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Global Maternal Health

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Table of Contents

Introduction. 3

Main Context 3

Conclusion. 6

References. 8

Introduction

Indian culture is an amalgamation of various cultures. In India pregnancy is a normal physiological phenomenon and the pregnant women seeks medical help in the event of a problem. In rural India the maternity care services are scarce which often leads to infant mortality. The new mothers are discharged after few hours of delivery and hence post natal care is not that widespread in India.

Urban women have good maternity care centre but that is not the case with Indian rural women (Wells & Dietsch, 2014).A nurse is duty bound to provide effective services in cross-cultural situations. Nurses are specially trained health care professionals that take care of pregnant women and mothers of newborn babies. Nurses care for women during pregnancy, labour and after birth.

Nurses help mothers of newborn babies with breastfeeding and other related care for newborn babies. The Australian Institute of health and welfare releases reports tracking maternal health in Australia. The national core maternity indicators have indicated that caesareans and birth weight are increasing in Australia. The rate of smoking among pregnant women has also decreased in Australia.

The Australian healthcare system is approaching the goal of achieving improvement in maternal health. The three important areas that need attention in maternal health are antenatal period, labour and birth outcomes. In Australia, the national core maternity indicator has shown concern that smoking during pregnancy can raise the risk of placental complications and prenatal death of the newborns. The four key indicators in maternal and child health care are smoking during pregnancy, infant mortality, low birth weight of the infants and antenatal visits during the first trimester of pregnancy.

The rate of smoking is higher in pregnant rural women than in pregnant urban women. The mortality rate among infant is much higher in rural areas than in urban areas. The city of Melbourne faces the highest rate of migration because of the availability of a good transport system and other facilities.

Main Context

Reflecting on cultural competence

Cultural competence can be described as the culturally appropriate behaviors and policies of an organization that permits providing services in cross-cultural situations. Cultural competence must contain basic human rights. Cultural competence includes a set of values and principles at both individual and organizational level. As a nurse, I have to provide maternity care service to a woman who has migrated from China in search of better health care facilities (Bauce, Kridli & Fitzpatrick, 2014).

As the health care organization is culturally competent, the migrated Chinese woman will be getting the same advantage in maternity care like other Australian women. While providing maternity care service to a woman of different culture a nurse has to be culturally aware of the existing differences between her and the childbearing woman. Cultural awareness is a step towards attaining cultural safety.

A nurse has to be culturally sensitive towards her patient in order to achieve cultural competency (Luquis & Perez, 2014). An example can be given of limiting cultural sensitivity when the nurses acknowledge the fact that women have the right to make informed choices and then judge her for refusing antenatal screening. Cultural safety involves understanding, respecting, empowering and supporting women from diverse cultures.

A nurse cannot provide culturally safe health care without reflecting her own cultures, values, and beliefs. Cultural safety is important but sometimes it can clash with basic human rights like female genital mutilation and forced child marriages. Respecting an individual within a culture is a human right and a component of cultural security. Any health care services provided by the health system will not compromise with the cultural rights of the other people seeking health care services (Courtney, Wolgamott, Wehbe-Alamah & McFarland, 2013).

A nurse should not discriminate culturally while offering health care services. Cultural humility enables us to recognize a diverse culture with an attitude of appreciation. Cultural humility requires us to perform any activity even if we do not agree to it. The migrating woman may have a different culture that the attending nurse is not aware of or does not agrees but still, the nurse has to perform the activity as a part of cultural humility. Cultural humility includes valuing and learning from others' culture (Hart & Moreno, 2016).

A nurse must treat her patient with respect, equality and maintain her privacy. Chinese women seeking maternity care has a different culture than the Australian nurse. The culture of the Chinese patient can be such to which the Australian nurse may not agree but keep in mind cultural humility the Australian nurse has to render service. The Chinese woman seeking maternity care has cultural barriers as the nurse did not have much knowledge about the cultural background of the patient.

