This article covers Cultural Competency, Awareness, Sensitivity, and Humility.
NUR 643 Topic 1: History Taking and Physical Exams
Topic 1: History Taking and Physical Exams
Health Assessment Topic Reflection 1
Complete a 250‐word reflection of what you learned during this topic. Include the following in your reflection:
- Think about an experience you’ve encountered when viewing or completing the particular assessment.
- Discuss difficulties that could potentially arise or specific questions related to completing this type of assessment.
- Include illustrative examples of potential strategies used to overcome the difficulties encountered when completing (the particular) assessment.
- Describe how the Christian worldview and compassion for all plays a role in this type of assessment.
Topic 1: History Taking and Physical Exams
APA style is not required, but solid academic writing is expected.
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Topic 1 DQ 1: NUR 643 Topic 1: History Taking and Physical Exams
You are working with a nursing student who is introducing herself to a Native American patient to establish rapport. The nursing student is trying to make eye contact and puts her hand on the shoulder of the patient to get his attention. What situation could arise with this approach? How would you handle this situation? Defend rationale with references.
Topic 1 DQ 1
Cultural Competency, Awareness, Sensitivity, and Humility
Establishing rapport and a therapeutic nurse-patient relationship is an essential step to cultivating a culture of care (Treas, Wilkinson, Barnett, & Smith, 2018). According to Treas et al. (2018), approaching patient care from a holistic perspective includes active engagement in culturally competent care, which includes: cultural awareness, cultural sensitivity, and cultural competence. The American Nurses Association (ANA) as cited by Treas et al. (2018) has developed cultural competencies for the registered nurse that outline expectations for the nurse to operate in a culturally congruent manner. Some of the culturally congruent competencies include; demonstration of respect, empathy, equity, lifelong learning of culture, creating an inventory of values and beliefs, applying knowledge, considering the impact of discrimination, utilizing culturally sensitive skills, communicate with appropriate language and behaviors, identify cultural-meaning of interactions, respect patient decisions, advocate for policy to protect culturally diverse groups, and educates colleagues (ANA as cited by Treas et al., 2018).
When faced with the scenario of working with a nursing student who introduces herself to a Native American patient by making eye contact and physical touch, some potential situations that could arise regarding specific cultural expression and cues (Office of Rural Health, 2012). According to the Office of Rural Health (2012), communication norms for Native American individuals may differ from Western cultural norms. Eye contact varies in many cultures, and for many Native American cultures, direct eye contact could potentially be considered rude and disrespectful (Office of Rural Health, 2012). Personal space is also a concern with culturally diverse populations such as Native Americans as a wide variation in comfort levels with interpersonal proximity, touch, and non-verbal communication (Office of Rural Health, 2012). From the patient’s perspective, the patient may feel offended, intimidated, or afraid of the direct eye contact and touch. The student nurse may misinterpret the patient’s lack of eye contact or withdrawal from touch and document their findings as depression or assume the patient is in pain or upset (Office of Rural Health, 2012). Some barriers to culturally competent care include; bias, ethnocentrism, and cultural stereotypes (Treas et al., 2018).
Some ways to instill cultural competence in nursing students is to kindly and respectfully educate them regarding concepts of cultural humility. Bickley and Szilagyi (2017) proclaim that there are three dimensions to cultural humility that include; self-awareness or learning about our own bias, respectful communication or striving to eliminate assumptions about what we believe to be normal which also involves a pursuit of learning directly from patients, and collaborative partnerships or building patient relationships on respect and mutually acceptable plans. The Office of Rural Health (2012), offers some tips for interacting with Native Americans in the health care setting in a culturally humble manner and suggest that healthcare providers become familiar with communication styles, ask patients about their tribe and family history, personal practices, and expectations, build rapport, understand potential system transference, and listen.
Bickley, S., & Szilagyi, P. (2017). Bate’s guide to physical examination and history taking (12 ed.). Philadelphia, PA: Wolters Kluwer.
Office of Rural Health. (2012). Cultural awareness to help while serving native veterans. Retrieved from https://www.ruralhealth.va.gov/docs/webinars/richardson-cultural-sensitivity-062712.pdf
Treas, L. M., Wilkinson, J. M., Barnett, K. L., & Smith, M. H. (2018). Basic nursing: Thinking, doing and caring (2 ed.). Philadelphia, PA: F.A. Davis Company.
Topic 1 DQ 2: NUR 643 Topic 1: History Taking and Physical Exams
While completing a health assessment, you notice that there are indications that the patient may have been cutting herself. You inquire about the marks and she indicates that she scratched her wrist when she tried to break her fall. How do you handle this information? How can you incorporate your Christian worldview to help in providing quality care? What are the key elements to accurately obtaining the needed information for effective treatment?
Re: Topic 1 DQ 2
According to Jones, Cohen, Worley & Worthington ( 2015), some adolescents use sharp or rough objects to inflict injuries on their arms, legs, or other parts of their bodies. Individuals may cut, scratch, burn, abrade, or prick the skin repeatedly, often leaving scars. They may then attempt to hide the resulting injuries with clothing Self-cutting often is grouped with those for other forms of non-suicidal self-injury (NSSI), including burning, hair-pulling, self-hitting, and self-poisoning. According to Jones, Cohen, Worley & Worthington (2015), these self-harm behaviors have been reported in more than 10% of ninth graders7 and college students,8 and in up to 4% of adults. It is very important for a healthcare provider to check for all of their body parts, especially on hands, legs, as a routine health assessment.
According to kids health (2015) Cutting is is an attempt to interrupt strong emotions and pressures that seem impossible to tolerate. It can be related to broader emotional issues that need attention. Most of the time, cutting is not a suicide attempt. Cutting is usually associated with some kind of mental condition such as anxiety/depression, borderline personality disorder, and bipolar disorder. Detail self and family history is needed to find out what is going on with her.
We are healthcare professionals. To provide quality care, any patient should be treated holistically. To treat a patient holistically and provide spirit-guided care, nurses must attend to their own spiritual self-care. For Christians, spiritual self-care involves personal time with God in Bible study, prayer, worship, fellowship with other believers, and Sabbath rest. nurse to truly be the hands and feet of Christ to holistically intervene to restore and maintain the patient’s whole being, not simply his/her physical being. Providing Spirit-guided care encompasses the acts of Christ as a foundation for our professional practice. For nurses with a foundation in Christianity, we strive to live a Christ-like life, treating others as Christ would (John 13:34-35). We strive to think and act like Christ because the Holy Spirit of God lives within us ( Murphy & Walker, 2013)
Hodge D. R., Horvath V. E. (2011). Spiritual needs in health care settings: A qualitative meta-synthesis of clients’ perspectives. Social Work, 56(4), 306-316.
Jones, J.G., Cohen, A.L, Worley, K.B., Worthington, T. (2015) Accidental scratch or a sign of self-cutting? J Fam Pract. 2015 May;64(5):277-281
Kids health (2015) Helping teens who cut Retrieved from https://kidshealth.org/en/parents/help-cutting.html
Murphy, L. S., Walker, M.S. (2013) Spirit guided care; Christian nursing for the whole personRetrieved from https://www.nursingcenter.com/cearticle?an=00005217-201309000-00009&Journal_ID=642167&Issue_ID=1562623
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