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Professional Philosophy of Nursing
My philosophy of nursing is that a nurse puts the patient first. The patient is to be in the center of the plan of care. A nurse is to advocate for the patient, especially when the patient is in a state where they cannot advocate for themselves. Nurses must be objective and open minded when approaching every case that is presented to him or her. They must see the patient first and not the disease or disorder. A holistic approach should be taken when implementing a plan of care for the patient.
My core values and beliefs are that one is to be empathetic, attentive, diligent, and just. A nurse must be empathetic and be able to put themselves in the patientâs shoes. For example, a nurse must ask, âIf I were in this situation, how would I like to be treated?â A nurse must be attentive to certain details. A nurse must pay attention to both verbal and non-verbal ques. A nurse must be diligent and must work herd at managing the cases presented as well as the tasks that are assigned. Lastly, a nurse must be just and fair in every situation, remaining unbiased when analyzing cases.
With all of the responsibility that comes with the position of being a nurse, self- awareness is imperative. A nurse must know how they identify themselves and what culture they relate to. They must understand and be aware of these values, customs, and beliefs that they have so that they can assess their readiness to take on the challenges that will be inevitable.
Nursing is more than a profession. It is the mindset and understanding of selflessness as well as the importance of patient advocacy and care.
References:
Jack, K. Smith, A. Promoting self-awareness in nurses to improve nursing practice. (2007) Nursing Standard. 21, (32) ,47-52. doi: 10.7748/ns2007.04.21.32.47.c4497
Paper Case Management RN-BSN
Running Head: Case Management and Cultural Competence in Mental Health 1
Case Management and Cultural Competence in Mental Health
The Importance of Cultural Competence in Mental Illness in Case Management
Danielle Bouyer
New York City College of Technology
Running Head: Case Management and Cultural Competence in Mental Health 2
For centuries, mental illness has been somewhat of a taboo subject in society and in health care. Those suffering from mental illness were treated as subhuman compared to individuals who were not ill or even those who suffered a physical illness such as the common cold. âMental illness refers to a wide range of mental health conditions â disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors. Many people have mental health concerns from time to time,â Mayo Clinic.
Individuals who suffered from a mental disorder were deemed as a curse to their family or as an individual who was possessed by an evil spirit, especially amongst those involved in religious organizations. According to Elizabeth Yetter who wrote the article, â10 Brutal Accounts of Torture in Old Insane Asylumsâ, these people were scalded, forced to take cold showers, tied down to a chair, starved, and were allowed to be beaten. When claims were made against these asylums, the employees of the asylum, who were more like overseers disputed these claims by stating that these individuals were âinsaneâ and could not be believed simply because they were mentally ill. After all, how could anyone take their claim of their horrifying reality at face value, when their illness continuously causes their reality to be distorted. The major issue with this entire concept was that these groups of people were in an asylum to be subjected to what seemed like punishment as opposed to being admitted to a facility where they can be treated.
Someone suffering from these issues require a great deal of empathy. However, society and even health care professionals in the past were apathetic towards these individuals. This is a topic of interest because mental illness and the issues surrounding this topic is never
Running Head: Case Management and Cultural Competence in Mental Health 3
black and white, which is the same for many other illnesses. However, despite health careâs advancement in this area of the field, it is still a challenging and complex dynamic that many still do not dare to explore. In this paper, the relationship between mental illness and case management will be analyzed.
According to cmbodyofknowledge, nursing case managers are to follow a code of ethics. These code of ethics include autonomy, beneficience, nonmaleficience, justice, and veracity. These code of ethics applicable when managing the cases of adults whose mental capacity and cognitive ability is not comprised. So the great argument lies in this question; Are case managers able to manage the cases of those who have a mental illness fairly and justly? Do all of the code of ethics still apply? This questions is one of the examples demonstrates how the subject of mental illness can be very challenging for any health care professional, especially for case managers.
âRespect to patientsâ autonomy is a cornerstone of medical ethics and nurses have a key role in respecting patientsâ autonomy,â (Alahbakhshian, Ghahramanian, Rahmani, 2010). Autonomy is independence. When patients have autonomy in their care, they are able to make their decisions without an overwhelming amount of external influence. In health care, a patientâs autonomy is to be regarded at all times. However, when a patient or client has a mental disability or disorder, it may sometimes be hard for them to make autonomous decisions depending on what level of severity their illness is. This is when the clients need an advocate. While nurses are viewed as one of the main members of a health care team to be a patient advocate, the case managers are also responsible for advocating for the patient. A case manager can advocate for a
Running Head: Case Management and Cultural Competence in Mental Health 4
client with severe mental illness by focusing on what kind of outcome would produce the best quality of life for their client.
