Culturally Competent Care: A Reflective Case Study Analysis

This reflective essay explores the ethical and cultural considerations in caring for John, a 20-year-old Aboriginal Torres Strait Islander with end-stage renal disease. The author, a registered nurse, grapples with John's decision to forgo further treatment and return home, balancing legal obligations, ethical principles, and cultural sensitivity. The essay delves into the importance of respecting John's autonomy, understanding his cultural beliefs regarding death and illness, and providing culturally competent palliative care. Through reflection, the author acknowledges personal biases and emphasizes the need for non-judgmental, patient-centered care that honors diverse cultural perspectives. The experience ultimately strengthens the nurse's decision-making skills and reinforces the importance of cultural awareness in nursing practice. Desklib offers a wealth of resources, including similar essays and solved assignments, to support students in their academic pursuits.

Running head:REFLECTIVE CASE STUDY
Reflective Case Study
Name of the Student
Name of the University
Author Note

1REFLECTIVE CASE STUDY
As a Registered Nurse, I am compelled to take many decisions while being ethically
as well as legally on point. In the current scenario, I am in charge of caring for a 20-year-old
man named John. John is an Aboriginal Torres Strait Islander (ATSI) presently suffering
from end-stage renal disease (ESRD). He has been living in a hospice 500 km away from his
home in a remote Indigenous community and is receiving dialysis. He has been given three
months to live on dialysis, but he has decided to go home with no further treatment, which
will drastically shorten his life. This essay sheds light on how I took decisions based on the
legal and ethical expectations, how I was able to provide culturally competent care to John,
and finally, what I learned by reflecting on this experience.
As per our duty, we have sworn to provide care for the patients to the best of our
abilities, and John is no different. I have made sure that he remains as comfortable as
possible, and he is being administered the best possible care. However, now that John has
decided to deny treatment and go home, I am faced with a huge ethical dilemma (Butts &
Rich, 2019). As per the NMBA Code of Conduct for registered nurses, I am required to work
collaboratively with John and consider his wish when making necessary decisions for his
treatment (Nursingmidwiferyboard.gov.au., 2020). According to the Australian Charter of
Healthcare Rights, a patient has the right to make his own decisions regarding his treatment
path (Www2.health.vic.gov.au., 2020). Under common law, any patient has the right to deny
healthcare (ALRC., 2020). However, I am also aware that withdrawing treatment from John
with result in a shortening of his life expectancy. This puts me in front of a big dilemma of
what is the right thing to do. It will involve the interdisciplinary team as we have to talk to
both the patient and his family. At this point, I will comply with his wishes as it is ultimately
his right to decide. For this, I will discuss it with John. At first, I will talk to him to ensure his
mind is healthy, and he is fit enough to make such a critical decision. Once I ensure that his
decision is final, I will make sure that he understands the consequences of his choices. The

2REFLECTIVE CASE STUDY
interdisciplinary team will talk with his family to understand their point of view. After
completing the required processes, I will comply with his decisions. I will give him and his
family some necessary precautions and points to remember so that the remaining of his days
are as comfortable as possible in his familiar environment with his loved ones around him,
caring for him.
Palliative care is administered to patients to ensure the most comfortable quality of
life to patients in at the end of life. Once John has made his decision, I must acknowledge any
culturally relevant traditions that he may want to uphold and ensure that I help him with
anything that he requires. It is vital to collaborate with the patient successfully and educate
him and his family on aspects of palliative care. It has been observed that there is a high
preference for living amongst the family. John has already expressed his wish for the same.
Also, open communication is highly appreciated, which I always try to adhere to (Shahid et
al., 2018). It is important to make sure that the care administered to the patient is culturally
sensitive and adheres to his beliefs properly. It has been seen that the aboriginals often tend to
'prepare the spirit' for 'coming back from where we came from.' It is believed that death is not
the end of the life, and there is another journey waiting. I must make sure that his and his
family's beliefs and traditions are respected. For this, I would need to understand certain
aspects of his culture in order to become culturally competent. According to aboriginal
beliefs, guarding the spirit of the person is very important. It is believed that the more people
talk about death and illness, the nearer it comes. So it is possible that John might not want to
talk or discuss about what is coming up too much. If that is the case, I will not pester him
with questions or talk about his disease after the necessary formalities are done. It is also
believed that giving a name to the illness helps it progress, so if John wishes not to talk about
it, I would respect his wishes. I would also instruct my team to comply with John's requests.
They also believe in spiritual healing and other beliefs that should be respected (Duggleby et

