Nursing 243 Assignment: Cultural and Spiritual Assessment

Cultural and Spiritual Assessment
Transcultural nursing and culturally congruent care are important ideas of today’s nursing, especially in North America. In order to give a culturally congruent care, the nurse should do a cultural assessment; a good cultural assessment will reveal the invisible part of a culture. According to Potter and Perry (2009), “It is important to understand that the invisible value-belief system of a particular culture is often the major driving force behind visible practices” (p. 107). Cultural and spiritual assessment paper gives me a chance to look at my own culture. “Becoming culturally competent first requires you to examine your feelings and experiences regarding diversity, starting with an understanding of your own heritage. Then, you will need to learn more about specific cultural differences so you can develop an appreciation for the values and beliefs of both patients and staff co-workers” (Ignatavicius & Workman, 2010, p. 28). As far as mental health patients, it is an absolute necessary to understand the client’s culture since it has a very big influence on their wellness state. If a healthcare provider does not consider the client’s culture, it will cause lots of trouble and pain for the client. “Clients suffer cultural pain when health care providers disregard their valued way of life” (Potter & Perry, 2009, p. 113).
Spirituality has an important role in a person’s well-being. “Spirituality and spiritual well-being are significant factors in maintaining health and coping with chronic and terminal illnesses” (Potter & Perry, 2009, p. 447). Spirituality helps patients to cope with their illness. It may be an outside force that supports them. “Research shows that spirituality positively affects and enhances health, quality of life, health promotion behaviors, and disease prevention activities” (Potter & Perry, 2009, p. 444). The nurse should respect and consider the client’s spirituality while giving care. In order to understand the client’s spirituality, the nurse should have self awareness about their own spirituality. Each individual’s spirituality is unique to that person, and giving care according to that is a tough job. This paper helped me to look into my own spirituality and assess the client’s spirituality without having any bias or misconceptions.
Discussion
Client’s Profile
Understanding the profile of the client is an important part of the assessment, and gathering the demographic data is an initial step. My client, Mr. GP is a 59 years old, divorced, Caucasian male. He appears as his stated age, well nourished with normal BMI (21.6), and not in apparent distress. His dress was appropriate, neat, and clean; however, his face was unshaved. He was sitting comfortably and was enjoying his snack. His birth place is Brooklyn, NY. He is unemployed, and he is not looking for a job. He is oriented to place, person, and situation. He seemed pleasant when we discussed about his childhood. Client was not hesitated to release the personal information except about his marriage and divorce. I noticed that he was using suppression as the defense mechanism. Videbeck (2011) defines suppression as the “conscious exclusion of unacceptable thoughts and feelings from conscious awareness” (p. 47). He diagnosed with schizoaffective disorder 22 years ago. He was not experiencing rigidity, or psychomotor retardation. When we approached, and introduced us, he greeted us without hesitation. Our place of discussion was a quiet part of the day-room. We used calm and soothing voice while communicating with the client. Client’s primary language is English, and he did not have any difficulty to communicate. He was able to concentrate, and his affect was also appropriate; he has a good eye contact. He was not experiencing hallucinations and delusions; however, he said he had experienced auditory hallucinations. He has a good insight; he understands his situation, and the reason for his hospitalization. He did not have poverty of content. We had our discussion in an open place, and that did not hinder him to communicate. He did not disclose anything about his marital relationship may be because of distrust. He is a college graduate in accounting; he was in military for 3 years. Currently, he was not experiencing any psychotic symptoms.
Culture and Ethnicity
Culturally Mr. G is an American, and grew up as a catholic. He was born and raised in US. His mother was an Italian, and father had an ethnic composition of German, French, and Polish. He was born in Brooklyn, New York and he completed his 4 year college from New York. Nurses should know the ethnicity of the client and it will help them to formulate proper care plans and diagnose. “Certain genetic disorders are also linked with specific ethnic groups, such as Tay-Sachs among Ashkenazi Jews and malignant hypertension among African Americans” (Potter & Perry, 2009, p. 117). My client is a Caucasian. He identifies himself as “ American with Italian ties”. Currently he is not a practicing Catholic; however, he believes in spirituality. Knowledge about client’s spirituality will give the nurse an idea about how to teach the client, and it will help to implement the interventions also. “Religious and spiritual beliefs are major influences in the client's worldview about health and illness, pain and suffering, and life and death. Many cultures do not separate religion and spirituality, whereas others have a totally distinct concept of spirituality. Nurses need to understand the emic perspective of their clients” (Potter & Perry, 2009, p. 117).
