Diversity in Nursing

Culture and Diversity assignment

This assignment is going to focus and explore an incident that happened whilst the writer was on placement. My last placement was in the acute dementia ward with elderly mainly over sixty-fives. The majority of the patients were white British whilst females were more than males. The writer will concentrate more on issues around cultural diversity and competences during the placement. The ACCESS model of cultural competence which was invented by Narayanasamy (1998) is going to be used. The acronym ACCESS represents (A)ssessments, (C)ommunication, (C)ultural negotiation and compromise, (E)stablishing respect and rapport, (S)ensetivity, and (S)afety. The writer will discuss about the issues around the incident and what his opinions were about this incident. To help the reader understand the incident an appendix 1 and 2 have been attached at the end of this assignment. Appendix 1 is about the incident and appendix 2 is about the model used.

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Culture is the way people live, think and relate to each other. Helman (1994) states that, “culture is a lens through which an individual perceiving and understanding his own world”. These days there are more people from different background living in the same community this has managed to encourage diversity Nolan (2003). According to Le Var (1998) Britain is regarded as one of the most ethnically diverse countries in Europe. Diversity can be defined as appreciating and respecting the natural differences of people e.g. colour, age and nationality without discriminating Purnell et al (1998). Health care workers can promote diversity in practice by identifying their own beliefs and prejudices because much of discrimination is unintentional, learned attitudes and lack of knowledge Kenworthy et al (2002). The disadvantages of not identifying these issues such as prejudice maybe approaching people with own judgement and this can lead to prejudge others and discrimination Papadopoulos at el (2006). Assessment

Healthcare professionals are expected to be equipped with appropriate attitudes, knowledge and skills to deliver high quality care based on accurate assessments of needs. On his arrival Nathan was welcomed, and was told of his rights whilst in the hospital since he was an informal patient.

Before the assessment a drink was offered to the client followed by an introduction to other staff nurses to the client. Narayanasamy’s (1998) ACCESS model begins with assessment as the corner stone in admission; this is when the client’s needs are established. The assessment focuses on the cultural aspects of the client’s lifestyle, health beliefs, and health practice. Rawaf & Bahl (1998) mentions that, “health needs assessment has proved an important population approach to the systematic tackling of inequality, responding to actual needs and investing in effective interventions rather than haphazard uncoordinated reactive response to demands”. During the assessment it was established that he was a strong practicing Rastafarian who did follow his culture very strictly. As a result of his heavy smoking Nathan had a lung disease hence he was on nebulisers to help him with his breathing. After the diagnosis, Nathan did not stop smoking; this made the writer think that maybe it meant a lot to him as part of his moral, belief, social norm and acceptable behaviour in his culture. Communication

There was evidence of stereotyping in the incident; this was seen through offering the interpreting and translating services to Nathan which he did not need. This could be seen as prejudice as staff presumed that because of his ethnic origin he could not speak English. Ogunsola (1991) writes about all forms of prejudice and racism as disabling both for the perpetrator and the victim which can lead to blockage of communication between the provider and the receiver. He went on stating that, an atmosphere of rejection can be created as a result and reduces the chance of concordance. On the other hand, it could be also argued that the professionals did nothing wrong by offering services to the client. The RCN (1998) states that, proper translation services should be available for clients who have difficulties in communicating in English. Staff members and other clients did not have any problem with linguistic limitations since Nathan’s English was good. He could express his wishes and problems with no difficulty. Rungapadiachy (1999) states that, communication is central to care delivery, in whatever capacity or health care discipline one happens to be.

The nursing team decided to maintain his individual needs by consulting the client on the assessment and discussed with him his future care. Nathan was made aware that his cannabis smoking habit was not going to be easily meet as it was against the ward/hospital policies. During the interaction the nurse used communication skills such as eye contact, facial expressions, posture and proximity that were not threatening to the client as this can affect the intervention. The writer was made aware of the importance of the body language as it is also a vehicle of communication. Cultural negotiation

After a week in hospital Nathan’s sister was invited for a ward round to help in meeting his needs since she was the one who knew him well. The fact that the sister was involved in his care plan was of benefit of both parties. It was going to benefit Nathan by giving him the care that suited his cultural beliefs and benefited the professionals in getting more information about Nathan’s culture. Nathan’s sister was also a heavy smoker the doctor explained to her the implications of Nathan’s smoking to his health. She was also told that Nathan was not going to be stopped smoking for ever but that it was going to reduce smoking. With the client’s values as priority it was arranged for Nathan to have vegetarian meals, a hair dresser was also arranged to come and wash his hair regularly. Nathan’s sister agreed to pay the hair dresser’s charge and was also going to bring him more cigarettes. Valuing Nathan’s culture made him feel accepted which helped in empowering him. The sister showed some understanding in how this was going to benefit her brother. She was pleased with how her brother was looked after; and the fact that the hospital was flexible in meeting Nathan’s needs such as meals and hair care. Andrews & Boyle (1995) referred to transcultural care as a synthesis of nursing and that the more care matches the clients’ expectations, the more accepted it will be. Establishing respect

