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Case Study
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Discussion Postings on Cultural Influence (Case Study Sample)

I have listed three discussion postings on Cultural Influence and i need you to state whether you agree or disagree and if you agree (why) and if you disagree (why). Presented by Bridget: 1)Determining the patients cultural preferences can have an influence on how pain will be perceived and managed, who will be present in the room during childbirth, cord cutting, gender of doctor and staff allowed in room, any certain herbal supplements they may rely on and possible interactions with western medicine that may be used, any specific birth rituals or customs followed during or after birth, and also what type of medication and treatment will be accepted if complications arise. There may be a language barrier or they may not fully understand what is happening if a complication arises. Everyone on the delivery team should be made aware of the information and if a member of the team does not support the modifications made then it may be best to get another staff member to be part of the patients team. EXAMPLES: Labor/Delivery Korea - stoic; Fathers usually not present Japan - natural childbirth practiced; May labor silently; May eat in labor; Father may be present China - stoic response to pain; Fathers usually not present; Side-lying preferred (thought to decrease infant trauma) India - natural childbirth practiced; Father usually not present; Female relatives usually present Iran - Fathers not present; Prefers female support and female care givers Mexico - may be stoic until second stage, then may request relief; Fathers and female relatives may be present Laos - squatting position used; Fathers yes or no; Prefer female attendants Cultural Beliefs about Pain Chinese - may no exhibit reaction to pain. Although it is acceptable to exhibit, they consider it impolite something when first offered - may need to offer interventions more than once.; Acupuncture Arab/Middle Eastern - may be vocal in response to labor pain; may prefer pain meds in labor Japanese - women may be stoic in response to pain, but may request meds when pain is severe Southeast Asia - may endure severe pain before requesting relief Hispanic - may be stoic until late labor, when they may become vocal and request relief Native American - may use meds or remedies made from indigenous plants. Are often stoic in response to labor pain African-American - may express pain openly; use of meds varies Presented by Jamie: 2) According to Greene (2007), culture is defined as a particular group's beliefs, norms, and values, rules of behavior and lifestyle practices that are shared. Childbirth can be viewed as a universal experience among all women but cultural belief systems and traditions define the way a person responds to and participates in their care. Each particular culture has its own sets of beliefs, attitude and values surrounding childbirth and it is important for the nurse to ask about and understand those cultural views in order to provide sensitive, appropriate and effective care to the patient. During the initial assessment the nurse will determine the condition of the mother and fetus and the progression through the stages of labor. Because the nurse will continually asses the patient through the labor and birthing process it is important to establish a rapport with her and the family, if present. I would begin by making sure the patient and family understand the language that will be spoken in the delivery suite and provide an interpreter if needed. I would ask the patient if there are any specific requirements needed to ensure the patient's comfort and adherence to their cultural and spiritual beliefs. As the nurse it is my job to maintain and promote a safe and comfortable environment, provide emotional support and comfort, serve as the patient's advocate and assist to provide a positive birth experience for all. During the nursing process I should be cautious not to judge or criticize for differences between my beliefs and those of my patients and continue to provide a consistent standard of care. I would be aware of my patients and family's way of communicating, gestures, facial expressions and the space in which they occupy. Because cultures are so different, it is impossible to be familiar with all of them so I would get the majority of information by observing, listening, mirroring and paying attention to clues, so that way I could provide a more individualized path of care for my patient. Touch is a very “touchy” situation in some cultures so I would probably avoid any unnecessary touching unless I was prompted by the patient. It would be important for me to pass along information to every member of the health care team as it relates to my patient's assessment, the current labor stage and my patient's cultural beliefs and practices in order to continue to provide safe, effective and compassionate care. If there were team members who had a major problem with the patient's culture, preferences or beliefs I would recommend that another provider take that person's place if possible. If it was just a circumstance of someone not agreeing with someone else's beliefs, I would remind that provider that as a nurse our responsibility for our patients safety and wellbeing is first and foremost regardless of their spirituality or culture and as long as patient's culture does not interfere with what happens medically, than they should accept it and remain professional or have someone replace them. In a situation where complications arose during the labor or birthing process, I would try to keep the mom and family (if applicable) informed of what was happening and let them know the reality of things happening quickly but only out of necessity for her wellness and safety of the baby. Depending of the cultural preferences, that information could also come from the MD or the midwife. 3) Presented by Tracy As a culturally competent RN working in labor and delivery collecting information from my patient regarding her cultural preferences is an important tool to help me understand and meet the needs of both the patient and her family. The goal is for them to have a positive birth experience and to meet that goal one would have to take into consideration the customs, beliefs and values of the patient as they relate to healthcare, the birthing process, communication, modesty, pain, and support systems even if they are not considered main stream in the medical community. Many cultures have distinct and varying views as to how the birthing process should progress. Some cultures rely strongly on the husband to speak for the patient while others consider it immodest for the husband to be present during the birth. Like modesty there are different views on the pain experienced during the birthing process. In some cultures it is considered shameful to cry out in response to pain while in others it is acceptable. Some cultures accept pain as part of the due process of childbirth that must be endured (Kinsman, R. 2010). The knowledge of my patient's cultural preferences may influence the care and approach I use in ways such as the volume and tone of my voice, suggestions I make for pain management, whether or not I defer questions to the patients husband or family, if it is acceptable to make eye contact or avoid making eye contact, how I approach physical assessments, and direction I give to other members of the healthcare team who may assist with the care and monitoring of my patient. Making sure that others are aware of my patients cultural preferences and adhere to them is also an important way to ensure a trusting relationship between the nurse, her patient and the patients support system. If a member of the healthcare team chooses to not honor the cultural preferences of the patient then I would ask the individual to not partake in her care. Allowing the staff member to disregard a patient's cultural beliefs could damage the relationship and trust that has been developed which could be detrimental to the birthing process or at the least impact the experience. I think that it is important to form a good relationship with your patient and her support system. This will provide them with a level of comfort and a sense of security and may help them to trust that as her nurse, if complications were to arise you would attempt to maintain their preferences as much as you could without endangering the health or well-being of the patient and child. source..

Cultural Influence on the Birthing Process
In the first discussion, Bridget acknowledges the importance of considering the cultural preference of the patient during delivery. This assertion is true given the fact that different communities have varying cultural beliefs on how a delivery should be conducted and how the mother should react during the procedure. According to Littleton & Engebretson (2005), it is imperative for a nurse to establish the cultural goals, expectations, attitudes and ideas specific to a client...
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