Cultural Overview
Leila is a woman aged 34 years old. She is of Haitian descent, and she resides in the State of Connecticut. She is married with four children: two girls and one boy. She is also five months pregnant. Leila lives with her husband and children in the same house. In addition, her Uncle and two siblings also reside in the same neighborhood as she does. They meet quite often and even share some meals together. Leila also has no friend apart from members of her ethnic group. Besides, she spends little time with her friends. The only people with whom Leila spends adequate time are her extended family members.
Leila works as a casual laborer in one of the nearby groceries in the same neighborhood where she stays. She earns an average annual income of $9, 254. Her husband works at a fire station and earns an average annual income of $13,078. In total, their annual household income is $22332. None of the members of Leila’s family has a medical insurance policy. All their four children are enrolled in a nearby school.
Leila and all other members of her family are Christians of Catholic faith. In addition, they hold the belief in voodoo. Occasionally, they visit Haiti for traditional rituals and traditional medications. The visits are usually scheduled during times of distress. They believe that Laos, their god, brings suffering to the people whenever they fail to observe his rituals. According to voodoo, illnesses occur due to the following reasons: nature imbalance such as when the hot and cold equilibrium is disturbed, pronouncement by Laos, and sympathetic magic. Leila’s family seeks modern medical intervention mostly when the traditional efforts fail. Besides, they hardly visit physicians for regular checkups. Instead, they visit health facilities mostly when sick. Leila’s diet and that of her family are mainly comprised of fruits and vegetables. During her assessment, she hardly maintained eye contact with the nurse. In addition, she also expressed her interest in being assessed at a quiet place that could guarantee maximum privacy. She was also hesitant to allow performance of procedures that involve undressing.
Functional Health Pattern Assessment (FHPA) with Cultural Considerations
Based on the assessment of Leila’s health perception and management pattern, a number of findings were made. First, Leila is not sure of what might have caused the problem for which she has been hospitalized. However, she holds various theories regarding what could be the cause of her problem. However, she suspects supernatural causes as is often the case with people who belief in traditional aspects of health. In this case, Leila suspects that her earlier failure to travel home to attend the ritual undertaken in honor of her late father could have led to her present condition.
Leila was able to explain the duration that has elapsed since she started experiencing the problem. In this case, she informed the nurse who conducted the interview that the problem started two months after had learned she was pregnant. Since Leila learned of her pregnancy a month after conception, the problem has been occurring for four months.
The assessment revealed that Leila has contacted the traditional medicine men severally. She has traveled home twice for the period she has been pregnant to seek help from the traditional medicine men. In addition, she has managed to perform the rituals she ought to perform in order to free her from the suspected consequences. However, Leila has not visited any modern health facility before over the matter. In addition, she has never been examined in relation to the problem. This assessment is the first one she is undergoing during the present pregnancy. When asked what type medication she thinks her family would recommend for her condition, Leila states that her family would recommend traditional herbs for her condition. When asked if she prefers special clothess during her stay in the hospital, Leila states that she prefers long dresses. She also states that she would prefer being attended to by a female doctor and nurse especially when the procedures performed on her require her to undress. She also states that she prefers assessments and procedures to be conducted on her in private places where maximum privacy is guaranteed. The assessment further revealed that Leila has adopted a special nutritional habit aimed at managing her condition. However, the habit is not affective in the management of her condition. In general, the health perception assessment on Leila reveals that her perception of the cause and the nature of her problem are misplaced. In addition, the assessment reveals that her management patterns are mainly informed by traditional beliefs.
