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Application of the Nursing Process to Deliver Culturally Competent Care
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Introduction
Cultural competence refers to the capacity to interact effectively with persons of different cultural and socio-economic backgrounds. The US has frequently been multicultural. The society and people tend to become extremely mobile as the world is becoming smaller and smaller each day. However, in the recent years, the interests and presence of various cultural constituencies have made themselves more strongly felt in nursing and medicine. Various minority cultural groups witness disproportionate burden of health disparities. The imperative to offer cross-cultural care is linked to such disparities, quality of care and access to health care. It integrates patient provider communication and the ways that linguistic and cultural variations can compromise communication and jeopardize trust.
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According to Dayer-Berenson (2010), patients’ trust improves satisfactions, understanding and adherence. When patients do not comprehend the procedures and rationales linked to recommended therapy, they are not likely to adopt it, or they might adopt it incorrectly resulting in harmful outcomes. Treating patients without knowing their beliefs can be frustrating to both the patient and the nurse and might delay medical care itself. When patients’ health related worldview differs from that of the provider, they might resist treatment recommendations, which possibly results in health disparities. Culture has an impact on almost every activity an individual does, and the decision they make. In this regard, this paper is focused on how nursing process can be applied in delivering culturally competent healthcare (Glaser, 2013).
Background of Jewish Culture
The Jewish culture is richly tied to religion, heritage, and tradition. The Jews have originated in Israel and they strongly practice Judaism (Hollins, 2009). Presently, the Jewish people can be found in several places of the world. Despite establishing smaller communities with their own combination of values, the Jews are still deeply tied to their cultural roots. The Jewish is a way of life that is dictated by the Torah which is the first five books of the Bible. The culture is communicated in Hebrew and is branded with a rich history of struggles and trials (Hollins, 2009).
According to Kersey-Matusiak (2013), the Jewish culture is usually traced back to biblical figures and political trouble. This culture is highly linked to Israel where ancestry comprises of biblical figures such as Jacob, Isaac and Abraham. Nevertheless, individuals identifying themselves as Jews in the contemporary times have not essentially maintained a robust religious tie to their heritage. Indeed, their personal Jewish tradition is described by the region they live in and communities they interact with. Individuals tied to the Jewish race identify themselves via their maternal line. In addition, one can be assimilated into the Jewish culture by active participation in Judaism and sincere engagement in community and a commitment to the Jewish values and norms. The bottom-line is that not all Jewish people have blood ancestry that ties them to the culture.
Most individuals often believe that the culture deeply tied to the region is flooded with specific mandatory beliefs and rules (Hollins, 2009). Nevertheless, Judaism itself does not have a set of mandatory compulsory concepts. Instead, most recognize the 13 principles of faith: God is one, God exists, God is incorporeal, prayer is directed towards God, the words of Prophets are true, the written and oral Torah were given to Moses, there will be no other Torah, and God will reward the good and punish the bad, and the dead will be resurrected.
According to O’Mahony & Donnelly (2007), the 13 principles of faith enable for much personal opinion while offering stability and guidance. There are three types of Jewish people based on how strongly one believes the principles are God’s word. The three levels include Reform, Orthodox and Conservative. The Orthodox Jewish people are the oldest and they may speak Yiddish. Each level or movement has various sects, beliefs, and traditions. The Jewish law, Judaism or Torah, describes Norms in the Jewish tradition. Women are considered as separate and equal. They are the individuals determining when marital sex is appropriate, and they are not to be mistreated.
According to statistics, there are about 14 million Jews in the world. Approximately 5 million of them reside in the United States. The first language of majority of the Jews living in the US is English. They can be found in several metropolitan regions in the United States; some of them are New Jersey, New York, Massachusetts, the District of Columbia, Maryland, California, Illinois, Florida, and Pennsylvania. Out of the total number of American Israeli in the USA, New York has approximately 9.1 per cent, followed by New Jersey with 5.5 per cent, Florida with approximately 4.6 per cent, and the District of Columbia with 4.5 per cent. California, Connecticut, Illinois and Pennsylvania have about 11 per cent of the entire US Jewish population (Purnell, 2005).
Jewish people have also witnessed significant historical events which might have influenced their global distribution. One of the major events is the discrimination during World War II. For several centuries, very limited education was available for the Jews living in Eastern Europe. According to Glaser (2013), the absence of a regulation prohibiting discrimination in employment significantly increased the incidents of discrimination. In the United States, Jews have taken part in the US healthcare industry.
