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Cultural Competence in Health Care

Introduction

In healthcare, cultural safety refers to the operational nursing practice of a family or a person from a different culture that is determined by that family or person. Cultural safety originated from nursing education, and according to it, culture can range from disabilities, religious beliefs, occupation, sexual orientation, gender, generation or age. Cultural safety is associated with four principles. The first principle aims at improving the well-being and the health status of all the people in the country regardless of their cultural background. The second principle involves improving the health services’ delivery. The third principle focuses on the differences that exist among the individuals being treated and accepting these differences. The last principle centers on understanding the power associated with health services as well as the manner in which health care influences families and individuals. The subsequent literature explores circumcision, the aboriginal people and the importance of birth on country and organ donation and acceptance as unique cultural needs of people to enable the provision of culturally safe care.

Circumcision

Circumcision refers to the removal of the male’s foreskin from the penis (Tobian, Reed & Njeuhmeli, 2016, p. 295). Using the common method, the foreskin is opened, the grips are detached, and the foreskin is disjointed from the glans. After this procedure, the circumcision devices are placed, and the foreskin is removed. To reduce physiological stress and pain, locally or tropical injected anesthesia can be used. Circumcision is considered to be an elective surgery that is carried out on children and babies for cultural or religious reasons. However, this procedure may be carried out for preventive reasons or as a treatment for some medical conditions. In the medical field, circumcision is considered to be a treatment choice for problematical cases of balanoposthitis and phimosis which cannot be resolved through the use of other types of treatment as well as enduring urinary tract infections.

Although male circumcision is considered to be a simple process an emotive and complex health issue, in Australia, it continues to generate endless debates among the medical professionals and the community. In Australia, the current prevalent public policy suggests that no medical reasons are associated with routine circumcision especially in newborns. As a result, the circumcision rate in Australia has decreased in the recent years. Statistics show that only 32% of the men under 30 years in Australia are circumcised. In the year 2010, the Royal Australasian College of Physicians published an updated strategy report on male circumcision. This report analyzes both the benefits and the risks as well as the states. After reviewing the available pieces of evidence, the Royal Australian College of Physicians perceives that the occurrence of the diseases that can be modified through circumcision, the amount of protection that is provided by circumcision as well as the rate of complications associated with circumcision do not deserve routine newborn circumcision in Australia. However, this report states that it important for the parents to weigh both the risks and the benefits associated with circumcision to come up with a decision on whether to circumcise their sons. In Australia, if a parent decides to circumcise his son, he is responsible for ensuring that the procedure is carried out in a safe and family-friendly environment and by a competent and appropriately trained practitioner. It is also important to ensure that the practitioner performing the procedure can handle all the complications that are likely to arise and is also well-informed in using proper analgesia. Although Australia continues to offer circumcision in situations where there are identified needs for a surgery to be carried out to enhance the physical health of the patient, circumcision without a therapeutic reason is no longer performed in public hospitals.

To provide culturally safe health care on circumcision, registered nurses are responsible for providing both the pros and cons of circumcision to the parents to ensure that they can come up informed decisions on whether their sons should undergo circumcision. This is because many communities differ in their perception towards circumcision where some consider it to an important rite of passage while others consider it to be less important. Whether important or not as per the beliefs of the cultures that one is associated with, registered nurses are responsible for ensuring that the circumcision procedure is carried out in a clean environment to make sure that the patient is not exposed to risk factors leading to unexpected outcomes. Nurses are also responsible for taking care of the patient from when the procedure is fully undertaken to the time that he recovers fully.

Organs Donation and Acceptance

Organ donation and acceptance occurs when one individual allows one of his organs to be legally removed, either by agreement when he is alive or after his death with the approval of his next of kin and another individual accepts the removed organ to be transplanted in her body to save her life (Goldberg et al, 2016, p. 847). However, the donation may take place for research purposes. Some of the organs that are commonly donated include corneas, skin, bone marrow, bones, lungs, intestines, pancreas, liver, heart and kidney. Although some tissues and organs such as part of the intestines, lungs, pancreas, liver and kidney are commonly donated when the donor is alive, most donations take place after the death of the donor. In case the donor is alive, the process of organ donation involves extensive testing including the psychosomatic evaluation to determine if the donor agrees and understands the process. In case the involved donor is dead, the physicians are responsible for verifying the death multiple times to ensure that doctors do not overlook any signs of life. After the verification, the body is kept on a mechanical ventilator to ensure that the organs that are to be donated are in good condition.

In Australia, organs donation and acceptance system are different, and it is based on the model of informed consent (Alexander, Clayton & Chadban, 2017, p. 891). According to this model, people decide to donate their organs during their death. An individual can record his objection or consent to become a donor on the Australian Organ Donor Register. Whether a person has recorded his donation consent or not, the practice of organs donations and acceptance in Australia is to seek treaty the donor’s relative before the donation process starts. Due to the high demand for transplantation in the country, statistics indicate that the rate of organ donation does not meet the demand. For instance, 2014 statistics indicated that more than 1600 people needed every month but only 1117 people underwent the transplant. To increase the rate of organ donation in this country, the government came up with a clinical taskforce on organ donation. Additionally, the government came up with a national reform program to portray Australia as a leader in organ donation in the whole world. The objectives of this reform program were to increase both the capacity and the capability in the health system to increase the rate of donation to raise stakeholders’ engagement and community awareness across the country to promote organ donation.

