Cultural Competency Chapter 1

Channel

The means by which a sender sends a message.

Cultural desire

The motivation of the HCP to want to engage in the process of becoming culturally competent.

Cultural care accommodation/negotiation

The patent's practices need some change. Work with him to figure out a good plan.

Cultural care preservation/maintenance

The patient is well, so encourage him to continue with what he has been doing.

Decoding a message

The receiver translates the original message from the encoded form into a form that can be understood.

Dominant group

The group in the culture that controls the value system.

Cultural relativism

The idea that each culture is unique and should be judged only on the basis of it's own values & standards

Cultural diversity

Variations among cultural groups.

Therapeutic communication

Interpersonal interactions between nurse & patient. Focuses on the client's needs.

Culture shock

Occurs when an individual is placed in a different/strange culture. Results in psychological discomfort

Cultural knowledge

Seeking and obtaining a sound education about diverse cultural groups

Describe the iceberg model

- Surface culture is visible. Food, music, language, dance, clothing - Deep culture is invisible. Beliefs, roles, norms, perceptions, expectations

In what ways does culture influence healthcare?

1. Gender roles 2. Food & nutrition 3. Space & time 4. Socioeconomic 5. Language & communication

Cultural assessment

1. Identify cultural affiliation 2. Health beliefs and values 3. Customary health practices 4. Spiritual beliefs and practices 5. Cultural social structures related to healthcare

Functions of gazing

1. Monitoring 2. Expressing 3. Regulating

Life long learning in nursing (stages)

1. Novice 2. Advanced beginner 3. Competent 4. Proficient 5. Expert

Examples of noise

1. Pain 2. Anxiety 3. Language barriers/cultural differences 4. Lack of interest 5. Hearing/sight impairments

How might poverty effect healthcare?

1. Poor, cramped, unsafe housing 2. More health complications 3. Less likely to regain full health & longer recovery time 4. Lack of access to care 5. Lack of health insurance

What families are at high risk for poverty?

1. Single females headed families with one income 2. Elderly with fixed income 3. Future generation of those living in poverty

TCNS standards

1. Social justice 2. Critical reflection 3. Knowledge of cultures 4. Culturally competent practice 5. Culturally competent healthcare systems/organizations 6. Patient advocacy and empowerment 7. Multicultural workforce 8. Education in the workplace 9. Cross-cultural leadership 10. Cross-cultural communication 11. EBP 12. Policy development

Why explore diversity?

1. Society is increasingly diverse 2. Patients and coworkers are from diverse backgrounds 3. Health practices are culturally defined

Cultural destructiveness

A belief that rights and privileges are reserved for the dominant groups and other cultures are inferior.

Culture

A complex social concept that includes socially transmitted communication styles, family customs, political systems, and ethnic identity by a group of people.

Transcultural nursing

A formal area of study & practice focused on comparative human care differences & similarities of beliefs, values, and patterned lifestyles of cultures. Provides culturally congruent, beneficial healthcare to people.

Cultural blindness

An attempt to be "unbiased" by ignoring differences between groups. Treats everyone the same, but only meets needs of the dominant group.

Channel noise

Anything that disrupts the channel's ability to carry a message clearly.

Noise

Anything that inhibits effective communication.

Haptics

Applying touch to control interaction

Stereotyping

Assigning characteristics to a group of people without considering individuality.

Cultural competence

Attitudes, knowledge, and skills necessary for providing quality health care to diverse populations.

Kinesics

Body motions such as shrugs, tapping, winking, facial expressions, and gestures

How does one begin to develop competence?

By becoming self-aware of personal values, attitudes, and perspectives. Then developing knowledge & acceptance of others differences.

Leininger's tenets

Care diversities and universalities exist among all cultures. These must be discovered & analyzed for meaning in order to establish a body of knowledge for transcultural nursing.

Reaction to pain

Cultural expression of pain varies. Asking the client for acceptable pain-relieving measures is helpful.

Describe the model of cultural competence continuum

Desire, awareness, knowledge, skills, encounter. *Desire* is #1 important.

Diversity

Differences in values, beliefs, behaviors, physical & mental characteristics, and attitudes of groups of people in society.

Cultural pre-competence

Efforts are extended to develop cultural competence, but complacency sets in and growth ceases.

Oculesics

Eye-related non-verbal communication

Posture

How a person holds themselves while communicating

Locomotion

How a person moves while communicating

Vocalics

How people express themselves through voice

Olfactics

How smells are percieved

When did Leininger begin her work?

In the 1950's with her doctoral dissertation conducted in New Guinea.

