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Family and Cultural Care of the Critically Ill Patient 163

TABLE 8.2 Levels of cultural practice 100 Practice tip

Level of cultural The ability to deliver culturally competent nursing practice
practice Indicators involves self-awareness, the nurse’s actions undertaken to
improve the patient’s and family’s health experience, and
1 Awareness Recognition that differences between integrating their beliefs and practices into treatment and
groups of people extend beyond
socioeconomic differences. intervention plans.
2 Sensitivity Recognition that difference is valid, which
initiates a critical exploration of personal
cultural beliefs and practices as a ‘bearer’ Cultural competency is about practising in a sound
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of culture that may affect others. manner rather than about behaving correctly. Durie
encouraged the development of cultural safety (which
3 Safety Delivery of a safe service as a result of
undergoing education about culture and focuses on the experience and determination of the
nursing practice, and reflecting on their appropriateness of care received), to a construct that can
own and others’ practice. measure the capability of the health worker, such as the
critical care nurse. Culturally competent nursing prac-
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tice is about:
● the nurses’ knowledge about their own cultural beliefs
recipients of that care. These models have been used to
guide nursing practice in Australia and New Zealand, and practices and the impact these may have on others
respectively. Such models require that critical care nurses ● the actions of the nurse to improve the patient’s health
recognise patients’ and families’ views of their health experience, and the integration of culture in clinical
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experience and any that subsequently have discordant practice 103
priorities. Wood and Schwass have described three levels ● delivering culturally competent and safe care.
at which a nurse may practise with respect to cultural Cultural competence provides a framework to objectively
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issues (see Table 8.2). These levels, ranging from cul- measure the nurse’s performance. The ability of the criti-
tural awareness to cultural safety, describe the differing cal care nurse to deliver culturally competent and safe
characteristics of nurses’ cultural care. For example, a care is dependent on determining the cultural needs of
nurse practising in an organisation where cultural safety patients and families, and the provision of patient-
was required would need not only to recognise differ- centred, individualised care.
ences between groups of people, but also to deliver dif-
fering cultural care to individuals after undergoing DETERMINING THE CULTURAL NEEDS
appropriate education. OF PATIENT AND FAMILY
From a transcultural nursing perspective, culturally com- The concepts of health and illness are generally con-
petent nursing care requires the nurse to incorporate cul- structed within the context of people’s sociocultural envi-
tural knowledge, the nurse’s own cultural perspective and ronment and the groups they belong to; these vary from
the patient’s cultural perspective into intervention plans. person to person and group to group. To this end, culture
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However, Ramsden argued that it is not possible to collate influences how health and illness experiences are con-
cultural knowledge specific to various groups owing to structed and lived. When people become critically ill,
the diversity that exists both among and within groups. their cultural beliefs and practices can be just as impor-
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Therefore, critical care nurses are advised to critically tant as their physical health status. Yet cultural beliefs
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examine theories and models to guide their practice, to and practices are often compromised when healthcare
ensure they deliver appropriate and effective care for the providers’ concern about physical health takes prece-
patients and families they work with. dence – invariably, health services also do things differ-
ently than patients and families would do them. While
Competence is an important dimension of nursing prac- the importance of psychosocial and cultural needs is the
tice, as it provides users of nursing services with confi- focus of this chapter, the presence of life-threatening
dence in nurses’ knowledge, skill and attitudes necessary events or crises experienced by the patient in critical care
to undertake their practice. Given the importance of must rightfully take precedence. However, on stabilisa-
culture in the delivery of nursing care, the measurement tion of the patient, creating a positive working relation-
of cultural competence is also important. There is evi- ship with the family can facilitate the determination of
dence of numerous variations on the concept of cultural their perspectives and needs and negotiation about how
competence. 101-103 The attributes of cultural competence these can be included in a potentially complex plan of
include cultural awareness, cultural knowledge, cultural care. Incorporating cultural requirements becomes vital
understanding, cultural sensitivity, cultural interaction in a delivery of nursing care that is both appropriate and
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and cultural skill. However, the inherent need for the acceptable. Therefore, given the nature of critical care set-
acquisition and use of culturally specific information tings, the quality of interactions with the patient’s family
limits the application of these attributes: the collation of is just as crucial as interactions with the patient.
culturally specific information is becoming increasingly
problematic as our communities become more diverse in Promoting a genuine, welcoming atmosphere and the
their composition. use of effective communication invites the family to be