Week Three

Cultural Competence: Cultural Care

Chapter 2

Cultural Assessment, Mental Status, General Survey, Vital Signs Chapters 2, 5, & 9

Objectives
Demographic profile of United States National standards for Culturally & Linguistically Appropriate Services Background of Heritage Assessment Methods for conducting Heritage Assessment Traditional health & illness beliefs & practices Steps to cultural competence

Cultural Competency
Who are you meeting for the first time? Where does the patient come from? What is his or her heritage? What is his or her cultural background, ethnicity and religion? Does the patient understand, speak, and read English? What language does the pt understand, speak, and read? What are his or her health and illness beliefs and practices?

Demographic Profile of United States

Total Population > 300 million in 2006

1 out of 3 residents are in a group other than single-race, non-Hispanic white Minority or emerging majority populations total 98 million Hispanics: largest & fastest growing group Blacks: second largest population Asians, American Indians, Alaska natives, Native Hawaiians, & other Pacific Islanders make up the 3rd largest part of the population

Demographic Profile of United States (cont.)

Emerging majority groups:
Younger Lower median ages Higher proportions under 18 yo

Dominant, non-Hispanic, single-race, white population is:

Older median age Smaller proportion under 18 yo

Demographic Profile of United States (cont.)

One birth every 8 seconds One death every 13 seconds One international migrant (net) every 30 seconds Net gain of one person every 11 seconds

National Standards
National Standards for Culturally & Linguistically Appropriate Services in Health Care
First & Landmark care
Health care organizations should ensure that patients receive from all staff members effective, understandable & respectable care that is provided in a manner compatible with their cultural health & beliefs & practices & preferred language*
*Source: National Standards for Culturally and Linguistically Appropriate Services in heatlh Care, Final Report, March 2001. Washington DC: Office of Minorty Health, DHHS

National Standards for Culturally and Linguistically Appropriate Services in Health Care

Effective care: positive outcomes and satisfaction for patient; Respectful care: considers values, preferences, and expressed needs of patient; Cultural and linguistic competence: congruent behaviors, attitudes, and policies that come together in a system among professionals that enables work in cross-cultural situations.

Linguistic Competence
Title VI of Civil Rights Act of 1964:
Services cannot be denied to people of limited English proficiency 47 million Americans over 5 years of age speak a language other than English in their homes Language assistance in the health care settings is required by some states
CA, MA, NY

Cultural Competence
Culturally sensitive:
Possessing basic knowledge of and constructive attitudes toward diverse cultural populations

Culturally appropriate:
Applying underlying background knowledge necessary to provide the best possible health care

Culturally competent:
Understanding and attending to total context of a patients situation

Heritage
Culture Ethnicity Religion & Spirituality Socialization
Acculturation Assimilation Biculturalism

Time Orientation

Heritage (cont.)
Heritage consistency:
Degree to which a persons lifestyle reflects his or her traditional heritage

Heritage consistency continuum:

Traditional: living within norms of traditional culture Modern: accultrated to norms of dominant society

Heritage (cont.)
Culture: the thoughts, communications, actions, beliefs, values, and institutions of racial, ethnic, religious, or social groups.
Learned from birth Shared Adapted Dynamic

Heritage (cont.)
Ethnicity:
pertains to a social group within the social system that claims to possess variable traits
The Melting Pot

Heritage (cont.)
Religion:
the belief in a divine or superhuman power or powers to be obeyed and worshipped as the creator/ruler of the universe. **Plays a significant role in how people practice their health care. Spirituality- borne out of each persons unique life experience *Personal effort to find purpose & meaning in life

Heritage (cont.)
Socialization:
the process of being raised within a culture and acquiring the characteristics of that group.
Acculturation Assimilation Biculturalism

Concepts-Heritage
Time Orientation
Focus on the past
Traditions and ancestors play important role in persons life

Focus on the present

Little attention paid to past or future; concerned with now; future perceived as vague or unpredictable

Focus on the present

Progress and change highly valued; possible discontent with both past and present

Heritage Assessment
What are some indicators of heritage consistency?
Childhood occurred in country of origin or immigrant neighborhood of like ethnic groups Extended family support or traditional activities Frequent visits to old country/neighborhood Family home within ethnic community to which they belong Participation in ethnic cultural events Raised in extended family setting

Heritage (cont.)
Indicators continued:
Regular contact with extended family Educated in parochial school Social activities primarily with members of ethnic community Knowledge of language & culture of origin Expresses pride in heritage

Cultural Factors that Aid Understanding of Patients

Health beliefs and practices
How do they define illness? How is death expressed?

