Fundamentals - Principles, part 9: Cultural Considerations, Complementary and Alternative Medicine
In this article, we cover what you need to know about how to give culturally competent care, religious and cultural considerations for your patients, how to use a medical interpreter, and we'll share some example religious and cultural considerations that could apply to Muslim patients, Jewish patients, Catholic patients and more! We'll also cover complementary and alternative medicine and what to look out for. Who shouldn't get acupuncture? Who shouldn't meditate? We'll answer these questions and more.
The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
The key points you need to know when it comes to cultural considerations in nursing are: what a culture is, culturally competent care, how to do a cultural assessment, what ethnocentrism is and how to avoid it, language differences and best practices for the use of an interpreter, and then some example religious and cultural considerations to be aware of in your practice.
What is a culture? A culture is a set of shared beliefs, values, and customs that are influenced by race, geographic location, ethnicity, and language.
Parts of culture may have religious origins, but have become more generalized to geographic location and social group. For example, per a 2013 Pew Research poll, 90% of Americans polled celebrated Christmas, but only half considered it a religious holiday.
Culturally competent care
Nurses must strive to provide culturally competent care. Culturally competent care is care that meets the religious, cultural, and social needs of the patient. Culturally competent care improves the quality of care and improves patient health outcomes.
Cultural competency begins with a nurse identifying their own beliefs and values so they understand where they are coming from and what beliefs they bring to the table.
In nursing, it is important to understand ourselves because it helps us better understand our patients. For example, in the phases of the nurse-client relationship, during the pre-orientation phase we examine our thoughts and feelings about working with a patient.
Why is culturally competent care important?
If you've studied Med-Surg, you may have noticed that race is listed as a risk factor for some diseases and disorders. As we have explained in our articles on these subjects, race virtually never plays a biologically predetermined role in a disease, but risks can be higher statistically for nonwhite and minority patients for a variety of reasons, including the social and environmental determinants of health — which includes access to adequate and nondiscriminatory health care.
Culturally competent care is an important way that nurses, as individuals, can provide adequate and nondiscriminatory health care. Culturally competent care leads to better health outcomes for your patients.
A cultural assessment is a key part of giving culturally competent care going to be essentially just identifying what your patient's cultural/religious/spiritual needs are. And the ways that we can cater to those, what our best practices may be.
Ethnocentrism is the belief that one's own culture is superior to somebody else's. Nurses should not practice ethnocentrism, and should take care to assess their own beliefs and behaviors continually to assess for, and eradicate this.
Language differences and interpreter use
As a nurse, you will be caring for patients who speak many languages. Patients have a legal right to appropriate language services, like medical interpreters and printed material in their preferred language.
It is important that a patient's interpreter is an official medical interpreter, approved and hired by the facility. We do not want to use a patient's friends or family members to interpret, if at all possible.
Best practices for interpreter use
Speak directly to the patient, not to the interpreter. We're having the conversation with the patient, the interpreter is just assisting us.
Ask one question at a time, to allow the interpreter time to ask the patient, and then give you the response.
Try to limit your use of additional hand gestures.
Example religious/cultural considerations
There are different cultural practices and religions that may influence the care that you provide. Below, we've provided some examples that you may encounter.
NOTE: Regardless of what your patient's stated religious practice is, every person practices differently, so it is best never to assume. Instead, ask your patient directly about any religious practices that they may follow that would influence their care.
Islam is the world's second-largest religion, and followers of Islam are known as Muslims. Patients who follow Islam may not choose to eat pork products, alcohol, or shellfish.
Ramadan is a month-long holiday during which many Muslim adults fast (abstain from food), from dawn till sunset. You may have a patient who is fasting during Ramadan and you may need to accommodate for this.
You may need to make accommodations for your patient to be able to pray five times a day. And female patients may request female care providers.
Some patients who are Jewish follow Kosher diets. If your patient does follow a Kosher diet, then they may not eat pork, shellfish, or meat combined with dairy.
For example, a hamburger would be considered Kosher, but a cheeseburger would not.
Patients who are Mormon may abstain from alcohol, tobacco, and caffeine products.
Patients who are Catholic may avoid meat on Fridays during the period of Lent (a religious observance period that lasts around 40 days and ends with Easter).
Jehovah's Witnesses may refuse blood products, like blood transfusions. If they were having surgery, they may say that they do not wish to have a blood transfusion.
For more information on blood transfusions, check out our Pharmacology Basics and Safe Medication Administration Flashcards for Nursing Students.
Complementary and Alternative Medicine (CAM)
Complementary and Alternative Medicine (CAM) is an umbrella term for practices and products that are not a typical part of conventional (allopathic) medical care.
Complementary means that the practice may be used alongside (as a complement to) traditional forms of medicine, and alternative may mean that it's being used instead of traditional medicine. It's very important to assess a patient's use of CAM during their initial intake assessment.
Acupuncture is a technique in which practitioners stimulate specific points on the body, usually by inserting thin needles through the skin. Acupuncture procedures may be contraindicated if a patient has a bloodborne pathogen, because of the potential of exposure to blood.
If your patient is taking herbal supplements (like ginkgo biloba, St. John's wort, valerian root, or saw palmetto), you need to know exactly what they're taking and how much, because there is the potential for interactions with standard pharmacological therapies.
Massage is a great use of CAM for many patients. However, a patient with a deep-vein thrombosis should not receive a massage, as this could dislodge the clot.
Psychosis is another contraindication for massage, because touching may aggravate some conditions. To learn more, check out our Psychiatric Mental Health Nursing Flashcards.
Hypnosis & meditation
Hypnosis and meditation can be great tools for patients. Psychosis, either current or previous, may be a contraindication for hypnosis or meditation, as it may exacerbate some traits.
