Cultural Competence - Chapter 21

What is the LEARN model?

Listen to the patient's perception of the problem -be nonjudgmental and use encouraging comments Explain your perception of the problem Acknowledge and discuss differences/similarities Recommend treatment -must involve the patient Negotiate treatment -incorporate preferences of the patients culture

What are the National Culturally and Linguistically Appropriate Services (CLAS) Standards?

a blueprint to help individuals and health care organizations implement culturally and linguistically appropriate services

What is oppression?

a formal and informal system of advantages and disadvantages tied to membership in social groups

What is disease?

a malfunctioning of biological or psychological processes

What is a health disparity?

a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage

What is cultural encounter?

a process that encourages health care professionals to directly engage in face to face cultural interactions and other types of encounters with patients from culturally diverse backgrounds aims to modify a health care providers existing beliefs about a cultural group and to prevent possible stereotyping

What does racial identity refer to?

a sense of group or collective identity based on ones perception that she or he shares a common heritage with a particular racial group

What is the iceberg analogy?

a tool that helps you visualize the visible and invisible aspects of your own world views

What are examples of social determinants of health?

age race & ethnicity socioeconomic status access to nutritious food transportation resources religion sexual orientation level of education literacy level disability (physical & cognitive) geographical location

How should you use the teach back method?

ask open ended questions -what will you tell your partner about the changes we made to your medication today -i have given you a lot of info. please explain it to me so that i can be sure that the info i have given you is what you want and need to take good care of yourself

What is illness?

the way that individuals and families react to disease

What is cultural competence?

to provide appropriate culturally sensitive care related to the clients beliefs and practices.

Cold treatments

(Foods) barley water, chicken, dairy products, fresh veggies, fruits, honey (Medicines and herbs) bicarbonate of soda, milk of magnesia, sage

Hot treatments

(Foods) beef, cereals, chili peppers, chocolate, eggs, liquor, onions (Medicines and herbs) anise, aspirin, castor oil, cinnamon, garlic, ginger root, iron, penicillin

What are the seven sets that core measures are found in?

-Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), and Primary Care -Cardiology -Gastroenterology -HIV and Hepatitis C -Medical Oncology -Obstetrics and Gynecology -Orthopedics

What are assessment tools to determine the level of a patients health literacy?

-Short Assessment of Health Literacy-Spanish and English (SAHL-S&E) -Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) seven item word recognition test

Cultural Assessment Guide: Aspects of Understanding Sources of Support Beyond the Family

-are there ethnic organizations that may influence the patients approach to health care -are there individuals in the patients social network that influence perception of health and illness -is there a particular cultural group with which the patient identifies

Working with interpretors

-ensure they are competent in medical terminology and understand issues of confidentiality and impartiality -do not use patients family members as interpreters -if an interpreter is not available, phone service -speak in first person (do not say tell her/him) -speak directly to the patient -have the interpreter sit next to or slightly behind the patient -speak in short sentences -avoid using jargon, acronyms, and jokes -ask the patient for feedback and clarification at regular intervals -be observant -thank the patient and interpreter at the end

Cultural Assessment Guide: Aspects of Understanding Health Beliefs and Practices

-how does the patient define health and illness -how are feelings concerning pain, fatigue, and illness in general expressed -are particular methods used for treatment of illness -what is the attitude towards preventative health measures such as immunizations -are there restrictions imposed by modesty that must be respected -what are attitudes toward mental illness, pain, chronic disease, being handicapped, and death and dying -is there a person in the family responsible for health related decisions -does the patient prefer a health professional of the same gender, age, and ethnic and racial background

Cultural Assessment Guide: Aspects of Understanding Faith Based Influences and Special Rituals

-is there a religion or faith to which the patient adheres -is there a significant person to whom the patient looks for guidance -what events, rituals, and ceremonies are important within the life cycle of birth, puberty, marriage, and death

What are things that all health care organizations must provide regarding language assistance?

