HOLISTIC NURSING AND THE FUTURE OF NURSING

African-Americans form a distinct group of people with a unique culture. This paper will look at different points of information that I have managed to gather about this particular group. Black-Americans have health beliefs and practices that are mostly anchored in spiritual and religious inclinations. This is more pronounced when it comes to women who are of middle ages. In fact, as Giger, Davidhizar, and Turner (1992) highlighted, a majority of African Americans hold health as an element of luck or success. Some health complications among the Blacks are common due to lifestyle and feeding habits. Health complications, for instance, hypertension among the Black community are a common phenomenon. Usually, the health problem is perpetuated by high-stress levels, poor diet characterized by high carbohydrate intake, which stems out of cultural foods and low incomes as described by Fuchs (2011).  

The African American family functioning has been greatly shaped by cultural and environmental influences such as racism, segregation, immigration, and economic wellbeing among others Vereen (2007). The different elements that impact the family life of African Americans affect the family formation, gender roles, stability of families, and paternal involvement in family and child care. For instance, in a majority of African American setups, family formation originates once a child is born and not in marriage. Marriages and commitment in the African American setups are central and strong. There is an increasing tendency for singlehood especially for ladies who make the choice out of economic hardships or early childbirth.

Throughout history, African Americans have faced challenges and hardships in their daily lives, especially when interacting with the dominant culture, which overlooks their challenges. To date, African Americans have to combat adversity, racism, and discrimination, which has led them to develop their own unique way of communicating. They have their own unique vernacular English that is mostly used amongst themselves as well as standard English that they use when dealing with the dominant culture. The use of two sets of language is code-switching. Black English is characterized by features such as zero copula e.g. “you so active man”, double negatives e.g. “I ain’t going nowhere”, and perfectly done e.g. “she done got herself out of harm’s way”, among others. According to Hecht, Jackson, and Ribeau (2003), the development of this kind of communication is a means to find an identity. A nurse working in these kinds of environments need to understand the different language dynamics to effectively understand what patients are saying and put it in the right context.

Time orientation is a highly regarded subject in the white culture where time is equated to money and thus very important in preparing for the future. This, in African American culture, is different. African Americans have to adopt the white time perspective as well as the non-white time perspective, which forces the African Americans to have a dual time identity. African Americans have a preference for a relaxed and a socially engineered concept of time and according to Blue (2011), a majority have a rather present focused time perspective rather than future focused. For instance, a majority would rather enjoy the pleasantries of the present with a complete disregard for the future, an element that can be checked with how well this group subscribes to insurance products, more so, health insurance.

Culture and economic disadvantages have been held as major proponents of unhealthy nutrition among African Americans. According to Bahr (2007), African Americans have for a long time adopted diets characterized by high levels of total fat, high saturated fat, salt, and low levels of fiber. Eating practices, such as during social functions aggravate the matter by making the participants take in more than they need. As such, cultural attitudes, which largely dictate with whom and where food should be taken is also a contributing factor. Economic disadvantages contribute to poor nutritional patterns since making conscious decisions about feeding and nutrition is a question of economic ability. As described earlier in this paper, such poor nutritional patterns are often the precursor for certain health complications such as hypertension, cardiac complications, and obesity among others. 

Hastie, Riley, and Fillingim (2005) explain that ethnic and cultural disparities differ in pain prevalence, and cultures differ in pain mitigating behaviors. Hoffman, Trawalter, Axt, and Oliver (2016) further assert that African Americans are systematically undertreated for pain in comparison to dominant cultures, apparently due to racial bias about biological differences between blacks and whites. Campbell and Edwards (2012) explain that there are significant differences in healthcare structures among African American neighborhoods and those of dominant cultures. For instance, as Campbell and Edwards (2012) note, pharmacies in African American neighborhoods do not stock potent analgesics. This underlines the fact that pain, in African American culture, is not taken seriously. As such, pain responses and pain management have been inadequate in the culture and it has further been demonstrated that the medical fraternity has taken the cue and is also not taking Black pain seriously.

Childbirth and prenatal care among African American is an important subject across the entire culture. Childbirth among African Americans is a process that has great meaning and value. In its preparation, women are accorded full and positive support by family and community members as reported by Abbyad and Robertson (2011). Elderly women such as grandmothers and mothers provide vital information to their daughters as they go through the childbearing phase. Friends and partners are also important during the process. In healthcare setups, it has been described that poor communication between health care providers and a poor patient-provider relationship is to blame for poor outcomes when it comes to healthcare outcomes (Yi, 2011).

Death or dying are some of the very sensitive issues among African Americans. Death is often looked at as an event that is strongly tied to be within the hands of God (Daaleman, 2004). Daaleman (2004) further describes that death among African Americans is effectively handled through spiritual guidance and counseling to ease the pain of bereavement. African Americans were also found to minimally seek for professional assistance after the loss of a relative or friend as described by Laurie and Neimeyer (2008). They also do not like talking about their loss experience further complicating how professional assistance can be accorded to them. 

From this research, it has come to my realization that effective communication with people in this culture can make a difference. It is the missing link between African Americans and the healthcare providers even when all resources are available. For instance, the need for effective communication with expectant mothers is necessary to make the process fruitful. In pain management, communication is also key. Communication during death and dying is critical and from this research, it has been demonstrated to be effective when aligned along spiritual lines. Nutrition among African Americans has been found to a problem and a cause of important health problems. As such, there is a need for a sustained campaign against poor feeding as well as communicating important information that is necessary for the development of healthy feeding habits.

