23.4 IV Therapy Site Assessment & Complications
Open Resources for Nursing (Open RN)
Catheter Size and Type Selection
Peripheral IV catheters are available in a variety of sizes, most commonly ranging from 14 gauge to 26 gauge. Note that the lower the gauge size, the wider the diameter of the catheter, with 14-gauge catheters allowing for the greatest flow rate.[1] Catheter sizes are color coded to allow for easy identification of the catheter size after a vein is accessed. See Figure 23.12[2] for colors associated with IV catheter sizes and their associated flow rates.
Nurses must consider the purpose for venous access, along with assessment of the patient’s vessel size, when selecting an IV catheter to attempt cannulation. The smallest IV catheter should be selected that will accommodate the prescribed therapy and patient need.[3]
Catheters with a smaller gauge (i.e., larger diameter) permit infusion of viscous fluids, such as blood products, at a faster rate with decreased opportunity for catheter occlusion.[4] Additionally, an appropriately sized catheter also allows for adequate blood flow around the catheter itself. The most common IV catheter size for adult patients is 18- or 20-gauge catheters. However, frail elderly patients and children have smaller vasculature, so a 22-gauge catheter is often preferred.
There are different manufacturer brands of IV catheters, but all include a beveled hollow needle, a flashback chamber in which blood can be visualized when entering the vein, and a flexible catheter that is left in the vein after the catheter has been threaded into the vein and the needle removed.
IV insertion equipment varies among institutions, but common types include shielded IV catheters or winged (i.e., “butterfly”) devices. Variation is often related to the presence of a stabilizing device at the site of insertion, as well as the presence of short extension tubing. For shielded catheter types, the stabilizing device and extension tubing are typically added to the catheter itself and not included with the cannulation needle. See Figure 23.13[5] for an image of shielded IV catheters.
Nurses must ensure the selected size and type of IV catheter are appropriate for the procedure or infusion that is ordered because not all peripheral IV catheters are suitable for all procedures. For example, if a procedure requires the infusion of contrast dye, a specific size infusion port is required.
Despite the wide variation in catheter equipment that is available, there has been significant focus among manufacturers regarding the need for safety equipment during venipuncture. Many devices utilize mechanisms to self-contain needles within a plastic sheath after withdrawal from the patient. These devices can be activated through a button in the devices or a manual trigger initiated by the individual attempting cannulation. Regardless of the type of safety lock, it is important to utilize the equipment as intended and never attempt to disable or override the mechanism. These mechanisms are important to help prevent accidental needlesticks or injury with a contaminated needle after it has been removed from the patient. Additionally, after cannulation is attempted, the individual who attempted cannulation is responsible for ensuring all needles are disposed of in a sharps container. It is good practice to be aware of how many sharps were brought into the room, opened, and disposed. This helps to ensure that any needles are not inadvertently left in a patient’s bed, tray table, floor, etc. Nurses must be familiar with the equipment used at the health care facility and receive orientation on the specific mechanics related to the equipment and safety practices.
Initiating Peripheral IV Access
The steps for initiating peripheral IV access are described in the Open RN Nursing Advanced Skills “Perform IV Insertion and IV Removal” checklist in Chapter 1.
Monitoring for Potential Complications
Several potential complications may arise from peripheral intravenous therapy. It is the responsibility of the nurse to prevent, assess, and manage signs and symptoms of complications. Complications can be categorized as local or systemic. See Table 23.4a for potential local complications of peripheral IV therapy.
