Nursing Cultural Competence in Russian-American Culture
Introduction to Russian-American Culture
Russian-American culture plays an important role in the USA. This particular culture has combined Russian and American peculiarities which have affected the style and the way of life people of Russian-American culture live in. Russian-Americans are people originated from Russia but live for many years in the USA. They have already assimilated but they are still foreigners and it does not allow them to refer to Americans. It should be mentioned that, in this meaning, the notion ‘Russian’ refers not only to those originated from Russia, but also to those who come from former USSR and whose native language is English. The development of this culture started after the breakdown of the USSR and many people went to the USA for better living. The spread of this culture in the USA is supported by mass media, and religious similarity of Orthodox and Catholic Christianity (Ameredia, 2000). Speaking about healthcare in Russian-American culture, it is essential to remember about the way how people who belong to this culture identify diseases, how they follow their health and how precisely they care for American laws and ways of treatment. Russian-American culture differs from American one where people got used to nursing and insurance and from Russian one where people treat themselves by personal cost. Moreover, the views on medicine may differ greatly. Views on nursing competence in Russian-American may differ due to the cultural significance of the population. Such factors as the level of education, professional development, experience, independence, and satisfaction from work are the main categories which define nursing competences in Russian-American culture.
Health Care Beliefs in Russian-American Culture
Russian-American culture has blended the beliefs of Russians and Americans in this relation. However, Russian culture still dominates. When a patient is diagnosed, a doctor speaks about the diagnosis only with the family members and it is expected that they will deliver the information to a patient. Such measures are taken in order to prevent patients from worrying about their health (Shpilko, 2006). Moreover, Russian-American culture presupposes detailed explanation of tests which are to be taken and procedures of treatment. The family is to discuss the taken measures and to confirm their agreement. A head of the family is usually the first to be informed when urgent decision is necessary. In most cases, research participation is going to be refused. Speaking about the pain, most of the representatives of the Russian-American vulture are stoic to pain and may refuse from medication for a long period. These people are usually afraid of blood transfusions and other equipment they are not aware of (A dictionary of patients’ spiritual & cultural values for health care professionals, 2009). One of the most difficult problems for Russian Americans is mental and psychological health. Many Russian Americans do not consider that psychological disorders are to be treated, therefore, they refuse from attending hospitals. According to the research conducted among 7-4-year-olds, Russian Americans have about 70% higher cases of psychiatric disorder than in Britain (Goodman, Slobodskaya, & Knyazev, 2005). However, people do not hurry up to solve the problem by means of medicine (Polyakova, & Pacquiao, 2006). Therefore, Russian Americans prefer to follow traditional Russian vision of health care, but they tend to Western healthcare system due to understanding that they are the part of the new culture. In this case, Russian-Americans do not consider nurses competency as an important factor as they may either trust American system of healthcare or distrust it in general.
Folk Medicine in Russian-American Culture
Russian Americans do not turn to hospital first being sure that most of the Western medicines are harmful for them. Massage, herbs, and other similar procedures are usually taken at home before taking a person to the hospital. Many people refuse from treatment in hospitals and turn to healers who consider their practice as traditional one. Still, being afraid of fraud Russian-Americans pay attention to certified healers. They say, “There are no good or bad, right or wrong methods. There are only good or bad doctors” (Iarskaia, & Romanov, 2008, p. 5). Many people consider absence of the professional equipment and the possibility to have healers at home as a priority, still, they cannot explain how people without special medical education and equipment can treat others. Russian-Americans believe that healers do not only treat them, they also cure. None traditional medicine is aimed at caring not only about body but also about soul. Remembering spiritual and religious considerations of Russian-Americans, this particular way of treatment is very important. Russians care about their souls and when falling ill they may think about their personal sins or other bad behavior. Turning to healers may solve this problem and a disease is going to be cured when the soul is treated. According to Saks (2003), Russian non-traditional medicine has entered the USA much faster than Britain. This specific phenomenon is explained by Russian-American culture which has occupied the part of the USA (Saks, 2003). Living in the USA, many Russian immigrants prefer Russian doctors as they seem to be closer to Russians. Essentially, the way how Russian people want to be treated depends on their spiritual link with their native land (Long, 2011). So, Russian-Americans are more motivated by spiritual considerations while deciding which way of treatment to choose.