According to Nolan (2003) health services should respect people’s culture; the ward took into consideration his culture and tried their best to accommodate his personal needs. Gerrish et al (1996) states that, ”ethnic minority communities complain of poor health because of limited attention to their specific cultural and religious needs”. NMC (2004) states that service users should be treated as individuals whilst respecting their dignity and autonomy. In this incident the writer was impressed with how Nathan was treated and some of his values respected without ethnocentricity attitudes towards him. Narayanasamy (2002) explained it further stating that, to achieve transcultural care nurses should respect the patient as a unique individual with needs which are influenced by cultural beliefs and values Sensitivity

The problem which the writer thought the health professionals struggled with was his smoking habit. It was not medically advised for him to keep smoking as he was on nebulisers. The fact that smoking has been banned in hospital under the Smoke-free regulations (2006) and the fire safety policy in place meant that he could not keep his cigarettes with him and would ask a member of staff to take him for a smoke. The ward staff had mixed feeling about taking Nathan for a smoke; some would try to limit him on how many he could smoke a day. There was a few who would tell him that he had run out of cigarettes yet he had some. The writer asked them why they were not telling him the truth and explaining to him the implications of his smoking. They said they were doing what was in the best interest of his health that is, helping him to limit the damage he was causing to his lungs since he had no insight of it. The writer interpreted this as a form of infringing a client his autonomy to his life; Burr (2002) warns about the dangers of imposing one’s own values on to others. Nathan had been on the nebulisers before his neighbours and community nursing team referred him for admission for that reason he must have been aware of dangers of his behaviour.

It was suggested among staff members that Nathan should stop smoking; he was not happy with the decision and he started to get upset and withdrawn. The writer feels that the decision was not right as it did not show sensitivity to the patient’s wishes first. Transcultural care is the provision of care that is sensitive to the needs of individual (Herberg 1989). His breathing improved and he could walk around the ward without getting out of breath. He started complaining about getting bored and loosing his appetite. When the doctor was consulted about Nathan’s concern he came to the ward straight away to explore other alternatives. He later decided that Nathan should only cut down on his smoking rather than stopping altogether. The doctor suggested that stopping completely was not going to be practical since he had smoked all his life. The nursing team were told not to make him stop completely because it was going to give him other complications and making him more distressed. To help him through, Nathan had a stop smoking session arranged with a qualified health worker who gave him some nicotine patches and chewing gums to help with the cravings. Safety

Polaschek (2001) and Narayanasamy (2003) claims that clients need to derive a sense of cultural safety in the healthcare environment in which they are being engaged as respected partners with room for negotiation and promotion of cultural diversity. The idea of giving clients trust and confidence in the service makes it easier for them to feel accepted and will accommodate the therapeutic interventions which are designed to meet their cultural needs. Nathan had a named nurse allocated to him so that they could build a professional relationship and for him to know who to approach if he had any concerns. Papadopoulos (1999) states that, the care of the client should have approaches that are adapted to meet their cultural needs; this alone can give a patient a sense of safety and would not feel ashamed of their culture or who they are. Using this approach the nursing team managed to meet Nathan’s needs without causing him any discomfort.

Following this incident the writer is convinced that professional practice has improved a lot in meeting cultural diversity needs of the black and ethnic minority groups hence there is still room for improvement. Lees (2004) are optimistic about the improvement of cultural diversity in this country, they state that multicultural and diversity will flourish in the UK, although racism and British imperial history may act as obstacles. In practice the writer felt that professionals are being too sensitive and careful when caring for clients from a different cultural background to theirs.

This could be because of lack of knowledge or complains that are made with clients and relatives as a result of their needs not being met in hospital. Patients are most likely going to feel alienated as they are being judged before full assessment has been carried out for example; most nurses presume that all Asian people are Muslims. Le Var, Gerrish and Papadopoulos (1999) believe that cultural care is more than responding to the patient’s religious, dietary and dying needs, which encompass cultural safety, and attention to cultural sensitivity, communication, respect for cultural beliefs, equality of access to treatment and care and antioppressive and discriminatory practices. As a whole the writer thinks that nurses are not well equipped to deal with the more significant aspects of culturally specific needs of their patients. Narayanasamy (1999) acknowledges this by stating that there are more than 3000 cultures and it will be almost impossible to be expects in them all.