Table 23.4a Local Complications of Peripheral IV Therapy[6],[7]
| Complications | Potential Causes and Prevention | Treatment |
|---|---|---|
| Phlebitis: The inflammation of the vein’s inner lining, the tunica intima. Clinical indications are localized redness, pain, heat, purulent drainage, and swelling that can track up the vein leading to a palpable venous cord. | Mechanical causes: Inflammation of the vein’s inner lining can be caused by the cannula rubbing and irritating the vein. To prevent mechanical inflammation, choose the smallest outer diameter of a catheter for therapy, secure the catheter with securement technology, avoid areas of flexion, and stabilize the joint as needed.[8]
Chemical causes: Inflammation of the vein’s inner lining can be caused by medications or fluids with high alkaline, acidic, or hypertonic qualities. To avoid chemical phlebitis, follow the parenteral drug therapy guidelines in a drug reference resource for administering IV medications, including the appropriate amount of solution and rate of infusion. Infectious causes: May be related to emergent VAD insertions, poor aseptic technique, or contaminated dressings. |
Chemical phlebitis: Evaluate infusion therapy and the need for different vascular access, different medication, slower rate of infusion, or more dilute infusate. If indicated, remove the Vascular Access Device (VAD).[9]
Transient mechanical phlebitis: May be treatable by stabilizing the catheter, applying heat, elevating limb, and providing analgesics as needed. Consider requesting other pharmacologic interventions such as anti-inflammatory agents if needed. Monitor site for 24 hours post-insertion, and if signs and symptoms persist, remove the catheter.[10] Infectious phlebitis: If purulent drainage is present or infection is suspected, remove the catheter and obtain a culture of the purulent drainage and catheter tip. Monitor for signs of systemic infection.[11] |
| Infiltration: A condition that occurs when a nonvesicant solution is inadvertently administered into surrounding tissue. Signs and symptoms include pain, swelling, redness, the skin surrounding the insertion site is cool to touch, there is a change in the quality or flow of IV, the skin is tight around the IV site, IV fluid is leaking from IV site, or there are frequent alarms on the IV pump. | Infiltration is one of the most common complications in infusion therapy involving an IV catheter.[12] For this reason, the patency of an IV site must always be checked before administering IV push medications.
Infiltration can be caused by piercing the vein, excessive patient movement, a dislodged or incorrectly placed IV catheter, or too rapid infusion of fluids or medications into a fragile vein. Always secure a peripheral IV catheter with tape or a stabilization device to avoid accidental dislodgement. Avoid sites that are areas of flexion. |
Stop the infusion and remove the cannula. Follow agency policy related to infiltration. |
| Extravasation: A condition that occurs when vesicant (an irritating solution or medication) is administered and inadvertently leaks into surrounding tissue and causes damage. It is characterized by the same signs and symptoms as infiltration but also includes burning, stinging, redness, blistering, or necrosis of the tissue. | Extravasation has the same potential causes of infiltration but with worse consequences because of the effects of vesicants. Extravasation can result in severe tissue injury and death (necrosis). For this reason, known vesicant medications should be administered via central lines. | Stop the infusion. Detach all administration sets and aspirate from the catheter hub prior to removing the catheter to remove vesicant medication from the catheter lumen and as much as possible from the subcutaneous tissue.[13]
Follow agency policy regarding extravasation of specific medications. For example, toxic medications have a specific treatment plan. |
| Hemorrhage: Bleeding from the IV access site. | Bleeding occurs when the IV catheter becomes dislodged. | If dislodgement occurs, apply pressure with gauze to the site until the bleeding stops and then apply a sterile transparent dressing. |
| Local infection: Infection at the site is indicated by purulent drainage, typically two to three days after an IV site is started. | Local infection is often caused by nonadherence to aseptic technique during IV initiation or IV maintenance or the dressing becomes contaminated or non-intact over the access site. | Remove the cannula and clean the site using sterile technique. If infection is suspected, remove the catheter and obtain a culture of the purulent drainage and catheter tip. Monitor for signs of systemic infection. |
| Nerve injury[14] | Paresthesia-type pain occurring during venipuncture or during an indwelling IV catheter can indicate nerve injury. | Immediately remove the cannula, notify the provider, and document findings in the chart. |
In addition to local complications that can occur at the site of IV insertion, there are many systemic complications that nurses must monitor for when initiating peripheral IV access, as well as monitoring a patient receiving IV therapy. See Table 23.4b for a list of systemic complications, signs, symptoms, and treatment.
Table 23.4b Systemic Complications of Peripheral IV Therapy[15]
| Complication | Signs, Symptoms, and Treatment |
|---|---|
| Pulmonary Edema | Pulmonary edema, also known as fluid overload or circulatory overload, is a condition caused by excess fluid accumulation in the lungs due to excessive fluid in the circulatory system. It is characterized by decreased oxygen saturation; increased respiratory rate; fine or coarse crackles in the lung bases; restlessness; breathlessness; dyspnea; and coughing up pink, frothy sputum. Pulmonary edema requires prompt medical attention and treatment. If pulmonary edema is suspected, raise the head of the bed, apply oxygen, take vital signs, complete a cardiovascular assessment, and immediately notify the provider. |
| Air Embolism | An air embolism refers to the presence of air in the cardiovascular system. It occurs when air is introduced into the venous system and travels to the right ventricle and/or pulmonary circulation. Air embolisms can occur during catheter insertion, changing IV bags, adding secondary medication administration, and catheter removal. Inadvertent administration of 10 mL of air can have serious and fatal consequences. However, small air bubbles are tolerated by most patients. Signs and symptoms of an air embolism include sudden shortness of breath, continued coughing, breathlessness, shoulder or neck pain, agitation, feeling of impending doom, light-headedness, hypotension, wheezing, increased heart rate, altered mental status, and jugular venous distension.
