Diversity

Family role and organization

-Head of household -Decision makers within the family -Roles of aged and extended family -Childbearing practices -Views toward alternative lifestyles Ask questions like Who makes most of the decisions in your family? What type of decisions do the females in your family make? What are the duties of the man/woman in your family? What should children do to make a good/bad impression for themselves and the family? What are the roles of older people in your family? What is the role of the extended family members of the household? Is it acceptable to you for people to have children out of wedlock? To live together and not be married? To admit being gay or lesbian?

Clinical Management

-Learn and use a few phrases of greeting in the patient's native language -Repeat important information more than once -Always give the reason or purpose for a treatment or prescription -Make sure the patient understands by having them explain it themselves -Teach patients their options and let them decide -Recognize personal information may be closely guarded and difficult to obtain -Use an interpreter. -Use National Standards for Culturally and Linguistically Appropriate Services (CLAS) -Reinforce verbal interaction with visual aids and materials written in the client's language -Be aware of personal biases and work toward eliminating them -Make sure same standards of care are followed for all patients regardless of cultural or ethnic background -Interpreters must be available in healthcare facilities -Ask Interpreter to repeat exactly what was said. -When speaking or listening, watch the patient, not the interpreter -Patient often requests to bring a specific interpreter to the clinic -In some cultures, it may not be appropriate to suggest making -a will for dying patients as this is equivalent to wishing death on a patient

What is a healthcare disparity?

A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage Health care disparities are things that make someone at a disadvantage for receiving the same standard of care as someone else (of a different socio, economic, racial group) with the same problem Health equity Achieved when every person has the opportunity to attain his or her health potential and no one is disadvantaged

Who is more susceptible to disease?

¬African Americans have a higher incidence of hypertension and sickle cell disease ¬Caucasians have a higher incidence (almost exclusive) of Cystic fibrosis ¬Native Americans have a higher incidence of Diabetes

What is the C in RESPECT?

Cultural Competence: Respect the patient and his or her culture and beliefs Understand that the patient's view of you may be identified by ethnic or cultural stereotypes Be aware of your own biases and preconceptions Know your limitations in addressing medical issues across cultures Understand your personal style and recognize when it may not be working with a given patient

Ageism

Discrimination against older adults

What is the E in RESPECT?

Empathy: Remember that the patient has come to you for help Seek out and understand the patient's rationale for his or her behaviors or illness Verbally acknowledge and legitimize the patient's feelings

Factors affecting diversity

¬Age ¬Gender ¬Race ¬Class ¬Homeless ¬Poverty ¬Undocumented immigrant ¬Sexual Orientation

What is the E (second E) in RESPECT:

Explanations: Check often for understanding Use verbal clarification techniques

RESPECT Model

The RESPECT Model of cross-cultural communication Use the RESPECT model as a guide to conduct an assessment of sociocultural contexts of people's health care needs

Antecedents to Diversity

Individual differences and similarities in: ¬Age ¬Religious/spiritual ¬Ethnic/Race ¬Cultural ¬Sexual Orientation ¬Education ¬Life Experiences

Gender- Transgender

Individuals who do not identify with the gender assigned to their body * Do not ask why they transitioned.

What are the effects of Poverty?

Many families with adequate shelter live in poverty. Patients may not get health care because they cannot pay for it or because of the costs associated with travel for health care. • Refugee or undocumented immigrant status may deter some patients from using the health care system. • Immigrant women who are heads of households or single mothers may not seek health care for themselves because of child care costs. • Patients may lack health insurance.

Human trafficking:

Modern day slavery Exploitation of men, women and children for forced labor or sex by a third party for profit or gain Estimated 40.3 million victims globally Affects all demographics but one common factor is vulnerability Victims can be found anywhere- any age, race, nationality, gender, or socioeconomic status May not self-identify May be runaway children May decline help or be uncooperative with law enforcement

Undocumented Immigrants contd.

Often receive healthcare information from TV, internet, friends, family which can lead to misinformation and improper treatment It depends on the state whether it is required to present proof of citizenship when providing care. Some states require reporting of undocumented people Ethically, nurse has to deliver same high-quality care to all patients Use of an interpreter or interpreter system is required if non-English speaking Nurses should maximize each opportunity to care for and teach self-care to these individuals

Healthy People 2030

Overarching goal is to "eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all."

