Competent health care for African americans
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Deadline: Thur, July 23rd, 10 pm
Topic: Competent health care for African americans
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Details:â—¦Evaluation (48 percent of grade as detailed below) â– Develop a tool to evaluate the effectiveness of your plan of health care. (25 points). â– Explain how this tool will be implemented – How the results will be collected. (23 points) Application of the Nursing Process to Delivery Culturally Competent Care – Part 1 Evaleen Amoranto, Carol Covarrubias, Adriana Gonzalez, Eduardo Martin, Marta Ross, Sharon Spann, and Eileen Valdes Sanchez Miami Dade College Abstract When delivering culturally competent care to a specific community, it is important to take into consideration many aspects of their customs and background (Spector, 2013). For the development of this paper the African American community will be analyzed from a cultural point of view in order to deliver appropriate care. The physiological, environmental, and psychosocial factors that influence communication, the influence of their beliefs in health care practices, barriers to cultural competent care, and dilemmas in the delivery of health care to this community will be discussed, as well as some of the common health issues and illnesses seen in Blacks. The Joyce Newman Giger and Ruth Elaine Davidhizar’s Transcultural Model will be used to conduct a cultural analysis of this community, and a plan of care applying this model will be provided. Lastly, we will explore the utilization of community organizations, governmental organizations, non-for profit organizations, hospitals, and professional associations as resources to improve health maintenances and promotion among the African American community. Application of the Nursing Process to Delivery Culturally Competent Care The application of the nursing process for the delivery of culturally competent care requires a deep analysis of the main characteristics of the specific population being treated. The provision of a culturally congruent care involves being able to comprehend key aspects of culturally diverse individuals. This more evolved level of culturally competent care is aimed at providing context-specific health care that can be rendered devoid of discrimination through developing awareness of cultural world views and attitudes toward a given population. The main objective of this paper is to analyze the African American culture and use this information to increase the understanding of this community’s health practices and provide a health care that is culturally congruent. To meet this objective the Joyce Newman Giger and Ruth Elaine Davidhizar’s Transcultural Model will be used to develop a plan of care for the African American community based on their health care needs. The African American Community – Background information African American refers to a person having origins of the Black racial groups of Africa who lives in the United States. The term, Blacks are used in similar manner, but comprise the diverse ethnicities including immigrant groups from Africa, West Indies and the Caribbean. African Americans have been in the United States since before the arrival of the Pilgrims. A great number of them came between 1600 and 1700 brought as slaves. At present, there are 13 % or 38.9 million Blacks living in the United States (U.S. Census Bureau, 2011). Although Blacks represent all the socioeconomic classes, 25.11% of them live in poverty. They live in urban areas, dealing with many problems including older housing, unsafe living conditions, environmental hazards and violent crimes, many of them stem from drug and alcohol abuse. They have suffered great injustice because of their race. Physiologic response to racism has resulted in chronic stress. Unequal treatment causes anxiety and release of stress hormones. Chronic stress puts wear and tear on the body, more specifically to the organs which puts the individual in a health risk. Chronic inflammation leads to chronic diseases such as heart disease, gastrointestinal issues and such, as well as disabilities. African Americans lead in cardiovascular diseases, particularly hypertension and high cholesterol. Family is an important resource for support. Most have female-headed households and as such the primary caregivers. African Americans use prayer and religiosity to cope with and treat health concerns. Their religion, may it be Christianity or Islam, provide them with spiritual and psychological support. In order to deliver culturally competent care, assumptions on patient’s race and ethnicity should be avoided. Personal preferences, risk behaviors and experiences must be identified through direct inquiry. They use slang words. It is necessary to ask for clarification so that there is no misunderstanding. African American communication styles include direct eye contact, conveying a sense of concern for the person and the problem, a nonjudgmental approach, and listening (Welch, n.d.). Health beliefs and practices of African Americans vary according to geographic location and socioeconomic class but common themes are identified. Strong social support networks, belief in the well-being of the community, use of informal health care systems for information, mistrust of the medical establishment, and fears and fatalism related to cancer are common themes (Welch, n.d.). They view health as being in harmony with nature and illness as disharmony. They generally categorize them into: Natural illnesses are those that results from God’s will or any exposure to nature such as cold air or wind. These diseases are treated with antidote or protective actions. Because they believe it is God’s will, they turn to prayer and leave it for God to take care of it. These, sometimes, may lead to delay in seeking for help. Unnatural illness are those that caused by evil spirits. They are founded from witchcraft beliefs such as Voodoo. Amulets and herbs are used to counteract these illnesses. African American values of church and family are key