If an air embolism is suspected, occlude the source of air entry. Place the patient in a Trendelenburg position on their left side (if not contraindicated), apply oxygen at 100%, obtain vital signs, and immediately notify the provider. To prevent air embolisms, perform the following steps when administering IV therapy: ensure the drip chamber is one-third to one-half filled, remove all air from the IV tubing by priming it prior to attaching it to the patient, use precautions when changing IV bags or adding secondary medication bags, ensure all IV connections are tight, and ensure clamps are used when the IV system is not in use. |
| Catheter Embolism | A catheter embolism occurs when a small part of the cannula breaks off and flows into the vascular system. When removing a peripheral IV cannula, inspect the catheter tip to ensure the end is intact. Notify the provider immediately if the catheter tip is not intact when it is removed. |
| Catheter-Related Bloodstream Infection (CR-BSI) | Catheter-related bloodstream infection (CR-BSI) is caused by microorganisms introduced into the bloodstream through the puncture site, the hub, or contaminated IV tubing or IV solution, leading to bacteremia or sepsis. A CR-BSI is a hospital-acquired preventable infection and considered an adverse event. A CR-BSI is diagnosed when infection occurs with one positive blood culture in a patient with a vascular device (or a patient who had a vascular device within 48 hours before the infection) with no apparent source for the infection other than the vascular access device. Treatment for CR-BSI is IV antibiotic therapy.
To prevent CR-BSI, it is vital to perform hand hygiene prior to care and maintenance of an IV system and to use strict aseptic technique for care and maintenance of all IV therapy procedures. |
- This work is a derivative of StatPearls by Beecham & Tackling and is licensed under CC BY 4.0 ↵
- “Color-coding_of_IV_cannulas.jpg” by Dr.Vijaya Chandar is licensed under CC BY-SA 4.0 ↵
- Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., Sharp, E., & Alexander, M. A. (2021). Infusion therapy standards of practice. Journal of Infusion Nursing, 44(Suppl 1S), S1–S224. https://doi: 10.1097/NAN.0000000000000396.org ↵
- This work is a derivative of StatPearls by Beecham & Tackling and is licensed under CC BY 4.0 ↵
- “IV_Catheters_(9).JPG” by Intropin is licensed under CC BY-SA 3.0 ↵
- This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0 ↵
- Simin, D., Milutinović, D., Turkulov, V., & Brkić, S. (2018). Incidence, severity and risk factors of peripheral intravenous cannula‐induced complications: An observational prospective study. Journal of Clinical Nursing, 28(9-10), 1585-1599. https://doi.org/10.1111/jocn.14760 ↵
- Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., Sharp, E., & Alexander, M. A. (2021). Infusion therapy standards of practice. Journal of Infusion Nursing, 44(Suppl 1S), S1–S224. https://doi: 10.1097/NAN.0000000000000396.org ↵
- Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., Sharp, E., & Alexander, M. A. (2021). Infusion therapy standards of practice. Journal of Infusion Nursing, 44(Suppl 1S), S1–S224. https://doi: 10.1097/NAN.0000000000000396.org ↵
- Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., Sharp, E., & Alexander, M. A. (2021). Infusion therapy standards of practice. Journal of Infusion Nursing, 44(Suppl 1S), S1–S224. https://doi: 10.1097/NAN.0000000000000396.org ↵
- Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., Sharp, E., & Alexander, M. A. (2021). Infusion therapy standards of practice. Journal of Infusion Nursing, 44(Suppl 1S), S1–S224. https://doi: 10.1097/NAN.0000000000000396.org ↵
- Wang, J., Li, M. M., Zhou, L. P., Xie, R. H., Pakhale, S., Krewski, D., & Wen, S. W. (2022). Treatment for grade 4 peripheral intravenous infiltration with type 3 skin tears: A case report and literature review. International Wound Journal, 19(1), 222–229. https://doi.org/10.1111/iwj.13624 ↵
- Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., Sharp, E., & Alexander, M. A. (2021). Infusion therapy standards of practice. Journal of Infusion Nursing, 44(Suppl 1S), S1–S224. https://doi: 10.1097/NAN.0000000000000396.org ↵
- Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., Sharp, E., & Alexander, M. A. (2021). Infusion therapy standards of practice. Journal of Infusion Nursing, 44(Suppl 1S), S1–S224. https://doi: 10.1097/NAN.0000000000000396.org ↵
- This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0 ↵
Active listening: Process by which we are communicating verbally and nonverbally that we are interested in what the other person is saying while also actively verifying our understanding with the speaker. (Chapter 2.3)
Aphasia: A communication disorder that results from damage to portions of the brain that are responsible for language. (Chapter 2.3)
Assertive communication: A way to convey information that describes the facts, the sender’s feelings, and explanations without disrespecting the receiver’s feelings. This communication is often described as using “I” messages: “I feel…,” “I understand…,” or “Help me to understand…” (Chapter 2.2)
