Download 18. Caring in Nursing Practice, Culture and Ethnicity

Caring in Nursing Practice,
Culture and Ethnicity
Nursing Care Delivery
Nursing care can be carried out through a variety of
organizational methods.
The model of nursing care used varies greatly from one facility
to another and from one set of patient circumstances to
another.
NURSING CARE DELIVERY MODELS
The four classic nursing care delivery models used during
the past five decades are
• total patient care,
• functional nursing,
• team nursing,
• primary nursing.
TOTAL PATIENT CARE
The oldest method of organizing patient care is total patient care,
sometimes referred to as case nursing. In total patient care
nurses are responsible for planning, organizing, and
performing all care, including personal hygiene, medications,
treatments, emotional support, and education required for their
assigned group of patients during the assigned shift
FUNCTIONAL NURSING
In the functional nursing method of patient care delivery, staff
members are assigned to complete certain tasks for a group of
patients rather than care for specific patients. For example, the
RN performs all assessments and administers all intravenous
medications; the LVN/LPN gives all oral medications; and the
assistant performs hygiene tasks and takes vital signs. A
charge nurse makes the assignments and coordinates the care.
TEAM NURSING
• Originated in the 1950s and 1960s.
• Involves use of a team leader and team members to provide
various aspects of nursing care to a group of patients.
• In team nursing, medications might be given by one nurse
while baths and physical care are given by a nursing assistant
under the supervision of a nurse team leader.
• Skill mixes include experienced and specially
qualified nurses to nursing orderlies.
• The quality of patient care with this system is
questionable, and fragmentation of care is of concern.
PRIMARY NURSING
Primary nursing refers to comprehensive, individualized care provided
by the same nurse throughout the period of care.
Primary nursing is a method of nursing practice which emphasizes
continuity of care by having one nurse provide complete care for a
small group of inpatients within a nursing unit of a hospital.
This type of nursing care allows the nurse to give direct patient care.
The primary nurse accepts total 24-hour responsibility for a
patient’s nursing care.
Nursing care is directed toward meeting all of the individualized
patient needs.
The primary nurse communicates with other members of the
health care team regarding the patient’s health care.
This care method is rejected by many institutions as too costly.
PROGRESSIVE PATIENT CARE
• PPC is a system of nursing care in which patients are placed in
units on the basis of their needs for care as determined by the
degree of illness rather than on the basis of a medical
specialty.
• Organization of medical and nursing care according to the
degree of illness and care requirements in the hospital.
Progressive patient care is the systematic grouping of patients
according to their degree of illness and dependency on the
nurse rather than by classification of disease and sex.
It is a method of planning the hospital facilities, both staff and
equipment, to meet the individual requirements of the patient.
PPC has been defined as "the right patient, in the right bed, with
the right services, at the right time"
Elements of PPC
▫ Intensive care units for critically ill patient
▫ Self-care units for convalescent patients or those requiring
investigation.
▫ Intermediate care units for those patients not requiring to
be housed in either of the foregoing, and who would
constitute approximately 60%, of all patients in hospital.
▫ Beds attached to out-patient departments for " one day"
patients.
The elements can also be named as intensive care, intermediate care,
self-care, long-term care, and organized home care.
Major concepts of PPC
• PC is defined as better patient care through the organization of
hospital facilities, services and staff around the changing
medical and nursing needs of the patient
• PPC is tailoring of hospital services to meet patients needs
• PPC is caring for the right patient in the right bed with the
right services at the right time
• PPC is systematic classification of patients based on their
medical needs
JEAN WATSON NURSING THEORY
Jean Watson nursing theory is also known as the Theory of
Human Caring. This theory was developed by nurse Jean
Watson, a highly respected professor at the University of
Colorado. Ms. Watson's theory focuses on the idea of bringing
basic love and caring back into healthcare.
Watson's theory was radical in that it stated that caring should
come before curing. Caring is a choice nurses make in their
clinical interactions, and caring should be the bedrock of
nursing practice. To care for patients, nurses must respect their
value as a human being and the sensitivity of their situation. In
Watson's theory, caring preserves human dignity in healthcare.
Some aspects of caring theory..
• Caring Occasions: The
caring occasion is a
particular moment in time
when the patient and nurse
connect. During the caring
occasion, the two share life
experiences and a
connection on the spiritual
level. In person-to-person
encounters nurses can use
touch, eye contact, body
language, a positive attitude,
and listening skills to foster
a caring occasion.
