Cultural beliefs of a certain group of people greatly influence their reception to many different things including medical care. In achieving success in medical care delivery, one of the most important steps is tailoring that care to suit the cultural beliefs of the target population. Hawaii is no different from other cultural heritages in this aspect. Their acceptance of the conventional medical services is heavily dependent on their cultural beliefs.
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This therefore means that the approach by American nurses, in providing the most needed services, has to take a new direction, if at all the target of those services shall benefit from them. This paper focuses on the cultural influence on the medical service delivery in Hawaii with the aim of equipping medical staff in the area with the relevant information concerning the locality and thus enabling them to offer culturally sensitive medical services.
Principles of culturally sensitive care
Elements of Culturally sensitive care (Campinha-Bacote)
There are several elements in providing culturally sensitive care. The first element is self-reflection, which Campinha-Bacote refers to as cultural awareness (2002, p. 181). The nurse has to understand his or her cultural values and those of the nursing profession. This is important because it helps the professional to identify the beliefs and values which may underscore their interventions or approach and their effect on the client (Andrews & Boyle, 1995; Andrews, 1992). It is also important for the nurse to understand the values of the nursing profession like for instance, autonomy of the client, which may affect the interactions between them and the client. The cultural values of the client may also influence how they interpret the caregiver’s behavior and therefore it is important for the caregiver to understand these values.
The other element is cultural knowledge. Though it is impossible for nurses to have a deep understanding of all cultures, it is possible to obtain a broad understanding of how a culture can affect beliefs and behaviors. This involves the client’s worldview, which ultimately determines how they interpret their illness (Campinha-Bacote, 2002, p.182).The other element is cultural skill. This concept includes learning how to conduct cultural assessments and cultural physical assessments. The caregiver needs to understand the relationship between the client’s physical, biological, and physiological variations and their ability to conduct an accurate and appropriate physical evaluation.
Another element is cultural interactions. This will help the caregiver to refine or modify their existing beliefs about a cultural group and will prevent possible stereotyping that may have occurred from prior interactions with people from a particular cultural belief. The last element is cultural desire (Campinha-Bacote, 2002, p.182). Cultural desire enables the caregiver to become culturally aware from a point of willingness rather than from coercion of any form.
Culture Care Diversity and Universality (Leininger)
This is a research-based theory whose aim was to promote culturally congruent nursing to people with similar cultures. By culturally congruent care, Leininger meant a meaningful and beneficial care tailored to meet patient’s cultural values (Leininger, 2002. As cited in Smeltzer, Bare, Hinkle, & Kerry, 2009).
Unlike the five-factor model by Campinha-Bacote, this theory focuses on achieving culturally congruent care through culture care accommodation and culture care restructuring. By culture care accommodation, he referred to actions or decision the caregiver makes on behalf of the patient of a particular culture, to help them achieve beneficial or satisfying health outcome. The tern culture care restructuring in this theory refers to professional actions or decisions that enable the patient alter their lifestyles towards new, different and or more beneficial healthcare patterns (Leininger, 2002. As cited in Smeltzer et al, 2009).
Unlike the model by Campinha-Bacote, which focuses on the nurse or the caregiver as the person who should conform to the cultural values and practices of the patient, Leininger in his work bring a new insight into the matter. He introduces a means by which the caregiver can help the patient abandon some cultural values and practices that are not beneficial to the patient in terms of their health in exchange for more beneficial practices health wise. Therefore, is necessary that in providing culturally sensitive care, the caregiver, in addition to achieving cultural competence, acts and makes decisions that help the patient restructure their culture to reap more benefits in healthcare.
Establishing mutual goals
Another important thing that the caregiver has to do is to ensure that there exist mutual goals between them and the clients. One of these goals, which must rhyme, is the goal to preserve culture. In this case, the caregiver makes efforts to integrate the client’s preferences into the plan of care when these preferences are important to the client’s physical, emotional or spiritual health, especially when those preferences bear no harm to the client or to others.
Another goal is culture accommodation where the nurse honors client’s choice by minimizing risks or finding ways to overcome barriers (Andrews & Boyle, 1995). Another goal is culture care re-patterning whereby the caregiver works with clients to develop new patterns that extend beyond the client’s usual way of doing things, while respecting traditional values and beliefs.
The Hawaiian community
Cultural preferences of Hawaiians
One of the most important aspects in the Hawaiian health environment that caregivers have to note and respect is the fact that the Hawaiians have their traditional medicine, which they use even when using the conventional medicine (Broad & Allison, 2002). Therefore, it is important to know other medications that the clients are using before prescription otherwise; the caregiver exposes such clients to the dangers of overdosing and other risks associated with combination of drugs.
Another important knowledge that the health workers in the region must understand is the fact that the people consider rushing through an examination not only offensive but also a taboo (Broad & Allison, 2002). Nurses must therefore engage the patient in a conversation besides the examination before letting them go otherwise; failing to do this may make them stop seeing the doctor (Broad & Allison, 2002). Such time spend with the Hawaiian people gives them a high satisfaction for the medical services.
In addition to these, Hawaiians place a high value on a holistic approach to their medical issues. It is important therefore, that the caregiver holistically examines the clients and then focuses on identified problems whether they are physical, emotional or social (Broad & Allison, 2002). The process should therefore avoid a physical dysfunction approach and focus on the patient as a whole.
Providing Culturally Sensitive Care to Hawaiian patients
Some of the practices that the Hawaiians engage in present the caregiver with an extra responsibility of treating and protecting the clients from possible harm arising from their cultural practices. One of the important points to remember is that they combine both traditional and conventional medicine (Broad & Allison, 2002). Furthermore, they have a heavy drinking and smoking culture during pregnancy, which endangers the health of the baby. In addition, it is important for the medical staff to realize that the people do not like sharing about their traditional medicine practices because of discrimination.
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When learning how to offer culturally sensitive care, respecting the patient’s cultural practices is an important thing for the caregiver to accept. However, when such cultural practices are harmful to the patient, the caregiver should find a way of discouraging those practices in a way that respects the culture of the patient. This leads to the conclusion that it is not the caregiver who should be sensitive but also the patient need to be flexible for the own good.
Andrews, M. (1992). Cultural perspectives on nursing in the 21st century. Journal of Professional Nursing, 8(1).
Andrews, M., & Boyle, J. (1995).Transcultural concepts in nursing care. 2nd Ed Philadelphia: Lippincott.
Broad, L. M., & Allison, D. M. (2002). Nurse Practitioners and Traditional Healers: An Alliance of Mutual Respect in the Art and Science of Health Practices. Holistic Nurse Practitioners, 16(2); 50-57.
Campinha-Bacote, J. (2002). The Process of Cultural Competence in the Delivery of Healthcare Services: A Model of Care. Journal of Transcultural Nursing, 13; 181.
Smeltzer, S.C., Bare, B., Hinkle, J.L., Kerry H.C. (2009). Brunner and Suddarth’s Textbook of Medical-Surgical Nursing (Two Volume Set). 12th Edition. New York: Lippincott Williams & Wilkins.
- Elements of Culturally sensitive care
- Establishing mutual goals
- Cultural preferences of Hawaiians