Nonmaleficience, doing no harm, and beneficience, do good of right by the patient, are both to codes of ethics that would have prevented the horrific and truculent crimes and offenses committed against the mental illness community in the past as stated earlier. No matter the age, mental capacity, or severity of the illness, these two codes must be followed without question. This is simply because everyone has the right to be treated with this type of respect. Justice and veracity, or accuracy of statements and claims about the client and their medical history, are also the right of the people in this particular community as it is to any other client.
When a case manager maintains awareness of the code of ethics and utilizes them when managing his or her clientâs cases, cultural competency is practiced. It is believed that a âculturally competent healthcare system as one that acknowledges and incorporatesâat all levelsâthe importance of culture, assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, expansion of cultural knowledge, and adaptation of services to meet culturally unique needs,â (Dauvrin, Lorant, 2015). It is important for case managers to be culturally competent because it helps them to remain unbiased and nonjudgmental when managing their clientâs cases. Furthermore, it enables them to help in providing their clients an outcome that will produce the best quality of life for them. âCultural competency is now a core requirement for mental health professional working with culturally diverse patient groups,â (Bhui, Bughra, Edonya, McKenzie, Warfa, 2007).
Running Head: Case Management and Cultural Competence in Mental Health 5
âDespite concern about ethnic disparities of access to culturally appropriate mental health care, and calls for cultural competency training to be mandatory, there is little information about the effectiveness of cultural competency training in mental health settings.It is well established that in order to provide culturally competent care, knowledge of cultural beliefs, values and practices is necessary otherwise health practitioners can easily fall prey to errors of diagnosis, inappropriate management and poor compliance,â (Bhui, Bughra, Edonya, McKenzie, Warfa, 2007).
âFrequent users of healthcare services are a vulnerable population, often socioeconomically disadvantaged, who can present multiple chronic conditions as well as mental health problems. Case management (CM) is the most frequently performed intervention to reduce healthcare use and cost,â (Chuoinard, Hudon, Krieg, 2016). When case managers practice cultural competence, they are able to view cases objectively but also with empathy. The rights, needs, and desires of the client are respected. With respects to the type of insurance provided, the social construction surrounding the client as well as their environment and realistic situation, a case manager can help to create the healthiest and best outcome for the client of interest. In regards to mental health, this is very necessary. The more cultural competence is exercised in the mental health community, the less vulnerable this group will be. This will also have a positive impact and change for the better in the community as well. Case managers must also educate the family members and anyone else that is a member of the support system of the client that has the mental disorder. The client must also be educated; this is regardless of whether
Running Head: Case Management and Cultural Competence in Mental Health 6
or not they have a support system. The education must include, triggers, treatments, what can cause symptoms to worsen, as well as what can cause relapses into behaviors that will be
harmful to the client and those around them. Each member, including the client, of this support
system must have their level of health literacy assessed so that the information can be delivered to them in the appropriate context. The level of accurate knowledge about mental illnesses among the general public has been reported to be rather low. For example, in a population survey in England, 63 % estimated that less than 10 % of the population would be likely to experience a mental-health problem at some time in their lives,â (Birner, Hanisch, Nowak, Sabariego, Szeto, Twomey, 2016).
Any client in health care should be seen as a human being first. Any illness that they have is simply secondary. This is applicable for all types of illnesses. This includes mental illness. Though there is still stigma that is attached to mental disorders and mental health, health care is advancing in this area of this field. The advancement is being done through treatments, providing safe space for those who are mentally ill, and most of all cultural competency. The need for more culturally competent health care professionals, especially case managers in the mental health community still exists. Hopefully, his need will decrease tremendously within the next few years.
References:
Birner, U.W. Hansisch, S.E. Nowak, D. Sabariego, C. Szeto, A.C.H. Twomey, C. D. The Effectiveness of Interventions Targeting the Stigma of Mental Illness at the Workplace: a systematic review. 2016. BMC Psychiatry. Doi: 10.1186/s12888-015-0706-4
Chouinard, M.C., Hudon. C. Krieg, C. Effectiveness of Case Management Interventions for Frequent Useres of Healthcare Services: a scoping review. Sep 29 2016. BMJ Open. Doi: 10.1136/bmjopen2016-012353
Dauvrin, M. Lorany, V. Leadership and Cultural Competence of Healthcare Professionals. May 2015. Nursing Research. Doi: 10.1097/NNR.0000000000000092
Alabakhshian, A. Ghahramanian, A. Rahmani, A. Respecting to Patiensâ Autonomy in Viewpoint of Nurses and Patients in Medical-Surgical Wards. 2010. Iranian Journal of Nursing and Midwifery Research. 15(1): 14-19.