-language assistance resources (trained medical interpreters, translators, telecommunication devices for the deaf) for individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services -Inform all individuals of available language assistance services clearly and in their preferred language verbally and in writing -Ensure the competence of individuals providing language assistance (do not use untrained interpreters or translators) -Provide easy to understand print and multimedia materials and signage in the languages commonly used by populations in the service area

What are tips to consider when using the teach back method?

-plan your approach -use handouts, pictures, and models to reinforce -chunk and check (throughout teaching) -clarify and check again -start slowly and use teach back consistently -use the show me method -clarify

What are basic questions that can help you explore a patients culture when beginning a cultural assessment?

-what do you call your problem? -what do you think caused it? -why do you think it started when it did? -what does your sickness do to you? -how long do you think it will last? -what benefit will you get from the treatment? (open ended responses)

Cultural Assessment Guide: Aspects of Understanding Dietary Practices

-what does the family like to eat -does everyone in the family have similar tastes in food -who is responsible for food prep -are any foods forbidden by the culture -are some foods a cultural requirement in observance of a rite or ceremony -how is food prepared and eaten -are there periods of required fasting

Cultural Assessment Guide: Aspects of Understanding Language and Communication

-what language is spoken in the home -how well does the patient understand spoken and written English -are there special signs of demonstrating respect or disrespect -is touch an acceptable form of communication

Cultural Assessment Guide: Aspects of Understanding Parenting Styles and Family Roles

-who makes the decisions in the family -what is the composition of the family -how many generations are considered to be a single family -what is the role of and attitude toward children in the family -when do children need to be disciplined or punished and how is this done -do family members show physical affection toward each other and their children -what major events are important to the family and how do they celebrate

What are the two phases of stereotyping?

1. activation of a stereotype when an individual is categorized into a social group 2. people use these activated beliefs and feelings when they interact with the individual

What are the two goals of a cultural encounter?

1. communicate in a way that generates a variety of responses and to send and receive both verbal and nonverbal communication accurately and appropriately in each culturally different context 2. continuously interact with patients from culturally diverse backgrounds to validate, refine, or modify existing values, beliefs, and practices about a cultural group

What are the 12 domains of culture?

1. overview, inhabited localities - country of origin and current residence 2. communication - interrelationship of verbal language skills (dominant language, dialects, touch, contextual use of language, and willingness to share info) 3. Family roles and organization - defines relationship of all insiders and outsiders; includes concepts related to head of household, gender roles, family goals and priorities, and developmental goals of family members 4. Workforce issues - type of employment, location, autonomy, language barriers 5. Bicultural ecology - skin color, heredity, genetics, drug metabolism 6. High risk behaviors - smoking, alcohol, recreational drugs, physical activity, safety 7. Nutrition - meaning of foods, common foods, deficiencies, rituals, limitations 8. Pregnancy and child bearing practices - fertility practices, views toward pregnancy, birthing, postpartum 9. Death rituals - bereavement, ceremonies 10. Spirituality - religious practices, use of prayer, meaning of life 11. Health care practices - focus of health care, traditional practices, responsibility for health, self-medication, pain, sick role, barriers 12. Health care providers - perceptions of providers, folk practitioners, gender, health care status

What is intersectionality?

A research and policy model used to study the complexities of peoples lives and experiences

What is a worldview?

A set of assumptions that begin to develop during childhood and guide how one sees, thinks about, experiences, and interprets the world

What is storytelling?

A way to begin to understand a patients cultural perspective -conveys culture, combines personal experience with the commonalities of all human experiences

What is a bias?

An inclination or the holding of a partial perspective, often accompanied by a refusal to consider a different POV

cold conditions

Cancer, Cold, flu, aches, joint pain Menses, Pneumonia, Stomach cramps

Hot conditions

Constipation, Diarrhea, Fever, Infection, Kidney Problems, Rash, Sore Throat

Campinha-Bacote's model of cultural competency

Provide a framework for you to practice in a culturally competent manner Cultural awareness Cultural knowledge Cultural skills Cultural encounters Cultural desire

plain language

Using clear, concise language that avoids showy words, long sentences, and confusing expressions

When do the CLAS standards apply?