Language
English is my client’s primary and the only language that he is fluent. Knowing the client’s language and fluency is very important since it can affect the treatment. “Those who speak English as a second language often experience difficulty with self-expression or language comprehension” (Potter & Perry, 2009, p. 350). Most people do self expression by their conversation, and if the nurse cannot understand them, then the nurse will fail to give a competent care. According to the client he “was always good at mathematics”. He does not have any difficulty in reading and writing English. During our conversation, he was speaking fluently in a good pace; he has a good vocabulary too. He said he doesn’t have a job, and he is not looking for one; even so, he can be adapted easily to vocational training, and rehabilitation.
Family Constellation
In many occasions, the nurse has to deal with the family; in order to do that, the nurse should understand the family dynamics. “You need to assess family functions, such as the ability to provide emotional support for members, the ability to cope with its current health problem or situation, and the appropriateness of its goal setting and progress toward achievement of developmental tasks. Also determine whether the family is able to provide and distribute sufficient economic resources and whether its social network is extensive enough to provide support” (Potter & Perry, 2009, p. 130). He had a matriarchal family structure. He stated that “my mom was taking decisions and giving commands in my home”. His mother has the authority in his family and all others were subordinate. Patient’s father was the main financial supporter. The family used to go to church together. He and his only brother used to play together. His mother used to cook lots of Italian dishes for the family. He stated that “my mom cooked several Italian dishes throughout the week for dinner”. Patient said that he loves Italian dishes. His family had celebrated birthdays by cutting cakes, preparing many Italian dishes, and had invited his close friends. He did celebrate X-mas, Easter, and New Year. He had attended few marriages with his family. Currently he is living alone, and he avoided more discussion on that subject. The client’s chart indicates that he was divorced and has no children. Currently, he doesn’t have any contact with his brother, and he has no friends. Understanding the client’s immediate and extended family support is necessary for discharge planning. “Some clients are more in need of discharge planning because of the risks they present (e.g., clients with limited financial resources, limited family support, and clients with long-term disabilities or chronic illness)” (Potter & Perry, 2009, p. 22).
Health and Illness Beliefs and Practices
The client believes in his spirituality, and he thinks it is very important for his life, because he said it help with his depression and mood disorders. He stated that “I do like to speak to God, and it comforts me”. He said that “spirituality is different from religiosity, and I do like to practice meditation”. He said that “I am a very spiritual person”. He believes there is a superpower and he has good connection with him; however, he does not have a good connection with his fellow people around him. “The concept of spiritual well-being is often described as having two dimensions. The vertical dimension supports the transcendent relationship between a person and God or some other higher power. The horizontal dimension describes positive relationships and connections people have with others” (Potter & Perry, 2009, p. 446).
He really doesn’t like to be in the hospital; however, he admits that it is essential. He said “I don’t like to be here because I don’t like to see others fighting; it elevates my anxiety”. He likes calm and quiet places where he can be alone. He doesn’t have any ideas about the cause of his disease, and he did not blame anybody. He does eat more vegetables, and fruits to help his body. Whenever he is sick he goes to see his doctor, and he does not use any kind of folk medicines. He has clear ideas about the life and death. He said “there is no such thing as death, we just moving to another stages of life”. He believes in incarnation. He doesn’t believe in death, and he said “life is going and it always continuous”.
Conclusion
I noticed that my client was using ego defense mechanisms, such as, suppression. I doubt whether he succeeded the Erikson’s stages of psychosocial development of intimacy vs. isolation, because he does not have a meaningful relationship or attachment with others. He was on mild anxiety level because of his hospital admission. He stated that “today I am little sad”. He was taking several antipsychotic and anticonvulsant medicines. He does not have suicidal ideation or ideas of hurting others which are a very important part of the client assessment. In the past, he was thinking to kill himself, but not now. I think he has a low level of hardiness and resilience because he stated that “I don’t like to see others fighting; it elevates my anxiety”. He needs to practice better coping skills, and he needs more social supports. During the assessment, I used several therapeutic communication techniques, such as, accepting, encouraging comparison, exploring, focusing, general leads, giving information, silence, and listening. It helped me to look into my own spirituality, bias, and misconceptions. I learned the importance of positive regard, and self awareness. Videbeck (2011) states positive regard as “unconditional nonjudgmental attitude” towards the clients (p. 83). Understanding the client’s culture and spirituality is necessary to give a culturally congruent care. Nowadays, transcultural nursing is getting more importance, so nurses should prepare for that; a good cultural and spiritual assessment is the first step towards that.
Reference
Ignatavicius, D. D., & Workman, M. L. (2010). Medical surgical nursing: Patient-centered collaborative care. (6 ed., Vol. 1). St.Louis, Missouri: Saunders Elsevier.
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing. (7 ed.). St.Louis, Missouri: Mosby Elsevier.
Videbeck, S. L. (2011). Psychiatric-mental health nursing. (5 ed.). Philadelphia, PA: Lippincott Williams & Wilkins.