Culturally Competent Care for CLAD Pregnant Women Assignment Examples

Introduction

In this descriptive paper, I will focus on one of the patients I was fortunate to encounter during my practice in Australia – a pregnant CLAD woman. In this particular patient, I describe 40-year-old female from Southeast Asia who had recently arrived in Australia and didn’t know much about the system and her English was limited. I have selected this case because it grounded me with specific difficulties and culturally sensitive aspects of caring for CLAD women, more so those who are pregnant. These two factors made it very challenging to explain to the patient the care plan, making her feel at ease to report her needs and have confidence in the healthcare system. Some elements of specific care, which are self-explanatory when caring for patients who are of native English speaking or already acquainted with the system of healthcare in the United States, have to be approached differently regarding this patient (Australian Institute of Health and Welfare, 2020).

The services offered were routine ante-natal appointments, dietary advice, and counselling that was culturally sensitive and in her preferred language. Most of the communication was done in sign language and; therefore, she had ample time to comprehend her medical possibilities and pregnancy care. Also, culturally appropriate educational materials were given to her, which enabled her to manage her pregnancy according to her cultural norms. Poorani’s cultural practices were regarded and her preferences of handling especially when she was pregnant were highly considered to make her feel comfortable and appreciated all through the period. Patient content has been removed from this document and all features that may allow patient identification have been removed in a process known as de-identification (Baker & Mason, 2021).

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Identify Why your Population is Considered Diverse

Social determinants of health

The social determinants of health placed CLAD pregnant women in Australia at a unique disadvantage resulting from cultural and linguistic barriers. Social, economic, and demographic characteristics, level of education, quality of housing, and health care influence their health considerably. In essence, the impacts presented in this paper can be explained by the use of the Social Ecological Model that embraces individual, interpersonal, community, and societal levels. For instance, low packaging can bar people from getting good nutrition and proper antenatal care; language and, in some cases, low education levels affect health literacy and communication with doctors. Stable housing and employment significantly affect the pregnancy stress level which in turn can harm the pregnancy. Furthermore, the lack of sufficient culturally appropriate services amplifies these issues, and consequently, ramps up disparities in women's and infants’ health (Bradley & Williams, 2020).

Health inequalities

There are several crucial aspects in which culturally and linguistically diverse pregnant women’s health disparities are apparent in Australia. The situation of these women is quite grim as they suffer from poor mental health, including higher incidences of depression rates and anxiety caused by issues like migration stress, social isolation, and cultural displacement. Also, they are more likely to develop some diseases of pregnancy as gestational diabetes, for example, among representatives of some ethnical groups because of the hereditary predisposition and improper diet. Abuse and violence rates are also higher in some CLAD communities and stress and the effects on both maternal and fetal health are also worse. These factors impinge on the healthy life expectancy of CLAD pregnant women and increase morbidity and mortality among them (Dawson & Rossiter, 2019).

Health inequities 

Information regarding culturally and linguistically diverse (CLAD) pregnant women's health inequalities in Australia indicates that socially constructed and preventable factors such as healthcare access, costs, and income define them. Lack of translation services, cultural differences, and lack of familiarity with the country’s health care system deny such women proper prenatal care thus contributing to poor health. Budgetary limitations also worsen this problem, mainly because some CLAD women may not afford all the healthcare services needed, or good quality food that is crucial in pregnancy. Moreover, income inequalities have also been attributed to these disparities, whereby the CLAD women of the lower income strata have the most difficulty in ensuring that both they and the unborn babies are healthy. These are actualised institutionalised injustices that prove hugely disadvantageous to CLAD women, thus leading to premised and unnecessary health disparities (Higginbotham & Brown, 2021).

Health outcomes 

Several main health concerns CLAD pregnant women experience in Australia influence their health and pregnant women’s outcomes negatively. These include; they are the majority prevalent; it is noted in women of South Asian and Middle Eastern origin due to genetic and lifestyle influences; on gestational diabetes. Emotional problems, including depression, anxiety, and post-traumatic stress disorder (PTSD), are also prevalent, with migration stress, social exclusion, and the change in living environment being the root of these problems. Also, CLAD women are most likely to give birth to preterm individuals and those who are Low Birth Weight, mainly due to poor access to prenatal care, poor diet, and high stress rates(International Council of Nurses, 2021).

