NR 501 Week 3 Concept Analysis

Introduction

NR 501 Week 3 Concept Analysis

The nursing profession is a dynamic profession where different cultures integrate together. Nurses treat patients from a different culture. To provide holistic care by considering all the aspects of the patient, it is important to understand their behavior, psychology, mental conditions, beliefs, and culture (Fahlberg, Foronda & Baptiste, 2016). It is important to analyze concepts, which affects the nursing outcome. One major reason is concept analysis provides both theoretical and empirical evidence to a concept and its theories. American Nurses Association identifies cultural humility as an important concept. As a result, colleges and graduate programs are integrating cultural humility in their curriculum (Farber, 2019). Further, hospitals and nurses are working together to provide better community care through diversified treatment for different cultures. Cultural humility can be explained through different concepts. However, transcultural theory (Prosen, 2015). It is a well-followed theory, which provides both theoretical and empirical explanation for cultural humility and its frameworks. 

NR 501 Week 3 Concept Analysis

Definition or Explanation of the Selected Nursing Concept

Cultural humility concept in a multicultural world with power imbalance is defined as a process of self-awareness, openness, self-reflective, being egoless and inclusive to willingly interact with diverse individuals to understand and establish a better relationship. Cultural humility concept is a combination of cultural care and cultural competence. It results in mutual empowerment, partnership, respect, inclusiveness, lifelong learning and optimal care (Foronda, Baptiste, Reinholdt & Ousman, 2015). The concept explains how understanding cultural factors affect the view and experience of people towards health and decisions they make during treatment. Factors such as education, cultural values, religion, beliefs, economy, lifestyle, and customs affect the decision. Hence, the concept uses five key aspects: cultural knowledge, cultural awareness, cultural encounters, cultural desire and cultural skills (Fahlberg, Foronda & Baptiste, 2016). For nurses, these elements provide guidelines for providing better care. 

Literature Review

Foronda, Baptiste, Reinholdt & Ousman (2015) published a research paper to provide a modern definition of cultural humility through theoretical framework analysis. The research analyzed the concept by identifying ethnic, racial, social status, sexual preference, economy, society, and perception of healthcare and individuals. Authors used both individual and societal values to understand how cultural aspects affect healthcare outcomes. After reviewing different articles on a theoretical basis, the study found that cultural humility empowers both individuals and healthcare (Foronda, Baptiste, Reinholdt & Ousman, 2015). Authors defined the cultural concept by considering culture, healthcare, individual and nurses. The study identified ethnicity and racial diversity as two major factors of cultural humility. 

Fahlberg, Foronda & Baptiste (2016) published a concept analysis article on cultural humility. The study analyzed different cases and established the importance of having better patient, family and healthcare relationship. Authors used culture care theory to understand the perspective of individuals and factors, which affects their healthcare decisions. Further, the study showed that cultural competence and care are the same topics but there are some minute differences. The study established that with better collaboration, skills, knowledge, and learning, it is possible to provide the best possible care in a culturally diverse society (Fahlberg, Foronda & Baptiste, 2016). The study concluded that cultural humility is the key for better patient and healthcare relationship and decision-making in difficult situations. 

NR 501 Week 3 Concept Analysis

Repo, Vahlberg, Salminen, Papadopoulos & Leino-Kilpi (2016) conducted an empirical study by using structured Cultural Competence Assessment Tool to find the level of cultural humility in nursing graduate students and different factors, which affects the nursing. The study was carried out on 295 students. Majority of students were from the multicultural nursing field. The study used the tools and correlation factors such as linguistic skills, different cultures, and knowledge to see whether multicultural teaching should be included in nursing. The study found that the competence level was moderate. To increase the cultural integration, the program should include student’s interaction with people from different cultures, linguistic skills, and lifelong learning (Repo, Vahlberg, Salminen, Papadopoulos & Leino-Kilpi, 2016). The study showed the importance of culture and its aspect but it does not evaluate all the factors affecting nursing care. 

Steefel (2018) concept-wise research on drive correctional nursing practice based on Madeleine Leininger’s Theory of Culture Care Diversity and Universality. The analysis was carried out by considering three main aspects of the transcultural theory. They maintain the patient’s culture, adapting according to culture and reconsider cultural treatments, which are unhealthful. The author analyzed cultural correction, cultural humility, patient behaviors, and correction without cultural humility. The study found that actions recommended by Leininger’s theory can help in correcting cultural care but it is always not feasible (Steefel, 2018). However, the study concluded that cultural humility will lead to better care and it should be implemented. 

Empirical and statistical study on cultural humility in baccalaureate nurses and their relationship with the cultural experience provided statistical evidence to cultural competence. The study was descriptive and correlational. It was carried out to find the cultural experiences including transcultural self-efficacy, cognitive, effective and practical skills on 118 registered nurses. The study used Jeffrey’s Transcultural Self-Efficacy Tool to measure these experiences by using transcultural nursing theory as the base for nursing care. The study found that nurses feel less confident in transcultural knowledge and as a result, they lacked international experience leading to lower cultural care (Farber, 2019). Therefore, it is important to add transcultural teaching in nursing for better care. 