What is the P in RESPECT?

Partnership: Be flexible with regard to issues of control Negotiate roles when necessary Stress that you will be working together to address medical problems

Implementation

Promote safety, nutrition, and mobility. Safety - patients who don't understand may not adhere to your instructions for safety including using call light and getting out of bed. Family members may bring comfort foods from home that might interfere with fluid or diet restrictions. Some might complement patients care with traditional healing remedies that may interact with medications. Nutrition - many ethnic foods may not be available in the hospital. Many cultures see food as a way to provide comfort. Some patients may not eat hospital food because it is foreign or taboo. Jewish may not eat it because it isn't prepared and served in a kosher manner. Vietnamese may ignore western diet recommendations if they follow traditional cultural practices regarding certain foods during illness. Mobility - many believe the sick must remain in bed with little physical activity. This may cause conflict with nurses trying to promote activity to prevent skin integrity breakdown, clots, etc. Nurse must educate about these things

What is the R in RESPECT?

Rapport: Connect on a social level Seek the patient's point of view Consciously attempt to suspend judgment Recognize and avoid making assumptions

Hispanic Traditions -contd.

Since pregnancy is seen as normal, many may not seek prenatal care Since mother is preferred birthing partner, it is important to include her in patient teaching because she may have most say in day-to-day care of the infant Birth is thought to deplete body of heat. Restoring warmth is important. Offer liquids other than ice water which may be seen as too cold. Colostrum is viewed as bad so may choose to delay breastfeeding for first few days. Be sure to educate on the health benefits of colostrum. oAsk about patient's family and interests before focusing on health issues as this will generally increase rapport and trust oTypically have a present time orientation which may impede preventive medicine and follow up care oPatients in pain may tend to be expressive (loud) when in pain oLarge numbers of family members may visit the patient as a way of expressing love and concern. oModesty is important particularly among older women oMore traditional wives may defer to husbands to make decisions Allow family members to spend as much time as possible with the patient. Try to keep them covered whenever possible.

What is the S in RESPECT?

Support: Ask about and try to understand barriers to care and compliance Help the patient overcome barriers Involve family members if appropriate Reassure the patient you are and will be available to help

What is the T in RESPECT?

Trust: Self-disclosure may be an issue for some patients who are not accustomed to Western medical approaches Take the necessary time and consciously work to establish trust

Cultural Assessment

Use the RESPECT model to assess sociocultural contexts of people's health care needs Conduct a health history including religion, diet, language, educational background, health care beliefs, and family support Conduct a spiritual assessment: Spirit-enhancing practices or rituals Experience of God or Transcendence Sense of meaning Giving and receiving love, or connectedness to self and others Sources of hope and strength Link between spirituality and health

Islam/Muslim traditions

¬Abortion is forbidden after 4 months. It is allowed prior to that only when the mother's life is in danger or in cases of rape. ¬Attempts to shorten life are prohibited ¬Maintaining life for a prolonged time through life support is not encouraged ¬Organ donation is acceptable ¬Autopsies are permitted for medical and legal purposes only (because will delay burial) ¬Cremation is forbidden. Body should be washed by a same-sex Muslim at the time of death and burial should occur within 24 hours

Factors related to health disparity:

¬Access to transportation ¬Accessibility to healthcare ¬Health insurance ¬Religion ¬Geographic location ¬Sensory deficits ¬Physical disabilities ¬Mental Health ¬Cognitive disabilities ¬Socioeconomic status ¬Race ¬Ethnicity

What is Religious variations?

¬A set of doctrines accepted by a group of people who gather together regularly to worship ¬God or a higher power than their spiritual being ¬Plays a greater role in some communities than others

What is core measures?

