Posts Tagged ‘Forensic Nursing ethnicity and culture’

Is it Necessary to Document Your Efforts in Providing Culturally Competent Care?

April 5, 2013

Cultural competence has been a responsibility addressed in nursing programs since before I became a student and I have noticed a steadily increasing amount of focus placed on the topic throughout the years. As with all aspects of nursing (including forensic nursing), there will always be room for improvement in how we conduct our profession in a culturally sensitive manner. It seems to be a basic understanding that any nurse be acutely aware of his or her own cultural beliefs, practices and biases. I also notice universal agreement that health care professionals need to attempt to learn about all clients’ cultural attitudes towards healthcare and allow for specific integration of these attitudes when at all possible. As this is a responsibility of the health care professional, is documentation of the practice necessary as well? Cultural competence can be applied in forensic nursing and all aspects of nursing care; so documenting the practice is very complicated. Much discussion will be needed to determine how it can be applied to daily documentation without taking excessive time from other nursing responsibilities. A basic need of clients is to have their healthcare options given to them in their first language to maximize the potential for full understanding. Hospitals have addressed this need in a variety of ways including written translation of informed consent and having native speaking interpreters present during any medical explanation before “informed consent” is given. The practice of providing culturally sensitive care is then “documented” by the presence of the signed translated copy of the consent or the presence of the interpreter’s signature on the English version of the consent. The cost to health care providers in both the areas of finance and time is great to accommodate these needs. Therefore, the value of our current practice should be continuously evaluated in order to assure we meet the needs of the client without excessive cost. Value is the key word in this sentence. In the case of the written translated consent form, I have seen consents get signed without being read and this has forced me to think about the various reasons this might occur. Could the client read the consent? Although the consent was in the language self-identified by the client, was the terminology not familiar to the client? Were the opinion and “desires” of the healthcare professional deemed sufficient and therefore explanation not required? The signed consent, however, is placed in the client’s chart and acts as documentation that the client was explained the procedure in a manner facilitating understanding. Healthcare facilities are also managing costs by trying to minimize the amount of paper used in documenting. I have seen consents presented to clients in the form of laptop computers with electronic writing devices. Does this technology intimidate the patient and further compromise their comfort during their healthcare experience? I am sure the answers to the questions posed above are as varied as are the cultures and people of those cultures seeking healthcare in this country. Is it really of value, then, to “document” all of our efforts in providing culturally competent care? Or rather, should we seek to create an environment in healthcare settings where continued education and discussion enhances the healthcare professional’s awareness of the need for culturally competent care? This in turn might increase our accountability to this responsibility without further straining the healthcare system with the financial and emotional stress of balancing the application of good care with the documentation of the process.

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Cultural Diversity and Community Oriented Nursing Practice

November 26, 2008

Culturally competent nursing care is guided by four principles (AAN Expert Panel, 1992). One of those four guided principles addresses sensitivity. Cultural competent nursing care entails providing care with sensitivity based on the cultural uniqueness of your patient. Sensitivity would be of utmost importance in the field of forensic nursing. One subspecialty of forensic nursing is the care of sexual assault patients. As a sexual assault nurse examiner cultural competence must be demonstrated as a caregiver as you observe, recognize and collect evidence in legal cases for traumatic sexual assault injury. Because we live in such a diverse society it is essential that the nurse demonstrate cultural competence in the care of all patients but especially sexual assault patients. (Stanhope: Community and Public Nursing Chapter 7)

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Cultural Competency in Death

November 19, 2008

The family is the central caretaker of the dead throughout the world, including the US. The US is also a virtual melting pot of cultures and we must be cognizant of all the different belief systems at work. According to the text, cultural competency from the death related standpoint looks at subjective, objective and the cross-cultural encounter. The first encompasses the victim, family, cultural and social characteristics including worldview and communication. Subjective perspectives deal with self-awareness, values and beliefs. Communication is key. Death notification should never be communicated by telephone; rather empathetically face-to-face. Factors that are of upmost importance are compassion, consideration of the family’s language skills, tone of voice, nonverbal communication, privacy, personal space, eye contact, touch, time orientation, socioeconomic status, social class, sexual orientation, disability and death rituals. Support of the grieving family is a major factor in this process. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Forensic Nursing Female Genital mutilation? Female Circumcision, comment

December 4, 2007

Forensic Nursing Female Genital mutilation? Female Circumcision posted Sunday, March 11 2007
I visited a Maasi tribe in Kenya. We spoke to the women about their female circumcision. They could not believe we were not circumcised. They called us “little girls” Without this procedure a girl cannot become a woman in their eyes. The circumcision is usually done with a razor blade some of the time not a new razor. No anesthesia is used and women in the family hold the girl down. Usually the incision usually will be “pinned together by acacia bush thorns. Myrrh is placed on the incision and the girl’s legs are tied together for two weeks. Infection and tetanus sometimes occurs. A problem with periods and urination occurs it often takes several minutes to urinate if the whole is very small. Painful sexual relations also are a problem. If it is a problem to have sex women will increase the whole with a knife.

With childbirth the skin needs to be cut open then restored together. Scar tissue becomes a problem when the woman has many children. Depending upon the repair a vaginal inspection is almost impossible. These women usually do not come in for a vaginal inspection.

