NUR141#7

Set of values, beliefs, and traditions held by a specific social group...

Ð Subculture: ex: Little Italy, Chinatown. Regional culture: Philly is no more like NY than NY is like Philly, differences in language

Ð Dominant group: larger cultures such as the American culture

Ð Minority group: Amish, inbreeding can cause health issues

• • Share common heritage-German, Vietnamese
• • Belong through birth or adoption of the group characteristics
• • Unique cultural/social beliefs and behavior patterns

• Based on specific physical characteristics, such as
• – skin color
• – body stature
• – facial features
• – hair texture
• -based on geography, Ex: equator, darker skin, northern europe=lighter skin

Ethnic values are replaced by the values of the dominant culture. First generation of immigration generally don't want to know about their culture, not until 2nd generation.

• • Stereotyping-assuming all members of a culture act alike, everyone is "one way".
• • Cultural Imposition-belief everyone needs to conform to the majority
• • Cultural Blindness-assuming an immigrant knows how to conform to rules of the hospital
• • Culture Conflict-becoming aware of cultural differences and respond by ridicule.

• Feelings experienced when someone is placed in a culture different
• from their own.

The belief that one’s own ideas, practice and beliefs are superior to that of others. Not uncommon in US. Look at Table 3-1.

• Gender roles- many cultures where male makes most of decisions

• • Language and Communication-difference of language, do not let a child or a member of family be a translator. Get a professional translator trained in medical terminology.
• Try to have same gender as patient, especially concerning sexual matters.

• Food and Nutrition-can vary greatly between cultures, but be careful of diet the patient may be on so family can bring in food.

• • Personal space is the area that surrounds a person’s body.
• • Intimate zone- 0 to 18 inches
• • Personal zone- 18 inches to 3 feet
• • Public zone- 3 to 6 feet

• • Socioeconomic factors: ex: cold water flats in Wilmington and outhouses, working poor have no access to healthcare so they don't come in until very sick. No access to dental care.
• • Family support- some have large extended families, others do not.
• • Physical and Mental Health-some view illness as punishment from God.Some believe illness is caused by spirits.

• • Biological differences exist among people of various racial and cultural groups
• • During your assessment you will note variations in: body structure, skin color, enzymatic and genetic variations, and disease susceptibility ex: malaria---->sickle cell

• The provision of nursing care that is sensitive to the needs of patients, families, and groups of diverse cultural backgrounds. If you have questions ask them.

• Cultural ignorance may lead to incorrect diagnoses.

• • Includes verbal and nonverbal behavior
• • Assess YOUR personal beliefs
• • Nurse must demonstrate RESPECT!

• • Establish and maintain trust.
• • Demonstrate respect and privacy
• • Preserve cultural beliefs Ex: Mr. Mrs. and miss
• • Accommodates a client’s cultural needs-Ex: Gypsys
• • Implement a transcultural nursing approach

No need to be blunt, but do not lie.

• Ethics (Us=ANA code of ethics) Look in back of Taylor
• • Questions how we should act

• What is right and wrong

• Values
• Belief of worth that determines behavior

• • Modeling-children learn from our behavior
• • Moralizing-environment can determine moral grounding
• • Laissez-faire-no particular rules
• • Rewarding/Punishing-good behavior=reward, bad behavior=punishment
• • Responsible choice: allows child to decide for themselves

• • Altruism-thinking of the other
• • Autonomy-adult patients have this to decide course of care
• • Human Dignity-every human has this right, each one is unique, treat them
• • Integrity-act within code of ethics for nursing, tell truth, don't lie about mistakes you made, especially medication. Own up to it.
• • Social Justice-uphold the law and morals, and your own moral code. Equal treatment.

• • Nursing Codes of Ethics-international council of nursing, ANA
• • Standards of Practice
• • Patients Bill of Rights-found in patients rooms. Written by Joint Commission

Role of Nurse as Advocate

• -Representing patients:
• If patient doesn't understand what is happening, then bring back the doc!

- Promoting self determination:



- Being politically active: join the groups that are out there

• Types of Law
• • Constitutions
• • Statues
• – Nurse Practice Acts http://www.state.de.us/research/AdminCode/title24/1900%20Board%20of%20Nursing.shtml#TopOfPage
• • Administrative Law
• – Board of Nursing
• • Common Law-comes from English common law

• Voluntary Standards:developed by nursing organizations, ANA are voluntary standards, but not necessary to obey

• Legal Standards-developed by legislation, such as licensure, some states have joined to have same standard

• Purpose of Credentialing-exam demonstrates a mastery of a certain skill.

• • What is a crime?
• – Misdemeanor-less than a year in jail
• – Felony-more than a year in jail

• • What is a Tort?
• – Negligence-covers a wide perimeter, when dr. or nurse commits a wrong it is malpractice, civil suit. Criminal charges rarely brought against RNs. malpractice is to due with professional practice.

• • Assault(threat) & Battery(actual contact)
• • Defamation of character-making statements about anyone that defames their character. Don't do it verbally or in writing
• • Invasion of Privacy-speaking about a patient outside the proper realm
• • False Imprisonment-restraining a patient inappropriately, don't lock their door, If patient wants to leave, they must sign paper
• • Fraud-Willful misprepresentation such as a test the patient needs, charging to much for services as in medicaid and medicare.

• • Purpose……….. patient must parrot this back
• • When………..
• – Admission
• – Specialized diagnostic procedures/treatments
• – Experimental treatments/procedures
• • Who………

• Follow hospital protocol and procedure!
• • Ensure Patient Safety
• • Proper Techniques
• • Monitor & Report-If you haven't documented it hasn't been done.
• • Avoid Medication Errors-5 rights 3 checks

Note box 7-4 on pg 136 (Taylor) Nursing Malpractice Prevention

• Responsible for own actions-if you pass the test, you are responsible for contents
• Held to same standards as the RN
• Responsible for knowing how to perform skills
• Responsible for knowing agencies policies
• Responsible for noting changes clients and informing the instructor or the RN responsible for the client.

• • Follow Agency Protocols
• • Documentation
• • Equipment Use
• • Report Adverse Incidents

• • Communication-spelling and punctuation do count
• • Legal Document-computer program counts, one line through error and date and initial
• • Other Purposes- to create nursing plans of care.

• – Objective…..NOT….Subjective
• – Avoid generalized terms or statements
• – Note occurrences in order
• – Document other consultations & procedures
• – Know & adhere to legal & professional standards
• – Document response to questionable medical orders or treatment …. or failure to treat.

• F = Factual


• A = Accurate


• C = Complete


• T = Timely