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Death and Dying Rituals in Russian-American Culture
Death is connected with the spiritual aspects, therefore, Russian-American do not consider medical benefit from the situation. People are sure that body is to be buried, therefore, any research on it is forbidden. While dying, do not resuscitate patient wish may be ensured. This specific wish may be characterized by the sacredness of the earth and the soul. Russian-Americans may wish not to worry a person after death not to bother his/her soul, therefore, the after death procedures are aimed at comforting a dead one (End-of-life care, 2007). Autopsy may be allowed when doctors are absolutely sure in patient’s death, however, many patients and their relatives prefer to leave a body intact. The same is about organ donation. Particular spiritual and religious beliefs create the necessity to wash a body by family members and to put special closing on (A dictionary of patients’ spiritual & cultural values for health care professionals, 2009). The problems usually appear when people have cancer. Having a disease which leads to death, Russian-Americans do not speak about it. Therefore, they may prevent longer living due to treatment. Speaking about death and all related issues to it is taboo (American Geriatrics Society, & Ethnogeriatrics Committee, 2006). Trying to perceive life as it comes, medical aspect of human body after death is not considered at all. Therefore, the role of nurses in dying rituals is minimal. Russian patients do not allow nurses to touch them and to speak with them about their death. This is a considerable difference of Russian-American culture in comparison with American one.
Russian and American Culture Influences on Health-Seeking Behavior
To prevent diseases, Russian-American representatives are sure that they are to be warmly dressed and to avoid stress. Nutrition plays important role in health behavior as well as regular bowel movements. If one falls ill, Russian-Americans may consider it as God’s punishment or God’s will (A dictionary of patients’ spiritual & cultural values for health care professionals, 2009). Of course, living in the USA for a long period of time, Russian immigrants start thinking about their health more attentively. Visits to doctors and vaccination become their main procedures. However, when it comes to serious cold for example, people usually prefer to use non-traditional medicine. Therefore, it may be concluded that when Russian-American culture tends more to traditional Russian methods of treatment which have nothing in common with traditional American ones. However, the affect of both cultures is seen and when Russian-Americans search for the ways to remain healthy, they follow both Russian non-traditional methods and speak to competent nurses to get to know about medicine which may help. However, due to cultural peculiarities, Russian-Americans stop follow nurses’ pieces of advice when the situation changes and there is less risk to be infected.
Common Variables across Cultural Groups to Provide Culturally Competent Care
Speaking of culturally competent care, the standard of American nursing care is to be considered with relation to the Russian-American vision of each of the points. Standard of Practice for Culturally Competent Nursing Care comprises 12 issues. The first issue is related to social justice. These policies are to be followed for all. Russian-American culture presupposes some level of mistrust to officials, therefore, they do not really trust in social justice, however, this point may depend on the period of time Russian-Americans managed to live in the country and on the level of their assimilation. Critical reflection and nurses’ ability to perceive it from patients of different cultural heritage, values and beliefs are the next standard point. Russian-American culture presupposes the consideration of the critical issues from the point of view of personal cultural heritage. However, they value transcultural nursing knowledge that makes many Russian-Americans reconsider their vision of nursing competence and look at them from another side (Maier-Lorentz, 2008). Cross cultural knowledge and its practical implementation is important for Russian-American culture (Douglas, et al, 2009).
Furthermore, speaking of the next standard, hospitals are to provide population with all the needs. Due to the absence of the necessity, many Russian-Americans do not speak English. It is enough for them to know Russian. Coming to the hospital, they are unable to understand any nurse, therefore, his/her competence remains unnecessary for these people. Russian-American culture values those who have to promote multicultural workplace. Therefore, nurses of another culture (especially with Russian origin) are valued higher than more competent nurses. Nevertheless, the level of nurses’ education plays an important role. Nurses are to be certified, with all the necessary documentation. Nurses should know legislation and other policies necessary in their work. Finally, nurses are to refer their intervention on evidence-based research, as only in this case their practice is going to be effective (Douglas, et al, 2009). Therefore, when considering different variables related to the nurses’ competence, Russian-Americans prefer to check the standard and refer it to personal cultural needs and interests. Nursing Cultural Competence in Russian-American Culture
Russian-American Cultural Implications for Nursing Practice-Communication
Dealing with Russian-American culture and immigrants, it should be stated that Russian and American nurses collaborate for many years. The conferences take place each year for experience exchange. Nurses from Russia and the USA express their desire to participate in the conferences. The themes discussed while such conferences are numerous as participants have an opportunity to take a floor and to his/her vision of medicine (Russian and American nurses, 2006). The implications after such communications are various, however, it is impossible to avoid the advantages of such experience sharing. The main opportunity offered by such conferences is to see how medical care is offered in another country. Coming to Russia, American nurses are able to see the peculiarities of Russian medicine. Absence of computerization, hard work and other supportive issues are usually presented to American professionals. Being interested in American nurses’ experience in Russia, the second aspect which is to be considered is the ability to see the conditions Russian nurses work at. This may allow them understand why Russian-American representatives refuse from trusting American professionals. Experience sharing and exchange of cultural heritage are the main points nurses are to deal with. The importance of cultural interchange cannot be overestimated. Working with Russian-Americans, nurses are to understand the peculiarities of Russian healthcare in order to be able to make them comfortable. Patients are unable to express their needs, but practical experience and communication with Russian nurses helps American colleagues to draw necessary conclusions (LaRocco, 2010). Cultural affect is great and working with Russian-Americans nurses have to work hard in order to assure patients in safety of the U.S. medicine and the advantages of another healthcare system. Communication between Russian and American nurses helps them to see those differences and to make necessary steps in order to improve the collaboration between Russian-American immigrants and nurses.
