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The community health nurse needs to be open to different cultures.   We have all heard this statement, “They are in the U.S. and so they should learn to conform”.   In our interactions with people, their health is of upmost importance.   To be able to provide care, the nurse must be able to provide culturally consistent, suitable, and meaningful nursing and health care.   This will help to eliminate misunderstandings and miscommunications (Maurer & Smith, 2013, p. 268) .   We will not know everything about all cultures, however, over time we will add more and more to our cultural competence suitcase.

Cultural preservation maintains the importance of the specific culture.   In the Native American culture, the placenta is often saved and used in ritual planting of a tree.   In looking at the placenta, you can see the symbolic tree of life in the veins and arteries of the placenta.   By asking about this preservation ritual before throwing the placenta away, you show a cultural competence and respect for the patient’s culture.  

Cultural accommodation is including aspects of culture into western practice if it is not harmful.   In the Gypsy culture, childbirth is viewed as unclean.   Many of their women will receive prenatal care through their midwives in their village and only go to the hospital for the birth so as not to make their home unclean.   They believe in the support of the village.   When we had a patient come in to give birth, she arrived with no less than 15 people to attend the birth.   The OB was not happy with this and tried to empty the room until the nurse took charge.   The number of people was reduced but the majority remained with an understanding that if an emergency came up they would need to exit the room.   Once the OB understood the cultural relevance, he could take a step back and allow for this ritual.  

Cultural repatterning is changing a harmful health practice while still respecting the culture.   In L&D, we see the practice of female genital cutting.   This is practiced in 28 African countries as well as other areas.   Genital cutting is the excision of part or all the female external genitalia for non-medical reasons.   This takes place around the age of 14.   The negative outcomes are many.   Women’s groups and human rights activist have placed this as a high priority to stop this harmful practice.   Community education is key to increase public awareness.   Harmful traditions seem impossible to change.   Through policy makers, community leaders, and education the message will get out there (Hersh, 1998) .

Cultural brokering is the intervening for the patient, providing the appropriate care.   An example of this would be the young Hispanic girl that comes to the hospital to have a baby, her family refuses to sign for the epidural.   They believe that the epidural could have negative long lasting effects on her back.   They also believed that this young girl needed to be taught a lesson, through the pain, maybe she would not have sex again before marriage.   This type of withholding medication is not allowed, the patient could sign for her own epidural even though she was a minor.     We could provide the best care for her.   The barrier is the families wishes were not observed.  

 

References

Hersh, L. (1998). Giving up harmful practices, not culture. Retrieved from http://www.advocatesforyouth.org/publications/publications-a-z/521-giving-up-harmful-practices-not-culture

Maurer, F. A., & Smith, C. M. (2013). Community/public health nursing practice (5th ed.). [Elsevier]. Retrieved from Elsevier eBooks

 

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All populations have some risk, but risks for multiple illness conditions and premature death are much higher for specific populations. Community health nurses need to explore the multiple factors that contribute to health disparities among vulnerable portions of the population. Vulnerability is the predisposition or susceptibility to injury, illness, or premature death. To improve health status and reduce risk in high-risk populations, nurses must work with communities to identify and change, where possible, the factors that contribute to the populations’ vulnerability (Maurer & Smith 2013 paga 398).

The awareness of groups “at risk” for poor health differs from vulnerable populations. “A population at risk is a population with common identified risk factor exposure that poses a threat to health (Stanhope & Lancaster, 2014 pg 189). For instance, a population at risk for cardiovascular disease consists of all adults who are overweight and hypertensive. A population at risk is characterized by homogeneously high level of exposure to a single risk factor and all individuals in an “at risk” group can potentially develop an adverse health condition due to some risk factor. For example,  smoking, which places all smokers at risk for developing lung cancer.

 A vulnerable population is a “subgroup of the population that is more likely to develop health conditions for which they are at risk, which makes them more vulnerable” (Stanhope & Lancaster). For example, an individual with chronic condition such as cancer may already have difficulty managing his/her condition and have less physical ability to cope with stress than someone without such condition, thus putting them at risk for developing other comorbidities. Therefore, vulnerability results from the combined effects of limited resources, which create a more hazardous situation (Stanhope & Lancaster.

Living in a community with limited resources affects vulnerability in many ways. Those who are poor are faced with many risk factors that cause chronic stress. For Example, violence, barriers to health care and bills. Thus impacting their abilities to effectively respond to stressful situations.  Lack of knowledge, resources, skills and language barriers can further negatively impact the ability to overcome stress producing situations. The goal for nurse is to represent vulnerable population and help them solve problems and develop solutions for their situations. For example, elderly groups, they are vulnerable to emotional, physical health and socioeconomic problems. Those who are mentally and physically disable and do not speak English and are financially burden all need assistance to at take advantage of and utilize services and programs that may benefit them. In the role of advocacy, nurses should collaborate with the elderly and develop understanding of their values and perception and help the achieve independence through effective education and access to resources.

 

Maurer, F., Smith, C. (201). Community/Public Health Nursing Practice, 5th Edition. [VitalSource Bookshelf Online]. Retrieved from http://evolveebooks.elsevier.com/#/books/978-1-4557-0762-1/

Stanhope, M. & Lancaster, J. (2014). Public Health Nursing: Population-Centered care in the community (8^th ed). Retrieved from http://books.google.com