Cultural Care and Safety in Nurcing

7 July 2016

Culture plays an important role on nurse’s ability to provide culturally skilled care which involves the ability to manage complex differences in attitudes, religion, world views and even language (Jones & Bourgeois, 2011). Culture is well-defined as the way of people live in a society. Cultural safety established as a concept in nursing practice in New Zealand with respect to health care for Maori people and later it progressed to provide quality care for people from different ethnicities and cultures.

Therefore, nurses must provide the care within the cultural values and norms of the patient, otherwise which diminishes,demeans or disempowers the cultural identity and well-being of an individual (Wepa, 2005). The definition of Cultural Safety given by New Zealand Nursing Council is, “ The effective nursing practice of a person or family from another culture and is determined by that person or family.

Culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief; and disability”(Nursing Council New Zealand [NCNZ], 2009). This assignment will discuss the health needs of New Zealand teenagers who involved in smoking. Apart from that,it will discuss how nurses should recognize the attitudes,cultural beliefs and how to demonstrate flexibility in their relationship with clients.

Finally, I have discussed how theTreaty of Waitangi and Cultural Safety principles reflect on the nursing values for providing culturally safe practice. TASK ONE: Six million people die per year because of tobacco smoking and this yearly death rate might upswing to more than eight million by 2030, unless a significant effort is made (World Health Organization [WHO], 2011). It is a well-known risk factor for many cancers and for respiratory and cardiovascular diseases. In 2009, 22 per cent of people aged 15–64 years were cigarette smokers (Ministry of Social Development, 2010).

Tobacco Smoking starts in early adolescence, usually by age 16 and most of them uses before high school graduation (Teen Smoking Facts, n,d). According to the Year 10 Smoking Survey conducted by Action on Smoking and Health New Zealand, and the Health Sponsorship Council, 28. 6 % teenagers were linked with Tobacco Smoking in 1999 and it plunged to 14. 2 % in 2006. The Auckland District region became the least Year 10 smoking rate with 8. 5 % whereas; Wanganui District Health region got the highest rate with 23. 3 % (Action on Smoking and Health[ASH], n. d. ).

According to ASH Statistics, 12.8 % of youth aged 14-15 are regular smokers in which 10. 6 % among boys and 14. 9% among girls (Coe, n. d). The main health needs of Smoking teenagers are rehabilitation services, which include initiating smoke free homes, comprehensive school based education programs and policies, moreover, try to render help if they need any medical assistance to quit smoking (Lannelli, 2004). Programs should be fun and interactive, which can be tailored to the health issues faced by youth people. Parents who smoke are more likely to have children who smoke, so it is better to avoid smoking which helps the child to think logically (How to Quit Smoking, n.d).

The environment in which teenagers live have a profound effect on their health; these are known as the social determinants of health (SDOH), including poverty, unemployment, poor education, bad nutrition, poor housing, less social support and higher level of stress (WHO, Social Determinants of Health , 2008). Low socio economic status makes the higher rates of smoking statistics. Health inequalities are not unavoidable which stem from avoidable disparities in society: on the basis of income, education, employment and neighbourhood circumstances and can be significantly reduced.

While smoking causes ill health and physical addiction, the social determinants are those aspects that persuade or encourage individuals to become smokers, and to continue in the smoking habit despite their knowledge of the harm it is doing (Social Determinants and Smoking,n. d). TASK TWO Cultural safety is based within a framework of dual cultures and is consistent with the beliefs of Aotearoa/New Zealand’s founding document, the Treaty of Waitangi.

Cultural safety is designed to guide health care delivery defined as ‘safe’ by the person receiving the care, which is indispensable part of nursing education in which nurses are responsible for effectively establishing and maintaining the limits or boundaries in the therapeutic nurse-client relationship (Richardson & Macgibbon, n. d. ). In the case of New Zealand population, it is necessary to respect the key principles of Treaty of Waitangi, and they are 3 P’s like Participation, Protection and Partnership. Moreover, the health professional should consider these principles in their health care practice.