Barriers to Healthcare of the Russian-American Culture
Apart from a number of positive and neutral aspects in nursing, Russian-American culture has a number of barriers which prevent professionals to give top quality care. First of all, cultural barrier is present. Russian-Americans consider their health as something different. They do not appreciate speaking about cancer and the end-of-life procedure which is freely discussed by Americans. Language barrier may also be important if cultural misunderstanding is present (Dohan, & Levintova, 2007). Speaking of barriers on the way to treating people who belong to Russian-American culture, the national aspects stand at the first place. No matter how long Russians have lived on the territory of the USA, their vision of nurses competence still remains the same. Nurses in Russia are supporting staff who have medical education, but whose qualification is low. American nurses are competent in many problems, therefore, when Russians face American nurses they do not expect them to provide treatment. Differences in the health problems may be problematic for American nurses (Bola, Driggers, Dunlap, & Ebersole, 2003). Experience shows that Russian people have medical conditions in their native country, therefore, they have the same expectations of the American nurses. Having little knowledge about competence nurses require and drawing wrong conclusions prevent Russian-American people to have quality treatment (Anderson, 2004). The whole approach to nursing is different in Russia, however, it is impossible to make sure that Russian-Americans are going to be treated particularly to their national healthcare rules even if a hospital they attend tries to overcome the barriers of cultural and nurses competence (Benson, Melgard, Trebil, & Heuer, 2002).
Implications for Culturally Sensitive/Competent Nursing Care of the Clients from Russian-American Culture
Those Russian immigrants who do not experience problems with adaptation and cultural shock do not experience any issues connected to health care. However, there are many Russian-Americans who are too sensitive to cultural changes and even highly competent nurses do not awake trust. “Implications for nursing practice include the need for interventions to build trust and to assess both self-care practices and values” (Resick, 2006, p. 1). The inability to build trustful relationships will never give sensitive to cultural changes people accept the nursing care. Thinking logically, such situation may cause many problems with health condition of the community. The refusal to turn to nurses may cause epidemics of some diseases which are going to spread in the community and out of its borders. Competence does not play any role in this case as (Gary, Sigsby, & Campbell, 1998).
Evidence-Based Research about Nursing Care of Russian-American culture
Much attention has been given to Russian-American population and their vision of health care in the country they live. Providing many arguments, personal and professional opinion, several research results have also been presented in order to show that the data is relevant. Benisovich and King (2001) have conducted a research where they referred to the evidence-based practice. The main idea of the research is to show how personal beliefs about healthcare may affect human health behavior. Completing several tasks, the research is aimed at experiencing “a sense of stress and helplessness in the US because they do not understand the English language or the US health care system” (Benisovich, & King, 2001, p. 135). The research has proven that no matter which level of nursing care is offered, the absence of the cultural comfort leads to low rate of recovery. The research involved elderly people who should have chronic diseases. The research has shown that people refused to speak about the problems due to their cultural peculiarities and the way how such diseases are considered in patients’ native countries.
Therefore, it may be concluded that being a particular group with specific customs and traditions, Russian-American population also has specific in understanding healthcare. Paying low attention to the nurses’ competences, Russian-Americans care more about cultural correspondence of treatment. Nursing competence is regarded by means of their awareness of the cultural peculiarities of Russian-American culture. Having a number of difficulties, Russian and American cultures have been combined, however, Russian cultural peculiarities still dominate. This may be a barrier on the way to correct treatment. In this case nurses’ competence should include the understanding of cultural heritage of patients, the way how they consider healthcare and treatment. Russian-American culture is significant due to collaboration of Russian and American culture, but in healthcare issues, immigrants prefer to follow their national considerations ignoring the fact that American healthcare is better. Nursing Cultural Competence in Russian-American Culture