Cultural Competence And Diversity In Healthcare: Reflection And Examination

Analysis

Critically examine and reflect upon cultural competence and diversity in healthcare based on your practice learning experiences to date.

A rationale for your chosen approach to reflection.

A critical reflective discussion of cultural competence and diversity in healthcare within the context of the four Nursing and Midwifery Council domains of professional values; communication and interpersonal skills; nursing practice and decision making; leadership management and teamwork.

A critical review and evaluation of how these experiences will influence and inform your nursing practice.

Reference to relevant literature to support your discussion using the APA referencing format.

The objective of this paper is to present my reflection on cultural competence and diversity in healthcare. This paper is based on my personal experiences. The cultural competence and diversity in health care depends on the way health is defined (Hockenberry & Wilson, 2014). The term ‘health’ could be defined from multiple perspectives. The definition of health could be based on the perceptive of multiple worldviews. An important definition of health is from ‘Person’ perspective. Fawcett describes the person as “the recipient of nursing, including individuals, families, communities, and other groups.” Another important worldview is ‘Environment’. According to Fawcett the environment “refers to the person’s significant others and physical surroundings, as well as to the setting in which nursing occurs, which ranges from the person’s home to clinical agencies to society as a whole (Miller, 2006).” I think that health is a subjective term and health could have multiple connotations. For example, health could be related to physical fitness, mental satisfaction, psychological wellbeing etc. I personally believe that good health is a mental frame or feeling of belief and confidence. It would include physical health as well as mental health. In this paper I have used the four Nursing and Midwifery Council domains of professional values; communication and interpersonal skills; nursing practice and decision making; leadership management and teamwork. A brief definition of these four domains can be discussed as:

Professional values: These values refer to the professional values that nurses carries as a part of their profession (Peek & Park, 2013). I have learned that these values should be common across all the nurses and NMC promotes high ethical and moral values as the professional values of nurses

Communication and interpersonal skills: This domain refers to the need to communication and interpersonal skills that the nurses should have (Parker, 1998). It is important that the nurses should be able to communicate effectively with patients and other stakeholders.

Description

Decision Making: This domain on NMC focuses on the effective decision-making. It is important that nurses should not waste the time to take critical decisions

Leadership management and teamwork: As the nurses grow in profession, it is important that they must have the traits of leaders

In this reflection paper, I would discuss my learning of past three years and I would share my experiences in all the four domains. The Phenomenological community I belong to is nursing. As nurses we share knowledge, we conduct research and perform evidence based practice. We put into effect what we have learned, seen, experienced and place together all of the outcomes to provide better care for our patients. The field of nursing has changed greatly over the past few years and many older nurses are more outgoing and willing to help the new nurses with their understanding and application when they are just starting off (Balls, 2009). Nurses are super caring, involved in the community and gain pride in helping others. The reflection cycle that I have used in this paper can be shown as:

The story that I would follow with this reflective model is the way a trusting relationship is build with the patient as well as their family.

Analysis

I would like to begin the analysis with the definition of the terms like cultural competency, diversity and reflection. These terms are defined with respect to their application in the health care industry.

Cultural competence: Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations (Delgado & Ness, 2013).

Another definition of cultural competency is the ability to manage the cultural differences in a multicultural environment.

Diversity: Diversity in health care refers to the state of being diverse. This is the state where the stakeholders have different and diverse background (Long, 2012)

Another definition of diversity and diverse workforce is the presence of people from different cultural backgrounds and different attitudes.

Critical Reflection: The term critical reflection means that the content of this paper is based on my learning and experiences 

I believe that spirituality has an important role to play in healthcare diversity. I would like to start my reflection with the role of spirituality in health care industry and cultural competency in health care. Spirituality has an important role to play in health care industry (Seright, 2012). It is correct to say that philosophical and cultural tension has increased between science and religion. I believe that this tension could reduce and both science and religion could co-exist in health care industry. With time and with advancements in science, health care industry has seen various transformations (Dogan, 2012). However, I believe that spirituality still exists in the roots of health care industry. With time, the definition of spirituality and being spiritual has also changed (Olson, 2015). I believe that spirituality is not only about God and Christ. Spirituality is a broader term that provides confidence and strength to patients and their family members. It also provided strength of doctors, physicians, nurses and other stakeholders. This tension between science and religion could be eased if people are open to accept the viewpoints of other people with different views. The reflection cycle for this reflective paper can be discussed as:

