My initial thoughts when the family first closed the curtains were that they were anxious about their child and simply wanted some privacy, and when the nurses began to open the curtains I still agreed with their actions. Allowing the child to remain in the dark all day was not promoting empowerment of the patient back to good health. After speaking to mum my feelings changed as it became apparent that her anxieties were partly down to worries about her child, but notably initiated from the cultural conflict she was feeling. These conflicts were caused by the environment that we had placed her in and this really disappointed me, that an important aspect of her life had been overlooked. Upon reflection we had no respect for the family’s autonomy and therefore failed to promote and protect the interests and dignity of the patient/client irrespective of their cultural and religious beliefs (NMC 2004).
As the family became withdrawn and unresponsive towards us I became increasingly worried and upset that a simple lack of knowledge about the families cultural beliefs was compromising the family centred care I was striving to achieve. The lack of respect of the client as an individual meant that care was being compromised:
“A client who experiences nursing care that fails to be reasonably congruent with his beliefs and values will show signs of cultural conflict, non-compliance or stress to ethical or moral concern” (Leininger 1997 p.2-3).
After speaking to mum about her anxieties I felt reassured in my ability to communicate effectively to diffuse the situation, and happy that I was able to subsequently make a difference in the care I was now able to give. The simple acknowledgement of the family’s distress meant that I gained the understanding and compliance of mum and was now able to promote justice, and respect the client as an individual.
If I could change the experience in any way I would have liked the confidence to gain more insight about my families cultural preferences on admission, therefore avoiding stereotyping them into one particular religion, causing the subsequent withdrawal of the family that compromised care.
“When you are caring for a patient from a different culture from your own you need to respect his cultural preferences and beliefs otherwise they may consider you to be insensitive and indifferent, possibly even incompetent” (Lippincott et.al 2005 p.1).
I believe that my family perceived us to be incompetent due to their non-compliance with care, and if we had not assumed that all members of the Hindu religion all act and behave in the same way we would have avoided stereotyping and thus adhered to the code of professional conduct, respecting the client as an individual. Goold (2001 p.1-2) states that “everyone has the right to be treated differently, because treating people the same can be seen as discriminating”. Failing to recognise their cultural beliefs meant we failed to promote the interests of my client.
This experience prompted me to research further into Hinduism and the cultural aspects involved, and has given me the understanding of how stereotyping people into particular religions can have detrimental effects on care. Within Hinduism “a caste system exists which divides society into four social classes, inherited at birth due to karma” (Bungalia et.al 2003 p1-2). My family were of a higher class and were therefore in cultural conflict having to share a room with a lower class family, which culturally they are forbidden to do. We failed to acknowledge these cultural issues but learning about them has enabled me to become more beneficent within my nursing care, making it my responsibility to respect the client as an individual. From this I have realised that it is incredibly important to establish a good rapport with my clients in order to give individualised holistic care, adhering to the code of professional conduct.
In the future I aim to apply the knowledge that I have acquired to provide more competent, individualised care using in depth assessments on admission, allowing me to become more sensitive to cultural diversity.
“The best way to avoid stereotyping is to view each patient as an individual and to find out cultural preferences using a culture assessment tool to discover and document them for other members of the health care team” (Lippincott 2005 p1).
I am encouraged by the number of tools proposed, one example being the ACCESS model (Narayansamy 1999) which promotes sensitivity towards patient’s individual cultural/religious and spiritual needs.
Reflection within the code of professional conduct has helped me to apply my knowledge and a skill in practice to the competencies set out by the code of conduct, and has allowed me to identify gaps in my knowledge. It is incredibly important to promote clients as individuals in order to give competent care. Not respecting clients cultural values compromises care and takes away client autonomy.
References:
BHUNGAlIA, S, KELLY, T, VAN DE KEIFT, S and YOUNG, M. (2005) Indian health care beliefs and practices. Indians. Baylor university, Texas <>(updated 09/2004, accessed 06/2005).
CAMPINHA-BACOTE, J. (2003) Cultural desire: the key to unlocking cultural competence. Journal of nursing education, 42(6), pp.239-240.
GIBBS, G. (1988) Learning by doing: A guide to teaching and learning methods. Further education unit: Oxford Brookes University.
GOOLD, S. (2001) Transcultural nursing: can we meet the challenge of caring for the Australian indigenous person? Journal of transcultural nursing, 12(2), pp.94-99.
JUNTUNEN, A, DEPARTMENT OF NURSING HEALTH AND ADMINISTRATION (2001). Professional and lay care in the Tanzanian village of Ilembula-Leiningers culture care theory. University of Oulu<>(accessed 06/2005).
LIPPINCOTT, WILLIAMS and WILKINS (2005) Understanding transcultural nursing, career directory supplement. Nursing, 35(25), pp.14-23.
NARAYANASAMY, A. (1999) ASSET: a model for actioning spirituality and spiritual care education and training in nursing. Nurse education today, 19(4), pp.274-285.
NURSING AND MIDWIFERY COUNCIL (2004) Code of Professional conduct.