What is positive aspect of Leininger's theory?

It can be used in many situations.

Social vs. Market Justice

Market justice focuses on an individual's ability to take action and earn something. In health care, this would be an individual's ability to earn their insurance through their job or pay personally for care. Social justice focuses on equality and the right of all individuals to access the same quality and type of care.

Cultural care repatterning

Practices are destructive and should be restructured.

Cultural awareness

Self-examination & exploration of one's own cultural background.

Encoding an idea

Sender puts the idea into a form that can be communicated

Adornment

Something that is worn to decorate

Sound symbols

Study of speech sounds: production, transmission, transcription

Chronemics

The role of time in communication

Weakness to Leininger's model

The theory is put in terms that are difficult to understand.

Why is transcultural nursing needed?

There is a growing diversity that characterizes national & global populations.

TCNS mission

To enhance the quality of culturally congruent, competent, and equitable care that results in improved health and well being for people worldwide.

What is the goal of Leininger's theory?

To provide culturally congruent care that contributes to the health and well being of people or all cultures.

Cultural conflict

When one ridicules others beliefs & traditions in order to make their own more secure.

What are the cultural phenomena that Giger & Davidhizar believe individuals should be assessed on?

1. Communication 2. Space 3. Time 4. Social organization 5. Environmental control

Describe the cultural competence continuum

1. Cultural destructiveness 2. Cultural incapacity 3. Cultural blindness 4. Cultural pre-competency 5. Cultural competence 6. Cultural proficiency

Characteristics of poverty

1. Despair, hopelessness, resignation 2. Unemployment with need for financial aid 3. Alcohol/drug use 4. Unstable family structure with potential abuse 5. Decline in self respect & retreat from society

What is therapeutic communication used for?

1. Establishing the therapeutic relationship 2. Identifying the client's concerns 3. Assessing the client's perceptions 4. Recognizing the client's needs 5. Promoting patient well-being 6. Guiding the patient towards healthcare solutions

TCNS goals

1. To advance cultural competence for nurses worldwide 2. To advance the scholarship (substantive knowledge) of the discipline 3. To develop strategies for advocating social change for culturally competent care 4. To promote a sound financial non-profit corporation

Types of communication

23% verbal 70% non-verbal 7% written

Multiculturalism

A heterogenous society in which diverse cultural worldview can coexist, while general characteristics can still be shared among the population.

Subculture

A smaller group of people living within the dominant culture who have adopted a lifestyle separate of the mainstream.

Respectful and accepting nursing care is:

A universal expectation not reliant on culture.

Culture assimilation

AKA acculturation. When minority groups living inside of the dominant group lose their cultural characteristics and develop those of the dominant group.

NLN CNEA

Accredits nursing programs across the country with respect to diversity, caring, and competence in work.

Cultural proficiency

Being proactive in developing new approaches to cultural understanding & sharing that knowledge with others.

Giger and Davidhizar

Believe that individuals are unique and should be assessed on 6 cultural phenomena.

Culture-universals

Commonly shared values, behaviors, and lifestyles that are held similarly among cultures.

Caring

Essential for healing. Every culture has its own (health) care practices, which may vary.

Ethnic vs. non ethnic cultures

Ethnic: related to heritage. Non ethnic: unrelated to heritage. (LGBTQ)

Ethnicity

Groups in which members share a common heritage between generations.

Cultural encounter

HCPs directly engage in face-to-face interactions with clients from diverse cultural backgrounds.

Minority group

Has some physical/cultural characteristics that identify them as different.

Three types of non verbal communication

Kinesics Proxemics Touch

Silence

Lack of sound during communication

Folk healers

Less expensive, more accessible and understanding of cultural needs. Speak the client's language.

Culture-specific

Particular values, beliefs, and patterns of behavior that are unique to one group & do not tend to be shared.

Cultural incapacity

Paternalistic approach towards other cultures. Think of parenting, or looking down at others.

Race

Socially created categories based on specific physical characteristics

TCNS vision

The TCNS seeks to provide nurses and other health care professionals with the knowledge base necessary to ensure cultural competence in practice, education, research, and administration.

Cultural sensitivity

The ability to be appropriately responsive to the attitudes, feelings, or circumstances of groups that share a common heritage.

Cultural skills

The ability to collect relevant data regarding the patient's CC. Also performing a culturally based physical assessment.

Cultural imposition

The belief that everyone should conform to the majority belief system.

Ethnocentrism

The belief that one's own culture should be the norm because it is better than others.

Proxemics

Use of space to make contact or provide privacy