Decent Work Employment and Transcultural Nursing

Module #12 Student Activity Sheet

Name: _________________________________________________________ Class number: _______

Section: ____________ Schedule: ___________________________________ Date: _______________

Lesson title: CULTURALLY COMPETENT NURSING CARE Materials:

Electronic gadget, pen, & notebook
Learning Targets:
At the end of the module, students will be able to:
 Critically analyze the complex integration of knowledge,
attitudes, and skills needed for the delivery of culturally
competent nursing care;
 Compare and contrast individual cultural competence and
organizational cultural competence;
 Evaluate guidelines for the practice of culturally competent References:
nursing care; and,
 Use a transcultural interprofessional framework for the Andrews, M. M. & Boyle, J. S. (2016).
delivery of culturally congruent and culturally competent Transcultural concepts in nursing care (7th
nursing care for clients with special needs. ed.). Philadelphia, PA: Wolters Kluwer.

A. LESSON PREVIEW/REVIEW

Let us have a quick review of what you have learned from the previous session. Kindly answer the posted task on the
space provided. You may use the back page of this sheet, if necessary. Here is the task:

When Dr. Madeleine Leininger established transcultural nursing in the middle of the 20th century, she identified eight
reasons why this specialty was needed. Review the reasons and discuss the relevance of these reasons in contemporary
nursing and health care.

B. MAIN LESSON

By introducing national and global guidelines for the delivery of culturally competent nursing care and identifying cultural
assessment instruments, we provide nurses with tools to guide them in the delivery of care that is culturally acceptable
and congruent with the client’s beliefs and practices, culturally competent, affordable, accessible, and rooted in state of
the science research, evidence-based, and best practices.

Rationale for Culturally Competent Care:

Multiple factors are converging at this time in history to heighten societal awareness of cultural similarities and differences
among people. In many parts of the world, there is growing awareness of social injustice for people from diverse
backgrounds and the moral imperative to safeguard the civil and health care rights of vulnerable populations.

 Vulnerable populations are groups that are poorly integrated into the health care system because of ethnic,
cultural, economic, geographic, or health characteristics, such as disabilities or multiple chronic conditions.

 Immigration and migration result in growing numbers of immigrants, people who move from one country or
region to another for economic, political, religious, social, and personal reasons. The verb emigrate means to
leave one country or region to settle in another; immigrate means to enter another country or region for the
purpose of living there. People emigrate from one country or region and immigrate to a different nation or region.

This document is the property of PHINMA EDUCATION

 Decent Work Employment and Transcultural Nursing
Module #12 Student Activity Sheet

Name: _________________________________________________________ Class number: _______

Section: ____________ Schedule: ___________________________________ Date: _______________

 Nurses respond to global health care needs such as infectious disease epidemics and the growing trends in
health tourism, in which patients travel to other countries for medical and surgical health care needs. By
traveling to another nation, clients often obtain more affordable care services or receive specialized care that is
unavailable in their own country.

 Nurses also respond to natural and human-made disasters around the world and provide care for refugees
(people who flee their country of origin for fear of persecution based on ethnicity, race, religion, political opinion,
or related reasons) and other casualties of civil unrest or war in politically unstable parts of the world.

 In all of these situations, nurses are expected to demonstrate effective cross-cultural communication and deliver
culturally congruent and culturally competent nursing care to people from diverse countries and cultures

 Interprofessional collaborative practice refers to multiple health providers from different professional
backgrounds working together with patients, families, caregivers, & communities to deliver highest quality care.

 Interprofessional teams have a collective identity and shared responsibility for a client or group of clients.
Culturally competent care is an extension of interprofessional collaborative practice, involving clients and their
families; credentialed or licensed health professionals; folk or traditional healers from various philosophical
perspectives, such as herbalists, medicine men or women, and others; and religious and spiritual leaders, such as
rabbis, imams, priests, elders, monks, and other religious representatives or clergy, all of whom are integral
members of the interprofessional team.

