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Cultural Competency in Advanced Practice Nursing
Culturally competent care involves utilizing knowledge, attitudes, and skills that support caring for people of various cultures and different values and beliefs. Specifically, for health professionals, cultural competence can be determined as an understanding of how social and cultural factors influence the health beliefs and behaviors of patients and how these factors are considered at different levels of a healthcare delivery system to assure quality healthcare (Kaihlanen et al., 2019). For instance, while most Jehovah’s Witness community members refuse blood transfusions, there are still possible alternatives that they may be willing to accept based on effective communication. An advanced practice nurse must then need to effectively communicate and inform their patients about substitutions for blood administration and the risks and benefits of available alternatives (Campbell et al., 2016).
An APRN must ensure that the patient is making an informed decision on the refusal of blood. With this informed decision, the APRN then must inform the patient on the evidence-based alternatives to transfusions. It is important to realize that respecting the patient’s right to refuse blood transfusions does not mean denying medical treatments (Campbell et al., 2016). An APRN can still provide quality medical care while respecting the cultural and religious beliefs of the patient. It is vital to complete a thorough history and physical with a family history of any bleeding disorders (Campbell et al., 2016).
There are options and alternatives for blood transfusions, such as autologous donation preoperative. The use of a multidisciplinary approach, one that is culturally competent and meets specific patient needs, can be essential to optimize preoperative Hgb levels before elective surgery (Campbell et al., 2016). They have found that the preoperative period is the best time to optimize the patient and prepare for any known challenges related to blood loss during the procedure; such optimization should begin at least four weeks before the day of surgery (Campbell et al., 2016). Research has shown that the preoperative period can be used to develop strategies to minimize blood loss during the procedure, including the use of less invasive surgical techniques, controlled hypotension, or the use of a blood cell salvage system (Campbell et al., 2016).
Furthermore, recent studies have shown that blood transfusions can be avoided by considering alternative bloodless treatment modalities. “Bloodless surgery” is a new innovative phenomenon that medical centers are adopting for patients who refuse blood transfusions (Campbell et al., 2016). Essentially, bloodless surgery protocols have been found to lower risks to patients and may be offered to patients who decline blood transfusions.
Campbell, Yasmine N,D.N.P., C.R.N.A., Machan, Melissa D,D.N.P., C.R.N.A., & Fisher, Marquessa D,D.N.P., C.R.N.A. (2016). The jehovah’s witness population: Considerations for preoperative optimization of hemoglobin. AANA Journal, 84(3), 173-178. Retrieved from https://search.proquest.com/docview/1812276972?accountid=100141
Kaihlanen, A., Hietapakka, L. & Heponiemi, T. Increasing cultural awareness: qualitative study of nurses’ perceptions about cultural competence training. BMC Nurs 18, 38 (2019). https://doi.org/10.1186/s12912-019-0363-x