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The Importance of Cultural Competence in Healthcare: The Case of Nigeria

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Nigeria is a country located in west Africa. Nigeria borders with Cameroon in the north, chad in the northeast and Niger in the north. Nigeria originated from British colonial and gain independent 1st October 1960. Nigeria is the largest and popular country in African” Giant of African or Mama African”. The three largest and powerful ethnicities in Nigeria are Igbo, Yoruba and Hausa. Nigeria ethnic group has more than 266 dialect which made English their primary language for communication, and the entire ethnic group in Nigeria practice different cultural belief. When it comes to religion, Nigeria half muslins to the northern part and half christian to the southern part. In the upcoming paragraphs, I will be discussing my personal and cultural belief along with Nigerian cultures and some traditions and how my cultures, values and belief might have influenced how I provide care to my patient. And how my knowledge and acceptance of other people’s culture has helped me in providing culturally competent care for my patients.

In my own thought, health is a state that allows individual to adequately cope with all demands of daily life including the absence of affliction and impairment. The health promotions that I practice includes regular physical exercise, healthy diet, screening disease yearly, routine dental care, minimizing hazards in the work place, compliance with immunization, practicing safe sex, practicing good hygiene, and avoiding the use of tobacco, alcohol and illegal drugs. Health does not really mean absence of sickness or affliction but that the state allows the drugs. Cause of illness depends on a wide range of factors, such as an unusual genetics pattern and lifestyle choices such as smoking, alcohol and fast food consumption. Sometime an environmental trigger can cause illness in a person who is genetically susceptible. Furthermore, people with low socioeconomic status have a greater risk of illness due to their inability to access healthcare readily.

Pain is subjective, in life, pain is something that is common and can be expected depending on the kind of work you have done in a past for a living and what you are doing now. depending on the severity of the my symptoms, for instance, if I am having pain and the intensity is what I can manage at home, I usually use ice pack with over the counter ibuprofen as needed and massage and exercise the location of the pain with menthol. I experience shortness of breath some time when in a warm environment like when the heater is too high or with household bleach or smell cigarette. I will start by coughing with a deep breathing exercise or I use my rescue inhaler and my symptoms will subside. For nausea and vomiting, I drink Jamaica hibiscus flower tea. For constipation, I have not experience constipation, I go every other day by drinking enough amount of water and eating vegetables. For diarrhea, I take iron tablet or garri powder processed from cassava tube and for fatigue, warm milk and enough rest will help.

Food is very relevant in an individual life based on the nutritional value derived from them. What we eat is an expression of who we are. If we eat nutrient dense food, it will increase ones immune system, promote growth and repair wean out tissue and make one less prone to diet deficiency disease. Nutritious food choice support heath life. The choice of food we make every day can benefit or harm our health. So, there is need for one to pay attention for what he or she eats. My idea meal pattern in consideration to my culture is three time a day. Depending on the occasion, something our food choice can depend on festival or ceremony. Not necessary eating three times a day but making half of each meal with fruit and vegetable. Judging at my culture, I do not think we have any food belief or ritual. We eat all kinds of food except unhealthy food that affects ones health. My usual diet is whole food which includes grain, poultry and low fat foods, vegetable and fruit. Culturally I don’t have food prohibition, but I discourage my family from eating process foods because they have very minimum nutritional value. Hot fish soup cooked with fresh herbs scent leaf, mint leaf, parsley leaf serves as herbs medicine to burst sick person appetite.

In my family we communicate infectively with one another because we speak the same language. Nonverbal communication is mostly used when we have visitor in the house, or we are out with kids in public places and any nonverbal communication is understood. Greeting is one of the most important parts of my culture. As from the childhood, kids are taught to greet anyone who is older than them, greeting is a sign of respect. Usually a younger person does not reach out hands to shake an older person. There is time for everything, doing things at the right time or being punctual to events like school, work, doing house related activities is very important and passes down to children. In other word, time is of great important in whatever we do because a time wasted is never regain. Generally, our tone of voice is acceptable but can be different base on the pitch when compared to some voice from another culture or tribe. Generally, we do not invade people privacy, but we get close to people who want our friendship without thinking of them harming us. It is good to keep your privacy but not to an extreme that you don’t communicate with your next-door neighbor. Decision making is one of the things that help one to make the right choice. Decision can be taken from parent to the children on family issues. Again, individuals can take personal decision that doesn’t affect other family members.

Based on my religion and culture, we only believe in male and female gender and each gender have roles. Choosing career is not based on gender but house chores are assigned sometime base on gender. For example, male wash cars while the female help the parent with kitchen work.

As for family relationship structure, we practice extended family structure where a man lives with cousins, aunt, parents and grandparent who are not able to provide for their own needs. It is belief that after parent have trained their children, the children will in turn take care of their aged parent to reciprocate the labor of their parents. Grow up children of the aged parent can bring their parent to live in their home for proper care especially their health and financial needs. It is not in our culture to send our elderly parent to the nursing homes. In my culture, children are expected to carry out their responsibilities such as doing laundry, cooking and cleaning the house. The girls does most of the house chores and the boys do little house chores such as making sure there is water and firewood in the house. House chores are delegated according to age. But the younger one who are less than 6 years old don’t participate in the house chores. They are expected to work hard in their academic related work and be good law-abiding citizen.

