Diversity among individuals, as well as cultures, provides a challenge for nurses when it comes to delivering meaningful health promotion and illness prevention-based education. How do teaching principles, varied learning styles (for both nurses and patients), and teaching methodologies impact the approach to education? How do health care providers overcome differing points of view regarding health promotion and disease prevention? Provide an example.
1)We live in a very diverse nation and overcoming challenges related to cultural beliefs and preferences is a very common obstacle for health care workers today. In an article in The Online Journal of Issues in Nursing cultural diversity is defined as being more than just race,
Health care workers must realize that addressing cultural diversity goes beyond knowing the values, beliefs, practices and customs of African Americans, Asians, Hispanics/Latinos, Native Americans/Alaskan Natives, and Pacific islanders. In addition to racial classification and national origin, there are many other faces of cultural diversity. Religious affiliation, language, physical size, gender, sexual orientation, age, disability (both physical and mental), political orientation, socio-economic status, occupational status and geographical location are but a few of the faces of diversity. (Camphina-Bacote, 2003)
Health care workers have to diligently accommodate the many needs of all the individuals they encounter. These needs range from diverse deep cultural backgrounds, varying learning styles and learning preferences, and mixed opinions defining health and well being. Language barriers may also be a hardship for health care workers to overcome.
An example of how health care workers can overcome differing points of view would be demonstrated in their ability to accommodate to the specific needs of the patient. For example a Hispanic patient who is a Jehovah’s Witness and only speaks Spanish has been ignoring abnormal signs and symptoms of rectal bleeding for several weeks. She comes into the hospital and is worked up and then diagnosed with colon cancer. The early treatment process requires a colon resection. The risks are discussed with the patient and the risk of blood loss with the surgery is covered. During the operation the patient does experience some bleeding and has hemoglobin that drops down well below normal range to 5.3. In the Jehovah’s Witness culture they do not believe in accepting blood transfusions. After the procedure the pt. is transferred to the ICU. In the ICU the visiting hours are typically restricted to specific hours and this patients family does not understand and does not feel comfortable leaving there loved one unattended.
In the scenario described above there are several examples of possible obstacles that the health care worker must overcome. First would be the language barrier. The use of an interpreter service would be required to be certain that the patient has a concrete understanding of the diagnosis, the treatment, signs and symptoms of chemo and radiation, education for follow up treatment etc. The second obstacle to consider would be the religious belief and refusal of blood products. The risks associated with anemia and possibly educating the pt. and family about natural options available to try and raise hemoglobin nutritionally with iron and vitamin supplements. The third obstacle could be the cultural preferences of family dependency and honoring and providing care for elders. The new diagnosis of cancer is difficult and when you add complexities like language barriers and specific religious beliefs it can make the process even more complicated. Health care workers must be very agile in their abilities to create flexible learning environments for the many diverse encounters the will have.
Camphina-Bacote, J. (2003). Many faces: Addressing diversity in health care. The Online Journal of Issues in Nursing, 8, retrieved from http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No1Jan2003/AddressingDiversityinHealthCare.aspx
2) Health practices and beliefs are diverse among all cultures in relation to health, illness, birth and death. What is equally true is that there is also diversity within the cultural group; therefore nurses must develop health promotion and illness prevention-based education that is focused on the individual while taking into considering teaching and learning styles that are culturally relevant.
Teaching and learning methodologies, principals, styles or approaches are perhaps the most challenging for nurses. Not only are nurses diverse in culture, sex, age, socioeconomic and religion, we are also part of a discipline that is diverse in practice. It is necessary to acknowledge our own beliefs, biases as it relates to other culture groups so that we don’t unintentionally create barriers to learning.
Health care providers can overcome differing points of view regarding health promotion and disease prevention by creating a learning environment built on mutual trust, respect and acceptance. The goal is to provide education that is built upon the individual or group strengths that empower and engage the group/individual to be an active participant. It should encourage decision-making that positively affects lifestyle and health behavior changes.
Through experience and education I have had the opportunity to see the diversity within the Hispanic culture. There are major differences with this group in terms of immigrants and acculturated Hispanics. One notable difference is in health care practices. Immigrants take on the traditional formal practices in regards to illness. They are more likely to practice home remedies recommended by a relative such as the use of herbs (yerbas), and healers (curandero), or seek a spiritual healer or religious leader for prayer before seeing a physician because the perception of illness is that it is an act of God for bad life or lifestyle. Therefore their life is in Gods hands. Acculturated Hispanics are more likely to adopt American health practices, depending on access and resources available in health care. However, in some cases a certain residual traditions and practices are seen even acculturated Hispanics.
