Ethical consideration is important in nursing practice, especially when providing care to patients from diverse sociocultural backgrounds. The population of the United States comprises various ethnic/racial groups with different cultural and social beliefs, practice, norms, and values. There is an increasing disparities on the incidence and prevalence of type 2 diabetes among different communities in the United States. According to the Center for Disease Control and Prevention (CDC), Hispanics and African Americans have the highest incidence and prevalence of type 2 diabetes in the country (Concha, Mayer, Mezuk, & Avula, 2016). Caring for patients from different ethnic/racial groups require consideration of ethical principles and concepts to prevent ethical issues that may arise during nurse-patient interaction.
Recently, I cared for patient with type 2 diabetes mellitus who had been hospitalized for more than two weeks due to acute hypertension, partial loss of vision. Also, the patient had a chronic diabetic foot ulcer. The analysis of his medical history revealed that the diabetic foot ulcer had developed in the last two years and had never healed. The patient was so worried about his health status and kept asking when he was going to be discharged from the hospital. The patient came from the Hispanic community, which is one of minority groups with the highest incidence and prevalence of type 2 diabetes mellitus in the country. Being a culturally competent registered nurse, I had an obligation to take into account the specific ethnic background of the patient when providing care. Considering patient’s ethnic/racial background is important in providing quality, holistic, and patient-centered care based their health concerns, preferences, and values (Concha et al., 2016).
When collecting subjective data for analysis and planning for the care. I asked the patient about his perceptions about the possible causes of type 2 diabetes that he was suffering from. Hispanics have different beliefs in the causation of diabetes mellitus (Frieden, 2016). First, the patient believed that diabetes is a temporary condition that is not fatal. Second, the patient narrated a story that attempts to identify the cause of diabetes and concluded that they believe that people with “good diabetes” do not experience a lot of complications. The Hispanics use the term “good diabetes” when referring to the type of diabetes that do not require insulin for therapeutic purposes; non-insulin-dependent diabetes mellitus (T2DM) (Frieden, 2016). Also, the patient had a fatalistic attitude and believed that his health condition is likely to be a punishment from God.
The patient had a low health literacy level because caregivers had encouraged him to engage in some physical exercise and adopt a self-management approach as a way of controlling and preventing complications related to his condition, but he never implemented them. Also, the patient had failed to comply with routine checkups scheduled by the caregivers; therefore, resulting to escalation of his medical condition. Home remedies is an important care approach because it promotes cultural competence. These remedies ensure that the patient able to effectively adjust to the self-management measures suggested for controlling the complications or comorbidities related with diabetes mellitus.
The last person I took care of was an 82-year-old woman who had suffered a stroke. However, she was able to get a thrombectomy and she was left with little to no deficits. She was alert, oriented, and independent. Thus, she was very aware of the cause of her health condition, and why it caused her symptoms. However, I would say her health literacy was low because she has a history of noncompliance with the meds that could have prevented her stroke.
Health and social wellbeing are determined by many factors outside the health system which include socioeconomic conditions, patterns of consumption associated with food and communication, demographic patterns, learning environments, family patterns, the cultural and social fabric of societies; socio-political and economic changes, including commercialization and trade and global environmental change ( Kumar & Preetha, 2012). These social determinants prove that these many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. Factors such as where we live, the state of our environment, genetics, our income, and education level and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact (World Health Organization (WHO), n.d).
“Determining which identities are most salient to the person’s health needs to be performed in partnership with the patient and/or family. These identities can fall anywhere along a continuum of privilege–disadvantage that is grounded in a social justice perspective” ( Lor et al., 2016). On the Continuum of Privilege–Disadvantage, her privileges are: congruent gender, heterosexual, white, historically privileged, able body and mind, high education, proficiency in English, and Christian. Her disadvantages are: elderly, female, low health literacy, low income (Lor et al., 2016). While she has a lot of advantages, she has two major disadvantages: elderly and low income. “Assessment of individual and family needs relative to privilege–disadvantage facilitates tailored interventions and socially just care that can promote health equity, [and]Nurses need to assess the impact of these interesting identities to optimize the quality of care ( Lor et al., 2016).
Culture is integral to the person as a unique individual. It impacts greatly on the client’s health, and their reactions to treatments and care (Registered Nursing, 2020). However, my patient did not have any specific cultural beliefs, perspectives, values, and practices that she wanted to be implemented in her care. Thus, my approach to care for her (and all my other patients), is to listen to them and care for them as best as I can.
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