NR305 Week 6 Discussion, Providing Culturally Competent Nursing Care

Week 6: Providing Culturally Competent Nursing Care Option #1: You are the nurse assessing an Orthodox Jewish client with peptic ulcer. The client is strictly religious and refuses to eat the food provided at the health care facility. 1. Describe how you would further assess and provide care for this client. 2. What steps could you take to increase your cultural competence, if you were not familiar with this faith? Option #2: You are the nurse caring for a client with Crohn's disease. The client believes he is being punished by God. The client is spiritually distressed and cannot come to terms with the illness. 1. How would you respond to this client? 2. What are some identified risk factors for spiritual distress, and recommended interventions? Option #3: Describe a time in your clinical nursing practice when you have cared for a client of cultural, religious, or spiritual practices different from your own. 1. What were some of the challenges you faced caring for this client? 2. What steps did you take (or could you have taken) to ensure the patient received culturally/spiritually competent care? I recall a patient that was admitted for severe anemia due to suspected GI bleed. She underwent endoscopy and colonoscopy, and the exam showed multiple bleeding ulcerations in her stomach which were cauterized during the procedure. Her stool was positive for occult blood, and she had hematemesis on several occasions. Her H&H became dangerously low, and the doctors ordered her to receive several units of blood. This patient refused the transfusion, and the doctors tried several “scare tactics” to get her to accept the transfusion. She was steadfast in her beliefs as a practicing Jehovah’s Witness and adamantly refused transfusions. “JW members do not accept transfusions of whole blood or any of the ‘‘four major components’’ of RBCs, platelets, plasma and white blood cells” (Saby, Jotkowitz, & Barski, 2017, p. 733). I initially thought that she was being difficult, and potentially scared about the risks of a transfusion, as I was unaware of the Jehovah’s Witness culture. I didn't bring up the transfusion, or information I received in shift report about her religion when I first went in to meet her. I spent a few minutes on my break looking it up online to try to learn more about it before returning to my shift. After my break, I recall going to talk to her and discussing how she views her religion. I presented questions such as "do you belong to a church" and " as your nurse, is there anything I can do to help you feel more comfortable?". After speaking to this patient about her condition, and she expressed concern that if she accepted the transfusion, she could face sanctions from her church family, and she explained she fully understood the seriousness of her condition. I learned that she was willing to accept IV fluids, iron infusions, and other medications that could help her state, but that she would continue refusing the transfusions and was tired of doctors telling her that she had to accept them. She explained that she was already in touch with her fellow church members about her condition. She was also tired of having her labs checked every 6 hours to monitor her blood count. The way the patient explained it was that every time they took a vial of blood, she lost what her body was trying to replenish. I went to my charge nurse and relayed the information I gathered from my discussion with this patient. In my area, I hadn't treated any patients of this faith, and I was a relatively new nurse. The charge nurse was surprised that I was able to get the patient to talk about the situation, and agreed to relay the information to the GI doctors. I recall they ordered iron infusions and decided not to draw blood so often to continue monitoring her counts. She was kept in the hospital for a while longer (maybe a week, the details are fuzzy as it’s been over ten years since this case), but was eventually discharged to home. I remember I ran into her at the store a few months later, and she approached me and thanked me for lending a kind ear and not judging her beliefs. While reviewing the text this week, I noted that "nurses need to assess the clients basic religious and spiritual background" (Webber & Kelley, 2018, p. 209). I feel that I worked with this patient's culture and religious beliefs appropriately, allowing her to speak and explain her feelings, and relaying information to the doctors. Since that time, I have cared for many patients of this faith, and have learned more about the practices they believe. References Sagy, I., Jotkowitz, A., & Barski, L. (2017). Reflections on Cultural Preferences and Internal Medicine: The Case of Jehovah’s Witnesses and the Changing Thresholds for Blood Transfusions. Journal Of Religion And Health, 56(2), 732–738. Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: Wolters Kluwer