Culturally Competent Nursing This order require medical field, preferable. A Registered Nurse case management experiences, a Doctor, ORDER: I requesting a 5 pages, paper written DOUBLE SPACED, APA format, excluding Title Reference Page make total 7 pages.

Culturally competent transcultural nursing:

Case management when dealing with Mexican-Americans

The concept of case management in nursing is used to "monitor the utilization and quality of health-care services and intervene as necessary" (Case management, 2012, Medi-Smart). A nurse case manager can be defined in three different ways: as a utilization review manager who reviews "charts for the use of interdependent hospital systems, timeliness of service as well as safe and appropriate 'utilization' of service;" a quality manager who "is accountable for the overall quality of care being delivered" and as a discharge planner who "coordinates all the facets of a patient's admission/discharge" (Case management, 2012, Medi-Smart). In all three capacities, the concept of culturally competent nursing is critical to optimize healthcare delivery. Nurse case managers must coordinate resources to facilitate care for patients so that they include the patient's family; ensure that quality care is being dispensed that is commensurate with the patient's view of health, and also ensure that when discharged the patient and his or her caregiver understands the needs of the patient clearly and can provide that care to the family member.

Case management is founded upon the concept of taking an individualized approach to nursing, which means that it is vital that nursing care is culturally informed of the patients' worldview and health assumptions and that care is dispensed in a sensitive, nuanced fashion. "Nursing practice includes providing care that is holistic. This holistic approach in nursing addresses the physical, psychological, social, emotional, and spiritual needs of patients" (Maier-Lorentz 2008: 37). This paper will specifically address the concept of culturally competent care of in the case management of Mexican-Americans. As Mexican-Americans become an increasingly sizable population within North America, nurses must become acculturated to the differences between the assumptions they bring to the nurse-patient relationship that may be at odds with those of their patients. "In order to promote culturally congruent care, nurses need to understand the known cultural care needs of the individual, family, and community, thus providing ethically-motivated care" (Zoucha & Broome 2008: 140).

As the United States grows more diverse, cultural competence becomes more of a vital cornerstone to care than ever before. "Transcultural nursing has become a key component in healthcare and a requirement for today's practicing nurses because of the soaring multicultural phenomenon occurring in our American population. According to the U.S. Bureau of the Census (2000), over 30% of the total population, or one out of every three persons in the United States (U.S.), is comprised of various ethnicities other than non-Hispanic Whites" (Maier-Lorentz 2008). In the case of dispensing care to Hispanics, "although Hispanics have become the majority minority in the U.S. (U.S. Bureau of the Census, 2000), it is estimated that there are only 2% Hispanic Registered Nurses in the nursing profession" (Maier-Lorentz 2008: 37). This indicates a notable discrepancy between the character of the nursing population and the population nurses serve.

Interacting with Hispanic-Americans often presents an initial cultural challenge of a potential language barrier between the nurse and the patient. Language barriers have been cited as one of the primary reasons nurses feel they cannot provide culturally-competent care (Maier-Lorentz 2008: 37). "Communication is a fundamental part of nursing. It involves sharing information, caring conversations and social interactions. Communication is a significant factor with regard to patient satisfaction and the quality nursing care" (Jirwe, Gerrish & Emami 2010: 437). It can be financially or logistically unfeasible to obtain a translator, so nurses "to bridge the language barrier they often rely on relatives to interpret, rather than use an accredited interpreter" (Jirwe, Gerrish & Emami 2010:...

Since relatives are not professional translators, they may mistranslate the nurse's words, particularly if they are unsure of what the nurse means in terms of medical terminology. Also, not all medical and health concepts have perfect, exact corresponding meanings in Spanish and English. Something is always 'lost in translation' and sometimes what is lost is the valuable, emotionally subtle one-on-one communication between patient and nurse. Family members may even deliberately rephrase meanings, out of a sincere desire to protect the feelings of an elderly person or child from knowing the extent of his or her condition.
However, there are also more subtle barriers that can inhibit culturally competent care. Several recent qualitative studies suggest that nurses "were not able to understand other cues used by these [Mexican-American] patients to communicate," such as the nonverbal communication which often nurses relies upon when patients have difficulty articulating their symptoms (Maier-Lorentz 2008: 37). "Nurses need to assess pain by asking patients' to describe how they feel, but it is also necessary to include facial expressions and body language in their assessments" (Maier-Lorentz 2008: 40). Mexican-Americans often exhibit a high degree of anxiety about pain which may cause nurses to over-medicate pain responses; in contrast, other ethnic groups may show great stoicism in the face of pain but may still be feeling its effects (Maier-Lorentz 2008: 40).

Cultural differences beyond that of the purely verbal are manifested regarding the use of eye contact. In North American cultures, if a person looks someone in the eye he or she is considered honest and forthright. But this is not so in all cultures. "Hispanics use eye contact only when deemed appropriate by their cultural standards. This is based on age, sex, social position, economic status, and position of authority" (Maier-Lorentz 2008: 38). An adult will make steady eye contact with a child, but a subordinate will not necessarily do so with a superior. "In a health care environment, Hispanic patients expect that nurses and other health care providers give direct eye contact when interacting with them, but it is not expected that Hispanic patients reciprocate with direct eye contact when receiving medical and nursing care" (Maier-Lorentz 2008: 38). Touching is also a culturally-sensitive issue. Some traditional Mexican-American males may not feel comfortable permitting a male caregiver to touch a female family member. This does not mean that the healthcare provider should ignore the need for physical contact if necessary, but it does mean that the nurse may wish to broach the topic with greater sensitivity and explain why touching is necessary.

The family is a central institution in Mexican-American culture, and it is not unusual for extended family members to be present when making health-related decisions. Many family members may consider themselves to be part of the critical decision-making circle when discussing the health of others. While patient privacy must be respected and the nurse's ultimate responsibility is always to the patient, the nurse must be prepared that family members may want a larger number of people involved in treatment. This can be beneficial when balancing care demands for an elderly family member. However, the nurse may need to take a stand to protect patient privacy, such as when a young woman wishes to discuss family planning, abortion, or other sensitive matters without her husband or family members present. Family may also extend beyond concepts of traditional 'blood' relatives. "Family has meaning beyond blood or related connectedness. In the Mexican-American culture, family may mean close friends of the family, known as 'compadres' (Zoucha & Broome 2008: 141).

When directing resources, particularly in regard to orders the patient or patient's family is expected to perform him or herself, the nurse must be cognizant of the health beliefs of the patient within a culturally-bound context. "Hispanics feel that they have less control over their lives and tend to be more fatalistic in their views about health. These patients may not be as cooperative about complying to a prescribed diet and medication regime" (Maier-Lorentz 2008: 38). Nurses may have to be more rigorous when…