NR 501 Week 3 Concept Analysis

Edwards (2019) implemented cultural humility and transcultural theory on culturally competent registered nurses. The purpose of the study is to find the importance of cultural humility in nursing education and how transcultural nursing education will improve nursing care. The study used Healthcare Professionals-R tool and statistical package to analyze the data collected by 22 RNs. Further, the study used paired t-test in determining the effects of transcultural programs on the nurses. The study found that 77% of nurses find positive effects of cultural concept education on nursing (Edwards, 2019). It is evident from this study that, cultural humility can bring in positive change in society and improve cultural care. 

Defining Attributes

Cultural humility and transcultural nursing theory find five main attributes. They are openness, self-awareness, egoless, supportive interaction, and self-reflection and critique. 

Openness

Every nurse and healthcare individual should be inclusive with open-mindedness. Nurses should interact with patients without any prejudices or biases. Openness is an approach and an attitude, which allows the individual to explore new concepts, beliefs, customs, concepts, and ideas (Foronda, Baptiste, Reinholdt & Ousman, 2015). This attribute provides better understanding leading to high-level patient, physician and nurse relationship. 

NR 501 Week 3 Concept Analysis

Self-Awareness

Self-awareness is a concept of keeping oneself aware of their strengths, beliefs, values, limitations, appearance, and behavior. Self-awareness in cultural humility represents medical education, medicine, clinical research, psychotherapy, social education, and physical therapists (Leininger & McFarland, 2006). Self-awareness keeps the nurse and healthcare staff alert and allows them to respond in a better way when the situation needs decision-making. 

Egoless

Egoless is a term, which denotes a nurse’s responsibility and obligation in nursing practice. It is a term, which refers to removing ego and staying humble in healthcare. This term includes other descriptions such as being modest, down to earth, humility, being equitable, inclusiveness, and equality. With a better hierarchy, healthcare can reduce power differentials to provide better care for all. 

Supportive Interaction

Supportive exchange is referred to as an initiative, attitude, and support, which provides detailed, clear and satisfactory information and care to the patient, which increases communication and care output (Foronda, Baptiste, Reinholdt & Ousman, 2015). The term also includes communication, sharing, intersectionality, engaging nature, active support, and better support. Supportive interaction should be between all the health staff and patient as they all can create a better environment in hospitals by considering cultural humility. 

NR 501 Week 3 Concept Analysis

Self-Reflection and Critique

Self-reflection refers to one’s ability to critically evaluate their thoughts, feelings, actions, decisions, and outcomes. The critical approach through skills, cognitive ability, knowledge, and evaluation of every process of action betters nursing care (Foronda, Baptiste, Reinholdt & Ousman, 2015). It is an endless process, which includes continuous reflection, understanding and refinement. 

Antecedent and Consequence

Antecedents in cultural humility concept refer to situations, which preceded the instance of different concepts of cultural humility. In cultural humility, power imbalance and diversity is considered as one of the most important antecedents (Foronda, Baptiste, Reinholdt & Ousman, 2015). Diversity is defined as a multicultural state where there are different cultures, beliefs, values, customs, health disparities, perception to sickness and treatment, demands for care, linguistic differences, ideas, material privilege, lifestyle, taboos, religion, ethnicity, and attitudes. 

The consequence is the output or an event that takes place after the implementation of cultural humility. The outcome is culture-based holistic care. This includes better communication between patients and healthcare, respect, lifelong learning, empowerment, understanding, optimal care, treatment, and decision-making (Farber, 2019). All of these help in providing the best care to the patient and at the same time healthcare staff continues to learn, adapt and reflect on decisions critically. 

NR 501 Week 3 Concept Analysis

Empirical Referents

Research by Farber (2019) and Edwards (2019) used the cultural humility and transcultural nursing theory to find evidence of cultural humility and transcultural theory on nurses. Farber (2019) identified that nurses who are least confident in transcultural knowledge did not have the skills, ability, and knowledge to handle the multicultural clients as they did not have high cultural competence (Farber, 2019). Transcultural self-efficacy was needed to provide better care. This was identified by Edwards as the results showed 77% of nurses found cultural competence and transcultural knowledge helped in giving better care and increasing patient outcome through social impact (Edwards, 2019).  

Construct Cases

In the model case, Andrew and her mother Karen had a car accident. Andrew had severe head injuries. Karen was dead on arrival. Andrew’s father wanted to take the body back to Australia for final rites as it was their ritual and religious belief to perform final rites at their ancestor’s place. As Andrew’s condition may deteriorate when his father is away, cultural consent is obtained from the father after discussing everything. Finally, the father agreed if there is any need for an urgent operation on Andrew, the hospital is allowed to perform the surgery. It was possible because, nurses and healthcare understood the cultural needs, beliefs, and customs by using all five aspects of cultural humility including egoless decision-making, openness, self-awareness of decisions, proper interaction and critically evaluating the situation.