Analysis of Jewish Culture and Its Effect on Healthcare
According to O’Mahony & Donnelly (2007), Jewish culture teaches that life is of inestimable value and that the preservation of life surpasses all other considerations. According to Reform Judaism, God endowed humans with the understanding and capacity to become partners with Him in making the Universe a better place. The utilization of knowledge to cure diseases has been a core theme in Jewish culture throughout the history. Offering healthcare is an obligation not only for the sick but for the entire society as well. Because of this, the revered scholars of Jewish culture placed health care first on the list of ten most significant communal services which cities must provide to their residents. Approximately, all self-governing Jewish individuals throughout the history established a system to guarantee that all citizens have an access to health care. In such system, doctors should be required to decrease their rates for poor patients, and if that is not adequate, communal subsidies should be established.
Among the Jewish people, it is an obligation to save life. They refer to this obligation as Pikuach Nefesh. Kersey-Matusiak (2013) pointed out that saving life is very significant among the Jewish people. The principles of this obligation state that any Jewish person must do everything in order to save the life of another individual, which comprises organ donation. The Jews are allowed to travel during Sabbath if it is necessary to save the life. Other ways of saving life include deferring Sabbath for women who have delivered in the last three day and eating non-kosher food if it is necessary for the recovery of one’s health.
The US has experienced an increasing crisis in health within the few recent years. Whereas the US spends on healthcare per individual significantly more than any other country in this world, the increasing numbers of people cannot afford the basic treatment, not to mention responding to chronic and catastrophic illnesses. Young children, especially from minority communities, live in absurd poverty without medical insurance. Many US citizens are uninsured, and millions are under-insured. This exposes minority communities to out-of-pocket expenses threatening their economic survival. Pacquiao (2000) affirmed that healthcare spending is one of the leading causes of personal bankruptcies in the US. In addition, American business companies are disadvantages in the business world due to the high costs of healthcare. This companies need to cater for employees insurances, which is extremely expensive.
As a culture that is deeply tied to biblical roots, the Jews have often supported universal healthcare coverage, which feels called to action in the face of such a massive challenge (Glaser, 2013). The Jewish tradition clarifies that communities are required to offer medical help to everyone. A physician who refuses to provide health services is considered to have shaded blood regardless of the reasons for not doing so. The widely shared concern for justice forces the Jewish community to foster the establishment of health care system that adequately meets the needs of everyone.
Transcultural Assessment Model
Giger and Davidhizars developed this model to assess the cultural values of patients’ concern about disease behaviors, health and their impacts (O’Mahony & Donnelly, 2007). The model comprises six cultural dimensions that include space, communication, time, social organization (family), environmental control, and biological variations.
According to the pioneers of this model, transcultural is a significant aspect of health care. As reported by Hollins (2009), transcultural nursing was developed due to the need of offering care to people from widely varying cultures. It refers to a formal area of practice and study focused on comparative human care similarities and differences of values, beliefs and patterned ways of life. This model is aimed at ensuring that nurses offer culturally congruent, beneficial and meaningful health care to individuals. Transcultural assessment model requires health care givers to appreciate and recognize cultural difference in healthcare customs, beliefs, and values.
According to Noble, Engelhardt, Newsome-Wicks, & Woloski-Wruble (2009), nurses need to acquire the essential skills and knowledge in cultural competency. Culturally competent healthcare ensures patient satisfaction and positive outcomes. Nurses can significantly benefit from several guides and models while making a cultural assessment. Transcultural nursing model offers a good guide for nurses being acquainted with the cultural structure of the Jewish society. In addition to studies of Glaser (2013), other studies have also been performed and other researchers such as Paulanka, Purnell, Andrew, Boyle and Campiha-Bacote have suggested other models.
Application of Transcultural Model
In Giger and Davidhizar’s model, every person is accepted as a unique and evaluated in terms of six cultural dimensions comprising of communication, space, social organizations, time, environmental control, and biological variations. Communication
Communication adopts the whole world of human behavior and interaction. According to Noble, Engelhardt, Newsome-Wicks, & Woloski-Wruble (2009), communication establishes a sense of commonality with others and allows sharing of information, feelings and ideas (Hollins, 2009). Communication refers to the means by which culture is shared. Both nonverbal and verbal communications are leaned in one’s culture. It is one of most significant problems when working within cultural groups. The key elements of communication include style, rhythm, volume, use of touch, vocabulary, body posture and kinesics.
Throughout the history, the Jews have spoken various languages. In several cases, the Jews have slightly twisted the language of the communities around them to create their own versions of the languages. Presently, many Jews speak English or Jewish version of English that incorporates simple phrases from Hebrew and Yiddish. For healthcare providers, language barriers are usually not an issue except dealing with elderly Jewish people.
The verbal communication style of the Jewish is usually expressive. They often say what they feel and think. They also use their hands while communicating. However, the younger generation seems to adopt communication style of the surrounding culture in order to be expressive. In healthcare cases, this implies that younger American Jewish persons will usually be similar to the general American population. As a result, the older Jews might be dealt differently because of their expressive way of communication. For instance, healthcare providers might need to be careful when evaluating how an older Jew is feeling since their expressiveness might pose challenges to measure the severity of the problem.
