The purpose of this topic is to discuss regarding “In what way advanced speciality nurses’ personal values and beliefs should not interfere with the delivery of their nursing care when preparing the care of critically ill patient and family”.
The nursing role has changed much over the years. With the progress of health standards and professional care, nurses must have an understanding of individual’s cultural values and family relationships.
Advanced speciality nurse or advanced practice nurse means the registered nurse having education beyond basic nursing education and certified by nationally recognized professional organization in a nursing speciality, or meeting criteria established by a Board of Nursing. The Board of Nursing establishes rules specifying which professional nursing organization certification can be recognized for advanced nurse and sets requirements of education, training, and experiences (Mosby’s medical dictionary, 2009).
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Ethics and values are closely related which complicate the nurse’s balancing the ethical principles of the client in health care professionals. Values influence the development of belief and attitude rather than behaviours although they often indirectly influence behaviours. A value system is an individual’s collection of inner beliefs that guides the way the person’s act and helps determine the choices the person makes in life (Lois., 2005).
Cultural values refer to enduring ideals or belief systems to which a person or society is involved. Cultural practices identify specific nursing approaches on how nurses should provide care in the situation (Evelyn, 2001). The dimensions of culturally competent care are caring, cultural sensitivity, cultural knowledge and skills. Nurses can learn to become culturally competent in their care.
A therapeutic nurse-patient relationship is the foundation of nursing practice. It contributes to patient well being and their health. Conflict can interfere these collaborative relationship between the nurse and the patients’ families by different cultural values, beliefs and family relationships. Good communication skills and knowledge of cultural sensitivity in nurses can prevent conflict in caring patients.
There are different values and beliefs among people of different culture. In recent year there has been growing interest between religious belief and the component of life stress. Care of terminally ill patient is very difficult. However holistic nursing care can be achieved when there is thoughtful consideration and implementation of patient specific nursing action according to their psychosocial requirements. Core beliefs and value system are held more strongly when people lose control over aspects of their life due to terminal illness (Thomas, 2001).
Among illness population, the association between religious belief and psychosocial adjustment has been more investigated among cancer patients. Another population frequently examined for the effects of religious belief on psychosocial adjustment has been chronically ill or hospitalized elderly. (Karolyn et al, 2001).
Nurses often care for clients whose value systems conflict with their self values and beliefs. For example, a patient with a value system of “grin and bear it” may be insulted by a nurse’s attempt to offer pain medication. In order to ascertain those things are meaningful to the patient, the nurse must have understanding of clients’ values system. The nurse should not impose personal values on the patients.
Attitudes and approach to death and dying vary among different peoples. Some are very accepting to death but others view dying people and death with fear. Some people prefer that their family member dies at home. The nurses are required to respect individuals and beliefs regardless of consequences. The moral standards include keeping promise, avoiding or preventing harm, and respecting person; these are principles that morally required and are consistent with the rules provided in our professional code of ethics. The trend to approach ethical decision making using this four principles approach predisposes clinician to overlook other ethical obligations toward patients. (Marianne.M. et al, 2009).
When families face tough situation, including health problems, their religious belief and practice can help them fight feelings of helplessness to promote regaining a sense of control. For some families, spirituality can be a powerful and important source of strength. Nurses must accept, learn to expect and encourage increased participation of the patient and family in actual care without conflict with personal values and belief. Caring behaviour is very important but that went beyond to a more cultural expectation of caring with patient’s beliefs and values.
For example touching of the patient is part of serving in therapeutic relationship with patients but comforting by touching was considered by patients as not important caring behaviour. This may be considered to cultural taboos in some others religious beliefs and values especially the segregation of man and woman. This was apparent in male patient admitted to males ward but having both male and female nurses. However, touching female patients by female nurse was considered acceptable.
One of the most important aspects of nursing care for terminally ill patient is the development of therapeutic relationship between nurse, patient and even family members. According to Peplau, nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care. Nursing can be viewed as an interpersonal process because it involves interaction between two or more individuals with a common goal.
The nurse’s as well as the patient’s culture, religion, race, educational background, beliefs, values and expectation all play a part in the nurse’s reaction to the patient. The same influencing factors play a part in the patient’s reaction to the nurse. It is important to recognised that each patient responds differently to nurses. Not every patient will communicate their feelings and needs. It is the responsibility of the nurse to keep the opportunity that communication to be opened.
The nurse must recognized that the patient is an individual not a diagnosis. The nurses must also respect the patients as well as their values and beliefs. Family members also need to feel a sense of caring from the nurse. Families, that are providing care to a patient who is terminally ill, express about fear and concern about their loved one. The nurse is the person who spend the most time and communicate with the family.
One of the most difficult situation in nursing practice is that, despise the best effort, the patient will die. The death may be brain cancer and severely road traffic accident. That situation ‘nothing more can be done patients’, who need comfort and care of everyone until their death. But end of life is always a complex process that involves not only the patient but also the patient’s family.
