diabetes and mexican culture, nutrition issues in diabetes- a cultural perspective

Nutritional Issues in Diabetes: Cultural Perspective
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Nutritional Issues in Diabetes: Cultural Perspective
1.1 Importance of Cultural Competency in Diabetic Care
Cultural competence is extremely necessary to render a patient-centric care across different ethnicities. Lack of cultural competence has been associated with poor health outcomes and reduces patient adherence to treatment guidelines (Cameron, 1996). Improving cultural competence in healthcare providers not only increases the effectiveness of care but also increases their job satisfaction. Cultural competence has been described as the understanding of learned patterns of behavior and range of beliefs within a specific group of individuals which is carried over from generation to generation (Brach & Fraser, 2000).
A healthcare associate who inculcates culture based care provides assistive, supportive, facilitative care, in the context of the cultural beliefs of the patient population. To be culturally competent, a health care provider builds on cultural awareness (which involves self-reflection upon owns treatment biases), knowledge of different cultures, cultural skills, cultural encounters ( which involves interaction with the targeted patient and cultural desire. To provide effective care, health care professionals like nurses must be culturally competent. They should treat patients on their religious, spiritual and nutritional beliefs (Brach & Fraser, 2000).

A review, on the epidemiology of diabetes in the United States, reflected that the prevalence of diabetes varied across different ethnicities. Individuals belonging to African, Asian and Asia-Pacific cultures had poor control of diabetes, compared to Native Americans and Europeans (Caballero, 2005a). The factors that were identified included genetic factors, lifestyle factors, cultural issues and nutritional beliefs. The other factors that influence the quality of care are poor health insurance facilities and lack of awareness on diabetes. It is necessitated that health care providers, must identify cultural differences, and implement a tailor-made approach to wiping out the jeopardy in diabetes management (Caballero, 2005b). The present article will evaluate the cultural factors associated with a diabetic patient, belonging to Indian ethnicity. Depending upon the cultural needs, a care plan would be designed to manage her condition of diabetes (Brach & Fraser, 2000).
1.2. Patient Description
The patient in context belongs to Indian ethnicity. She is 65 years old and has been in the United States for the past 30 years. Her husband was an engineer with a renowned construction company and is now self-employed in his business firm. They migrated to the United States around 30 years ago. Mrs. Veena (name changed), is suffering from diabetes mellitus, for the past 15 years and her diabetes is not under tight control. She is suffering from type-II diabetes mellitus and therefore, her blood glucose levels are fairly high in fasting and post-prandial states. Her average fasting blood sugar levels are 155mg/dl, and the Post-prandial levels are 260mg/dl. Mrs. Veena also complains of frequent urination during the night, and she cannot check her urine.
She had her glycosylated levels at 8.4 and 8.7 as per the last two assessments. Mrs. Veena also suffers from hypertension, although her blood pressure is controlled with antihypertensive. Her body weight is 51 kg, and she is 174cm tall. Presently she complains of impaired vision and pain on walking. She also comments that sometimes the pain gets unbearable, and she cannot put her foot down. She is a vegan as per the norms of her “Hindu” culture. The diabetic medications prescribed to her include subcutaneous insulin doses and Saxagliptin. For her blood pressure control, she is prescribed Amlodipine. Further, she complains of extreme fatigue and mentions that she is losing weight.
Her risk factors for diabetes include depression, inability to perform a physical activity like brisk walking. Moreover, her food habits are devoid of first class proteins and consist of excess intake of low glycemic index carbohydrates.
1.3. Evaluation of Patient Specific Cultural Aspects of Mrs. Veena
The cultural beliefs and the health care needs were assessed through a qualitative interview questionnaire method. The questions in the template were asked to unfold the cultural beliefs, the perception of healthcare rendered and self-perception of the disease. This will help to understand the care requirements, based on the cultural and nutritional perspective of Mrs. Veena. The chat transcript with Mrs. Veena is provided in the template below:
(Implementation of Health Perception/Health Management Template)
Me: Are you able to understand and speak English fairly well? Is it your native language?
Mrs.Veena: Yes, I can understand and speak fairly enough. I have been in the States with my husband for the last 30 years. However, I am an Indian Gujarati and English is not my native language. My native language is Gujarati. What do you think caused your diabetes?
Mrs. Veena: I do not know, but when I came to the States I have become used to a lot of junk food and aerated drinks and ice-creams. Being a Gujarati, I do not consume fish or chicken and completely depend upon rice, cereals and vegetables. Me: Is there anything that might have prevented this problem?
Mrs. Veena: What I think I should not have taken so much junk food when I was young and recently settled in the United States. Oh yes, and one thing I was fairly obese even last three years back, and rarely I did any physical activity. My children were born here, and I had to rear them up.Me: What have you done so far to try to get better?
Mrs. Veena: I actively seek physician help, and currently on various medications.
Me: Have you been using any medications, herbs, or other treatments?
