NR 305 Providing Culturally Competent Nursing Care

NR 305 Providing Culturally Competent Nursing Care

NR 305 Providing Culturally Competent Nursing Care

I am going to tie together the first and third option.

I am blessed to work and live in a culturally diverse neighborhood. I was raised in Skokie, IL. I work in Evanston, IL. Both are very celebratory of cultural diversity and are neighbors. In Skokie, IL we have a cultural fest each summer (skipped this year due to Covid19). During this fest, each culture has an opportunity to display what defines them such as art, artifacts, books, dolls, or performance arts like dance which defines them (Weber & Kelley, 2018). As a nurse, I can work with patients of all different cultural backgrounds and learn to celebrate them or help relate to them.

I work in hospice or end of life care as part of my unit’s specialties. During Covid19, we are forced to follow special guidelines and I would like to discuss a difficulty that I experienced.

I had an Orthodox Jewish patient who was a coroner’s case recently. He passed overnight. We have a policy to allow visitors for 30 minutes only. We need a release form filled out to release the body from the hospital to another party – which was not yet signed. We have four hours total to remove the body from the unit and Jewish patients are usually never removed by anyone other than a Jewish funeral home. I had to advocate for this patient’s rights to Coroner’s office which was incredibly difficult to allow them to have the Jewish funeral home remove the body. They decided after much argument that I could fax the ENTIRE chart to them, which was not yet printed, and they would make a determination from there. I had no secretary. I had to print the chart myself and fax everything while the printer was barely working, the fax machine was not allowing me to fax such a big file at first either!

I barely made it to have the family come sign the form in the middle of the night, have the Jewish funeral home on guard to come as soon as I knew it was allowed, and get all my documentation done.

Time crunch extraordinaire.

I made it happen. With zero help and five other patients because it was important to this patient and his family.

If we rewind to prior to the patient’s death, the patient had been in ICU for brain bleed post fall. The patient’s family allowed their family rabbi to make some decisions for them which helped determine to go ahead and transition to hospice level of care. Often Orthodox Jewish patients involve a Rabbi even more-so than the medical team (Gabbay, et al, 2017). This has been witnessed several times on my unit. Pre-Covid19 I would often see a Rabbi in the room with patient’s making decisions for them. Family also would be incredibly involved and bring in Kosher foods as although the hospital offers a Kosher diet, their food was more appropriately Kosher.

We have an opportunity to respect and learn from people and their cultures all the time.

References

Gabbay, E.,  McCarthy, M., and Fins, J. (2017). The care of the ultra-orthodox Jewish patient. Journal of Religion & Health 56(2): pp. 545-560. http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.1007/s10943-017-0356-6 

Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: Wolters Kluwer.

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The hospital in which I work, is a satellite hospital of the Cleveland Clinic. It was built in 1949, and was originally run

NR 305 Providing Culturally Competent Nursing Care
NR 305 Providing Culturally Competent Nursing Care

by a convent. When it was transferred to the Cleveland Clinic, part of the agreement was to continue the Catholic values and symbols throughout the hospital. There is a statue of Mary in front of the building, photographs of the last three Popes in the hallway, and crucifixes hung in random offices. If you’re there early enough in the morning, you will hear a morning prayer over the PA system. One of the more controversial practices of the hospital is that they are not allowed to prescribe birth control in the OB/GYN office, and the pharmacy is not allowed to dispense these medications. On a personal level, it kind of blows my mind that a hospital is so connected to religion. That said, I think that for a lot of the patients who choose our hospital, it is a comfort, and luxury to be encompassed by their faith.

I do not consider myself religious. I was brought up with a Christian faith, and spent some time and a lot of Sundays with a Mormon family, but never found my niche’. When I was diagnosed with IBC two years ago, which has up to a 50% mortality rate, faith did not soothe me. I read stories of people a lot more religious than myself that died, and it just made me feel worse. Friends and family offered to pray for me, and I let them, but I didn’t think it was actually going to do anything.

The convent is still on the property of my hospital, and there are Sisters who frequently visit my office as patients. They don’t usually wear their habits, but they wear their crosses, and carry prayer books. For the most part, they don’t force their religion or beliefs on myself or others. Rather, they assume that we believe. I try never to be disingenuous with them, so I generally avoid the topic of religion altogether. Occasionally, out of genuine curiosity, I will ask them about the origin of certain Catholic holidays or practices, and they are happy to share with me. They know that I am not Catholic, and I suspect they know that I don’t go to church.

When in the presence of a patient who is outwardly religious, I will listen attentively and offer what I can in terms of support and resources. Pastoral care has been said to help patients with their emotions and spiritual distress, and also can act as a mediator between patient and caregivers. (Lobb et al., 2018) Our hospital also has a prayer board and chapel. If the patient is able to walk/travel to the chapel area, I will suggest it. Sometimes just surrounding one’s self with the familiar can be soothing. If I feel that the patient really needs something more from me, I have been known to tell them I will say a prayer for them. I actually do make a point of saying a few words to an empty room to make good on my promise. I believe in the power of positive thinking. That is, if the patient thinks that my prayer is going to help them, then even if I don’t believe, it will help.

I found the SPIRIT assessment tool in our text particularly interesting. (Janet R. Weber Rn Edd & Kelley, 2018)  This tool might have its use in my office, for a more pressing surgery or issue. I think it would be an excellent addition to an initial interview with a primary care office, lengthy hospital stay, or as a care manager in Oncology. In my experience, surgeons typically want to do what they think is best for the client, which is not wrong, but may be wrong for the patient. The “Implications For Medical Care”, and “Terminal Events Planning” portion of this tool would be most helpful in planning care for a surgical client. (Lobb et al., 2018) I think it’s important for caregivers to realize that modern society doesn’t fit into certain check boxes. A patient may be Christian, but can also spend a lot of time meditating, or dabbling in other cultures. It is important to know all beliefs that may impact their care path.

 

 

References

Janet R. Weber Rn Edd & Kelley, J. H. (2018). Health assessment in nursing (6th ed.). Lww.

Lobb, E. A., Schmidt, S., Jerzmanowska, N., Swing, A. M., & Thristiawati, S. (2018). Patient reported outcomes of pastoral care in a hospital setting. Journal of Health Care Chaplaincy25(4), 131–146. https://doi.org/10.1080/08854726.2018.1490059Links to an external site.