Reading Journal for Sociology 340



Tammy Garcia

Reading Journal for Sociology 340

The book I am using as my secondary text for the reading journal is Caring for Patients from Different Cultures by Geri-Ann Galanti. I think the title is going to be an accurate description of the book and hopefully will give useful information that will be easy to apply in my daily practice. I do think I will enjoy the book. I am a nurse and if I am able to offer a patient a little more comfort, dignity, and respect by being mindful of my patient’s cultural background, then reading the book will have been a positive experience.

Chapter1: Basic Concepts

In this chapter the reader is introduced to the basic concepts of providing care to a culturally diverse population. Because of how different cultures view and interpret words and actions, misunderstandings are often the result if the health care provider does not achieve cultural competence.

In order to provide patient centered care to a culturally diverse population, the provider must understand how the patient interprets the health issue at hand. Asking the right questions helps to gather that information. The author then introduces a line of questioning the author calls the four C’s. The four C’s stand for: What does the patient call the problem; what does the patient think caused it; what has the patient done to cope with the problem; what concerns does the patient have about the illness and treatment?

Additional topics defined and explained include: culture, subculture, stereotyping, prejudice and discrimination, values, values and the American health care culture, worldview, patient’s relationship to nature, defining the terms emic and ethic, ethnocentrism and cultural relativism, time orientation, hierarchical versus egalitarian cultures, family of orientation versus family of protection, models of disease and disease etiology, theoretical perspective-adaptation theory, and cultural customs. The author uses a variety of case examples and case studies, to provide examples and increase understanding.

As a nurse I frequently have contact with patients from different cultural backgrounds. Throughout nursing school, during training sessions at places of employment, and during various classes I have taken at Ferris while working on my BSN, education has been provided on how to provide care, in a culturally respective way, to patients from different cultures.

I will defiantly be able to apply the information I learned in this chapter to my nursing career. Nursing care is supposed to take care of mind, body, and spirit. Having additional knowledge on how to provide culturally competent care to patients can help with caring for the patient as a whole.

I found the case examples to be very helpful in understanding the differences in culture. This chapter covering the basics had a lot of information that I’m sure will be enhanced further as I continue to read this book.

Chapter 2: Communication and Time Orientation

It is very easy to have miscommunication when communicating with patients from different cultures. Misunderstanding happens based on more than just a language barrier. Some issues that can cause or contribute to misunderstandings include: the use of idioms; variations of English; different meanings for the same words; different connotations in different languages; using yes and no, positive and negative; grammar, pronouns; formal versus informal language; directive versus nondirective approaches; personalismo; respeto (respect); not asking questions (patients may be unwilling to); not asking questions about their culture or religion.

This chapter also gave a good argument for the use of professional interpreters. Family interpreters can leave important information out of the communication for reasons ranging from respect, embarrassment, family hierarchy, and not understanding medical terminology. I would also add abuse to the list because abuse happens in all cultures.

Nonverbal communication can be easily misunderstood as well. Body language, eye contact, touching, and gestures may mean different things in other cultures. Time orientation may be different among different cultures.

The information in this chapter was very useful. I can see using information learned in this chapter in my nursing career. It is very easy to offend someone to when the verbal and nonverbal communication means different things to the people trying to communicate.

Learning to be a culturally competent nurse would make my interactions with patients from different cultures go smoother and make my job easier. It will also help the patients I care for by not adding additional stress, confusion, anger and fear to an already difficult time in their lives.

I thought this chapter was very easy to read and comprehend. It had excellent information and gave me a lot to think about. The case examples were very helpful to be able to visualize how a misunderstanding affects lives.

Chapter 3: Pain

Pain is an individual experience. We are taught in nursing school that pain is what the patient says it is. Different cultures have different ways of expressing pain. Hispanics tend to be more expressive of pain, where Asians tend to be more stoic.

Different cultures also may differ on the use and attitude towards pain medication. A nurse can’t assume that if a patient doesn’t ask for anything for their pain, that they are not having any.

Pain management is a big issue in nursing. One of the continuing education requirements to renew a nursing license in Michigan is at least 1 hour of continuing education requirements (CEU’s) in pain management. I know from 12 years experience as an RN that a good portion of the health care providers I have worked with do not take a patients pain seriously.