Chiropractors use spinal manipulation and deep massage for the relief of chronic pain. Chiropractic adjustments may be contraindicated for patients with existing fractures, bone cancers, or spinal cord compression.
Hi. I'm Meris. And in today's video, we're going to be talking about cultural considerations, along with complementary and alternative medicine. I'm going to be following along with our Fundamentals of Nursing flashcards. These are available on our website at leveluprn.com. If you have a set already, and you're following along with me, we're going to be starting on card number 26. So let's get started.
Okay. So first up in cultural considerations, let's start with what is a culture?
So a culture's going to be shared beliefs, values, and/or customs that are influenced by race, geographic location, ethnicity, language, those sorts of things.
We strive to provide something called culturally competent care, meaning that we are meeting our patient's religious and cultural needs as well as their health and medical needs because this improves patient care and improves their outcomes and their feelings on the care that they received.
When it comes to culturally competent care, we need to start with a cultural assessment. Cultural assessment's going to be essentially just identifying what your patient's cultural/religious/spiritual needs are. And the ways that we can cater to those, what our best practices may be.
This may also influence things like the medication that a patient receives, the therapies they receive, and even things like postmortem care.
We also want to talk about something called ethnocentrism. Ethnocentrism is the belief that one's own culture is superior to somebody else's. This is not a belief that we should have as nurses. This is going to be a negative connotation for culturally competent care.
We do have a key point icon here which means pretty important.
Cultural competency begins with identifying your own beliefs and values so that then you have an idea of where you're coming from. So the nurse should start by identifying his or her own beliefs and values.
Next up, let's talk about language and interpreter use. So you will be caring for patients who speak many languages. And it is important to understand that patients have a legal right to have a medical interpreter available to interpret for them.
Notice that I said a medical interpreter. We do not want to use a patient's friends or family members to interpret if at all possible. We want to be using an approved medical interpreter hired by the facility.
It's also to understand that when we use a medical interpreter, we have some ways that we can communicate best with the patient when using an interpreter.
For instance, we want to speak directly to the patient, not to the interpreter. We're having the conversation with the patient. The interpreter is just assisting us.
So we're not having the conversation with the interpreter, so talk to your patient.
The other thing is when you are using an interpreter, try to ask what one question at a time to allow the interpreter time to ask the patient and then give you the response.
And also, try to limit your use of additional hand gestures and things. So instead of saying, "Do you want to eat?" just say, "Do you want to eat?" That is going to be best practices for speaking with an interpreter.
It's also important to understand that there are different cultural practices that may influence the care that you provide.
This may be based on religion. So we have here some examples of religious considerations here on card number 28. We do have a nice chart here for you.
But before I begin, I want to point out this key point at the bottom here, which is that regardless of what your patient's stated religious practice is, every person practices differently, so it is best not to assume based on these kinds of general religious preferences, but instead ask your patient directly about any religious practices that they may follow that would influence their care.
For instance, Jehovah's Witnesses may refuse blood products. So if they were having surgery, they may say that they do not wish to have a blood transfusion.
Patients who follow Islam, they may not want pork products. They may not drink alcohol. Shellfish may be prohibited for their diet.
There may be special fasting considerations during the month of Ramadan.
You may need to make accommodations for your patient to be able to pray five times a day.
And female patients may request female care providers. So those are some possible considerations for your Muslim patients.
Now when it comes to Judaism, some patients who are Jewish follow Kosher diets, but not all patients do, so you need to ask and not assume. But if your patient does follow a Kosher diet, then this may mean that they have no pork products or shellfish and that meat and dairy should not be combined. For instance, a hamburger would be okay but a cheeseburger would not.
Then we also have Mormonism. Patients who are Mormon may abstain from alcohol, tobacco, and caffeine products.
And then patients who are Catholics, they may avoid meat on Fridays during the period of Lent.
So again, if you were in that time period, you would just want to ask your patient about their dietary needs for their religious preferences.
Lastly, we're going to talk about complementary and alternative medicine. This is sometimes called CAM, C-A-M.
You can see here on card 29, we have a very nice list here in a table form of different types of therapies and possible contraindications.
Now, why do we call it complementary and alternative? So complementary means that it is going along with more traditional forms of medicine, and then alternative may mean that it's being used in the place of.
So it's very important to assess for a patient's use of CAM during their initial intake assessment. Now, I'm not going to go into all of these. You can refer to the card for more detail.
But here are some important contraindications to understand.
A patient with acupuncture-- if that's the kind of practice that they're interested in, it may be contraindicated if they have a bloodborne pathogen, just because there is the potential with pricking the skin and getting blood out.
That could be a possible contraindication.
Massage. Massage is a great use of CAM for many patients. However, a patient with a deep-vein thrombosis should not receive a massage, as this could dislodge the clot. And then, also, a patient with psychosis. This is something as well that we should be thinking of.
Another one we have here is hypnosis and meditation. These can be great tools for patients. However, again, psychosis, either current or previous, may be contraindications for a patient.
Some other ones that we have are herbal supplements, hypnosis and meditation, chiropractic adjustments. We have a whole list here. It is really important to understand where your patient is coming from and what might be contraindicated for them.
Herbal supplements, for instance. You really need to know exactly what they're taking and how much because there are the potential for interactions. Definitely see our pharmacology flashcards and videos for more information on that.
Okay, so that is it for cultural considerations and complementary and alternative medicine. I hope you liked that. If you did, please be sure to like the video. You can always leave me a comment down below. I would love to hear from you. And be sure that you subscribe to the channel because you want to be the first to know when we post new videos. For instance, in my next video, I'm going to be talking about patient positions, which is one of the biggest things you need to know as a Nursing Fundamentals student.
Thanks so much, and happy studying!
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