Page 187 - ACCCN's Critical Care Nursing

164 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

involved early in the patient’s critical care experience, and convenience. The critical care nurse is discouraged from
is essential to determine the cultural needs of the patient adopting a ‘one-size-fits-all’ approach to nursing practice,
and family. While communication has been mentioned as this disregards the cultural systems of the patient and
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earlier, interpreting cultural needs requires the critical care family. Individualised care is optimised by nurses having
nurse to be attentive to communication. Nurses are sufficient information about the patient and family in
advised to talk less, attend to details that may arise, and order to identify the needs and plan interventions. Incor-
simply listen. The need to intervene and to dominate porating each family’s cultural beliefs and practices pro-
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discussions and ‘interviews’ with the family from the vides a ‘bigger picture’ of the patient than would have
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nurse’s perspective needs to be curbed, so time is made been gained by simply focusing on the presenting disease
available for cultural beliefs and practices to be shared. 20,94,105 or illness and its management. Such an approach to indi-
Understanding and supporting the patient and family can vidualised care enables the critical care nurse to become
be improved by the nurse’s empowering them through familiar with the context of the patients’ life circum-
the processes of listening, understanding and validating stances and how they interpret illness, and also improves
what they have to say. 106,107 Conning and Rowland’s the quality of care and interactions they have with patients
research on the attitudes of mental health professionals and families. 112,113
towards management practices and the process of assess-
ing patients and decision making found that those who Sometimes the nurse will want to have a full understand-
had a greater ‘client orientation’ (versus management ori- ing of a cultural belief or practice before being willing to
entation) were more likely to engage in assessment pro- incorporate it. For example, several years ago a Māori
cesses that facilitate patient-centred, individualised care. 108 patient was dying and the family wanted to organise the
patient’s expedient removal from the hospital environ-
Working in partnership with a family can bridge the cul- ment on the patient’s death. This was necessary so that
tural ‘gap’. However, this is not always easy to achieve in the spiritual and cultural grieving processes could be
challenging situations, such as when various members of commenced. But the nurse blocked the family’s desire to
a large family come and go, compounded by changing plan and organise a prompt postmortem on death
nurses with shift changes. Receiving clear and consistent because the patient had not yet died. This created unnec-
messages about the patient, including his/her progress essary tension and conflict between the nurse and the
from all members of the health care team, can reduce family. Clearly the nurse’s and the family’s beliefs about
cross-cultural confusion and misunderstanding, espe- death and dying were different, and the apparent position
cially as messages are prone to distortion and change of ‘power’ adopted by the nurse did not encourage com-
when many are involved. A strategy to manage this may munication and negotiation about how this situation
involve discussing the management of information dis- could be resolved to the satisfaction of both parties. This
semination with the family, and the identification of one is an example of where the identification and acceptance
or two family members who become the point of contact of cultural beliefs and practices of the family (to the
through which staff discuss and communicate informa- extent that they will not deliberately harm the patient),
tion about the patient. Often apparent ‘cultural con- and working with the family on how these are incorpo-
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flicts’ will arise as a result of communication problems rated in an intervention plan, can be beneficial to all
with the family; communicating information in a clear parties. Once this has occurred, it is crucial this informa-
and understandable manner helps prevent these prob- tion is documented thereby making visible the patient’s
lems from occurring. individualised care. 114
INDIVIDUALISED CARE
‘Individualised care requires the patient and nurse to Practice tip
work together to identify a path towards health that
maintains the integrity of the patient’s sense of self and Determining cultural needs means the critical care nurse must:

is compatible with their personal circumstances’. 109, p. 46 ● identify a spokesperson to communicate information to so
This means the critical care nurse ideally working in part- the messages the family receives are consistent;
nership with the family to identify important cultural ● engage in genuine communication and partnership with
beliefs and practices that need to be observed during the the patient and family;
patient’s critical care experience; in other words eliciting ● be willing to listen, understand and validate information
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a patient’s view to individualise care. It is recognised received.
that ‘the work’ of the nurse involves responding, antici-
pating, interpreting and enabling, all of which are crucial
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for individualised care. Indeed, partnership requires the
nurse not only to work with the patient and family but Practice tip
also to identify the power that the nurse possesses and
the potential for its inadvertent misuse. 94 To optimise interactions with people from a culture different
from yours as a critical care nurse:
Facilitating the inclusion of cultural beliefs and practices ● Avoid making assumptions.
requires them to be identified and then incorporated in ● Avoid culturally offensive practices that are known and
an individualised plan of care. However, given the resource learned.
constraints and the culture of some health services, uni- ● Remember that actions speak louder than words.
versal approaches to planning care may be adopted for