Page 184 - ACCCN's Critical Care Nursing

Family and Cultural Care of the Critically Ill Patient 161

and they’d be saying stuff and I’d think “Oh no!” They
Practice tip would ask me, “Do you understand?”, “Are there any
questions?” And I … “I don’t even know what you just
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Routinely, both document and inform the nurse taking over the said; how do I know if I have questions or not?” ’. In this
patient’s care, any points of patient and family discussion and case, both parties were speaking to the other, but it was
any codes that have been developed during the shift to apparent that the patient was not able to take in and
promote communication. This fosters continuity of care and process the information about her current condition and
consistencies in information sharing and is useful to the entire therefore had difficulty comprehending. Basic principles
health care team. of patient autonomy and respect need to be used cau-
tiously with critically ill patients who may appear com-
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petent, when in reality their cognitive ability is impaired.
An effective strategy to promote good communication is Effective communication with the family is vital in order
for health professionals to seek and maintain eye contact to determine the cultural beliefs and practices of patients
(if culturally appropriate). This may mean the nurse or and their family to further enhance communication and
doctor sitting down on a chair beside the bed to facilitate understanding.
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face-to-face communication. This act also conveys a
sense of the importance the health professional is placing CULTURAL CARE
on the interaction by taking time to ensure they under- The challenge for critical care nurses is to establish posi-
stand each other. Associated with this is the need to use tive working relationships with the patient (when possi-
commonly understood language. One method of check- ble) and the family so their important values, beliefs and
ing patients’ responses is to repeat these back to them. A practices can be shared and incorporated in plans of
quiet environment reduces extraneous noise and poten- intervention and treatment. It is not always possible to
tial interruptions, and may promote communication and ‘know’ another person’s culture in any great depth, or
concentration. Codes may also be developed by the nurse ‘know’ all cultural beliefs and practices of the patients
and patient, with facial expression, head nods and eye and families a critical care nurse comes into contact with.
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blinks used to respond to questions. These codes should Therefore, relationships with the patient and the family
be passed on to the next nurse and recorded in the during their critical care experience are crucial, and also
patient’s notes to promote continuity of care. demonstrate both respect for, and valuing of, patients
When communication seems unsuccessful, talking loudly and their families and the cultural beliefs and practices
will not improve the interaction; one good strategy is for they hold. This enables health teams to better meet their
the nurse and patient to agree to try again later. Com- needs. While people’s ethnicities may provide a clue to
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munication can also occur through physical contact, and their culture, it is not a reliable indicator and ignores the
touch often communicates empathy and provides spiri- multiple cultural groups people belong to that extend
tual comfort. Spiritual needs may further be met by pro- beyond ethnicity, such as age and gender. Making assump-
1
viding comfort, reassurance and respect for privacy, and tions about a person’s culture and reliance on universal
by helping patients relate to others. 86 approaches to direct nursing practice engenders risks to
nursing practice and potentially compromises the out-
comes of interactions and interventions. Even within cul-
tural groups (e.g. indigenous and immigrant groups),
Practice tip variation in beliefs and practices can exist. Such differ-
ences result from factors such as colonisation, interac-
Communication with the family is essential: when family tions with the various groups a person belongs to, and
describe the patient as the 35-year-old partner of Jack and responses to societal changes, and the socialisation of
mother of two young children, Rob and Charlotte, who works immigrants into a new country. Thus, patient-centred,
one day a week as a pharmacy assistant, they help to individualised care of patients and their families is imper-
individualise the patient for the staff. ative to incorporating specific cultural needs in the plan-
ning and delivery of interventions. This section outlines
important strategies critical care nurses can develop for
Language barriers may necessitate the assistance of an working with patients and their families to identify the
interpreter with knowledge of healthcare terminology to essential beliefs and practices they need to have incorpo-
ensure the content is adequately translated. An indepen- rated into treatment and intervention plans during a
dent person ensures that the patient receives the message stressful time in an unfamiliar environment. Such actions
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in its entirety from the health professional. Interviews can optimise their spiritual wellbeing and lessen some of
with previously intubated patients after discharge from the stress they feel.
the ICU capture, from the patients’ perspective, issues
with communication and highlight the need for further DEFINING CULTURE
improvement and understanding of the two-way process. Wepa describes culture: ‘Our way of living is our culture.
An example of this was from an ex-patient, who related It is our taken-for-grantedness that determines and defines
her situation: ‘They would come into the room in masses our culture. The way we brush our teeth, the way we bury
to talk to me. One doctor would stand there and read off people, the way we express ourselves through art, reli-
a summary: “[Subject’s name], we find her this and that”, gion, eating habits, rituals, humour, science, law and