Guidelines for the Practice of Culturally Competent Nursing Care

 A set of guidelines for implementing culturally competent nursing care was recently developed by a task force
consisting of members of the American Academy of Nursing (AAN) Expert Panel on Global Nursing and Health
and the Transcultural Nursing Society (TCNS).
 This set provides a useful framework for implementing culturally competent care.

This document is the property of PHINMA EDUCATION

 Decent Work Employment and Transcultural Nursing
Module #12 Student Activity Sheet

Name: _________________________________________________________ Class number: _______

Section: ____________ Schedule: ___________________________________ Date: _______________

This document is the property of PHINMA EDUCATION

 Decent Work Employment and Transcultural Nursing
Module #12 Student Activity Sheet

Name: _________________________________________________________ Class number: _______

Section: ____________ Schedule: ___________________________________ Date: _______________

Definitions and Categories of Cultural Competence

 There is no universally accepted definition of cultural competence. Rather, there are hundreds of definitions that
have “evolved from diverse perspectives, interests, and needs and are incorporated in state legislation, Federal
statutes and programs, private sector organizations, and academic settings”.
 Cultural Competence conceptually can be divided into two major categories:
1. Individual cultural competence, which refers to the care provided for an individual client by one or more
nurses, physicians, social workers, and/or other health care, education, or social services professionals
2. Organizational cultural competence, which focuses on the collective competencies of the members of
an organization and their effectiveness in meeting the diverse needs of their clients, patients, staff, and
community.
 Cultural baggage refers to the tendency of a person’s own culture to be foremost in his/her assumptions,
thoughts, words, and behavior. People are seldom consciously aware that culture influences their world view and
interactions with others.

Cultural Self-Assessment
 The purpose of the cultural self-assessment is for nurses to critically reflect on their own culturally based attitudes,
values, beliefs, and practices and gain insight into, and awareness of, the ways in which their background and
lived experiences have shaped and informed the person the nurse has become today.
 The nurse’s cultural self-assessment is a personal and professional journey that emphasizes strengths as well as
areas for continued growth, thereby enabling nurses to set goals for overcoming barriers to the delivery of
culturally congruent and competent nursing care.
 Part of the cultural self-assessment process includes nurses’ awareness of their human tendencies toward bias,
ethnocentrism, cultural imposition, cultural stereotyping, prejudice, and discrimination.
 Bias refers to the tendency, outlook, or inclination that results in an unreasoned judgment, positive or negative,
about a person, place, or object.
 The term ethnocentrism refers to the human tendency to view one’s own group as the center of and superior to
all other groups. People born into a particular culture grow up absorbing and learning the values and behaviors of
the culture, and they develop a worldview that considers their culture to be the norm. Other cultures that differ
from that norm are viewed as inferior. Ethnocentrism may lead to pride, vanity, belief in the superiority of one’s
own group over all others, contempt for outsiders, and cultural imposition.
 Racism, the belief that one’s own race is superior and has the right to dominate others, has a profound impact on
the body’s stress management system. Exposure to racism over prolonged periods of time may result in severe
cardiovascular disease.
 Cultural imposition is the tendency of a person or group to impose their values, beliefs, & practices onto others.
 Cultural stereotype refers to a preconceived, fixed perception or impression of someone from a particular
cultural group without meeting the person.
 Prejudice refers to inaccurate perceptions of others or preconceived judgments about people based on ethnicity,
race, national origin, gender, sexual orientation, social class, size, disability, religion, language, political opinion,
or related personal characteristics Whereas prejudice concerns perceptions and attitude.
 Discrimination refers to the act or behavior of setting one individual or group apart from another, thereby treating
one person or group differently from other people or groups. In the context of civil rights law, unlawful
discrimination refers to unfair or unequal treatment of an individual or group based on age, disability, ethnicity,
gender, marital status, national origin, race religion, and sexual orientation.