¬A set of evidence-based, scientifically researched standards of care. Key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs. Not only do core measures improve the standard of care, they are meant to reduce health disparities

Spirituality

¬An intuitive, interpersonal, altruistic, and integrative expression that is contingent upon the nurse's awareness of the transcendent dimension of life but that reflects the patient's reality ¬Refers to a person's effort to find purpose and meaning in life. It relates to the soul and spirit more than the body. It is unique to each person but is universal. ¬Depends on a person's culture, development, life experiences, beliefs, and ideas about life. ¬Joint Commission requires all health care facilities to address patients' spiritual needs ¬Chaplain is part of the health care team. ¬Spiritual care helps people identify meaning and purpose in life, to look beyond the present, and maintain personal relations as well as a relationship with a higher being or life force

Using an Interpreter :

¬Any facility that receives funding from DHHS is required to communicate effectively with patients or risk losing funding ¬Bilingual nurses ¬Access to language banks through electronic or telephone systems that nurses can dial for interpreter services (Blue phones and Iphones) ¬When possible, use an interpreter to translate and provide meaning behind the words ¬To protect patient confidentiality and to guard against the possibility of the interpreter misunderstanding medical information, avoid using a family member as an interpreter ¬Use an interpreter of the same gender as the patient if possible ¬Address your questions to the patient, not the interpreter, but maintain eye contact with both the patient and the interpreter

What to avoid/do when using an interpreter?

¬Avoid using metaphors, medical jargon, similes ¬Observe the patient's nonverbal communication ¬Plan what to say and avoid rephrasing or hesitating ¬Use short questions and comments. Ask one question at a time ¬Speak slowly and distinctly but not loudly ¬Provide written materials in the patient's language as available

How to learn cultural competence: (having cultural sensitivity is an on going practice)

¬Begin by developing cultural awareness and how culture shapes beliefs, values, and norms ¬Develop cultural knowledge about the differences, similarities, and inequalities in experience and practice among various societies ¬Develop cultural understanding of problems and issues facing societies and cultures when values, beliefs, and behaviors are compromised by another culture ¬Develop cultural sensitivity to the cultural beliefs, values, and behaviors of their patients ¬Develop cultural competence and provide care that respects the cultural values, beliefs and behaviors of their patients ¬Nurses practice lifelong learning through ongoing education and exposure to cultural groups

What is Transgender?

¬Biological gender needs to be established so that the client receives appropriate screening and testing ¬CDC guidelines state nurses should ask about 5P's ¬Sexual Partners ¬Sexual Practices- Do they practice safe sex ¬Protection methods from infection (HIV, etc.) ¬Past history of infection ¬Prevention of pregnancy

Age in diversity (children and adults) :

¬Children and older adults are considered vulnerable populations ¬Both often depend on others for: ¬Nutrition ¬Healthcare ¬Transportation ¬Personal safety ¬Large disparities in income of men over 65 vs women over 65 ¬Many older adults live in poverty

What is classism?

¬Classism- oppression of groups of people based on their socioeconomic status ¬Homeless ¬Poverty ¬Undocumented Immigrants

Planning:

¬Collaborate with the patient to increase likelihood of patient following care plan. ¬Collaborate with patient and family to provide safe, effective care

What does human trafficking look like?

¬Commonly seek health care for STI, pregnancy testing, abortion procedures ¬Often not allowed to seek healthcare until symptoms are severe

Jehova's Witness

¬Do not vote or serve in the military. Do not celebrate traditional Christian holidays or birthdays and do not use the symbol of the cross ¬Believe life is sacred and that reasonable efforts should be made to sustain it, but don't believe in taking extraordinary measures if it would merely prolong life with no quality ¬Organ donation is an individual decision. However, all blood must be removed beforehand. ¬An autopsy is acceptable if required by law, however, they prefer to avoid it ¬Burial or cremation is accepted.

