Real Life Scenario-Leah
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Question 1: Major Professional issues
The major professional issues that come up in this life scenario include diversity and culture in health and illness as a result of Leah’s Aboriginal background. Communciation between the students and qualified nurses is also an issue of concern that has bearing on the success of the student’s clinical placement. The last issue is nurse-patient relationship which is a concern because of the fact that the student knows the client, Leah well.
Question 2: Definition and demonstration from the scenario
The issue of culture and diversity is demonstrated by the focus of the nursing staff on Leah’s origins. They already seem to have adopted a prejudiced attitude towards Leah as they have began to associate the fact that she is from the Aboriginal community with her poor health. They have come to this conclusion based on a stereotype generalisation of members of the Aboriginal community where they assume that it is to be expected that all members of the community do not take care of their health. The danger with such an attitude is that it comes in the way of providing quality care for Leah. It also indicates lack of cultural competency.
Another factor related to culture is the fact that the nurses want to put restrictions on the number of people that can visit Leah. In addition, the nurses would also like to reduce the amount of time Leah’s relatives spend with her when they visit. For Leah, the help she receives from her family and the fact that they visit often and in large numbers is important to her as it helps her to heal. In addition, during their visits, the family keep her updated on the progress of her young son who is currently in the care of an aunt. This issue is of significance because by choosing to ignore Leah’s feelings concerning visiting by her family members, the nurses may be creating an obstacle to Leah’s healing process.
The nurses can be described as ethnocentric because they are mainly using their own perspective to measure Leah’s culture. Ethnocentrism is defined by Geiger and Davidhizar (1991) as a view that one’s culture is the best and using it as the standard for measurement of all other perspectives. This is illustrated by the fact that they want to do decrease the number and time of Leah’s visitors simply because it bugs them.
Culture is defined as the practices and norms that a certain group of people have, share and generally use as a guide for decision making, thinking and acting (Leninger, 1991). In Leah’s case her culture is helping her to feel better. Taking this away from her would result in her progress after the surgery being poor. In addition, by bringing news of her son, they help her to allay anxiety and worry about her son’s care. The nature of nursing is that it is holistic and it considers not only pathophysiology but also social issues that may affect the patient’s health (Bishop and Scudder, 2000). Reducing the number of visitors that Leah is getting may result in her worrying more about her son increasing her stress levels and making the healing process slower.
Cultural competency refers to an understanding of world views beyond those that one holds. It involves making the effort to get information on the culture of another group and applying this knowledge to the healthcare of the patient with an aim of providing quality healthcare and improving health outcomes (Meyer, 1996; Cross, Bazron, Isaacs and Dennis, 1989). This is because for many patient’s their beliefs and values have a bearing on their well-being. Respect for culture is also necessary in establishing the trust of the patient which is necessary for improving healthcare outcomes.
Communication between the student nurses and the qualified nurse is an issue illustrated by the inability of the student to convey her true feelings about Leah’s situation to the nurses. In addition the student nurse is also not able to ask questions. This impairs the learning process for the student nurse, having a negative impact on the student’s experience of clinical placement. The likelihood of the student nurse picking up behavior that is unprofessional such as lack of respect for other cultures is high. The student is being treated in a hurtful way when the nurse uses intimidation through her abrupt communication methods that leaves no room for questioning or addition of input. This is counter-productive for the nursing profession (Butts and Rich, 2005). This poor communication makes nursing advocacy difficult for the nursing student as she cannot express her worries concerning disregard for Leah’s culture. In addition it diminishes the role of qualified nurses as teachers in the ward. The professional nurse has a major role to play in advancing and broadening nursing (McConell,1993). This is however not well demonstrated by the qualified nurses in Leah’s case.
The patient-nurse relationship is the major focus in nursing care. The nurse has a responsibility of ensuring that the patient receives the best quality care possible. If there is something that may hinder the nurse from doing this, the nurse is expected to remove herself from the care of that patient (Rumbold, 1999; Bishop and Scudder, 2000 ). In Leah’s case this results from the fact that the student nurse is a close association of Leah who knows her well. This is likely to come in the way of the nursing student providing personal care to Leah. In effect by providing Leah with personal care as a close associate she may be robbing Leah of her personal dignity. The fact that the student nurse is uncomfortable with this situation means that she may be unable to provide quality care. Since the main aim of nursing care is to ensure as much as possible the well being of the patient, the student nurse has a responsibility to voice her concerns about being able to adequately care for Leah.
3) Professional practice improvement strategies
To manage the cultural issue, it is necessary that the nurses be trained to achieve cultural competency such that they remain open to other people’s culture. This will enable them to have a better understanding of health behaviors that are culturally influenced (Cross et al, 1989). This can be done by first by impressing upon the nurses the need for valuing diversity and secondly, by adapting service delivery such that it reflects a comprehension of cultural diversity (Cross et al, 1989). The first strategy will involve sensitizing the nurses on the importance of culture through a cultural sensitization program. This can be done by the student communicating to the nurse manager Leah’s case and the need for the program. Implementing the second strategy in Leah’s case may mean allowing her visitors to visit her without necessarily reducing their number. The visitors should also be allowed to visit during visiting hours and as long as they do not get in the way of the nurses providing nursing care they can be allowed to help Leah.
Communication is an important link in nursing care and to be able to meet the needs of the client it is necessary that communication be effective (McConnell, 1993). Communication is an important tool of the learning process. To improve the communication between the student nurse and qualified nurses may require a confrontational strategy where the nurse with an abrupt communication method is told of the effect her communicating style has on the student nurses who would like to learn. McConnell (1993) advises that confrontation is a technique that needs to be applied with diplomacy and honesty for it to be effective. Thus confronted, the nurse is likely to change her communication style and be more accommodative to students who may have questions or require clarification regarding nursing care issues.
To enhance the students’ clinical experience the nurse manager could also use a less direct approach. Fahy, Travett-Jones, Parsons and Mitchell (2007) argue that ongoing communication and evaluation is necessary to improve communication between the clinicians and students is necessary for improving learning. The situation in Leah’s case can thus be improved by having both the students and qualified nurses reporting and exploring the issues, concerns and claims that they have. This will open up the communication process and possible solutions may be found that will improve communication and thus enhance the learning process.
To manage the last problem, the first step will involve the student nurse voicing her concerns over her closeness to Leah. These concerns could be communicated to the nurse she is working with directly. When the student tells the qualified nurse about her concerns it encourages communication between them and may result in the student being removed from the care of Leah. Often what may appear to be a dilemma is related to a breakdown in communication between different people and the solution to a problem may lie in use of tact in discussing the problem (Thompson, Melia and Boyd, 2000). In Leah’s case, this will require the student to be tactful in talking to the nurse. Another strategy that could be employed is the student nurse talking to another nurse that she is comfortable with. The qualified nurse will in turn speak to the other nurse on the student’s behalf. This is also an ingenious method of initiating communication between the student and the qualified nurse.
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