Cultural Assessment of Clients

 The foundation for culturally competent and culturally congruent nursing care is the cultural assessment, a term
that refers to the collection of data about the client’s health state. There are two major categories of data:
o Subjective data (i.e., what clients say about themselves during the admission or intake interview)
o Objective data (i.e., what health professionals observe about clients during the physical examination
through observation, percussion, palpation, and auscultation)

This document is the property of PHINMA EDUCATION

 Decent Work Employment and Transcultural Nursing
Module #12 Student Activity Sheet

Name: _________________________________________________________ Class number: _______

Section: ____________ Schedule: ___________________________________ Date: _______________

 When conducting a comprehensive cultural assessment of clients, nurses need to be able to successfully form,
foster, and sustain relationships with people who may frequently come from a cultural background that is different
from the nurse’s, thus making it necessary to quickly establish rapport with the client.
 The ability to see the situation from the client’s point of view is known as an emic or insider’s perspective; looking
at the situation from an outsider’s vantage point is known as an etic perspective.
 Cross-cultural communication is based on knowledge of many factors, such as the other person’s values,
perceptions, attitudes, manners, social structure, decision-making practices, and an understanding of how
members of groups communicate both verbally and nonverbally.

Individual Cultural Competence

 This is a complex integration of knowledge, attitudes, values, beliefs, behaviors, skills, practices, and cross-
cultural nurse–client interactions that include effective communication and the provision of safe, affordable,
accessible, research, evidence-based, and best practices, acceptable, quality, and efficacious nursing care for
clients from diverse backgrounds.
 The term diverse or diversity refers to the client’s uniqueness in the dimensions of race; ethnicity; national origin;
socioeconomic background; age; gender; sexual orientation; philosophical and religious ideology; lifestyle; level of
education; literacy; marital status; physical, emotional, and psychological ability; political ideology; size; and other
characteristics used to compare or categorize people.

Organizational Cultural Competence

According to the National Center for Cultural Competence, cultural competence requires that organizations have the
following characteristics:
 A defined set of values and principles and demonstration of behaviors, attitudes, policies, and structures that
enable them to work effectively cross-culturally

This document is the property of PHINMA EDUCATION

 Decent Work Employment and Transcultural Nursing
Module #12 Student Activity Sheet

Name: _________________________________________________________ Class number: _______

Section: ____________ Schedule: ___________________________________ Date: _______________

 The capacity to (1) value diversity, (2) conduct self-assessments, (3) manage the dynamics of difference, (4)
acquire and institutionalize cultural knowledge, and (5) adapt to diversity and the cultural contexts of the
communities they serve
 Incorporation of the previously mentioned items in all aspects of policy making, administration, practice, and
service delivery and systematic involvement of consumers, key stakeholders, and communities

Clients with Special Needs:

This covers the delivery of culturally competent nursing care for 3 groups of clients with special needs: those at high risk
for health inequities & health disparities, those who are deaf, and those with communication and special language needs.

Health Disparities
 The Health Resources and Services Administration defines health disparities as population specific differences in
the presence of disease, health outcomes, or access to health care. These differences can affect how frequently
a disease affects a group, how many people get sick, or how often the disease causes death.
 Many different populations are affected by disparities. These include the following:
o Racial and ethnic minorities
o Residents of rural areas
o Women, children, and the elderly
o Persons with disabilities
o Other special populations such as the deaf
 In the US, health disparities are a well-known problem among panethnic minority groups, particularly African
Americans, Asian Americans, Native Americans, and Latinos. When examining health disparities globally, the
WHO uses the term health inequities.
 Disparities in health care exist even when controlling for gender, condition, age, and socioeconomic status.
 The U.S. Department of Health, Health Resources and Services Administration, identifies culturally competent
nursing care as an effective approach in reducing and eliminating health disparities and inequities in high-risk
populations such as Blacks, Latinos, and American Indians.
o Studies demonstrate that these groups have a higher prevalence of chronic conditions, along with higher
rates of mortality and poorer health outcomes, when compared with counterparts in the general
population.