The Future of Nursing 

The Institute of Medicine (2010) has explained that the nursing profession is growing phenomenally and has hit the 3-million-member mark, making it the biggest segment of professionals among the healthcare professionals. The increasing number of nurses underlines the changing dynamics in the healthcare field, which is overly complex. Blais and Hayes (2016) opine that there is a need for changes that will make the nursing profession adjust to the changing landscape. This paper will look at the Robert Wood Johnson Foundation Committee Report which was aimed at providing a guidance document that would be followed to give the nursing profession a new face. The paper will end by projecting the future of nursing. 

The Report 

The report has four main issues that it is addressing. The very first issue that is articulated in the report is the concept of encouraging the nursing profession to rise and practice in accordance with their education and training. The report is emphatic that nurses have been practicing way below their training. Part of the blame that the report attributes to the non-practicing of nurses to their full potential is the legal restrictions. For instance, the report highlights that despite nurses being trained on medication prescription without the supervision by physicians, they are not legally allowed to go to such extents. The other thing that the report identifies as critical is the need to have sufficient mechanisms that would reduce nurses’ turnover especially during their transition from training to practice.

The second element in the report is the call for the advancement of education status of nurses in order to transform the nursing profession. Education has been singled out as the most appropriate mechanism that nurses can use to respond to the increasing demands. The report recommends that nurses with bachelor degrees should be more than 80 percent of the entire nursing population. The number of nurses that should have Masters and Doctorate degrees has been recommended to double the current numbers. The need for this kind of a shift in educational levels has been anchored on the need to enhance critical and holistic thinking rather than the task-oriented thinking as described by Blais and Hayes (2016).

The third element of emphasis in the report is the need for nurses to be full partners with other professionals including physicians in redesigning health care in the U.S. It, therefore, means that being partners will allow nurses to take the responsibility of identifying problems and areas that need improvement. It will help nurses in conceptualizing nursing as a profession where they are shapers of the future and not people who wait for the future to happen to them. Leadership and partnerships are thus items that should be pursued by nurses in a progressive manner. 

The last item on the report that has been given emphasis is the planning of workforce through the use of improved data collection and information infrastructure across the entire medical fraternity. Data collected by medical professionals should be used to develop and improve planning of roles, skills, and demography dynamics, which will be critical in pinpointing the areas of education that require advancement. 

The future of nursing is critical and needs to be improved using calculated steps. As such, I envision a nursing profession that will be marked by highly educated professionals with whom more than 80 percent will have bachelor degrees. The current number of Masters and Doctorate holders should be more than double in the near future. Besides, nursing professionals should hold important leadership positions that will enhance collaboration among the entire professional categories in health care as described by Grossman and Valiga (2016). Nurses in the future will have improved data collection and analysis tools which will be necessary for the development of sound hypothesis and improvement techniques.  

References

Abbyad, C., & Robertson, T. R. (2011). African American women’s preparation for childbirth from the perspective of African American health-care providers. The Journal of perinatal education, 20(1), 45.

Blais, K. K. & Hayes, J. S. (2016). Professional nursing practice: Concepts and perspectives (7th ed.). Boston, MO: Pearson.

Blue, C. (2011). CP Time. Racial Ideology and Time Orientation Among African Americans.Doctoral Thesis / Dissertation-Psychology

Bahr, P. R. (2007). Race and nutrition: an investigation of Black-White differences in health-related nutritional behaviours. Sociology of health & illness, 29(6), 831-856.

Campbell, C. M., & Edwards, R. R. (2012). Ethnic differences in pain and pain management. Pain management, 2(3), 219-230.

Daaleman, T. P. (2004). Death and Dying among African Americans. Journal of the National Medical Association, 96(7), 996.

Giger, J. N., Davidhizar, R. E., & Turner, G. (1992). Black American folk medicine health care beliefs: implication for nursing plans of care. The ABNF journal: official journal of the Association of Black Nursing Faculty in Higher Education, Inc, 3(2), 42-46.

Grossman, S., &Valiga, T. M. (2016). The new leadership challenge: Creating the future of nursing. FA Davis.

Hastie, B. A., Riley, J. L., &Fillingim, R. B. (2005). Ethnic differences and responses to pain in healthy young adults. Pain Medicine, 6(1), 61-71.

Fuchs, F. (2011). Why do black Americans have higher prevalence of hypertension? An enigma still unsolved. Hypertension American Heart Association 57 p. 379-80. Retrieved from http://hyper.ahajournals.org/content/57/3/379.full

Hecht, M. L., Jackson, R. L., & Ribeau, S. A. (2003). African American communication: Exploring identity and culture. Routledge.

Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences, 113(16), 4296-4301.

Laurie, A., & Neimeyer, R. A. (2008). African Americans in bereavement: Grief as a function of ethnicity. Omega-Journal of Death and Dying, 57(2), 173-193.

Vereen, L. G. (2007). African American family structure: A review of the literature. The Family Journal, 15(3), 282-285.

Yi, C. H. (2010). African American Women and Prenatal Care: Effect of Patient-Provider Interaction.