Culture refers to the way of life of a given group. The term way of life concerns their traditional practices, beliefs, organization, among other social factors that give a particular group a unique identity. Culture encompasses all aspects of people’s life, including their social interaction as transferred from one generation to another. These research papers seek to discuss transcultural nursing with specific emphasis on Italian culture. Different groups of people hold diverse cultures that make them respond differently to the issue of healthcare and other medical-related problem (Holland & Hogg, 2010).
Transcultural nursing refers to the situation where a nurse rises above ethnocentricity to practice nursing in a wider cultural diverse environment. Transcultural nursing meets the individual cultural requirement of the patient at an individual level. In the modern cosmopolitan world, transcultural nursing has become an essential aspect of nursing practice. are the nurses are expected not only to recognize but also appreciate the existence of the cultural differences in customs, beliefs, and healthcare values (Holland & Hogg, 2010). Nowadays, the nurses are required to achieve cultural competence in order to elicit a positive outcome from the patient as well as his satisfaction.
Literature refers to communication as a process used to relay information from one person to another through a viable medium. Several factors may interfere with the process; thus, this discussion starts with the corresponding physiological factors. Physical disability stands as one of the physiological barriers to effective communication. Individuals with physical disabilities may find it difficult to self-express, thus hindering effective communication in a dialogue setup. The deaf people, for example, will not hear what one says, thus failing to respond adequately. The dumb person will undoubtedly fail to respond even though he/she might have heard whatever was being said. Physical blindness may also cause communication challenges, especially in cases when non-verbal cues are used up (Holland & Hogg, 2010). Communication entails the use of the entire body to convey the message both verbal and non-verbal.
Ill health is another physiological factor that may hinder effective communication. An individual in pain or distress may fail to communicate effectively due to the interference by the pain. This explains the reason for which responding to emergency cases, especially if the patients lose consciousness, becomes a big challenge to the nurses at the hospital levels (Holland & Hogg, 2010).
The linguistic barrier also plays a prominent role in hampering communication. The linguistic barrier occurs due to the differences that arise in language due to the influence of the first language. Though English remains the most spoken language in the world, various people speak the language differently. In Africa, English is spoken differently from the way it is spoken in England and Asia. These variations may completely cause a breakdown in communication when these individuals meet (Holland & Hogg, 2010).
Noise refers to unwanted noise in the environment. It can interfere with effective communication in a way that may hinder one from relaying his/her message effectively to the other person. For example, picking a phone while standing on the roadside creates a noisy track which passes by hooting. This automatically breaks the communication between the two individuals. One will not only find it difficult to understand his/her message, but also the other party will have problems decoding the information being conveyed (Holland & Hogg, 2010).
Distance causes challenges in the actual process of communication. For example, if the manager wishes to communicate to his/her secretary and both people are in different buildings. Therefore, the channel of communication will have to change from verbal or direct communication to the use of a phone or email. This may reduce communication effectiveness since it hinders other aspects of communication that would have aided in communicating the same information more efficiently. Thus, distance acts as a barrier to effective communication because it also manipulates the medium of communication used (Holland & Hogg, 2010).
Environmental factors, such as weather elements, may also interfere with effective communication. Heavy rains and strong winds cause complete paralysis in verbal communication, especially when the communication occurs outdoor. The weather elements also interfere with the mediums of communication especially if they destroy infrastructure related to the communication devices (Holland & Hogg, 2010). Communication requires a serene environment to occur smoothly. Noise remains a fundamental element in the field of communication, and for effective communication, noise ought to be contained to the most possible extent.
Psychological factors that interfere with communication encompass all factors that relate to the human mind and his state of mental being. Ignorance of the communication medium may hamper effective communication. Communication entails the use of both verbal and non-verbal cues. Ignoring the non-verbal cues during communication has a significant impact on the process of communication. One can ignore the non-cues due to his concentration on other things in the environment. The concentration of the listener determines how much information one decodes from the non-verbal cues.