Bedside handoff report: A handoff report in hospitals that involves clients, their family members, and both the off-going and the incoming nurses. The report is performed face to face and conducted at the client's bedside. (Chapter 2.4)
Broca's aphasia: A type of aphasia where clients understand speech and know what they want to say, but frequently speak in short phrases that are produced with great effort. People with Broca's aphasia typically understand the speech of others fairly well. Because of this, they are often aware of their difficulties and can become easily frustrated. (Chapter 2.3)
Charting by exception (CBE): A type of documentation where a list of “normal findings” is provided and nurses document assessment findings by confirming normal findings and writing brief documentation notes for any abnormal findings. (Chapter 2.5)
DAR: A type of documentation often used in combination with charting by exception. DAR stands for Data, Action, and Response. Focused DAR notes are brief, and each note is focused on one client problem for efficiency in documenting, as well as for reading. (Chapter 2.5)
Electronic Health Record (EHR): A digital version of a client’s paper chart. EHRs are real-time, client-centered records that make information available instantly and securely to authorized users. (Chapter 2.5)
Expressive aphasia: A type of aphasia where the client has difficulty putting thoughts into words. The client may cognitively know what they want to say but are unable to express their thoughts. (Chapter 1.4, Chapter 2.3)
Global aphasia: A type of aphasia that results from damage to extensive portions of the language areas of the brain. Individuals with global aphasia have severe communication difficulties and may be extremely limited in their ability to speak or comprehend language. They may be unable to say even a few words or may repeat the same words or phrases over and over again. They may have trouble understanding even simple words and sentences. (Chapter 2.3)
Handoff report: A process of exchanging vital client information, responsibility, and accountability between the off-going and incoming nurses in an effort to ensure safe continuity of care and the delivery of best clinical practices. (Chapter 2.4)
Health Insurance Portability and Accountability Act (HIPAA): Standards for ensuring privacy of client information that are enforceable by law. (Chapter 2.3)
Incident reports: Also called variance reports, incident reports are a specific type of documentation that is completed when there is an unexpected occurrence, such as a medication error, client injury, or client fall, or a near miss, where an error did not actually occur, but was prevented from occurring. (Chapter 2.5)
ISBARR: A mnemonic for the format of professional communication among health care team members that includes Introduction, Situation, Background, Assessment, Request/Recommendations, and Repeat back. (Chapter 2.4)
Minimum Data Set (MDS): A federally mandated assessment tool used in skilled nursing facilities to track a client’s goal achievement, as well as to coordinate the efforts of the health care team to optimize the resident’s quality of care and quality of life. (Chapter 2.5)
Narrative note: A type of documentation that chronicles all of the client’s assessment findings and nursing activities that occurred throughout the shift. (Chapter 2.5)
Nontherapeutic responses: Responses to clients that block communication, expression of emotion, or problem-solving. (Chapter 2.3)
Nonverbal communication: Facial expressions, tone of voice, pace of the conversation, and body language. (Chapter 2.2)
Progressive relaxation: Types of relaxation techniques that focus on reducing muscle tension and using mental imagery to induce calmness. (Chapter 2.2)
Receptive aphasia: A type of aphasia where the client has difficulty in understanding what is being communicated to them. The client may be able to verbalize their thoughts and feelings but does not understand what is spoken to them. (Chapter 2.3)
Relaxation breathing: A breathing technique used to reduce anxiety and control the stress response. (Chapter 2.2)
SOAPIE: A mnemonic for a type of documentation that is organized by six categories: Subjective, Objective, Assessment, Plan, Interventions, and Evaluation. (Chapter 2.5)
Therapeutic communication: The purposeful, interpersonal information transmitting process through words and behaviors based on both parties’ knowledge, attitudes, and skills, which leads to client understanding and participation. (Chapter 2.3)
Therapeutic communication techniques: Techniques that encourage clients to explore feelings, problem solve, and cope with responses to medical conditions and life events. (Chapter 2.3)
Verbal communication: Exchange of information using words understood by the receiver. (Chapter 2.2)
Active listening: Process by which we are communicating verbally and nonverbally that we are interested in what the other person is saying while also actively verifying our understanding with the speaker. (Chapter 2.3)
Aphasia: A communication disorder that results from damage to portions of the brain that are responsible for language. (Chapter 2.3)
