Cultural Responsiveness In Healthcare: A Case Study Of Breast Cancer And Brain Tumor Patients

Cultural responsiveness and healthcare services

Question:

Do you think People living in regional areas are less or more Culturally Competent than those living in Cities? why? what is the best way to learn about Cultural differences?

Cultural responsiveness is a key element of the recovery oriented service delivery and is of great paramount in improving quality and safety of healthcare services (Bloomer & Al-Mutair, 2013). As the cultural diversity in Australia continues to grow, health care service providers need to know and respond to changes in the local communities they serve. According to Bloomer & Al-Mutair (2013), these changes include the arrival of refugees and immigrants whom their values, social structures and beliefs (both traditional and religious) might vary significantly from those of the Australian tradition. Cultural beliefs about what constitutes pain and chronic diseases and how to address it may affect how refugees and immigrants seek help in the hospitals and whether or not they’ll consider accessing healthcare service (Crail,Walker, & Brown,  2013).

Besides, understanding cancer (either brain or breast ) as a serious illness that requires early medical treatment is a concept that may seem strange or even threatening to different people from culturally linguistic diverse set ups.  However, to respond to the needs of the culturally diverse set ups, Evans, Menace, Koffman, Harding, Higginson, Pool, & Gyles  (2012) holds that healthcare service providers need to first know who their patients are before engaging them in partnership to deliver health care services that are culturally responsive. This essay explores how cultural views and values play out in two different ethnic religious community groups. To address this issue, the essay will narrow down its research into two cases; one for Jessie, an indigenous Australian who had breast cancer and Raghda, a Syrian refugee but immigrant in Australia who had brain tumor-both are females.

Wiener, McConnell, Latella, & Ludi (2013) define pain as an intense, unpleasant sensory feeling that has physical, social and psychological implications. It has been noted that non-aboriginal physicists carry out unsafe Procedures especially during pain assessment. However, culturally pain assessment techniques have been adopted based on the research findings as well as though consultation with the Torres Strait Islander people (Wiener et al., 2013). Surprisingly, indigenous Australians suppress pain behaviors, as well as show reluctance their pain experiences with other people. This point manifests itself clearly in the case study where nurses come to realization that Jessie was aware of her condition one year later but could not seek biomedical health care; instead, she chose to use traditional herbal medicines. According to Fang, Sixsmith, Sinclair, & Horst (2012), suppression of pain by the indigenous Australians can be as a result of suppression and oppression they’ve endured since colonization.

Case studies

 Fang et al., (2012) postulate that Aboriginals express their pain by muting, even when undergoing excruciating pain. However, Indigenous Australians who do as they’re requested and appear to accept health care process are considered to be well-behaved. On the other hand, non –indigenous nurses refer to the Aboriginal patient as ‘unobtrusive’ since they don’t draw attention to themselves especially when in pain (Hanser & Pedersen, 2013). Besides, most of them don’t seem to bother about receiving a pain relief. This behavior has been referred as ‘stoicism.’ The behavior manifests in Jessie’s case when she continues to use herbal medicines knowing that, they were not as effective as they were initially. According to the clinical observations, Aboriginals  are “reserved and non-obtrusive especially” when undergoing pain; besides, this shouldn’t mean that they don’t  feel pain (Lopez-Sierra & Rodriguez-Sanchez, 2015). This phenomenon may enhance nurse’s belief that Aboriginals don’t experience pain and have high tolerance to pain. But if such practices are taken into consideration, there’ll be limits in the palliative care provided. For cultural safety, Non- Aboriginal physicists should be cautious of the undesirable variables which define pain behavior including suggestive assessment, body language, caretakers, and measuring tools.