Healing Consciousness
• Healing consciousness is also referred to as caring
consciousness. Caring consciousness is the mindset the nurse
brings to healing. A nurse with a caring, healing, and loving
consciousness can transcend a physical moment of clinical
care, to make a connection with a patient. To develop a healing
consciousness, nurses must find a balance between their own
belief systems and the belief systems of others.
Transpersonal Caring
• Transpersonal caring refers to caring for another person's spirit
and well-being, on a nonphysical level. Nurses practicing
transpersonal caring are respectful of their patients' life space
and condition of being. During transpersonal caring, nurses
focus on healing and wholeness of the patient, rather than a
disease to be cured. Nurses provide an emotionally and
physically calming presence for patients.
Culture
• Culture may be defined as "the learned and shared beliefs, values
and life ways of a designated or particular group that are generally
transmitted intergenerationally and influence one's thinking and
action modes."1 Many assume overcoming language barriers or
having a basic understanding of some ethnic practices is enough to
successfully address the needs of diverse clients within our
practice. However, this is not the case.
• Cultural competence and respect for others becomes especially
important for us in the nursing practice because we are patient
advocates.
• Cultural competence is the capacity of individuals or services
to incorporate ethnic/cultural considerations into all aspects of
their work relative to health promotion, disease prevention and
other healthcare interventions. It also is described as the ability
to perform and obtain positive clinical outcomes when
engaging in cross-cultural encounters. Acquiring skills related
to culturally competent nursing practice is important for better
client outcomes, satisfaction and quality of care.
The five essential elements of cultural competentce:
• Valuing diversity
• Having the capacity for cultural self-assessment.
• Being conscious of the dynamics inherent when cultures
interact.
• Having institutionalized cultural knowledge.
• Having developed adaptations of service delivery reflecting an
understanding of cultural diversity.
• To be culturally competent the nurse needs to understand
his/her own world views and those of the patient, while
avoiding stereotyping and misapplication of scientific
knowledge. Cultural competence is obtaining cultural
information and then applying that knowledge. This cultural
awareness allows you to see the entire picture and improves
the quality of care and health outcomes
Nurses can increase their own cultural competencies
by following a few guidelines:
• Recognizing cultural differences and the diversity in our
population.
• Building your own self-awareness and examining your own
belief systems.
• Describing and making assessments based on facts and direct
observation.
• Soliciting the advice of team members with experience in
diverse backgrounds.
• Sharing your experiences honestly with other team members
or staff to keep communication lines open. Acknowledging
any discomfort, hesitation, or concern.
• Practicing politically correct communication at all times –
avoid making assumptions or stereotypical remarks.
• Creating a universal rule to give your time and attention
when communicating.
• Refraining from making a judgment based on a personal
experience or limited interaction.
• Signing up for diversity and inclusions seminars.
• Becoming involved in your agencies diversity programs – find
out what your resources are - most institutions have something
in place.
Culturally diverse nursing care
• An optimal mode of health care delivery, refers to the
variability of nursing approaches needed to provide
culturally appropriate care that incorporates an
individuals cultural values, beliefs, and practices
including sensitivity to the environment from which
the individual comes and to which the individual may
ultimately return.
Stages…
Cultural awareness
• which begins with an examination of our
personal value base and beliefs. The nature of
construction of cultural identity as well as its
influence on people's health beliefs and practices
are viewed as necessary planks of a learning
platform.
Cultural knowledge
• Cultural knowledge (the second stage) can be gained in a
number of ways. Meaningful contact with people from
different ethnic groups can enhance knowledge around their
health beliefs and ehaviours as well as raise understanding
around the problems they face. Through sociological study the
students can be encouraged to learn about power, such as
professional power and control, or make links between
personal position and structural inequalities.
Cultural sensitivity
• An important element in achieving cultural sensitivity (the
third stage), is how professionals view people
• in their care. Unless clients are considered as true partners,
culturally sensitive care is not being achieved;
• to do otherwise only means that professionals are using their
power in an oppressive way. Equal
• partnerships involve trust, acceptance and respect as well as
facilitation and negotiation.
The achievement of the fourth stage (cultural competence) requires the
synthesis and application of previously gained awareness, knowledge and
sensitivity. Further focus is given to practical skills such as assessment of
needs, clinical diagnosis and other caring skills.
A most important component of this stage of development is the ability to
recognise and challenge racism and other forms of discrimination and
oppressive practice. This model combines both the multi-culturalist and the
anti- racist perspectives and facilitates the development of a broader
understanding around inequalities, human and citizenship rights, whilst
promoting the development of skills needed to bring about change at the
patient/client level.