Experience
While in my professional practice, an elderly patient, Jean, 81, who had been admitted a day, was reported to have multiple comorbidities, thus challenges in eating and fragility fragile. My preceptor had knowledge of the patient and her condition and expected to take me to the room later to learn a few things. Later in the day, my preceptor let me know that we would be making rounds assessing patients and giving medications as prescribed. As we made our way to the various rooms, we noted and recorded the patients’ physical assessments and progress. I reminded my preceptor of the visit she had promised to Jean.
In her report, Jean had been diagnosed with cancer on top of her pre-existing diabetes and hypertension, which had led to her hospitalization. I also learned from the nurse that she was adamant about starting treatment for cancer because of her cultural background as an Indigenous woman. Therefore, she stood her ground and declined any form of treatment, including chemotherapy, because she believed her own traditional herbal medicine could work and help heal her condition. The three of us would then dedicate the rest of our time to engaging in meaningful conversations with Jean about her available options, including the possibility of collaborating with professionals to ensure her traditional medicine would be included in the treatment. However, the nurse advised that it would be a matter of discussion and determine how the two forms of treatment, i.e., western medicine and traditional healing practices, would be introduced without interference or interaction with each other.
Standards of Practice for Community Health Nurses: Building Professional Relationships
Nurse-client interactions and relationships are often described as therapeutic because they have to yield results. According to Diem and Moyer (2006), community health nurses’ relationships are based on the principles of connecting and caring. When a supportive environment exists, the nurses, patients, and their families can participate and be self-determining in the care process. Otherwise, it should be that these relationships foster patient empowerment while preserving, protecting, and enhancing respect for life and dignity (CNO, 2019). In the scenario described above, the professional relationship that developed in our interaction with the patient provided an opportunity for me to reflect on the complex underlying issues and the contribution of personal characteristics in the engagement.
Cues
Using the NGN model, I have identified the influence of cultural beliefs on traditional healing practices vs. modern medicine, which leads to patients from indigenous communities being against cancer treatments. When having a conversation with the patient, she expressed fear about starting chemo because of her community and her belief in traditional healing practices as compared to modern medicine. There was no agitation, and the patient was frank that this was part of her ingrained beliefs and asked that they be respected.
Analyzing Cues
The first action entailed us recognizing the role of our personal beliefs, attitudes, assumptions, feelings, and values before engaging the patient. As a nursing student, I believe that all patients’ beliefs and values should be recognized and valued in their care process. Therefore, when I learned about the patient’s perception of all forms of cancer treatments involving Western Medicine, I thought of how I would talk the patient into considering chemotherapy as a treatment without undermining her beliefs.
Secondly, I identified the effect of my individual and community beliefs and attitudes on our therapeutic relationship and intervention. Some studies have shown that a patient’s attitude can affect the treatment process as they need their mental capacity to facilitate the positive effects of treatment. For instance, optimism helps in the care process by stimulating the action of an intervention. If a patient perceives that a treatment or intervention was pushed on them, it can affect their satisfaction with the care. On the other hand, the awareness and use of culturally relevant communication played a significant role in our interaction with the patient. We particularly respected Jean’s decision not to start chemo but thought like nurses on how we can intervene respectfully. By trusting Jean in her decision as an individual, we opened up a path for communication and understanding.
Lastly, a nurse should collaborate with other professionals as part of the relationships being built for the sake of the patient and practice (CHNC, 2019). In my case, I worked closely with the preceptor while supplementing our knowledge about the issues surrounding Jean. For instance, I requested we take time to understand Jean’s point of view so that we can establish why she has insisted on not proceeding with chemo. When I finally provided recommendations on how Jean’s beliefs could be included in the treatment process, the preceptor let me know that she would communicate that information to the oncology professional so that they could ensure Jean’s wishes were met. In the same way, a community health nurse can create a relationship with the client to understand them and then communicate with the relevant personnel to ensure the patient’s needs are met.
Hypothesis
Nurses require enough knowledge and skills to understand that the indigenous community is still concerned that their traditional healing practices are getting forgotten with the influence of Western medicine and treatments.
Solutions
It will be unfair to assume that patient beliefs like Jean’s are not a reality. According to Gall et al. (2018), the use of traditional indigenous and complementary medicines alongside Western medicine is increasingly becoming popular among cancer “patients” to help in curing and coping with cancer diagnoses. However, information is lacking on the use of these healing practices alongside medicine in Canada, the US, and Australia because of limited systematic reviews. Given such, providing the information would only include areas of advice to eliminate reluctance and encourage a collaborative approach toward treatment.
