Genogram Analysis: Cultural Competence Among Nursing Students

Abstract

Cultural competency encompasses the ability to positively see other people’s world after you have understood your own. It includes the attitudes, beliefs, and behaviors that makes up the individual. Through assessment, nurses have the ability to collect information about their patients that other professionals do not have the time to do. In this assignment, I was able to interview my classmate, AC, and gain significant knowledge about who she is as an individual and how to she came to be who she is. The world is made of a diverse population and this can cause problems when nurse must communicate with and education their patients. Through this assignment, I was able to improve my interview skills, improve my understanding of AC, and remain nonjudgmental in my assessment. The topics that were discussed included: heritage, culture, health, and our families’ genogram.

Introduction

Born in Raleigh, North Carolina, I was raised by two devoted, educated parents. My mother, Donna, was born and raised in Bluefield, West Virginia whereas my father, Mark, lived in multiple places before residing in Norfolk, Virginia. I was raised in the midst between two siblings, a brother and sister, and instilled the value of church and family life. We were taught that family meant everything so we must preserve it. I am currently 27 years old and identify as a single heterosexual Caucasian woman. I attended college previously at East Carolina University and obtained my first degree in Health Service Management. After I graduated, I chose to work first before thinking about going back to increase my education. I moved to Roanoke in 2017 and began working in Carilion Clinic’s Health Analytics department as a Health Analytics Consultant I. There, I learned new skills and had the opportunity to present in conferences as well as be a forerunner in creating business intelligence dashboards. It is in this position I grew in my respect for the operational and data leaders in the medical field. In 2019 I reached a fork in the road; I was promoted in my position to a level II but I wanted more. I wanted to pursue my passion of being in the trenches, so to speak. I wanted to be the one to improve patient care firsthand. My decision was to move to flextime and being Nursing school.

On the first day of nursing school orientation I met my now classmate, AC. Her story and background were similar mine and we instantly became good friends. AC is a 27-year-old single Caucasian heterosexual woman that was born and raised in Rocky Mount, Virginia. She has a twin brother and no other siblings. Like myself, AC is aiming to obtain her second degree with Nursing. She attended Radford University in the past and gained a Bachelor of Business Administration of Marketing. She currently works in the Resource Pool at Carilion Clinic as a Certified Nursing Assistant.

Similarities in the Genogram

Heritage

The practices of our upbringing, known as heritage, have been passed down through the years. Through it, we can see what traditions we will continue to keep and teach to our own children. Born of English and Irish descent, AC and I have a tradition to go to church on Sundays and read our Bibles. AC followed her parents and grandparents' footsteps to do devotionals in addition to attend church. My grandfather was a pastor and liked to sing hymns with me. In our family aspect, both AC and I had a large focus on family. We both believed in attending family functions and remaining close to each other. AC goes to annually family reunions whereas I attend family reunions that are every couple of years. We both make a point to go to family functions, especially around holidays. Family doesn’t just include the two-legged kind. Having animals around was another similarity AC and I had when we discussed our heritage. AC and her family had a couple of dogs growing up and now have a Yorkie-Pom, named Lily. My family had dogs and a cat growing up. We cherished the moments we had with them but after they all passed, my parents decided it was not a good time to get another animal. I currently have a feline companion, an American short haired, name Piper, that I treat as one of my family members.

Culture

An individual’s culture includes everything that is thought, says, or does that make up the learned attitudes and beliefs that is transmitted from generation to generation. As a child, my siblings and I were told that we must speak up, make good decisions, and do what’s right. Good manners were always the first thing we needed to think of when interacting with others. AC’s childhood had similarly ideologies in that she was taught to take care of herself mentally, physically, and spiritually, and always speak her mind. We both were told hard work will get you places, and God is number 1. We believed in God and that he will always provide for what we need and because of this belief we were both lead to get baptized. The idea of baptism means we are washing away our sins and admitting the Lord is our savior. Both of our parents also instilled the notion that sunscreen was essential if we were to take care of our pale skin. Our similar descent, English and Irish, has partial blame for this as well.