support systems and should be considered in planning care for this population. Jezewski (1990) defined cultural brokering as “the act of bridging, linking, or mediating between groups or persons of different cultural backgrounds for the purpose of reducing conflict or producing change†(As cited in National Center for Cultural Competence, n.d.). As cultural brokers, we need to bridge between their culture, using cultural and health science knowledge and skills, and the healthcare system for an effective plan of care. Include the family in the care. Acknowledge and respect the patient. Avoid assumptions and inquire specific risks. In order treat our patients in an effective manner, we need to be familiar with their perception on health and illness, how these affects their health seeking behaviors and attitudes toward health care providers, and how to incorporate their traditional beliefs and health practices in their plan of care, all the while providing safety. Barrier factors that influence the provision of culturally competent care in the Black community include mistrust towards the health care system, health illiteracy, and health beliefs and practices. African Americans have a tendency to distrust institutions and authority figures due to fact that they have an extensive history of slavery and racial discrimination. There have been studies that have shown that African Americans were less likely to trust their doctors and health care institutions when compared to Caucasians. This lack of trust in turn leads to racial disparities in health outcomes. When a patient trusts his/her physician the patient will be more likely to comply with medical advice and costs. Patients with lower levels of trust were less likely to comply with a medical regimen for diabetes. Furthermore, the quality of patient–physician communication may be lower when Caucasian physicians treat African American patients. According to Johnson et al., physicians are more verbally dominant and less engaged in patient-centered communications when dealing with African Americans (As cited in Eiser & Elis, 2007). Some Blacks fear or resent health clinics. They often receive inadequate care, are told what their problem is i
n incomprehensible medical jargon, and are not given an identity, being seen rather as a body segment (Spector, 2013). The concept of trust in race, ethnicity, and culture is complex. The U.S. Public Health Service study on “Untreated Syphilis in the Negro Male†(the infamous Tuskegee Study) is often cited as the prime example of why African Americans mistrust the medical community (Crawley, 2000). However, other research suggests that this mistrust stems from a centuries long history of medical mistreatment and abuse (Byrd & Clayton, 2000). For all these reasons we should be very respectful with this patient population and be aware of their feelings and emotions with medical encounters. Pay close attention to your body language and tone of voice while caring for these patients. As it was mentioned on the previous segment, medical jargon may contribute to the mistrust of the Black patient. Health illiteracy may become a deterrent to provide the best health care, and it is very or more common in lower socioeconomic groups. The prohibition against educating African American slaves has seriously impacted on the long-term literacy of certain components of the African American population (Eiser & Elis, 2007). Some studies reveal that health illiteracy increases medical costs and reduced efficiency of services. Thus, improving health literacy can conceivably improve outcomes and reduce costs if it is culturally sensitive. (Eiser & Elis, 2007). Some recommendations that may assist in dealing with this barrier may be to use simple language that the patient has an easier time understanding. Get feedback from your patient if he or she clearly understands the information or instructions given and if necessary find someone from the medical team that has a similar ethnicity as the patient that may be able to better explain the information being provided. It is better to give the patient instructions and demonstrate the skills needed rather than telling them what not to do. If the patient uses slang language, ask for clarification and avoid using slang language back to prevent offending the patient or having the patient misunderstand the intention of the health care provider. Health beliefs and practices also represent barrier factors in the delivery of care of the African American population. There are some characteristics that apply to the African American community. For the most part they believe in prayer and are very religious. Many manage health concerns by relying on prayer and faith. Many times their religious affiliation provides them with both spiritual and psychological support (Eiser & Elis, 2007). All these factors may lead to a delay in treatment, due to the fact that the patient may turn to use home or natural remedies, they may turn towards these before going to a health care clinic or before following the care provider’s instructions. The patient’s belief in and practice of folk medicine must be respected; the patient must not be criticized for those beliefs. Effort should be made to assist the patient to combine folk treatment with standard Western treatment, as long as the two are not antagonistic. (Spector, 2013). It is also important to avoid making disapproving or negative comments about the patient’s beliefs, but it is important to clearly and in a non-judgmental approach explain to the patient the risks of some of these home remedies or if there are contraindications for any of these remedies to be taken with traditional medicine treatment. Disparities in diabetes care in the African American community represent an ethical dilemma in the delivery of health care to African Americans. For practitioners, disparities “pose moral and ethical dilemmas that will be among the most significant challenges of today’s rapidly changing health systems.