DELIVERING CULTURALLY COMPETENT NURSING CARE 10
DeliveringCulturally Competent Nursing Care
Cultureis an accumulated pattern of values beliefs and behavior shared by agroup of people with common history and verbal and non verbal symbolsystem (Neuliep, 2009). This paper will discuss Haitian culture withthe aim creating an understanding of the culture of Haiti people to the healthcare providers, which is essential in provision healthcarein harmony with Haitians cultural values, beliefs, and practices.AccordingAmericanGeriatrics Society (2004), anunderstanding of culture helps health providers to know how to relatewith patients and thus, tailor healthcare to effectively treatpatients while respecting their values and cultural framework.
GeographicalLocation and Population
Haitiis a Caribbean country located between Cuba and Puerto Ricoandsouth of the Turks and Caicos. It shares the Island of Hispanola withthe Dominican Republic.All Haitians speak Creole and only 2 to 5% who are educated speakFrench. Schuller(2016), describes Haiti,to have the total estimated population of 10 497 847, with thepopulation density is 379 people per square kilometer asof January 2016. He also describes the population of the under 15,between 15 and 64 and 65 and above years to be 35.9%, 61.1% and 3.9%respectively.
Haitiwas colonized by French and declared its independence in 1804 andthus becamethe first post-colonial black-led nation in the world. Howeverin most of its history Haitihas experienced political instability. In 2004 for example, aninterim government took office after an armed rebellion which forcedresignation and exile of President Jean-Bertrand Aristide. Fromthen, it is in May 2006 that they inaugurated the democraticallyelected president and parliament and in 2010, they elected thecurrent president.
Aseries of natural disasters has affected Haitian people. Thisincludeshurricanes which in 2008 wiped out 70%of Haiti`s crops, resulting in deaths of children due tomalnutrition, stripped bare of 98% of their forest cover and affected8% of Haiti`s total population(World Bank & United Nations 2010).In 2010, an earthquakeof 7.0 magnitudes struck Haiti with an epicenter about 25 km (15 mi)west of the capital, Port-au-Prince. An estimated 300,000 people diedand 1.5 million left homeless.
Differentcultures have different ways in which health and illness areperceived and this determines how care is given (AmericanGeriatrics Society, 2004).In Haiti, illnesses are believed to result from natural orsupernatural causes.Inhealthcare provision, consulting a traditional healer when sick isusually the first option. Herbalists who believed to be knowledgeablein the use of various herbs and other natural substances areconsulted.
Useof spiritualhealing and healers isanother common healthcare practice among the Haitians. Clergy areconsulted for prayer, spiritual guidance and encouragement, whichsome believe can result in miracles. Voodou priests are also oftenare consulted about illness or misfortune perceived to be caused bythe supernatural. They prescribe certain herbal remedies to cureillness and/or perform rituals to expel spirits causing misfortune.
Barriersto Culturally Competent Healthcare
Culturalfactors are barrier to culturally competent healthcare. For example,normative multiple sex relationships which is a clash withprofessional healthcare practice is said to have increased HIVprevalence in Haiti (InPurnell, 2013). Thefact that Haitians have a history consulting spiritual healers andhealing and use of herbal remedies, may also hider them from seekhealthcare from medical facilities.
Diagnosticexpectation is another barrier to culturally competent healthcare.SomeHaitians, especially those who practice traditional healing, expectthe practitioner to diagnose their problem without asking forinformation (Gold,1991). This eventually hinders effective information provision and mayresult to gap in care provision. Given that many Haitians preferalternative modes of treatment for illnesses, by the time theyconsult mental health professionals as resources, they are likely tobe desperate
EthicalDilemmas in Healthcare Provision
Healthcareethics are meant to assist healthcare providers in delivering highestlevel efficient care. However ethical dilemmas may present themselvesin various ways. For instance Haiti being prone to natural disasterwhere so many people need medical attention at almost the same time,when a disaster occurs, limited healthcare resources presents anethical dilemma of who to treat first. Under the normalcircumstances,the order in which care is delivered is determined, presuming that itwill ultimately be delivered to all. In a case of emergency ofnatural disaster, care providers may be forced to first determinewhether the patients` lives could be saved. This is due to limitationof resource becausepersonswith the most urgent need for care are often the same ones whorequire the greatest expenditure of resources (Schuller,2016).
Naturaldisasters also bring varied healthcare needs which may result toethical dilemmas. Conditions like bone fractures and other limbinjuries may require surgery which may lead to surgeon’s dilemma(Schuller,2016). Cultural issues may arise if patients refuse a needed amputationpreferring to risk death over loss of a limb in relation to theculture. In case of emergency of a natural disaster, patients incritical conditions could be amputated without their consent asamputation could be perceived as best treatment.
