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Running head: PROFESSIONAL DEVELOPMENT ASSIGNMENT 1

Professional Development Assessment

Mallory White

Aspen University

November 2016
PROFESSIONAL DEVELOPMENT ASSESSMENT 2

Professional Development Assessment

Many nurses take a pledge to do no harm to patients, to maintain a standard of care in the

profession, and to care for all patients that we come in contact with. This includes caring for

patients of different cultures and backgrounds. This makes one wonder, what is cultural

diversity, how does it affect nursing care. The answers to these questions can range from simple

to highly abstract.

Cultural diversity is a norm for many nurses. Firelands Regional Medical Center is a

moderate size medical facility in Sandusky Ohio with a high tourist population. Patients from all

different walks of life and cultural backgrounds come into the facility. Patients that come

through the doors range from being homeless to CEO’s of large companies. Many patients are

born and raised in the United States, but some are from other countries. Most speak English, but

some have a different primary language. Being a culturally competent nurse means caring for

these patients in the same manner.

As with different socioeconomic differences, patients come from different cultural

backgrounds. Amongst the heritages there are many similarities and many differences. As a

culturally competent nurse, it is highly important to build a rapport with patients to get a better

understanding of the patients cultural preferences.

Patients may have cultural beliefs that affect nursing care, from the openness of sharing

medical information to the preference of providers. Cultural backgrounds may also affect

nursing care in the influence of holistic beliefs. Again, it is important to understand patient how a

patients holistic beliefs can affect nursing care.

Being a culturally competent nurse means providing care for all patients, regardless of

their religious, cultural, or socioeconomic backgrounds. Nurses who provide direct patient care
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should practice patient care without bias and preference. Nurses should care for all patients the

same way, whether they have similar of different backgrounds. Being a competent nurse means

understanding that there may be differences but caring for the patient anyways.

All nurses should strive to care for patients the way that they would like to be treated.

Nurses should provide care that complies with patient wishes. For example, some patients prefer

not to receive blood transfusions, nurses should accept patient wishes and suggest other

treatments that are congruent with patient beliefs.

Another example may include how patients or their families handle death and dying.

Many cultures, like Jewish culture, believe death is a part of the natural life cycle, and instead of

preventing it, they accept and embrace it. It is important for nurses to accept patient wishes and

provide care that matches those wishes, instead of pushing their own views.

Nursing is a profession with great potential for learning. When caring for patients of

different backgrounds, nurses can not only learn about their patients, but they can also learn

about themselves. Listening to different perspectives can expand a nurse’s cultural tolerance. It

can also provide them with the opportunity to look within themselves and build upon their own

beliefs. Learning in nursing can occur through direct patient care and also through case studies.

Through this class, this writer has gained more insight into other cultures. This class has

offered this nurse with the opportunity to further develop an understanding for her own beliefs

and also understand the beliefs of the patients that are cared for. Having the belief that all

patients should be treated the same is important for all nurses. Whether a nurse is caring for a

patient with a specific cultural background or a diverse background, all patients should be treated

with dignity and respect. All patients should be offered the opportunity to have care that not

only meets their medical needs but also meets their cultural, spiritual, and personal beliefs.
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Amish Heritage

Elmer and Mary Miller are a middle-aged Amish couple who live on a family farm with

their five children in Indiana. They live in the main house while Mary’s parents live in the

attached grandparents’ cottage. Elmer has plans of taking over the family farm when Mary’s

father Aaron retires. The Miller’s youngest child was born prematurely and is currently having

respiratory problems. The couple does not carry medical insurance and is worried about

mounting medical bills caring for themselves and their children.

To guide in a better understanding of the Miller’s views on what health means to them, it

is important to ask what distances they are willing to travel to seek folk medicine. Going along

with that question, it is also important to understand what their beliefs about folk practices are

and when they will seek Western medicine. Finally, to better understand what health and caring

mean to the Miller’s it is important to know what role health plays in their religious beliefs.

