Background information on the German Population in the United States
Germans were the first non-English-speaking immigrant group who entered the United States and played very vital roles in the economic development of the United States. They were also part of the abolitionist movement and served in the United States military back in the 19th century. Their contributions in the United States continued through the 20th century. A large number of German immigrants relocated to the United States during the 19th century. However, it is important to recognize that the arrival of Germans in the United States began as early as 1608. This is when they offered help to English settlers in the founding of Jamestown, Virginia. They also had a role in the creation of New Amsterdam by the Dutch. This later became New York City. By the 19th century, German immigrants began to advance farther inland to other states such as Texas, Minnesota, Kansas, Wisconsin, Missouri, Illinois, Ohio, and Nebraska. The number of German immigrants in the United States has remained fairly constant. Between 1850 and 1970, German language happened to be the second most widely spoken language in the United States behind English. According to statistics from the 1990 United States census, about 58 million Americans claimed to have a sole German descent or were partly German. This demonstrates how the German heritage had persisted in the United States (Greenwood & Ward, 2015).
There are various factors that influence communication within the German population together with their communication with other groups. Language can be a problem especially for those who have Low English Proficiency or those who cannot speak English at all. Therefore, it becomes a hefty task for healthcare providers to have effective communication with German patients who are unable to speak English. Usually, Germans like the idea of speaking openly about what they deem to be important to them. They tend to avoid being evasive in matters that are regarded as sensitive. Looking at non-verbal communication, gestures specifically, there are some that we find common in various cultures but can mean a completely different thing in the German culture. Some can even be offensive. Therefore, one has to be considerate when using non-verbal communication to avoid offending the patients without their knowledge.
Looking at Germany’s health beliefs, Germans are usually aware of their health and health care issues. The most commonly embraced methods of treatment are medications, prayer and religious rituals, exercise, diet, surgery, self-care for minor offenses, and home remedies. In the German culture, direct eye contact is highly valued because it is seen as a sign of honesty and having interest in any particular conversation, especially face to face conversations. Failure to maintain direct eye contact may be regarded as being untrustworthy and being a weak character. Smiles are used with discretion. They are typically reserved for family and friends only.
It is very important for a health care provider to be punctual when seeing a German patient because lateness is considered an insult to the patient. Close contact is not encouraged among Germans. Therefore, health care providers should consider giving patients some space. In the event that the patient is unable to speak English, the services of professional interpreters should be used. Also, it is important for a healthcare provider to offer education to German patients about the differences between the healthcare systems of the United States and Germany. There are several challenges to health care that Germans are likely to experience. These include difficulty with understanding the United States health care system, differences in communication styles and language, and differences in access to health care and insurance between the two countries. According to most European cultures, the cause of illness is usually associated with punishment for sins, self-abuse, outside sources, and lack of cleanliness.
There are several barriers that have an influence on the provision of culturally competent health care. These barriers range from language to limited resources and the patients’ cultural beliefs (Ogbolu, Scrandis & Fitzpatrick, 2018). Language barrier is a major impediment to the provision of culturally competent care. This is so because ineffective communication between the healthcare provider and the patients may lead to difficulties in the assessment of patients (Ali & Watson, 2018). Getting the wrong information from the patient may lead to the administration of the wrong medications thereby resulting to negative patient outcomes. Inadequate resources also present a barrier to the provision of culturally competent care. Healthcare providers may never get the chance to be trained on cultural competence and professional translation services may also not be accessed easily. Patients are also influenced by their cultural beliefs in their view of health and health procedures to be undertaken. Therefore, it becomes necessary for the healthcare provider to be aware of these beliefs and be able to navigate around them in order to provide satisfactory care to the patients.
There are several ethical dilemmas that exist in the delivery of healthcare. There are instances when a healthcare provider may conduct an assessment on a patient. The results come out and the patient is diagnosed with a very serious disease. The family may come to know about the results before the patient does. Knowing how this will affect the patient negatively, the family requests the healthcare provider not to reveal this to the patient. The ethical dilemma in this case is whether or not the healthcare provider should tell the truth. Based on ethical principles, the provider is charged with duty of valuing the patient’s autonomy, doing good and acting in the best interest of the patient. Since the patient has the right to know about the diagnostic results, the provider is bound to revealing the truth whether or not this will have negative effects on the patient.
Leininger Sunrise Model
There are various conceptual models available to guide nursing education in the application of cultural competency. Leininger Sunrise Model is one of the cultural competency assessment models used in nursing education. The Leininger Sunrise Model is essential in discovering the relationship between care and culture among cultures.
