The globalization has influenced not only the economy of many countries but also the process of cultural exchange between them. Nevertheless, despite the blurring of the borders between nations, each person still has his/her own culture (including its geographic, ethnic, moral, ethical, religious, political, and historical aspects) as well as cultural identity. As a result, the problem of cultural competence in all areas of human life, including health care, is especially acute nowadays. In this regard, cultural competence becomes one of the most important traits of the health care professionals, namely the registered nurses (RNs). Therefore, the following work is dedicated to the study of the concept of culturally competent nursing care, development of the guidelines for the RNs that must provide it, and the review of the role and activities of a nurse either providing the end-of-life care or engaged in the process of treatment of a chronic disease for the representative of the Chinese culture.
A culturally competent nursing care is a care that is based on the sensitivity to issues related to ethnicity, morals, and social class of the patient as well as his/her perception of suffering, health, and medical care as a whole (Kersey-Matusiak, 2012). Culturally competent nursing care consists of several components. The first is cultural awareness, i.e. the sensitivity to cultural diversity and the ability to assess one’s bias, as well as the knowledge of culture, which involves the study of beliefs and values of different cultural groups. Another component is cultural skills, i.e. the use of cultural awareness and knowledge by planning the appropriate nursing intervention. Finally, there is the cultural desire, i.e. the motivation to obtain cultural awareness, knowledge, and skills (Dayer-Berenson, 2011).
In the conditions of globalization, providing culturally competent nursing care may be a difficult task. As a result, it is possible to offer a set of guidelines for the RNs. The first of them is self-reflection. To provide culturally competent care, the RN must understand the principles of her own culture, which may affect her attitude towards the patient (Jeffreys, 2009). For example, when treating the representatives of the other cultures, she may perform actions that may be considered unacceptable (touching of the specific parts of the body, the maintenance of the eye contact, etc.), so she has to place the beliefs and customs of the patient before her own.
The second guideline refers to the continuous acquisition of cultural knowledge by the RN to understand how the culture may affect the beliefs and behavior of a patient. In terms of health care, the beliefs and values of a particular patient are affected by his/her cultural norms that include the perception of health, suffering, and death as well as the role of a health care specialist in the process of care (Jeffreys, 2009). For example, when dealing with a religious patient suffering from a disease that is accompanied with twinges and perceiving it as a punishment, the RN must not force her professional ethics on him/her to eliminate the pain at any cost but rather discuss it with the patient by using particular religious dogmas and principles (e.g. the unacceptability of suffering) as the basis (Hollins, 2009).
The third guideline is the facilitation of a patient’s choice. Various cultures have different definitions for such concepts as health and well-being as well as the ultimate goals of treatment. As a result, the RN must help a patient in meeting these specific goals. Moreover, in some cases, the patient may have difficulties with the identification of what may be best for him/her (Jeffreys, 2009). For example, when dealing with a patient who believes that the diseases are caused by evil spirits (e.g. the resident of Central Africa or the jungles of South America), it is possible to question him/her on what kind of spirit has entered his/her body to identify the symptoms of the disease and develop the corresponding plan of care (Hollins, 2009).
The final guideline refers to the establishment of productive communication with the patient so he/she becomes an informed partner directly participating in the process of care. Depending on the cultural peculiarities, it may be based on either verbal or non-verbal approaches as well as both of them (Jeffreys, 2009). In particular, during the treatment of an illiterate patient (e.g. the resident of under developed countries of Africa or Southeast Asia) suffering from diabetes, it is even possible to explain the medication regiment to him/her by using illustrative examples, such as pictures, signs, etc. (Hollins, 2009).
As a health care professional that spends most time in the direct contact with a patient, the RN is the one that is able to evaluate whether his/her cultural needs have been met. The primary criterion is the response of the patient, which may be obtained either directly in the form of his/her opinion or indirectly through monitoring of any changes in his/her behavior. Additionally, the RN may also evaluate the cultural competence of the provided care by using her knowledge of the features of a particular culture. In case the behavior and response of the RN were adjusted in consideration with certain cultural peculiarities and no negative reaction of the patient was observed, it is possible to stay that his/her cultural needs have been met.
Nevertheless, despite the importance of the cultural practices in the RN’s activities, their accommodation in all aspects of health care is unacceptable. In particular, this statement refers to the emergency care, where they may become a serious obstacle for the process of provision of health care services. For example, certain cultures, namely the Hispanic and Arab, are known for the strict rules concerning the separation of sexes – male physicians cannot touch or examine certain parts of the female body and vice versa (Hollins, 2009). As a result, in the situation when a female patient suffers from an internal uterine bleeding but cannot receive help immediately due to the fact that only male health care specialists are available at the moment, cultural competence does not only prevent the provision of a timely care but may also lead to the death of a patient.
