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For Ruben

For Ruben

 

Under his cloak of sadness,

Like stark ebony of night,

Despite anguish and despair,

Burns soft prisms of light.

 

This gentle spark of fire

So delicate and sweet,

Begs for flighty release

From the burden of deceit.

 

What must he do

To release this sorrow?

To bring forth hopes & dreams

For a better tomorrow?

 

Sue Mika

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My 2nd Grad-Level Research Paper

Introduction

     Cultural competence is an ever-changing subject of interest to health care providers.  As nurses provide care to culturally diverse patients, it is essential that they are able to provide culturally sensitive nursing care.  Cultural competence was brought to the forefront by Madeleine Leininger, who developed the Theory of Culture Care Diversity and Universality.  Leininger (2008) coined the term “culturally congruent care” in the early 1960s as the goal of her theory.  She described culturally congruent care as “culturally based care knowledge, acts and decisions used in sensitive and knowledgeable ways to appropriately and meaningfully fit the cultural values, beliefs, and lifeways of clients for their health and wellbeing, or to prevent illness, disabilities, or death” (p. 8).  The goal of her Culture Care Theory has been “to provide culturally congruent and safe care” (p. 8). Her theory is the only nursing theory that is specifically focused on transcultural nursing with emphasis on culture care.

 Leininger (2008) coined the term transcultural nursing, which she defined as a “discipline of study and practice focused on comparative culture care differences and similarities among and between cultures in order to assist human beings to attain and maintain meaningful and therapeutic health care practices that are culturally based” (p. 9).  The roots of her theory are entrenched in clinical nursing practice.  Leininger believes that caring is the very essence of nursing and that “there can be no curing without caring, but caring can exist without curing” (p. 1). Since Leininger’s theory highlights the importance of caring, it can be applied to all aspects of the nursing process.

Overview of Theory of Culture Care Diversity and Universality

The Theory of Culture Care is “known for its broad, holistic, yet culture-specific focus to discover meaningful care to diverse cultures” (Leininger, 2002, p. 190).  In order to fully understand Leininger’s Theory of Culture Care Diversity and Universality, one must understand her view of the concept of culture care.  Leininger (2008) considers culture care to be “both an abstract and/or a concrete phenomenon” (p. 5).  She defines care as “those assistive, supportive, and enabling experiences or ideas towards others with evident or anticipated needs to ameliorate or improve a human condition or lifeway” (p. 5).  When considering care in her theory, this includes folk care and professional care. Folk, or emic, care refers to the “local, indigenous, or insider’s cultural knowledge and view of specific phenomena” (p. 6) and professional, or etic, care refers to “the outsider’s or stranger’s views and often health professional views and institutional knowledge of phenomena” (p. 7).  Leininger acknowledges that both emic and etic care have been predicted “to influence and explain the health and wellbeing of diverse cultures” (p. 5). The theory takes into consideration both the expertise and knowledge of the nurse (or professional), as well as the individual (folk) that is from a different culture than the nurse. 

In considering Leininger’s beliefs about culturally congruent care, one can see how important it is for the nurse to consider the patient’s cultural beliefs, values and norms when carrying out the nursing process with those from different cultures.  It would be inappropriate to adopt a one-size-fits-all approach to nursing when caring for people, regardless of their cultural background.  The central thesis of Leininger’s theory is that “different cultures perceive, know, and practice care in different ways, yet there are some commonalities about care among all cultures in the world” (Fawcett, 2002, p. 131).  Another important concept to consider is that of worldview.  Leininger (2008) considers worldview to be the “way people tend to look upon their world or their universe to form a picture or value stance about life or the world around them” ( p. 8).  How people view their world can influence the decisions that they make concerning their health and wellbeing.