The practitioner needs to be accepting of this culture because it is important to the woman and her family.

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Women from many different cultures

October 18, 2007
The forensics nurse is called upon to take care of many women from many different cultures. Rape and abuse happen every day. Women of all ages, from all cultures are victims. Providing culturally competent care in forensics nursing happens at many levels.
To begin with, the provider must understand her own feelings about different cultures, and acknowledge that one’s life experiences reflect the way in which one reacts to the world. Did the provider grow up in a tightly knit, excusive community? Was she exposed to many cultures prior to working in the health care setting? What messages did she hear as she was growing up?
The second step is to look at her own feelings working with cultures different from her own. Does she find it difficult and awkward, or does she approach each encounter as a learning experience? Stepping outside the box helps. The culture that condemns female circumcision needs to understand that other cultures may condemn the male infant circumcision. Also, try to visualize what it would be like to seek care and not be able to speak the language or understand the customs.
The third step is knowledge. The provider who learns about different cultures on many different levels is open to new information and ways of doing things. Ask questions. Are there certain personal or religious beliefs the client observes? Are there healers from different cultures who can do an inservice?
The fourth step is understanding basic human rights. Look into your client’s eyes, use touch and acknowledge that she is above all a woman of the human race. With the basic human right comes the right for privacy. Although it may seem easier to use the support person for an interpreter, this can be disempowering for the client. Have a good working knowledge of how to contact the interpreter and explain that the interpreter is specially trained. Some cultures require a female attendant. Know how to access this before the situation happens. If the partner seems reluctant to leave, have a plan worked out for a fellow nurse or medical secretary to find a reason to have him or her leave the room.
Lastly, ask the client if there is anything you could have done different. Reflect on the situation and learn from each case. Share information with your colleagues (maintaining confidentiality).

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Assessment for Drug Abuse, Understanding the Impact of Culture and Gender

August 23, 2007

Assessment comprises a medical and psychological history along with family, social, sexual, and drug use histories and a physical examination.

Who should assess? Clinical nurse specialist with experience in empathic motivational interviewing may perform intensive assessment after receiving training in, the signs and symptoms, biopsychosocial effect of drugs and likely progression of the disease, common comorbid conditions and medical consequences of abuse, use of the Diagnostic and Statistical Manual of Mental disorders, and their relationships to the findings the emerge during the assessment history, and the appropriate use, scoring, and interpretation of standardized assessment instruments.

Focusing on the in-depth assessment:

The Clinician should understand how patients’ gender and cultural background bear on the characteristics and severity of the disease. Studies have shown that more males than females abuse alcohol and drugs. Older women are more likely than older men to abuse prescription drugs.

Culture influence the patients’ recognition of their problems, norms may accept or condone male drunkenness, and their reaction to the assessment process and recommended treatment interventions. Substantial stigma may be associated with substance abuse treatment, especially for women and older patients of either sex.

The Clinician needs to be aware of the influence of their own gender and cultural background and their response to patients with suspected substance abuse problems.

Understanding of typical patterns is useful in anticipating problem areas, experienced clinicians resist the temptation to stereo type patients and subsume them within a broad categories based on language, ethnicity, age, education, and appearance.

In conclusion, when referring patients for assessment, Clinicians should consider whether a particular patient will relate more readily to a male or female assessor similar cultural backgrounds or if a patient who speaks English as a second language will respond more easily to question posed in his native tongue.

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Ethnic and Cultural Considerations in Forensic Nursing – Comment

May 30, 2007

Becoming culturally aware is something we all as nurses need to work on. In my area of work you have to be and you have to be nonjudgmental. It does not take a license to have a baby. Some of the nurses on my staff, particularly to younger ones are always saying, “we can’t let that Mom take that baby home”. It may not be the way we would live. It may not be upper middle class. They need not personalize it so much and give the parent the best tools that we can to help them care for the child. We are not going to change with way some people live and their culture, but we can give them ways to help themselves in our culture that will fit theirs.

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Ethnic and cultural considerations in Forensic Nursing

February 21, 2007

I read about cultural sensitivity and becoming culturally competent, and having worked in a very culturally diverse setting I studied assessment skills of special populations a lot. I tried diligently to not stereotype, to utilize interpreters, and to plan care based upon the values of the person and their health seeking behaviors/needs.

Now, I am in a predominately forensic setting (long-term care state psychiatric hospital) with many cultures and ethnicities present. Some attitudinal issues perplex me; be cautions around this patient, not only is he Hispanic but he murdered his Mother. Watch this person, he is African American and is a repeat offender, you know he is antisocial. Oh, this guy is willing to be deported because he is so kind and he thinks life will be better if he returns to Ethiopia.

I challenge the mindset of stereotyping by culture/ethnicity and by crime. I challenge the mindset of stereotyping based upon Axis II disorders. I wonder, is it complacency or is it overt familiarity with the long-term care patient that develops this thinking in the staff.

I find it exciting to conduct thorough and comprehensive assessment in collaboration with the patient and the interdisciplinary team to move toward planning that will optimize positive outcomes in the patient. Is that naivety on my part or is that our job?

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