Enhancing Cultural Competence in Nursing Practice

Problem

Nurses are the front line of care, each nurse in Canada encounter different types of cultures such as Muslims, Jewish, and many more cultures. I remember one of my experience where I was in last year of my Bachelor of Nursing and assigned in the obstetric ward for my clinical case management. One of the rooms in the ward was composed of five-bed capacity, my task is helping them to do morning care, bedside care and washing them up is included. Majority of the clients are able to stand on their own two feet and all I can do is to get them a basin and water, position them and provide privacy.

One of the clients rejected me because of being a male nurse. A woman patient is not comfortable with a man in providing her the morning care, bedside care and washing her up. I was so sensitive with her concern and I asked her “why you feel that way?” She mentioned that they were Muslim and it was their culture that nobody can touch them either the husband or the same gender I respected their decision and I informed my clinical instructor about the case and resolved the problem with the client.

Strategies

Nurses must enhance their ability to provide patient-centered care by reflecting on how the culture, values, and beliefs can affect the relationship between nurse and patient (CNO, 2006). In my experience as a nurse I started with the following strategies:

• To establish rapport by introducing myself on first meeting, used her name in calling her attention, I listen and address her concerns, maintain eye contact with appropriate nonverbal response like nodding and smiling, speak to her calmly and slowly, making sure in providing privacy and the most important is maintaining professional boundaries.
• Establish and maintain a relationship with the client base on my knowledge and skills. Even though I showed a professional relationship with a clear intention the patient still refused my care and it was based on their cultural beliefs and practices as Muslim. Muslim clients should always be modest and privately respected during hospitalization, and ideally, doctors and nurses of the same sex should be cared for, this is particularly important for the care of maternity or gynecology (Rassool, GH, 2015).
• I reiterated to the client that the intention and relationship are plainly professional.

Goal Statement for Future Learning

• To identify my gaps in providing nursing care among culturally challenge client and;
• To understand culture and ethnicity in providing culturally sensitive care.
• As an RPN Student, I will prioritize to obtain the knowledge of the roles and responsibilities of an RPN under the CNO. It will be achieved by March 26, 2019.

Goal: Activities and Timeframe

• By March 20, I will gather my resources from CNO, Canadian Fundamentals of Nursing and RPNAO to further understand what cultural nursing is.
• By March 21 to 23, I will read about cultural diversity, gender preference of client and culturally sensitive care.
• By March 24 to 26, I will write a Cultural Reflective Paper with Program Learning Plan Form related to my personal experience.
• I am going to enlist myself to seminar symposium related to cultural nursing

1. In the study of Kauffman, S. 2018 the Preference for Female Obstetrical Provider among Muslims. Most of the patient prefer to have a female doctor and they are fine with male doctors if female doctors are unavailable. If I compare my case with this study the conflict in providing care is the profession and the scope of practice that doctors are highly respected by the client and the availability of health care providers on the floor.
2. The Therapeutic Nurse-Client Relationship Practice Standard of CNO will help nurses to accommodate the issue of gender preference. The following are the strategies to deal with the issue:
   • Even if the patient isn't comfortable with the health provider. Client's well - being is the primary concern in providing Client-centered care, and it also depends on the weight of the case if emergency or not.
   • Patients should be treated respectfully and compassionately. Competent patients have the right to refuse undesirable treatment and unwanted healthcare provider.
   • Students, healthcare workers, and medical practitioners should be fair.
   • Health care providers should not deal with the situation on their own. There are important roles in navigating clinical meetings where patients seek the gender preferences of care for all members of the health care team
3. Cultural Gap Between Nurse-Client Relationship

The main objective of health care providers is to provide care to clients with maximum holistic and culturally competent care. To achieve this, we must always keep in mind that the patient is taken care of as they want you to take care of them. To provide culturally competent care and identify my gaps on my previous experience, it is important to understand the difference of views and how their culture affects the thinking of people from different origins by gaining the knowledge, skills, and attitude.

• Improving knowledge about the culture base is the first step to strengthening cultural competence. To acquire the knowledge, we have to LEARN to Listen with sympathy and understanding to the patient's perception of the problem. Explain your perceptions of the problem, Acknowledge and discuss the differences and similarities, Recommend treatment, and Negotiate treatment
• Attitude plays a major role in becoming and serving as a culturally skilled caregiver. Try to understand the basics of all cultures you engage with, such as spirituality, customs, and hierarchy of the family
• It can be accomplished by focusing on skills such as communication and conflict resolution to develop a skill set based on increasing your cultural competency.

Conclusion

The relationship between a patient and nurse acquires increased stability and stronger bond if we treat them as a person and understand that every person has a culture and they hold great importance for the patient (CNO, 2009). Cultural nursing skills focus on knowledge, attitude, and skills. Working consistently to be culturally capable is a compassionate and respectful exercise. As nurses, we are responsible for integrating that cultural teaching into our practice while caring for various clients and families. In doing so, our patients will consider us more trustworthy, which will eventually lead to satisfied patients, satisfied nurses through their contribution to care, and positive outcomes for patients.