The Chinese patient seeking maternity care was unable to convey her perception to the nurse as there was a communication gap between them (Dreachslin, Gilbert & Malone, 2013). The nurse conveyed her perception regarding maternity care services to the Chinese patient and offered prenatal and postnatal services to her. Good communication skill enables migrant women to participate in their own care.

In a non-English speaking nation like China, the language barrier plays a great role in receiving maternity care services. Global researches have shown that cultural factors affect skilled maternity care service (Harkess & Kaddoura, 2015). Childbirth is a social and cultural event governed by norms. The cultural factor should be considered while delivering services in order to encourage the services important for reducing maternal and infant mortality.

The Australian government has taken intercultural approaches for delivering national policies. The orderly mapping of the literature aims to understand the range of interference that has been applied to address cultural factors affecting woman's use of maternity care. Most health care organization of Australia seeks to grow a culturally competent workforce.

The leading health care organizations of Australia had laid down professional standards regarding respecting the cultural diversity of the patients, which the nurses are bound to follow. The nursing workforce equipped with the knowledge and cultural sensitivity will bring positive change. Cultural diversity is significantly impacting the nursing care quality. Cultural insensitivity will result in a poor outcome for the consumer of health services.

Culturally competent nursing care should be promoted to wipe out the poor outcome in the health care sector (Fink & Mayrhofer, 2009). Nurses must pay attention to developing respect and interpersonal relationship with health consumers. Growing cultural diversity can give rise to a misconception, which has a serious effect on health and patient safety. Linguistic frameworks in nursing practices can help nurses to understand the communication between patients of a different culture. The nurse should be culturally aware and have an understanding of how caring is an essential part of nursing.

Cultural awareness is a stage where people let go of their own assumption and presumption about the other person disregarding his ethnicity, race, and color. Once this stage of awareness is reached a person becomes culturally competent (Gezon & Kottak, 2014). A culturally diverse patient can be taken care of by listening to their problem carefully, by acknowledging their perception and explaining ours, by acknowledging the similarities and differences, by recommending and negotiating treatment. A care plan should include assessment, diagnosis, expected outcomes, interventions, and evaluation. Nursing provides continuity of care, safety, and compliance.

Demonstrating personal and professional insight

I have found that the Chinese women face huge problems due to the cultural and language barriers in Australia. However, there are a child and maternal health centers in the country which consisted of a large number of healthcare professionals. It is being found that the local child and maternal health services provided support to the Chinese women after the baby born. I also supported women inappropriate by using my nursing skills and expertise.

I was able to provide regular health check-ups for both the mother and the baby (Ko & Turner, 2017). I also supported and advice the mother for taking care of the baby when it comes to immunization, washing the baby, getting the baby to sleep and breastfeeding. I also provided support when the women were emotional or anxious, suffering from depression and also provided assistance to the family members. However, I have found that the cultural differences were the most common factor which imposed a significant impact on the quality of care provided to the women (Taylor, 2015).

The healthcare services are being provided to the people but the cultural and language barrier creates a huge problem. The women were not able to speak English which created a barrier for us to understand her issues. It was difficult for me to communicate with the women in order to assist her and overcome the situation.

The language barrier is considered to be creating huge difficulties for healthcare professionals. However, the government of Australia provides free English classes to immigrants. I was able to determine how much it is difficult to manage a situation if the patient belongs to a different culture. I took the help of an interpreter in order to address the language barrier issue. The woman was not able to read, speak and understand the English language.

The women suffered due to the lack of information about maternal services and care (Kovner, Fine & D'Aquila, 2009). The women also suffered due to the lack of examining services and information associated with the healthcare system. It is being found that healthcare professionals are not able to meet the needs of ethnic minorities because of the lack of understanding of the cultural diversities (Powell Sears, 2012).

The traditional understanding of the Chinese people is based on the nature of the postnatal period and it is being believed that women are in the extreme imbalance state towards cold because of the loss of energy and blood during delivery and labour. The traditional practiced aimed at correcting the imbalances of the body (Sanchez, 2012). The practices consisted of keeping warm, staying inside for avoiding draughts, having hot drink and food and avoiding baths or showers.

