Culturally Responsive Nursing Care

Madeleine Leininger

Developed the theory of Transcultural Care

Culturally Responsible Nursing Care

In order to provide quality care nurses and health care professionals need to be informed about and sensitive to the culturally diverse subjective meaning of health, caring and healing practice.

Health Traditions Model

The Health Tradition Model is a concept (idea) of the holistic health. It includes the balance of all aspects of body, mind and spirit. The term "traditional" refers to those customs, beliefs, or practices that have existed for many generations without changing

Health Disparities

are the differences in care experienced by one population compared with another population. Although everyone should receive high- quality health care, the National Healthcare Disparity Report (2011), shows in the US, some people receive inferior care others.

Cultural responsive nursing care improves

communication, fosters mutual respect, promotes sensitive and effective care, and increases adherence with the treatment plan client's and family needs met. It encourages client decision making by introducing self- empowerment strategies.

2 Major Factors contributing to Health Care Disparities:

1. Quality of care 2. Access to care

Enculturation

Learning the beliefs and values of one's own culture

Multi/Bi-cultural

describes a person who crosses two cultures, (multi/bi- cultural) lifestyles and sets of values. ex. Children of immigrant parents raised America.

Verbal Communication PRACTICE GUIDELINES:

1. Avoid using a family member, a member of the health care team or person approved by the facility is ok. 2. Be aware of gender and age differences 3. Politically and socially compatible with client 4. Address questions to client/family not interpreter 5. Speak slowly and distinctly 6. Observe facial and body language of client 7. Become aware of individual expressions and words used in specific regions

The 4Cs of Culture

1. What do problem? 2. What do you think CAUSED problem? 3. How do you COPE with your problem? 4. What are your CONCERNS about your problem?

Characteristics needed to provide culturally responsible care

A. Develop self awareness of his or her own culture, attitudes and beliefs nurse holds about different cultures B. Examine the biases and assumptions that the C. Nurses need to gain necessary knowledge and skills to create and environment where trust can be developed with the client D. Nurse needs to responds to the clients cultural needs

Folk medicine

Are those beliefs and practices relating to illness revention and healing that derive from cultural radition, rather that from modern medicine scientific base. Healer assesses the patient's condition and prescribes treatment i.e. herbs, poultices, charms or amulets, to be worn. Please note that a significant portion of the population e.g.38 % in 2010 used some form of Complementary Alternátive Therapy (CAM) in the past year. These included natural products, deep breathing, meditation, massage and yoga.

Verbal Communication

Is the most obvious cultural difference •language differences •vocabulary voice qualities •who initiates it ATI Connection: Paraphrasing the client's communication will decrease misinterpretations

Scientific /biomedical health beliefs:

Life and life processes are controlled by physical and biochemical processes that are controlled by humans or breakdown of the body germs, viruses and bacteria are responsible for illnesses. Pills/treatment cures the

Time Orientation

Refers to an individual's focus on the past, present or future (time awareness). Most cultures include all three orientations but one orientation is more dominant ✅Nurses need to be aware of the meaning of time for clients is placed on how past behavior affects future health. For example within the client's culture litle importance

Race:

The classification of people according to Social and cultural characteristics. According to the 2010 census racial classification are the following: ✔️white ✔️black ✔️American Indian or Alaskan Native ✔️Asian Indian ✔️Chinese ✔️Filipino ✔️Korean ✔️Vietnamese ✔️Other Asian ✔️Native Hawaiin ✔️

Holistic health belief:

The forces of nature must be maintained in balance or harmony. Human life must be in harmony with the rest of nature. When something occurs to disrupt that balance or armony illness occurs. The yin-yang concept of "balance". Hot / cold (Middle Eastern, Spanish and Asian cultures) Note: Part of Holistic health belief is something we call Folk Medicine.

Providing Cultural Care:

The nursing process is affected by client and the nurses culture ,beliefs and behaviors. Nurses must be aware of their biases, their own and the cultural values dominant in the health care setting. To provide culturally responsible nursing the nurse must be able to develop self awareness and convey cultural sensitivity

Cultural competence is:

The ongoing process in which the health care professional continuously strives to achieve the ability and availability to work effectively within the cultural context of the patient (individual, family, community)."

Assimilation

The process by which an individual develops new cultural identity. i.e. becoming "like the members of the dominant culture

Prejudice:

a preconceived notion or judgment that is not based on sufficient knowledge which may be favorable or unfavorable.

Religion

a system of (organized) beliefs, practices, and ethical values about divine or superhuman power worshipped as the creator and ruler of the universe.

Transcultural nursing:

focuses on providing nursing care with the differences and similarities of the beliefs, values and patterns of cultures (Leininger & McFarland, 2010). Leininger created the theory of culture care diversity and universality.

Acculturation

involuntary process of adapting to or borrowing traits from one culture to another, usually to survive

Culturally sensitive

means that nurses are knowledgeable about the cultures prevalent in their area of practice

Culturally competent

means that nurses understand and address the entire cultural context of each client within the realm of the care they deliver

Culturally appropriate

means that the nurses apply their knowledge of a client's culture to their delivery

Subculture

of people who have a is usually a group distinct identity yet are related to a larger cultural group. (a sub cultural group generally shares ethnic origin, occupation, or physical characteristics with the larger cultural group) ex. Feminists, nurses

Diversity

refers to the fact or state of being different. Ex., age, ethnicity, socio- economic status, gender, sexual orientation, religious affiliation.

Ethnocentrism

refers to the view that the beliefs and values of one's own culture are superior to those of another culture ATI Connection Ethnocentrism ideas interfere with the provision of cultural nursing care (Egocentric has no place on care)

Ethnicity

relationship between individuals who believe that have distinctive characteristics that make them ATI Connection (the shared identity, bond, or kinship people feel with their country of birth place of ancestral origin) affected by culture.

Discrimination

the differential treatment of individuals or based on categories such as groups race, ethnicity, gender, social class, etc.

Cultural responsive care is:

✔️ care that is centered on the clients cultural point of view ✔️integrates the clients values and beliefs into the plan of care.

Quality of Care The NHDR shows the following (p. 278 text)

✔️Adult ages 65 and over received worse care than adults ages 18 to 44 for 39 % of measures ✔️Blacks received worse care than whites for 41 % of measures ✔️Asians, American Indians and Alaska Natives received worse care than whites for about 30 % of measures ✔️Hispanics received worse care than non-Hispanic whites for about 39 % of measures ✔️Poor people received worse care than high income people for about 47 % of measures

Culture

✔️Can be defined as the thoughts, communications, actions, customs, beliefs, values and institutions of racial, within, religious, or social groups (USDHHS) ✔️Each person is born into a culture Influenced by place of birth and family origin. ✔️Ever nurse-client interaction is a cultural encounter. ✔️ATI behavior. For example connection-Values if health promotion and gulde decision-making and Every nurse-client interaction is a cultural encounter. maintenance are valued, monthly self exams are done. Values develop unconsciously durong childhood

Cultural imposition

✔️nurse's understanding and awareness of their own culture and any bias that might affect care delivery ✔️Nurses should accommodate each client's cultural beliefs and values whenever possible, unless there is direct conflict with essential health practices.