I think that it is very important that nurses (and doctors) are educated about different cultural expressions of pain. For me in my current nursing position, I can assist with that by educating the admissions directors in the buildings I represent. When I am going to send a patient there for rehab I can give a gentle reminder that culturally Asians (or European or…) are very stoic about pain and to make sure nursing staff is diligent about asking the patient about his pain.

I thought this chapter presented very useful information. Unfortunately as I stated above, I have worked with a lot of jaded health professionals who I don’t think take pain seriously enough. As they have been in every chapter, the case examples really make the information practical and applicable.

Chapter 4: Religion and Spirituality

This chapter pertained to religious and spiritual beliefs and rituals. It is very easy for conflict and misunderstanding to increase an already stressful situation for patient and health care providers. As providers we may be following evidence based practice guidelines but because of a patients beliefs or religious practices our care for the patient can be wrong.

Some religions do not allow for health care providers of the opposite sex, like the Buddhist monk. Other religions may have symbols or statues that they need to have close by so that they are honoring their commitment to their beliefs. Shaving areas of skin for surgery is not allowed in some spiritual practices. Jehovah’s Witnesses do not believe in accepting blood products.

The biggest way this impacts me in my career is gathering the information from a variety of sources and then making sure I pass it on to the admissions director at the building so that upon admission, additional information can be gathered to ensure we stay culturally competent. By doing so I am advocating for the patient.

This book just gets better and better. I say this about every chapter but the case examples are extremely effective in being able to demonstrate how the knowledge can be applied. It really doesn’t take much extra effort for health care providers to think outside the box and make a difference for a patient and their family.

Chapter 5: Activities of Daily Living and the Body

This chapter really builds on the previous chapter and applies religious and cultural beliefs to the patient and how he/she functions with their activities of daily living (ADL’s). The basic ADL’s include eating, bathing, toileting, and grooming. The concept of ideal body image, as it varies from culture to culture, is also discussed.

Different cultures have different dietary restrictions. Some cultures are not allowed to eat certain kinds of meats on specific days or at all. Different cultures often have different food preferences as well.

Views and beliefs on bathing, toileting and grooming vary from culture to culture. Healthcare providers who lack cultural competency may not understand why a patient is refusing to bathe, if it is not a cultural norm for the patient to bathe daily.

Body image is viewed differently by different cultures. What American’s perceive as fat maybe considered desirable by others. The differing views on ADL’s and body image can make understanding the patient and teaching the patient healthy options difficult.

The topics in this chapter were a logical continuation of the previous chapter. The case examples given, once again, helped to further demonstrate the vast differences in views and beliefs among patients with different cultural backgrounds.

Chapter 6: Family

Chapter 6 covered the role that family plays in a patient’s health care. Different cultures have differing views on the role of the family. American’s are very independent and view the individual’s wishes over family wishes. The individual is his or her own decision maker as long as they are competent to make decisions. Other cultures, such as the Hispanic culture, value family interdependence and the family wishes over the individuals. Decision maker’s maybe a family member even if the patient is competent.

The information from this chapter is very applicable in providing care for a culturally diverse population. Knowing who the decision maker is in the family is important for timely medical decisions and compliance.

Another applicable lesson from this chapter is how family is viewed in the recovery process. Some cultures want minimal family involved in their hospitalization and recovery, while others want even extended family involved. To some cultures it is assumed that family will stay with the patient all the time during the hospitalization. These expectations may not be the same as the hospital or facility but to be culturally competent in providing care there needs to be flexibility to what is considered routine.

Once again the case examples put the message of the chapter into a clear perspective. I thought that the chapter covered some information that will be helpful to any nurse working in an environment where multiple cultures will be present.

Chapter 7: Men and Women

This chapter covered issues related to men and women. Some cultures are patriarchal and the decision of the male head of the family is the one most valued. Other cultures are matriarchal and the female head of the family is the decision maker. The inequality of the decision making based on gender can be difficult for American women to accept but it is a cultural norm for some. Female circumcision and domestic abuse were also discussed in this chapter.