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al., 2015). It is imperative that we provide John with a culturally competent and safe
environment before he is discharged. This will help John be comfortable and not feel
discriminated against due to his culture (Schill & Caxaj, 2019).
Needless to say, many of my beliefs and thoughts are not in line with John's views. I
have my own set of beliefs and thought process, and above all, I am a nurse who tends to set
her beliefs and opinions on practicality. For starters, I am skeptical of John's decision to deny
treatment, since this will most certainly reduce his life expectancy significantly. However, as
a nurse, I must be culturally aware and non-judgemental. Priority must be to respect his
spirituality (Attard, Baldacchino & Camilleri, 2014). It is critical for me to remember that he
comes from a different background than me and has different belief systems, and that his
choices are the only things that matter in his life. I must remember why he took the decision
that he did, and that he deserves to have the people he loves around him. It would do him no
good to remain far from home and stay in an unfamiliar environment. Another excellent way
for me to deal with this is to become more aware and learn more about John's culture. The
more I will learn about the fascinating culture and traditions of Aboriginal Torres Strait
Islanders, the more I will become culturally competent (Kelly et al., 2016) and more I will
respect the decisions of the patient. This will also ensure that I can use this experience as a
tool to learn more about how to care for aboriginal patients (Kelly et al., 2016).
From the above essay, I can conclude that while on the professional level and as a
nurse, I am concerned about John's shortened life expectancy, releasing him sending him
home is ethically and legally the right thing to do. This decision should be taken by John
alone, and his decision should be respected no matter what it is. This reflection and
experience will help me become more culturally competent and ensure that I can administer
better care to another patient with similar circumstances. It will also strengthen my decision-
making skills and thus make my more knowledgeable. It is essential that we respect all

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cultures equally and not discriminate among patients while providing care. This case is a
prime example of that, and it has been an enlightening experience.

5REFLECTIVE CASE STUDY
Reference
ALRC. (2020). Informed consent to medical treatment | ALRC. Retrieved 19 March 2020,
from https://www.alrc.gov.au/publication/equality-capacity-and-disability-in-
commonwealth-laws-dp-81/10-review-of-state-and-territory-legislation/informed-
consent-to-medical-treatment/.
Attard, J., Baldacchino, D. R., & Camilleri, L. (2014). Nurses' and midwives' acquisition of
competency in spiritual care: A focus on education. Nurse Education Today, 34(12),
1460-1466.
Butts, J. B., & Rich, K. L. (2019). Nursing ethics. Jones & Bartlett Learning.
Duggleby, W., Kuchera, S., MacLeod, R., Holyoke, P., Scott, T., Holtslander, L., ... &
Chambers, T. (2015). Indigenous people's experiences at the end of life. Palliative &
supportive care, 13(6), 1721-1733.
Kelly, J., Wilden, C., Chamney, M., Martin, G., Herman, K., & Russell, C. (2016). Improving
cultural and clinical competency and safety of renal nurse education. Renal Society of
Australasia Journal, 12(3).
Kelly, J., Wilden, C., Herman, K., Martin, G., Russell, C., & Brown, S. (2016). Bottling
knowledge and sharing it-using patient journey mapping to build evidence and
improve Aboriginal renal patient care. Renal Society of Australasia Journal, 12(2),
48.
Nursingmidwiferyboard.gov.au. (2020). Nursing and Midwifery Board of Australia -
Professional standards. Retrieved 19 March 2020, from
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/
Professional-standards.aspx.

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Schill, K., & Caxaj, S. (2019). Cultural safety strategies for rural Indigenous palliative care: a
scoping review. BMC palliative care, 18(1), 21.
Shahid, S., Taylor, E. V., Cheetham, S., Woods, J. A., Aoun, S. M., & Thompson, S. C.
(2018). Key features of palliative care service delivery to indigenous peoples in
Australia, New Zealand, Canada and the United States: a comprehensive
review. BMC palliative care, 17(1), 72.
Www2.health.vic.gov.au. (2020). Australian Charter of Healthcare Rights. Retrieved 19
March 2020, from https://www2.health.vic.gov.au/about/participation-and-
communication/australian-charter-healthcare-rights.