Understanding and implementing culturally competent and culturally congruent care are the key factors for effective and excellent nursing care (Srivastava, 2007). However, health care provider’s roles and responsibilities in meeting health care needs of the clients in consideration to cultural perspective and diversity are getting more challenging and complicated due to increased number of people from a group of multi-ethnic and multi-cultural society, which, in turn requires health care providers to acknowledge and understand variations of cultural healthcare beliefs, values and practices.
Transcultural nursing is essential in the process of nursing care because of the different factors, which includes increasing diversity and multicultural identities, emergent use of health care equipment that occasionally dispute the cultural ethics and beliefs of the clients and a rise in feminism and gender issues (Andrews &ump; Boyle, 2008). Maier-Lorentz (2008) states that the fundamental aspect of healthcare is transcultural nursing since culturally competent nursing care help guarantee patient satisfactions and health beneficial outcome.
According to the Royal College of Nursing (2009), providing care with respect to health and illness based on the expectations of the people’s values, beliefs and practices corresponding with culture is the focal point of transcultural care. Influenced by the principles and theories of transcultural nursing, the author defines transcultural nursing as a discipline of culturally care for individuals, families, groups and communities representing different cultural lifestyle, values, habits, life process, beliefs and practices.
Furthermore, the author believes that the aims of transcultural nursing are to bestow effective and excellent care to people from diverse backgrounds and avoid cultural conflicts and negligence related to health care practices. Transcultural nursing helps ensure effective communication, accurate assessment and culturally appropriate interventions to patients with distinct cultural backgrounds.
(Andrews &ump; Boyle, 2008; Giger &ump; Davidhizar, 2004) Galanti (2008) report that increased patient contentment to health, developed and improved medical outcome and greater cost productivity are the main benefits of effective transcultural and culturally competent care. To provide effective transcultural care, nurses should have the required knowledge, skills, attitude, values and awareness in caring for people with different cultures.
Nurses should understand the different cultures of the society they are caring for and develop awareness of ones own culture and ethnic identity to avoid biases, misunderstanding and prejudices to other culture (Royal College of Nursing, 2009). For the purpose of this essay the author will critically discuss and evaluate Campinha-Bacote’s Model of Cultural Competence (2003) and focus on the application of the above-mentioned model in the process of nursing care. The author chose the aforementioned model of transcultural nursing because the model specifically tackles the importance of culturally competent care in nursing practice.
It is also concise, specific and easy to understand. Moreover, the model is simply applicable in all areas of healthcare practice. Aside from being useful as a structure in providing culturally relevant healthcare services, Campinha-Bacote’s model of cultural competence has been endorsed and recognized as a guiding framework for organization and administration development (Brathwaite, 2009; Campinha-Bacote &ump; Munoz, 2001). In the author’s point of view the model is categorically specific, measurable and systematically applicable in the assessment of healthcare provider’s competency in cultural care.
In addition, the nurses can use the model as a step by step guide to understand and practice culturally competent care without biases and misunderstanding to other culture. However, like in the other theories and models of transcultural nursing, limitations also hits Campinha-Bacote’s model of cultural competence (2003). In the author’s point of view, the model is not comprehensive; it merely focuses on cultural attributes of healthcare providers in providing culturally competent care.
Capell, Veenstra &ump; Dean, (2007) report that the model is limited solely to the assessment and evaluation of the cultural competence of healthcare professional but the patient’s cultural attributes and possible health outcomes are not addressed. Campinha-Bacote’s Model of Cultural Competence (2003) is figuratively illustrated as a volcano in which the cultural desire serves as a stimulus in the course of cultural competence. Once the cultural desire erupts, strong inclination in seeking cultural awareness, attaining cultural knowledge, searching for cultural encounters and showing cultural skills take place.
The model regards cultural competence as a continuing process for healthcare providers in achieving culturally competent care. It consists of five major constructs which includes cultural awareness, cultural knowledge, cultural skill, cultural encounters and cultural desire, as discussed below based on Campinha-Bacote’s model of care (2002). Cultural awareness is the process of introspection and detailed exploration of one’s own cultural background. It involves avoidance of cultural imposition (imposing personal beliefs, values and behaviour on another culture).
Cultural awareness helps identify one’s predisposition, prejudices, biases and assumptions to individual with diverse cultural backgrounds. The stages of cultural awareness are unconscious incompetence, conscious incompetence, conscious competence and unconscious competence (Weber &ump; Kelley, 2009). Cultural knowledge is the process of searching and acquiring fundamental facts and information about different cultural and ethnic groups focusing specifically on the issues of health-related beliefs and cultural values, disease prevalence and treatment effectiveness.