Considering the common notion that professionals’ beliefs and perceptions of traditional indigenous and complementary medicines are likely to affect the patient’s response, i.e., some beliefs will hinder the patient’s willingness to disclose their reasons or encourage them (Kelak, Cheah, and Safii, 2018). Therefore, professionals must put aside their individual beliefs and attitudes because the patient is likely to perceive and sense when the attitudes are not right. In our case, we encouraged the patient to discuss with us her recent diagnosis, how she feels about it, what she would like to do, she was comfortable with her decision, and such questions. We then asked if she would like to consider professional advice, to which she would decide if to take it up or ignore it. This is where the solution began.
Nurses are required to ensure patient participation through decision-making (CNO, 2022). We recognized how important Jean’s beliefs were to her family and herself, and we took time to understand her approach. As a solution and an attempt to achieve a common ground, Jean was aware that both treatment strategies could be brought together but, first, be assessed by a professional for potential interaction. As Gall et al. (2018) explain, indigenous cancer patients often rely on open decision-making and communities across the involved parties for effective, safe, and coordinated care.
In summary, the solution to the indigenous fear that their healing practices are gradually being forgotten is informing them that there is a way they can bring their traditional healing practices to the Western medicine scene to determine how the two can be used without a health conflict or hazard (Redvers and Blondin, 2020). Nonetheless, the Indigenous people view health from a holistic point of view that the physical, cultural, and spiritual aspects underpin their tendency to seek care from healthcare professionals.
Priority
The priority is ensuring an improved quality of life while preserving the important aspects of the social and cultural contexts. As a nurse, I believe that patients should receive the appropriate care to improve their health outcomes and encourage the whole community towards that same perspective. Despite being elderly, some cancer patients have a high quality of life that can be managed with appropriate advice. Therefore, the priority is to change perspective to ensure effective collaboration with the community and individual patients and their families to seek medical services.
Evaluation
After speaking with Jean, she agreed to give chemotherapy a chance, but she had to consult with her traditional healer. She agreed that she understood what we meant and the nature of our intentions. Jean also appreciated our interaction and acknowledged how we contributed to her understanding of her health despite the old-age comorbidities catching up with her. Therefore, using such an approach with the whole community of indigenous cancer patients can ensure they are aware of their decisions and choices about treatment and the aspect of autonomy is maintained. The CNO (2019) explains that nurses should establish a therapeutic relationship based on respect and dignity to help patients trust them. Again, communication is significant in the whole process as it streamlines the interaction to lead to a therapeutic relationship.
References
CHNC. (2019). Canadian Community Health Nursing Professional Practice Model & Standards of Practice. Standards of Practice. https://www.chnc.ca/membership/spdf?spdf=63&file=.pdf
CNO (2019). Therapeutic Nurse-Client Relationship, Revised 2006. CNO Practice Standard.https://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf
CNO. (2022). Professional Standards. CNO Practice Standard. https://www.cno.org/globalassets/docs/prac/41006_profstds.pdf
Diem, L. & Moyer, A. (2006). Canadian Community Health Nursing Standards of Practice (CCHN Standards) Toolkit. https://www.chnc.ca/en/membership/documents/loadDocument?id=501&download=1
Gall, A., Leske, S., Adams, J., Matthews, V., Anderson, K., Lawler, S., & Garvey, G. (2018). Traditional and Complementary Medicine Use Among Indigenous Cancer Patients in Australia, Canada, New Zealand, and the United States: A Systematic Review. Integrative cancer therapies, 17(3), 568–581. https://doi.org/10.1177/1534735418775821
Kelak, J. A., Cheah, W. L., & Safii, R. (2018). Patient’s Decision to Disclose the Use of Traditional and Complementary Medicine to Medical Doctor: A Descriptive Phenomenology Study. Evidence-based complementary and alternative medicine: eCAM, 2018, 4735234. https://doi.org/10.1155/2018/4735234
Redvers, N., & Blondin, B. (2020). Traditional Indigenous medicine in North America: A scoping review. PloS one, 15(8), e0237531. https://doi.org/10.1371/journal.pone.0237531
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