Chapter 9 Potter and Perry

to gather significant information from the client that will enable the nurse to implement culturally congruent care

goal of cultural assessment

determine how much an individuals life patterns are consistent with his or her heritage (emic stance)

heritage consistency

Disease is what?

malfunctioning biological or psychological processes

herbs, chemicals, heat, cold, massage and surgery

naturalistic practitioner healing methods

attribute illness to natural, impersonal and biological forces that causes alteration in the equilibrium of the body.

naturalistic practitioners

supernatural, magical and religious beliefs along with massage, aromatherapy and herbs

personalistic practitioner healing methods

believe than an external agent which can be human (e.g. sorcerer) or nonhuman (e.g. ghosts, evil or deity) causes health and illness

personalistic practitioners

significant social markers of changes in a person's life

rites of passage

Oppression

system of advantages & disadvantages tied to our membership in social groups

Illness is what?

the way that individuals & families react to disease

a comparative study of cultures to understand similarities (culture universal) and differences (culture-specific) across human groups.

transcultural nursing

socioeconomic and immigration status, residential patterns, personal beliefs and political orientation

Secondary characteristics of Culture

Make up of household or family. The culturally expected roles of people e.g. in decision making and caregiving

Social Organization

represent various ethnic, religious, and other groups with distinct characteristics from the dominant culture (e.g Appalachian or Missouri Ozark cultures)

Subcultures

All cultures have past, present and future time dimensions. Not all respect hurried and businesslike communication

Time Orientation

easily seen

Visible aspects of culture

Mnemonics

- LEARN - RESPECT - ETHNIC - C-LARA

Patient Centered Care

- Landmark reports- Cultural competence & pt-centered care

Iceburg analogy is what?

- Most aspects of a person's world view are hidden - Conduct a cultural assessment

1. Cultural assessment

- cultural assessment model - open ended focused & contrasted Qs- explanatory model - trust

Culture

- norms, values, traditions- ethnicity, race, nationality, language- gender, sexual orientation, location, class, immigration status

8. Which explanation provided by the nurse is the most accurate meaning for "providing culturally congruent care"? 1. It fits the patient's valued life patterns and set of meanings. 2. It is the same set of values as those of the health care team member providing daily care. 3. It holds one's own way of life as superior to those of others. 4. It redirects the patient to a more socially expected set of values. 8. Which explanation provided by the nurse is the most accurate meaning for "providing culturally congruent care"? 1. It fits the patient's valued life patterns and set of meanings. 2. It is the same set of values as those of the health care team member providing daily care. 3. It holds one's own way of life as superior to those of others. 4. It redirects the patient to a more socially expected set of values.

1

During a nursing assessment a patient displayed several behaviors. Which behavior suggests the patient may have a health literacy problem? 1. Patient has difficulty completing a registration form at a medical office 2. Patient asks for written information about a health topic 3. Patient speaks Spanish as primary language 4. Patient states unfamiliarity with a newly ordered medicine

1

1. A nurse is seeing all of these patients in the community health clinic. The nurse identifies which patient(s) as having a health disparity? (Select all that apply.) 1. A patient who has a homosexual sexual preference 2. A patient unable to access primary care services 3. A patient living with chronic schizophrenia 4. A family who relies on public transportation 5. A patient who has a history of hypertension

1, 2, 3

9. Which statements made by a nursing student about the teach-back technique show understanding of the technique? (Select all that apply.) 1. "After teaching a patient how to use an inhaler, I need to use the teach-back technique to test my patient's ability to use the inhaler correctly." 2. "The teach-back technique is an ongoing process of asking patients for feedback." 3. "Using teach-back will help me identify explanations and communication strategies that my patients will most commonly understand." 4. "Using pictures, drawings, and models can enhance the effectiveness of the teach-back technique." 5. "When doing my patient teaching, I will use plain language to make the material easier to understand for the patient."

1, 2, 3, 4, 5

5. Health care agencies must provide which of the following based on federal civil rights laws? (Select all that apply.) 1. Provide language assistance services at all points of contact free of charge. 2. Provide auxiliary aids and services, such as interpreters, note takers, and computer-aided transcription services. 3. Use patients' family members to interpret difficult topics. 4. Ensure that interpreters are competent in medical terminology. 5. Provide language assistance to all patients who speak limited English or are deaf.

