Caring in Nursing Practice, Culture and Ethnicity

Nursing Care Delivery

Nursing care can be carried out through a variety of organizational methods.

The model of nursing care used varies greatly from one facility to another and from one set of patient circumstances to another.

NURSING CARE DELIVERY MODELS

The four classic nursing care delivery models used during the past five decades are

• total patient care, • functional nursing, • team nursing, • primary nursing.

TOTAL PATIENT CAREThe oldest method of organizing patient care is total patient

care, sometimes referred to as case nursing. In total patient care nurses are responsible for planning, organizing, and performing all care, including personal hygiene, medications, treatments, emotional support, and education required for their assigned group of patients during the assigned shift

FUNCTIONAL NURSINGIn the functional nursing method of patient care delivery, staff

members are assigned to complete certain tasks for a group of patients rather than care for specific patients. For example, the RN performs all assessments and administers all intravenous medications; the LVN/LPN gives all oral medications; and the assistant performs hygiene tasks and takes vital signs. A charge nurse makes the assignments and coordinates the care.

TEAM NURSING• Originated in the 1950s and 1960s.• Involves use of a team leader and team members to provide

various aspects of nursing care to a group of patients. • In team nursing, medications might be given by one nurse

while baths and physical care are given by a nursing assistant under the supervision of a nurse team leader.

•Skill mixes include experienced and specially qualified nurses to nursing orderlies.

•The quality of patient care with this system is questionable, and fragmentation of care is of concern.

PRIMARY NURSING

Primary nursing refers to comprehensive, individualized care provided by the same nurse throughout the period of care.

Primary nursing is a method of nursing practice which emphasizes continuity of care by having one nurse provide complete care for a small group of inpatients within a nursing unit of a hospital.

This type of nursing care allows the nurse to give direct patient care.

The primary nurse accepts total 24-hour responsibility for a patient’s nursing care.

Nursing care is directed toward meeting all of the individualized patient needs.

The primary nurse communicates with other members of the health care team regarding the patient’s health care.

This care method is rejected by many institutions as too costly.

PROGRESSIVE PATIENT CARE • PPC is a system of nursing care in which patients are placed in

units on the basis of their needs for care as determined by the degree of illness rather than on the basis of a medical specialty.

• Organization of medical and nursing care according to the degree of illness and care requirements in the hospital.

Progressive patient care is the systematic grouping of patients according to their degree of illness and dependency on the nurse rather than by classification of disease and sex.

It is a method of planning the hospital facilities, both staff and equipment, to meet the individual requirements of the patient.

PPC has been defined as "the right patient, in the right bed, with the right services, at the right time"

Elements of PPC ▫ Intensive care units for critically ill patient ▫Self-care units for convalescent patients or those requiring

investigation.▫ Intermediate care units for those patients not requiring to

be housed in either of the foregoing, and who would constitute approximately 60%, of all patients in hospital.

▫Beds attached to out-patient departments for " one day" patients.

The elements can also be named as intensive care, intermediate care, self-care, long-term care, and organized home care.

Major concepts of PPC• PC is defined as better patient care through the organization of

hospital facilities, services and staff around the changing medical and nursing needs of the patient

• PPC is tailoring of hospital services to meet patients needs • PPC is caring for the right patient in the right bed with the

right services at the right time • PPC is systematic classification of patients based on their

medical needs

JEAN WATSON NURSING THEORY Jean Watson nursing theory is also known as the Theory of

Human Caring. This theory was developed by nurse Jean Watson, a highly respected professor at the University of Colorado. Ms. Watson's theory focuses on the idea of bringing basic love and caring back into healthcare.

Watson's theory was radical in that it stated that caring should come before curing. Caring is a choice nurses make in their clinical interactions, and caring should be the bedrock of nursing practice. To care for patients, nurses must respect their value as a human being and the sensitivity of their situation. In Watson's theory, caring preserves human dignity in healthcare.

Some aspects of caring theory.. • Caring Occasions: The

caring occasion is a particular moment in time when the patient and nurse connect. During the caring occasion, the two share life experiences and a connection on the spiritual level. In person-to-person encounters nurses can use touch, eye contact, body language, a positive attitude, and listening skills to foster a caring occasion.