Attributes of Diversity

¬Enculturation ¬Acculturation ¬Biculturalism ¬Application Enculturation: Process by which a person learns norms, values, and behaviors of another culture Example: A high school student from the United States spends a summer abroad with a family in Switzerland Acculturation: Process of acquiring new attitudes, role, customs, or behaviors Example: An immigrant from China develops a preference for Western foods and music Biculturalism: Dual pattern of identification Example: A woman of Christian faith married to a Muslim adopts some Muslim practices and also maintains some traditional Christian practices Application: Use of diversity implications when interacting/educating/providing care

Hispanic Traditions- Misc

¬Families may choose to shield a family member diagnosed as terminal from that fact. ¬Families of terminal patients may be reluctant to remove life support as they may think it encourages death. ¬Illness is often seen as a result of an upset in body balance ¬Fat is seen as healthy. ¬Ask about remedies the patient has used before coming in. Ask patients before the need to know arises, how much information they want to know regarding their condition and to whom the information should be given. Hospice may be resisted as they fear it will emphasize their loved one is dying and encourage the patitne to give up hope. If illness is deemed punishment by God, life support may be considered as interfering with the opportunity for the patient to redeem his or her sins through suffering. Traditional respect and courtesy towards physicians may cause family to agree to it even though they oppose it. Say things like "I know that some people have serious concerns about removing life support. Do you share those concerns? May we talk about them?" Patients may refuse certain foods or medications if they believe they will upset the hot/cold body balance. Offer alternative foods and liquids. Ask if they prefer water with ice or at room temperature. Caution about Mexican foods being high in fat and salt. Offer nutritional counseling to individuals with hypertension or heart disease. Suggest "heart healthy" Mexican cookbooks Ask about remedies in a way that implies all of your patients attempt self-treatment before coming in so that you can prevent something that interacts negatively with that. Do not make your patient feel criticized for trying home remedies or seeing other healers. Doing so might lessen patients trust in you.

What is poverty and who is more likely at risk?

¬Females and those living in female-headed households are at greatest risk of poverty ¬28.2% women ¬14.9% male headed households ¬5.4% married couples ¬Median income $56,516 ¬Children of African American identity are more likely to live in poverty than their white counterparts

Islam/Muslim Traditions

¬Food should be halal (permissible under Islamic law). Pork and Alcohol are prohibited ¬During month of Ramadan, Muslims fast from sunrise to sunset. ¬Prayers and reading from the Koran are used for healing. ¬Right hand is used for eating. Left hand used for toileting and hygiene. ¬Muslim women may wish to only be examined by female providers and may insist on always covering their body ¬Muslims are supposed to pray 5 times a day while facing Mecca (east). Supposed to pray 5 times a day while facing Mecca (east) Islamic law considers the method of slaughter Fasting may be postponed during illness, but many may wish to fast anyway so medications bay need to be adjusted. Use same sex providers and provide modest gowns or let them wear their own If possible, make sure their bed faces east. This may prevent them from getting on the floor to pray. They may use prayer beads to help count recitations.

What are the exemplars for diversity?

¬Hispanic Traditions- Maternity with Complementary/Alternative Medicine ¬Jehovah's Witness - Blood Products, Pediatrics ¬Traditional Islamic - Ritual Dying Patient ¬Spirituality including Spiritual Distress ¬Race, Gender, Sexual Orientation, Age, Education, Abilities and Life Experiences

What is Race ?

¬Historically defined by physical attributes linked to continents of origin ¬Variations in skin color and hair texture have traditionally been used as markers of race

What is Biases?

¬Homophobia-fear, hatred, or mistrust of gays and lesbians expressed in discrimination ¬Heterosexism- view of heterosexuality as the only correct sexual orientation

What are other things to consider?

¬Hygiene ¬Nutrition ¬Skeletal and growth and development differences ¬Social organization Cleanliness practices- is body odor disguised, ignored, enhanced. Hairstyles and grooming practices Nutrition - food preferences can be an indicator of or cause of disease. Cooking techniques may vary. Social patterns around eating and food choices •Meaning of food •Access to food •Dietary food choices •Ritualistic food observations •Taboos •Food usage during illness and health promotion *Skeletal - small framed American women of European descent are at greater risk for osteoporosis. Pubertal developmental changes occur at different times Social organization - roles of older adults and respect given them vary. Who is recognized as the head of household and gender roles also exist Work and recreational patterns and norms vary. Role of adult children and caretaking expectations also vary among groups Patients may not make or keep appointments because of the time lag between the onset of an illness and an available appointment. • Hours of operation of health care facilities may not accommodate patients' need to work or use public transportation. • Requirements to access some types of care may discourage some patients from taking the steps to qualify for health care or health care payment assistance. • Some patients have a general distrust of HCPs and health care systems. • Lack of ethnic-specific health care programs may deter some individuals from seeking health care. • Transportation may be a problem for patients who have to travel long distances for health care. • Adequate interpreter services may be unavailable. • Patients may not have a primary HCP and may use emergency departments or urgent care centers for health care. • Shortages of HCPs from specific ethnic groups may deter some people from seeking health care. • Patients may lack knowledge about the availability of existing health care resources. • Facility policies may not be culturally competent (e.g., hospital policy may limit the number of visitors, which is problematic for cultures that value having many family members present). members present).