Case Management Body of Knowledge. Ethical Principles and the Case Manager. Cmbodyofknowledge.com
Running Head: Case Management and Cultural Competence in Mental Health 1
Case Management and Cultural Competence in Mental Health
The Importance of Cultural Competence in Mental Illness in Case Management
Danielle Bouyer
New York City College of Technology
Running Head: Case Management and Cultural Competence in Mental Health 2
For centuries, mental illness has been somewhat of a taboo subject in society and in health care. Those suffering from mental illness were treated as subhuman compared to individuals who were not ill or even those who suffered a physical illness such as the common cold. âMental illness refers to a wide range of mental health conditions â disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors. Many people have mental health concerns from time to time,â Mayo Clinic.
Individuals who suffered from a mental disorder were deemed as a curse to their family or as an individual who was possessed by an evil spirit, especially amongst those involved in religious organizations. According to Elizabeth Yetter who wrote the article, â10 Brutal Accounts of Torture in Old Insane Asylumsâ, these people were scalded, forced to take cold showers, tied down to a chair, starved, and were allowed to be beaten. When claims were made against these asylums, the employees of the asylum, who were more like overseers disputed these claims by stating that these individuals were âinsaneâ and could not be believed simply because they were mentally ill. After all, how could anyone take their claim of their horrifying reality at face value, when their illness continuously causes their reality to be distorted. The major issue with this entire concept was that these groups of people were in an asylum to be subjected to what seemed like punishment as opposed to being admitted to a facility where they can be treated.
Someone suffering from these issues require a great deal of empathy. However, society and even health care professionals in the past were apathetic towards these individuals. This is a topic of interest because mental illness and the issues surrounding this topic is never
Running Head: Case Management and Cultural Competence in Mental Health 3
black and white, which is the same for many other illnesses. However, despite health careâs advancement in this area of the field, it is still a challenging and complex dynamic that many still do not dare to explore. In this paper, the relationship between mental illness and case management will be analyzed.
According to cmbodyofknowledge, nursing case managers are to follow a code of ethics. These code of ethics include autonomy, beneficience, nonmaleficience, justice, and veracity. These code of ethics applicable when managing the cases of adults whose mental capacity and cognitive ability is not comprised. So the great argument lies in this question; Are case managers able to manage the cases of those who have a mental illness fairly and justly? Do all of the code of ethics still apply? This questions is one of the examples demonstrates how the subject of mental illness can be very challenging for any health care professional, especially for case managers.
âRespect to patientsâ autonomy is a cornerstone of medical ethics and nurses have a key role in respecting patientsâ autonomy,â (Alahbakhshian, Ghahramanian, Rahmani, 2010). Autonomy is independence. When patients have autonomy in their care, they are able to make their decisions without an overwhelming amount of external influence. In health care, a patientâs autonomy is to be regarded at all times. However, when a patient or client has a mental disability or disorder, it may sometimes be hard for them to make autonomous decisions depending on what level of severity their illness is. This is when the clients need an advocate. While nurses are viewed as one of the main members of a health care team to be a patient advocate, the case managers are also responsible for advocating for the patient. A case manager can advocate for a
Running Head: Case Management and Cultural Competence in Mental Health 4
client with severe mental illness by focusing on what kind of outcome would produce the best quality of life for their client.
Nonmaleficience, doing no harm, and beneficience, do good of right by the patient, are both to codes of ethics that would have prevented the horrific and truculent crimes and offenses committed against the mental illness community in the past as stated earlier. No matter the age, mental capacity, or severity of the illness, these two codes must be followed without question. This is simply because everyone has the right to be treated with this type of respect. Justice and veracity, or accuracy of statements and claims about the client and their medical history, are also the right of the people in this particular community as it is to any other client.
When a case manager maintains awareness of the code of ethics and utilizes them when managing his or her clientâs cases, cultural competency is practiced. It is believed that a âculturally competent healthcare system as one that acknowledges and incorporatesâat all levelsâthe importance of culture, assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, expansion of cultural knowledge, and adaptation of services to meet culturally unique needs,â (Dauvrin, Lorant, 2015). It is important for case managers to be culturally competent because it helps them to remain unbiased and nonjudgmental when managing their clientâs cases. Furthermore, it enables them to help in providing their clients an outcome that will produce the best quality of life for them. âCultural competency is now a core requirement for mental health professional working with culturally diverse patient groups,â (Bhui, Bughra, Edonya, McKenzie, Warfa, 2007).