Pregnancyperiodis usually a happy period for the entire family in both the USA andHaitian cultures. For Haitians pregnant women are expected to carryout their duties throughout the pregnancy period but for Americansthey only perform light duties. Majority of women in Haiti do noseek prenatal care (InPurnell, 2013),unlike in the USA where prenatal care is highly valued. Also, boysare preferred as a firstborn so as to carry the family name to thenext generation and preferred in large families so as to help inhousehold chores. In the USA Baby boys and girls are equallyappreciated.
Duringlabor women are expected to take an active role when giving birthlike talking loudly, screaming or cursing, and may become hysterical.Normal delivery is the most common but for women of higher socialclass they prefer cesarean section delivery just like American women.During delivery, fathers in Haiti do not participate because of theybelieve that birth is a private event best handled by women but inthe USA, fathers plays a great role to support, and their presenceduring delivery is acceptable as a sign of support.
Bythe age eight most rural children engage in serious work in Haiti.This includes household chores and looking after the livestock.Education is however highly valued although unaffordable to many inHaiti. Children are sent to school and when a child performs well andparents can afford education cost, such are exempted from work.They may also be given to other individuals to provide domesticservices with an expectation that, the fostering will benefit thechild by taking them to school. Frenchmodel is used Haiti schools system. It comprises of kindergarten, 6years of primary school, and 7 in secondary school. Those from poorfamily end their education at primary schools
Inmarriage, a man asks from the woman’s father the permission tomarry her andno bride price is paid. Women are however expected to bring domesticitems into the union and men provide a house and garden plots.Withor without legal marriage, a union is considered complete and getscommunity respect when especially when a man builds a house and thefirst child is born. This is unlike in the USA where a bride priceand marriage legalization are vital.
Divorceis very rare in Haiti unlike separation which is common, especiallyafter a couple`s children are raised and have families of their own.Children live with their mother after separation, but they may alsomove in with grandparents or other relatives. This is unlike in theUSA where divorce is prevalent and acceptable.Either a man or a woman can file for divorce and be legally allowedto divorce and the children may be divided between the two.
Incare provision for the elders, children are expected to respect andcare for the elders in Haitian culture. Elders are considered asfamily advisers, babysitters, historians, and consultants. Theelders are cared for at home despite the challenges that come withit. Very few consider taking the elders at nursing homes(Kersey-Matusiak,2013). Howeveralthough the elderly are honored, celebrated, and respected in theUSA, it is common and acceptable for them to be removed from thecommunity and taken to hospitals and nursing homes.
Ondeath rituals in Haiti, there is a deep respect for the dead. Sevenconsecutive days of prayer are done so as to facilitate passage ofthe soul from this world to the next. During the seventh day a massis held beginning with official mourning process. A family memberalso gives the deceased a final bath and in case of a postmortem,healthcare provider is expected to allow the family to participate.Haitians do not encourage nor acknowledge organ donation unlike inthe USA. In the USA people prefersnot to talk about death as they mostly have an attitude of denial.Just like the Haitians Mass for the dead is however held although themorning period is not prolonged as that of Haitians.
Art,Music and Dress
TheHaitian has a rich tradition of music and dance, but rely publiclyfunded. The government however occasionally provides support tokenfor the arts. Their music combinesinfluence from peoplewho have settled among them like French, African, Spanish andothers. Music styles unique to the nation include music from voodoo traditionceremonies, Rara, ballads and rock bands.
Costumefor men is a hand-embroidered shirt made of cotton, linen, or denimfabric while that of women is an embroidered short-sleeved blouse, acolorful skirt, and a scarf wrapped around their hair. However,lightweight Western-style clothes are also worn where men wearloose-fitting shirt, and although it is acceptable for women to wearpants, they continue to wear skirts or dresses.
Healthcareproviders in Haiti need to understand the fact that Haitians oftenbelieve illnesses are supernaturally induced. Toboost effectiveness of healthcare provision, modern professionalhealthcare groups can devise way to collaborate with voodoo priestsso as to reach many in healthcare provision. Healthcare can bedeliveredmore effectively if they incorporate core beliefs and indigenoushealing practices into the treatment process (Jeffreys,2010).
Alsocare needs to be taken to ensure that procedures that requireundressing are adequately explained because Haitians are very privateand modest. If possible, undress only the area that needs to beexamined.
Fromthe discussion it is evident that culture plays a central role in thelives of Haitian and that they share a lot with African culture. According toWorld Bank and United Nations (2010),95%of the Haitian population is descendents of African slaves and theremaining 5% is White and/ or persons of mixed heritage.Asa nurse when working within Haitian there is need to be aware oftheir culture so as to provide competent healthcare while respectingtheir culture.
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