In terms values and beliefs, the assessment reveals that Leila prefers being attended to by a female nurse. She also prefers a nurse or physician who can speak French. In addition, she prefers the physician or nurse of Haitian descent. Leila also prefers her examination be conducted in places that ensure maximum privacy. She wouldn’t like other patients to know about her condition. Leila also had concerns that she wanted the doctor to address. She asked if she would be allowed to pray and conduct certain prayer rituals while in the hospital. She also asked if she would be allowed to choose when to be examined. Leila also sought to be allowed to choose one nurse and physician to attend to her every time. When asked if there is a special diet she prefers to be put on, Leila indicated the special dishes she prefers. The assessment also revealed that Leila considers maintaining direct contact with an elderly person or a people older than herself a sign of disrespect. She also informed the nurse that she prefers being referred to as Mrs. Leila. Other values Leila believes in include the following: one must greet everyone when entering a room and kisses on the cheeks is only acceptable between friends and acquaintances.
Leila is presently on medication following her admission to the inpatient care. Earlier assessments revealed that Leila had been suffering from preeclampsia and vaginal bleeding. She had not gone for CT scan to check the fetus’ state. Consequently, she has been put on methyldopa and nifedipine. Methyldopa functions by undergoing metabolism to form alpha-methylnorepinephrine. The alpha-methylnorepinephrine lowers arterial pressure through the stimulation of the central inhibitory alpha-adrenergic receptors. On the other hand, nifedipine functions by inhibiting the growth of fibroblasts that are isolated from the adventitia of aorta (Hérembert, Zhu, and Marche, 1995).
The interventions proposed for Leila have also been applied successfully in various settings. They have also led to positive feedback. As a matter of fact, many organizations currently use the ultrasound technology in detecting ectopic pregnancy. The technology is highly accurate and reliable. In general, the interventions proposed in this case are highly appropriate and reliable.
Nursing Care Plan (NCP) with Cultural Considerations
Nursing Diagnoses
The following diagnoses were made from the assessment of Leila’s condition:
Actual risk for disseminated intravascular coagulopathy (DIC) related to religious restrictions as evidenced by ectopic pregnancy
- Actual risk of severe bleeding related to the presence of ectopic pregnancy and restrictive cultural and religious beliefs and
- Actual risk of poor fetal development related to restrictive cultural and religious beliefs.
- Actual risk for spiritual distress related separation from religious and cultural ties or conflict between own belief system and western medical management
- Actual risk for non-compliance related to conflict between own cultural beliefs, values, and practices and Western medicine.
- Actual risk for malnutrition related to poorly-selected diet
Expected outcomes/planning
Since Leila complained of vaginal bleeding and abdominal pain on admission, Leila and her family think that the absence of vaginal bleeding and abdominal pain should be the priority outcome. Similarly, according to the professionals, the priority outcome is the absence of vaginal bleeding and the patient’s improved attitude and skills for managing ectopic pregnancy. All the outcomes chosen for Leila’s case take into consideration her cultural orientation and religious beliefs. The intervention goals aim at integrating Leila’s cultural and religious beliefs when educating her on the importance of constant visit to the doctor. In addition, the outcomes chosen are appropriate for her age.
Leila expects her vaginal bleeding to ease in the second day after admission. In addition, she expects that her abdominal pain will also ease in the second day. Leila also expects that the episodes of vaginal bleeding will reduce significantly and eventually cease altogether by the time of discharge. She also expects that her condition will be stable one month after visiting the hospital, and she will be able to deliver safely eventually. Some of the outcomes chosen are not similar to the views of Leila. For instance, one of the expected outcomes is that Leila will have developed a positive attitude towards seeking medical services from the modern health facilities rather than the supernatural interventions especially during critical physiological conditions such as pregnancy and lactation. This outcome contradicts Leila’s cultural belief that dictates that she consults the supernatural interventions. Leila’s die pattern is also expected to improve. However, this outcome too is not congruent to her beliefs. However, the outcome is very crucial for her condition.
The expected outcomes for the patient have been selected using specific, measurable, and realistic criteria. The criteria are appropriate in facilitating the achievement of the various intervention goals to the client. The criteria used are also time-bound. Consequently, the health care providers are able to monitor the patient’s condition based on the expected outcomes.