Leininger Sunrise Model is characterized by a culture care theory structure that explains the connection between nursing and anthropological philosophies and beliefs. Leininger Sunrise Model is applied by nurses while evaluating the cultural background of a patient. The Leininger model acts as a connection between the medical practices and theory concepts, and it offers an organized method to categorizing values, customs, beliefs and behaviors of a community (McFarland, & Wehbe-Alamah, 2019). The Leininger model of competency is comprised of various cultural features including legal, political, social, financial, religious, technological and educational aspects (Albougami, Pounds, & Alotaibi, 2016). Leininger’s theory of culture care is determined to make clinical care appropriate, just, decent and reverential to anyone in the globalized healthcare system.
The cultural features impact the type of services offered by medical systems despite being traditional or professional. Traditional medical systems and treatment constitute herbal and spiritual methods of healing, while professional or contemporary clinical systems and treatment encompasses modern, informed and evidence-based methods of treatment (Albougami, Pounds, & Alotaibi, 2016). Leininger’s model proposes a combination of both traditional and professional cultural Medical care and treatment to form a clinical system that uses science and evidence-based treatment and still respects and safeguards the cultural values, beliefs and concerns of the patient. Therefore, Leininger’s wish was to form a cultural model in clinical systems that respects the globalized cultures.
Leininger model uses culture care preservation, accommodation and restructuring to achieve desired clinical results. European culture is increasingly becoming culturally diverse since the European Union allows free movement of people across countries of the European Union. The free movement across Europe has led to political, social and economic positive strategy (McFarland, & Wehbe-Alamah, 2019). Migration causes higher mortality and morbidity of migrants compared to local people from failure by health systems to cater for their needs. Failure to address the needs of migrants is often caused by language barriers and knowledge of the local clinical system. Due to increased migration and immigration, many people suffering from various health and psychological issues offer room for medical practitioners a chance to develop transcultural care (Sagar, & Sagar, 2018). Migration of medical practitioners and nurses in Europe is increasing, thus creating an increased number of foreign health professionals providing health care to native and non-native patients. Thus, there is a challenge in the recipients and providers of health care services. Therefore, a plan of care needs to be developed to meet the needs of cultural diversity in Europe.
There is a need to address the high morbidity and mortality of non-native populations compared to native populations. Also, there is a need to address the increasing number of non-native practitioners caring for native communities and quality care challenges faced by recipients and givers of care. Various bodies such as government organizations, non-profit organizations, outreach centers and medical care associations need to improve caring science to enhance knowledge and research to broaden health care professions to improve patient’s condition and outcome. Nurses, doctors and other medical practitioners should ensure good communication such that, there are smooth transmission and preservation of someone’s culture. The practitioners should also provide space and respect the social organization of individuals by considering family, tribe and religious associations.
Ali, P. A., & Watson, R. (2018). Language barriers and their impact on provision of care to patients with limited English proficiency: Nurses’ perspectives. Journal of Clinical Nursing, 27(5-6), e1152-e1160.
Greenwood, M. J., & Ward, Z. (2015). Immigration quotas, World War I, and emigrant flows from the United States in the early 20th century. Explorations in Economic History, 55, 76-96.
Ogbolu, Y., Scrandis, D. A., & Fitzpatrick, G. (2018). Barriers and facilitators of care for diverse patients: Nurse leader perspectives and nurse manager implications. Journal of nursing management, 26(1), 3-10.
Albougami, A. S., Pounds, K. G., & Alotaibi, J. S. (2016). Comparison of four cultural competence models in transcultural nursing: A discussion paper. International Archives of Nursing and Health Care, 2(3), 1-5.
McFarland, M. R., & Wehbe-Alamah, H. B. (2019). Leininger’s theory of culture care diversity and universality: An overview with a historical retrospective and a view toward the future. Journal of Transcultural Nursing, 30(6), 540-557.
Njie-Carr, V., Adeyeye, O., Zhu, S., Sanneh, K., & Ludeman, E. (2018). Evaluating relevance of nursing theories in cross-cultural and international contexts. Journal of the National Black Nurses Association, 29(1), 13-21.
Rong, X., Peng, Y., Yu, H. P., & Li, D. (2017). Cultural factors influencing dietary and fluid restriction behaviour: perceptions of older Chinese patients with heart failure. Journal of clinical nursing, 26(5-6), 717-726.
Sagar, P. L., & Sagar, D. Y. (2018). Current State of Transcultural Nursing Theories, Models, and Approaches. Annual review of nursing research, 37(1), 25-41.
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