To provide culturally safe health care on organs donation and acceptance, registered nurses are responsible for ensuring that both the organ donor and the organ recipient are in agreement with the rules of the procedure and they are willing to undertake it. This implies that registered nurses are responsible for making sure that both the recipient and the donor are aware of all the steps associated with the process as well as its outcomes. Additionally, nurses are also responsible for interrogating both the donor and the recipient to determine whether the procedure is acceptable as per their culture. This is to ensure that nobody is involved in a procedure that is not acceptable in her culture. After ensuring that both the donor and the recipient are fit for the procedure, registered nurses are also responsible for helping the involved doctor during the procedure as well as for monitoring the patient’s heart rate and vital signs and administering various medicines to reduce pain.

The Aboriginal People and the Importance of Birth on Country

According to research, about 9.6 of every 1000 aboriginal infants are born dead or die during birth or during their first 28 days after birth as compared to more than 8 non-aboriginal infants. This implies that ensuring that maternity care is factual for the aboriginal women is crucial to make sure that this gap is closed. This is because most of the aboriginal women cannot access culturally competent and high-quality maternity care. For instance, an audit that was carried out in Western Australia found out that more than 70% of the services failed to give sensitive maternity care to the aboriginal culture (Thackrah, Thompson & Durey, 2015, p. 77). However, in 2014, the federal government reviewed the maternity services and recommended improvements in access to care for the aboriginal moms thus increasing birth choices. Some of these options include birthing on country. Birthing on country refers to a situation whereby an aboriginal mother is allowed to go and give birth in her ancestral land. In the ancestral land, a traditional midwife with expert knowledge is responsible for providing care to the pregnant women. There are many reasons as to why most of the aboriginal women prefer giving birth in their ancestral land even without healthcare support. For instance, some women develop some physical connection to their ancestral land during birth while others feel that it is impossible to have a culturally and spiritually enriching hospital birth due to traumatic hospital experiences.

In Australia, birthing on country occurs when Australia’s first persons hold on to the traditional practices to connect the pregnant women, the process of birthing and the infants with their ancestral land commonly referred to as the country (Kildea et al, 2018, p. 231). However, no approach to birthing on the country has been established in Australia since most of the Aboriginal and Torres Straits Islander communities in this country differ in their ethnic values as well as the manner in which they approach birthing on the country. According to various organizations, birthing on the country is a metaphor for the start of life for the aboriginal infants as well as their families that provides the right changeover to parenting and motherhood as well as a holistic, integrated and culturally suitable model of providing healthcare to all. According to scholars, in Australia, birthing in the country is important since it helps in providing various cultural elements and health benefits for the country’s first persons. This is because early childhood, birth and pregnancy are considered to be important periods for both the babies and the mothers’ health.

To provide culturally safe health care on birthing on the country, registered nurses should play a major role in pushing for the birthing on country programs through highlighting on the need for aboriginal midwives and especially the role that these midwives can play in facilitating birthing on the country. Through these programs, registered nurses can also help in ensuring that aboriginal women can also access culturally safe childbearing care in their communities. This will help safe aboriginal women from travelling long distances to give birth in places where they experience racism and end up giving birth in culturally unsafe environments. Scholars also claim that implementing birthing on country programs through registered nurses helps in providing stronger relationships between the health care providers and the community. Additionally, these programs help in reducing diabetes and smoking during pregnancy since through the relationships that are established, nurses can guide pregnant women on healthy eating as well as on the risks associated with smoking in pregnant women.

Conclusion

From the literature above, it is evident that cultural safety exemplifies a major philosophical change from providing health care regardless of their cultural differences to healthcare that takes consideration to the unique needs of other people. This is because the literature above indicates that there are different and unique cultural needs that ought to be met by the health care providers to provide culturally safe healthcare. This implies that health care providers and especially the registered nurses play a major role in ensuring culturally safe healthcare since they work hand in hand with the members of the community.

Reference

Alexander, S. I., Clayton, P. A., & Chadban, S. J. (2017). Organ transplantation in Australia. Transplantation, 101(5), 891-892.

Goldberg, D. S., French, B., Lewis, J. D., Scott, F. I., Mamtani, R., Gilroy, R., ... & Abt, P. L. (2016). Liver transplant center variability in accepting organ offers and its impact on patient survival. Journal of hepatology, 64(4), 843-851.

Kildea, S., Hickey, S., Nelson, C., Currie, J., Carson, A., Reynolds, M., ... & West, R. (2018). Birthing on Country (in Our Community): a case study of engaging stakeholders and developing a best-practice Indigenous maternity service in an urban setting. Australian Health Review, 42(2), 230-238.

Thackrah, R. D., Thompson, S. C., & Durey, A. (2015). Exploring undergraduate midwifery students’ readiness to deliver culturally secure care for pregnant and birthing Aboriginal women. BMC medical education, 15(1), 77.

Tobian, A. A., Reed, J., & Njeuhmeli, E. (2016). An evidence-based analysis of voluntary medical male circumcision devices. Nature Reviews Urology, 13(5), 295.

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