Assertive communication: A way to convey information that describes the facts, the sender’s feelings, and explanations without disrespecting the receiver’s feelings. This communication is often described as using “I” messages: “I feel…,” “I understand…,” or “Help me to understand…” (Chapter 2.2)
Bedside handoff report: A handoff report in hospitals that involves clients, their family members, and both the off-going and the incoming nurses. The report is performed face to face and conducted at the client's bedside. (Chapter 2.4)
Broca's aphasia: A type of aphasia where clients understand speech and know what they want to say, but frequently speak in short phrases that are produced with great effort. People with Broca's aphasia typically understand the speech of others fairly well. Because of this, they are often aware of their difficulties and can become easily frustrated. (Chapter 2.3)
Charting by exception (CBE): A type of documentation where a list of “normal findings” is provided and nurses document assessment findings by confirming normal findings and writing brief documentation notes for any abnormal findings. (Chapter 2.5)
DAR: A type of documentation often used in combination with charting by exception. DAR stands for Data, Action, and Response. Focused DAR notes are brief, and each note is focused on one client problem for efficiency in documenting, as well as for reading. (Chapter 2.5)
Electronic Health Record (EHR): A digital version of a client’s paper chart. EHRs are real-time, client-centered records that make information available instantly and securely to authorized users. (Chapter 2.5)
Expressive aphasia: A type of aphasia where the client has difficulty putting thoughts into words. The client may cognitively know what they want to say but are unable to express their thoughts. (Chapter 1.4, Chapter 2.3)
Global aphasia: A type of aphasia that results from damage to extensive portions of the language areas of the brain. Individuals with global aphasia have severe communication difficulties and may be extremely limited in their ability to speak or comprehend language. They may be unable to say even a few words or may repeat the same words or phrases over and over again. They may have trouble understanding even simple words and sentences. (Chapter 2.3)
Handoff report: A process of exchanging vital client information, responsibility, and accountability between the off-going and incoming nurses in an effort to ensure safe continuity of care and the delivery of best clinical practices. (Chapter 2.4)
Health Insurance Portability and Accountability Act (HIPAA): Standards for ensuring privacy of client information that are enforceable by law. (Chapter 2.3)
Incident reports: Also called variance reports, incident reports are a specific type of documentation that is completed when there is an unexpected occurrence, such as a medication error, client injury, or client fall, or a near miss, where an error did not actually occur, but was prevented from occurring. (Chapter 2.5)
ISBARR: A mnemonic for the format of professional communication among health care team members that includes Introduction, Situation, Background, Assessment, Request/Recommendations, and Repeat back. (Chapter 2.4)
Minimum Data Set (MDS): A federally mandated assessment tool used in skilled nursing facilities to track a client’s goal achievement, as well as to coordinate the efforts of the health care team to optimize the resident’s quality of care and quality of life. (Chapter 2.5)
Narrative note: A type of documentation that chronicles all of the client’s assessment findings and nursing activities that occurred throughout the shift. (Chapter 2.5)
Nontherapeutic responses: Responses to clients that block communication, expression of emotion, or problem-solving. (Chapter 2.3)
Nonverbal communication: Facial expressions, tone of voice, pace of the conversation, and body language. (Chapter 2.2)
Progressive relaxation: Types of relaxation techniques that focus on reducing muscle tension and using mental imagery to induce calmness. (Chapter 2.2)
Receptive aphasia: A type of aphasia where the client has difficulty in understanding what is being communicated to them. The client may be able to verbalize their thoughts and feelings but does not understand what is spoken to them. (Chapter 2.3)
Relaxation breathing: A breathing technique used to reduce anxiety and control the stress response. (Chapter 2.2)
SOAPIE: A mnemonic for a type of documentation that is organized by six categories: Subjective, Objective, Assessment, Plan, Interventions, and Evaluation. (Chapter 2.5)
Therapeutic communication: The purposeful, interpersonal information transmitting process through words and behaviors based on both parties’ knowledge, attitudes, and skills, which leads to client understanding and participation. (Chapter 2.3)
Therapeutic communication techniques: Techniques that encourage clients to explore feelings, problem solve, and cope with responses to medical conditions and life events. (Chapter 2.3)
Verbal communication: Exchange of information using words understood by the receiver. (Chapter 2.2)
Learning Activities
(Answers to "Learning Activities" can be found in the "Answer Key" at the end of the book. Answers to interactive activity elements will be provided within the element as immediate feedback.)
