Running head: PROFESSIONAL COMMUNICATION
Professional Communication: Cultural Sensitivity
Claudette D. Johnson
Grand Canyon University: NUR 502
January 11, 2012
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PROFESSIONAL COMMUNICATION
Personal Communication Cultural Sensitivity: Care of Jehovah Witnesses
Increase diversity in nursing has created a challenge for caregivers. The concept of
diversity advocates understanding the uniqueness of each individual taking into consideration
personal differences in language, traditions, moral and religion, and spiritual choices (Hood,
2006). The constitution of the World Health Organization’s states that the highest attainable
standard of health is one of the fundamental rights of every human being without regard to race,
religion, political belief, economic or social condition (Barker, 2009, p.494). Understanding
one’s culture will enable caregivers to holistically care for patients of different cultures
contributing to positive outcomes (Hood, 2010).
Jehovah Witnesses have cultural beliefs that have nursing implications unique to their
culture. Cultural awareness and sensitivity will enable nurses to support choices differing from
their own to improve patient outcomes. This paper will analyze the article, The Pregnant
Jehovah’s Witness: How Nurse Executives Can Assist Staff in Providing Culturally Competent
Care with focus on cultural differences and nursing intervention aimed to address cultural and
practice issues with the Jehovah Witnesses population (Trovarelli & Valenti, 2005). Healthcare
professionals must possess the cultural general knowledge and skills that will support them in a
rapidly changing healthcare system.
Summary of Article
Overview
The article from the Journal of Nursing Administration’s (JONA) Healthcare Law,
Ethics, and Regulation; The Pregnant Jehovah’s Witness: How Nurse Executives Can Assist
Staff in Providing Culturally Competent Care discusses the role of nurse executives in
facilitating cultural awareness in the care of Jehovah Witnesses (Trovarelli & Valenti, 2005).
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The Federal Patient Self-Determination Act, passed in 1991 requires health care providers to
uphold patient’s right to make decisions even if the decision has life threatening impact (Barker,
2009). Healthcare providers are required to respect patient’s informed decisions even if it
conflicts with science and opinions.
Background
Jehovah's Witnesses started in Pennsylvania in 1870 led by Charles Taze Russell. The
Watchtower Bible and Tract Society was founded in 1886 and due to a split in the organization,
it was renamed the Jehovah’s Witnesses (Witness for Jehovah, 2011). Jehovah's Witnesses
believe that the Bible prohibits the eating of blood. They believe that injecting blood into their
veins is the same thing as eating it. They believe they are showing respect for blood by refusing
blood transfusions, thus, showing respect for human life and God by refusing blood transfusions
(Jehovah’s Witnesses Official Media Website, 2012).
Article summary
The article discusses the fate of a 28 year old Jehovah’s Witness pregnant woman in
sickle cell crisis on her twenty-ninth (29th) week of pregnancy and the ethical dilemma during
her care. The woman’s refusal to receive blood and undergo a C-section resulted in the woman’s
death 11 days after delivery and the demise of her baby girl shortly after birth (Trovarelli &
Valenti, 2005).
It reexamines the care provider (specifically nurse executives) alternatives and options in
addressing patient care. Discussing Bloodless Program, use of advance directives and durable
Power of attorney papers to outline wishes, ensuring that enough albumin or other blood
alternatives are available during surger, advocate for patient by upholding their decision, policy
advocacy in one’s institutions, educator and resource of clinicians, patient and doctors to diffuse
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difficult situations and more importantly create a trusting environment free from condemnation
for Jehovah witness patients and an environment for staff to be heard (Trovarelli & Valenti,
2005).
Cultural and ethical differences
Facing decisions that may result in death is never easy. It is even harder when the life of
the unborn is involved, creating ethical and religious dilemma for all parties involved. The
question of who is advocating for the unborn complicates this situation. In the eyes of the patient
and families it is seen as devotion their faith as influenced by religious and cultural factors. On
the other hand, caregivers may see the patient’s choice in the context of science; saving lives,
using evidenced- based intervention with the best options for improving one’s health, and
conflicted by the oath to do no harm (nonmalificience) and the decisions to honor patient’s
autonomy and religious belief may differ from that of the patient. These views and the nurse’s
drive to improve patient outcomes can over shadow the patient/family’s wishes.