Healing Consciousness• Healing consciousness is also referred to as caring

consciousness. Caring consciousness is the mindset the nurse brings to healing. A nurse with a caring, healing, and loving consciousness can transcend a physical moment of clinical care, to make a connection with a patient. To develop a healing consciousness, nurses must find a balance between their own belief systems and the belief systems of others.

Transpersonal Caring• Transpersonal caring refers to caring for another person's

spirit and well-being, on a nonphysical level. Nurses practicing transpersonal caring are respectful of their patients' life space and condition of being. During transpersonal caring, nurses focus on healing and wholeness of the patient, rather than a disease to be cured. Nurses provide an emotionally and physically calming presence for patients.

Culture• Culture may be defined as "the learned and shared beliefs, values

and life ways of a designated or particular group that are generally transmitted intergenerationally and influence one's thinking and action modes."1 Many assume overcoming language barriers or having a basic understanding of some ethnic practices is enough to successfully address the needs of diverse clients within our practice. However, this is not the case.

• Cultural competence and respect for others becomes especially important for us in the nursing practice because we are patient advocates.

• Cultural competence is the capacity of individuals or services to incorporate ethnic/cultural considerations into all aspects of their work relative to health promotion, disease prevention and other healthcare interventions. It also is described as the ability to perform and obtain positive clinical outcomes when engaging in cross-cultural encounters. Acquiring skills related to culturally competent nursing practice is important for better client outcomes, satisfaction and quality of care.

The five essential elements of cultural competentce:

• Valuing diversity • Having the capacity for cultural self-assessment. • Being conscious of the dynamics inherent when cultures

interact. • Having institutionalized cultural knowledge. • Having developed adaptations of service delivery reflecting an

understanding of cultural diversity. 

• To be culturally competent the nurse needs to understand his/her own world views and those of the patient, while avoiding stereotyping and misapplication of scientific knowledge. Cultural competence is obtaining cultural information and then applying that knowledge. This cultural awareness allows you to see the entire picture and improves the quality of care and health outcomes

Nurses can increase their own cultural competencies by following a few guidelines:

• Recognizing cultural differences and the diversity in our population. 

• Building your own self-awareness and examining your own belief systems. 

• Describing and making assessments based on facts and direct observation. 

• Soliciting the advice of team members with experience in diverse backgrounds.

• Sharing your experiences honestly with other team members or staff to keep communication lines open. Acknowledging any discomfort, hesitation, or concern.

•   Practicing politically correct communication at all times – avoid making assumptions or stereotypical remarks.

•   Creating a universal rule to give your time and attention when communicating.

• Refraining from making a judgment based on a personal experience or limited interaction.

•   Signing up for diversity and inclusions seminars.

• Becoming involved in your agencies diversity programs – find out what your resources are - most institutions have something in place.

 

Culturally diverse nursing care

•An optimal mode of health care delivery, refers to the variability of nursing approaches needed to provide culturally appropriate care that incorporates an individuals cultural values, beliefs, and practices including sensitivity to the environment from which the individual comes and to which the individual may ultimately return.

Stages…

Cultural awareness•which begins with an examination of our

personal value base and beliefs. The nature of construction of cultural identity as well as its influence on people's health beliefs and practices are viewed as necessary planks of a learning platform.

Cultural knowledge

• Cultural knowledge (the second stage) can be gained in a number of ways. Meaningful contact with people from different ethnic groups can enhance knowledge around their health beliefs and ehaviours as well as raise understanding around the problems they face. Through sociological study the students can be encouraged to learn about power, such as professional power and control, or make links between personal position and structural inequalities.

Cultural sensitivity• An important element in achieving cultural sensitivity (the

third stage), is how professionals view people • in their care. Unless clients are considered as true partners,

culturally sensitive care is not being achieved; • to do otherwise only means that professionals are using their

power in an oppressive way. Equal • partnerships involve trust, acceptance and respect as well as

facilitation and negotiation.

The achievement of the fourth stage (cultural competence) requires the synthesis and application of previously gained awareness, knowledge and sensitivity. Further focus is given to practical skills such as assessment of needs, clinical diagnosis and other caring skills.

A most important component of this stage of development is the ability to recognise and challenge racism and other forms of discrimination and oppressive practice. This model combines both the multi-culturalist and the anti- racist perspectives and facilitates the development of a broader understanding around inequalities, human and citizenship rights, whilst promoting the development of skills needed to bring about change at the patient/client level.