Culture of the Deaf

 Although nurses tend to think about clients from racially and ethnically diverse backgrounds, when discussing
culturally competent nursing care, there are many people who self-identify with nonethnic cultures and/or with
more than one culture or subculture.
o For example, more than 5% of the world’s population (360 million adults and 32 million children)
experience disabling hearing loss (WHO, 2014).
o Additionally, nurses will encounter clients who are Black and deaf, gay and deaf, Native American and
deaf, and many other combinations of two or more cultures.

 Disabling hearing loss is defined as the loss of greater than 40 decibels in the better ear in adults and the loss
of greater than 30 decibels in the better ear in children. Disabling hearing loss means that a client has very little or
no hearing, which has consequences for interpersonal communication, psychosocial well-being, quality of life, and
economic independence.
 Hearing loss may affect one or both ears, can be congenital or acquired, and occurs on a continuum from mild to
severe. Hearing loss leads to difficulty in hearing conversational speech or loud sounds.
 Clients who are hard of hearing usually communicate through spoken language and can benefit from hearing
aids, captioning, and assistive listening devices.
 From an emic perspective, many deaf people see their bodies as well, whole, and non-impaired, and they self-
identify as members of a linguistic minority, not with the culture of disability.

This document is the property of PHINMA EDUCATION

 Decent Work Employment and Transcultural Nursing
Module #12 Student Activity Sheet

Name: _________________________________________________________ Class number: _______

Section: ____________ Schedule: ___________________________________ Date: _______________

o As members of a cultural minority, some deaf people perceive themselves as being on a journey of
cultural awareness, one of several stages on the way to achieving a positive sense of self and deaf
identity.
o On the other hand, others who are deaf advocate reframing the concept of a deaf culture and
conceptualizing it as the deaf experience based on values stemming from a visual orientation.
o Recognizing that literature and the arts provide forums for cultural awareness, appreciation, and
expression of ideas and feelings, there are a growing number of deaf people using these media to
communicate their experiences with one another and with hearing members of society.

 From an etic perspective, some physicians and other members of the hearing society embrace concepts about
deaf peoples’ bodies that emphasize their differences from the bodies of people in the hearing society, thereby
placing unwanted, unwarranted, and unnecessary limitations on deaf people’s lives and capabilities.
o In the biological sciences, for example, the bodies of hearing people historically have been constructed
with a normative bias. In other words, the body that hears is the normative prototype.
o Some physicians engage in the cultural imposition of medical and surgical interventions on members of
the deaf culture through eugenics (a science that tries to improve the human race by controlling which
people become parents), genetic engineering, and insistence that deaf people should use hearing aids,
agree to cochlear implant surgery, and embrace other technologies that profoundly change their lives and
their culture.

 In the US, an estimated 500,000 people communicate by using American Sign Language (ASL), including many
who are deaf and hearing impaired, and family members, friends, or teachers of people with hearing impairments.
o An ASL interpreter is often helpful in avoiding communication difficulty when caring for someone who is
deaf or hearing impaired. Signaling and assistive listening devices, alerting devices, telecommunication
devices for the deaf (TDD), and telephone amplifiers might also help promote effective communication
and facilitate the provision of culturally competent care in home, community, hospital, and other settings.

Communication and Language Assistance

 With growing concerns about racial, ethnic, and language disparities in health and health care and the need for
health care systems to accommodate increasingly diverse patient populations, language access services (LAS)
have become a matter of increasing national importance.

 By 2050, more than half the population will come from racial or ethnic minority backgrounds. Diversity is even
greater when dimensions such as geography, socioeconomic status, disability status, sexual orientation, and
gender identity are considered.

 Attention to these trends is critical for ensuring that health disparities narrow, rather than widen, in the future.

This document is the property of PHINMA EDUCATION

 Decent Work Employment and Transcultural Nursing
Module #12 Student Activity Sheet

Name: _________________________________________________________ Class number: _______

Section: ____________ Schedule: ___________________________________ Date: _______________

Check for Understanding

After studying the main lesson, you may now answer the following multiple choice questions and provide the rationale for
each item.