I felt this chapter was a valuable addition to the book and to the practicing nurse who deals with a variety of patients from various cultures. The perception of female health professionals (doctors, nurses) and the lack of respect for their knowledge and authority by some males from different cultures are difficult for me to accept but knowing that this is a cultural view for some is beneficial in the event the situation arises. Ultimately it is about providing the best care for the patient.

The information on female circumcision and domestic abuse was eye opening as well. By having the information it will be easier to put situations in a clearer perspective if faced with one of the scenarios.

Being a feminist I had some difficulties with some of the cultural views that put women in a subservient role. This is my prejudice and I need to make sure does not come into play with patients and families with these beliefs. I felt the scenarios and examples given were beneficial in understanding how it may be necessity in providing care for some patients.

Chapter 8: Staff Relations

This chapter covered some of the issues encountered when staff is from different cultures. In health care there is a hierarchy based on job title. Doctors, having the most education are typically the authority. Nurses are next on the hierarchy, with nurses’ aides or techs next in line.

The trend in health care now is to take a team approach toward patient care. When working with staff from different cultures, especially those cultures where men are considered superior to women there are challenges. Some of those challenges include male staff not taking orders from women despite job titles. An additional challenge is American nurses who are accustomed to having their input valued on the health care team not receiving respect from Doctors from traditionally male superior cultures. This is also an issue with male nurses’ aides from male superior cultures not taking orders from female nurses despite the nurses’ place in the health care hierarchy.

During the course of my nursing career I have been lucky not to have experienced this type of conflict. Honestly I don’t think I would handle this very well. I am very much a firm believer of equality among the sexes. I refuse to take a subservient role just because I am a woman. As a nurse who has been practicing for 12 years I have almost always worked in health care environments that took the team approach to patient care. I do have respect for doctors based on their advanced education and have no problem following doctor’s orders. My licensure as a registered nurse requires that I use critical thinking on the job. Using critical thinking involves questioning doctor’s orders when the orders are not understood or when they do not appear to be in the best interest of the patient. I have no problem doing this and have not encountered issues when doing it.

The author suggests that a cultural inservice be required for staff of different cultures. The rationale being that those from different cultures will be informed of the expectations of health care professionals in the American health care system. I think this is a great idea. I think it is also important for American staff to be required to take an in service or cultural class (such as Sociology 340) so that there is the understanding of the differences and potential challenges. By knowing of these differences all staff from all cultures can gain a sensitivity towards others.

Chapter 9: Birth

This chapter was about the different cultural views and practices surrounding birth. In America it is the norm that the partner, if there is one, be involved in the birth process. This is not the norm for all cultures. The way women in labor express pain and the attitudes toward pain medication also vary by culture.

One of the areas in nursing I have never wanted to work in is obstetrics. I love babies and feel it is a miracle when a new life is brought into the world. One of the reasons I have always wanted to avoid obstetrics is even though it is primarily a happy place and statistically outcomes are positive, when the outcomes are not positive, they are heart breaking.

Because I have not worked in this area except when required for clinical experience, I had difficulty applying the information in this chapter to my practice. That being said, I do not believe any education is ever a waste and if I am ever in a situation where I am dealing with a birth and patients from different cultures, I will have some information to reference back to.

As previously stated this chapter was difficult to apply to my practice and experience as a nurse. As has been the pattern in this book, I found the case examples very helpful in understanding the material, perhaps even more so because of my lack of experience in this area. For nurses working in obstetrics I feel this chapter would be helpful and a good reference for nurses to provide culturally competent care.

Chapter 10: End of Life

Chapter 10 covered the different views and practices different cultures have surrounding end of life care and death. Informed consent and a patient’s right to know are a foundation in not only end of life care but in all areas of patient care in the American health care system. That is not the case in some cultures. Some cultures believe that if a patient knows that they are dying, they will give up and die sooner.

Cultures vary on views of advanced directives, organ donation, life support and withdrawal of life support. This chapter really highlights the importance of trying to work with the patient and family beliefs while practicing within legal and ethical boundaries of the American health care system.

The majority of my nursing career has been spent in geriatrics and hospice so this chapter contained information that is very applicable to my practice. I currently work for a Catholic organization which has some beliefs and practices, especially in regards to life support and withdrawal of it, which could necessitate cultural education to others not familiar with the Catholic beliefs.