Nursing interventions
Based on the goals set for managing Leila’s condition, the following interventions were selected;
- Conducting vaginal ultrasound examination
- Conducting nutrition counseling
- Conducting patient counseling to encourage attitude and behavior change hence encouraging the patient to adopt a positive attitude towards modern health services
- Providing patient education on management of the symptoms of ectopic pregnancy
- Administration of medication
All these interventions take into consideration the involvement of the client and members of her family as their input is crucial in the decision-making process to achieve positive patient outcome. In addition, some of the interventions require direct participation of the family members. For instance, behavior change is best achieved collectively. In the case of Leila, having other members of her family take part in counseling sessions would help them understand why Leila should have started visited the antenatal clinic from the onset of her pregnancy. Therefore, they would be able to appreciate health services offered by the modern health facilities.
Patient education and counseling are very crucial in encouraging behavior change. Consequently, it is an appropriate intervention to be used in the case of Leila. Patient education has succeeded in various studies in achieving positive patient outcome. A study conducted by Hacihasanoğlu and Gözüm (2011) aimed at determining the effectiveness of patient education in the treatment and management of hypertension reported an improvement in healthy lifestyle behaviors self-efficacy among the subjects. Similarly, patient education can register an improvement in Leila’s attitude and trust towards health services offered in the modern health facilities.
Alternatively, non-invasive methods can be employed in the examination of the client for ectopic pregnancy. In this case, urine and serum tests can be employed (Hajenius, 2007). High-resolution transvaginal sonography is also highly applicable in this case. Urine and serum tests are highly suitable in the case of Leila partly due to her values: she does not feel comfortable having to undress to undergo various procedures. The interventions conducted on Leila take into consideration her strengths and resources. For instance, the nutrition counseling intervention focuses on encouraging Leila to embrace a balanced diet that comprises of foods she can afford. In addition, where her practices do not contradict healthy recommendations, she is encouraged to continue. The interventions are also rationalized to reflect Leila’s preferences. In general, Leila’s strength and resources have been considered in the development of the various interventions.
During patient education sessions, culturally-sensitive teaching materials are used. In this case, the materials are selected carefully while considering their implications on the client’s values and beliefs. This approach helps foster ethics in healthcare services. For instance, culturally-acceptable foods to the client are selected and used for demonstration during nutritional education and counseling. Leila also holds the belief that a balanced diet is a diet comprised of balanced proportions of cold and hot foods is also taken into consideration. This belief is common among the Haitian population. They believe that the time of the day dictates whether one should take hot or cold food. In this case, nutrition intervention focuses on clarifying the meaning of a balanced diet. The outcomes also considered the client’s cultural expectations for recovery.
Provision of culturally sensitive nursing care is paramount to the achievement of positive patient outcome. Nursing care aims at improving all the aspects of the clients that determine their health and well-being. In other words, nursing care seeks to provide the physical, psychological, and the spiritual needs of the clients. These needs can be effectively and efficiently achieved if a holistic approach is applied in the assessment, intervention, and monitoring and evaluation stages of the nursing care process. Therefore, nurses must incorporate among other things the clients’ values, and cultural and religious beliefs in the provision of care.
Conclusion
Culturally-sensitive care is special in the sense that it incorporates the client’s values and cultural orientation in the delivery of care services. Health practices among different population are highly influenced by cultural beliefs and individual values. In many cases, cultural practices that have implications on health contradict scientifically-proven health recommendations. Consequently, nurses need to balance cultural health requirements with the scientific health requirements in order to prevent any situation that may result into the compromising of the health status of the client.
Decisions on whether to discourage cultural health-related practices or not depend on the danger they exhibit on the client’s health and wellbeing. Where cultural health-related practice contradicts scientifically-proven health practice, the cultural practice should not be discouraged as long as it does not put the health and wellbeing of the client in danger. However, in cases where a given cultural health-related practice poses danger to the patient, it should be discouraged, and the patient should be advised to abandon the practice immediately.