†(Minority Nurse, 2013). The Institute Of Medicine committee defined health care disparities “as racial or ethnic differences in the quality of health care that are not due to access related factors, clinical needs, preferences, and appropriateness of intervention.†According to the Department of Health and Human Services, health care disparity can be linked with economic, social, and environmental disadvantages (Minority Nurse, 2013). According to different studies African Americans have the highest rates of diabetes diagnosis. It has been found by researchers that racial and ethnic disparities in disease management contribute to this factor. These disparities are considered unacceptable, but they still exist in the U.S. Health Care system. Ethnic discrimination is one of the main factors that contribute to disparities, and as we can see African Americans are widely affected. According to the Centers for Disease Control and Prevention (CDC), diabetes is the leading cause of many health problems, such as kidney failure, blindness, lower limb amputations, stroke, and heart disease; it is the seventh-leading cause of death in America. Reasons attributed to diabetes disparities include differences in income, barriers to health care (type and lack of insurance), and divergent medical needs (Minority Nurse, 2013). Despite all these statistics racial and ethnic disparities in the delivery of health care continue to occur. According to many researches it has been shown that disparities occur as a result of omission, commission, or inadequacy of action, and once again African Americans are highly affected. The patient, healthcare provider and the system are all involved in this disparity issue. As it was mentioned on the barriers that the Black community experiences, for the most part African Americans mistrust the health care system, and they as well, at times, seek Folk medicine prior to reaching out for the Western Health care system, which in turn may contribute to the worsening of their condition. The provider on the other hand may have bias, stereotype and may lack Cultural Competency while caring for this population of patients, and as it was mentioned earlier the system does not favor this minority population, this is evidenced by the shortage of access to health care services to include proximity of health care facility and insurance coverage, amongst other factors. Analysis of the African American Culture using The Joyce Newman Giger and Ruth Elaine Davidhizar’s Transcultural Model The Joyce Newman Giger and Ruth Elaine Davidhizar’s Transcultural Model was used to analyze the African American population. This model proposes a fairly comprehensive approach that each nurse should consider when providing care for every patient. In order to accomplish its objectives, the transcultural model proposed by Giger and Davidhizar’s uses six main and different points that must be taken in to consideration while caring for the patient (Giger & Davidhizar, 2012). Each point describes a cultural phenomenon that affects the health of a given population. These six points are Communication, Time Orientation, Space, Social Organization, Environmental Control, and Biological Variations. Communication refers to the means (written or oral language, gestures, facial expressions, body language, space, or other symbols) by which people connect. It vary among culture-specific groups in terms of language spoken, voice quality, pronunciation, use of silence, and use of nonverbal communication. Space includes personal space, which is the area that surrounds a person’s body; it includes the space and the objects within the space. It is the individual’s comfort level. Social Orientation refers to patterns of cultural behavior that are learned through a process called enculturation (also referred to as socialization), which involves acquiring knowledge and internalizing values. Time has two distinct but related meanings. It means an interval of time and also specified instances or points in time. Environmental Control is the ability of an individual or persons from a particular cultural group to plan activities that control nature. Biological Variations include dimensions such as body structure, body weight, skin color, internal biologica
l mechanisms such as genetic and enzymatic predisposition to certain diseases, drug interactions, and metabolism (Cultural Competence Project, 2011). Giger and Davidhizar’s model can be applied to the African American culture by first taking into consideration their customs and characteristics. When interacting with the Black community, the correct method of communication, the language and literacy level must be properly assessed before starting the interaction. It is also important to be time oriented, inform step by step the delivery of care, and talk about the measures to take at the moment to treat or prevent the occurrence of diseases. During the interaction, maintaining a close personal space is permissible and viewed as a sign of trust and unbiased by the Black population. Another important factor, which must be considered when working with this community, is to be respectful to the family and their religious practices. African Americans’ beliefs on their health practices have a strong influence on their health care habits. Many individuals rely better in religious health methods such as the Voodoo. Voodoo is a combination of many forms of religions that were brought to the Americas by Blacks from Africa many years ago (Meyer, 2013). Voodoo and rooting, a derivative from voodoo that consists of the use of magic to accomplish this goals, are still used as an important source of diagnosing and treatment. Traditional healers, who use herbs and roots for the treatment of illnesses, are also part of the African American health care practices. In this culture it is believed that illness is a disharmony and it is due to the presence of demons and evil spirits. Cure is accomplished by removing these presences. Pray is the most common way of health restoration. There are also many home remedies that have been reported by Blacks to be useful and effective in the treatment of illness. For example, cod liver oil is drunk to avoid