NR 501 Week 3 Concept Analysis

In borderline case; A Muslim man admitted to the healthcare had severe neck pain. He was given treatment and his family members brought some holy water and food for the person. Hospital physician was on rounds and when he arrived to check the patient, he instructed family members not to give him that water and food as hospital supply cleaner food. Family members requested but the physician did not agree. Nurse intervened and informed the physician that it is filtered water and completely clean. They have brought a couple of dates with olive fruits to pray for quick recovery. The physician just walked out of the room by looking angrily at the nurse and said do what you please. Here, the nurse showed better understanding with openness, self-awareness of decisions, and proper interaction. But, the physician was egoistic and he neither contemplated on his decision nor tried to convince the patient with a better conversation. 

A contrary case was found when a patient named Martha was admitted to healthcare for labor pain. Due to rules of hospital and government along with Christian values, abortion was not allowed. To save the woman, her husband agreed for abortion as the patient was critical. However, due to Irish laws, doctors declined to perform the abortion even though they were atheists and did not have any problems with abortion. However, due to laws and rejection from the hospital, Martha died in healthcare due to no treatment. Here, healthcare did not show any attributes from cultural humility concept. 

Theoretical Applications of the Concept

Due to globalization and multiculturalism, healthcare and nurses facing many cases where the importance of culture is high. If the culture does not understand the importance of culture in patient care, it is difficult to provide holistic care (Leininger & McFarland, 2006).  Therefore, there is a need for conceptual-level analysis of cultural humility in the modern world. The concept allows the nurses to learn and understand new ideas. The cultural humility concept helps in solving most of the cultural related issues in healthcare if not all. This helps the individuals to develop skills, which are not only cognitive but also social. Healthcare can understand different perspectives of life and their importance. Transcultural nursing theory uses the same concept where culture is considered as one of the important aspects in best care. The theory considers the importance of understanding the culture, language, behaviour, customs, religion, individual choices and decisions. Further, it says, nurses should learn, adapt, implement and critically evaluate the nursing decisions based on culture (Foronda, Baptiste, Reinholdt & Ousman, 2015). The same attributes are associated with cultural humility. By integrating concept and the theory, it possible to establish cultural integration, inclusiveness and diverse treatment within the healthcare. Nurses and healthcare staff can opt for lifelong learning to remove barriers in treatment. Further, cultural disparities and inequality can be reduced by diversifying the treatment, decision-making process and approach. 

NR 501 Week 3 Concept Analysis

Conclusion

In a growing multicultural society, cultural humility should be included. The article provided an analysis of cultural humility concept by integrating its aspects in transcultural theory. It is evident from cultural humility concept that healthcare professionals should study, understand and respect the values of different cultures by adopting the egoless, interactive, responsible, self-reflective, critical, and holistic practice, which is highly aware. Transcultural nursing theory identified the same aspects. This theory helps in reducing the disparity and increasing better integration of culture in society. After analyzing the concept, it is clear that nursing should not only concentrate on cognitive ability and skills, but it also should consider cultural aspects of individual and society in a progressive way. 

References

Edwards, A. (2019). Implementation of a Transcultural Nursing Education Program to Improve Nurses’ Cultural Competence. Public Health Education And Promotion Commons, And The Social And Cultural Anthropology Commons. Retrieved from https://scholarworks.waldenu.edu/dissertations

Fahlberg, B., Foronda, C., & Baptiste, D. (2016). Cultural humility: The key to patient/family partnerships for making difficult decisions. Nursing46(9), 14-16. doi: 10.1097/01.nurse.0000490221.61685.e1

Farber, J. (2019). Cultural Competence of Baccalaureate Nurse Faculty: Relationship to Cultural Experiences. Journal Of Professional Nursing35(2), 81-88. doi: 10.1016/j.profnurs.2018.09.005

Foronda, C., Baptiste, D., Reinholdt, M., & Ousman, K. (2015). Cultural Humility. Journal Of Transcultural Nursing27(3), 210-217. doi: 10.1177/1043659615592677

NR 501 Week 3 Concept Analysis

Foronda, C., Baptiste, D., Reinholdt, M., & Ousman, K. (2015). Cultural Humility. Journal Of Transcultural Nursing27(3), 210-217. doi: 10.1177/1043659615592677

Leininger, M., & McFarland, M. (2006). Culture care diversity and universality. Sudbury, MA: Jones and Bartlett.

Prosen, M. (2015). Introducing Transcultural Nursing Education: Implementation of Transcultural Nursing in the Postgraduate Nursing Curriculum. Procedia – Social And Behavioral Sciences174, 149-155. doi: 10.1016/j.sbspro.2015.01.640

Repo, H., Vahlberg, T., Salminen, L., Papadopoulos, I., & Leino-Kilpi, H. (2016). The Cultural Competence of Graduating Nursing Students. Journal Of Transcultural Nursing28(1), 98-107. doi: 10.1177/1043659616632046

Steefel, L. (2018). Cultural Humility: An Active Concept to Drive Correctional Nursing Practice. Journal Of Forensic Nursing14(1), 27-30. doi: 10.1097/jfn.0000000000000187

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