The cultural view on the family’s role in end of life care is something I have encountered in my practice and have found my experiences to be similar to those mentioned in this chapter. Patients from the Hispanic culture are cared for by family more times than not. Understanding the degree of importance that families have in end of life decision making is critical to making a very emotional and stressful time of life easier for patient and family.

The views on advanced directives will be of assistance to me. Working with geriatric patients, every day I am reminded about the importance of having advanced directives. Without having them in place the burden on family, emotional and financial, is great. Knowing that and now knowing that not all cultures view the value the same way will change the way I present the topic to patients and families.

The information presented in this chapter will definitely be helpful to my nursing practice. The examples presented are beneficial in understanding how to apply the information when working with patients and families from different cultures who are dealing with end of life issues.

Chapter 11: Mental Health

This chapter covers mental health. Galanti states “One definition of mental illness is behavior that deviates significantly from the norm” (Galanti, 2008, p. 183). Since different cultures have different norms it is easy for someone from a different culture who demonstrates behavior and attitudes that are different from the norm of their culture to fit the description of mental illness. That is the premise of this chapter. Additionally attitudes towards mental illness in various cultures are also covered.

If I were from a traditionally Japanese culture I would have been considered mentally ill when I wanted to go back to school to become a nurse once my children were in school fulltime. That thought is very sobering when considered against American standards. By American standards, I wanted more for myself and my family when after years of being a stay at home mom, cutting hair on the side and running a fulltime home daycare, I decided I wanted to go back to school and become a nurse. By some cultures norms I would have been considered mentally ill.

In my practice I have not consciously had a situation like this arise. I say consciously because I never considered this a possibility. I don’t know how much this issue would actually become something that I would come across in my practice because of the population I serve but this is defiantly information that I was not aware of before.

As mentioned in previous chapters the examples given make the information easier to understand. This is an issue I never considered before. I think that the information is valuable to health care providers, especially those who work with populations most likely to experience issues along these lines.

Chapter 12: Traditional Medicine-Practices and Perspectives

This chapter contained information on traditional medicine. Various cultures have traditional medicine practices and beliefs. Some of those practices can be misinterpreted and appear to be abuse. Coining and cupping are two of those practices.

I have had little experience with traditional medicine. I can appreciate how knowing about traditional medicine. Its practice and perspectives could be beneficial. For health care providers who come in contact with this population frequently the information presented could be very helpful.

The examples presented in this chapter are once again, very informative. Nurses who provide care to patients from cultures that rely on traditional medicine should find this chapter very helpful.

Chapter 13: Making a Difference

This chapter covered additional ways to make a difference in caring for patients and families from different cultures. Interpreters to help with language barriers, diets that reflect cultural beliefs and preferences, respecting cultural practices, and allowing for flexible scheduling to accommodate religious and cultural days of importance all make a difference.

In the course of my practice I have mostly encountered language barriers. Making sure the facility I am planning on admitting a patient too can provide culturally competent care is important. We have needed to arrange for interpreters and to have assistance putting together communication boards so that the patient can express themselves and communicate with staff.

I feel that having knowledge of some of the differences in the various cultures is not only a sign of cultural competence but also one of cultural responsibility. A complete interview upon admission or assessment will help to identify those unique cultural needs.

I felt that this chapter really completed the book. The topics it covered may have been touched upon in previous chapters, however in this chapter, the topics were elaborated on. Once again, the examples given in the book help to increase understanding of the issues faced when multiple cultures interact within the American health care system.

Conclusion

This book was an excellent choice for my reading journal. The cultural information presented was presented in language easy to understand and further defined by case examples. The flow of the book made reading it a pleasure and did not feel like a typical college reading assignment. I do not have any negative comments to say about the book or information presented. I can see some areas and situations in my practice where I will be able to utilize the information. In areas where it is unlikely I will come across situations like those described, the information was still easy to understand and will contribute to an increased cultural competency for me.

The book contained several appendices that included cultural profiles, key information to know about various religions, do’s and don’ts of providing culturally competent care, and summaries of the case studies presented in the text. The benefits of learning the information presented are well worth the time invested in reading the text and completing the assignment. I would recommend this book to other nurses.

Galanti, G.A., (2008). Caring for patients from different cultures (fourth ed.). Philadelphia, PA:

University of Pennsylvania Press.

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