colds. Sulfur and molasses preparations are apply to the skin in spring to prevent illness in general (Spector, 2013). Black Muslims belief they are what they eat. As a result, the follow a rigid diet called halal. They do not eat pork and most probably will refuse the regular hospital food. It is important to keep in mind that insulin, which is usually derive from pork’s pancreas, will have to be substituted for a different one. The religious practice of praying five times a day could interfere with some treatments. Also important is to consider that they follow gender specific care which means women will have to be attended by females and men by males. Regarding environmental control, nurses’ major actions should be identifying the use of folk and other alternative health measures used by this community and integrating them to the conventional health care measures. A focused assessment based on the diseases that affect this community the most should be a priority for the plan of care, as well as teaching regarding the detection and treatment of these diseases. As explained earlier, Giger and Davidhizar’s model proposes six phenomena that should be considered when planning care for a unique culture being influenced by culture, ethnicity, and religion (2002). They are Communication, Space, Social Orientation, Time, Environment Control, and Biological Variations. These phenomena are essential for developing a plan of care for the Black community. When it comes to Communication it needs to be provided on levels that will benefit everyone in their ethnicity. A nurse may care for those that are Black but only speak Creole or even Spanish and she or he needs to be able to establish a rapport with each individual. You need to assess body language to make sure that you have their attention plus that you are being attentive to the community needs. You also have to make sure the patient feels a part of the planning that is done in the community. Assess the needs of the community. Space is important because you want to allow patients to be comfortable and not to be over bearing by invading personal space. You do not want to come on too strong or intimidate the patient because it could lead to patient refusing care or not wanting to return for follow up. Social Orientation, the nurse needs to know the beliefs of the patient. For the Black community religion is one of the ways you will be able to reach the people. Meeting with the spiritual leaders and offering information as well as health fair at their organization will be very beneficial. (Spector, 2013, p. 272). Prayer plays a big role in many Black individuals’ live. There are also those who practice other religions like “Voodoo†as a traditional method of health restoration. So being aware of these factors is important for the nurse because he or she is able to understand the client’s thoughts regarding health and healing practices. Time is very important because you must be aware of what is going on at the time you are making a plan of care for the community. Is it a need for immunization, vaccination, or teaching on any topic that is affecting the Black community at this particular moment? Environmental Control is very important when it comes to the Black community because home remedies are one thing that is commonly practiced due to the lack of access to healthcare and cost of doctor (Spector, 2013, p. 272) and some have managed to be successful with the use of them. Biological Variations means that you should be aware what health issues pertaining to the Black community, which is different from other communities, and focus on that. An example is that African American has three times higher tuberculosis incidence than the white population and hypertension onset is earlier and more severe than that of the white population (Giger & Davidhizar, 2002). In the African American community there is a need for teaching and monitoring of diabetes, hypertension, cardiovascular issues and obesity which can lead to all kinds of cancers. There is also a need to teach about the importance of making better food choices (Spector, 2013, p. 279). Because of the lack of healthcare access, some African Americans wait until symptoms are severe to seek conventional health care. It is important to provide this community with mobile health clinics to do screenings on above-mentioned issues and also to establish workshops to educate the community about what is available to improve their health. Premature births are very high in the Black community and teaching on the importance of prenatal care and planning is needed to implement clinics. Also check- ups with transportation available would help greatly. Lastly, Sickle-Cell Anemia is a red blood cell disorder that is prevalent in the Black community and it is manifested in a child when both parents are carriers of the sickle-cell trait. It is important to inform African American patients about this disease because of its painful and deadly complications. The use of an interdisciplinary approach must prevail when attending to this group. All health care providers must deal with their different internal feelings towards this population, because in the end, these patients can perceive these difficulties. When attending to the Black community, it is imperative to put aside the sense of segregation and racism that has characterized the health care system for so long in many regions of the U.S. The participation of not only nurses, but of physicians of different specialties and other medical personnel, working directly in the community, will result in a more positive outcome for the better screening, detection and diagnosis of a specific disease. Also, the participation of community resources results in great deal of help. For instance, some centers provide with screening for children at risk for lead poisoning, which provides with early diagnosis and treatment for children with lead poisoning (Spector, 2013) Governmental organizations, such as Medicaid and Medicare, facilitate, up to a point, better access to health care for this community. Unfortunately, sometimes the hidden costs of some treatments, abse