Practice what you have learned in this chapter by completing these learning activities. When accessing the online activities that contain videos, it is best to use Google Chrome or Firefox browsers.
1. To test your understanding of therapeutic and nontherapeutic terms, complete this online quiz:
Therapeutic Communication Techniques vs. Non-therapeutic Communication Techniques Quizlet
2. Consider the following scenario and describe actions that you might take to facilitate the communication experience.
You are caring for Mr. Curtis, an 87-year-old client newly admitted to the medical surgical floor with a hip fracture. You are preparing to complete his admission history and need to collect relevant health information and complete a physical exam. You approach the room, knock at the door, complete hand hygiene, and enter. Upon entry, you see Mr. Curtis is in bed surrounded by multiple family members. The television is on in the background, and you also note the sound of meal trays being delivered in the hallway.
Based on the described scenario, what actions might be implemented to aid in your communication with Mr. Curtis?
Test your knowledge using this NCLEX Next Generation-style question. You may reset and resubmit your answers to this question an unlimited number of times.[1]
Test your knowledge using this NCLEX Next Generation-style question. You may reset and resubmit your answers to this question an unlimited number of times.[2]
Learning Objectives
- Reflect upon personal and cultural values, beliefs, biases, and heritage[3]
- Embrace diversity, equity, inclusivity, health promotion, and health care for individuals of diverse geographic, cultural, ethnic, racial, gender, and spiritual backgrounds across the life span[4]
- Demonstrate respect, equity, and empathy in actions and interactions with all health care consumers[5]
- Participate in life-long learning to understand cultural preferences, worldviews, choices, and decision-making processes of diverse clients[6]
- Adapt care considering all aspects of diversity
- Identify principles of protecting client dignity
- Identify principles of holistic, client-centered care
- Identify strategies to advocate for clients
- Identify principles of religion and spirituality
No matter who we are or where we come from, every person was raised with cultural values and beliefs. The impact of culture on a person’s health is profound because it affects many health beliefs, such as perceived causes of illness, ways to prevent illness, and acceptance of medical treatments. Culturally responsive care integrates these cultural beliefs into an individual's health care. Culturally responsive care is intentional and promotes trust and rapport with clients. At its heart, culturally responsive care is client-centered care. The American Nurses Association (ANA) states, "The art of nursing is demonstrated by unconditionally accepting the humanity of others, respecting their need for dignity and worth, while providing compassionate, comforting care."[7]
Nurses provide holistic care when incorporating their clients’ physical, mental, spiritual, cultural, and social needs into their health care (referred to as holism). As a nursing student, you are undertaking a journey of developing cultural competency with an attitude of cultural humility as you learn how to provide holistic care to your clients. Cultural competence is a lifelong process of applying evidence-based nursing in agreement with the cultural values, beliefs, worldview, and practices of clients to produce improved client outcomes.[8],[9],[10]
Cultural humility is defined by the American Nurses Association as, "A humble and respectful attitude toward individuals of other cultures that pushes one to challenge their own cultural biases, realize they cannot know everything about other cultures, and approach learning about other cultures as a life-long goal and process."[11] Nurses improve the quality of health care by understanding, respecting, and incorporating their clients' cultural values, beliefs, and preferences, which can ultimately help reduce health disparities.[12]
This chapter will introduce concepts related to adapting nursing care that considers all aspects of diversity.