Description

Cultural diversity and cultural competence care is something that all nurses will struggle with at one point or another during their practice due to the increase progression of diverse populations. This issues focuses on my personal experiences of patients with different cultural backgrounds. Cultural competence can include: language, religion, beliefs, customs, traditions, etc. and all should be respected no matter what the current medical situation is being presented. I find that within my current community, although everyone’s culture is similar to my own, when I go to work in another community their is a broad variety of cultures that are either similar to my own or completely different. This was an issue as I have to manage the people from different cultural backgrounds and I was not able to develop good rapport with all the patients.  It is interesting to get to know these patients and their culture as it helps me not only perform needed care but also understand their healthcare needs based upon their own current practices. I feel that by knowing and understanding their culture it also helps me advocate for their healthcare needs as well which leads to higher patient satisfaction, compliance, and most importantly helps me build a trusting relationship with the patient as well as their family. By getting to know the patient, I am able to treat them holistically, which shows them my true passion and caring nature toward their health. However, I was not sure that how to deal with the patients when they belong to different culture and they are not able to show confidence in you. There was an Indian patient named Sarabjit and she was not able to share anything with. Probably she was not comfortable with the service provider of any other culture.

Feelings

I was not feeling good and in fact I was feeling bit apprehensive at the starting. However, my colleagues told me that it was natural and it happens a lot of time in nursing practice. Unlike my situation however, I do understand that as nurses being able to learn cultural competence has to occur at a very fast pace regardless of the specialty area or unit in which we work due to the high patient demand. There are several challenges that inhibit the progression of culturally competent care within the communities but there are many progressions that are being made as well with medical facilities incorporating more culturally diverse staff, educational programs, etc. that are becoming readily available for their staff members. According to Truong, Paradies, and Priest (2014), culturally competent care can increase once the nurse is aware of their own values, attitudes, beliefs and behaviors as well as help the nurse increase development of their assessment and communication skills.

Evaluation

The challenges that community nurses face while providing care for different communities include language barriers (Orange Coast Memorial Medical Center, 2013). Some of the possible solutions to language barriers is providing educational materials in the language of the target population. Other ways to address language barriers is to assign a community health nurse that speaks the language of the targeted population. Some of the challenges a nurse may face if she is presented with a community that is different to her are related to cultural differences, and would include barriers such as verbal and body language differences. At the same time, this is a benefit because the nurse is able to evolve their cultural competency.

Conclusion

In a community similar to his or her own, a nurse would feel comfortable but would not have the same room for growth that they would have in a different community. And finally, being in the same community can be restrictive, a challenge that I’ve faced working in the community that I live in is encountering people I know personally or professionally as patients and finding that it is difficult for them to communicate with me as openly as a patient who was a stranger to me would. Ways to overcome these challenges are to continually stay open minded and willing to adapt to changes (Rosenkoetter, 2014). Nurses need to accept that ideal situations are dismal in this field and we all need to be willing to expand our knowledge regarding different communities.

Action

The action is about the action plan that I would use as a part of self-improvement. I believe that education is definitely the key to success with everything and anything. We are not only responsible for caring for our communities but also educating them so that they are able to improve their health situations (Kirmayer, 2012). However, education will only be successful if it is tailored specifically to each communities needs. First, before we are able to implement the needed changes to create a healthy community we have to get a basic understanding of where the community is and what their own personal beliefs or understandings are toward living healthy because not everyone has the same understanding and beliefs about what healthy is. Once we can understand their visions and understandings then we can begin to work with the community and tailor a plan specifically for them so that they will have a healthier community (Phyllis, 2009). Creating a healthy community is a progressive chain of events that will not happen overnight but with proper commitment, tools, education, planning, and resources it can be accomplished to ensure better healthy for everyone.  The timelines for the action plan can be shown as:

Phase	Time
Assessment	3 weeks
Framework Development	3 weeks
Learning curve	15 weeks
Continuous Learning	Ongoing

The reflection of the four Nursing and Midwifery Council domains of professional values can be discussed as:

Domain 1: Professional values

I believe that the nurses can have high professional values only when the community has high professional values. A healthy community will reduce racial, ethnic, and socio-economic health disparities (Community Cheer, 2011). Each community member should be given room for growth to develop skills and abilities. Community members should not be held back and should be able to share creativity and talents with each other. Communities as a whole should develop goals and produce positive outcomes. The Community/Public Health Nurse needs to focus on creating partnerships with the public, health providers, and health entities to develop healthy relationships (CDC, 2014). The American Nurses Association (ANA) feels that community health nursing must focus on the prevention of illness and the promotion and maintenance of health (Mauver & Smith, 2009). Other nurse preventions/promotions for a healthy community are to write a legislator, become active in local politics, or write a letter to the editor of a newspaper regarding health policy issues. 