Health

Illness affects many families, and as a child, both AC and I were vaccinated and continue to stay vaccinated each season, including the flu shot. Western medicine has come a long way and AC and I continue to utilize the benefits it provides. We make sure to go to our primary care providers when we are struggling to stay well, if we have questions about our health, and get services done. We both know and focus on healthy living. Eating meals with appropriate health benefits are important but we both struggle to stay on the wagon of healthy living. Home remedies played a large role in AC’s life of staying in good health. She was taught to make concoctions to keep colds away as was I. My parents strongly encouraged the use of gargling salt water to help with sore throats whereas AC’s family used a moonshine and honey mixture to “knock the cold out of ya”. We both must be sensitive to certain foods. Due to AC’s diabetes, she has to be sensitive to how much sugar she can consume. I have to be sensitive to the amount of dairy I ingest due to a lactose sensitivity.

Genogram

When looking at AC’s and my Genogram there is a strong similarity of heart diseasing running through our families. We both have histories of high cholesterol and lung cancer. We also have one grandparent on each side of our family passed on. Both of us have a brother and our parents still alive. Based on information gathered from her grandfather, AC’s grandmother suffered from an undiagnosed mental disorder. In my family, Dementia is more prevalent on my paternal side of the family. Both of our families have also someone that had lung cancer.

Differences in the Genogram

Heritage

Having a solid foundation of people, I can count is an essential component of my life. I rely on my family during difficult times but because I am in a different state, I also have strong ties to my friends since they are closer. Due to residing at home with her mother, AC still heavily relies on her family. She lives in an area where all of her family surrounds her. I left my parents after graduation and moved to another state, so my family members are scattered around. AC makes a point to always spend holidays with her family. Due to living out of state and having to take days off of work for holidays, I missed a few holidays with my family.

Taking photographs are something my parents always did when we took vacations, spend time with others, or had family reunions. They taught us to remember to capture memories so later we can pass them down. My parents love to bring out albums of books to show us our past relatives. As more of older relatives passed on, I really appreciate the pictures. My family also has a deep love for cookbooks. We have very old cookbooks from my great grandparents and grandparents. There is this one red cookbook called Carolina Cooking that we all have and love to use. On my mother’s side of the family we created our own cookbook with homemade recipes passed down.

Culture

My parents believed that eating as a family was important. So, they taught us the importance of home cooked meals. We didn’t buy a lot of processed food or ate what my mother said was “unhealthy”. In her mind, fast food and friend foods were not good so they were limited in our house. Today, I still don’t buy a lot of processed food, but I do eat some fast food. I make a lot of my meals from scratch, such as biscuits. Biscuits were that one item my dad loved to say all his kids could make from scratch. AC’s family wasn’t as strict with the limited eating out policy. AC loves Chick-fil-A and makes sure to get her breakfast every morning before clinicals or lab. Her mom sometimes makes her lunch for school and dinner after she gets off. Because of her diabetes, AC also has to be cautious with her intake so she could give herself enough insulin. Another difference between AC and myself is how much we drink. I like my occasion glass of wine or beer but the frequency of when I have a drink is few, i.e. every six months. AC is more opened in her drinking and has a glass of wine or beer in a higher frequency, once a week or month.

Health

I have no major diseases as a child, except for the occasion pneumonia, strep throat, and cold. Today, I only get treated for the occasion cold and checked for glaucoma. On my maternal side of the family, many of the females suffer from glaucoma. My mother and I are checked annually to make sure this do not develop for us. In AC’s childhood, there were no major disease until she was diagnosed with Type I diabetes in her young adulthood. AC focused heavily on going to the doctor when she is unwell. Though I believe this is important, I also use other methods to distress. Listening to music, getting a massage, reading a book, taking a bath, and taking a nap are other avenues I use to try and feel better. The frequency I go to the doctor is small; I diverged from my parent’s push to always go to the doctor. Instead, it takes me a longer to decide when to go to the doctor. Health eating and exercise are two other instances I focus on when making sure I stay healthy and well. I try to work out at least two days a week with a run or doing lifting whereas AC using a spin class to get her exercise in. One of my favorite beverages is coffee. AC does not drink coffee but instead likes getting her caffeine from soft drinks.

Genogram

When comparing my Genogram to AC’s, there is a lot of more prevalent conditions that her family must deal with. Her father has the factor IX deficiency and gout and her mother has diabetes and hypothyroidism whereas my father deals with high cholesterol and hernias and my mother had scoliosis as a child. Another interesting difference between AC and I is that both of her grandmothers have died whereas both my grandfathers has died. The years on which her grandmothers passed are close to mine. AC only has one sibling, whereas I have two and I am the middle child. AC’s parents have divorced and remarried whereas my parents are still married.