Social Organizations
The Jews are a very family-oriented cultural group with a unique emphasis on children. According to Pacquiao (2000), parents are very protective and want the best for their children. Jewish children are expected to learn about their culture. In addition, majority of Jewish parents send their children to Jewish schools in order to learn about their traditions, beliefs, and customs. Studies indicate that about 27 percent of American Jews send children to some kind of all-day religious school. According to Purnell (2005), the Jews do this in order to pass the heritage down.
Jewish families also seem to be members of Jewish community where they live as a local Synagogue. In general, the structure of the family is patriarchal. The male have the duty of working and financially taking care of the family. On the other hand, the responsibility of the woman is to take care of home and children. Nevertheless, these roles are not as rigid, especially in the US where frequent times both parent work. With regard to healthcare, this implies that Jews are likely to seek communal health care services provided within Jewish communities.
Biological Variations
As a cultural community, the Jews are prone to certain genetic illnesses. The Ashkenazi, Jews from Eastern Europe are at the highest risk with one in every five being a carrier of at least one of the following genetic diseases: Cystic Fibrosis, Gaucher, Tay-Sachs, Niemann-Pick, Mucolipidosis, Bloom Syndrome, Fanconi Anemia, Familial Hyperinsulinism, Nemaline myopathy, Spinal Muscular Atrophy, Glycogen Storage Disease and Usher Syndrome (Glaser, 2013).
Thee reason for the high vulnerability to these diseases is that a small group of individuals that grew into a larger population founded the Jews. This significantly increased their chances of acquiring genetic diseases because the growth happened within the group. The gene pool did not increase very much. As a result, the defective genes continue to cause genetic diseases. The Sephardic, Jews from Italy, North Africa, Middle East and Iraq, are more vulnerable to the following genetic disorders: Familial Mediterranean Fever, Beta Thalassemia, and Glycogen Storage Disease. As a health care provider, it is imperative to be aware of the exposures of Jewish patients.
Environmental Control
Hollins (2009) defines environmental control as the ability of an individual to control nature and to plan and direct factors in the environment affecting them. If an individual comes from a cultural group in which there is less belief in internal control and more in external, there might be a fatalistic perspective by which the search for healthcare is perceived as useless. The Jews are a cultural group that has a strong belief in internal control. As such, they approve the attempts to improve health.
Space
Space is the intimacy and distance techniques used when relating nonverbally and verbally to others. All communications take place in the context of space. The four zones of communication include: intimate, personal, social and consultative, and public. Territoriality refers to the attitudes or feelings towards one’s personal area. Every individual has his or her own territorial behavior. Violation of the patients’ personal and intimate space can cause discomfort and might lead to refusal of treatment (Glaser, 2013).
Time
Time is a significant aspect of interpersonal communication. Cultural groups can be future, past or present oriented. Groups that focus on the past seem to offer tradition and have little motivation for formulating future goals. Groups or communities with future orientation have a time plan and organize for the future. The Jews belong to the present and future oriented communities. As such, they plan and organize their future in terms of health (Glaser, 2013).
Nursing Plan of Care
The nursing process consists of five significant steps that include assessment, diagnosis, planning, implementation and evaluation. The assessment phase comprises deliberate and systematic collection of data. It is impossible to create a plan of care for patients about whom the nurse has no information. With the required information, a nurse can create a care plan relating to 6 cultural domain of transcultural model. The assessment stage of nursing process is important in understanding the history of the Jews, their reason for admission and current health status (Glaser, 2013).
Diagnosis refers to the clinical judgments concerning the possible health problems faced by the Jewish community. Depending on the assessment, one can identify the appropriate nursing diagnoses for the Jews. The planning of care integrates carefully reviewing each listed intervention and determining if it will contradict Jewish culture (Glaser, 2013).
The implementation phase involves executing the interventions identified as essential for the patient care. When an individual reports for a clinical help, a nurse must evaluate or reevaluate the Jewish patient’s views in order to determine whether the planned nursing intervention is required for the patient. The last phase allows the nurse to determine whether the deployment of nursing process was efficient in dealing with health care needs of the Jewish people.
Conclusions and Recommendations
Jewish culture has certain beliefs concerning certain healthcare practices that nurses should consider when treating Jewish patients. Majority of these beliefs have been transferred down by generations through tradition. Nevertheless, the Jews of modern times are very lenient concerning the traditional rules. Therefore, there is no significant conflict between contemporary American culture and Jewish culture. However, it is recommended that nurses should be aware of the specific Jewish religious movements, and how strictly they adhere to the traditional law. This will significantly reduce the clash between the two cultures during healthcare delivery. The Jews are willing to put aside their traditional beliefs in life-threatening circumstances in order to save another person’s life.
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