Cultural barriers

¬Importance, or lack of importance of family members involvement in managing illness ¬Lack of trust in the healthcare system and providers ¬Belief that illnesses are not linked to scientific pathophysiology ¬Refusal of modern healthcare providers to believe the mind-body connection ¬Fear or denial of death or life after death ¬Cultural assumptions about disease and illness that may influence the presentation of symptoms or the response to treatments Many cultures won't continue treatment once they begin feeling well. Showing a nonjudgmental attitude of respect can help to reduce a patient's discomfort and promote trust. Common defense mechanisms like anger, avoidance, denial, intellectualization or projection may be used when an individual feels threatened.

What should nurse do about human trafficking?

¬Important for nurses to recognize patient signs or symptoms that may indicate trafficking ¬Provide safe nonthreatening care ¬Never confront trafficker directly - for both your safety and the patient's safety ¬Always demonstrate patience. Most trafficked persons don't identify themselves as such ¬Ellicit trust. Provide with information and options

Recommendations to decrease Healthcare Disparities

¬Increase awareness of disparities among public, healthcare providers, insurance companies, and policy makers ¬More diverse healthcare providers are needed in underserved communities ¬More interpreters needed in clinics and hospitals to improve equality of care

Gender- Non-traditional

¬Intersex - individual born with reproductive or sexual anatomy that does not seem to fit the typical definitions of male or female

Skin color:

¬Labeling of people based on their skin color should be avoided ¬Explore ethnic variations and do not make assumptions based on skin color ¬Skin assessment ¬Darker skin requires closer inspection and enhance lighting to observe changes ¬African Americans and Native Americans have a lower incidence of skin cancer due to higher levels of melanin (Skin assessment example when assessing for changes in oxygenation, erythema and cyanosis are subtle and palpation and lighting will need to be used for skin assessment)

Gender- Traditional

¬Male ¬Female Adult women use health care services more than men. Women may not receive the same quality of care. (Women are less likely than men to receive procedures). Add race to that and it intensifies

Minimum standard of care for Human Trafficking

¬Promote a safe environment which includes not further endangering the patient ¬Set appropriate boundaries in all situations ¬Remember the nurse-client relationship ¬It may be most helpful to the victim to provide information as to how they can access help at a later time if they so choose ¬Meet the patient's medical and physical needs ¬Never confront the trafficker directly - for both your safety and the patient's safety ¬Always demonstrate patience. Most trafficked persons do not identify themselves as such. ¬Elicit trust. Provide with information and options. ¬Texas Law requires reporting of child abuse and neglect. Recognize patient signs and/or symptoms that may be indicative of trafficking

Hispanic Traditions- Pediatric

¬Many folk diseases affect children ¬Mal de ojo (Evil eye) ¬Caida de la mollera (fallen fontanelle) ¬Empacho (stomach pain) ¬Herbal remedies are often used ¬Chamomile tea - used to treat colic (safe and sometimes helpful) ¬Greta - yellow to greyish yellow powder used to treat empacho (contains lead and can be dangerous!) ¬Azarcon - Bright reddish-orange powder used to treat empacho (Also can contain lead and can be dangerous!) ¬A chubby baby is seen as a healthy baby ¬Febrile baby will often be bundled up ¬Belly button binders may be used to prevent an "outie" Evil eye is believed to be caused by envy when someone compliments a child. Be sure to touch the child when complimenting him or her to prevent this. The child may be wearing a red string or deer's eye ( a large brown seed with string) to prevent this. Educate parents of chubby or overweight babies about appropriate diet and health risks of obesity (diabetes) Keeping a baby bundled up when they have a fever is counter intuitive to cooling measures. Be sure to explain the rationale without disrespecting beliefs. Make sure the coin being used for belly button binder is clean and not to tight instead of advising caregivers not to use a binder. Educate them on need for cleanliness and binder not being too tight.

