The story of Lia Lee and her family highlights the importance of cultural competence in the care of a diverse patient population and the tragedy that occurs due to the lack of cultural competence in the healthcare setting. “The Spirit Catches You illustrates how much time, energy, and commitment are necessary to understand another culture’s perspective on health and wellness and to translate that understanding into the day-to-day practice of medicine.” ( CITATION Big98 l 1033 (Bigby, 1998).
The main theme of The Spirit Catches You and You Fall Down is cultural discordance and how it can lead to tragic results if it isn’t addressed and resolved.
Culturally discordant care arises “from unaddressed cultural differences between healthcare providers and patients.” CITATION Day1410 l 1033 (Dayer-Berenson, 2014). Another very important theme of Lia’s story is love. Her parents’ great love for their daughter gave them the strength and determination to fight for her the best they could in an unfamiliar environment, while never relinquishing their efforts to care for her every need until the day she died.
Foua stated “I gave birth to Lia, so I will always take care of her with all my heart.” CITATION Day1410 l 1033 (Dayer-Berenson, 2014). She and Nao Kao dedicated their lives to her.
My primary thoughts and impressions were of shock and dismay. I was shocked at Lia’s story and dismayed at the lack of understanding between her family and her healthcare providers. As a nurse, I fully understand the frustration that occurs when a patient’s culture interferes with standard practice and quite possibly best practice, however, I also understand the need for knowledge and understanding when caring for a diverse patient population.
Without that, we are unable to develop a therapeutic relationship with our patients, which can lead to patient dissatisfaction and noncompliance with care. “Having a greater knowledge of the cultures served by the nurse will play an important role in improving the quality of health care.” CITATION Day1410 l 1033 (Dayer-Berenson, 2014). Overall, I was deeply moved by her family’s complete devotion to Lia and her well-being.
Lia’s story has helped me to realize the importance of cultural diversity when caring for people of all cultures. I have worked in small rural facility for the past 22 years. We are a small, mainly white county, however, when I closely examine our community, I realize that we do have many different cultures represented therein. It’s vitally important to recognize those cultures, examine my own cultural biases, and work toward my own personal commitment to cultural competency. I have also recognized the increased cultural diversity in our workforce within the facility. Two of our hospitalists are originally from the Middle East. Over the past few years, we have shared our cultures with each other, expanding our awareness. This is just a small example of the impact cultural diversity has had on our small facility, but it is much larger than that overall, and has helped us all to grow as healthcare providers. “The prevalence of cultural diversity requires the nurse to strive for cultural competence, so he or she may meet society’s expectations regarding nursing care delivery.” CITATION Day1410 l 1033 (Dayer-Berenson, 2014).
I feel Lia’s story is very much relevant today. According to an article, “·diversity has increased in 98 percent of all metropolitan areas, and 97 percent of smaller cities in the U. S. since 1980.” CITATION Van17 l 1033 (Van Hook & Lee, 2017). Because of the increasing diversity in all communities, and their myriad of healthcare needs, nurses must be culturally competent to meet those needs. “Because we provide direct patient care, it is critical for nurses to understand how to work effectively within a diverse cultural atmosphere.” CITATION Day1410 l 1033 (Dayer-Berenson, 2014).
This class has opened my eyes to the great cultural diversity in my own community and helped me to realize how much my cultural beliefs affect the care I give. I have had to recognize and face my own cultural biases, moreover, apply cultural humility to my own patient care practices in a more comprehensive manner. It has helped me to realize just how culturally diverse even a small county like ours has become and given me the incentive to try harder to learn and understand so that I can personally give the best care possible to my patients. “In order to deliver high-quality culturally diverse nursing care, nurses need to utilize this unique nursing knowledge; it is not enough to know, but we must also attempt to do.” CITATION Day1410 l 1033 (Dayer-Berenson, 2014).
