Culture and the understanding of advanced heart failure: A mixed-methods systematic review

BackgroundCultural values and beliefs influence understanding of health and illness, but we do not know their impact on patients’ understanding of advanced heart failure.AimsWe explore how culture influences the understanding of advanced heart failure for patients and their family members, and how culture influences the adoption of healthy behaviours.Method/Data SourcesIn this mixed-methods systematic review, we systematically searched MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, PsycINFO, and Cochrane CENTRAL with no time limits using relevant MESH terms and keywords. Papers were themed, synthesised, and grouped into domains. The theoretical framewok PEN-3 was used to underpin the findings.FindingsWe screened the full-text of 194 studies and found 13 articles eligible; of which six were qualitative studies, five quantitative and two were mixed-method studies. In these studies, patients’ understanding of, and response to, symptoms were strongly linked to cultural beliefs. Patients from Eastern and Middle Eastern countries somatised symptoms more than those from Western cultures. Patients from Western cultures reported higher symptom distress scores. Peoples’ cultural beliefs about health and disease inform lay knowledge of heart failure diagnosis, causes, treatment and self-management and influence their healthcare decisions and behaviours.ConclusionWe found that health care practice and research in heart failure has not previously been influenced by culture. People with heart failure and their family members could be helped better by health care practitioners if their cultural values and beliefs were integrated into health care practice and policy. We argue that this is essential for the successful development of culturally competent care interventions for all people with advanced heart failure.     

Culturally competent nursing care during the perinatal period

Effective nursing interventions require culturally competent nursing practice. Nurses can develop the skill sets needed to provide culturally competent care. These skills derive from nursing principles and practice that support respect for individual dignity and self-determination. Sweeping changes in health care delivery have shortened the length of client exposure to nursing care, especially in perinatal nursing. Moreover, changes in the United States population challenge the nurse's ability to respond appropriately to the expectations, values, and beliefs of many diverse cultural groups. Nursing theoretical frameworks provide a basis for cultural competence in practice.     

End-of-life practices at a Lebanese hospital: courage or knowledge?

End-of-life care requires knowledgeable and culturally sensitive clinicians to assist patients and families dealing with the difficult journey of death. The authors present important end-of-life considerations for health care providers dealing with culturally diversified patients. A case study approach is used illustrating two case vignettes derived from the practice of an intensive care setting of a tertiary teaching facility in a large urban area in Lebanon. In a multidisciplinary fashion, practices of end of life were explored and a protocol developed to guide health care providers. Special cultural values were identified such as importance of family involvement and religious beliefs. Implications for practice are described.     

Cultural considerations in interprofessional education and practice

Promoting cultural competency in health care was examined from the Canadian perspective, and explored practice environments and educational programs for future health professionals that foster cultural awareness and support culturally sensitive care. Many of the issues raised are generic and likely to occur whenever patients' health practices and beliefs differ from conventional Western care. The main theme that emerged with respect to the practice environment was the use of a participatory action approach to foster collaboration with patients, traditional healers and the community. Successful collaboration is likely to result in a blend of ideas and perspectives from traditional health practices and conventional Western health care. With respect to education, programs need to focus on providing opportunities both in the classroom and in the clinical arena for students to work in interprofessional teams. These teams should not only comprise partners from medicine, nursing, physical therapy and other health professions but also include aboriginal paraprofessionals. Pedagogical initiatives also need to incorporate case-based formats and interactive sessions with patients and families. The principles underlying this approach: openness, mutual respect, inclusiveness, responsiveness and understanding one's roles should be fundamental to the delivery of culturally competent health care to all ethnic communities.     

Culturally competent nursing care: listening to the voices of Mexican-American women

Mexican-Americans represent the fastest-growing minority population group in the United States. Gaining a cultural perspective of health care in the Mexican-American population necessitates listening to the voices of women because they assume primary responsibility for maintaining family health. The Transcultural Assessment Model developed by Giger and Davidhizar (2004) provides the framework for this exploration of Mexican-American women's health care views. From this model the investigators developed an interview guide based on social organization and environmental control. Thematic analysis of interviews with six Mexican-American women revealed the importance of the family, religion, and locus-of-control in the health beliefs, attitudes, and lifestyle practices of this culture. Using the voices of Mexican-American women the investigators seek to promote an understanding of the culture as a guide for nursing care. The purpose of this article is to increase awareness of the Mexican-American cultural phenomena of social organization and environmental control which can guide the nurse to provide culturally competent care that meets the needs of Mexican-American women and their families.     

Smooth a heart with water: Thai mothers care for a child with schizophrenia.

