Cultural Diversity in Nursing: Caring for a Diabetic Patient

Client Interview Data and Health Beliefs

The client comes from a family-focused background in which she plays the role of chief household organizer and attends to her family and their needs. She believes one ought to lead a life of a good and virtuous individual and support one's family, particularly in times of need. In her opinion, sickness must be tended to for the purpose of preserving life. She believes in healthcare professionals and the services they offer for leading a healthy life, and she is comfortable having healthcare professionals take care of her health needs.

The client's culture impacts her appearance, though not to a significant extent. With regard to healthcare services, she has a few cultural and personal preferences. For instance, she is very particular about maintaining her modesty and prefers certain tests and physical examinations to be conducted by a female healthcare provider. She believes in always appearing feminine and presentable.

The patient's behavior change must occur in five steps — referred to here as the 5C intervention:

Behavior Change Intervention and Risk Factors

Construction of problem definition: The behavior change process ought to begin by considering the patient's specific affliction. This principle lies at the core of patient-centered healthcare delivery. When any patient suffers from an issue that troubles them, starting with their stated problems is a sound approach unless the healthcare team has detected additional problems that are immediately debilitating or life-threatening. This strategy, when applied to the client in question, will increase her confidence in her own capacity to change while simultaneously increasing clinician influence and credibility. The second part of this step involves specifying the patient's problem. Because the client possesses crucial information regarding her condition, the clinician must play the part of facilitator for the client's self-examination and aid her in correctly defining her health problem so that healthcare providers can help resolve it.

Collaborative objective setting: Specific goals must be set, and the basis for these must be concrete actions — for instance, taking care not to snack after dinner — rather than mere values such as "healthy eating." Targets need to be measurable (addressing questions such as how often or how much; for example, the client may be instructed to take a 30-minute walk three times a week). Behavior should be addressed (e.g., exercise) rather than physiology (e.g., weight loss). Goals must be action-oriented, realistic, and challenging — neither so difficult as to discourage the patient nor so easy as to provide no sense of accomplishment.

Collaborative resolution to the problem: This step involves formulating strategies for achieving the established goal and identifying obstacles to goal achievement.

Committing to bring change: At this stage, commitment to the established objectives and strategies must be made, and a start date must be decided upon. It is generally helpful to formulate a clear written agreement, or "behavioral contract," specifying what the client and the clinician are each expected to do. The agreement is not strictly enforceable; rather, it serves to make responsibilities explicit. A copy of this agreement must be provided to the patient as a reminder.

Continuing support: Studies demonstrate that long-term interventions prove more successful in diabetes care than short-term ones. This is expected with all chronic health conditions, though not in the case of acute ailments. It is therefore imperative to engage in relapse prevention planning, as every patient will be prone to relapse at some point — that is, they will experience instances in which their level of self-care reverts to a suboptimal state (Peyrot & Rubin, 2007).

Personal Reflection: Illness Beliefs, Customs, and Interpersonal Dynamics

The client is a Portuguese Azorean, hailing from the island of São Miguel, Açores, off the Portuguese coast. She displays a generally positive attitude, and her background is quite family-oriented. She plays the role of chief household organizer and attends to her family and their needs. Her overall beliefs about life are that one ought to be a good and virtuous individual and support one's family, particularly in times of need. She tends to gauge her own feelings before deciding whether to seek medical assistance, assessing whether she feels sick and whether her problem requires professional attention.

The women of her culture prefer the services of female healthcare professionals, in deference to their husbands, regardless of whether those husbands are living. The client can process, to a fair degree, what a clinician explains to her; when she cannot, her daughter — who accompanies her to medical appointments — translates and explains the healthcare provider's message. The client takes care to mention when she has not understood something and when she requires additional information or education.

She believes her genetic makeup contributes partly to the diseases she is diagnosed with, but also believes that nothing can be done to avert what has been planned for her by God. In addition to availing herself of modern clinical services and medication, the client makes use of medical rubs, herbal remedies, and prayers when handling sickness.

The client is a private person in every aspect of life and is naturally reserved in the medical and healthcare setting. She prefers to have female healthcare professionals tend to her and wishes to receive an explanation regarding any physical examination prior to its performance. She is not opposed to physician or nurse touch for comfort or for the purpose of physical examination. She has no issues with having healthcare providers of different social classes or age groups attend to her needs. She opens up to providers of nationalities other than her own, believing that all individuals have something unique to offer and that those from other cultural or ethnic backgrounds can provide insightful ideas that may assist her with diabetes management.

The client's culture is strongly indicative of her religion and spirituality. She is Roman Catholic, firmly believes in God, prays the rosary on a daily basis, and expresses her religious beliefs without allowing others' opinions to influence them. While she endeavors to attend church once every week, this does not always happen.

Family constitutes the social network of the client. Her family members occasionally undermine her health goals by suggesting that foods she is supposed to avoid are not truly detrimental in small amounts, reasoning that everyone deserves "cheat days" and that anything eaten in small quantities should not make a real difference. Despite this, she views her family as supportive, defining that support as caring for and being around her, taking care of family needs when she cannot do so herself, and standing by her when she is in need.