Running Head: Case Management and Cultural Competence in Mental Health 5
âDespite concern about ethnic disparities of access to culturally appropriate mental health care, and calls for cultural competency training to be mandatory, there is little information about the effectiveness of cultural competency training in mental health settings.It is well established that in order to provide culturally competent care, knowledge of cultural beliefs, values and practices is necessary otherwise health practitioners can easily fall prey to errors of diagnosis, inappropriate management and poor compliance,â (Bhui, Bughra, Edonya, McKenzie, Warfa, 2007).
âFrequent users of healthcare services are a vulnerable population, often socioeconomically disadvantaged, who can present multiple chronic conditions as well as mental health problems. Case management (CM) is the most frequently performed intervention to reduce healthcare use and cost,â (Chuoinard, Hudon, Krieg, 2016). When case managers practice cultural competence, they are able to view cases objectively but also with empathy. The rights, needs, and desires of the client are respected. With respects to the type of insurance provided, the social construction surrounding the client as well as their environment and realistic situation, a case manager can help to create the healthiest and best outcome for the client of interest. In regards to mental health, this is very necessary. The more cultural competence is exercised in the mental health community, the less vulnerable this group will be. This will also have a positive impact and change for the better in the community as well. Case managers must also educate the family members and anyone else that is a member of the support system of the client that has the mental disorder. The client must also be educated; this is regardless of whether
Running Head: Case Management and Cultural Competence in Mental Health 6
or not they have a support system. The education must include, triggers, treatments, what can cause symptoms to worsen, as well as what can cause relapses into behaviors that will be
harmful to the client and those around them. Each member, including the client, of this support
system must have their level of health literacy assessed so that the information can be delivered to them in the appropriate context. The level of accurate knowledge about mental illnesses among the general public has been reported to be rather low. For example, in a population survey in England, 63 % estimated that less than 10 % of the population would be likely to experience a mental-health problem at some time in their lives,â (Birner, Hanisch, Nowak, Sabariego, Szeto, Twomey, 2016).
Any client in health care should be seen as a human being first. Any illness that they have is simply secondary. This is applicable for all types of illnesses. This includes mental illness. Though there is still stigma that is attached to mental disorders and mental health, health care is advancing in this area of this field. The advancement is being done through treatments, providing safe space for those who are mentally ill, and most of all cultural competency. The need for more culturally competent health care professionals, especially case managers in the mental health community still exists. Hopefully, his need will decrease tremendously within the next few years.
References:
Birner, U.W. Hansisch, S.E. Nowak, D. Sabariego, C. Szeto, A.C.H. Twomey, C. D. The Effectiveness of Interventions Targeting the Stigma of Mental Illness at the Workplace: a systematic review. 2016. BMC Psychiatry. Doi: 10.1186/s12888-015-0706-4
Chouinard, M.C., Hudon. C. Krieg, C. Effectiveness of Case Management Interventions for Frequent Useres of Healthcare Services: a scoping review. Sep 29 2016. BMJ Open. Doi: 10.1136/bmjopen2016-012353
Dauvrin, M. Lorany, V. Leadership and Cultural Competence of Healthcare Professionals. May 2015. Nursing Research. Doi: 10.1097/NNR.0000000000000092
Alabakhshian, A. Ghahramanian, A. Rahmani, A. Respecting to Patiensâ Autonomy in Viewpoint of Nurses and Patients in Medical-Surgical Wards. 2010. Iranian Journal of Nursing and Midwifery Research. 15(1): 14-19.
Case Management Body of Knowledge. Ethical Principles and the Case Manager. Cmbodyofknowledge.com
My Strengths:
My strengths are being able to work with a team as well as being tenacious. Another strength of mine is being resilient. No matter what hardships I face, I always manage to find a way to deal with the situation and learn from it. I take accountability for my actions and though I am not perfect, I am constantly challenging myself to be better and do better.
