Introduction
Define Cultural Competency is a well set of congruent or harmonious behaviors, policies, and attitudes that come together in a professional, system, or among agencies that enables actual work in cross-cultural circumstances (HHS, 1997). In our world increasing population growth dealing with cultural and ethnic and racial communities, every people have their own health profiles and cultural personality, so for these things it creates a great challenge for US health care system (Behn J D & Gonwa T, 1992). In United States Cultural Competency is most important to the health care because it's the best way doctors and patients discuss about health related matter without any cultural differences distressing the conversation but simultaneously enhancing it (HHS, 1997). For a health care organization cultural competency has more benefits. Such as it increases trust, increases respect, decrease unwanted surprises, increases creativity, helps the defeat fear of mistakes, increase involvement from other cultural groups, and promotes fairness and inclusion. Health care organization can show cultural competency by writing a good mission statement that bind to cultural competence as portion of the organizations behavior.
Emerging Standards of Care
According to the United States department of DHHS Office of Minority Health, Incorporated health care attitude must obey the entire person, work diagonally the lifetime, include early intrusion methods and prevention method, and be person-centered, recovery focused and strength-based" (U.S. Department of Health and Human Services, 2000). In the model of healthcare, patient must be treated or cared not only according to usual nursing practice but respect for the people's belief system with their culture and integrate into the care.
Providers that esteem the languages, cultures, and people's worldviews they serve are more victorious in activating and engaging individuals, communities and families to be an effective accomplice in their own health care (U.S. Department of Health and Human Services, 2000)
By integrating into people's care beliefs and requirements, the professional can make rapport with the people in such a good way that must be encourages the people to be functioning or more active in their own health care decisions based on the individual's belief system and professional's medical understanding. Culturally competent care is care that responsive or respectful to an individual's health requirements, beliefs, and practices.
This particular type of care is responsive to the individual's religious and cultural beliefs as well as ethnic beliefs that have been revealed to engage individuals into share or in some cases participating in their healthcare.
The skill to provide culturally competent care is most important for all nurses. Those nurses who work in high-stress or high-acuity healthcare system surroundings, culturally competent care is mainly significant to patient effects. Nurses need to evolve their cultural competency to be very effective in developing health bonds with patients, and to evaluate properly, and to develop and execute nursing involvements designed to get together patients' requirements.
As patient encourages, nurses are compelled to support good choices made by specific patients or the families of patients that may replicate a cultural perspective that divergence with predictable healthcare practices and may even variance with the nurse's personal healthcare thinking. In the present society, culturally competent care cannot be available to all the patients unless the nurses have a good understanding of various cultural backgrounds.
In USA, we have clearly observed that the globalization of the world. According to the United States National Center for Cultural Competence (NCCC), the structure of the US population is changing as a consequence of immigration plan and significant raises among linguistically, racially, culturally, and ethnically diverse populations residing in America (Sue D W, Arredondo P & McDavis R J, 1992).
The United States alone has experienced a transformation that is motivated by an incursion of people from assorted ethnic and cultural groups. If the present trends of population continue, by the year 2080 it is predicted that those population is Caucasian which is now the majority part, will become a low minority group, consisting of 47.9% of the whole projected population of the America. The census data of 1980 and 2000 show a clear variation in the trends of ethnic population with four ethnic groups: Native American, African American, White, and Hispanic. These specific trends are a symbol for the absolutely need of culturally experienced nurses for the future.
Populations served and any issues of population vulnerability
Working for a large, internationally recognized healthcare organizations makes it very important that the cultural competence must be trained to all staff. In orientation program, new staff of the organization are required full four-hour training on the competence of cultural that must be implicate on patient experience surpass the patients and the patients families beliefs (Sue D W, Arredondo P & McDavis R J, 1992). The healthcare organization makes obtainable interpreters to help communication between the patients, healthcare organization staff and the patient's family. As a whole the organization is responsive to the differing religions and cultures that enter their health organization.
On any given day the organization of healthcare takes good care of people from around the globe. All over the world they have some hospitals including the America, Saudi Arabia and Canada. In northeast Ohio in several of the hospitals we observed the hospital and the staff that many of these are diverse populations.
Christian, Muslim, Catholic, Atheist, and Jewish religious belief usage have been observed at the health care as well as African-American, Hispanic, Asian, Latino, , and Islamic cultures. While the healthcare unit is very sensitive to the culture and religious beliefs that every day comes in communication with its employees, there is helplessness to providing good competent care to different patients that come for hospital (Sue D W, Arredondo P & McDavis R J, 1992).
In these hospital one hospitals that mostly serves a higher than standard Hispanic people, and within the hospital all are signs and written both in Spanish and English. While the signage of bilingual is caring for those who cannot speak and read English, if the people cannot read in any way, the signs of bilingual are of no assist.