Care Considerations

Providing culturally competent and evidence-based care for CLAD pregnant women involves several key considerations:

• Language Support: The availability of professional interpreters and health information in an understandable language is one more aspect aimed to contribute to the achievement of the goal. This complies with the ACHRS right of a patient to be provided with clear information, a principle summarized below.
• Cultural Competence: All staff who work in healthcare settings should receive cultural competency education to acknowledge CLAD women’s cultural practices and attitudes. This entails understanding the cultural practices of the female on modesty, family participation, and childbearing (Kassam & Rahman, 2022).
• Access to Care: Documents such as the Maternity Services Inter-Jurisdictional Committee’s National Maternity Services Plan promote the expansion of culturally tailored maternity care for CLAD women, including increasing services targeted at CLAD women that would give them access to midwives-centred clinical care accessible in communities.
• Mental Health Support: In this case, there is a need to ensure the extension of psychological services to cover CLAD women during antenatal care. The National Perinatal Depression Initiative focuses on escalating the process of screening, diagnosing, and developing intervention programs for women with perinatal analytical disorders and depressive episodes.
• Policy Implementation: Policies like the Racial Discrimination Act 1975 and Multicultural Access and Equity Policy assist the healthcare services to look for cultural equality hence providing the CLAD women the same quality as all other women (Loftus & Darlington, 2019).

Critically Reflect and Evaluate

Reflect upon your own practice

When considering the CLAD client that I attended as a pregnant woman, it is clear that there are best practices that I employed in my practice and areas that require enhancement. Also, I would like to underline that the main strength was multicultural sensitivity which is a significant aspect of professional nursing activities. Concerning cultural factors, I ensured that I enquired about the culture of the patient and how it affected her perception and expectations during pregnancy. This comprised aspects of her dietary habits, her views on family engagement in healthcare decisions, and the views she had on childbirth. I try to consider these cultural aspects and respect them as much as I can, and I think it helped me tremendously to establish a good rapport and good therapeutic communication with her, and I think it will go a long way in enhancing her overall care experience. Regarding one of the key managerial competencies, namely the ability to provide effective communication, I believe I did rather well in this aspect. Due to communication difficulties with the patient caused by the need for interpretation in a language, the patient spoke and understood I made sure that there was a professional interpreter with me during all crucial consultations and utilized culturally appropriate educational tools (McFarland & Wehbe-Alamah, 2019). This allowed the patient to be knowledgeable of the care plan that had been prepared for her, make choices, and state her woes without any misunderstanding. This also involved speaking with the interpreter just as a source of checking for give and take to go a notch higher than mere translation in light of the patient’s culture. There was a list of strengths, but I also had to look for possible weaknesses that were notable merits of the applicant. I found it difficult when dealing with conflicting ethical dilemmas such as respecting the patient’s cultural beliefs while undertaking the right procedures as prescribed by health care. For example, some cultural beliefs on the appropriate diet during pregnancy were a challenge to the dietary advice I had to give her for her gestational diabetes. Although I sought to honour her cultural practices, I shifted between honouring her and ensuring that she complied with medical prescriptions considered important in enhancing her and her baby’s health. This compelled me to realize that there was a missing competence in me to manage such conflict sustainably without influencing the patient's seniority or sparing the quality of care. Another area, where I noted a deficiency, was in the inclusion of the social factors influencing the health of the patient. As much as I took my time in looking for her health concerns and tackling them, I could have searched for other additional social services that could take care of some of her other needs that I noticed included social exclusion, housing, and financial problems. While providing a cure for the patient I was more preoccupied with her clinical management and failed to realize that other factors are equally or even more important in order to enhance the CLAD women’s health status. The last element that I had to face during this experience was bias. Despite the efforts of ensuring equal treatment of all patients, I identified a lens through which I judged the patient based on an assumption that since the latter was not a regular healthcare consumer, then he or she possessed little or no knowledge and disability in health matters. This prejudice could have made her be assumed to have a low level of self-care and therefore tend to get worse than she was. Being aware of this bias has helped me to understand the need to meet and treat every patient without negative presumptions about their cultural or language barrier. This is one of the most challenging things about this experience, the patient’s anxiety and stressful feelings especially originating from the time they spent migrating and lack of social contact. This is because I was limited on how well I could handle these problems in the health facility, in which the body is considered more important than the mind. Even though I offered her mental-related services and support during our communication, I concluded that more could have been done in an attempt to address her mental-related issues comprehensively (Murray & Wynter, 2021).

Changes required

Based on the experiences with CLAD pregnant women, it is obvious that several changes must be made to my practice to improve the quality of such care. In the following practical implementation, the nursing changes will be implemented based on research evidence, by the nursing professional standards that require cultural sensitivity, patient-centred care, and a broader focus on patients’ health.