Application to Practice
Self- assessment of one’s feelings about religions will promote acceptance of patient’s
choices. One does not need to approve to accept differing choices. Respecting once decision
even if it may not agree with our belief is important in differing cultures.
Institute of medicine (IOM) report on safety attributed the growing number of errors
resulting from miscommunication (IOM, 2000). Unclear orders, lack of critical information and
misinterpretation of information all can lead to medical errors (O’Daniel & Rosenstein, n.d.).
Communication errors are identified by the Joint Commission as the primary root cause of
sentinel events across all categories. Improving the effectiveness of communication among
healthcare providers is listed as one of the Joint Commission National Patient Safety Goals since
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2005 (O’ Daniel & Rosenstein, n.d.). Clear communication is the key in providing a caring
environment for Jehovah Witnesses. Communicating information with accuracy, clarity during
admission and discharge of patient can prevent readmission (Institute of Healthcare
Improvement (IHI, 2011). Readmission is not only costly but it also decreases patient
satisfaction and increases length of stay (IHI, 2011). Communication of risks with use of
accurate, concise information and language understood by patient and family is important.
In the book, What’s Practical about Technical Writing, the authors referred to
professional communication as not simply workplace activity but as human conduct in those
activities that maintain the lives of our patients and our community (Bertie, Fearing & Keats
Sparrow, 1989). Professional communicators use strategies, theories, and technologies to
effectively communicate in the business side of nursing which is vital not only for safety but for
our profession. According to American Psychological Association (2010), one can achieve
accurate and concise communication by way of orderly presentation of details.
Respectful and nonjudgmental acknowledgement of their choices should be the
foundation of care. The Joint Commission holds hospitals accountable for addressing and
maintaining patient rights. Furthermore, the American Nurses Association in its Code of Ethics
for Nurses where it states, provision 1, demands that the nurse in professional relationship should
practice with compassion and respect for the dignity, worth and uniqueness of every individual
(ANA, 2012). Cultural sensitivity and awareness by understanding the Jehovah Witness’ religion
enables caregiver to put parental decision in perspective.
Knowing before-hand the Jehovah Witnesses’ preferences can prepare the institutions to
minimize risks. Preparation can be planned ahead to ensure enough blood alternatives are
available. The use of specialists ensure safety of patient and baby (the article suggested a
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hematologist and perinatologist presence during crisis). Jehovah Witnesses has the option of
auto-infusion of their own blood, thus, some may store their own blood for planned procedures,
referred to as salvaging (JW-Media 2012).
Proactive approach can help the cultural and ethical issues faced during this trying time.
Plan to use resources such as the Ethics committee, Ethicist, or Chaplain to support the family
and patient should be foremost. Reaching out to the Jehovah’s Witness elders and community to
support the psychological and spiritual needs of the family is highly encouraged by the church
and elders (Trovarelli & Valenti, 2005). The availability of a 24/7 hotline is an option to support
the patient, family and staff. Elders have access to libraries national and international which can
be faxed to hospitals (Trovarelli & Valenti, 2005).
The ability to communicate in the language of the client is critical for clarity and
accuracy when educating the patient (Barker, 2009, p. 496). Educating staff not only on
honoring patient choices care options as outlined by the bloodless program which includes
respectful acceptance of patient choices, use of blood replacement products and familiarizing
staff with the consent forms that they usually present during admission. This ensures that proper,
accurate and important information is relayed to ensure safe patient care and positive outcomes
(Hood, 2010).