In contrast with western medicine, it is being seen that illness is being caused by the pathogens and efforts are made on the early ambulation during the period of postnatal. Thus, it depicts a conflict between Western medicine theory and Chinese theory.

I have also found that the women are asked to take a bath immediately after childbirth and provided with icy drinking water in order to motivate them to become more mobilized. The practices are considered to the traditional beliefs that they should be kept warm, avoid cold showers and food and have plenty of rest. I have also lack of knowledge of the cultural practices and beliefs and the Chinese woman was not willing to have the shower.

The unwillingness is considered unhygienic and showing an uncooperative attitude and behavior (Kumar & Maskara, 2016). The culture of Asia teaches people to be inhibitive and unassertive from childhood. I had also found that the woman was suffering depression because of the lack of understanding and adequate support. Apart from this, I have also observed that emotional abuse and physical violence also imposes a significant impact on the health of immigrants.

It becomes very much important to assess and respond to the health of the Chinese woman. I used my nursing skills and knowledge in order to deal with the circumstances in an appropriate manner.       

I was able to provide adequate care to the Chinese Woman. However, I have seen that the migrant mothers significantly experience morbidity in the period of postnatal which leads to the occurrence of many health problems. Thus, it becomes very much important that the mental and physical health of the patient should be taken into account while providing healthcare services. Communication is considered to be the most significant factor in ensuring effective maternity care.

Effective communication would have enabled the Chinese woman to participate and understand fully their own care (Littleton-Gibbs & Engebretson, 2013). I have also determined that there was a cultural barrier while providing healthcare services to the woman. The woman was ashamed of expressing her needs in an appropriate manner. Lack of assertiveness obstructed her to express their preferences. I had also limited access to the resources which created problems for me to apply the required clinical practices.

I had used the required healthcare providing procedures and techniques in order to avoid any kind of uncertainties. I took steps for making her comfortable and provided her the necessary medication. It was considered to be a huge challenge for me to understand the health issue of the woman and supporting her to give birth to the child. I was difficult for the Chinese woman to understand the instructions appropriately (Prevost, 2012).

I was in huge trouble and trying to figure out how it can be solved. It was a challenging situation but assisted me to gain huge experiences. I also respected the culture of the woman and achieved success in providing the required health care delivery processes. I had also coordinated my work with another healthcare professional in a sequential manner.

The Chinese woman faced very problems but we made efforts to assist her in the delivery process. I also provided assistance after the birth of the child which was also a unique experience. It becomes very much important for the nurses to use their skills and knowledge in an effective manner.                       

Recommendations

The use of appropriate nursing skills and knowledge is considered to be very much important for providing adequate care to the patients. The use of interpreting services can assist to overcome communication or language barriers. It is significant that an interpreter should be employed for understanding the language of migrant women. The use of the interpreter had assisted to understand the thinking and views of the Chinese woman (Neal-Boylan, 2015). I

t is also vital that the services need to be accessible easily and the healthcare information needs to be delivered in such a manner so that the patient can understand it. Booklets and pamphlets can be distributed about the maternity care in various languages. The cultural barriers can be managed by providing training to the staffs for developing an understanding of the issues that are being faced by the migrant woman.

Training can assist to improve the knowledge of various cultural practices and beliefs associated with childbirth and decreasing the mismanagement and misunderstanding in providing care to the migrant woman (Grant, Stuhlmacher & Bonte-Eley, 2012). I think that the first thing that should be done is to make the patient comfortable. The skills, abilities, and knowledge need to be applied for ensuring that quality healthcare delivery process is being carried out.     

Conclusion

Nurses should be culturally competent and culturally tolerant towards persons of other culture. Nurses should listen to the perceptions of their patients’ seeking maternity care service. Communication gap may result in delivering poor services.