Within the organization the main hospital serves a diversity of religious and cultural systems. Within the effective system the organizations staff has good resources such as interpreters, information resources of computer based, bilingual staff, and to make easier to educate staff and for the patients provide competent care. Another important issue that stands out inside the system is its food and cafeteria departments. For the cafeteria while all of the foods make and prepared it must be health determined choices with the dietary content openly stated on the food menus, the religious and cultural trust are not. Within the health care system observing the different hospitals cafeteria, there is not a constant attempt at presenting culturally suitable foods on their patient options as well as in the health cafeteria.
Comment on standards of cultural competence
The preferences of cultural food have been a big issue in health care system for many years. The food manufacturing unit has capitalized on the favorite for American hospitals and foods are no diverse (Sue D W, Arredondo P & McDavis R J, 1992). You find in a standard cafeteria a pizza, hot dogs, soda pop, hamburgers, and French fries. For some cultures stricter dietary rules, these specific types of foods are unacceptable for eating. Cultural food mostly preferences are taken into consideration when choosing a selective cafeteria; however, the preferences of religious food are given a back seat. For example, the doctor that I work with is a traditional Jew, and he must follow the laws of the Torah. It symbolize all food that he consume has to be Kosher. According to Jewish law Kosher is suitable and pure. The Kashrus laws include widespread rules concerning forbidden and permitted foods. There are some numbers of aspects to these specific dietary rules that the dedicate and devote Jew must pursue.
In a diet of kosher, there are specific animals that may be eating while other animals may not. In this law Animals considered such as veal, bulls, lambs, cows, goats, sheep, lambs, and springbok while in Torah law the camels and pigs may not be consumed because due to their incapability to chew cud or having tear hooves which is prohibited according to the Torah laws (Tellis G, 2002). About animals, when these specific animals are killed for consumption, a ritual or Schochet killer needs to slaughter the animal in accordance to Torah law (Tellis G, 2002). In such a way the overwhelm animal has to be done when death happen almost instantaneously and there is no pain to the animal (Tellis G, 2002). In the practice of the killing of the animal, the Torah prohibits the eating of the sciatic insolence. In the world you see most western country the animal generally sold off to non-kosher kills to sell. Eggs and poultry follow the similar rules of consumption and slaughter as the other animals that are measured kosher. Traditionally, turkey, goose, chicken, and duck are mostly considered kosher rule and these animals may be eaten. Kosher animals eggs only may be consumed if these animals are free of blood that means each individual egg of Kosher must be consider before eating.
When dealing about kosher animals milk products this is more difficult. Those animals only kosher they can produce milk (Tellis G, 2002). In this point, non-kosher products and no animal additives must be added to kosher milk otherwise the milk of the other animals is no longer kosher. According to the law of Torah you may not consider or cook young animal mother milk (Ayonrinde O, 2003). As the Torah prohibits the combination of addition milk and meat together for eating, it makes the food non-kosher (Ayonrinde O, 2003). In some precise religious system Jewish sects, they needed the separation of milk and meat during the period of preparation to the extent of having to separate instruments and pans that must be cleaned separately (Ayonrinde O, 2003). Also, the utilization of meat and milk must be timed properly so that at the time meat and milk consumption avoid being mixed in a peoples stomach. For an individual it is not uncommon to eat meat and wait some time before eating dairy as to respect kosher law.
In kosher diet law, only fish with scales and fins may be eating such salmon, tuna, and herring (Ayonrinde O, 2003). Shellfish such as crawfish, shrimp, crabs and lobster are mostly forbidden. In the soil all plants are grown, plants and trees their vegetables, flowers and fruits are kosher. According to the kosher diet consuming vegetables and fruits, must be carefully examined for insects as insects are not acceptable. Other some laws may be applying particularly to the sowing and planting of grains, vegetables, and fruits. From trees any of fruits may not be eating if the special tree planted within last three years.
Biblically, new trees or grain may not be bread baked or eaten before one brings an omer of the first fruits of the trees or grains on the Passover of second day (Ayonrinde O, 2003).
At the end, some of the beverages must be kosher as well to be eating. Grape-based derivatives and those beverages produced from grape only are drunk if these specific grapes come from a kosher wine grower, and it must be prepared under strict rabbinical regulation (Hallowell B & Henri B, 2007). As for kosher casein, wine, bull blood, and gelatin are mostly prohibited in the wine-making method. For fermentation only kosher enzymes and bacteria from the bowl may be used (Hallowell B & Henri B, 2007). All of the utensils and devices used for the produce and processing of the grapes must be purify under kosher regulation.
By dietary restrictions another great population that is effected is the Muslim society. According to the Quran law and regulation to Muslims communities, eating is a important matter of faith for those Muslims who must follow the dietary laws and regulation that is called permitted foods or Halal Hallowell B & Henri B, 2007). Those specific foods that are prohibited, such as birds of prey and pork, are well known as Haram Hallowell B & Henri B, 2007). While these foods that are indecisive for no consuming are also known as Mashbooh Hallowell B & Henri B, 2007). Mainly Muslim communities eat to preserve and also they maintain their health. Use of refreshments or overindulgence such as alcohol, tea, and coffee are strongly prohibited. On Mondays and Thursdays fasting is commonly practiced, and more regularly for other holy holidays Hallowell B & Henri B, 2007).
