Explore innovative images of culturally competent advanced nursing practice grounded in caring.
Incorporate an understanding of wholeness of persons connected with others and the environment through caring.
Implement caring into nursing situations that nurture wholeness and well being within the context of cultural humility.
In my clinical nursing practice, a patient was brought to the hospital by Mr. Alex. At an advanced age, he was of African descent, and he walked relying on rollators. I could see he was very knowledgeable regarding many matters of life as he talked with other nurses and patients on the corridors despite being the only ‘person of color’ in the facility. After some time, I understood that he was unhappy with the level of care and treatment. He was forced to stand and wait long as other patients were on the line. I came to understand that he had an accident a year before, and he underwent a few operations on both legs. The prior surgical processes made him weak, and he was in some stiffness and aching. A nurse went ahead to assist the older man and make him comfortable, made him sit, and offered him a drink and snack. The patient choked and started coughing, and he looked uncomfortable. His breathing changed, and it became irregular, and a doctor was called immediately and took the patient under his watch.
Vulnerability of the Patient
The patient is elderly, a minority, and it is presumed that there are high chances of the people in this group being taken advantage of, misled or mistreated. Old age does not create automatic vulnerability, but there are various complications that people in this group have increased vulnerability (Bozzaro et al., 2018). These problems include; low sensory consciousness, uncoordinated functionality, lack of strength, and high tiredness. The level of vulnerability of the elderly is dependent on each person and the environment. There are fundamental approaches to look at their vulnerability: social network, individual capital, and social protection. The elderly without social protection like the patient above have increased risk due to a lack of family or friends. Individual capital consists of wealth and the human capacity to handle situations. Lack of wealth has increased the patient’s risks seeking support, while individual capital helps an elder person cope with all arising vulnerabilities. These include; things like exercising and a good diet.
Health disparities are related to many situations that impact the quality of life, access to care, reaction to treatment, lifestyle, or diagnosis. Health disparities are the variation of heath and care among groups of people or communities (Martin et al., 2019). There is a wide range of aspects related to these situations like; age, race, access to healthcare, level of education, culture, environment, disability, etc. Health insurance among the minorities and those with low income are very low, contributing to poorer quality of care. The access to healthcare by the minorities, especially the elderly, has been underwhelming due to the lack of essential services like undertaking rehabilitation, preventive care, and technology. In the case above, the patient is disadvantaged as all these factors touch on him.
The Advocacy Role of DNP
All nursing professionals need to be involved in health care policy decisions and social policy advocacy that affect the nursing practice. The DNPs should play a role in; influencing the policymakers by active participation on boards, committees, or nursing institutions (Giardino et al., 2020). They should be involved at all levels from the local, state, national or international to have positive health outcomes. It is also important to play an advocacy role in equity, ethical practices, and social justice in the healthcare sector. For example, in the case above, the DNPs should look at ways to help achieve cultural competence by advocating for ways to; manage the differences, adapt to cultural diversity, value diversity, do self-assessment, and acquire cultural knowledge. They also have a role in advocating for cultural competence, and nursing practitioners should empathize with their patients always by aligning care according to their beliefs, culture, or religious background (King et al ., 2019). Also, there should be advocacy to reward nurses for outstanding care to patients, including wholeness and wellbeing in the execution strategy. The measures will ensure that these values are anchored in the whole chain and ensure cultural humility is practiced as a norm by everyone in the nursing chain.
Bozzaro, C., Boldt, J., & Schweda, M. (2018). Are older people a vulnerable group? Philosophical and bioethical perspectives on ageing and vulnerability. Bioethics, 32(4), 233-239. https://philpapers.org/rec/BOZAOP
Giardino, E. R., & Hickey, J. V. (2020). Doctor of nursing practice students’ perceptions of professional change through the DNP program. Journal of Professional Nursing, 36(6), 595-603. https://pubmed.ncbi.nlm.nih.gov/33308560/
King, B. M., & Barry, C. D. (2019). “Caring between” the nurse, the one nursed, and the healthcare robot: an interpreted nursing situation using the Barry, Gordon, King Framework. International Journal for Human Caring, 23(2), 168-177. https://www.amazon.com/Nursing-Case-Studies-Caring-Practice/dp/0826171788
Martin, A. R., Kanai, M., Kamatani, Y., Okada, Y., Neale, B. M., & Daly, M. J. (2019). Clinical use of current polygenic risk scores may exacerbate health disparities. Nature genetics, 51(4), 584-591. https://pubmed.ncbi.nlm.nih.gov/30926966/