Provision of culturally-sensitive nursing care is important since it is part of the holistic approach aimed at achieving an overall positive patient outcome. Patients should not be made to think that their cultural beliefs are discredited. Instead, they should be allowed to exercise their beliefs. In addition, culturally-sensitive nursing care should be given in order to provide a nursing environment where everybody feels accommodated. Besides, every client needs to be understood in all perspectives in order to inform appropriate care decisions. All the stages of nursing care process should be culturally-sensitive in order to capture all the need of clients.
Evaluation
The care plans for Leila were selected on the basis of their effectiveness in incorporating cultural considerations the available evidence supporting them. For instance, patient education and counseling are supported by strong evidence of studies conducted for different disease conditions. For instance, a study conducted by Hacihasanoğlu and Gözüm (2011) provides a rationale for this intervention. The employment of vaginal ultrasound technology is also supported by a wide range of evidence. In this case, several studies showing the effectiveness of using this method in diagnosing ectopic pregnancy are available. The effectiveness of pelvic ultrasonography in detecting ectopic pregnancy especially during the first trimester has been proven in a study by Durham and colleagues (1997). The suitability of transvaginal sonography has also been proven in several studies. For instance, a study by Shalev and colleagues (1998) among women with presumed ectopic pregnancy admitted to the department of obstetrics and gynecology led to the detection of ectopic pregnancy using transvaginal sonography among 380 women out of the 840 who took part in the study.
Most of the pieces of evidence relied upon in the interventions are provided by experts in nursing. Besides, most evidence is obtained from a similar setting as the surgical unit to which Leila is admitted.
Professional Nursing Journal Article
The article by Sivalingam and colleagues is one of the scientific sources that provide an insight into management and other aspects of ectopic pregnancy. The article explores diagnosis, assessment, and management of ectopic pregnancy. Symptoms associated with this condition are also highlighted in the article. The assessment of Leila’s problem partly relies on the insight provided by the article. For instance, the article provides means of diagnosis of ectopic pregnancy. Some of the techniques can be used in handling Leila’s situation.
Bibliography
Hajenius, P. J., Mol, F., Mol, B. W., Bossuyt, P. M., Ankum, W. M., & Van der Veen, F. (2007). Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev, 1(1). http://www.ncbi.nlm.nih.gov/pubmed/10796710
Hérembert, T., Zhu, D. L., & Marche, P. (1995). Mechanism of action of the inhibitory effect of nifedipine on the growth of cultured aortic cells from spontaneously hypertensive and normotensive rats. British journal of pharmacology, 114(8), 1703-1709.
Sivalingam, V. N., Duncan, W. C., Kirk, E., Shephard, L. A., & Horne, A. W. (2011). Diagnosis and management of ectopic pregnancy. Journal of Family Planning and Reproductive Health Care, familyplanning73.
Hacihasanoğlu, R., & Gözüm, S. (2011). The effect of patient education and home monitoring on medication compliance, hypertension management, healthy lifestyle behaviours and BMI in a primary health care setting. Journal of clinical nursing, 20(5‐6), 692-705.
Sivalingam, V. N., Duncan, W. C., Kirk, E., Shephard, L. A., & Horne, A. W. (2011). Diagnosis and management of ectopic pregnancy. Journal of Family Planning and Reproductive Health Care, familyplanning73.
Durham, B., Lane, B., Burbridge, L., & Balasubramaniam, S. (1997). Pelvic ultrasound performed by emergency physicians for the detection of ectopic pregnancy in complicated first-trimester pregnancies. Annals of emergency medicine, 29(3), 338-347.
Shalev, E., Yarom, I., Bustan, M., Weiner, E., & Ben-Shlomo, I. (1998). Transvaginal sonography as the ultimate diagnostic tool for the management of ectopic pregnancy: experience with 840 cases. Fertility and sterility, 69(1), 62-65.
