Problems / Needs (Include the date.) | Goals | Interventions/Actions | Discipline/Person Responsible | Outcome/Comments (Initial and date.) |
| On 8 th May 2020 provide hospice care which is well aligned with Shanti’s culture | 1. To achieve anegotiation with Shanti’s family as well as implement hospice care which is culturally congruent 2. Gather focused data concerning Shanti’s presenting illness together with information on her perception of the causes of the condition together with the beliefs on the cultural treatment modalities 3. Develop a trusting relationship with Shanti and her family through sensitive and open communications, actively listening as well as respecting their cultural practices and beliefs. 4. Assess the Shanti's psychological, physical, and cultural factors and use the data gathered in prioritizing and planning the care appropriately. | The practice of cross-cultural nursing incorporates knowledge on the various cultural beliefs and practices, attitudes on people's cultural differences, one’s worldview awareness, and various skills in communication and cross-cultural assessment (Douglas et al., 2013). To plan care in Shanti’s case thorough assessment of the physical, cultural foci and psychological wellbeing is undertaken. The assessment in this case culturally focuses on understanding the ethical, socio-cultural, and religious barriers that influence the health-illness in Shanti. The important tool in the effective assessment in Shanti's case is the adoption of the cross-cultural communication skills to help develop a common understanding as well as a meaning that is shared in the health-illness encounter (Douglas et al., 2013). To explore Shanti’s suffering, questions, are necessary to inquire about factors more extreme than pain in Hindu's deaths rights as well as her willingness to endure pain as a way of honoring her religious beliefs. The competence in the cross-cultural practice in Shanti's case is built on the continued interest of learning on her spiritual beliefs in the Karma concept, which influences Shanti’s willingness to endure pain to help attain a soul’s growth towards nirvana (Sagar, 2011). Skillful communication with the 64-year old Shanti and negotiating with her family to understand better the concept of nirvana in her religious journey would develop trust in some form of medications to alleviate pain as well as remain conscious for her death rituals (ANA, 2016). The family’s role in Shanti’s death ritual was to remain close during the last journey. Therefore, the acculturation aspect of Shanti's daughter would help in the administration of the pain medications especially because she embraced the western culture on palliate pain (ANA, 2016). | Shanti’s daughter Shanti Hospice caregiver | By the end of 8 th May, important information concerning Shanti’s case was gathered through a negotiation process that developed trust with her and her family that led her to accept some form of pain medications to help alleviate pain. |
| On 9 th May 2020 hold communication with Shanti and the family to understand their culture as well as have a critical reflection to avoid enrolling her in hospice care that she does not want | 1. To understand the cultural impact on values, traditions and behavior 2. To understand the effects of communication and language styles of Shanti and the family 3. To understand the health-seeking behaviors of Shanti and the family | Cultural competence is attained through undergoing a lifelong and dynamic learning process. Assessment of factors and cultural patterns influencing differences in people is important to avoid stereotyping and overgeneralization. Various communication patterns as well as negotiation tactics are employed to avoid biomedical and cultural beliefs clash (Sagar, 2011). The critical reflection, in this case, emphasizes understanding the ethical factors that govern the medical system in the US, which emphasizes self-determination as well as autonomy. Therefore, communication will help to understand the nature of Shanti's collective culture emphasizing patient's protection from prognosis and diagnosis information as well as encouraging communal decision making. Additionally understanding the karma religious concept in Hindu is crucial in the analysis process of Shanti's care, in which factors such as pain in her health are a punishment or reward resulting from her previous life actions. The Karma concept emphasizes that death and life are in God's hands, with one’s soul preparing for its next life through the responses to the present situations, and in cases without suffering welcoming pain in the next life. The Hindu religion emphasizes on a cyclical path of life with the experiences of a certain living influencing another, which differs from the linear form of life found in various religions such as Christianity in the US. To promote cultural care and ensure Shanti attains her higher incarnation negotiating with her on the various form of medicine capable of alleviating little pain though she remains conscious to meditate could help improve care as well as avoid clashing the two beliefs (ANA, 2016). | Shanti Family | By the end of 9 th May, an understanding of religious beliefs on behavior is achieved as well as the health-seeking behaviors of Shanti's family |
| By the end of 10 th May, 2020 understand the acculturation effect and Shanti’s husband engraved nature in the Hindu culture | 1. To consider Shanti as part of the family which is diverse hence influenced by a wide socio-cultural system 2. To respond to Shanti's needs through the application of challenges that are easily addressed. 3. To ensure the family grievances are channeled in the right source to ensure they are attended quickly | To provide culturally competent care in a family of mixed socio-cultural system, facilitating a voice for Shanti is the way to go (Sagar, 2011). Nonetheless, ensuring the autonomy of Shanti’s population is paramount, while ensuring they safeguard their values while still catering to their healthcare needs. The education levels between Shanti's husband and the daughter are one of the factors influencing the diversity of Shanti's care options (Douglas et al., 2013). Shanti's daughter, who has embraced the western culture incorporating to her already learned Hindu religion is willing to administer pain medication to her mother, which the father could not do (ANA, 2013). Other barriers of the Shanti’s husband admission of care could be his cultural beliefs on patient care admission being the role of a woman hence he could not administer help to his wife though she was suffering | Shanti’s husband Daughter | By the end of 10 th May, deal with Shanti's case as a part of a family that is diversely influenced by the socio-cultural system and ensure her daughter can administer the pain-relieving drugs which Shanti's husband is incapacitated to administer due to cultural reasons. |
References
American Nurses Association. (2016). Nurses’ roles and responsibilities in providing care and support at the end of life. Revised position statement . https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/endoflife-positionstatement.pdf
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Douglas, M. K., Pierce, J. U., Rosenkoetter, M., Pacquiao, D., Callister, L. C., Hattar-Pollara, M., ... & Purnell, L. (2013). Standards of practice for culturally competent nursing care: 2011 update. SALUTE E SOCIETÀ .
Sagar, P. L. (2011). Transcultural nursing theory and models: Application in nursing education, practice, and administration . Springer Publishing Company.
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