REPLY 1 and 2 (7)

REPLY 1

It’s important for nurses to provide culturally competent care. It’s important to assess the importance of a client’s culture/ethnicity (and their accompanying beliefs and values) when planning, providing, and evaluating care. Nurses' practice must incorporate cultural needs and beliefs into their nursing practice to provide care that is individualized for the client and appropriate to the client's needs (Cultural Awareness and Influences on Health: NCLEX-RN, 2020).

In the Asian culture, there is often a belief that terminally ill patients should not be informed about their prognosis, and many believe that speaking of it may bring bad luck or a poor outcome (Ritter & Graham, 2017, P. 235). Except in emergency situations in which a patient is incapable of making an informed decision, withholding information without the patient’s knowledge or consent is ethically unacceptable (AMA, 2020). After completing a cultural assessment, if the patient holds this belief, I would respect the cultural practice and withhold the information. 

The patient would be encouraged to specify preferences regarding the communication of medical information, preferably before the information becomes available (AMA, 2020); it’s important to honor a patient’s request not to receive certain medical information or to convey the information to a designated surrogate, provided these requests appear to represent the patient’s genuine wishes (AMA, 2020). For the family who believes this, “decisions and communication are often considered the responsibility of the oldest male in the family, and can be seen as a moral obligation for that person to act in that capacity” (Ritter & Graham, 2017, P. 235). 

For health care providers to balance the patient’s right to know with respect to the cultural practices and beliefs of the family, it’s important to: assess the amount of information the patient is capable of receiving at a given time, and tailor disclosure to meet the patient’s needs and expectations in keeping with the individual’s preferences; Monitor the patient carefully and offer full disclosure when the patient is able to decide whether to receive the information (AMA, 2020). 

In short, each year, the United States becomes more diverse, with people of different races and religions, and with differing beliefs about medicine and medical care. As nurses, we owe it to our patients to provide them with the best care possible in ways they find appropriate (Reed, 2017).

References

AMA. (2020). Withholding Information from Patients. Retrieved from https://www.ama-assn.org/delivering-care/ethics/withholding-information-patients

Cultural Awareness and Influences on Health: NCLEX-RN. (2020). Retrieved from https://www.registerednursing.org/nclex/cultural-awareness-influences-health/

Reed, C. (2017). Cultural Competence. Retrieved from https://journals.lww.com/ajnonline/Fulltext/2017/07000/Cultural_Competence.5.aspx

Ritter, L.A., & Graham, D.H. (2017). Multicultural Health (2nd ed.). Burlington, MA: Jones and

Bartlett Learning. ISBN: 9781284021028

REPLY 2

        Health is viewed as a cultural concept, and culture determines how we perceive the world. Therefore, respect for cultural practice in Asia is predetermined because culture helps shape how both the patient and the healthcare provider perceive illness and what they believe to be its cause (Fowler et al., 2011). I will only respect the culture if I lack the knowledge and skills of delivering bad news, the appropriate provision of optimal care to a dying patient, and the compassion to ensure that the patient retains his or her self-worth even at the time of his or her death. 

      According to Rosenberg et al. (2017), negative information should be briefly relayed to patients. The author recommends that the information be rehearsed to communicate the bad news concisely and how the healthcare team is committed to the patient's support and treatment at the terminally ill stage. A good example of a prognosis that should be delivered to the patient, especially by word of mouth, is as follows: 'The tests done on your collected samples have confirmed that your condition arose from a malignant tumor (sad news). Therefore, I have informed a radiotherapist and the oncologist to speak with you about the condition and then advise you further. Once I receive the recommendations from their examinations on you, I will decide on what best treatment to give to you (doing something about it). As things unfold, I will always be around to discuss with you on how we will go on with the treatment.' Maintaining a silent observation at this point will lead to the patient's psychological condition's best results (Sarafis et al., 2014). Therefore, I will respect the culture, but any information that must reach the patient will always be delivered just as the profession prescribes.

        Healthcare providers can balance the patient's right to know their prognosis concerning their cultural practices and beliefs. To achieve such a balance, healthcare personnel should always try hard to become culturally sensitive (Chaet, 2016). Such sensitive care can be achieved through creating awareness, avoiding assumptions, and learning about other cultures. In any social issue, the first step is always to be aware. Any competent healthcare provider must always be endowed with culturally sensitive care. A good nurse or doctor will always strive to become culturally sensitive personnel while letting others understand their line of duty (Swihart & Martin, 2020). Secondly, a good healthcare provider should always avoid making assumptions because it is always important not to assume matters that you are not familiar with. Making such assumptions can cause a breakdown of trust and rapport between the healthcare provider and the patient. Lastly, a good doctor or nurse should always learn about other cultures. Learning a patient's culture includes their medical history, medications, and current symptoms. Learning different cultures will involve immersing oneself in the culture of others. 

     In conclusion, it is always essential to have a truthful and open communication between the patient and the medic. Such open communication will enhance trust in the relationship and respect for autonomy. On the other hand, not fully disclosing information to the patient is an ethical breach because it brings the clash between the physician's duty of promoting the patient's health and the physician's respect for the patient's autonomy.

References:

Chaet, D. H. (2016). AMA Code of Medical Ethics’ Opinions Related to Discrimination and Disparities in Health Care. AMA Journal of Ethics, 18(11), 1095-1097.

Fowler, F. J., Levin, C. A., & Sepucha, K. R. (2011). Informing And Involving Patients To Improve The Quality Of Medical Decisions. Health Affairs, 30(4), 699–706. https://doi.org/10.1377/hlthaff.2011.0003

Rosenberg, A. R., Starks, H., Unguru, Y., Feudtner, C., & Diekema, D. (2017). Truth Telling in the Setting of Cultural Differences and Incurable Pediatric Illness. JAMA Pediatrics, 171(11), 1113–1119. https://doi.org/10.1001/jamapediatrics.2017.2568

Sarafis, P., Tsounis, A., Malliarou, M., & Lahana, E. (2014). Disclosing the Truth: A Dilemma between Instilling Hope and Respecting Patient Autonomy in Everyday Clinical Practice. Global Journal of Health Science, 6(2), 128. https://doi.org/10.5539/gjhs.v6n1p128

Swihart, D. L., & Martin, R. L. (2020). Cultural Religious Competence In Clinical Practice. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK493216/

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