N201 Family and Culture

• Family-centered care


  Bringing the perspectives of patients and families directly into the planning, delivery and evaluation of health care – improving quality and safety
• Core concepts of family-centered care

  • Dignity
  • Respect
  • Participation
  • Collaboration
  • Information sharing
• Hospitalization is stressful for patient and families, can be life changing, and may threaten the equilibrium of the family unit
• Family often feel alone and unsure of their role in acute care setting, may have feelings of uncertainty, loss of control, even chaos
• Caregivers may focus attention on ill family member and not their own health needs, leading to stress, risk of depression, fatigue, anxiety, PTSD
• Benefits of Family Centered Care Model

  • Promotes a Holistic nursing model
  • Builds relationship with patient and family
  • Earn trust; improves communication and care planning
  • Family inclusion as part of the health care team
  • Involved in intervention strategies will strengthen family relationships and enhance effectiveness of treatments
  • Prevent errors; promote adherence to treatment/management plans upon discharge
  • Improve patient outcomes
• Nursing Role in providing Family support

  • Effective communication
  • Respect and support – family coping, behavior
  • Recognize uniqueness of individual/families
  • Include family in decision making for patient when appropriate
  • Visitation; privacy needs; balance with patient care & assessment
  • Facilitate family conferences; collaborate with the team
  • Clarify information; share resources for support post discharge
  • Foster positive nurse/patient/family relationships through all phases of recovery
• Effective communication between patient, family and health care team can find 4 benefits
• Discharge planning begins upon admission, is part of care planning, and nursing should anticipate and prepare to meet the patient's needs for post hospitalization – discharge home
• Priorities for Discharge


  • Care requirements
  • Medication/new prescriptions/analgesics
  • Activities allowed/prohibited
  • Dietary restrictions/modifications
  • Reporting symptoms: eg. s+s of infection
  • New stoma care: cost of supplies
  • Red cross equipment/aids
  • Follow up care; Physician/surgeon appointments; Rehab/physio appointments
• Identifying primary support person, enhancing coping with decreased LOS, and providing home support following discharge are ways to maximize resources and promote family centered care
• Cultural competence


  A set of congruent behaviours, attitudes, and policies that come together in a system and enables them to work effectively in cross-cultural situations
• Cultural safety


  Focuses on root causes of power imbalances & inequitable social relationships in health care
• Cultural diversity


  The variation of cultural factors between people. It does not simply refer to difference but rather implies difference from the majority which is assumed to be the norm
• The most common languages other than English and French were Chinese languages and Tagalog (Philippino language)
• Approximately 5 million people in Canada in 2011 were Indigenous (born in Canada) and make up 61% of Canada's population which included Inuit & Metis
• Cultural humility


  A stance toward understanding culture that requires a commitment to lifelong learning, continuous self reflection on one's own assumptions and practices, comfort with 'not knowing', and recognition of the power/privilege imbalance that exists between clients and health professionals
• Inez Louis: 'The gap between Indigenous people and the rest of Canadians is something that needs to be addressed but will take time'
• The approach of First Nations Elders involves paced listening, a gentle approach, calmness and well thought out responses where silence is not a tense thing
• Comments from 2 First Nation RNs about culturally safe and culturally humble nursing care of Indigenous people


  • Remember everyone has a different story with a past – they are individuals
  • Partner with patients and remember they are the experts in their own lives
  • Don't rush; allow time for reflection and response of elders
  • Accept decisions and lifestyles – nurses educate and offer care but don't pass judgment or work harder to "convince" them
  • Elders may use silence as power - trusting takes time
  • In a fast paced environment such as surgical nursing there is little time to connect but it is valued in First Nation's culture so look them in the eye, show you care and be genuine!
  • There is no formula – cultural safety and humility requires a learner approach
  • Remember you are a nurse serving human beings – honour them no matter their choices, background, and ethnicity – be Person-centered!!
• Behind every task is a human being, and kindness, compassion, and tolerance are important in providing culturally competent care
• Steps to achieving cultural safety in nursing practice

  • Acquire a knowledge base of cultures in your service area, especially in relation to healthcare practices and beliefs
  • Avoid making stereotypical assumptions about your patients' culture; become aware of your own biases and prejudices
  • Learn new communication skills to simplify language for any patient, regardless of primary language
• Treat each person with respect, kindness, compassion, and tolerance, make individual assessments to identify relevant cultural factors, do not make assumptions, recognize power differentials, and be aware of your own attitudes and tendencies to stereotype in order to provide culturally safe care