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Patient and family have numerous question to the nurse and answering them involves sensitive disclosure from the nurse. Denial on the part of the patient and family members about seriousness of terminal illness has been barrier to discuss about end of treatment options (Richard. 2008). A nurse needs to be sensitive and concerns about the situation allowing patient’s family to reflect and react the situation. Terminally ill patients require specialized and sensitive care that addresses their physical, psychosocial, and spiritual needs. Ensuring the delivery of culturally sensitive care during the last stage of an individual’s life means a great deal to patients and families.
The process begins with when the patient and family receive the bad news about terminal illness. The family’s fears about loss of their loved one often results in conflicts, which requires nurses to spend more time and energy. But the barrier of time constraints and excessive workload in nurse’s life has to become problems (Namasivayam, P. 2005). The nurses are confronted not only by the patient families’ emotion but also their own.
Another type of problem is on the withdrawal of medical treatment. There is a lot of conflict between patient, patient’s families and medical team members. In some cases the patient wants to withdrawal the treatment such as close monitoring, intravenous infusion, antibiotics but the family wants to carry the treatment. In this situation the nurse as a patient advocate has to think carefully ethical and legal balance between medical decision and patient with his or her family decision in end of life care.
It is very likely that individuals who are diagnosed as having cancer have some psychological and sociological problems in coping with traumatic situation. Both cancer patient and family members will suffer physically, psychosocially and spiritually in traumatic experiences. The patient can express various stress reactions. Such stressful reactions may be due to fear of treatment, or dying, degeneration of the various parts of the physiological function, difficulty in sleeping, helplessness, depression and many other underlying reactions of illness. Most families react to the news of cancer with great shock. Each member may experience extremely distressing emotions. The whole family system becomes painfully imbalanced and no one knows what to do. Family members avoid speaking about the fear, anger or death.
When the patient and family members are facing such a traumatic situation, they will make unreasonable demands regarding care and medical treatment. This is in conflict with the reality facing problem in nursing care. Conflict can arise in critical care settings as a result of differing cultural values and professional values. Nurses and families with different cultural background bring beliefs and values to the care situation that can have impact on the care process. The families want to maintain cultural beliefs while nurses are not sufficiently culturally aware.
A culturally competent nurse must develop cultural sensitivity. Cultural sensitivity is the broadest sense to be an awareness and utilization of knowledge related to ethnicity, culture, gender or sexual orientation in explaining and understanding situation and responses of individuals in their environment. It is important to assess each patient individually and not make cultural assumption about a patient’s beliefs or health practice (Connie, 2005). General knowledge about specific cultures can increase understanding. . It is possible to form a holistic cultural understanding of the individual and family regarding care at the end of life.
In assessing cultural beliefs, some other areas also need to be considered including the patients’ perception of illness and treatment, the social relationship including families, communication behaviours, family health care practice and beliefs, past experience with care and language. The individual’s or family’s past experiences with health care provider influences the patient’s continuation of use of health services. Understanding these experiences from the patient’s perspective can strengthen the relationship, and misconceptions and offensive behaviours can be avoided (Potter & Perry, 2005).
Often individual will follow traditional health practices before seeking the medical professional as a last solution. An understanding of cultural influences on the health practices enables the nurse to deal effectively with the patients and their families in care plan. It is important for the nurses to try understanding of the other party. Some religion prohibits the ingestion and transfusion of blood and blood products to their body. As a culturally competent nurses need to avoid compromising the care of patient because of ethnicity, culture, gender, spiritual values, sexuality, disability, age, economic, social, health status or any other background.
Another issue is related to language problems. When English is the second language, individuals may have more difficulty speaking and understanding English during times of stress and illness. To prevent interference in nursing care between nurses and patients, patient families’ need an interpreter during a health crisis. The interpreter should be the person who is officially appointed in health care setting. Utilizing an accepted and professional interpreter will promote a more accurate sharing of information and more open communication.
Nurses are health care professionals, educated to think critically, to solve the problems and to make decision. Nurses need to learn as much as possible about cultural beliefs, families structure and practices of patients in their care. Learn to show respect for the patients and their families by using cultural competency in care for critically ill patients. In that ways compliance will be greater when the treatment plan incorporates the patient’s cultural values and beliefs , and will decrease interference in nursing care between nurses’ beliefs and patient families’ beliefs.
No one becomes culturally competent overnight or with one or two hours of training; certain attitudes need to be learned, skills transmitted, and knowledge absorbed (California Endowment, 2003). Cultural competence involves attitude changes and the examining of personal biases. Skills that enhance a health care provider’s ability to recognize different cultural values, beliefs, and practices and to address these factors in interventions are likely to lead to more successful treatment outcomes (Bonder et al., 2001).
In conclusion there are differences in individual’s perception in health practices according to different family structure, different family relationships, different cultural values and beliefs. So advanced speciality nurses should not interfere with their values and beliefs in nursing care plan with families values and beliefs by understanding patients’ needs through cultural sensitivity.
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