Little is known about caregiving of persons with schizophrenia in Asian families. This report explores culturally specific beliefs and patterns of response among Thai families. In-depth interviews were conducted with 12 Thai mothers of adult children with schizophrenia. Thai mothers responded to children's symptoms by practicing Thum-jai and creating a calm family environment. Maternal response was constituted by concerns about social expectations, escalation of the symptoms, and violating cultural values. Assessment of and attunement to Buddhist beliefs in the care of Thai families and immigrants are recommended.     

Cultural assessment and care planning

Culturally competent care adapts care to the patient's cultural needs and preferences and begins with a cultural assessment that forms the care plan's foundation. Nurses who assess their patients' cultural beliefs, values, and practices are better able to individualize care and achieve positive outcomes. This article describes a cultural assessment tool, strategies for obtaining cultural assessment data, and a process for creating a culturally appropriate care plan.     

Health beliefs, practice, and priorities for health care of Arab Muslims in the United States.

The Arab Muslim population is one of the dramatically increasing minorities in the United States. In addition to other factors, religion and cultural background influence individuals' beliefs, behaviors, and attitudes toward health and illness. The author describes health beliefs and practices of the Arab Muslim population in the United States. That population is at an increased risk for several diseases and faces many barriers to accessing the American health care system. Some barriers, such as modesty, gender preference in healthcare providers, and illness causation misconceptions, arise out of their cultural beliefs and practices. Other barriers are related to the complexity of the health care system and the lack of culturally competent services within it. Nurses need to be aware of these religious and cultural factors to provide culturally competent health promotion services for this population. Nurses also need to integrate Islamic teachings into their interventions to provide appropriate care and to motivate healthy behaviors.     

Unequal cancer survivorship care: addressing cultural and sociodemographic disparities in the clinic

The number of individuals diagnosed with cancer is growing worldwide. Cancer patients from underserved populations have widely documented disparities through the continuum of cancer care. As the number of cancer survivors (i.e., individuals who have completed cancer treatment) from underserved populations also continue to grow, these individuals may continue to experience barriers to survivorship care, resulting in persistent long-term negative impacts on health and quality of life. In addition, there is limited participation of survivors from underserved populations in clinical trials and other research studies. To address disparities and change practices in survivorship care, a better understanding of the roles of both socioeconomic status (SES) and of culture in cancer care disparities and the relevance of these to providing high-quality care is needed. SES and culture often overlap but are not identical; understanding the impact of each is especially relevant to survivorship care. To enhance health equity among cancer survivors, clinicians need to practice culturally competent care, address cultural beliefs and practices that may influence survivors’ beliefs and activities, gain awareness of historical patterns of medical care in the survivor’s community, and consider how barriers to cross-cultural communications may hinder communication in clinical settings. While the design and implementation of survivorship care programs emphasizing effectiveness and equity is complex and potentially time consuming, it is critical for providing optimal care for all survivors, including those from the most vulnerable populations.     

How do rural health care providers and patients view barriers to colorectal cancer screening? Insights from appalachian kentucky

This article reports findings from a qualitative study that explored the attitudes and beliefs concerning colorectal cancer (CRC) screening among patients and health care providers in Appalachian Kentucky. Results from 5 focus groups are discussed here: 3 with primary care providers and 2 with patients. Although there are some areas of agreement, there are marked differences between the perceptions of Appalachian health care providers and participants regarding CRC screening. This article compares and contrasts those perceptions and provides suggestions for culturally competent practice and culturally relevant research to improve CRC screening in this vulnerable population.     

Culturally sensitive communication in healthcare: A concept analysis

BackgroundLimited guidance exists on culturally sensitive communication related to interactions between clinicians, patients and families.ObjectivesTo explore the concept of culturally sensitive communication and identify clinical practice implications and knowledge gaps related to culturally sensitive communication in healthcare.MethodsA concept analysis was undertaken, using Walker and Avant’s (2011) framework which comprises eight consecutive steps to explore the concept and clinical practice implications. A systematic literature search was undertaken to identify papers published between January 1, 1995 and December 20, 2017, leading to the inclusion of 37 relevant research papers in the concept analysis.ResultsBased on the research literature, examples of model, borderline and contrary cases of culturally sensitive communication were developed. Three major uses of culturally sensitive communication were identified, including understanding one’s own culture, open and sensitive communication, and strategies to collaborate with the patient and family for optimal patient care. An awareness of one’s own cultural beliefs, values, attitudes and practices was identified as an essential first step before learning about other cultures. This awareness includes being sensitive and adaptive to individual cultural differences and relies on clinician self-understanding and reflection. Strategies to collaborate with the patient and family for patient care include respectful and supportive clinician interactions with the family that enable a collaborative approach to care.ConclusionsThis concept analysis aids understanding of culturally sensitive communication, the benefits and challenges associated with its use, and clinical practice implications.     