I prefer Giger and Davidhizar’s transcultural assessment model. “The model assesses differences between individuals in cultural groups by inquiring abut six cultural dimensions: communication, time, space, social organization, environmental control, and biologic variations.” CITATION Cri15 l 1033 (Critchfield, 2015). This model encourages self-awareness in these areas, as well as the provision of culturally competent care for their diverse patient populations. CITATION Cri15 l 1033 (Critchfield, 2015). Moreover, this model helps the nurse to realize the differences within cultural groups to avoid stereotyping within cultural context. “The model postulates that every patient is culturally unique and require culturally competent care.” CITATION Day1410 l 1033 (Dayer-Berenson, 2014).
“Patients should be assessed according to the six cultural phenomena.” CITATION Day1410 l 1033 (Dayer-Berenson, 2014). Communication is the first phenomena and “embraces the entire world of human interaction and behavior and it is how we relate or connect to others.” CITATION Day1410 l 1033 (Dayer-Berenson, 2014). This includes verbal and nonverbal, written and oral language, which if overlooked can result in alienation and powerlessness on the behalf of the patient and their family, moreover, resulting in poor patient healthcare outcomes. CITATION Day1410 l 1033 (Dayer-Berenson, 2014).
Cultural views of time are important in virtue of the patient’s view regarding passage of time, points in time, and duration of time. Patients’ cultural views on time may be past-oriented, causing a mistrust of new technology or medical treatments. Present-oriented patients may disregard future consequences, making them late for scheduled appointments. CITATION Cri15 l 1033 (Critchfield, 2015).
Personal space must be considered when caring for patients of differing cultures to avoid offensive touch, eye contact, or personal proximity to patients and family members, whereas, social organization factors in the patient’s geography, socioeconomic status, religious beliefs, gender, and sexual orientation, along with their age and position in the familial hierarchy. CITATION Cri15 l 1033 (Critchfield, 2015).
Environmental control “refers to the ability of the person to control nature and plan and direct factors in the environment that may affect them.” CITATION Day1410 l 1033 (Dayer-Berenson, 2014). Folk medicine, locus of control, and health beliefs are included in this area. We must assess the patient’s outlook and beliefs regarding alternative or complementary medicine to develop an individualized plan of care that will encourage patient cooperation and compliance. CITATION Day1410 l 1033 (Dayer-Berenson, 2014).
Biologic variations include “race, body structure, genetic variations, nutritional preferences, and psychological differences.” CITATION Cri15 l 1033 (Critchfield, 2015). Understanding biologic variations within cultures allows the healthcare provider to recognize the uniqueness of each patient within their own cultural context, which decreases the risk of stereotyping and discrimination. CITATION Cri15 l 1033 (Critchfield, 2015).
My professional responsibility is to recognize the uniqueness and individuality of every patient while recognizing the possible influence of my own cultural beliefs and background on the care I provide to them. Cultural competence is vital to this goal. CITATION Day1410 l 1033 (Dayer-Berenson, 2014).
To provide culturally competent care, I must first develop cultural awareness of my own values and beliefs, and understand that while they are mine, they are not necessarily the norm. “Self-awareness involves not only examining one’s culture by also examining perceptions and assumptions about the client’s culture.” CITATION Fer15 l 1033 (Ferwerda, 2015). Developing cultural knowledge through seminars, journal articles, workshop presentations, and classes such as this will expand my knowledge base regarding different cultural and ethnic groups. CITATION Fer15 l 1033 (Ferwerda, 2015). Culturally competent care also requires cultural skill in the use of a culturally specific assessment model to collect patient data and form an individualized patient healthcare plan. Directly interacting with and caring for patients with diverse cultural backgrounds fosters greater experience with diverse cultures, additionally increasing cultural competence. All of this begins with the willingness and motivation to become culturally aware and open to learning from other cultures. CITATION Sea181 l 1033 (Seal & Wiske, 2018).
All in all, the Lees struggle with the American healthcare system demonstrates the tragic consequences than occur with culturally discordant care. Her story stands as a costly and vital lesson to in the importance of acceptance and understanding for people of all cultures and ethnicity. “Our own lives will be enriched when we open ourselves to perspectives that are different from our own.” CITATION Bri18 l 1033 (Brinkman, 2018).
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