcomes (Lorentz-Maier, 2008, p.38).   Transcultural care does not just have implication for local or national levels, but globally. The sad fact is that not all people around the world have good access to medical care, and the Transcultural Nursing Society notes that “Inequities span a continuum of limited or no access to care to blatant cultural clashes between providers and clients…Cultural and social factors influencing health, healing, caring and well-being are often overlooked or ignored throughout the care system” (Transcultural Society of Nurses, 2013, p. 10).   Nurses can play many roles in helping to prevent this from happening.

In this case, the nurse taking care of the Jehovah’s Witness performed many roles. Firstly, she was an educator, teaching the family about the disease process of osteoarthritis and about the many non-surgical interventions that were possible for the patient which did not conflict with the family’s system of beliefs.  Secondly, she was a facilitator, arranging for a multi-disciplinary approach of care that involved not just nursing but physical and occupational therapy to help improve the patient’s quality of life.  Thirdly, she acted as an advocate for her patient with the family physician and the surgeon.   Perhaps most importantly of all, however, the nurse acted as a listener, hearing her patient’s concerns and acknowledging them without judgment, and working within the parameters of her patient’s religious beliefs to bring about a solution to the problem that all parties were satisfied with.

Conclusion

There is no doubt but that nursing care can be more complicated if one is taking care of patients from a very different culture from their own.  Even apart from the possible of issues of language barriers (which are difficult in and of themselves), the differences in beliefs and values and even the cultural context from which different people see the world can lead to misunderstandings, confusion and frustration for both the nurse and the patient. However, with a lot of patience and a good knowledge of the patient’s background, many of these barriers can eventually be overcome. Both the nurse and patient benefit from this: the patient will receive the medical care that they need in keeping with their cultural beliefs, and the nurse will have gained the traits of flexibility and compassion which are key qualities for good nursing care, no matter who the patient is.

References

Leningan, M.  (1991). Transcultural Nursing: The Study and Field Practice. Imprint. 38(2) 55-66

Lorenz-Maiten, M.  (2008). Transcultural Nursing and its Importance to Nursing Practice. Journal of Cultural Diversity.  15(1) 37-43

Middleton, J.  Nursing with Dignity: the Jehovah’s Witnesses. (2002).  The Nursing Times 98 (17) 36

Website.  Jehovah’s Witnesses.  (June, 2013).  Retrieved from www.jw.org

Website. Transcultural Nursing Society.  (January, 2014).  Retrieved from www.tcns.org