Appendix 1
While on placement we had a new male admission called Nathan who came in as an informal patient, he was a black male Caribbean Rastafarian. As part of his culture Nathan did not eating meat and smoked cannabis quite heavily. On his arrival he was allocated a named nurse who was going to assist him in settling in the ward and establish his care needs. He was offered access to interpreting and translation services to help with communication, it was later discovered that he did not need any of the services. Staff members and other clients did not have any problem with linguistic limitations since Nathan’s English was good. He could express his wishes and problems with no difficulty. The reason he was admitted was because he was getting forgetful and not taking care of his hygiene, nutrition and medically. His neighbours were getting worried as he would go and knock on their doors at midnight asking for unnecessary things. Nathan was also vulnerable with his money as he could not keep it safe and sometimes giving it away to little children in the streets and keeping large amounts in his flat. Nathan was in his mid sixties and lived alone, he had community nursing team who would go to his flat once in the morning everyday and set up his nebuliser and assist with medication. His only living sister lived in Coventry and she would come and visit him once every month. Nathan had dreadlocks and his hair was in a terrible state due to self neglect. The nursing involved Nathan in decision making towards his care to promote independency at present and in future. Nathan had vegetarian meals provided for him, a hair dresser was also arranged to come and wash his hair regularly. Nathan’s sister agreed to pay the hair dresser’s charge and was also going to bring him more cigarettes. Health promotion sessions where given to Nathan to help him with his smoking and the dangers of it t o his health.

Appendix 2
The ACCESS MODEL: A Transcultural nursing practice framework by Aru Narayanasamy, 1999

•Assessment: Focus on cultural aspects of clients’ lifestyles, health, beliefs, and health practices •Communication: Be aware of variations in verbal and non verbal responses •Cultural negotiation and compromise: Become more aware of aspects of other people’s culture as well as understanding clients’ views and explaining their problems •Establishing respect and rapport: A therapeutic relation who portrays genuine respect for clients’ cultural beliefs and values is required. •Sensitivity: Deliver diverse culturally sensitive care to culturally diverse groups •Safety: Enable clients to derive a sense of cultural safety

•Andrews, M.M. and Boyle, J S. 1995. Transcultural concepts in nursing care. Lippincott, Philadelphia Beck C K, Rawlins R O and Williams S R (eds) (1988). Mental Health Psychiatric Nursing: A Holistic Life Cycle Approach. St Louis: Mosby •Cortis, J. (2000). Cultural Assessment in Nursing: A Positional Paper. Bradford, Bradford College and Bradford University. •Gerrish, K and Papadopoulos I (1999). Transcultural competence: the challenge for nurse education. British Journal of Nursing. 8 (21) pp. 1453-1455 •Herberg, P (1989) theoretical foundations of transcultural nursing. In: Andrews M M, Boyle J S Transcultural concepts in nursing care, 2nd edn. Lippincott, Philadelphia. •Kenworthy, N. Snowley, G. Gilling, C. (2002) Common Foundation Studies in Nursing. 3rd edn. Churchhill, livingstone. London. •Nursing and Midwifery Council (2004). Code of Professional Conduct: Nursing, Midwifery and Health Visiting. London: NMC. •Nursing and Midwifery Council (2005). Guidelines for professional practice. London: NMC. •M and Lees. S (2004). Promoting cultural competence in healthcare through a research- based intervention in the UK. Diversity in Health and Social Care. 1 pp. 107-115 •Papadopoulos, I. (2006) the Papadopoulos, Tilki and Taylor Model of developing Cultural Competence. In Papadopoulos, I. Ed Transcultural Health and social care Development of Cultural competent Practitioners. Livingstone: Churchill pp. 7-26 •Polaschek N, R (2001). Cultural safety: a new concept in nursing people of different ethnicities. Journal of Advanced Nursing 27 (3) pp.452-457 •Rawaf, S and Bahl, V. (1998). Assessing health needs of people from minority ethnic groups. Royal college of Physicians. London. •RCN (1998). The Nursing Care of Old People from Black and Minority Ethnic Communities. RCN. London. •Rungapadiachy, M. (1999) Interpersonal Communication and Psychology for Health and Care Professionals. Butterworth-Heinemann. Oxford

•Goode, E.E (2003). The cultures of illness. US News and World Report. 114 (6) pp.74-76 •Le Var RNH. (1998). Improving educational preparation for transcultural health care. Nursing Education Today 18: 519-33 •Narayanasamy A. (2002) The ACCESS model: a transcultural nursing practice framework. British Journal of Nursing. Volume 11. Chapter (9). pages 643-50 •Narayanasamy, A. (2003) Transcultural Nursing: how do nurses respond to cultural needs? British Journal of Nursing 12(3), p 79-84 •Nolan P. (2003) ‘Learning to Live Together: Community Relations Education in Northern Ireland’. Journal of Adult and Continuing Education, Vol. 9, no. 2, pp.140-148. •Ogunsola, A. (1990) Roots and branches: Papers for the Open University/Health Authority. Winter school on community development and health. Buckingham. Open University press (1991)

•Royal College of Nursing (1998). Transcultural health care practice: Mental health and minority ethnic groups. (Online). Available from: www.rcn.org.uk/resource. (Accessed 26 November 2007)