1, 2, 4, 5

A 35-year-old woman has Medicaid coverage for herself and two young children. She missed an appointment at the local health clinic to get an annual mammogram because she has no transportation. She gets the annual screening because her mother had breast cancer. Which of the following are social determinants of this woman's health? (Select all that apply.) 1. Medicaid insurance 2. Annual screening 3. Mother's history of breast cancer 4. Lack of transportation 5. Woman's age

1, 4, 5

Skills & Interventions

1. Cultural assessment 2. Mnemonics

Cultural Knowledge -- World Views

1. Emic 2. Etic - AVOID STEREOTYPING - TREAT PT - SEE EVERY PT ENCOUNTER AS A CROSS CULTURAL

10. Match the cultural concepts on the left with the correct definitions on the right. ____ 1. Etic worldview - a. Factor that shapes how people perceive others and how they relate to reality ____ 2. Worldview - b. Insider's perspective in an intercultural encounter ____ 3. Cultural desire - c. A policy model that describes factors and power structures that shape and influence life ____ 4. Intersectionality - d. An outsider's perspective in an intercultural encounter ____ 5. Emic worldview - e. The motivation of a health care professional to "want to" engage in cultural competence

1d, 2a, 3e, 4c, 5b

4. A nurse desires to communicate with a young woman who is Serbian and who has limited experience with being in a hospital. The nurse has 10 years of experience caring for Serbian women. The patient was admitted for a serious pregnancy complication. Apply the LEARN model and match the nurse's behaviors with each step of the model. _____1. L - a. The nurse notes that she has learned that fathers can visit mothers at any time in both Serbia and the United States. _____2. E - b. The nurse shares her perception of the woman's experiences as a patient. _____3. A - c. The nurse asks the patient how she can maintain bed rest when she returns home. _____4. R - d. The nurse attends to the patient and listens to her story about hospitals in Serbia. _____5. N - e. The nurse involves the patient in a discussion of the treatment options for her condition.

1d, 2b, 3a, 4e, 5c

6. A nurse working in a large occupational health clinic knows that many of the workers at her company are marginalized and at risk for poor health outcomes. Which of the following individuals are most likely to be marginalized? 1. Wives of the employees 2. The head supervisors of the company 3. Workers who have a high school education 4. Workers employed for less than a year at the company

3

7. A mother is concerned about her child's flulike symptoms. You learn from the health assessment that the mother practices the use of "hot" and "cold" foods to treat ailments. Which of the following foods do you expect the mother to use to treat her child? 1. Chicken 2. Yogurt 3. Fresh fruits 4. Eggs

4

old lady "granny midwife", spiritualist, voodoo practitioners (Hougan- male and Mambo- female)

African American- Healer

Ayurvedic practitioner

Asian Indians - Healer

results when an individual gradually adopts and incorporates the characteristics of the dominant culture

Assimilation

Cultural Awareness

Bias: predisposition to see people in a certain light (positive/negative) Becoming more self aware of your biases- attitudes about human behavior is the first step in providing pt-centered care

when an individual identifies equally with two or more cultures

Biculturalism (multiculturalism)

Distinct health risks are due to the ecological context of the culture (eg parasites). Some genetic disorders are linked with specific ethnic groups

Biocultural History

C.-L.A.R.A.

C.alm L.isten A.ffirm R.espond A.dd

Herbalist, acupuncturist, fortune teller, shaman

Chinese and Southeast Asians- Healer

No person regardless of race, color, or national origin, should be excluded from participation, denied benefits, or be subjected to discrimination under any program receiving federal funding

Civil Rights Act

the distinct linguistic and communication patterns of different cultural groups e.g. conflict avoidance, eye contact and distance

Communication Patterns

Social Determinants of Health

Conditions in which people are born, grow, live, work, and age-- all shaped by the distribution of money, power, resources @ global/national/local levels

when an individual rejects a new culture because the experience with the new or different culture is extremely negative

Cultural backlash

adapt or negotiate with others for a beneficial or satisfying health outcome

Cultural care accommodation or negotiation

retain and/or preserve relevant care values so that clients maintain their well-being, recover from illness, or face handicaps and/or death

Cultural care preservation or maintenance

Reorder, change or greatly modify clients' lifestyles for a new, different, and beneficial health care pattern

Cultural care repatterning or restructuring

(cont. Cultural Competency)Campinha-Bacote (AKSED)

Cultural: AKSED A.wareness K.nowledge S.kills E.ncounters D.esire

the ability of a nurse to bridge cultural gaps in caring, work with cultural differences, and enable clients and families achieve meaningful and supportive care

Culturally competent care

E.T.H.N.I.C.

E.xplanation T.reatment H.ealers N.egotiate I.ntervention C.ollaboration

a shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics.

Ethnicity

Ex: You are in the process of admitting an ethnically diverse patient. To plan culturally competent care, you will conduct a cultural assessment that includes: ____________

Ethnohistory

knowledge of a client's country of origin and its history and ecological contexts are significant to health care

Ethnohistory

Ex: Mrs. Tao not drinking water?

