The atmosphere in Poland in the 1980’s was smoke filled and paradise for tobacco companies. The Case 14 Curbing Tobacco Use in Poland (n.d) illustrates a time where Poland had the highest smoking rate in the world and where most young men didn’t have the odds in their favor to reach the age of 60 years old. Tobacco companies had unrestricted advertising freedom including the freedom to not disclose the harm that tobacco causes. In the early 1990s, the scientific community in Poland began educating people on the deadly side effects of tobacco while linking tobacco use to the explosion of cancer cases in the country. This forced the hand of the government who in 1995, passed tobacco-control legislation that included smoking bans in certain areas, ban on sale of tobacco to minors, a ban on electronic media advertising, and required all cigarette packs to have a large warning on the package (Curbing Tobacco Use Study, n.d.). This legislation along with increasing social awareness are credited for the decline of smoking in Poland. This is a prime example of how most dominant issues require a multi-faceted defense to truly break the problem.
It’s always important to consider what social and political factors contribute to the rise of harmful habits that can be detrimental to health. In this case, the atmosphere in Poland was one of leniency. Leniency with the number of adults and children who were smoking, leniency with where smoking was allowed (public places, hospitals, etc.), leniency with the marketing tactics used by tobacco companies. Habits like smoking are many times the result of learned behaviors from peers or family members and these behaviors flourish in low-income communities where preventative marketing is non-existent and where these habits are widely accepted. This can be interchangeable with other harmful behaviors such as overeating, alcoholism and drug use. If the political environment isn’t strong enough with laws and structure it will allow the social wave to overwhelm the community.
One of the best qualities that a nurse can possess is the ability to care for all humans, despite ethnicity, background, or culture that they represent. This also means that nurse must be culturally competent in the care that they provide. Stanhope and Lancaster (2020) advise that maintaining cultural competency is a continuous and transformative journey. As a nurse, the only group of people that I find difficult to care are those who have a bias against nurses of certain ethnicities. This has not been a frequent occurrence, but this past week I was caring for a woman whose son did not want me as her nurse simply because of my ethnicity. Despite me taking wonderful care of his mother all day, my answers and updates on the day’s testing and upcoming plan of care, were simply not good enough, only because they came from a nurse whose ethnicity, he was not a fan of and he was very vocal about the topic. It can be a hard pill to swallow to know that you are not considered competent because of your race, especially for a nurse who care for all races and cultures despite their social background. I think this was an example of someone using stereotyping to determine how a person should be treated. Instead of being angry at man for disliking me because of the color of my skin and where he “thought” I came from, I decided to continue to give the best possible care to his mother and treat them all with the respect he didn’t feel I deserved. This was an opportunity to prove that I was not who he thought I was, but instead, see me as the competent, experienced nurse who cares for all patients as if they were my own family. I continuously strive to be the best nurse I can be and that includes being knowledgeable about all cultures and social backgrounds that I encounter so that it is a respectful and caring experience for everyone involved.
References
Center for Global Development. (n.d.). Case 14: Curbing tobacco use in Poland https://www.cgdev.org/sites/default/files/archive/doc/millions/MS_case_14.pdfLinks to an external site.
Stanhope, M., & Lancaster, J. (2020). Public health nursing: Population-centered health care in the community (10th ed.). Elsevier.
In Poland in the 1970s, it was estimated that an average of 3,500 cigarettes were smoked each year. This high amount of smoking has been considered due to the state running production of cigarettes, which created significant revenue, and the government did not fully disclose the health risks of smoking (Center for Global Development, n.d.). After the fall of communism, cigarette smoking in Poland took an all-time high, with more people smoking than ever. By 1995, cigarette smoking interventions were put into place, which included, but did not limit, the following: banning smoking and the sale of cigarettes in healthcare centers and enclosed workspaces, creating the largest health warning label on all cigarette packs, banning electronic media advertising, banning sales to minors, amongst others (Jassem, 2014). Around this time, the “Great Polish Smoke-Out” was developed (Center for Global Development, n.d.). This development allows former smokers to send a postcard for a chance to win a weeklong Rome vacation as well as a private session with Pope John Paul II. This incentivized residents to quit smoking for health reasons and opportunities they may never be privy to.
Often, unconscious bias can creep into a nurse’s care without them knowing. Unconscious bias is stereotyping others due to their culture, appearance, or behaviors without realizing it is happening (Schultz, 2017). Many providers may experience unconscious bias, which can affect their communication and treatment of the patient and cause them to overlook significant health concerns that can lead to patient harm. It is easy to develop a negative view of someone, primarily if a colleague has spoken about their poor perspective of the individual. Negative bias can be seen in nurse-to-nurse reports regularly. Many phrases heard during the report are “pain med seeking,” “hypochondriac,” “needy,” and so on. Nurses must stop the negativity and treat everyone fairly, without bias or prejudgment.