1. When a nurse from the Philippines leaves her home country in order to work in the United States of America, this is
an example of which of the following?
a. Immigrate
b. Emigrate
c. Work migration
d. Naturalization
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

2. Jose Dela Cruz who comes from Mexico currently enters the United States of America in order to legally settle and
work there. He is considered to be an
a. Immigrant
b. Emigrant
c. Alien
d. Illegal alien
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

3. A patient who is currently a student in the Middle East is seeking medical care in the Philippines but would want to
maintain that the food served would be Halal. This is a demonstration of which of the following?
a. Individual cultural competence
b. Organizational cultural competence
c. Cultural baggage
d. Cultural bias
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

4. Which of the following is NOT true regarding cultural self-assessment?

a. The purpose of the cultural self-assessment is for nurses to critically reflect on their own culturally based
attitudes, values, beliefs, and practices etc.
b. The nurse’s cultural self-assessment is a personal and professional journey that emphasizes strengths as
well as areas for continued growth, thereby enabling nurses to set goals for overcoming barriers to the
delivery of culturally congruent and competent nursing care.
c. Part of the cultural self-assessment process includes nurses’ awareness of their human tendencies toward
bias, ethnocentrism, cultural imposition, cultural stereotyping, prejudice, and discrimination.
d. The nurse is allowed to do unreasoned judgment about a person place or object.
Answer: ________

This document is the property of PHINMA EDUCATION

 Decent Work Employment and Transcultural Nursing
Module #12 Student Activity Sheet

Name: _________________________________________________________ Class number: _______

Section: ____________ Schedule: ___________________________________ Date: _______________

Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

5. A person who is Chinese wants acupuncture to be done on him instead of the medications that are currently
prescribed for him since he believes that acupuncture can provide him with more relief than drugs. This behavior is an
example of
a. Bias c. Racism
b. Ethnocentricism d. Cultural imposition
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

6. The nurse is bringing a newly admitted black patient to a shared hospital room. A male Caucasian who currently
occupies have of the room tells the nurse, “No. Please don’t room him in with me. I’d rather prefer non-colored people
to be with me in this room.” The Caucasian patient is demonstrating
a. Cultural bias c. Cultural imposition
b. Racism d. Ethnocentricism
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

7. A female patient in the psych ward tells the nurse that she doesn’t want to join the group activity since one of the
patients identifies herself as a lesbian. She is clearly displaying which of the following behaviors
a. Cultural stereotype c. Prejudice
b. Racism d. Cultural imposition
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

8. “Look at those Indian nurses, they all probably smell of curry,” says one of the Nurses at the ward. Her statement is
an example of
a. Cultural stereotype c. Prejudice
b. Cultural imposition d. Cultural bias
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

This document is the property of PHINMA EDUCATION

 Decent Work Employment and Transcultural Nursing
Module #12 Student Activity Sheet

Name: _________________________________________________________ Class number: _______

Section: ____________ Schedule: ___________________________________ Date: _______________

9. The hospital workplace has healthcare workers from various nationalities and races. We can say that the hospital has
a. Cross-culture c. People of color
b. Diversity d. Emic
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

10. The ability of a health worker to see the situation from the client’s point of view is known as
a. Emic c. Bias
b. Etic d. Cross cultural communication
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

C. LESSON WRAP-UP

Thinking about Learning

CAT 3-2-1

This strategy provides a structure for you to record your own comprehension and summarize your learning. Let us see
your progress in this chapter!

Three things you learned:

1. _______________________________________________________________________________________

2. _______________________________________________________________________________________

3. _______________________________________________________________________________________

Two things that you’d like to learn more about:

1. __________________________________________________________________________________________

2. __________________________________________________________________________________________

One question you still have:

1. __________________________________________________________________________________________

This document is the property of PHINMA EDUCATION