Cultural Competency Case Study

Madeleine Leininger’s Trans cultural Nursing Theory (TNT) has been identified as the ideal model for delivering culturally competent care. The theory involves having knowledge and understanding of the different cultures with respect to values, beliefs, health-illness caring practices, and nursing with the objective begin to provide efficacious and meaningful nursing services to patients according to their health-illness context and cultural values. It seeks to ensure that the cultural care worldview flows into the knowledge about institutions, communities, groups, families and individuals in diverse health care systems. The information presented in the diverse systems include the specific feature of care and characteristics of each culture. With this awareness, nurses are able to take actions and make decisions that involve the maintenance, preservation, negotiation, accommodation restructuring and re-patterning of cultural care so that nursing care is delivered at the cultural level (Masters, 2015).

The case makes use of TNT by assuming that a nurse helps the patient to move towards improving/ameliorating the health condition or practice. It concedes that this could be difficult to achieve since the very notion of instilling new health ideas into a different culture could present as an intrusive intent to members of a cultural group. This is based on the awareness that culture describes a strong set of practices that are difficult to change and are developed over generations. The activity of immersing into a different culture could be costly and take much time for the nurse, especially if the goal of the immersion is to understand the cultural practices and beliefs. These reasons make it difficult for nurses to engage in cultural immersion in order to better understand their patients. Besides that, cultural immersion is intrusive and could face resistance from the ‘insiders’ who could threaten the safety of the nurse. TNT addresses these concerns by presenting a structure for providing culturally sensitive nursing care without the need for engaging in immersion activities (McKenna, Pajmkihar & Murphy, 2015).Cultural Competency Case Study

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The case study will make specific use of the Sunrise Model of TNT. The model is considered useful since it enables nurse personnel to develop complex and critical thoughts to support nursing care delivery.  The model concedes that nurses can deliver culturally sensitive care by ensuring that their thoughts in the professional practice environment consider and integrate the social and cultural structure dimensions in each specific context, besides thinking about the psychological and biological aspect of nursing care delivery. In applying the model, the cultural care worldview would flow into the knowledge about institutions, communities, groups, families and individuals. The knowledge is then used to provide culturally specific expressions and meanings in relation to health, wellness and care. In addition, knowledge is collected about folk/generic systems, nursing care, and professional care systems, with the knowledge used to determine the specific care features and characteristics of each patient. All the collected knowledge allows nurses to identify the similarities and differences of cultural care diversity and universality (Pérez & Luquis, 2014).

In applying Sunrise Model of TNT, nursing care actions and decision will be presented in three modes. The first mode is cultural care restructuring and re-patterning. This includes the enabling, facilitative, supporting and assistive professional nursing decisions and actions that help the patient to modify, change or reorder lifeways for beneficial, different and new health care patterns while respecting the patient’s cultural beliefs and values while still providing a healthier and beneficial lifeway than before the change. The second mode is cultural care negotiation and accommodation. This includes the enabling, facilitative, supportive and assistive creative professional nursing decisions and actions that help the patient from a particular culture to negotiate with health care providers and adapt to the situation for a satisfying and beneficial health outcomes. The third mode is cultural care maintenance and preservation. This includes the enabling, facilitative, supportive and assistive creative professional nursing decisions and actions that help patients of a designated culture to preserve and retain the relevant care values in order to face handicaps and death, recover from illness, and maintain wellbeing (Butts & Rich, 2018).

History/Interview

Mary is a 32-year-old pregnant woman of Hispanic origin and married to a 37-year-old Hispanic male. They have a four-year-old daughter. Mary is in the early stages of her pregnancy. The gender of the fetus was determined as male and she has been advised to consider having the yet to be born baby circumcised before or on his third birthday. However, Mary is resistant to considering having her unborn son circumcised, mentioning that her culture does not discuss male circumcision. In addition, she fears hurting her son by subjecting him to a surgical procedure that she considers unnecessary. Besides that, her husband is uncircumcised and she fears bring up this topic with him as there is a chance of being misunderstood. She understands the need for male circumcision as a long-range tool for reducing STI incidences, but still remains resistant to having her son circumcised. She was diagnosed with a STI in her late teens and was successfully treated. She is not on any prescription medication, but has been taking some vitamin and mineral supplements during her pregnancy. She has not had any other significant medical concerns. She is allergic to penicillin. She dislikes using pain medication as they make her feel groggy. She does not drink alcohol or use other drugs. She is physically active and regularly attends an exercise program. She works for a health insurance company, but has taken a maternity leave in preparation for the birth of her son.  Cultural Competency Case Study

Family history

Mary is married with one child, a four-year-old daughter. She has two siblings. Her sister was diagnosed with breast cancer three years ago. She underwent successful treatment and has been free from cancer for the last one year. Her brother was diagnosed with HIV and is currently living with the condition while taking antiretroviral medication to manage the virus infection. Her parents are diseased. Her father suffered from heart disease and died at the age of 58 years. Her mother suffered from Alzheimer disease and died at the age of 65 years. Her husband contracted an STI as a young adult and was successfully treated. Her husband grew up in an orphanage and is unclear about his family origins (see Appendix).