One area of perinatal care to discuss with Mary is to discuss prenatal care. Along with

that, it is important to understand her physical post-partum care. It is also important to discuss

Mary’s choice on whether or not she chose to breastfeed or bottle-feed her son. Finally, it is

imperative to discuss with Mary her methods of pregnancy prevention.

Amish believe in aagwachse or livergrown. According to Purnell (2013), symptoms

include abdominal discomfort and crying. To treat this ailment, Amish women carry their babies

on a pillow.

The Amish have health-care beliefs that include folk remedies. Because Amish folk

traditions involve herbal remedies, it is important to have an understand what remedies the

Millers are using as they can interfere with Western medicine. Purnell (2013) explains that

Amish patients are more likely to discuss folk beliefs when they feel accepted by a nurse or
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health care professional. To learn more about the Miller’s use of folk medicine, it is important to

establish a trusting relationship and rapport.

To prepare the Millers for a consultation at the medical center, a nurse should encourage

them to be forthcoming about their folk practices. A nurse should also explain to the Miller

family things they may see or experience in the medical center. Because the Amish do not

traditionally seek Western medicine, they may be unfamiliar with equipment like x-ray

machines. It is also important to discuss with the Miller’s ways to prepare for the incoming

medical bills.

To help promote culturally congruent care when consulting with the medical center, it is

important to encourage the medical center staff to research Amish health-care beliefs. Purnell

(2013) explains that Amish prefer receiving care from providers who give consideration to their

beliefs, need for transportation, family influences, and cost.

The Amish do not have any religious reasons for not vaccinating their children. Instead,

they do not vaccinate because of lack of knowledge. Wombwell, Fangman, Yoder, and Spero

(2015) conducted research on the barriers against vaccinating against the measles. They

concluded that the Amish community could benefit from improved immunization education.

Working with state and local health department officials to provide education within Amish

communities can help improve immunization rates. If the Amish receive proper education and

vaccinations are offered within the community, they are more likely to choose that option.

Members of the Older Amish community choose to not carry traditional health insurance.

One reason behind this is because the Amish don’t traditionally seek outside medical care

(Schroeder, 2006). Within the Amish community, they have their own healers and practitioners.
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Purnell (2013) describes diseases and health conditions that are prevalent in the Amish

community. One condition prevalent in the Amish community is dwarfism. Another condition

is cartilage-hair hypoplasia. Purnell (2013) explains that this disorder is found within nearly all

Amish communities in Canada and the United States. Finally, phenylketonuria [PKU] is found

in high numbers within the Elkhart-Lagrange Amish settlement (Purnell, 2013).

The Amish use their elders as a source of strength and wisdom. Because the Amish

usually do not seek Western medicine, when they travel for medical care, it is typically done as a

multigenerational group. This is evident by the Miller’s traveling to Fort Wayne with Aaron and

some of their children. For a medical professional, it is important to understand this and plan

care for all members of the Miller family. It is important to understand that younger Amish

involve elders in their medical care.

When conducting educational classes, it is important to understand that Amish women

may use Amish and non-Amish midwives during their prenatal care. This is important for

healthcare providers to understand because treatments may contradict each other. Another

Amish value important to consider during prenatal education classes is the Amish preference for

home births. Home births can put the mother and baby at risk for complications. It is important

to educate Amish women on safe home birthing practices and when to seek outside medical care.

Finally, it is important to involve Amish husbands in prenatal classes. Purnell (2013) explains

that often times, Amish husbands are involved in prenatal classes. Amish men may not feel

comfortable viewing photos or videos of the childbirth process, but they can be educated through

discussion.

Amish diets are high in carbohydrates and fats. The Amish use meals as an opportunity

to spend time together as a family. Throughout the day, all members of the family are busy
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either at school, work, or both. Meals are a time of coming together. When developing a

nutritional guide for an Amish woman interested in losing weight, it is important to teach

moderation. All foods are okay in moderation. Amish are avid farmers and grow their own

fruits and vegetables. To encourage an Amish woman to lose weight, teach her to eat fresh fruits

vegetables raw or steamed, instead of other traditional Amish preparations.