What one individual or cultural group perceives to be important or relevant may be insignificant to another.
Lipson, J. G., & Dibble, S. L. (Eds.). (2006). Providing Culturally Appropriate Health Care: Culture & Care
3) Low health literacy, cultural barriers, and limited English proficiency have been coined the “triple threat” to effective health communication by the Joint Commission. Nurses, who work with patients from increasingly diverse cultural groups, experience daily how these three threats offer a challenge to the effective provision of care at the system, provider and patient levels. Patients deserve culturally and linguistically competent healthcare.
First and foremost nurses should continually develop their ability to practice cultural self-awareness so as to better recognize their own cultural and linguistic assumptions and biases. Because health literacy depends on cultural and linguistic factors, there is a need for patient assessment tools that can efficiently collect information on patient literacy, linguistic ability and cultural beliefs. So that providers rely on assessment tools, not on “gut feelings”.
Nurses should make appropriate use of medical interpreters and cultural brokers. Medical interpreters should be cross-trained in cultural competence and health literacy, in addition to medical interpretation training. Understanding cultural differences enables nurses to use appropriate teaching such as oral patient education instead of pamphlets or written materials they may not understand.
A teaching tool for ESL is Picture Stories for Adult ESL Health Literacy, which gives students and teachers a starting point for talking about complex healthcare problems and solutions.
The assumption that patients understand “enough” is a common misconception in the operating room. Nurses are responsible for assessing the patients while the surgeons and anesthesiologist often rely on the information in the chart. The patient is rarely able to verbalize or explain what the doctor is going to do. The Cyracom phone is a indispensable tool used in the operating room to assess and educate culturally diverse patients. We are the patient advocates and must be proactive in providing teaching and answering questions and making sure patients understand what is happening to them.
Singleton, K., Krause, E., (Sept. 30, 2009) “Understanding Cultural and Linguistic Barriers to Health Literacy” OJIN: The Online Journal of Issues in Nursing. Vol. 14, No. 3, Manuscript 4
4) Culture refers to the learned, shared and transmitted knowledge of values, beliefs and ways of life of a particular group of people that generally pass on from generation to generation and it influence thinking, decisions, and actions in certain way and manners (Singleton & Krause, 2009). Culture and language affect how patients attain and apply skills in health care which makes patient education very difficult for nurses to achieve a better outcome for the patient.
Nurses are in a position to make better connections between patient culture, language, and health literacy in order to improve health outcomes for culturally diverse patients. Nurses today are providing care, education and case management to an increasingly diverse patient population that is face with triad of cultural, linguistic, and health literacy barriers (Singleton & Krause, 2009).
Patient education is essential in assisting patients to live with illness and to have improved health outcomes. Patient education is also one of the most satisfying aspects of care provided by professional nurses. To facilitate learning, nurses must apply effective patient teaching strategies. This process includes assessing and prioritizing learning needs, assessing learning styles, and implementing teaching strategies designed to address identified learning needs (Chang & Kelly, 2007).
For example, a family friend had a baby three years ago; she lost a lot of blood as a result of some complication during child birth. Her hemoglobin was 8gm/dl (Normal 12.1-15.1gm/dl) which was low compare to the normal. Doctor wants her to get blood transfusion which she and her immediate family did not want because of their cultural beliefs. The provider gave options on how she can increase her hemoglobin by eating food rich in iron and vitamin B; eat fruits and vegetables high in vitamin C, which will help her body to absorb iron and Iron supplement tablet.
The first obstacle there was her cultural beliefs which the provider has to overcome by providing her with an alternative to increase her Iron level. Second obstacle was decision making. In different cultures, individual may look to the nuclear family, extended family, or family head to make decision. The decision for Iron supplement was a family decision due to their cultural beliefs.
Furthermore, patients make decisions that are similar to their health beliefs systems to which their culture permit. If the provider does not subscribe to the same health belief system regarding disease etiology as does the patient, health directions may not be followed and conflict may arise between the patient and the provider. Hence, it is important that providers consider the patient’s beliefs when providing health education and interventions (Chang & Kelly, 2007).
Chang, M., & Kelly, A. (2007). Patient Education: Addressing Cultural Diversity and Health Literacy Issues. 27(5), 411-417. Retrieved from http://www.medscape.com/viewarticle/564667
Singleton, K., & Krause, E. (2009). Understanding Cultural and Linguistic Barriers to Health Literacy. The Online Journal of Issues in Nursing, 4(3), Retrieved from http://www.nursingworld.org/mainmenucategories/anamarketplace/anaperiodicals/ojin/tableofcontents/vol142009/no3sept09/cultural-and-linguistic-barriers-.html
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