Whereas, cultural skill is one’s own capability in gathering relevant cultural information concerning to patient’s problem and accurately conducting culturally based physical assessment. Cultural encounters, on the other hand, are defined as a process that inspires healthcare provider to continuously engage openly in cross-cultural relations to individual with diverse cultural backgrounds. In addition, cultural encounter helps avoid possible stereotyping and culture-related negligence.
Lastly, cultural desire is the driving force of the healthcare provider to participate in the process of becoming culturally aware, knowledgeable, skillful and familiar with cultural encounters (Campinha-Bacote, 2003a). The author as a healthcare assistant working in the nursing home will present a case study of a patient who is confined in the frail unit of the care home. The author nursed the patient for more than three months until now and was able to have continuous one to one interaction occasionally.
The author will critically discuss the relevant culture-related aspect of care of this patient and identify transcultural challenges encountered from admission to the delivery of care. Moreover, using Campinha-Bacote’s Model of Cultural Competence (2003), the author will critically address and discuss the patient’s culture-related issues and care through the process of assessment, planning, implementation and evaluation. Mrs. Somers is an 88 years old British Asian who was born and grew up in Birmingham, England but presently residing and transferred to Kent, England eleven years ago. She was discharged from a tertiary hospital and admitted
to the nursing home where the author works on the 16th of October, 2010. She was diagnosed with osteoporosis, respiratory infections, rheumatoid arthritis, hypertension and myocardial infarction aside from a history of right hip replacement and spinal fusion approximately seven years ago. She was admitted to the nursing home because she needs partial to full assistance on her activities of daily living due to her present condition. Apparently, her only child is in France at the moment and no one could look after her as her whole family is in Birmingham. Mrs. Somers mentioned that she came from a happy or “lovely” family as she termed it.
Her mother is English while her father is half British and half Indian. She has two siblings and she is the eldest and the only girl among them. Aside from being used to the British culture as she was raised here, Mrs. Somers points out that her parents specifically her father thought her with some Indian cultures that she continuously practiced until now like dressing modestly, as all her clothes are below the knee and must cover the shoulders. Family roles and organization is a big issue for Mrs. Somers. She is married to a nurse. According to her, she has a prosperous life with her one and only child.
She gets whatever she wants and considers herself as the luckiest person in the world until her husband died in 1989 and problematic personal issues appears, which is the same reason why she leaves Birmingham with her child and transferred to Kent. As for workforce, Mrs. Somers is a nurse same with her husband. No high-risk behaviors was identified as she does not smoke or drink alcohol. On pregnancy and childbearing practices, Mrs. Somers explained that she did not opposed contraception but she was extremely against abortion. For communication, Mrs. Somers speaks two languages, Hindi and English.
She prefers to socialize more with women and avoids physical contact with men in public. As she is adapted to English culture, eye contact in communication and punctuality is very significant. In addition, Mrs. Somers honestly said that sometimes as part of being Indian, she just can’t say no when asked by someone. She sometimes has a habit of offering a response that she thinks someone wants to hear. In terms of religion, Mrs. Somers mother is a Catholic while her father is a Sikh. Even though her parents are practicing two different religions, the siblings were given the free will to choose which religion they would wish to follow.
Mrs. Somers chose Catholicism but said that she also has high regards to Sikh beliefs and practices. In accordance with spirituality, Mrs. Somers pray three times a day, every morning after she wakes up, every afternoon (6pm) with the holy rosary and before she go to sleep in the evening as she explained when asked about her prayer routine. On death and dying issues, Mrs. Somers believe in life after death, that the soul still exist after death and judgement, either to heaven, purgatory or hell. Mrs. Somers added that she is against euthanasia.
She further added that the sacrament of the dying and sick is essential as it will comfort the ill person and make them feel secure. Their family practiced common death rites which include washing and draping the body with white cloth, but prefer cremation after death. With regards to her Nutrition and Dietary habits, Mrs. Somers prefer to eat British foods like sandwich, fish and chips, pies, lamb and chicken served with potatoes and one other vegetable. In addition, as being part of Catholicism, she practiced meat restriction every Friday and fasting on specified holy days especially during lent.
In terms of health care belief and practices, Mrs. Somers consider medical treatment at the same time with natural/ traditional remedies as her father thought her. For instance, for fever she drinks chamomile tea, for cough and congestion she put formaldehyde crystals in a plastic bag and places it on her chest and for indigestion she drink buttermilk. Mrs. Somers further added that she takes cod liver oil daily to maintain health. She also mentioned that after cleaning a sick room she drinks brown ale to prevent catching the disease.