HOT & COLD THEORY =Balance between Yin & Yang -- needing to drink warm drinks

Curandero/a , Parteras-lay midwives, Yerbero- herbalist, Sabador- bonesetters, Espirista -spiritualist, Santero/a

Hispanic - Healer

Culture affects how an individual defines the meaning of ______________?

ILLNESS

less observable aspects of culture, often the major driving force behind visible practices

Invisible aspects of culture

Cultural Encounters

Involve a nurse directly interacting w/ pts from diverse bkgrounds - have potential for conflict bc of misunderstanding - enable new forms of community & collective identity - provide opportunity to show compassion

L.E.A.R.N.

L.isten E.xplain A.cknowledge R.ecommend N.egotiate

Cultural Desire

Motivation of HCP to "want to" not "have to" ENGAGE in the process of being CULTURALLY COMPETENT- Organizations are increasingly integrating cultural competence principles into practices

Linguistic competence, Health Literacy, Teach back

NEW CONCEPT: Health info, service info, change in management = Clinician explains new concept- Clinician asses pt recall/comprehension- Clinician clarifies & tailors explanation- Clinician reassess pt recall/comprehension- Pt recalls & comprehends = ADHERENCE

Shaman

Native Americans -Healer

Addressing health care disparities

New Standards:- focus on cultural competency, health literacy, patient-family centered care- recognize that valuing each patient's unique needs improves the overall safety & quality of care & helps eliminate health disparities

Health Disparity

Particular type of health difference that is closely linked with social, economic, environmental disadvantages

nationality, race, gender, age and religious beliefs

Primary characteristics of Culture

R.E.S.P.E.C.T.

R.apport E.mpathy S.upport P.artnership E.xplanations C.ultural competence T.rust

the common biological attributes shared by a group such as skin color or blood type

Race

1.Respect for and about the client 2.Concern for and about the client 3.Attention to details/in anticipation of client needs 4.Helping/assisting or facilitative acts 5.Active listening 6.Presence (being physically there) 7. Understanding 8. Connectedness 9. Protection (gender related) 10. Touching 11.Comfort measures

Recurrent Caring Constructs

How religion influence how you will provide care; special diets, certain banned medical interventions, holy days to observe and end of life care

Religious and Spiritual Beliefs

the process of adapting to and adopting a new culture

acculturation

Intersectionality

belonging simultaneously to multiple social groups

Culturally congruent care

care that fits a person's life patterns, values, system of meaning

Transcultural nursing

comparative study of cultures to understand their similarities & differences

a systematic and comprehensive examination of the cultural care values, beliefs, and practices of individuals, families and communities

cultural assessment

an in-depth self-examination of one's own background, recognizing biases and prejudices and assumptions about other people

cultural awareness

a process of development with 5 interlocking components; cultural awareness, knowledge, skill, encounters and desire

cultural competence

motivation to learn about other cultures

cultural desire

involve the engagement in cross-cultural interactions that provide learning of other cultures and opportunities for effective intercultural communication development

cultural encounters

using your own values and lifestyles as the absolute guide in dealing wtih clients and interpreting their behaviors

cultural imposition

obtaining sufficient comparative knowledge of diverse groups, including their indigenous values, health beliefs, care practices, worldview, and biocultural ecology

cultural knowledge

assessment of social, cultural and biophysical factors influencing treatment and care of clients

cultural skills

care that fits the person's valued life patterns and set of meanings (goal of transcultural nursing)

culturally congruent care

socially transmitted knowledge, behavioral patterns, values, beliefs, norms, and lifestyles of a particular group that guides their worldview and decision making

culture

the thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious or social groups.

culture (Office of Minority Health)

illnesses that are specific to one culture. Used to explain personal and social reactions of the culture's members.

culture-bound syndromes

insider or native perspective

emic worldview

Cultural Competency

enabling of health care providers to deliver services that are respectful to the health beliefs & cultural/linguistic needs of diverse patients

socialization into one's primary culture as a child

enculturation

a tendency to hold one's own way of life as superior to others. Source of bias and discriminatory behaviors

ethnocentrism

outsider perspective

etic worldview

Culturally competent organizations:

value diversity- conduct a cultural self-assessment- manage the dynamics of difference- institutionalize cultural knowledge- adapt to diversity Respect pt's health beliefs- Shifting a mode of understanding a pt's experience from a disease meaning in the pt's organ systems- Ability to elicit a pt's explanation of an illness & its causes- Ability to explain to a pt the HCP's perspective on the illness & its causes- Being able to negotiate a mutually agreeable, safe, effective TMT plan