In order to assist nurses to utilize her theory in practice settings, Leininger developed the well-known Sunrise Model, which serves as a “visual image to aid in conceptualizing the major components of the theory, thus making use of the theory easier for nurses” (Clarke, McFarland, Andrews & Leininger, 2009, p. 234). This model serves as a tool to help nurses “assess and understand the influences of (a) cultural values, beliefs, and practices; (b) religious, philosophical, or spiritual beliefs; (c) economic factors; (d) educational beliefs; (e) technology views: (f) kinship and social ties; and (g) political and legal factors that contribute to a client’s care and health” (Shapiro, Miller & White, 2006, p. 114).  It uses the symbol of a rising sun and a series of arrows to show the interrelationship between many different factors which affect a patient’s health and wellbeing.  A nurse can start anywhere on the Sunrise Model that he/she deems appropriate, depending upon the focus of the assessment. If the nurse finds the immediate need to assess the cultural values or beliefs of a patient to provide culturally congruent care, he/she can start at this section of the model.  Use of the Sunrise Model will enable nurses to carry out nursing actions that are specific to that patient’s culture. It is important for the nurse to consider all of the factors in the model in order to perform a comprehensive assessment.

Significance

Leininger’s Theory of Culture Care Diversity and Universality encourages nurses to respect and embrace the patient’s individuality.  Nurses can enhance the nurse-patient encounter by asking the patient what their cultural practices or preferences are.  By incorporating cultural preferences and practices into the nursing care plan, the nurse is able to tailor care to the needs of the patient.  Perhaps the male is the dominant figure in the patient’s culture and is the one who makes important medical decisions.  The nurse can encourage and include the dominant family member in the nursing process as a means of respecting and embracing the patient’s cultural preference for this.  The nurse should take into consideration the general characteristics of the ethnic group of the patient, while still providing individualized care. When planning and implementing nursing interventions, the nurse should try to be flexible so as to meet the cultural needs of the patient.  The nurse should consider any cultural factors, such as beliefs about mental health or use of folk remedies, throughout the nursing process.

Cultural competence is an essential component of practice when caring for individuals from cultures other than one’s own.  It is more important for nurses to gain the knowledge and skills necessary to communicate cross-culturally with others than it is to try to gain vast amounts of knowledge on the cultural beliefs and values of many different cultures.  Communication is a key component in delivering culturally congruent care.  When interacting with a patient from another culture, nurses can use their patient as the guide.  It is imperative that nurses not assume that everyone from a particular culture holds all of the beliefs or values that have been identified as belonging to such. The nurse who is cognizant of her own biases and preconceptions, is able to consider one’s culture throughout the nursing process, engages in meaningful cross-cultural communication with clients, and sincerely yearns to become more culturally competent, is the nurse who will enhance the nurse-patient relationship.  Becoming culturally competent is an ongoing, developmental process in which the nurse acquires the necessary experience and knowledge to effectively interact with and embrace the cultural differences and similarities of others.  More research should be done to determine whether cultural competency training enhances the nurse’s cultural competence level. 

References

Available upon request.

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My 1st Grad Research Statement Paper

My 1st Grad-Level Research Assignment on Cultural Competence
Introduction

Cultural competence is a constantly changing, newly evolving topic of interest within the healthcare community. As nurses care for more diverse patient populations, it is imperative that they are able to provide culturally sensitive, appropriate healthcare services to the patients that they work with. Cultural competence was brought to the forefront by Madeleine Leininger (2008), who described culturally congruent nursing care as “culturally based care knowledge, acts and decisions used in sensitive and knowledgeable ways to appropriately and meaningfully fit the cultural values, beliefs, and lifeways of clients for their health and wellbeing, or to prevent illness, disabilities, or death” (p. 8).
Cultural competence is an essential component of practice when caring for what is becoming an increasingly diverse society. One research study reported that the population mix in the United States from 2006 to 2010 “is projected to change with decreases in the percentage of Whites (80.1-77.6%) and increases in the percentage of African Americans (12.8-13.5%), Asians (4.4-5.4%), and Latinos (14.8-17.8)” (Starr & Wallace, 2009, p. 48-49). As the number of racial and ethnic minorities increase, nurses will require greater knowledge and skill to engage in meaningful cultural encounters with others. Nurses can work towards attaining cultural competence by becoming aware of how social and cultural factors influence the health of people.
Purpose and Significance