The arrival of a new born baby is of great joy in my culture. During pregnancy, pregnant women are taking care of beginning from the time friends and relative were aware or officially informed that the women is pregnant. Pregnant women are given mush preference than non-pregnant women. The pregnant woman is not allowed to engage in any strenuous activities. They are encouraged to go for antenatal to avoid complication. During labor, the pregnant women are taken to the hospital. Women in labor who have not reach 6cm dilation or those who express delayed labor are encouraged to walk around to help facilitate labor contraction interval. At this time laboring women are expected to cooperate with the midwife and doctor to help labor such as deep breathing exercise and participate in pushing when instructed to push. They are also encouraged to cooperate with doctors when there is a complication or when told to perform c-section delivery method.

After the birth of the child, new mother and baby discharged home after 72 hours. Friends and relative awaits the arrival of the new born baby with a feast. Nursing mother practice exclusive breast feeding for at least one year depending on individual decision. Because of high cost of formula, most women introduce their babies to infant baby food at six months. Mothers who want to breastfeed their babies for up to a year or so are expected to eat nutritious meal with enough vegetables. Most times friends and family bring fruit and cooked meal for nursing mother to help her rest. Nursing mother and baby do not live the house except foe postnatal so baby will not be expose to air borne diseases. Nursing mother are relieved of house chores for the first four month after delivery because traditionally it is believed that those periods is the time for the new mother to recuperate. Within the few weeks after delivery, the father is expected to care for mother and child, cook, take care of the older kids if there is any and provide all the necessary things needed for the nursing mother and baby.

In the aspect of the dead, traditional right is observed such as killing cow, goat, rams and so on for people who reach 90 years before dead. This type of traditional right is done based on family income. it is believe that the deceased adult in my culture will never finds peace in the beyond if the traditional funeral rites is not done or denied. The decease is put in the morgue for embedment and sometimes the body of the deceased can stay for some months before burial to help family members gather enough money for the funeral rite. After burial, the remaining family members are expected to wear black or white, the women both the young and old shave their hair to mourn their death. One year after mourning, family members gather for” wear off mourning cloth” and perform some ritual and then burn the mourning cloth. The idea of people donating any part of their organ is not commonly practice in my culture. On the aspect of autopsy, autopsy can only be done if there is evidence to point that there is a hand in the death, especially in the case of poison.

When it comes to religions, I am a practicing Christianity. My family and I worship God, attend church service. We do morning prayer and read bible. Though I believe in Gods healing and miracle as a christian. My christian faith does not prevent me from taking care of my health especially when it comes to blood transfusion or any life-threatening issue.

My family and I predominantly identify with some of Nigeria culture. As stated above, the three most influential ethnic group in Nigeria are Igbo, Yoruba and Hausa. The Igbo ethnic group most produce and trade in oil, cocoa and rubber. The Igbo ethnic group, of which I belonged to, are mostly christian. According to the book, which discussed generally about African American culture which Nigeria may belong. The book make mention that no special limitation on activities during pregnancy and that pregnant women continue work and perform other daily routines. This is a kind of different from my culture because in my culture, pregnant women are given mush preference and not to allowed to engage in a strenuous activity for the safety of the woman and the unborn child. It also mentions that African Americans have the lowest rate of breastfeeding. I disagree with this because nursing mother practice exclusive breastfeeding for 6 month or more in my culture. The book mentions about newborn male circumcision which is like the practice in my culture. Labor practice and role of the laboring woman during birth which my culture also practice.

The two patient I have taken care of in the past that have different ethnicities and cultural belief from me. Some time ago, I worked as a pediatric private duty nurse. I worked with a 3 years old Hispanic female patient with tracheostomy due to obstruction of the upper airway. During my initial assessment, I realized that the patient was chewing on the bracelet bead on her wrist. I was concern of this patient choking on the bead if it breaks off. I called patient mother and inform her of patient chewing on the bracelet bead and asked if I can remove it for the child safety. Patient mother replied NO to me and said please do not try to remove this bracelet from her wrist. It is for her protection from evil eyes. That it is there cultural belief to put bracelet beads on helpless kids so that evil eye will not see them. That I should just monitor her and keep her safe. I keep quite and continue providing care to the patient and move the bracelet beads close to her elbow where she can’t get it to her mouth.

I worked with another pediatric patient, 6 years old male patient from Palestine, diagnosed of Dawson disease type II after his 5th birthday. Patient has gastrointestinal tube and he is immobile, and bed bound. Patient live with parents and other extended family. My first day working with the patient, as I was providing care to the patient, her grandmother walked to the patient, whispered some thing and started spitting saliva on the patient from head to toes. His grandfather came to the patient and did the same thing his grandmother did. I started wandering in my mind what is go on. Based on my cultural belief, we only spite on something that is disgust, I assumed that they were doing that due to his disease process. I called the patient mother and asked her why they are spitting on the patient. Patient mother explain to me that it is there cultural belief for the sick, that it will protect him from evil demon and make him live long. That it is done once a day by the elders in the family.

Different cultures have different method of handing their wellbeing or ailments. As a nurse, the two way I will use in providing a culturally competent care to people who came from different culture is cultural skill which started According to Alvernia university that it involves collecting relevant cultural data. It is inconsiderate to accept someone cultural preferences based on appearance or religion. Instead, nurses should ask and seek information in a professional manner. Second one is cultural encounter which is the process of engaging with patients from culturally diverse backgrounds, as this exposure increases the nurse’s cultural competence.    

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