Knowing different cultures does help and hinder healthcare. For example, in Hispanic culture, we often see female family members performing the care for the patient, while male family members generally do not. We also see that Hispanic females are often addressed directly, but the males are to be addressed in conversation (Martinez, 2022). This may not necessarily be the case for all Hispanic families, and stereotyping the family can cause distrust between the provider and the family.
Having respect and educating ourselves in different cultures can increase trust within the provider-patient relationship but being mindful not to stereotype is just as important. The prevalence of smokers in Poland during the 1900s is a prime example. If nurses were biased toward these individuals with a general thought of “Polish people do not care about themselves, that is why they smoke,” the level of care would diminish. Educating ourselves and others is the key to preventing bias, stereotyping, and ensuring everyone gets the adequate healthcare they deserve.
References:
Center for Global Development. (n.d.). Case 14: Curbing tobacco use in Poland. Retrieved from https://waldenu.instructure.com/courses/27038/pages/week-3-learning-resources?module_item_id=766760
Jassem, J. P. (2014). Tobacco control in Poland—successes and challenges. Translational Lung Cancer Research 3(5), 280-285. Retrieved from Translational Lung Cancer Research, 3(5).
Martinez, I. L. (2022). Care v. Caring: Obligation, duty, & love among Latino Alzheimer’s Family Caregivers. J Appl Gerontol. 2022 Jul;41(7), 1744-1751.
Schultz, P. L. (2017). Teaching Strategies to Increase Nursing Student Acceptance and Management of Unconscious Bias. Journal of Nursing Education Vol. 56, Iss. 11, 692-696.
From the late 1970’s to the early 1990’s, Poland had the highest rate of smokers in the world. Children as young as 11 were smoking, while nearly 75% of men aged 20 to 60 were smokers and 30% of women in Poland were smokers. Almost half of all early deaths were caused by cigarette smoking and the complications that it caused (Center for Global Development, n.d.). At that time, Poland was under the control of a communist government that sourced a significant amount of revenue from tobacco production. The government also failed to provide education to its citizens regarding the dangers of tobacco smoking. Following the collapse of communism in Poland, the tobacco industry became privatized and brought in a flood of tactics to sell their products including aggressive marketing, producing a cheap, easily obtained product, and bringing in cigarettes from foreign brands that were now allowed to participate in the Polish economy (Center for Global Development, n.d.).
As the death rate continued to rise due to smoking, several studies revealed the link between cigarettes and death from cardiovascular disease and cancers. From there, non-profit organizations such as the Health Promotion Foundation were able to provide education through the media regarding the dangers of cigarette smoking. Because of this, legislation was introduced to the Polish government that led to the following: a ban on cigarette smoking in healthcare centers, schools, and enclosed workspaces, a ban on tobacco sales to those under 18, a ban on the production and/or marketing of smokeless tobacco, a ban on media promotion of tobacco, a requirement for printing health warnings on cigarette packages, and free treatment for smoking treatment (Center for Global Development, n.d.). Because of these interventions, the smoking rate in Poland dropped 10% over the span of 8 years, and the mortality rate in relation to smoking dropped by 30% (Center for Global Development, n.d.).
In order to understand how culture influences things such as cigarette smoking, we as nurses also have to examine our own cultural bias. The American Psychological Association (n.d.) defines cultural bias as “the tendency to interpret and judge phenomena in terms of the distinctive values, beliefs, and other characteristics of the society or community to which one belongs”. As nurses, we come across people of different cultural backgrounds daily. It is vital that we be culturally aware so that we can hopefully keep our own cultural biases at a minimum. For example, the vast majority of my hospice patients have some form of religious preference. Because of those preferences, there are times when they decline interventions such as pain medication due to their belief system. While that is very frustrating to me as a nurse who just wants to ease their suffering, I also have to respect their beliefs and change my care plan to suit those beliefs. Regardless of the fact that different cultures can make providing care more difficult, or what we perceive as difficult, we need to expand our knowledge of different cultures. By doing so, we can truly provide patient-centered care. However, I do think that it is easy to categorize people in our minds based on what we know about their culture and to form stereotypes. Being culturally aware is important, but we do have to remain mindful of our potential biases and ensure that they do not influence the care that we give.
References:
American Psychological Association (n.d.). Cultural Bias. APA Dictionary of Psychology. https://dictionary.apa.org/cultural-biasLinks to an external site..
Center for Global Development. (n.d.). Case 14: Curbing tobacco use in Poland. https://www.cgdev.org/sites/default/files/archive/doc/millions/MS_case_14.pdfLinks to an external site.