The cultural competence of the RN becomes of utmost importance when dealing with cultures that are quite different from the Western ones, namely the Chinese culture. At the same time, the concept of nursing is rather novel for the Chinese medicine, mostly being borrowed from the health care practices of the West (Smith & Tang, 2004). As a result, the role of the RN at the bedside of a patient is that of an intermediary between him/her and the physician. Although she does not treat the patient independently, performing a physician’s appointment, she monitors all the changes taking place in his/her state, and, most importantly, is able to calm him/her down and relieve his/her suffering. These functions of the RN are especially important for the patients suffering from chronic diseases or receiving the end-of-life care. However, the RN must take into account the following cultural features that influence the process of care.
The first of them is a traditionally strict hierarchical structure of the Chinese society that is based on the principle of a filial piety (Xiao), when the senior dominates over the young and men dominate over women (Davis, 2005). As a result, male Chinese patients (especially the elderly ones) may express the unwillingness to obey the RNs decrees. It is particularly serious in case of such chronic diseases as diabetes, when a patient must strictly adhere to a specific diet and medication regimen. In this case, cooperation of the physician is required so that patients understand that the RN is under his direct command and must be obeyed (Kersey-Matusiak, 2012).
The next feature involves environmental variations. The Chinese believe that the man has a certain degree of control over the events in his life, a belief that is presented in Taoism, a teaching that is still relevant in the Chinese society. As a result, it will be possible to establish efficient cooperation with a Chinese patient in the terms of health care regimens, which is particularly important in case of chronic diseases. The patient will see the benefits of his/her developing behavior, which may result in the improvement of his/her health (Dayer-Berenson, 2011).
The next feature is the eye contact, which is considered as culturally determined behavior. In the Western culture, the RNs are taught to maintain eye contact when speaking with patients. However, a strong gaze may be considered a sign of disrespect or even threat by the Chinese. It is especially critical in case the RN is providing the end-of-life care to the patient with a congenital or acquired heart disease as he/she may become anxious, which will result in an increased load on his/her heart, and ultimately provoke a heart attack (Dayer-Berenson, 2011).
The final cultural feature is touching. In the Chinese culture, touching someone else’s head is impolite as it is considered a receptacle of one’s spirit. Moreover, in the case of a patient receiving the end-of-life care, such action may be interpreted as hostility (Dayer-Berenson, 2011). In order to avoid such misinterpretations, which may result in the criminal prosecution for the RN, she must explain what is she doing and why before examining the head of a Chinese patient.
The cultural competence of the RN is primarily manifested in a wide array of nursing interventions performed by her. The first of them is the education of a chronically ill patient. In this regard, the RN must address him/her with utmost respect and explain all the aspects of heath regimen without a rush and be ready to repeat them many times (the Chinese culture is considered a slow-paced one), and, most importantly, not show her emotions (Davis, 2005). Another similar intervention is the moral support of the patient, which is to be conducted in the same way as his/her education (Kersey-Matusiak, 2012).
The next two interventions are primarily aimed at the patients receiving the end-of-life care. They include the implementation of patient care (the assistance with personal hygiene, changing the position of the patient in bed, etc.). In this regard, the RN must consider the way she can interact with a patient, namely in terms of touching certain body parts. Finally, the RN is responsible for planning the leisure of a patient receiving the end-of-life care (Kersey-Matusiak, 2012). However, such planning must be conducted in direct cooperation with the client. Otherwise, the patient may be feeling that he/she will have to return the favor to the RN in accordance with the basic principle of the Chinese society (Guanxi) (Davis, 2005).
Thus, it is clear that cultural competence plays a major role in the professional activities of the RN, especially on the background of globalization. When dealing with the representatives of the other cultures, the RN must consider their peculiarities and specific features to ensure the high quality of the provided care. This statement is especially true for the Asian cultures, namely the Chinese culture as many of the Western norms and customs are alien to it. Moreover, certain actions of the RN may result in the worsening of a patient’s condition and even in the criminal prosecution for the RN despite the fact that they are a part of her professional competence. In order to avoid such misunderstanding and ensure the high quality of care, it is necessary for the RN to follow the guidelines for the provision of the culturally competent nursing care and possess the knowledge of specific cultural features that may affect the process of treatment, including the ones described in the presented essay.