Mrs. Veena: I regularly take my medications as prescribed by the consulting physician and sometimes I take honey in the morning (since in Gujarat, I have seen people including my father and grandma used to take honey for fitness). Me: What kinds of treatments or medicine do you and your family think you should receive?
Mrs. Veena: The type of medications that I and my family require is to regain my energy levels and reduce my pain in my foot. Medications should also stop my loss of body weight.
1.4 Introspection of Values and Belief Pattern
Mrs. Veena was also interviewed to understand her cultural and nutritional belief pattern that could help her to come out of the problem. The chat transcript is represented below:
Me: Do you have any special food preferences that you think will help you?
Mrs. Veena: I do not know, but I think eating a lot of vegetables will be a good option for me.
Me: Any foods or fluids you should not have or make you sick?
Mrs. Veena: I think I should opt out from honey and the whole grains I take, make me very lethargic. Me: Do you have any spiritual beliefs that affect what foods you eat?
Mrs. Veena: Being a Hindu, I strongly feel that I should not consume meat or fish. Moreover, in our culture protein foods are a taboo. This is because I also believe that proteins belong to living creatures and in any form (milk, flesh) is an act of disrespecting God.
1.5: Analysis of Chat Transcript for Interventional Planning
Reflection on Self-Transcript
Overview of patient’s culture and common dietary practices and foods
Mrs. Veena is strictly a vegetarian and keeps away from protein rich foods. She cannot change her dietary habits in favor of protein food as it would hurt her spiritual belief. She consumes rice as a staple food, pulses, vegetables, and fruits.
Q. Analysis of the data & nursing diagnosis
From the various transcripts and the introductory history of Mrs. Veena, it is evident that she has uncontrolled diabetes mellitus. The major issue is her lifestyle and nutritional factors, which makes her prone to sustained diabetic complications. Since she consumes fewer amounts of proteins, and as her body metabolizes fat & proteins in preference to carbohydrates, she is losing weight. Consuming honey or sucrose has aggravated her problem with low glycemic index carbohydrates. Moreover, her physical activity is below normal (both due to pain and her stagnant lifestyle). Lesser physical activity has worsened her blood sugar control, and she is also suffering from neuropathic pain and probably prone to retinopathy (Polonsky, 2012). Q. Could cultural practices or beliefs be contributing to or causing the current problem?
Yes, the cultural practices and beliefs are clearly contributing/ aggravating her problem. For example, she needs to intake high amounts of protein in her diet which she is not adhering to.Q. Describe the specific conflict and design patient goals that accommodate these practices.
The conflict is taking protein rich diet and hence, I should inculcate various food items that are high in proteins. At the same time, I would not erode her belief on the vegetarian nature of her diet.
Q. Are the nursing diagnoses selected interpreted as “problems” by clients from different cultures or only in the Western medical culture?
No, these are problems all across the world. Personal preferences on diet and family beliefs drive eating habits all across the world.
1.6. Nursing Interventions Planned
The care interventions I intend to render to Mrs. Veena will include changes in dietary habits. I would encourage her to take protein rich foods like pulses and soy proteins. Moreover, I would discourage her to take honey and reduce the intake of rice. I would ensure a mix of whole grains and refined grains in her diet. Moreover, I should support her to walk at least for 30 minutes in the courtyard (www.diabetes.org). However, if she cannot walk due to pain, I would voice for treating her for neuropathic pain. I would inform her physician with my nursing assessment tool. I should also ask her husband’s support to encourage change in dietary patterns, which would make her comfortable. I would provide awareness materials from the Indian Diabetic Association and American Diabetic Association, to satisfy her on the evidenced based guidelines and the management recommended in her own cultural and ethnic context (Polonsky, 2012).
Learning for Future Practice
The case study provided me a unique opportunity to exhibit culture oriented practice. In my future endeavor, my take home points are to build on an empathetic relationship with the client. I should be counseling a client, with appropriate guidelines, without eroding his/her belief systems. Moreover, I must provide interventions like supportive therapies and care approaches that can be used as an adjunct to pharmacological interventions (Polonsky, 2012).
References
American Diabetic Association : http//:diabetes.org/
Caballero AE (a). 2005. Diabetes in minority populations. In: Joslin’s Diabetes Mellitus. 14th
ed. New York: Lippincott Williams & Wilkins, 505-524
Caballero AE (b).(2005). Diabetes in the Hispanic or Latino population: genes, environment, culture, and more. Curr Diab Rep. 5, 217-225
Cameron, C. (1996). Patient compliance: Recognition of factors involved and suggestions for
promoting compliance with therapeutic regimens. Journal of Advanced Nursing, 24,
244-250
Brach, C., & Fraser, I. (2000). Can cultural competency reduce racial and ethnic health
disparities? A review and conceptual model. Medical Care Research and Review, 57,
181-217
Polonsky KS (2012). “The Past 200 Years in Diabetes”. New England Journal of
Medicine 367 (14),1332–40