Pain assessment among  Aboriginals is not inclined to the person in pain alone, but to the extended family that conforms to the indigenous culture.  In most cases, nurses find that a family member may contribute to the pain assessment by acting as a distraction from the pain (O’Brien, Bloomer, McGrath, Clark, Martin, & Lock, 2013). An Aboriginal Torres strait islander person may seem to be comfortable, but once their relative appears, the physicist may be informed that their relative is in pain. This aspect of alerting health officers to the suffering of their family member is intertwined into the accountability within the Aboriginal family structure. According to O’Brien et al., (2013), the intimacy among family relations allows their members to seek alterations in character. To perform a patient -pain assessment, it’s significant to involve relatives into communication concerning pain experience of their loved ones.

After all the intervention methods have been exhausted and failed to cure an Aboriginal person, it’s then taken to be the spirits decision for them to die (Hansen & Pedersen, 2013). However, when palliate care is provided by the nurse, other perspectives can come into use. Treatment plus palliative procedure that cause pain to the patient are considered as inferences to the desire of the spirits. Basing on this perception, it’s likely that the patient or those with her will ask for the termination of the end of care procedure, as well as the adoption of culturally safe pain management methods (Evans et al., 2012). In the event of a death and it’s found to be “culturally immature”, investigations are conducted to unearth its cause. In such scenarios, a nurse may be implicated with banishment from the community. According to Evans et al., (2012), the use of injection in end of life care may be taken for poison by the indigenous Australians. Lastly, it’s common for Aboriginals with serious illness to ask to be escorted home when death approaches. Consequently, those doing the end-of –life care in hospitals may ask to be discharged to die in their home since there’s comfort and peace. Among the indigenous Australians, death is taken to be a natural event, unless suspicions arise. Since Aboriginals have a great value for their family, they consider it as a place where they’d like to be during the last moments of their life (Davidson, Jiwa, DiGiacomo, McGrath, Newton, Durey, & Thompson, 2013). Because Jessie is suffering from Brest cancer that is incurable, it’s expected all that she needs is peace of mind  as well as  reassurance as she spends her end of life moments before death,

Indigenous Australian breast cancer patient

Public health research across the globe has continually reported on patients, mainly women with immigrant background continue to face difficulties in getting sufficient levels of health care particularly in the social health care set up (Asadi,-Lari, Goushegir, Madjd, & Latifi 2012). Also, it’s evident that women with migrant background especially Muslims face large disparities in health care due to cultural, linguistic and socioeconomic factors. Muslims believe that health comes from Allah and that sickness can occur through his will. However, when sickness occurs, there are expectations put upon other people towards healthcare and welfare of those ailing (Crail et al., 2013). For example, Muslim culture encourages friends and family members to visit their loved ones in hospitals. This is evident in the case of Raghda, a Syrian refugee of Islamic faith but an Australian immigrant who has been receiving many visitors from the Syrian refugee community to check on her condition (brain tumor). According to Islam, visiting the patient in the hospital is an act of honoring the patient by praying for them or with them, seeking forgiveness from them for the wrongdoings they might have done to them in the past, or giving support in any means possible (Asadi et al., 2013). Such acts can be very comforting especially for patients who suffer chronic diseases as they struggle with a vast range of physical, psychological and spiritual challenges.

According to Bloomer and Al-Mutair (2013), a greater level of responsibility is encouraged for the close family members especially those in critical conditions. When such deeds are done in the aspect of care, it is with the aim of encouraging as well as supporting those ill, and to strengthen firmly their relationship with Allah prior to their death. The physical appearance of the relative or friends is believed to be essential to the physical and spiritual well being of the patient (Bloomer & Al-Mutair, 2013). Through this, the patient can be assured that she’s still valued and she has not been abandoned. In the event where the patient is not in a position to express her preferences in connection with treatment and health care, relatives especially the family members can be used to provide information in communications with the nurses.

When Raghda is admitted in the hospital, her husband acts as a communicator to the nurses. Essentially, Islam does not recognize the right to die voluntarily irrespective of the excruciating pain a person is going through. This stems from the belief that life is divine and sacred and each moment in life is very precious and should be cherished as well as preserved. However, Muslims are forbidden from ending their life. As a matter of fact, no health professional or family member should render any service to bring about their death. Since palliative care helps in alleviating pain and suffering, Islam holds that pain and suffering endured by a patient can lead him/her to spiritual and moral nourishment (Shahid, Bessarab, Van Schaik, Aoun, & Thompson, 2013).