Perceptual prejudice can also cause a serious breakdown in communication. The mental attitude that individuals develop to someone may determine whether one will decode the information being communicated. If, for example, one harbors a negative attitude towards a speaker, it is possible that he will not receive any message. The mind switches off from the information expressed by the speakers, thus acting as a barrier to communication. The cultural barrier may also hinder effective communication, and this stands as the most common barrier to communication. Prejudicing other peoples’ cultures may limit one from expressing himself clearly and freely. Lack of free expression marks the beginning of communication breakdown.
Emotions also can interfere with communication. Emotion refers to the state of people’s feelings, which can be positive or negative emotions. Emotions control information that a person wants to hear and that what he does not. Emotions also control from whom individuals can receive communication. Depending on one’s state of emotion, one can choose to listen to another person or to ignore him. Ignoring the person may be physical or just consciously by the individual depending on the influence of the communicational subject on the listener. One’s voice gains aggression if one speaks about a topic that carries strong feelings. One speaks aggressively when addressing an issue that affects him directly but also speaks calmly when the issue has no direct impact on oneself.
The Influence of Italians’ Beliefs on Health Care
Italians hold the belief that the family of a patient suffering from any terminal illness must be involved from the onset of medication to the end. They also believe that information regarding the diagnosis, as well as the prognosis provided by the medical experts, must be withheld from the dying person. This greatly influences healthcare, and the medical experts ought to keep the patient aware of his/her medical condition irrespective of whether it is negative or positive. Discussing the diagnosis with the patient offers an opportunity for the patient and the practitioner to address pertinent issues regarding one’s health. In addition, through the discussion, the medical expert can provide professional advice to the patient in the best way forwarding it with respect to the diagnosis at hand (Holland & Hogg, 2010).
Italians also hold the belief that the family of the patient must be the first party to get notified of any bad news. They insist that only after informing the family, the patient can be told the same information. This contradicts with the healthcare practice that requires that the patient must be the first person to receive any news concerning his/her health regardless of its positive or negative character. It amounts to a breach of confidentiality to reveal the patient’s information to other people before the patient himself (Holland & Hogg, 2010). This remains that way irrespective of the relation between the patient and the third party.
Italian culture also allows individuals to express their emotions openly. Individuals express anger, depression, and despair openly contrary to the provisions of health practices. A medical expert, such as a nurse, ought to conceal his/her emotions while handling a patient irrespective of whether the emotions are negative or positive. It can be chaotic, for example, if a nurse is angered by a patient and hauls insults at the patient in the name of expressing emotions. The Italians believe that its expression of anger is acceptable behavior and is thus expected at any given time. This kind of belief may cause serious challenges when an Italian Health practitioner attends to a patient from a different cultural background and may have different beliefs (Jeffreys, 2010).
Moreover, patients do not seek emotional support as it is regarded as a house affair. Health policies ensure that a health practitioner, such as a nurse, provide the patient with emotional support since they spend more time with the patient than any other person does during the period of medication. Emotional support from a nurse may accelerate the healing process of the patient since it accords the patient with some psychological benefits (Cox, 2010).
The Italians also hold the belief that morphine would only be used in the event when all other medication has failed. Some Italians totally refuse from the use of morphine while others accept its use as medicine only as a last resort. This strong opposition to applying morphine arises from their negative perception associated with morphine uses. This leads to a situation where the patient dictates to the health expert the kind of medication he/she wishes to take. The patient also dictates which medication he/she does not want to take (Cox, 2010).
Lastly, in the matter of beliefs, many Italians adhere to the Christian beliefs as provided by the Rome Catholic Church. The Catholic Church strongly opposes the idea of euthanasia or mercy killing. Italians refer to Holy Scriptures that forbids them to take a human life. They hold that God is the originator of life, and only he reserves the authority to take it. Italians, therefore, would not support euthanasia in their lives even if it remains clear that the patient in question has no chance of survival (Cox, 2010).
From the medical perspective, health experts have limits to which they can try to save a life. In some cases, it becomes logical to execute euthanasia in order to protect the patient from experiencing prolonged pain. The issue has become a debate that has no winner. Italians believe that a patient ought to be offered medication only as of the last measure. They believe in miracles, and that explains why they cannot allow a patient to undergo euthanasia (Holland & Hogg, 2010). These issues connected with Italians beliefs have caused great inefficiency regarding the delivery of health care services.
