NSE11A Week 7: Notes
1. Elements of culturally sensitive care based on the CNO guideline
Self reflection: Everyone has culture & nurses must understand culture if they are going to provide
culturally sensitive care. Beliefs & values affect nurses’ perception & knowledge, which in turn affects the
way they treat patients. Self-reflection is a process that helps nurses identify these values and beliefs, to
ensure they are not fostering prejudice or misconceptions of different cultural practices. This process can
be facilitated by asking culturally relevant question and interacting with client and coworkers who have
different values - both can help broaden a nurse’s understanding of different cultures.
Acquiring cultural knowledge: It is improbable that nurses will know all the values of every culture, yet
important they understand that culture shapes beliefs & interactions. Acquiring cultural knowledge ensures
that nurses are aware of how practices differ based on varying cultural contexts. Sources of cultural
information include clients themselves, as they are the experts of their own lives, colleagues, friends,
community groups & workplace resources. e. g. communication norms i.e. eye contact, touch, tone.
Facilitating client choice: The role of a nurse is to promote health by assisting and educating the client on
necessary information for making health decisions while not interfering with their personal wishes or goals
In order to do so, nurses must first understand their client’s perspective of their health problems and of their
goals. Clients might not always know what is best & may want to choose a treatment plan that is harmful to
themselves or others or a cultural practice that will negatively impact their health. In this case, it is important
that the nurse educate the client (in a nonjudgmental manner) of the best way to reach the clients goals,
while ensuring the safety of other clients.
Communication: Establishing meaningful communication between the nurse & the client results in better
care. When barriers exist, for example: language barriers, one way to help with this is to work with
interpreters. Caution in using family, as this can influence the communication to the client as they may have
a limited understanding of the issue and vocabulary and it may also be difficult for them to remain
objective. We can also try non-verbal communication strategies, such as gestures or pictures, and to
remain receptive while avoiding restrictive body language. Also, make sure the client’s questions are being
answered and be aware of cultural differences. Establishing a meaningful client-nurse relationship through
therapeutic communication allows the client to have their own voice in planning goals and treatment while
ensuring that privacy and confidentiality standards are met
2. The importance of assessment & establishing mutual goals in developing an approach to
culturally sensitive care based on the CNO guideline.
Assessment of mutual goals is simply asking the patient open ended questions and listening with respect to
their cultural beliefs and values. An example of an open-ended question would be, “What do you think has
led to the problem?”
Staying committed in designing creative approaches and alternatives to establishing mutual goals is done
in three ways. Culture-care preservation is an approach that preserves a client’s beliefs and values only
when there is no risk to the patient or others by following them. Culture-care accommodation involves
overcoming barriers that may arise due to the client’s culture. This mode of action is more of a compromise and incorporates as many of the client’s beliefs and values as possible. A final mode of creative approach
to alternatives in establishing mutual goals is culture-care re-patterning. This mode involves implementing
a client’s traditional values and beliefs while exploring and discussing options with the client.
An example of these creative approaches and alternatives to establishing mutual goals is the case of the
young Hindu man who is undergoing dialysis for renal failure. An important component of his treatment is
to consume a large amount of protein, ideally from animal sources. However, in order to devoutly practice
Hinduism, the client is required to follow a vegetarian diet, and feels he needs the help of his religion to get
through his illness. Specifically, culture-care accommodation can be used in this case. The client’s
vegetarianism is a barrier to his treatment. But, a compromise can be reached by finding alternate protein
sources for the client to consume such as cheese, lentils, and tofu. In this way, the client’s cultural beliefs
are adhered to, but he is also consuming a diet which will facilitate his recovery.
3. Concept ‘person’ according to Florence Nightingale, in relation to the metaparadigm of nursing &
how this perspective helps us view the client as a whole person.
Person is “the individual with recuperative powers within self to restore own health. Nightingale views a
person as a patient who is greatly influenced by nurses, in ways that affects the patient’s health status. For
instance, a nurse provides physical care, empathy and support towards the patient to improve the recovery
process. In addition, the health condition of the patients is affected by the physical, psychosocial, cultural,
developmental and social environment. “Recovery is in the patient’s power as long as a safe environment
exists” (Nipissing University, slide 18). For example, a patient in the long term care facility needs a quiet
and spacious external condition for them to be able to relax and rest.
Health is a broad concept that is used to describe an individual’s state of well-being & level of functioning In
other words, a person’s health is not just being free from illness and disease but also having a well
balanced diet & physically active lifestyle. For a patient to recover, they have to deal with diseases using
their reparative (tending to repair) powers and must have a positive attitude towards healing and life.
4. Concept of person according to Watson in relation to the metaparadigm of nursing & how this
perspective helps to view the client as a whole person
Person is a living, constantly growing totality comprising emotion & soul, a transpersonal transcendent
evolving consciousness; unity of mind body spirit; person-nature-universe as oneness, connected. Nurses
look past the illness and attend to what they were intended for, which is caring.
The role of person in the paradigm of nursing is just one aspect, but the most important. It gives a whole
new perspective on viewing the client as a whole, instead of treating the client as just another case. The
client should be treated as an individual, a human being with feelings and emotions. Client-centered care is
one way to achieve this. Nurses must embrace the values of a client such as respect, human dignity,
timeliness, and responsiveness. It should be approached in a way to view a client as a whole, by not
merely delivering services. It involves being non-judgmental, advocacy, and staying within the boundaries
of the client’s autonomy. Also, the client should have a major part in the participation of decision-making
especially in the care plan. There is no point in having a careplan the patient cannot complete successfully.
The nurse and client must wo