Journal Article

When people go into the nursing field, they accept the duty to take care of all their patients, no matter the race, ethnicity, gender, and culture. They have to be culturally diverse in order to take care of their patients wants and needs. After a mother gives birth, both she and the father must cope with their new positions as parents. In a 2016 article, a study was conducted about the struggles Thai teenagers face when they become parents. During the study, the selected teenagers were asked a series of questions to gain more knowledge about how the teenagers are preparing for parenthood and what kind of support are they receiving. The teenagers had to comprehend what is going on during pregnancy then alter their habits and lifestyle choices to prepare themselves for the impending child. They must receive support from either their family or outside resources. In this culture, the teenagers had to also work towards the goal of mothers being the caregiver while the father would be the breadwinner. Thailand has a high rate of teenagers giving birth in the past years while their rate for obstetric complications increases. Due to these complications there has been poor outcomes for the neonatal babies. In Thailand a law has been approved to allow abortions to be legal if there has been a rape, there are serious complications for the mother, or there will be a deformity of the child (Sriyasak et al., 2016). When interacting with expecting parents, it would be beneficial to offer resources, especially for young parents such as teenagers. Teenage parents are trying to be many roles when they are having a baby: parent, child, student, and worker. In the study, there are similar underlying concerns that each set of couples had to adapt to. Some of these include but are not limited to dividing labor in the household, concern about cost of living, practicing childcare, promoting the baby’s health, and sticking to traditional values. As nurse, there are opportunities that could be educating moments. For example before pregnancy, there could be emphasis on using contraceptives if the teenagers are sexually active. During pregnancy, the education could be towards how to take care of the baby and the changing of their roles. Some of the couples in this study were born into Buddhist families. In this religion, they must keep the infant because abortion is considered a sin.

In my own culture, I do not have the same beliefs towards teenage pregnancy. I don’t have negative thoughts towards those that have babies young. I believe it’s an unfortunate situation that has led to the pregnancy. As a Christian, I do not believe in intimacy before marriage and believe the concept of abortion is wrong. However, I also believe abortion is okay in certain situations: rape or complications to the mother or the baby. If the parents do not want the baby, I believe they could give the child up for adoption. I was surprised to learn of the acceptance and maturity Thailand teenagers are when they find out about their impending child. I do not have a child or had to go through pregnancy, but it is important to know how to help others going through this journey. It can physiological, socially, emotionally, and financially challenging.

Patient Experience

The purpose of Health Assessment is to learn the essential foundation for quality care and nursing interventions. We learn the how to discuss, assess, and identity the ways nurses can promote a healthy lifestyle in their patients. When I was talking to my partner about these topics, it was at first difficult to find a way to bring up their heritage and culture when we acted it if it was an actual head to toe assessment. I believe part of this was due to not understanding of the two words. I found when we acted as classmates it was easy to get the answers we needed. I realized based on this experience, it's important to build a rapport with my patients. I could start out by asking them about their family before asking if there was anything, they do to fight illness/infections. I struggled a little bit trying to keep my questions open-ended and not to just close-end questions. I found the close-ended questions helped me clarify or get a quick answer about a topic I knew could get derailed.

Cultural Competency in Nursing

The information gathered in this assignment can be applied to my own future care of patients because I had to understand where I came from before I could understand how other’s backgrounds can be different. I needed to create an open-minded approach on how the term health is universal but how it is defined is not. If I did not take this class or gather information for this assignment, my attitude, knowledge, and skill would be unbalanced. I must improve in my attitude and skills so that I can effective communication across language and cultural barriers. I have to be sensitive to the difference that I learn about others because no one will have the same heritage, culture, and health values as I do. Even though I believe my upbringing has modeled my mindset into the person I am today, I noticed that even I don’t have the same views I had as a child. I used to have the belief that I need to seek care the moment I felt sick. As I grew older, this urgency decreased. I am not totally efficient in my approach in asking questions regarding heritage, culture, and health, but I will continue to apply what I have learned in class and evolve as I practice as a nurse.

Works Cited

1. Jarvis, C., & Eckhardt, A. (2019). Physical examination & health assessment. St. Louis : Saunders, an imprint of Elsevier Inc., [2019].
2. Sriyasak, A., Almqvist, A.-L., Sridawruang, C., Neamsakul, W., & Häggström-Nordin, E. (2016). Struggling with motherhood and coping with fatherhood – A grounded theory study among Thai teenagers. Midwifery, 42, 1–9. doi: 10.1016/j.midw.2016.09.005