The Treaty of Waitangi has developed a well-defined smooth platform for maintaining interactions between client and nurses (Wepa, 2005). The principle of partnership is to accomplish best state of individual involvement through culturally safe nursing practice. The nurses and clients must work together for promotion of health and prevention of diseases. Besides, it should be based upon the welfare of both partners through collaboration of planning, assessment, decision making and delivery of health care services (NCNZ, 2009).

Partnership refers to the interactions between the client and the health Professional include developing a therapeutic relationship, respecting cultural differences, discussing options and involving them in the decisions about their care. The nurse establishes and maintains this key relationship by using nursing knowledge and skills, as well as applying caring attitudes and behaviours. There are five components to the nurse-client relationship: trust, respect, professional intimacy, empathy and power (College of Nurses of Ontario, 2006).

Strengthening of family functioning has utmost significance in developing positive thinking among smoking teens to quit smoking. Family should be encouraged to understand the needs of teenagers by giving care and being more responsive. Nurses can give health education regarding detrimental effects of smoking and divert their habit to nicotine replacement therapy, gum and lozenges to avoid smoking (McMurray, 2007). Protection refers to the responsibility of the government to provide funding for teenage health, which constitutes protecting their physical, spiritual, emotional, mental and family health (New Zealand Cancer Society,2009).

The principle of Protection aims to render safe health care and disability services to the clients. Nurses must aim to guard sense of identity of client throughout treatment which develops their self determination (NCNZ,2009). Nurses should keep the treatment confidential to maintain trust and inform the family of the client about progression of condition. Advocating and protecting teenagers include questioning goals of care when there is a misalignment between patient-family and medical team goals.

The strong assessment prompts nurses to act as client’s advocates to speak about the values embedded in the practice and the needs of patients and their families (Day, 2006). Nurses ought to create self-esteem and determination in teenagers by developing positive attitudes about their life and career development (National Public Health Partnership, 2000). Participation calls for the positive involvement of clients with high level of decision making about their health needs in order to gain positive outcomes.

It not only includes the clients, moreover discussing with their parents regarding prevention of teenage smoking. Access to learning and information gives significant achievement in active participation and the empowerment of teenagers (Hally, 2009). Active contribution from public as well as government helps in developing awareness and formulating tobacco prevention programs. Also, it conveys public policy initiatives to control youth access to tobacco and initiating cessation programs for youth is needed.

For the prevention of teenage smoking, nurse should motivate them to participate in various community projects such as media anti- smoking campaigns, prohibition of tobacco products (McMurray, 2007). Efforts should be targeted at the schools, community, health care system, media campaigns, and the public policy arena, hence there are many factors predispose young people to smoke, such as parental smoking, peer pressure, advertising and marketing, as well as the easy availability of tobacco products from vending machines and illegal sales.

Nurses are in a distinctive position to support a multipronged approach to the anti-smoking movement. Efforts to eliminate smoking and the use of smokeless tobacco products need to include in smoking prevention programs in schools. Nurses can help activate community participation in tobacco control strategies and implementation to reduce access by minors. Nurses are in a position to design and implement educational programs in school systems for students, teachers, staff members, and parents (LaSala & Todd, n. d). Significance of Erikson’s stage Identity vs.

Confusion should be considered by the nurses while dealing teenagers. Nurses must identify or develop smoking cessation programs that meet the needs of all types of adolescents and are effective in helping them to quit. Once designed, these smoking cessation programs should be made accessible to adolescents in a variety of settings. Techniques used in these programs include peer leadership, nicotine patch therapy, peer support, computer instruction, and one-on-one counselling with a nurse practitioner (Donovan, n. d).