Self reflection and self evaluation in BSN program and clinical:
The clinical experience during this semester for NUR 4010 met my expectations. Also the
objectives that were put in place were also met. The first four clinical objectives were being able
to demonstrate professionalism, critically think, communicate with a diverse group of people,
and helping to create environments for learning based on evidence- based practice. The
following four clinical objectives were to use informational technology when helping families in
the community, demonstrate commitment to growing in professionalism, including professional
nursing standards as well as accountability in our practices, and working with clients, those who
support them, and the health care team. Lastly, being aware of the economic, social, and
political construct of a particular community as well as demographics and how they impact the
health care services provided was the ninth and final objective.
The first objective, demonstrating professionalism, was met by fulfilling the tasks that were
required. First and foremost, the attire, as required was always a white top with a pair of black
pants or skirt. Anything other than what was previously stated is considered out of uniform.
Punctuality and participation in staff meetings and client assessments were also required.
Preparedness was assessed by both the clinical professor and preceptor and was essential to
meeting the first objective. Most of all, maintaining the clientsâ confidentiality was a huge way of
demonstrating professionalism through personal actions. It is appropriate to mention the sixth
objective in this portion of the self reflection which is, demonstrating a commitment to
professional development. By meeting this particular objective, objective one was always
fulfilled. Furthermore, facing challenges and responding to them professionally as well as self-
talk and self-evaluation was how this clinical objective was met.
The second objective was using critical thinking and analytical reasoning. Assessment of
the clientâs medical records and interviewing the client or observing the client being interviewed
by the health care professionals in the facility, was one of the basic ways that this objective was
met. However, being able to then use the given information to analyze the clientâs culture,
spiritual beliefs and family dynamics and whether or not they had a support system was how the
ability to use analytical reasoning to individualize and improve a plan of care appropriate for the
client was achieved. The obtained information can also aid in assessing the client's willingness
and readiness to be compliant with their care plan.
The third objective was being able to communicate effectively and strategically with
diverse groups and disciplines. This was achieved by learning and understanding their cultural
background. Woodhull hospital as well as their clinic, which will soon be recognized as the
Gotham Clinic is in Williamsburg. In this particular area, many people are of a Hispanic culture.
Being sensitive to this fact, speaking their language or giving them information translated in their
language prevents having a potential barrier between the client and the health care provider.
Also being mindful of their culture and showing respect for it yielded positive results as well. For
example, if a client of Hispanic origin was diabetic and needed to make alterations to their diet,
instead of telling them all of the things that they cannot eat, discussing alternatives or how to
make the food that they love into a healthier dish to help them manage their diabetes would
result in a positive response. This was done on several occasions at this clinic.
The fourth objective was establish a conducive learning environment based on evidence
based practice. This was done by doing research and based on the research, providing
information that is beneficial to the client in a language and way that they would understand. An
example of this is the diabetes presentation that was done at the geriatric clinic in Woodhull
hospital. The fifth objective was using informational technology when managing individuals and
families. Medical records and nursing informatics was used to help in creating an appropriate
plan of care for these clients. The information, of course, was always kept confidential.
Following the code of ethics and standards of nursing practice as well as being accountable
for oneâs actions in the clinical setting was how the seventh objective was met. The seventh
objective was incorporating professional nursing standards and accountability in to practice. By
incorporating professional nursing standards, it was easy to meet the eighth objective:
Collaborate with clients, significant support persons and members of the health care team. By
utilizing professional nursing practice such as therapeutic communication, motivational
interviewing, maintaining confidentiality, exercising empathy, and remaining unbiased and
nonjudgmental, both client issues as well as issues amongst were able to be better solved.
Specific examples in this case cannot be used for this self-reflection piece as it is a violation of
HIPAA.
The ninth and final objective was to recognize the effects of demographics, economics,
politics, and social construction on health care services. This was something that was hard to
not take notice of. Insurance, culture, and language played a huge role in how health care
services were provided. A major thing that stood out was the clients being somewhat unwilling
to receive service from someone who was not of the same origin. The biggest example of this
was taking note of how the Polish clients were reluctant to receive service from health care
professionals that were not Polish. It was also noted that the Hispanic clients expressed a sign
of comfort more when their health care providers were Hispanic as well. There can be many
assumptions made as to why these particular interactions occurred leading some nurses to
express that they felt slighted because it was clear their services were not wanted from a
particular individual.
Observing these events as well as engaging in some of these clinical activities made it
possible for self-evaluation. These things also made it possible for growth in professionalism
and nursing practice. These lessons learned in clinical for this semester are lessons to take and
keep for lifetime even beyond the nursing profession.
Introduction:
My name is Danielle Bouyer. I am a nurse who has a desire to make a change in the nursing field as well as in health care in general. I love to have fun and I am passionate about creative writing.