Domain 2: Communication and interpersonal skills

According to Shepard (2004), when working with community health, the member’s awareness and information concerning group needs and resources are considered sporadic as their access to their necessary resources relies on existing relationships or links within the community as well as word of mouth from other members who have had previous or current positive results. All healthy communities have the same goals in common and strive to maintain their goals as much as possible. The communities as a whole work together to ensure optimal health for all its members through utilize everyone’s knowledge to help one another. A great example of this can be seen through creating and maintaining a community garden where all its members are able to grown their own fruits and vegetables in a designated area within the community where all the varies families are able to come daily, weekly, or monthly to obtain their needed groceries to create their balanced meals so they do not have eat fast foods and have more healthier options for their family. Or it can be seen through having community exercise programs, community transportation to medical care, more readily available medical care within the community that includes urgent care, hospitals, medical teams, etc. that can be used by everyone regardless of their socioeconomic status.

Overall the primary goal of creating a healthy community is to ensure that its members are living according to their health guidelines where everyone is receiving the proper health promotion and maintenance. Through research by Smith (2009), it was found that communities where health living was pushed and supported there was improved community exercise compliance, reduced gas emissions with improved air quality, fewer injuries and even car accidents, more physical activity among adults and children, increased social development, lower body weights, and even decreased chronic disease. But before this can be achieved as a member of the healthcare team, a firm understanding of the community’s beliefs toward being a healthy community must be known and understood. Once their beliefs and understandings are known, then we can work together to create their healthy community goals. However, if their views and beliefs differ from my own, then it is important for me to understand why it differs and how to develop the proper plans, goals, and interventions based upon our differences while also reassuring the community of positives. Some things that I can do to help overcome this deficit include first and foremost, getting out within the community and actively helping its members by seeing and understanding why they live the way they live, seeing their daily patterns, understanding their concerns, etc. A lot of hands on and direct care must be taken as it can be challenging for the community to not just open up to change but also want to change based upon the recommendations of someone they do not know. Trust must be built and understanding has to be known so that everything will be individualized showing care and leading to increased compliance (Horey, 2014). This is something that will not just affect their home life, but work, school and all other aspects so compliance and maintenance can be sustained.  

Nursing practice and decision-making

The future of nursing practice depends on insurance (Kim, 2013). The future of healthcare that excites me most is the role of public-private partnership. In the current time, most of the mid size hospitals and healthcare institutions can not afford to make huge capital investments due to high costs and risks involved. In the future, these organizations can have integration with government to focus on excellent infrastructure that can help to provide excellent healthcare services to consumers. The role of private insurance would also increase, as government cannot cover all the citizens under its insurance plans (Compton, 2013). The possible effect of health care reform from a financial and accounting perspective is an increase in the capital investment made by hospitals. At the same time, the competition is increasing in healthcare industry. Therefore, healthcare organizations may have to cut their operational cost to make way for capital expenditure.

I work with a lot of elderly and it a sad sight when they end up hospitalized or in nursing homes with very few visitors other than their spouse, children, or grandchildren. Some of the elderly have no living relative and only one friend who are just as old as they are. Building a community where senior outreach is promoted can encourage seniors to be more active in their daily lives. Obstacles faced by seniors include lack of financial resources, lack of motivation, and physical limitations due to past surgeries, malnutrition, mental changes or other illnesses (Yang & Lee, 2012). Promoting healthy habits at an earlier age when the individual is able such good hygiene, as you have mentioned, diet, exercise, and community involvement can help the elderly age with less complications. I hope that you will reach your goal in establishing an outreach program for the seniors of the community.

Leadership management and teamwork

It is critical that leaders should promote the health life in the community through health communities. A healthy community to me is one that seeks improvement in all aspect of the community (Choi & Lee, 2016). It is one where healthcare is promoted through nursing outreaches or other route, and there it exists a huge social network where information is shared. A healthy community entails that its residents know what healthy behaviors, modifiable diseases, and risky behaviors are. In this type of communities, you will find people exercising, dieting and focusing on prevention of disease rather than their treatment. Most Healthy community has in common what is called healthcare community program (HCP) that are mostly put in place by the CDC. This program through leadership encourages or reinforces people commitment to healthy choices (CDC, 2015). As an example Tabaco use can be prohibited in public within certain communities where there is a HCP that makes smoking cessation a goal. For all communities out there that lack the information and the commitment to make their community a healthy place, nurses can help by implementing structures that would involve outreach, specific community leader training, disease prevention education, and monthly newsletter that will track the improvement of this specific communities. All healthy communities should be at proximity of a park where children can exercise and hospitals (Smit, 2013).  