It is important for nurses to gain the experience and skills needed to care for and communicate effectively with those from different cultures. Communication is a key element in providing culturally competent care to diverse patient populations. The nurse who is aware of her own biases and preconceptions, is able to conduct culturally based physical assessments, engages in meaningful cultural encounters with clients, sincerely wants to become more culturally competent, and who embraces and respects the cultural differences of others is one who will enhance “patient satisfaction, adherence, and subsequently, health outcomes” (Betancourt, Green, Carrillo, & Ananeh-Freempong, 2003, p. 297). Becoming culturally competent is an ongoing, developmental process in which the nurse develops the skills and knowledge necessary to effectively deal with and embrace the cultural differences of others.
Lack of cultural competency in nurses can lead to untoward consequences. Language barriers between the nurse and patient can adversely affect patient outcomes. Betancourt et al (2003) reported that “when providers fail to take social and cultural factors into account, they may resort to stereotyping, which affects their behavior and decision-making” (p. 297). If the nurse shows a lack of respect for the patient’s cultural differences, it can lead to patient mistrust in the healthcare system. Providers who are culturally incompetent “may be putting patients at risk for delays in treatment, inappropriate diagnoses, noncompliance with health care regimens, and even death” (Seright, 2007, p. 65).
Research indicates that cultural competency training enhances the nurse’s cultural competency level. “Having a baccalaureate degree or higher and/or participating in cultural diversity training has been found to be significantly associated with higher cultural awareness, cultural sensitivity, and cultural competence scores” (Starr & Wallace, 2009, p. 49).
Problem Statement

Do registered nurses (population) report enhanced cultural competency, as measured by the Cultural Self-Efficacy Scale (DV), after completion of a nine hour cultural competency training program (IV)? The implied hypothesis is that registered nurses will report an increased level of cultural competence, as measured by the Cultural Self-Efficacy Scale, upon completion of the cultural competency training module.
Definitions

Cultural Competency Training Program

· Independent (or input) variable.
· Theoretical – The delivery of culturally competent nursing care “requires the continuous seeking of skills, practices, and attitudes that enable nurses to transform interventions into positive health outcomes such as improved client morbidity and mortality, and client and professional levels of satisfaction.” (Smith, 1998, p. 121) The course is a nine hour cultural competency training program which provides nurses with the knowledge, awareness and skills to enable them to effectively care for diverse patient populations.
· Operational – The effectiveness of the cultural competency training program is measured utilizing a valid cultural competence measurement tool, the Cultural Self-Efficacy Scale (CSES).
Cultural Self-Efficacy Scale (CSES)

· Dependent (or outcome) variable.
· Theoretical – The Cultural Self-Efficacy Scale, developed by Bernal & Froman (1987), is used to measure the nurses’ perception of their level of cultural self-efficacy in caring for patients from diverse cultural backgrounds.
· Operational – The Cultural Self-Efficacy Scale measures the nurses’ self-reported cultural competency level utilizing a five-point rating scale, with higher scores indicating a higher level of cultural self-efficacy.


References

Bernal, H. & Froman, R. (1987). Influences on the cultural self-efficacy of community health
nurses. Journal of Transcultural Nursing, 4(2), 24-31.
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Freempong, O. (2003). Defining
cultural competence: a practical framework for addressing racial/ethnic disparities in health
and health care. Public Health Reports, 118, 293-302.
Leininger, M. (2008). Overview of Leininger’s theory of culture care diversity and universality.
Retrieved September 30, 2012, from http://www.madeleine-
leininger.com/resources/CCT_Overview_2008.pdf.
Seright, T. (2007). Perspectives of registered nurse cultural competence in a rural state – part II.
Online Journal of Rural Nursing and Health Care, 7(1), 57-69.
Smith, L. (1998). Cultural competence for nurses: canonical correlation of two culture scales.
Journal of Cultural Diversity, 5(4), 120-126.
Starr, S. & Wallace, D. (2009). Self-reported cultural competence of public health nurses in a
Southeastern U.S. public health department. Public Health Nursing, 26(1), 48-57.

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Good night, sleep tight, 
And pleasant dreams to you, 
Here’s a wish that all your 
Sweet dreams come true!

Good night, sleep tight,
And pleasant dreams to you,
Here’s a wish that all your
Sweet dreams come true!