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