Australian health care units have focused on developing a nursing workforce that is culturally competent. Women have different culture some prefer to feed their baby just after birth, some demand to wash them up and wrap them after birth. The nurses should focus on giving excellent maternity care service without judging the culture of the patient seeking maternity care. I have used my skills and knowledge in an appropriate manner in order to assist the Chinese woman.   

References

  • Bauce, K., Kridli, S., & Fitzpatrick, J. (2014). Cultural Competence and Psychological Empowerment Among Acute Care Nurses. Online Journal Of Cultural Competence In Nursing And Healthcare, 4(2), 27-38. doi: 10.9730/ojccnh.org/v4n2a3
  • Courtney, R., Wolgamott, S., Wehbe-Alamah, H., & McFarland, M. (2013). Assessment and Education: Building Blocks of Cultural Competence. Online Journal Of Cultural Competence In Nursing And Healthcare, 3(2), 16-16. doi: 10.9730/ojccnh.org/v3n2p1
  • Dreachslin, J., Gilbert, M., & Malone, B. (2013). Diversity and cultural competence in health care (3rd ed.). San Francisco: Jossey-Bass.
  • Fink, G., & Mayrhofer, W. (2009). Cross-cultural competence and management – setting the stage. European J. Of Cross-Cultural Competence And Management, 1(1), 42. doi: 10.1504/ejccm.2009.026733
  • Gezon, L., & Kottak, C. (2014). Culture (4th ed.). New York: McGraw-Hill.
  • Grant, H., Stuhlmacher, A., & Bonte-Eley, S. (2012). Overcoming Barriers to Research Utilization and Evidence-Based Practice Among Staff Nurses. Journal For Nurses In Staff Development, 28(4), 163-165. doi: 10.1097/nnd.0b013e31825dfaff
  • Harkess, L., & Kaddoura, M. (2015). Culture and Cultural Competence in Nursing Education and Practice: The State of the Art. Nursing Forum, 51(3), 211-222. doi: 10.1111/nuf.12140
  • Hart, P., & Moreno, N. (2016). Nurses’ Perceptions of Their Cultural Competence in Caring for Diverse Patient Populations. Online Journal Of Cultural Competence In Nursing And Healthcare, 6(1), 121-137. doi: 10.9730/ojccnh.org/v6n1a10
  • Ko, A., & Turner, J. (2017). Culturally Sensitive Care for Asian Immigrants. Home Healthcare Now, 35(9), 507-513. doi: 10.1097/nhh.0000000000000608
  • Kovner, A., Fine, D., & D'Aquila, R. (2009). Evidence-based management in healthcare (3rd ed.). Chicago: Health Administration Press.
  • Kumar, A., & Maskara, S. (2016). Overcoming language barrier in healthcare settings using information and communication technologies. Saudi Medical Journal, 37(3), 328-328. doi: 10.15537/smj.2016.3.13706
  • Littleton-Gibbs, L., & Engebretson, J. (2013). Maternity nursing care. Clifton Park, NY: Delmar, Cengage Learning.
  • Luquis, R., & Perez, M. (2014). Cultural competence in health education and health promotion(4th ed.). San Francisco, Calif.: Jossey-Bass.
  • Neal-Boylan, L. (2015). Overcoming Barriers. Journal For Nurses In Professional Development, 31(4), 246-247. doi: 10.1097/nnd.0000000000000186
  • Powell Sears, K. (2012). Improving cultural competence education: the utility of an intersectional framework. Medical Education, 46(6), 545-551. doi: 10.1111/j.1365-2923.2011.04199.x
  • Prevost, C. (2012). Language Barrier. Prairie Schooner, 86(2), 29-29. doi: 10.1353/psg.2012.0057
  • Sanchez, J. (2012). Patient safety (4th ed.). Philadelphia (Pa): Saunders.
  • Taylor, C. (2015). Fundamentals of nursing (4th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
  • Wells, Y., & Dietsch, E. (2014). Childbearing traditions of Indian women at home and abroad: An integrative literature review. Women And Birth, 27(4), e1-e6. doi: 10.1016/j.wombi.2014.08.006

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