Mrs. Margaret Foley's Culturally Congruent, Personalized Nursing Care Plan

Case Scenario Overview

Mrs. Margaret Foley (Maggie) is a 46-year-old Aboriginal female has had an emergency open cholecystectomy. Although the case does not specifically indicate why the laparoscopic surgery was changed to an open procedure, this is common whenever the surgeon has trouble accessing the gallbladder for any reason such as a patient's smaller frame. Furthermore, this has several implications for the length of her stay and her care plan. There are also factors that indicate that Maggie will benefit from a nursing care plan that is attunded to her cultural needs due to the fact that multiple previous misunderstandings were mentioned in her case history. For instance, the case indicates that Maggie "felt uncomfortable" with the medical jargon used which was essentially incomprehensible to her and likely led her to not follow the care plan that was recommended for her. This care plan will outline some of the important aspects of cultural competences in nursing and integrate these concepts into a personalized care plan for Maggie's recovery from the open cholecystectomy.
 

Cultural Competencies in Nursing

Nearly all nurses have the best intentions when trying to draft a care plan to treat a patient efficiently and effectively from a holistic perspective. However, there are many obstacles that can somewhat hidden or obscure in which can make following the care plan challenging for a variety of different reasons. Furthermore, any cultural differences that are present between the nursing staff and the patient can add a layer of complexity to any treatment plan by inhibiting communications.

Since cultural factors have been long recognized to be an important consideration in developing care plans, there have been various models that been constructed to help mitigate culturally-based challenges. One such model, the Campinha-Bacote's model of cultural competence in health care delivery, is defined as process of building Cultural Competence in the Delivery of Healthcare Services and is commonly remember by the mnemonic ASKED (awareness, skills, knowledge, encounters and desire) (Ingram, 2012). This model states that cultural competence and developing the needed skills relevant to overcome cultural barriers is ongoing process that essentially never ends. Since culture itself is continually evolving, integrating various cultural aspects into nursing must also be a continuous process.

In order to build cultural competencies, the health care provider must therefore continuously strive to improve their ability understand the cultural contexts of the patient and their environment (individual, family, community). To build such an awareness, the ongoing process involves the continual accumulation of cultural awareness, cultural knowledge, cultural skill,...
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Other models that have been developed are also in agreement that the definition of cultural competence should be thought of as a nonlinear and dynamic process that is never ending and ever expanding in its quest for increasing cultural knowledge and developing cultural skills from a perspective of humility (Grote, 2008).
Furthermore, since cultural competencies are a critical success factor in care management there have been many attempts to design training programs to build these skills in health professionals. One meta-analysis looked at a wide range of different training evaluations of a number of training programs that were designed to improve the overall cultural competence of health professionals (Beach, et al., 2005). The study collected data from 1980 through June 2003 that represented interventions that were primarily designed to improve the cultural competence of health professionals and found thirty-four such studies that were compiled into one larger dataset. Analysis of the synthesized data revealed that there is significant evidence that cultural competence training can in fact improve the cultural competencies of health professionals (17 of 19 studies demonstrated a beneficial effect), as well as the attitudes and skills of health professionals (21 of 25 studies evaluating attitudes demonstrated a beneficial effect and 14 of 14 studies evaluating skills demonstrated a beneficial effect); furthermore, although patient satisfaction was typically higher, there was no evidence that cultural competencies actually improve patient adherence to a treatment plan (Beach, et al., 2005).

Such research indicates that there are a wide range of benefits associated with building cultural competencies and training programs have been introduced in a range of healthcare environments. For example, there are at least five separate components of a cultural competency that been introduced to many baccalaureate of nursing programs consisting of different learning strategies, methods for evaluation, and recommendations for effective implementation for each component (Calvillo, et al., 2009). There have also been more hands-on approaches designed such as the community-based participatory research program that foster interactions with diverse community involvement which can also build cultural competencies quickly (Anderson, et al., 2007). However, despite these benefits, it should be noted that cultural competencies may not be enough on their own, given the lack of support relative to critical factors such as patient adherence and patient outcomes, and therefore great care must be taken to ensure patients are committed to their own recovery through adherence of the care plan.
 

Maggie's Care Plan

There are several aspects to Maggie's vital signs and other post-operative assessment measures that will…