Nurses can educate the population on the harmful effects and future health problems of tobacco use, whereas they can help tobacco users to overcome their addiction in community level by implementing some policy measures like making them engaged to be in smoke-free workplaces and extending the availability of tobacco cessation resources. Peer-led prevention programmes like health education should be encouraged for young people so that peers can teach them about social consequences of smoking (Kearney & Whyte, n. d. ). TASK THREE

Nursing is a practice discipline with a unique body of knowledge and skills underpinned by nursing theory and research. Nursing’s core focus is people, and the way in which people respond to health, wellbeing, illness, disability, the environment, health care systems, and other people. The discipline of nursing in Aotearoa New Zealand incorporates the uniqueness of our cultural experience, drawing on concepts of whakawhanaungatanga, manaakitanga, rangatiratanga, and aroha in developing effective relationships as an essential tool for improving health outcomes.

Nursing assures the human face in healthcare and provides professional, equitable nursing care for individuals, family whanau, hapu, iwi, and the wider society (New Zealand Nurses Organization [NZNO],2010). Nursing Culture can be defined as the combined pattern of human knowledge, beliefs, attitudes and behaviour that depends on the individual efficiency for learning and getting knowledge for the purpose of achieving positive health outcomes (University of British Columbia, 2006).

Nurses should provide efficient nursing services to the people and nurses should understand historical, social, economic and political power of relationships in delivering health care to the people (NCNZ, 2009). Communication, recognition of the diversity between cultural groups, and the impact of colonisation processes on minority groups has optimum significance on Nursing Culture. Cultural safety is an outcome of nursing education that enables a safe, appropriate and acceptable service that has been defined by those who receive it. It focus on understanding the impact of the nurse as a bearer of his/her own culture, history, attitudes and life experiences and the response other people make to these factors which makes them to examine their practice carefully.

Besides, it recognises the power relationship in nursing which is biased toward the provider of the health and disability service. The examination of our own personal, cultural and health values, beliefs and practices the beginning point towards culturally safe practice (NCNZ, 2009). The nurse can provide centralized care to the patient in which customs; traditions, interests, beliefs, values, life style and family circumstances should be given maximum priority.

The planning and designing of treatment for the patient along with health care team plays an important role in developing positive outcomes. The three basic factors such as respect, coordination and efficiency are associated with the positive outcome of patient centred care. The patient centred care depends upon the efficiency of nurse to provide information regarding understanding of the illness, diagnosis and treatment options (McKerns, n. d. ). According to nursing culture, communication is the first step for nurses in providing care within cultural safe practice.

Communication plays an important role in principle of partnership as the nurse has to rapport well with teenage smokers and their family members in order to gain positive health outcomes (McMurray, 2007). Other Strategies that improve the skill to be culturally safe includes reflecting on one’s own culture, attitudes and beliefs about ‘others’ which helps to value other culture. Moreover, clear, value free, open and respectful communication between clients and nurses which can develop trust. Also it recognises and avoids stereotypical barriers which can demean other cultures.

The nurse should be prepared to engage with others in a two-way dialogue where knowledge is shared and understand the influence of culture shock that can cause disparities in nursing care (Cultural Connections for learning, n. d. ). While providing culturally safe care, health care providers are asked to reproduce their personal and professional power in order to influence nursing interactions and achieve good health outcomes. Translating the concept into practice is complicated and reflected by different influences and practices such as: the cultures and identities of the nurse and patient.

Behaviour and attitude of the health professional is strategic in emerging culturally safe practice towards the recipient of the care. Nurses should be equipped with skills and culturally safe knowledge to work effective and collective with clients. The nurse can be positioned in the settings where she or he may not be able to uphold her own nursing or personal values and beliefs in the delivery of culturally safe care, which can be compromised with networks of relationships with varying dergrees of support (Richardson, 2010). CONCLUSION:

To conclude, nurses should know about the principles of Treaty of Waitangi as well as Cultural Safety guidelines for developing safe and equal distribution of health care services in New Zealand. Cultural Safety should bring to the attention of health professionals as it helps for a conscious and active intent to support, protect and value a person’s sense of identity and wellbeing during times of vulnerability, illness, suffering and life changes. It can be considered as an integral element of every day practice which helps to strengthen own cultural identity.

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