Clear handoff to next caregiver with sensitivity to the information and choices in their
care must occur for consistency in nursing practice. Since communication in our present society
is a rapidly changing area, advances in technology seems too often outpace the availability of
expert practitioners (Bertie, Fearing & Keats-Sparrow, 1989). This creates a demand for skilled
communicators which continues to exceed the supply of trained professionals, not to mention
that nursing serves a diverse population which is a constant challenge to our profession. To
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some, communication does not come easy. It is one to be practiced and learned. In as much as
most institution focus on changing processes for safety, they should also invest on people to be
able to communicate information accurately for safety.
Conclusion
The increasing diversity of our population makes the art of caring a challenge. Cultural
awareness, knowledge and competence can help bridge the gap. Awareness of cultural
differences in health care is the realization that communication walls are breaking down. With
nursing practice dedicated to caring for the patient’s physical, emotional, psychological and
social needs, awareness of cultural will help breakdown communication walls. As nurses we are
the catalyst in this process. This opens up doors for nurses and patient to understand one another
to achieve a common goal: optimal outcome for the patient and family.
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References
American Nurses Association. (2001). Code of ethics for nurses with interpretive statements.
Nursing World. Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Tools-YouNeed/Code-of-Ethics.pdf
American Psychological Association. (2010). Publication manual of the American Psychological
Association (6th ed.). Washington, DC: Author.
Barker, A. M. (2009). Advanced practice nursing – Essential knowledge for the profession.
Boston: Jones and Bartlett Publishers. 494 - 496.
Bertie, E., Fearing, E. and Keats Sparrow, W. (1989) What's Practical about Technical Writing?”
Technical Writing: Theory and Practice. New York: Modern Language Association.
Caminha-Bacote, J. (1991). The Process of Cultural Competence in the Delivery of Healthcare
Services, Retrieved from http://angel04.gcu.edu/section/default.asp?id=1065151
Hood, L. (2010). Conceptual Bases of Professional Nursing (7th ed.). Philadelphia, PA:
Lippincott Williams & Wilkins.
Illinois Department of Public Health (IDPH). (2010). Statement of Illinois law on Advance
Directives and DNR orders. Retrieved from
http://www.idph.state.il.us/public/books/advin.htm
Institute of Healthcare Improvement (IHI). (2011). Reducing Avoidable Readmissions By
Improving Transition Of Care. Retrieved from
http://www.ihi.org/offerings/Training/ReduceReadmissions/July2011ReducingReadmissi
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ons/Pages/default.aspx
Institute of Medicine. (2000). To Err is Human: Building a Safer Healthcare System. Retrieved
from http://iom.edu/~/media/Files/Report%20Files/1999/To-Err-isHuman/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
Jehovah’s Witnesses Official Media Website. (2012). Our View of Medical Care: Blood
Transfusions. Retrieved from http://www.jw-media.org/aboutjw/article01.htm
McFarland, M. M. and Eipperle, M. K. (2008). Culture care theory: A proposed practice theory
guide for nurse practitioners in primary care settings. Contemporary Nurse. 28(1-5), 4863. Retrieved from http://angel04.gcu.edu/section/default.asp?id=1065151
Northwest Community Hospital (NCH). (2011). Jehovah Witness Bloodless Program Policy.
NCH Policy and Procedure: Policy 105.
O’Daniel, M. and Rosenstein, A. (n.d.). Professional Communication and Team Collaboration.
Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Retrieved from
http://www.ahrq.gov/qual/nurseshdbk/docs/O%27DanielM_TWC.pd
Trovarelli, T. and Valenti, J. (2005, October-December). The Pregnant Jehovah’s Witness: How
Nurse Executives Can Assist Staff in Providing Culturally Competent Care. Journal of
Nursing Administration’s Healthcare Law, Ethics, and Regulation. 7(4), 105-109.
Retrieved from
http://library.gcu.edu:2048/login?url=http://gateway.ovid.com/ovidweb.cgi?T=JS&NEW
S=N&PAGE=fulltext&AN=00128488-200510000-00004&LSLINK=80&D=ovft
Witness for Jehovah (2011). Jehovah's Witness Beliefs and History. Retrieved from
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www.4jehoouah.org
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