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Factors Influencing the Provision of Culturally Competent Care
A language barrier may hinder the delivery of culturally competent care. Language forms part of people’s culture. Nurses might not have learned a particular language, thus being unable to communicate effectively with the patient during service delivery. The language barrier has hindered many practitioners from offering their services outside particular geographical locations. In extreme cases, a translator is sought to break the language barrier stalemate between the health care provider and the patient. This measure is effective, but it compromises the aspect of medical confidentiality, thus making transcultural nursing impossible (Jeffreys, 2010).
Gender issues have also hindered the provision of culturally competent care. Some patients from particular cultures hold that only members of their gender can attend to their health care needs. For example, some women will only accept a female midwife to help them during delivery, especially those from Islamic origin. Such issues prejudice members of a particular gender, even if their competence matches that of the preferred gender. This also causes psychological issues amongst the members of the prejudiced gender, thus hampering the provision of culturally competent health care (Holland & Hogg, 2010).
Age is also a listed factor affecting the provision of culturally competent health care. Some people hold the belief that older nurses have competence in their work owing to their long working period whereas the young nurses lack the same experience due to their shorter working periods. Thus, they insist to receive quality service from this experienced older person than from the young group. Such beliefs hamper the provision of culturally competent health care.
Due to the different training curriculum, e it is difficult to provide culturally competent care. Nurses follow different training guides, where some of them make the transcultural learning an integral part of their training, whereas others, make it optional. Consequently, the nurses graduate from their respective training schools with different competencies. The nursing profession lacks a standard guideline that would emphasize the transcultural education that would have ensured uniformity in their training sessions (Sagar, 2012). Therefore, it is impossible to provide culturally competent health care to the patients.
Ethical Dilemmas in Healthcare Delivery
Euthanasia remains the biggest health dilemma even in the modern world. Euthanasia refers to merciful killing as dictated by the health condition of the patient. Health regulations provide that a medical practitioner strives to save a life at all costs. Saving lives remains their basic purpose in the field but also allows them to conduct euthanasia when the patient shows no sign of recovery. In some cases, euthanasia remains the only reasonable option, especially for a patient who suffers from persistent pain. Whereas the option may appear crude and barbaric, it is guided by logic. Conducting euthanasia saves the patient from pain as well as the family members from the agony of watching helplessly their close person suffers from pain (Holland & Hogg, 2010).
Secondly, euthanasia saves resources that would be used for other useful activities. The same resources may help the remaining family members to return to their lives and continue from that point because their life should not stop with the death of a single person. However, euthanasia also has its disadvantages because it prevents the patients from a chance to live and, in some cases, it may be considered as a murder. Euthanasia also contradicts the religious teachings as well as medical regulations that hold life as sacred and worth salvation irrespective of the cost incurred (Holland & Hogg, 2010).
Abortion is another ethical dilemma that has led to sharp divisions in the medical field. It is the act of deliberate termination of a human fetus before its due delivery time. Some hold that abortion amounts to murder; therefore, it should be abolished. Health regulation permits abortion but only under special medical circumstances. It provides that abortion will only be procured if it endangers the mother’s life. A medical expert must also authorize this before executing the termination. The people supporting the practice hold that abortion should be just legalized since it will help deal with the issues such as unwanted pregnancies, early pregnancies among others, especially among the youths (Jeffreys, 2010). This ethical dilemma has caused a sharp division between the health workers as well as among the general society.
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Madeleine Leininger Healthcare Model
In the case of the Italian culture, the application of Leininger’s cultural assessment model is a common practice. Italian culture can easily be analyzed using this model. Leininger insisted on three approaches to conducting cultural analysis with the ultimate goal of establishing a nursing plan for their patients. Culturological assessment of the Italian culture reveals that the Italians hold certain cultural beliefs that are very valuable for them. While creating the patient care plan, the background cultural information revealed that Italians prefer to keep patients out of anxiety withholding diagnoses of their patients (Sagar, 2012). They prefer to receive all the bad news on behalf of the patient in the belief that if the patient is not informed about his disease, it will not hurt him/her. After conducting cultural background research on the Italian culture, it was evident that Italians do not approve of euthanasia.