Among those changes, the most significant one relates to enhancing cultural competence in nursing as a part of professional training. Although I have learned a lot about cultural competence in my practice, I can understand that cultural competence is a never-ending process of learning. National standards of nursing practice for the members of NMBA stipulate that all registered nurses should practice professional and relationship-based care that is culturally sensitive as per standard 2 (Santos & Lopez, 2020). To achieve this standard, I will enrol in cultured competition training and use the available literature to find out more about my clients hence being culturally competent. Promoting cultural competence may involve going for training sessions, involving the patient in cultural exercises, as well as enlightening oneself with the current literature and policies that relate to cross-cultural nursing. This way, I can be confident that I step into a patient’s presence with a level understanding of his or her cultural background to respect that cultural diversity in delivering healthcare to the patients. Another alteration that requires initiation is the strengthening of skills when responding to the SDH that affects the patients. The NMBA Standards for Practice including Standard 3 entail the delivery of detailed, safe, quality, and comprehensive nursing practice that is also patient-centred which means that the patient’s needs must be met fully. According to this standard, I require embracing broader care paradigms that extend beyond the clinical aspects of a patient’s status. This entails conducting screening tests on patients in health facilities concerning major social indicators like housing, finance, social connections, and healthcare. Research in the field of EBP points out that the combination of social care services in clinical practice enhances the quality and doesn’t just put a life but safely does so for CLAD pregnant women. Screening for social determinants will also be a part of my assessment plans, and I need to communicate with social workers and other individuals in the community, as well as with the other professional teams that can help the patient. This approach is in harmony with the NMBA’s Standards that require knowledge and evidence about safety and quality should be applied by nurses. Another area that needs enhancement is communication skills which remain a vital competency to this date. The NMBA Standards, especially those in Standard 2, list communication as something that must be done properly so that patients understand their health. Language is also a barrier especially for CLAD patients as this may result in misunderstanding and thus poorer health. In response to this, I intend to adopt formal professional interpreter services in the course of treating my patients even where informal translation can be done with ease (Whelan & Robertson, 2022). Also, I will ensure that I acquire and apply appropriate educational materials and charts that would enable me to close a communication gap. Research proves the efficiency of these tools in enhancing patient comprehension and participation as a determinant of pregnancy and other health issues to progress. Another important modification I intend to make is the improvement of the investigation of mental disorders in pregnant CLAD females. This indicates a high prevalence of depression, anxiety, and trauma in this population but unfortunately, they do not seek help because they face prejudice, cultural taboos, and lack access to health care. It embraces Standard 6 of the NMBA Standards for Practice directs the nurses to deliver care that is client-centred and focuses on the client's health and well-being, which entails mental health. Research has indicated that the inclusion of MH screening and treatment in the package of antenatal care can have positive results for both the mother and the baby. In the future, I will make it a point to assess current as well as past mental health disorders while doing prenatal checkups and if necessary, offer appropriate mental health care to the patient or, refer him/her to the right professional. This may require engaging with psychologists, counsellors, or other ethnocentric mental health care professionals who can provide the service.

Conclusion

So, it can be concluded from the overall study that the integration of tools and strategies promoting cultural competence, consideration of social determinants, communication, mental health care emphasis, and reflection on practice as foundational to improving care for CLAD pregnant women, providing equal, person-centred, and evidence-based nursing care.

References

Australian Institute of Health and Welfare. (2020). Australia’s mothers and babies 2018: In brief. AIHW.

Baker, E., & Mason, S. (2021). Cultural competence in nursing practice: Implications for patient outcomes. Journal of Nursing Education and Practice, 11(3), 10-17.

Bradley, H., & Williams, J. (2020). The impact of social determinants of health on maternal and child health outcomes. International Journal of Nursing Studies, 102, 103451.

Dawson, A., & Rossiter, C. (2019). Addressing the mental health needs of culturally diverse populations: Strategies for healthcare professionals. Australian Journal of Primary Health, 25(4), 329-336.

Higginbotham, N., & Brown, L. (2021). Culturally responsive care: Best practices for supporting CALD women during pregnancy. Midwifery Journal, 92, 102883.

International Council of Nurses. (2021). Nurses: A voice to lead - Nursing the world to health. ICN.

Kassam, S., & Rahman, A. (2022). Barriers to healthcare access among CALD women in Australia: A critical review. Health Equity Journal, 6(2), 99-108.

Loftus, S., & Darlington, S. (2019). Social determinants of health and their influence on pregnancy outcomes in multicultural populations. Global Health Journal, 14(3), 211-221.

McFarland, M. R., & Wehbe-Alamah, H. B. (2019). Leininger's culture care diversity and universality: A worldwide nursing theory. Jones & Bartlett Learning.

Murray, L., & Wynter, K. (2021). Mental health care for pregnant women: A guide for healthcare providers. Journal of Psychiatric and Mental Health Nursing, 28(5), 1024-1032.

Santos, M., & Lopez, J. (2020). The role of interpreters in providing culturally competent care for pregnant women. Journal of Healthcare Communication, 5(1), 17-26.

Whelan, J., & Robertson, N. (2022). Improving access to prenatal care for culturally diverse populations: Evidence-based strategies. Maternal and Child Health Journal, 26(4), 500-510*.