Using Campinha-Bacote’s Model of Cultural Competence the author will now illustrate how the aforementioned model will help the health care workers to provide culturally competent and quality nursing care. To provide excellent and culturally competent care to this patient, health care provider must reflect first and informally assess their level of cultural competence using the mnemonic, ASKED – Awareness, Skill, Knowledge, Encounter, Desire (Campinha-Bacote, 2003b). The care workers of Mrs. Somers may ask themselves with the following questions: For Awareness: Am I sensitive and supportive to the values, beliefs and life ways of Mrs.
Somers? Am I aware to my personal prejudices and biases towards the culture of Mrs. Somers? How can my own cultural beliefs and background affect the care that I need to give to Mrs. Somers? If Mrs. Somers cry for help and become demanding, should I ignore or disregard her? Would I behave like this toward any of my other patients? For Skill: Do I have the skill to conduct a cultural assessment in a sensitive manner? Do I have a skill to perform culture-based physical assessment and interpret the data accurately? Is there any language barrier in communication?
For Knowledge: Let me ask Mrs. Somers if she’s more used to British culture or Indian culture? Let me ask her about her cultural beliefs and practices that may affect the quality of nursing care. For Encounters: The care worker would like to care for other British Asian clients to learn more and gain additional knowledge and skills. For Desire: The health care provider showed signs of cultural desire by wanting to participate in the process of becoming culturally aware, knowledgeable, skillful as well as considering ways to have additional encounters with other British Asian patients.
The author will now critically discuss the cultural challenges identified as well as the aim, plan and evaluation of care based on the information obtained from Mrs. Somers. One of the identified cultural challenges is in the area of communication and cultural behaviour. As mentioned above, Mrs. Somers claimed that she sometimes has a habit of offering a response that she thinks someone wants to hear. This cultural behaviour serves as a barrier in providing excellent cultural care. For instance, the care worker asked Mrs. Somers if she wants to join in the fun art activity with other residents, Mrs.
Somers said yes, but in the actual activity the care worker noticed that Mrs. Somers is not doing the activity, don’t want to interact with others and not as bubbly as she usually was. When the care worker asked her if she’s alright, Mrs. Somers said that she’s not feeling well and wants to be alone in her room. So, the care worker decided to bring Mrs. Somers back to her room and asked if she wants anything, Mrs. Somers replied that she just want to have a rest with the music on while having a cup of tea. When the care worker followed her request, Mrs. Somers become relaxed and looks happy.
Care worker can overcome this barrier by looking for nonverbal cues such as facial expression that shows reluctance or excitement or enthusiastic response. Evaluation revealed positive outcome as the care worker makes Mrs. Somers comfortable and fulfilled. Another cultural problem identified is in the area of heath care belief and practices. The doctor wants to change Mrs. Somers old medications for heart condition and hypertension to the more effective one but the problem is, Mrs. Somers is still taking cod liver oil that may counteract and lessen the effectiveness of the new medication.
When the doctor and the nurse explained and politely asked Mrs. Somers if she can stop taking cod liver oil, Mrs. Somers refused and get mad. Then, the doctor decided not to change the medication and lessen up the dosage that Mrs. Somers taking up for her cod liver oil. Care provider explained to Mrs. Somers that she can still include her natural remedies if it is not dangerous to her health but she must still need to follow her medical treatment to improve her health. Evaluation revealed positive outcome as care provider respect and value patient’s right and cultural beliefs while giving best possible care.
Healthcare professionals can overcome this cultural problem by providing better alternative actions while respecting patient’s right and cultural practices (Zerweck &ump; Claborn, 2006). In conclusion, the main goal of transcultural nursing is to promote culturally competence care. However, excellent and quality cultural nursing care is impossible to achieve unless care provider acquire knowledge and skills in cultural health care as well as learn and apply cultural competency models into practice (Dayer-Berenson, 2009).
The author learns that to attain cultural competence and provide adequate cultural care, healthcare provider should develop the desire to achieve congruent care, be aware to any personal biases and prejudices, acknowledge and support other person’s cultural belief and practices, avoid stereotyping and cultural imposition and most importantly identify and overcome the barriers to effective assessment and intervention.
Understanding one’s own culture, being supportive, appreciative and sensitive to other culture and differences are the key factors to achieve cultural competence. The author recommends that aside from being focused to care provider’s cultural competency and cultural assessment, transcultural nursing theories and concepts also needs to develop ways on how to avoid cultural negligence, overcome personal biases and resolve cultural barriers that may affect quality nursing care.