Italians strongly believe in miracles and in fighting for their patients’ lives at all costs until the end. This cultural assessment model also revealed that Italians have ill tempers and are not able to keep their emotions. Italians are expressive individuals and believe in expressing their emotions irrespective of the place. While establishing the patient care plan from the assessment, it appeared that the nurse ought to understand completely the Italian culture and assess one’s attitude towards other cultures. Conducting self-assessment is an important process because it enables one to overcome the cultural prejudices that predict the current medical practices (Sagar, 2012).
A health care plan to manage weight increase
Date and sign
Plan and Outcome
The patient ought to:
(1)Reduce the intake of carbohydrates
(2)Increase physical exercise
(3) Reduce intake of sugary substances
(1) Documentation of the patient’s nutritional history
(2) Nurse-Patient discussion on the possible cause of the rapid weight gain
(3) Assessing motivational measures to rectify the overweight problem
(4) Dietician consultation on the appropriate loss measures
(5) Provision of positive reinforcement towards weight loss
(6) Record intake:
Weight – days at- am/pm
As a cultural broker, I will employ certain strategies to help broker cultural barriers. I will engage in interpreter services to break the cultural differences between the nurse and the patient. An interpreter will facilitate the communication process between the nurse and the patient. The interpreter will also acquaint the nurse with cultural knowledge that will enable the latter to handle other patients of similar origin. An interpreter, as a strategy, will also ensure that the patient feels comfortable due to the provision of a familiar environment (Cox, 2010). An interpreter, as a transcultural strategy, will also ensure that both sides, such as the patient and the nurse, acquaint with each other.
Establishing coordination with the available traditional healers will also provide a viable strategy for a cultural broker. Traditional healers in most societies also act as the custodians of the societies’ culture; thus, incorporating their services into healthcare practices will greatly help breach the cultural practices of individuals from diverse backgrounds (Cox, 2010).
Traditional healers play a unique role in society, and since their roles have a traditional attachment, it may be useful to integrate cultural practices. The availability of traditional healers, as a cultural brokerage strategy, can require much time and effort in order to ensure the harmonization of the healthcare practices with traditional practices provided by these traditional healers (Sagar, 2012). Traditional healers create the comfort of a familiar environment for the patients. Consequently, this may hasten the healing process of the patients and help eliminate the cultural gap that exists between nurses and patients.
Appropriateness of the Selected Strategies
These two strategies are appropriate for the Italians since their culture remains very strong and has far-reaching implications for the practice of healthcare delivery. First, the use of interpreters as a strategy by the cultural brokers eases the tension between the nurse and the patient because the interpreter will help convey the messages of one party to another. An interpreter, as a strategy, remains effective since it may influence the patient or the nurse to develop an interest in the foreign culture (Cox, 2010). This may lead to concerned individuals changing their attitudes and perceptions about other cultures. The strategy is outstanding because it is long term. Once a person learns a different culture, the impact is permanent, and the same cannot be changed. The person will be in a position to exercise the application of transcultural skills to other individuals from the same culture.
The use of traditional healers as cultural brokers also remains an effective strategy, especially in the Italian culture, which still upholds these individuals in high esteem. Traditional healers in Italian culture still have a great influence on the population, and their use for the purpose of promoting transcultural nursing might prove effective. Traditional healers can easily influence the masses to realize the need for embracing other cultures in the world (Cox, 2010). Their appreciation of modern healthcare practices might also convince the masses differently, especially those who still believe strongly in traditional healers and medicine.
Since traditional healers form the fabric of Italian culture, it, therefore, follows that incorporating these healers in the promotion of the transcultural nursing exercise will bring positive results. The same individuals will influence the masses they command into buying the idea. Thus, the use of traditional healers and interpreters remain effective strategies in the promotion of transcultural nursing practice in conservative societies (Jeffreys, 2010).