Amish people typically do not openly show emotion. Purnell (2013) explains that love

and fondness for family members are held privately. Amish people use nonverbal

communications to express caring for others as well. For example, Amish men may tilt their hat

as a sign of expression. Amish express caring by giving to others. By donating money, food, or

a service, Amish show they care for others in their community by giving back.

Jewish Heritage

Sarah is an 80-year-old Jew who is a first-generation American. She was recently

widowed after being married for 50 years. She is the mother of three children. Sarah practices

some variations of kosher-style eating, but her home is not kosher. Sarah has been diagnosed

with pancreatic cancer two months ago and is currently undergoing chemotherapy.

Many Jews believe that each day is a blessing and should be lived to its fullest. They also

believe that anything that artificially prevents death or prolongs the dying process should not be

used. Sarah has rapidly progressing pancreatic cancer that is not responding to chemotherapy

and causing complications within her gastrointestinal tract. Given this information, and the

Jewish belief on preventing death or prolonging the dying process, a nurse would expect Sarah to

sign a do not resuscitate [DNR] while continuing chemotherapy in an effort to cure her cancer.
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Purnell (2013) explains that Judaism teaches its members to choose life and considers the

refusal of life-saving medical treatments as suicide. It is this belief that helped Sarah make her

decision to undergo surgery and begin chemotherapy. A culturally competent nurse would

respect Sarah’s decision and help keep her informed on the risks and benefits of medical

surgeries and medications.

It is important to understand if Sarah is a practicing Orthodox Jew. Purnell (2013)

explains that in ultra-Orthodox denominations of Judaism, taking medications on the Sabbath

that are not necessary to preserve life are viewed as unacceptable. It is important to understand if

Sarah practices Orthodox Judaism she may need more education to stress the need for

medications during the Sabbath.

Purnell (2013) explains “the dying person should not be left alone” (p. 349). Sarah is

very ill and her cancer is not responding to medications or surgery. These factors are the reason

for her family members visiting. Popovsky (2007) describes the Hebrew phrase bikkur holim

which translates to “visiting the sick”. In Judaism, this refers to the obligations of healthy

family and friends to provide a range of care for those who are sick.

Hospice care may be appropriate for Sarah. As previously stated, many Jews do not

believe in measures that may prolong death. They also believe that the ill should be kept

comfortable and pain-free. Popovsky (2007) explains that hospice reflects the values that

Judaism has regarding caregivers at the end of life. Values such as respecting dignity, providing

peace, maximizing function, and pain management.

Purnell (2013) explains that the period of time between death and burial are short. It is

also unacceptable to cry, express anger, or talk about the deceased person’s life immediately
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after death. A culturally competent nurse should be aware of this and refrain from these actions

or expressions in front of family. It is acceptable for the nearest relative to gently close the

mouth and eyes at the time of death then cover the face with a sheet. It is the job of a nurse to

allow relatives to have this opportunity. Purnell (2013) also explains that Orthodox Jews may

wrap the body, place it on the floor with feet pointing toward the door, and light a candle near

the head. While the body may not be able to be placed on the floor, a nurse can position the

hospital bed with the patient’s feet touching the door. The nurse may also have a flameless

candle available to be placed near the head. With all deaths, communication about patient and

family wishes is very important for health care professionals.

Bloom syndrome is a rare genetic condition with genes carried by 1:110 Ashkenazi Jews.

Respiratory and gastrointestinal infections, photosensitivity, and dwarfism are a result of an

abnormal breakage of chromosomes. Gaucher’s disease is the most common disease affecting

Ashkenazi Jews (Purnell, 2013, p. 344). Gaucher’s disease is characterized as a lipid-storage

disorder that results in weakening bones, anemia, and platelet deficiencies. Gaucher’s disease is

carried by 1 in 10 Ashkenazi Jews. Another disease that is seen in 1:1000 to 1:3000 Ashkenazi

Jews in the United States is torsion dystonia. Torsion dystonia is a musculoskeletal disease that

leads to loss of motor control leading to permanent contractures.