My idea of a healthy community would include the ability to interact with other people in a smoke free environment. It would be a community with clean air, water and access to healthy food sources. It would include the ability for residents to have contact with natural surroundings in order to have a more walkable community to help reduce the amount of car traffic and have a healthier air quality in the community and reduce the risk of obesity and other cardiovascular and respiratory issues.

While most communities are unique, most healthy communities share common traits. According to the Health Resource in Action research, some common elements include the lack of disparities, a strong economy and employment, higher education, preventative health care services, a stable environment and ecosystem, housing, the ability to have access to healthier food, safety, involvement of all community members and the development of healthy children (Nuszen & Rom, 2014). It would be very difficult to expect to have all these elements in a healthy community, but understanding the most important elements needed to create a healthy community will help in successfully developing a healthy community (2015).          

If the idea of a healthy community didn’t match my community’s definition, then I would become a member of a community government group to help set up meetings with members of our neighborhood in order to assist in obtaining information on how to improve our community (Common Pathways, 2011). In trying to improve our community in working together we can all bring valuable ideas and skills that can help promote and develop a healthier community (2011).

A healthy community should have election based positive leaders that communicate openly through newspaper, radio, television, or in person. The people of the community should have some decision making ability and members work together for common betterment.  An example of this would be in our community, parents wanted a park. The community did not have the money to afford the full cost of what the public wanted. The community banded together and approached the city leaders with a plan devised to split the cost. The community not only raised over half the money, but over 100 volunteers came out to help build the park saving the county construction cost. As a result the kids of the community have a huge gym park, a water park, basketball court, and tennis court.

The Papadopoulos model of cultural competence can be shown as:

Common features of a healthy community include connecting people, providing resources, appreciating diversity, shaping the future of the community, producing leadership (common pathways, 2016), and promoting healthy habits from an early age. There are several ways to encourage the community to participate in healthier habits. One of the most effective ways is through social media. By utilizing the television, educational commercials about regular vehicle check-ups, benefits of owning a hybrid vehicle, and adverse effects of secondhand smoking. Another way to work towards a healthier community is through homeless outreach program (Lee & Kim, 2012).

I have found in our community we have a lot of success doing health fairs. We not only do them for general public but we partner with a lot of the local businesses and do health fairs for BP, Cholesterol, Flu Shots. We have found that a great resource to get preventative information out. We also partner with local schools doing programs such as hand hygiene and physical activity and health program. Preventative Health Maintenance Programs are a key component to the Health Program of a Healthy community (Romios & Crock, 2013). We need more involved community health workers to instill life long learning and education to meet the needs of the communities in which they live in. I feel that there are many resources and campaigns out there but not sure if they are reaching their target populations such as the low income, or immigrants who come here and are afraid to seek help. These populations end up seeking care in our ERs and usually once a disease process has already begun to cause irreversible change. And I think that it would not be considered taking their fate into their own hands but rather them understanding their are resources available to help guide them into the right direction.

In the last three years, I have learned that eliminating disparities, achieving health equity, and improving health for all groups are inevitable to create a healthy concept community as the Healthy People 2020 stated its goals for health promotion and disease prevention (Hart, 2014). I have also learned that community standard established by individual help in which he or she lives and it is responsibility for each one maintain positive living environment. Community standards are mutually agreed upon expectations, which guide our residential communities in maintaining a safe and respectful environment in which all are able to flourish and live healthy and wealthy life.

Conclusion

The above paper discusses the cultural competence diversity in health care. The above also discusses the challenges of cultural competence in nurses.  Some challenges for community health nurses are different beliefs and orientation of the community to health or cultural diversity. This is why cultural diversity is one of the challenges faced by the community nurses (Branson, 2013). Therefore it is very important for the community nurse to be aware of language and cultural difference. On the other hand, the benefit is that they shared values, interests, beliefs and goals these will make it easy for the community nurse to deliver health care with little or no problem. A possible solution to the challenges is delivering the education on health care to the community through the use of interpreter when dealing with patient who does not speak English. I agree that a nurse should have cultural competency in relation to the demographic for which they are serving. This can be difficult to establish at first, depending on what cultures you’ve already been exposed to. I will admit that feeling comfortable definitely is nice, and I can be fearful at times that people from other cultures may find me to be offensive. Also, at my hospital if we need to use a phone interpreter I feel that it drags out the conversation with my patients and a lot of times they seem very confused, but I don’t know if what I’m saying is being adequately translated.

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