Physical exam

Vitals

Temperature is 99oF, pulse at 88, respiration rate at 24, blood pressure at 114/78, and oxygen sats at 90% on room air and 95% on 4L oxygen.

General

Alert, calm and well developed female. Height and weight are proportionate. There has been some weaknesses in the arms and legs.

HEENT

Pupils are round, equal and reactive to accommodation and light. Intact extraocular movements. Moist mucous membranes in oropharynx. The teeth are white with no indications of caries.

Neck

Supple without thyromegaly or lymphadenopathy. No carotid bruits.

Lymph

No submental, pre-auricular, supraclavicular, cervical, axillary or occipital lymphadenopathy.Cultural Competency Case Study

Cardiovascular

Regular rhythm and rate with normal S1 and S2. No gallops, rubs or murmurs.

Lungs

No tenderness to palpitation. No agophony. No accessory muscle use or cyanosis, no wheezes.

Abdomen

Non-distended, non-tender, flat and soft. Liver span approximately 10 cm, no hepatosplenomegaly. Normoactive bowel sounds.

Skin

Well perfused, dry and warm. No lesions or rashes. Tanned forearms and neck.

Neuro

Alert and oriented to place, person and time. Able to communicate well. Sensation intact in all extremities. Normal gait. No clonus.

Illness analysis

Given the family’s Hispanic culture, it is expected that they would be resistant to the idea of having the son circumcised before he turns three-years of age. There are three significant concerns. Firstly, Mary fears that her husband may react badly if she raises the issue of having her son circumcised as a baby. Secondly, she fears hurting her son since circumcision involved conducting a surgical procedure. Thirdly, she appears to be unaware of the merits of male circumcision, especially with regards to contracting and spreading STIs.

Transcultural treatment plan

Mary is Hispanic and this has had an effect on how she perceived the circumcision of male children. Spense et al. (2017) acknowledges that newborns of Hispanic origin are less likely to be circumcised because of cultural reasons (newborn circumcision is not a cultural practice among Hispanics) and lack of awareness about the merits of the practice. Although the medical personnel should maintain a neutral position, this does not preclude them from discussing with Mary about the benefits versus the risks of newborn circumcision. Although the procedure is not medically indicated, Mary should be presented with evidence showing that male circumcision has the potential benefit of preventing urinary tract infection and STIs to include HIV (Sorokan, Finlay & Jefferies, 2015). Based on the assessment, it becomes clear that Mary should be subjected to a patient education program on newborn male circumcision then allowed to make a decision on whether or not to proceed with the procedure. In addition, she would be provided with the opportunity to invite her husband to the education program to get his input and support (Pérez & Luquis, 2014).Cultural Competency Case Study

Resources

A patient education program would be implemented to enable the Mary better understand the benefits and risks of newborn male circumcision. In addition, she would be provided with information on how to access patient support services to include counselling services.

References

Butts, J., & Rich, K. (Eds.) (2018). Philosophies and Theories for Advanced Nursing Practice (3rd ed.). Jones & Bartlett Learning, LLC.

Masters, K. (2015). Nursing Theories: A Framework for Professional Practice (2nd ed.). Jones & Bartlett Learning, LLC.

McKenna, H., Pajnkihar, M., & Murphy, F. (2015). Fundamentals of Nursing Models, Theories and Practice. John Wiley & Sons, Inc.

Pérez, M., & Luquis, R. (2014). Cultural Competence in Health Education and Health Promotion. John Wiley & Sons, Inc.

Sorokan, T., Finlay, J., & Jefferies, A. (2015). Newborn Male Circumcision. Pediatrics & Child Health, 20(6), 311-315. https://doi.org/10.1093/pch/20.6.311

Spense, J., Meller, J., Abbey, J., Foster, K., Sirri, C., & Naqvi, M. (2017). Why Are We Cutting? A Survey of Cultural Views on Circumcision in the Texas Panhandle. Global Pediatric Health, vol. 4, https://doi.org/10.1177/2333794X17711767

Cultural Competency Case Study