When you are caring for patients who have limited English proficiency and/or other communication needs

Collecting a nursing history

be mindful that cultural differences will exist do not make assumptions listen carefully let patients tell their stories, rephrase statements for clarity, and validate any assumptions made about the patients condition or needs of the patient be respectful and nonjudgmental

Why are people who are in marginalized groups more likely to have poor health outcomes and die earlier?

because of a complex interaction between their individual behaviors, the environment of the communities in which they live, the policies and practices of health care and government systems, and the clinical care they receive

What concept does cultural desire involve?

caring -genuine passion, acceptance, and willingness

What are the social determinants of health?

conditions in which people are born, grow, live, work and age

What does achieving cultural competence begin with?

gaining an awareness of your own racial, ethnic, and cultural identity which prepares you to better understand patients within the context of their own racial, ethnic, and cultural identity

What are examples of marginalized groups?

gay/lesbian/bisexual/transgender people of color people who are physically and/or mentally challenged people who are not college educated

social determinants of health are mostly responsible for...

health disparities seen within and between countries

What does the intersectionality model look at?

how being marginalized affects peoples health and access to care

What does someones world view determine?

how people perceive others, how they interact and relate to reality, and how they process information

What levels does oppression occur at?

individual cultural institutional

Culturally based assessment

keep in mind common findings of different cultures -ex; some asian subcultures use cupping or coining to release excess force from the body and restore balance which can commonly be misinterpreted as abuse or disease -ex; some people from african decent commonly have sickle cell anemia

What are the core measures?

key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs

What is cultural awareness?

the process of conducting a self-examination of ones own biases toward other cultures and the in-depth exploration of ones cultural and professional background involves being aware of the existence of documented racism and other isms in health care delivery

In return HCPs expect patients to...

make and keep appointments give a med history give informed consent follow (discharge) instructions read, understand, and use health education materials correctly complete insurance forms pay their bills go home and manage their care by taking meds the right way, eating the right foods, and stopping, starting, or changing a variety of behaviors

What does marginalization do?

places or keeps someone in a powerless or an unimportant position within a society or group

What are types of health disparities often interrelated or influenced by the conditions and social context in which people live?

poor health status disease risk factors poor health outcomes limited access to health care

What is culture?

reflects the whole of human behavior including ideas, beliefs, and values; ways of relating to one another; language and manners of speaking; work and lifestyle practices

When patients access the health care system they want to...

see their HCP feel better

What is an example of how culture affects how an individual defines the meaning of illness?

some illnesses (HIV and manic depression) are embedded with meaning that is not always based on the physical nature of the condition but is culturally interpreted, which affects how society responds to afflicted individuals and influences the experience of that illness

What is linguistic competence?

the ability to communicate effectively and convey information in a manner that is easily understood by diverse audiences

What is cultural skill?

the ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patients presenting problem as well as accurately conducting a culturally based physical assessment

What is ethnic and cultural identity?

the frame in which individuals identify consciously or unconsciously with those with whom they feel a common bond because of similar traditions, behaviors, values, and beliefs

What is cultural desire?

the motivation of a health care professional to want to engage in the process of becoming culturally aware, culturally knowledgable, and culturally skillful and seeking cultural encounters

What is cultural knowledge?

the process in which a health care professional seeks and obtains a sound educational base about culturally diverse groups in acquiring this knowledge, health care professionals must focus on the integration of three specific issues: health-related beliefs and cultural values, care practices, and disease incidence and prevalence

teach back method

use following any patient instruction to confirm that you have explained what a patient needs to know in a manner that the patient understands

When is care culturally congruent?

when it fits a persons life patterns, values, and system of meaning