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Set of values, beliefs, and traditions held by a specific social group...
Ð Subculture: ex: Little Italy, Chinatown. Regional culture: Philly is no more like NY than NY is like Philly, differences in language
Ð Dominant group: larger cultures such as the American culture
Ð Minority group: Amish, inbreeding can cause health issues
- • Share common heritage-German, Vietnamese
- • Belong through birth or adoption of the group characteristics
- • Unique cultural/social beliefs and behavior patterns
Race: Negroid, Mongloid, Caucasian
- Based on specific physical characteristics, such as
- – skin color
- – body stature
- – facial features
- – hair texture
- -based on geography, Ex: equator, darker skin, northern europe=lighter skin
Ethnic values are replaced by the values of the dominant culture. First generation of immigration generally don't want to know about their culture, not until 2nd generation.
Factors Affecting Cultural Sensitivity:
- • Stereotyping-assuming all members of a culture act alike, everyone is "one way".
- • Cultural Imposition-belief everyone needs to conform to the majority
- • Cultural Blindness-assuming an immigrant knows how to conform to rules of the hospital
- • Culture Conflict-becoming aware of cultural differences and respond by ridicule.
- Feelings experienced when someone is placed in a culture different
- from their own.
The belief that one’s own ideas, practice and beliefs are superior to that of others. Not uncommon in US. Look at Table 3-1.
Cultural and Ethnic Influences on Health Care
• Gender roles- many cultures where male makes most of decisions
• Language and Communication-difference of language, do not let a child or a member of family be a translator. Get a professional translator trained in medical terminology.
Try to have same gender as patient, especially concerning sexual matters.
• Food and Nutrition-can vary greatly between cultures, but be careful of diet the patient may be on so family can bring in food.
- • Personal space is the area that surrounds a person’s body.
- • Intimate zone- 0 to 18 inches
- • Personal zone- 18 inches to 3 feet
- • Public zone- 3 to 6 feet
Cultural and Ethnic Influences on Health Care:
- • Socioeconomic factors: ex: cold water flats in Wilmington and outhouses, working poor have no access to healthcare so they don't come in until very sick. No access to dental care.
- • Family support- some have large extended families, others do not.
- • Physical and Mental Health-some view illness as punishment from God.Some believe illness is caused by spirits.
- • Biological differences exist among people of various racial and cultural groups
- • During your assessment you will note variations in: body structure, skin color, enzymatic and genetic variations, and disease susceptibility ex: malaria---->sickle cell
• The provision of nursing care that is sensitive to the needs of patients, families, and groups of diverse cultural backgrounds. If you have questions ask them.
• Cultural ignorance may lead to incorrect diagnoses.
Guidelines for Communication:
- • Includes verbal and nonverbal behavior
- • Assess YOUR personal beliefs
- • Nurse must demonstrate RESPECT!
Tips to providing Culturally Congruent Nursing Care:
- • Establish and maintain trust.
- • Demonstrate respect and privacy
- • Preserve cultural beliefs Ex: Mr. Mrs. and miss
- • Accommodates a client’s cultural needs-Ex: Gypsys
- • Implement a transcultural nursing approach
No need to be blunt, but do not lie.
Nursing Values, Ethics and Advocacy
- Ethics (Us=ANA code of ethics) Look in back of Taylor
- • Questions how we should act
• What is right and wrong
- Belief of worth that determines behavior
Modes of Value Transmission:
- • Modeling-children learn from our behavior
- • Moralizing-environment can determine moral grounding
- • Laissez-faire-no particular rules
- • Rewarding/Punishing-good behavior=reward, bad behavior=punishment
- • Responsible choice: allows child to decide for themselves
- • Altruism-thinking of the other
- • Autonomy-adult patients have this to decide course of care
- • Human Dignity-every human has this right, each one is unique, treat them
- • Integrity-act within code of ethics for nursing, tell truth, don't lie about mistakes you made, especially medication. Own up to it.
- • Social Justice-uphold the law and morals, and your own moral code. Equal treatment.
- • Nursing Codes of Ethics-international council of nursing, ANA
- • Standards of Practice
- • Patients Bill of Rights-found in patients rooms. Written by Joint Commission
Advocacy: Advocacy is the protection and support of another’s rights.
Role of Nurse as Advocate
If patient doesn't understand what is happening, then bring back the doc!
- Promoting self determination:
- Being politically active: join the groups that are out there
Legal Issues in Nursing:
- Types of Law
- • Constitutions
- • Statues
- – Nurse Practice Acts http://www.state.de.us/research/AdminCode/title24/1900%20Board%20of%20Nursing.shtml#TopOfPage
- • Administrative Law
- – Board of Nursing
- • Common Law-comes from English common law
Nursing Standards & Credentialing:
• Voluntary Standards:developed by nursing organizations, ANA are voluntary standards, but not necessary to obey
• Legal Standards-developed by legislation, such as licensure, some states have joined to have same standard
• Purpose of Credentialing-exam demonstrates a mastery of a certain skill.
Crimes and Torts
- • What is a crime?
- – Misdemeanor-less than a year in jail
- – Felony-more than a year in jail
- • What is a Tort?
- – Negligence-covers a wide perimeter, when dr. or nurse commits a wrong it is malpractice, civil suit. Criminal charges rarely brought against RNs. malpractice is to due with professional practice.
- • Assault(threat) & Battery(actual contact)
- • Defamation of character-making statements about anyone that defames their character. Don't do it verbally or in writing
- • Invasion of Privacy-speaking about a patient outside the proper realm
- • False Imprisonment-restraining a patient inappropriately, don't lock their door, If patient wants to leave, they must sign paper
- • Fraud-Willful misprepresentation such as a test the patient needs, charging to much for services as in medicaid and medicare.
- • Purpose……….. patient must parrot this back
- • When………..
- – Admission
- – Specialized diagnostic procedures/treatments
- – Experimental treatments/procedures
- • Who………
- Follow hospital protocol and procedure!
- • Ensure Patient Safety
- • Proper Techniques
- • Monitor & Report-If you haven't documented it hasn't been done.
- • Avoid Medication Errors-5 rights 3 checks
Note box 7-4 on pg 136 (Taylor) Nursing Malpractice Prevention
- Responsible for own actions-if you pass the test, you are responsible for contents
- Held to same standards as the RN
- Responsible for knowing how to perform skills
- Responsible for knowing agencies policies
- Responsible for noting changes clients and informing the instructor or the RN responsible for the client.
Malpractice Payments by Nursing Category, 1998–2001 Incidence of Nursing Negligence Allegations by Setting, 1995–2001 Malpractice Prevention
- • Follow Agency Protocols
- • Documentation
- • Equipment Use
- • Report Adverse Incidents
- • Communication-spelling and punctuation do count
- • Legal Document-computer program counts, one line through error and date and initial
- • Other Purposes- to create nursing plans of care.
- – Objective…..NOT….Subjective
- – Avoid generalized terms or statements
- – Note occurrences in order
- – Document other consultations & procedures
- – Know & adhere to legal & professional standards
- – Document response to questionable medical orders or treatment …. or failure to treat.
F. A. C. T.
• F = Factual
• A = Accurate
• C = Complete
• T = Timely
Slander is spoken, Libel is written