nce from work, transportation and child care, are other factors that affect the provision of health care to this population. These factors need to be identified and addressed. Another way to help the Black community will be through non-for profit organizations such as American Association of Blacks in Energy (AABE), National Council of Negro Women, Inc. (NCNW), and National Association for the Advancement of Colored People (NAACP), (Diversity Best Practices, 2011). Charity works can include development of specific educational campaigns to better inform the general population about specific diseases present only in the Black community, such as Sickle-cell anemia. Also, religious organizations should become more involved by providing more spiritual support for the members of this group. Hospital-provided community activities such as blood pressure and blood sugar screening could also provide a preventive measure toward a better state of health for this group. Lastly, professional associations such as the National Black Nurses Association (NBNA), The Association of Black Psychologists, and National Medical Association (NMA) can join efforts with other community associations to work for this particular group and, therefore, address the real issues impacting African American health maintenance and promotion (Diversity Best Practices, 2011). Teaching regarding birth control methods as well as ways to avoid sexually transmitted diseases should become a big part of the plan when working with this population. When working with the Black community, the participation of other health care providers would result in a great deal of help and improved outcomes. Social workers, for instance, would be ideal to identify the main needs of the community as well as ways to solve the problems. Since teaching is one of the best ways to help this population or any other community for that matter, the participation of health care specialist such as dietitians, genetic counselors, and oncologists will be ideal for the better understanding of the major diseases affecting this cultural group. Successful collaborative models, such as The Dimock Center in Boston, which provides health and community services, child and family development services, and behavioral health services to African American communities, and The Children’s Hospital & Research Center Oakland Comprehensive Sickle Cell Center, which offers the largest program for sickle cell care and research in the Western United States and integrates primary care health with behavioral health, education, and vocational components, demonstrate that it is possible to successfully build an interdisciplinary team working towards a common goal, to improve health maintenance and promotion in the African American population (United States Department of Health and Human Services Office of Minority Health, 2011). Conclusion The need to develop culturally competent care has been paralleled by the emerging ubiquity of culturally diverse individuals around the world. Culturally competent care includes being able to comprehend varying aspects of the cultural and societal beliefs of culturally unique individuals. The cultural analysis of the African American community has provided us with valuable information about issues such as the prevalence of certain health conditions (e.g., cardiovascular diseases, hypertension, high cholesterol, and diabetes), the importance of family as a resource for support, the psychosocial support obtained through religion, communications styles, and health beliefs and practices. Also, we have been able to identify some barrier factors that influence the provision of culturally competent care such as health care system, health illiteracy, and health beliefs and practices. Disparity in diabetes care was identified as an ethical dilemma of health care to African Americans. The model utilized to culturally analyze this population, The Joyce Newman Giger and Ruth Elaine Davidhizar’s Transcultural Model, offers a fairly comprehensive approach that each nurse should consider when providing care to members of this community. The phenomena covered by this model include Communication, Space, Social Orientation, Time, Environment Control, and Biological Variations. The importance of being aware that some Blacks may not speak English, but Creole or Spanish, the need to assess body language, the respect for the personal space, the impact of religion as a source of spiritual and social support, the concept of time and its implications in issues such as immunization and teaching, the use of home remedies and traditional healers, and health issues pertaining exclusively to the African American population, are some of the important information obtained through the Giger and Davidhizar’s Transcultural Model. This information was, then, utilized in the development of a plan of care for the Black community. Finally, a discussion about the importance of developing an interdisciplinary approach to improve health maintenance and promotion among the African American and the involvement of community organizations, governmental organizations, non-for profit organizations, hospitals, and professional associations, provided key information that should be utilized to achieve a better application of the nursing process to the delivery of culturally competent care. References Byrd, W.M. & Clayton, L.A. (2000). An American health dilemma: A medical history of African Americans and the problem of race: Beginnings to 1990. Routledge, NY: Taylor & Francis. Crawley, L. (2000). African American participation in clinical trials: Situating trust and trustworthiness. In: For the Health of the Public: Ensuring the Future of Clinical Research. Association of American Medical Colleges (2), p. 17-21. Cultural Competence Project. (2011). Transcultural nursing theories and models: Giger & Davidhizar. Retrieved from http://www.ojccnh.org/project/
al and ethnic disparity in diabetes care. Retrieved from http://minoritynurse.com/racia
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