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I will assign every nurse to a personal interpreter who will work in close association with the nurse while delivering health services. These interpreters will always have to accompany the nurses, especially while attending to the needs of the patient. It will serve as a requirement for one to have an interpreter, even if the health facility will take responsibility for meeting the extra cost of the interpreter. Its interpretation as a healthcare policy will also facilitate the implementation of this strategy. The system will demand that every nursing practitioner must have access to a translator at the health facility at any given time. Establishing a Department of interpreters will also facilitate the implementation of the above-mentioned strategy. This will also require the recruitment of sufficient interpreting personnel in order to avoid overworking individuals (Cox, 2010). Following such a requirement, it will be easy for one to implement the above strategy.
Secondly, while implementing the strategy of incorporating traditional healers in the healthcare units, it will necessitate the drafting of a policy that will allow the traditional healers to have space at the medical facilities. Implementation frameworks that will, among other things, include sourcing for the traditional healers and establishing for them a department at the health facility will follow this policy. It is also crucial to incorporate these individuals in the healthcare facilities due to their influential ability. They may not necessarily heal a person, but they will provide psychological comfort to the patient. Ensuring that these traditional healers work in conjunction with health workers will be beneficial for Italian society still regard highly the healers (Holland & Hogg, 2010). Some Italians would seek help from these traditional healers first before proceeding with a health care facility.
To overcome the cultural barrier in the nursing profession, establishing cross-cultural studies at the training level will be very useful. While taking nursing studies, individuals will thoroughly cover cross-cultural studies. This will ensure that when the nurses complete their training, they have cross-cultural knowledge that will enable them to handle the patients from diverse backgrounds without any difficulties. This will also eliminate the need for hiring an interpreter or incorporating traditional healers to work alongside the nurse (Andrews & Boyle, 2008). The cross-cultural training will ensure that nursing students interact with various cultures, including paying actual visits to these diverse cultures and acquire first-hand information and experience.
Tool for Evaluation
Developing a questionnaire with the following six structured questions will provide a good basis for evaluating the effectiveness of the implemented strategies.
1) How did you find service delivery at this health facility? (a) Culturally sensitive (b) Culturally sensitive
2) Did the translator facilitate your interaction with the nurse?
3) Did the presence of the traditional healer have any impact on your healing process?
4) Did you see any element of your culture during the delivery of health care at the facility?
5) Briefly explain why you think that the traditional healer and the interpreter should remain at the health care facility.
6) Kindly give your recommendations on the transcultural nursing experience that you witnessed.
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Implementing the Tool
Implementing this tool will include issuing the questionnaires at random to the patients at a given health care facility. The patient will fill out the questionnaires independently, and then, the questionnaires will be collected from the respondents. After the recollection of the questionnaires, and analysis of the response will follow to ascertain the thinking of the respondents. From the responses given it becomes very easy to ascertain whether the strategies were successful or failed. From the recommendations provided by the patient, one can choose to change his/her strategies in case they are not working or retain them if they show a positive response (Cowen, 2011).
Issuance of the questionnaires remains a useful tool for evaluating the effectiveness of the implemented strategies because it provides the respondent with the freedom to share his/her mind freely about personal feeling about the current practice. The recommendations provided by the respondents will be also useful for the correction of mistakes, especially if the applied strategy has produced counterproductive results (Cox, 2010). Following the provided recommendations can help one attain the anticipated results if the respective recommendations are followed to the latter.
It suffices to conclude that although transcultural nursing faces various challenges, it provides many benefits to the patients and facilitate their recovery. Despite the fact that much time was required before its importance was noticed, individuals have now embraced the exercise and the health care services have improved significantly. Incorporating cultural studies in training will ultimately provide a lasting solution to the problem of the cultural barrier while issuing health care.
Nurses ought to be culturally competent in order to remain relevant in the modern world. Their cultural competence enables them to perform their duties anywhere at any required time. This will also facilitate the exportation of human resources in other countries. This exportation provides foreign exchange to the State, which in turn spurs economic development. Nurses are considered paramount people in the community due to the roles they play in society; thus, becoming competent through cross-cultural training is a necessity for them. The Federal government also needs to reinforce the cross-cultural training program providing sufficient resources that will enable the trainees to have a wholesome experience. Healthcare delivery is a good chance to become better and to improve the future, especially with such culturally sensitive service delivery strategies