What is communication?

¬Meaning of words can differ among various groups of people and misunderstandings from lack of common communication can occur ¬Misunderstanding of nonverbal communication ¬Eye contact Patients may not speak English and may not be able to communicate with HCP. • Even with interpreters, communication may be difficult. Things to consider •Willingness to share •Voice volume, tone •Spatial distancing •Eye contact •Facial expressions Direct eye contact may show disrespect in some cultures and be a sign of interest and active listening in others Nodding head up and down may not reflect agreement but instead respect for authority

What is Gender Differences?

¬Men typically less verbal and more action oriented than women ¬Men tend to have stronger skills in logic, mathematics and coordination ¬Women tend to be more skilled in languages, perceiving and responding to others needs and the arts ¬Access to and control over resources and decision-making power in the family and community ¬Be careful not to stereotype- These are just general tendencies and are not always the case ¬Stereotyping - overgeneralization of group characteristics that reinforce societal biases and distort general characteristics ¬Bias - favoring a group or individual over another ¬Sexism- occurs when male values, beliefs, or activities are preferred over female or vice versa ¬Prejudices- prejudgments about cultural groups or vulnerable populations that are unfavorable or false because they have been formed without the background knowledge and context on which to base an accurate opinion Health promotion and disease prevention and treatment need to address gender differences Men and women experience differences in symptom presentation too For example, myocardial infarction What may be seen as sexism in one culture may not be in another. Wearing of a hijab or head scarf is an example. In some regions of the world it is required for women to wear. In others, it is a personal choice. Some women find this empowering because their bodies cannot be sexualized. Many cultures prefer to have a woman's husband or father make healthcare decisions. For example, a woman might have an abscessed tooth, but the elder would determine if she needed to have it distracted or not.

Religion

¬More formal and organized beliefs including worshipping God or God's ¬Religious beliefs include cause, nature, and purpose of the universe including prayer and rituals ¬Religious care helps patients maintain faithfulness to their belief system and worship practices

Undocumented Immigrants

¬Often do not seek healthcare until condition becomes critical ¬Uninsured ¬Do not speak English ¬Unsure of culture of their new homeland ¬Belief that accessing healthcare will result in legal consequences and possible deportation ¬Concerns ¬Lack of preventive care (pregnant women might not get adequate care) ¬Inadequate immunizations ¬Lack of past medical records ¬Lack of border screening (increased risk of Tb and HIV)

What are the affects of homelessness?

¬Often live in dangerous, unsanitary conditions ¬Have diets severely lacking in nutrients ¬Very few resources for coping with illness ¬Must find food and shelter every day and cannot predict what the next day will be ¬Have difficulty obtaining, keeping, and storing medications ¬High instance of substance abuse and mental illness limits ability to provide self-care (can cause depression) Most homeless individuals avoid health care Prone to cardiovascular disease, hypertension, diabetes mellitus, high cholesterol, and infections HCP should limit the number of visits needed

Time- Is time is money in some cultures ?

¬Past-oriented cultures value tradition ¬May not be receptive to new procedures or traditions ¬Present-oriented cultures focus on the here and now ¬May not be receptive to preventive healthcare measures ¬Value of time ¬Some may not emphasize being on time for appointments For some cultures it is more important to attend to a social role than to arrive on time for an appointment with HCP. • Some cultures are future oriented(very punctual, focused on goal setting and working diligently to achieve goals, may delay rewards until a future goal is achieved); others are past ( highly focused on tradition, live in the glory days) or present oriented (focused on what's happening now rather than appointments, etc- generally don't adhere to a strict time structure).