On these specific occasions fasting comprises abstention from all drink and food from starting sunrise to ending sunset. Fasting can amplify the risk of a number of health problems especially if solids as well as liquids are must be included in the fast. When problem symptoms arise, it is very important to add water to the fast or end the fast to maintain health. Depending on the symptoms, the only alternative is ending the fast. In some cases of dehydration symptoms, primary medical care must be followed as soon as possible to reinstate health. In a present day hospital setting of western part, being able to stand by these nutritional restrictions can be very difficult if not practically impossible.
In Muslim community in ninth month of the Islamic year is the holy and pure month of Ramadan. It is a time devoted to charity, prayer, and fasting (Hallowell B & Henri B, 2007). Most Muslims peoples are required to desist from drink and food during the daylight hours for the whole month. Each evening after sunset the fasting is broken by a mealtime known as iftar, which usually includes sweet drink, dates and water and is restart again at sunrise.
During Ramadan fasting is one of the five important Pillars of religion faith, in Islam it is the most important religious duties. In a medical setting, to respect or honor the fasting during the time period of Ramadan may be very difficult as well as not in the greatest interest of the patient physical condition. The religious practice is to prompt Muslims cleanse the body, of the poor, spiritual devotion and foster serenity. With these specific religious dietary thinking, it illustrates the problems that the general hospital culture must have in obeying each ethnic beliefs, religion, and culture in a large health organization.
Although those people who observe contradictory beliefs, it would be very practical for those patients and their families if the healthcare organization would be particularly equipped to moderate a diet or another requirement to respect the patient's culture and belief system. From a patient's opinion, being able to have some well control of their valuable lives while being a patient in the healthcare is most important. By obeying and understanding religious and cultural beliefs of the patient, nurses must be individualizing the health care as well as providing ethnically competent care for patients.
Nursing Care
In most part nursing care is specially provided in regards to cultural competence as well as nursing standards of practice (Teresa M Kielhorn & J D LLM, 1997). In healthcare system nurses provide direct patient care are some of the hardest working and most compassionate nurses I have meet in my nursing professional career. The organization should present a full orientation program to the nursing floor as a new appoint as well as a skills ability check.
For those specific nurses that have been with the healthcare system for any duration of time over one year, an annual skills ability day is compulsory. The annual skills competency also comprises a part on cultural diversity in the workplace (Teresa M Kielhorn & J D LLM, 1997). The healthcare organization also provides its employees one day per year for a learning day so that they can concentrate or attain other such education program such as a seminar, conference in order to convene the CEU obligations for licensure. So, the health organization provides its employees many good opportunities for educating themselves concerning cultural diversity.
In the ground of patient care, the nursing staff takes special care to aware to the religious practices and cultural beliefs that are important part of their patient's care. For example, if there are requirements of certain bathing such as Islamic culture, the nursing staff does their best work to maintain the patient's custom. The culture of Islam strongly believes in spiritual as well as physical honor and purity. In the verses of Qur'an outlines it demonstrate that how to achieve tradition cleanliness and maintain purity. In Islam taking care of an individual the nurse must required to be aware of these specific rules and he or she must be abide by them also. For instance, the holy Qur'an goes into big point on the step by step directions on how an individual perform Wudu. Maintaining the patient and their family at ease by enduring by their religious customs during a complicated time can take them a feeling of peace and comfort.
Solutions that could be implemented
In the performance of how the healthcare organization attempts to be aware of the diverse people that enter doors, their valuable plans are not taking in proof (Teresa M Kielhorn & J D LLM, 1997). I have observed one big issue that has spoken at part about good deals with dietary assortments for patients with families in the cafeteria. We the people of world must not forget those family is just as essential in the patient care. For the religious customs that strict roles and control diets to stand by such as Islamic, Jewish, and Catholic religions, the selection standard leave slight for patients and their families to select from that principles their conventional beliefs. To the issues the valuable solution would be to execute some good changes to the cafeteria choice as well as increasing food selections that would respect and honor each and every belief system.
Conclusion
In cultural competence with all efforts, it is very difficult for any physician to enter a patient room with full armed with a comprehensive awareness and knowledge of the expected cultural suitable experience. It is really difficult for a nurse to be completely versed in every religious aspect and even the most culturally part nurse cannot understand what useful experience the patient and their families are deal with. Even most culturally expert practitioner cannot understand the patient's experience, and should not guess to do so. In spite of the professional's knowledge and experience, their particular job is to remain intrusive and open to the difference and complexities that make up the patients lives and describe their reality. There dishonesty the advantage of our work; a eminent honor we are given each and every time our patients invite us into their valuable lives, and they must give us a good opportunity to see the entire world from their eyes, a diverse and new perspective.