Future nurses’ cultural competencies: what are their learning experiences during exchange and studies abroad? A systematic literature review

kokko r. (2011) Journal of Nursing Management 19, 673–682
Future nurses’ cultural competencies: what are their learning experiences during exchange and studies abroad? A systematic literature review Aim This article describes the development of cultural competence among nursing students. The focus is on illuminating the learning experiences of nursing students during their exchange. Background As the world gets smaller, the demand for culturally competent nurses increases. Future nurses need to be open-minded towards international cooperation and willing to develop the quality of care from a cultural point of view. Nursing education in many countries provides an option for students to learn nursing in different cultures while taking part of their studies abroad. Methods A systematic literature search was conducted. Inductive content analysis was applied to the data consisting of empirical studies (n = 7) describing nursing students’ studies abroad. Results The process of developing cultural competence among nursing students on exchange was found to consist of three main themes, namely: (1) an increased cultural knowledge base, (2) personal growth and (3) the impact of exchange experiences on the nursing student’s own practice. Conclusions Studies abroad are a beneficial strategy for the development of future nurses’ cultural competence. Implications for nursing management Nursing is facing a crucial challenge to recruit culturally competent nurses, because an increasing number of patients are from different cultures. Nurses with experiences of studying abroad can offer employers a resource through their preparedness for culturally competent nursing.     

Understanding the culture of Chinese children and families.

Providing appropriate health care to a client can be accomplished only in an environment that is sensitive to the cultural values and beliefs of the client. As the population of first- and second-generation Chinese immigrants increases in the United States, the need to develop culturally sensitive health care becomes significant. Chinese immigrants and their families have become an important part of American society, including the school setting. The school nurse, who regularly works with students and families, should work in a manner that allows Chinese immigrants to maintain their cultural values and beliefs, while providing appropriate care for the student. The Chinese culture is unique and holds values and beliefs that contrast with those of the Western culture. A school nurse who understands and incorporates the Chinese culture will be better able to develop a positive interaction with the family and make arrangements for culturally appropriate care.     

Cultural diversity: a challenge for community nurses

Cultural diversity is a challenge for community nurses and can present many difficulties in the provision of quality nursing care and in achieving optimal health outcomes. In this paper seven enabling principles are identified and their application to diverse groups discussed. These include: willingness to recognize expert family skills and knowledge, acknowledging own and other nurses' strengths and weakness, taking time to establish rapport and acceptance, assessing influences on health and health care, providing care that is culturally appropriate, developing cultural competent practice and advocating for CLD appropriate resources and expertise. The aim of this paper is to assist community nurses to provide nursing care congruent with the many lifeway practices encountered in the community. Diverse cultural groups with distinguishing dominant characteristics of ethnic orientation, aboriginality, and disability are selected as examples to demonstrate the application of the principles.     

Cultural differences with end-of-life care in the critical care unit.

Critical care nurses are providing healthcare for an increasingly multicultural population. This ever-increasing diversity in cultures and subcultures presents a challenge to nurses who want to provide culturally competent care. It is common for patients and families to face difficult decisions about end-of-life care in critical care units, and minority cultures do not always believe in the Westerner's core values of patient autonomy and self-determination. Knowledge of these cultural differences is fundamental if critical care nurses wish to provide appropriate and culturally competent information regarding end-of-life decisions.     

Understanding culture care practices of caregivers of children with cancer in Taiwan

This ethnonursing method (Leininger, 1985) was used to explore the emic perspectives (insider's perspectives) of cultural care practices of caregivers who have children with cancer in Taiwan. Forty key and general informants, including 34 family caregivers and 6 nurses, were interviewed in a medical center located in the central region of Taiwan. The results and conclusions included the emergence of significant themes such as caregivers' use of all cultural knowledge (folk and Western) that was available to them and that became available to promote the best and most appropriate methods of health care for the child. The second theme was the influence of cultural context on caregivers' decision-making for the child's overall health and care. The third theme was the caregivers' promotion and expectation of a care practice of unconditional giving for the purpose of recovery from the illness and well-being for the child with cancer. The results of this study could promote culturally competent care for Taiwanese caregivers and children with cancer. Nurses would be able to understand and integrate generic and professional care and promote culturally congruent professional care to Taiwanese caregivers who have children with cancer.