Syrian refugee with a brain tumor

Muslims not only in Australia but all over the world are inclined not to use drugs containing alcohol because consumption of alcohol is forbidden in the Islamic culture (Asadi et al., 2012). It’s a matter of common sense that some Muslims take alcohol even though it’s against the Islamic tradition. However, it’s not uncommon that in some areas people prefer not to use sedatives when they’re sick. Asadi et al., (2012), holds that most people use analgesics when there’s need for it yet other prefer to remain alert and spend the rest part of their life in the memory for Allah, rather than being under the effect of alcohol or a sedative. According to the Islamic faith, Raghda chose to use cupping- a traditional middle east approach for treating headache especially migraines than analgesic medications that could keep her sedated

Conclusion

The nursing staff should keep a couple of things in mind when dealing with patients from different social-ethnic groups. First, a health care professional should notify his /her client of diagnosis& prognosis and should never at any time give an estimated life expectancy since they do not hold life! A patient should make peace with his creator through religious responsibilities in order to meet the Almighty free of sin. Second, nurses should be considerate to the patients fear that the choice of pain relief care is a type of discrimination, pushing them away so as to make a space for others. Third, nurses need to adopt cultural competencies plus sensible caution when dealing with patients from different social-ethnic groups. Essentially, a holistic approach to healthcare calls for an understanding of spiritual beliefs, cultural values, and practices as well as religious practice by the nursing staff. With open borders strategy as well as population shifts, it’s vital that medical officers be trans-cultural with sensitivity to the spiritual needs of the clients. A patient should be given attention and the differences in his value as well as faith be acknowledged. Finally, it should be noted that spiritual and psychological care are essential components of healthcare that should be provided alongside patient’s needs and wishes.

References

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Bloomer, M. J., & Al-Mutair, A. (2013). Ensuring cultural sensitivity for Muslim patients in the Australian ICU: Considerations for care. Australian Critical Care, 26(4), 193-196.

Crail, S. U., Walker, R., & Brown, M. (2013). Renal supportive and palliative care: position statement. Nephrology, 18(6), 393-400.

Davidson, P. M., Jiwa, M., DiGiacomo, M. L., McGrath, S. J., Newton, P. J., Durey, A. J., … & Thompson, S. C. (2013). The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery. Australian Health Review, 37(1), 70-78.

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Fang, M. L., Sixsmith, J., Sinclair, S., & Horst, G. (2016). A knowledge synthesis of culturally-and spiritually-sensitive end-of-life care: findings from a scoping review. BMC geriatrics, 16(1), 107.

Hanssen, I., & Pedersen, G. (2013). Pain relief, spiritual needs, and family support: Three central areas in intercultural palliative care. Palliative & supportive care, 11(6), 523-530.

López-Sierra, H. E., & Rodríguez-Sánchez, J. (2015). The supportive roles of religion and spirituality in end-of-life and palliative care of patients with cancer in a culturally diverse context: a literature review. Current opinion in supportive and palliative care, 9(1), 87-95.

O’Brien, A. P., Bloomer, M. J., McGrath, P., Clark, K., Martin, T., Lock, M., … & McGrath Margaret, O. C. (2013). Considering Aboriginal palliative care models: the challenges for mainstream services. Rural Remote Heal, 13, 2339.

Shahid, S., Bessarab, D., van Schaik, K. D., Aoun, S. M., & Thompson, S. C. (2013). Improving palliative care outcomes for Aboriginal Australians: service providers’ perspectives. BMC palliative care, 12(1), 26.

Wiener, L., McConnell, D. G., Latella, L., & Ludi, E. (2013). Cultural and religious considerations in pediatric palliative care. Palliative & supportive care, 11(1), 47-67.