Cultural Factors that Aid Understanding of Patients

Health:
Balance of a person is a complex, interrelated phenomenon:
Within ones being: physical, mental, spiritual In outside world: natural, communal, metaphysical

Illness: Loss of a persons balance:

Within ones being: physical, mental, spiritual In outside world: natural, communal, metaphysical

Cultural Factors that Aid Understanding of Patients

Religious influences and special rituals
Is this a religious patient? Is there a significant person the patient goes to for guidance? Does this patient celebrate events? (communion) Health-Related behaviors affects by Religion

Developmental Cultural Care

Culture affects the decisions families make:
Presumed cause of illness First treatment tried Acceptability of treatments offered by clinicians

For older patients, culture is likely to:

Define their family responsibilities Affect their view & knowledge of health care systems used by dominant culture

Traditional Causes of Illness

Biomedical
Assumes cause & effect Views the body as a machine Life can be divided into parts Endorses germ theory

Naturalistic
Forces of nature must be kept in balance Embraces idea of opposing categories or forces
Yin and Yang, Hot and Cold

Traditional Causes of Illness (cont.)

Magicoreligious
Supernatural powers predominate in area of health & illness
Examples include voodoo, witchcraft, and faith healing

Healing & Culture

Patients may seek help from both HCP & folk or religious healers Hispanics & American Indians may believe that cure is incomplete unless healing of body, mind, & spirit are all carried out

Traditional causes of Illness (cont.)

Folk Healers
Hispanic: curandero, espiritualista, yerbo, or sabedor Black: Hougan, spiritualists, old lady American Indian: shaman, medicine man/woman Asian: herbalists, acupuncturists, bone setters Amish: braucher

Transcultural Expressions of Illness

Transcultural expression of pain
Expectations, manifestations, & management of pain are all embedded in a cultural context Highly personal experience

Transcultural Expressions of Illness (cont.)

Culture-bound Syndromes
Condition that is culturally defined
Some have no equivalent in a biomedical, scientific perspective Anorexia nervosa & bulimia are examples of cultural aspects of illness in dominant cultural population in North America

Transcultural Expressions of Illness (cont.)

Culture & treatment
Alternative/complementary interventions are gaining recognition from HCP in health care systems

Culture & disease prevalence

Disparity continues in deaths/illnesses experienced by racial and ethnic populations Abnormal biocultural variations may be genetic or acquired

Cultural Care
Dietary practices
Does the family like to eat? Are meals the center of family entertainment? How is food prepared? Are there periods requiring fasting?

Steps to Cultural Competence

Understand ones own heritage-based values, beliefs, attitudes & practices Identify meaning of health to patient Understand how health care system works Acquire knowledge about social backgrounds of patients Become familiar with languages, interpretive services & community resources available to you as the RN and the patient

Ways to Develop Cultural Competency & Sensitivity Demonstrate R.E.S.P.E.C.T

Realize & examine own cultural beliefs
Recognize cultural diversity exists Recognize that cultural definitions of health/illness differ Dont expect all members of a culture to behave the same

Examine pts within a cultural context

Respect the unfamiliar Be willing to modify care in keeping with patients culture

Ways to Develop Cultural Competency & Sensitivity Demonstrate R.E.S.P.E.C.T

Select simple questions and speak slowly Pace questioning throughout the exam Encourage patient to discuss meaning of health and illness with you Check patients understanding and acceptance of recommendations Touch patient within boundaries of his or her heritage

Review Questions
1. Before determining whether cultural practices are helpful, harmful, or neutral, nurses must first understand:
A) the logic of the traditional belief systems. B) the beliefs of the patients family. C) their personal belief models. D) the risk of disease in the patients ethnic group.

Review Questions
2. What symptom is greatly influenced by a persons cultural heritage? A) hearing loss B) pain C) breast lump D) food intolerance

Resources:
Jarvis, C. (2012). Physical examination and health assessment (6th ed.). Philadelphia: W. B. Saunders

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