Nurses are moving from acute care to community-based settings.

Chapter 11: Culture, Family, and Community

 

Copyright © 2016 Wolters Kluwer Health | Lippincott Williams & Wilkins

 

 

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1

Community-Based Settings #1

An understanding of culture and cultural concepts contributes to the nurse’s knowledge and facilitates culturally competent nursing care in community-based settings.

 

Nurses are moving from acute care to community-based settings.

 

 

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Community-Based Settings #2

Concepts such as partnership, collaboration, empowerment, and facilitation now form the basis for community-based nursing practice with individuals, families, and aggregates in the community.

 

An aggregate is a collection of people who can be thought of as a whole simply because they happen to be in the same place at the same time.

 

 

 

 

 

 

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3

Community-Based Settings #3

Community-based collaborative action research (CBCAR) is an approach for nurses to partner with communities to address health issues.

 

Care that is not congruent with the client’s value system is likely to increase the cost of care because it compromises quality and inhibits access to services.

 

 

 

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4

Overview of Culturally Competent Nursing Care in Community Settings

The use of cultural knowledge in community-based nursing practice begins with a careful assessment of clients and families in their own environments.

Cultural data are discussed with the client and family to develop mutually shared goals.

Nurses must take into account the diverse cultural factors that will motivate clients to make successful changes in lifestyle and behavioral modifications.

 

 

 

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5

A Transcultural Framework

Cultural/social/ecological approach:

Nursing focus is on the community as client.

A cultural/social/ecological framework facilitates a view of the community as a complex collective yet allows for diversity within the whole.

Assists the nurse to identify values and cultural norms of a community.

 

 

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Question #1

Is the following statement true or false?

 

The goal of practicing in a culturally sensitive manner is to provide care that the client, family, and health care providers are in agreement with.

 

 

 

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Answer to Question #1

True

Rationale: The use of cultural knowledge in community-based nursing practice begins with a careful assessment of clients and families in their own environments. Cultural data that have implications for nursing care are selected from clients, families, and the environment during the assessment phase and are discussed with the client and family to develop mutually shared goals.

 

 

 

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8

Cultural Issues in Community Nursing Practice #1

Cultural influences on individuals/families:

Family roles, communication, decision making

Health beliefs/practices, alternative therapies

Patterns of daily living

Social networks

 

 

 

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Cultural Issues in Community Nursing Practice #2

Cultural influences on individuals/families (cont.):

Identification with a cultural group, language

Nutritional practices

Religious preferences

Culturally appropriate behavior styles

 

 

 

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Cultural Issues in Community Nursing Practice #3

Cultural factors within communities:

Influence of demographics on health care; the United States is more diverse; morbidity/mortality rates

Subcultures in the United States and diversity within them

Refugee and immigrant populations, asylees

Dinka community

 

 

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11

Cultural Issues in Community Nursing Practice #4

 

 

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Cultural Issues in Community Nursing Practice #5

Cultural factors within communities (cont.):

Maintenance of traditional cultural values and practices, assimilation, acculturation, integration

Access to health and nursing care for diverse cultural groups :

Economic status

Discriminatory factors

Geographic location

 

 

 

 

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Question #2

Is the following statement true or false?

 

Assimilation and acculturation can be defined as the process by which individuals shed their traditional culture and lifestyle and embrace and adapt to their new culture—something all successful immigrants and refugees experience.

 

 

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Answer to Question #2

False

Rationale: The terms assimilation and acculturation refer to ways in which immigrants and refugees adapt and change over time. These terms may imply giving up one’s traditional culture for the dominant culture. Integration, incorporating some aspects of the new culture while maintaining cultural traditions and values, may better describe a successful immigrant or refugee experience.

 

 

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15

Assessment of Culturally Diverse Communities #1

The community nursing assessment often focuses on a broad goal, such as improvement in the health status of a group of people.

 

 

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Assessment of Culturally Diverse Communities #2

Basic Principles of Cultural Assessments:

1. All cultures must be viewed in the context in which they have developed.

2. The meaning and purpose of the behavior must be interpreted within the context of the specific culture.

3. There is such a phenomenon as intracultural variation.

 

 

 

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17

Assessment of Culturally Diverse Communities #3

Cultural competence in health maintenance and health promotion:

Cultural competence in community settings begins with anticipatory planning.

Cultural sensitivity, the ability to be aware of the needs and emotions of others, is essential to meeting health needs that exist within diverse cultural groups.

 

 

 

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Assessment of Culturally Diverse Communities #4

Cultural competence in health maintenance and health promotion (cont.):

Requires knowledge about:

Family systems

Coping behaviors

Lifestyle practices

 

 

 

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Assessment of Culturally Diverse Communities #5

Cultural competence in primary, secondary, and tertiary preventive programs:

The major aim of community-based preventive programs is to reduce the risk for the population at large, rather than to prevent illnesses in specific individuals.

In their daily practice, community nurses are often involved in activities related to all three levels of prevention.

 

 

 

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Assessment of Culturally Diverse Communities #6

Cultural Competence in primary, secondary, and tertiary preventive programs (cont.):

Primary—prevent the occurrence of an illness, disease, or health risk

Secondary—early diagnosis and appropriate treatment of a condition or disease

Tertiary—rehabilitation and the prevention of recurrences or complications

 

 

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21

Question #3

The community health nurse should target certain high-risk behaviors for change during pregnancy, such as smoking, using drugs, consuming alcohol, and maintaining poor nutritional habits. Which of the following levels of prevention does this demonstrate?

Primary

Secondary

Tertiary

Assessment

 

 

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22

Answer to Question #3

A. Primary

Rationale: A program of primary prevention would focus on preventing infant morbidity and mortality and other health problems in mothers and their infants.

Early prenatal care may enhance pregnancy outcome and maternal health by assessing risk, providing health advice, and managing chronic and pregnancy-related health conditions.

 

 

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