Jewish funerals usually occur within 24-48 hours after death (Purnell, 2013). Caskets are

usually a simple pine box and flowers and fists are not usually seen. Purnell (2013) explains that

simplicity and realism are characteristics of the Jewish burial. Shiva is the 7-day period that

begins with the burial. During Shiva, mourners do not work and no activities are permitted as

not to divert the attention away from thinking about the deceased.
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Laws of Kashrut refer to the Jewish laws that dictate what foods are permissible to

consume. It is important for a nurse to understand a Jewish patient’s belief in Kashruth when

discussing meal options. Purnell (2013) explains that permitted meats must be slaughtered,

cooked, and served properly as all life, including animals, is sacred. Another example of a

Kashrut law is that milk and meat may not be mixed together in eating, serving, or cooking. To

follow this law, separate plates and utensils are used. They also believe that fruits and vegetables

must be carefully washed to ensure they are free of insects.

When entering a Jewish home to provide care, it is important to not bring in any outside

food without knowing whether it is kosher. It is also important not to prepare any food in a

patient’s kosher kitchen without discussing with the patient what items are used for meats or

dairy.

Sephardic and Ashkenazic Jews represent two different subcultures of Judaism. While

they both share the same basic beliefs, there are some differences in practices. Sephardic Jews

are from the Middle East, North Africa, Spain, and Portugal. Ashkenazic Jews are from Eastern

Europe, Germany, and France. Some differences between the groups include food preferences.

Rich (2011) explains that during Pesach, Sephardic Jews eat rice, corn, beans, and peanuts while

Ashkenazic Jews avoid them. She also explains that Sephardic Jews have become more

integrated with non-Jewish cultures in the United States, while Ashkenazic Jews remain more

traditional.

When having holidays in the workforce, it is important to be informed of co-worker’s

meal restrictions. Facilities can choose to celebrate holidays celebrated by all employees. By

preparing or purchasing foods that were prepared in a kosher manner, Jewish coworkers can
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share in the holidays. One example is during Rosh Hashana, Jewish people wish for a sweet year

by eating apples and honey. This is a tradition that many, if not all, cultures can participate in.

Purnell (2013) explains that Hebrew is the language used for Jewish prayers for all Jes

wherever they live. Hebrew is the official language of the state of Israel.

Conclusion

Understanding different cultures can not only help personally, it can help a nurse

professionally become more competent and deliver better care. Having an understanding of

different cultures can help guide care or help a family grieve the loss of a loved one. Providing

care to patients with differing backgrounds can not only help a nurse better understand their

patients, but it can also help them better understand themselves and their own personal beliefs.
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References

Popovsky, M. A. (2007). Jewish ritual, reality and response at the end of life: A guide to caring for Jewish

patients and their families. The Duke Institute on Care at the End of Life. Retrieved from

https://divinity.duke.edu/sites/divinity.duke.edu/files/documents/tmc/Jewish-Ritual.pdf

Purnell, L. D. (2013). Transcultural health care: A culturally competent approach. Philadelphia: F.A. Davis

Company.

Rich, T. R. (2011). Ashkenazic and Sephardic Jews. Retrieved from http://www.jewfaq.org/ashkseph.htm

Schroeder, M. (2006). Health of a community rising medical costs tax Amish tradition of self-reliance.

The Journal Gazette. Retrieved from

http://search.proquest.com/docview/411328625?accountid=34574

Wombwell, E., Fangman, M. T., Yoder, A. K., & Spero, D. L. (2015). Religious barriers to measles

vaccination. Journal of Community Health, 40, 597-604. doi:http://dx.doi.org/10.1007/s10900-

014-9956-1

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