Evaluation

¬Patient expresses cultural needs were met ¬Patient is able to verbalize understanding of medical diagnosis and treatment plan ¬Patient is able to collaborate with the care team when using complementary therapies ¬Patient is able to meet nutritional needs

What is Personal Space? (back,back,back,back, give me 50 feet)

¬Personal space defined by culture ¬Comfort may result from honoring the boundaries of personal space ¬Anxiety may occur if boundaries are not followed ¬Practices regarding ¬Proximity to others' ¬Body movements ¬Touch

Hispanic Traditions

¬Pregnancy is seen as a normal condition ¬The woman's mother may be the preferred birthing partner ¬Laboring women may be vocally expressive or very stoic ¬New mothers avoid cold, bathing and exercise for 6 weeks postpartum ¬Pregnancy is considered a "hot" condition ¬Colostrum may be seen as bad or spoiled milk and thus harmful to the baby

What is Racism?

¬Racism-the oppression of a group of people based on perceived race ¬Overt acts of hostility ¬Insidious policies, procedures, traditions, and rules that benefit one group of people over another Racial profiling Not providing translation services or not offering expensive diagnostic or treatment modalities based on race

Vulnerable populations

¬Refers to groups of people in our culture who are at greater risk for diseases and reduced lifespan due to lack or resources and exposure to more risk factors ¬Poverty is a major factor ¬Risk for Malnutrition, poor housing, violence, limited or no access to healthcare ¬Other risk factors are age, disability, health/disease state, education status, languages spoken, and socioeconomic status ¬Most vulnerable are those households with the fewest choices and greatest number of disabling factors

What is class?

¬Socioeconomic variations that contribute to a societal hierarchy based on money and access to resources

What is Diversity?

¬The sum total of the way of living; includes values, beliefs, standards, language, thinking patterns, behavioral norms, communication styles, etc. ¬Guides decisions and actions of a group through time

What is Sexual Orientation?

¬Those who have a strong preference for a partner of the same sex to those who strongly prefer someone of the opposite sex ¬Homosexual- prefer intimate relationship with the same sex ¬Heterosexual - prefer intimate relationship with opposite sex ¬Lesbian- describes a woman who prefers intimate relationship with other women ¬Gay - may refer to homosexual women or men but typically describes a male ¬LGBTQ - Lesbian, gay, bisexual, transgender, queer/questioning LGBTQ community is at a greater risk for healthcare disparities due to fear of discrimination and stigma- greatest risk is for obesity, mental health issues, substance abuse, violence Lack of healthcare providers with knowledge about providing care results in refusal of care due to gender status.

Jehova's Witness

¬Tobacco is forbidden; Moderate alcohol allowed ¬No meat from animals unless blood has been properly drained ¬Do not believe in blood transfusions. Adhere to New Testament command to abstain from blood ¬Accept medical and surgical treatment other than blood transfusions ¬Non-blood expanders are acceptable and alternatives to blood transfusions may be requested ¬Autologous blood donations are not acceptable ¬Medications are accepted unless derived from blood products ¬Believe life begins at conception and are opposed to abortion

How to develop cultural competence:

¬Value diversity ¬Have a capacity for cultural self-assessment ¬Awareness of the different dynamics present when cultures interact ¬Knowledge about different cultures ¬Adaptability in providing nursing care that reflects understanding of cultural diversity Cultural competence is the ability to apply the knowledge and skills needed to provide high-quality, evidence based care to patients of diverse backgrounds and beliefs to overcome barriers and access resources to promote health and wellness. Culture is a particularly important part of providing person-centered care. Culture is learned within the family unit, generation and or other social organizations. Cultural norms influence how people make decisions about treatment preferences, medication adherence, self-care, and perceptions of illness, which affects nursing care and healthcare delivery. The more we know about different cultures, the more patient specific our care will become.

Questions to ask during your assessment:

¬What language do you speak? Do you speak any English? ¬How long have you lived here? ¬Describe the illness that brings you here today. ¬What do you think caused your problem? ¬When did it start? ¬Why do you think it started when it did? ¬What does your sickness do to you? ¬What helps make it better? Worse? ¬What kind of treatment do you think that you need? ¬Are there any religious practices we need to know? ¬Who is your family? Who makes decisions most of the time? ¬Who do you go to for help when you need it? Make sure you assess for use of complementary therapies (things not considered traditional). Alternative therapies are those used instead of conventional therapies.