Page 185 - ACCCN's Critical Care Nursing

162 P R I N C I P L E S A N D P R A C T I C E O F C R I T I C A L C A R E

sport; the way we celebrate occasions … is our culture. drives its service delivery. The result is that consequently,
All these actions we carry out consciously and uncon- patients and their families become sandwiched between
87, p. 31
sciously’. Simply, culture refers to the values, beliefs differing world views.
and practices that an individual, family members and
nurses undertake on a daily basis. It determines how the Research highlights the lack of alignment that can occur
world is viewed, and their orientation to health, illness, between the needs of consumers of health services and
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life and death. 88-90 the intentions of healthcare providers such as nurses. It
is the potential for the non-alignment between patients
Culture involves a shared set of rules and perspectives and families and healthcare providers that critical care
acquired through the processes of socialisation and inter- nurse need to be aware of, as dissatisfaction with the care
nalisation, which provide a frame of reference to guide being delivered may arise when the patient’s and family’s
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how members interpret such phenomena as health and needs are not recognised or attended to, leading to
illness and death and dying. This in turn influences their unnecessary tensions and conflicts between patients, fam-
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actions and interactions. Culture is a more specific way ilies and nurses. A nurse’s willingness to acknowledge
of describing how groups of people function on a daily and respect patients’ world views and the things that are
basis, influenced by their beliefs, relationships and the important to them minimises the occurrence of any dis-
activities they engage in. satisfaction, as it values their specific needs during their
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critical care experience.
Understanding that culture, ethnicity and race are not
the same thing is crucial to meeting the cultural needs
of patients and their families. Race is generally deter-
mined on the basis of physical characteristics and Practice tip
is often used to socially classify people broadly as
Caucasians, Europeans, Polynesians or Asians, for Being able to deliver culturally appropriate and safe
example. 87,92 However, assigning people to a homoge- nursing care requires the nurse to undergo a process of
neous group is problematic, the antithesis of cultural education and self-examination of culture, own cultural beliefs
diversity, and does not account for the diversity that and practices, and the possible influence these may have on
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exists within many groups in contemporary society. practice.
Ethnicity extends beyond the physical characteristics
associated with race to include such factors as common
origins, language, history and dress – it is usually asso-
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ciated with nations, although a number of ethnic Where the world views of patients and families are con-
groups may exist within a nation. siderably different from that of the nurse, Ramsden urges
nurses to identify the beliefs they hold about the patient
DIFFERING WORLD VIEWS and family, the impact of these interactions on the patient
and family, and the power the nurse can utilise during
Culture influences how people view the world, what they such interactions. 98,99 Sometimes the nurse’s personal
believe in and how they do things, particularly with beliefs will be in conflict with professional nursing beliefs,
regard to practices around health, dying and death. The which necessitates choosing between personal and pro-
critical care environment is unfamiliar for patients and fessional beliefs in the practice setting. For example, a
families, especially as health professionals’ beliefs, prac- nurse’s personal beliefs about life, death and body tissues
tices and world views may not align with their own. What may be compromised by the duty to care for a patient
is important for critical care nurses may not be important with brain death awaiting the removal of organs for trans-
for the patient or the family, and may lead to tension plant. This may also be compounded by nursing staff
and dissatisfaction when the way patients’ and families’ shortages, less-than-desirable skill mixes, and the acuity
views are at variance. This does not mean that one world and complexity that critical care nurses are faced with on
view is necessarily more right or wrong – they are a daily basis. Therefore, it is vital, not only for the indi-
different. vidual nurse, but also for the team of critical care nurses
The biomedical model influences the way healthcare ser- to develop strategies that can optimise the development
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vices are structured and delivered. As a dominant model of working relationships with patients from different cul-
it heavily influences the necessary focus on the physical tural backgrounds.
wellbeing of patients within critical care environments.
Focusing on the management of disease and illness, and CULTURAL COMPETENCE
using processes that lead to health issues being frag- Different models exist to assist in the integration of the
mented and reduced to presenting signs and symptoms cultural beliefs and practices of patients and their family
and diagnoses, risks excluding what is important for the in critical care nursing practice. For example, Leninger’s
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patient and family. This contrasts with indigenous cul- cultural care diversity and universality theory requires
tures, for example, which tend to have a holistic eco- nurses to deliver culturally congruent nursing care for
spiritual world view, with a strong spiritual dimension people of varying or similar cultures. Ramsden’s work on
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that extends beyond a disease and illness focus. The cultural safety 98,99 focuses on the delivery of nursing care
world view of critical care nurses is influenced by the to patients (whose cultural beliefs and practices differ
cultural beliefs, practices and life circumstances of each from that of the nurse) that is determined appropriate
nurse, and the ‘world view’ of the critical care service that and effective by the patients and families who are the