Culture

Cultural Knowledge

-Learning or becoming educated about the beliefs and values of other cultures and diverse ethnic groups •Health-related beliefs and cultural values •Disease incidence and prevalence •Treatment efficacy •Cultural knowledge can help nurses determine the appropriate interventions that fit a patient's cultural traditions, beliefs, preferences and values. In addition, nurses should know how the effects of medications and manifestation of diseases are specific to different groups of patients based on their biology.

Cultural Concerns in Nursing

Being aware of or inquiring about a person's cultural or religious beliefs with respect to medical care can help nurses avoid causing cultural pain to patients. These concerns must be a priority when caring for patients and must be respected in order to gain a patient's trust and to be able to holistically care for them. Caring for patients not only focuses on the physical aspect of health, but must also include the mind and spirit as well.

nurse is providing care to a patient from a different culture. Which action by the nurse indicates cultural competence? A. Communicates effectively in a multicultural context B. Functions effectively in a multicultural context C. Visits a foreign country D. Speaks a different language

Correct Answer B Rationale: Cultural competence refers to a developmental process that evolves over time that impacts ability to effectively function in the multicultural context. Communicates effectively and speaking a different language indicates linguistic competence. Visiting a foreign country does not indicate cultural competence.

A nurse is beginning to use patient-centered care and cultural competence to improve nursing care. Which step should the nurse take first? A.Assessing own biases and attitude B.Learning about the world view of others C.Understanding organizational forces D.Developing cultural skills

Correct Answer: A Rationale: Becoming more aware of your biases and attitudes about human behavior is the first step in providing patient-centered care, leading to culturally competent care. It is helpful to think about cultural competence as a lifelong process of learning about others and also about yourself. Learning about the world view, developing cultural skills, and understanding organizational forces are not the first steps.

A nurse is assessing population groups for the risk of suicide requiring medical attention. Which group should the nurse monitor most closely? A.Young bisexuals B.Young Caucasians C.Asian Americans D.African Americans

Correct Answer: A Rationale: Gay, lesbian, and bisexual young people have a significantly increased risk for depression, anxiety, suicide attempts, and substance use disorders, being 4 times as likely as their straight peers to make suicide attempts that require medical attention. Caucasian youth, Asian Americans, and African Americans are not as likely to attempt suicide resulting in medical attention.

•An American nurse tries to speak with a Korean client who cannot understand the English language. To effectively communicate to a client with a different language, which of the following should the nurse implement? A.Have an interpreter to translate. B.Speak slowly. C.Speak loudly and closely to the client. D.Speak to the client and family together.

Correct Answer: A Rationale: Having an interpreter would be the best practice when communicating with a client who speaks a different language.

A nurse is providing care to a culturally diverse population. Which action indicates the nurse is successful in the role of providing culturally congruent care? A.Provides care that fits the patient's valued life patterns and set of meanings B.Provides care that is based on meanings generated by predetermined criteria C.Provides care that makes the nurse the leader in determining what is needed D.Provides care that is the same as the values of the professional health care system

Correct Answer: A Rationale: The goal of transcultural nursing is to provide culturally congruent care, or care that fits the person's life patterns, values, and system of meaning. Patterns and meanings are generated from people themselves, rather than from predetermined criteria. Discovering patients' cultural values, beliefs, and practices as they relate to nursing and health care requires you to assume the role of learner (not become the leader) and to partner with your patients and their families to determine what is needed to provide meaningful and beneficial nursing care. Culturally congruent care is sometimes different from the values and meanings of the professional health care system.

A nurse is assessing the health care disparities among population groups. Which area is the nurse monitoring? A.Accessibility of health care services B.Outcomes of health conditions C.Prevalence of complications D.Incidence of diseases

Correct Answer: A Rationale: While health disparities are the differences among populations in the incidence, prevalence, and outcomes of health conditions, diseases and related complications, health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications.

The nurse is caring for a patient of Hispanic descent who speaks no English. The nurse is working with an interpreter. Which action should the nurse take? A.Use long sentences when talking. B.Look at the patient when talking. C.Use breaks in sentences when talking. D.Look at only nonverbal behaviors when talking.

Correct Answer: B Rationale: Direct your questions to the patient. Look at the patient, instead of looking at the interpreter. Pace your speech by using short sentences, but do not break your sentences. Observe the patient's nonverbal and verbal behaviors.

A nurse is using core measures to reduce health disparities. Which group should the nurse focus on to cause the most improvement in core measures? A.Caucasians B.Poor people C.Alaska Natives D.American Indians

Correct Answer: B Rationale: To improve results, the nurse should focus on the highest disparity. Poor people received worse care than high-income people for about 60% of core measures. American Indians and Alaska Natives received worse care than Caucasians for about 30% of core measures.

The nurse learns about cultural issues involved in the patient's health care belief system and enables patients and families to achieve meaningful and supportive care. Which concept is the nurse demonstrating? A.Marginalized groups B. Health care disparity C. Transcultural nursing D. Culturally congruent care

Correct Answer: D Rationale: The nurse is demonstrating culturally congruent care. Culturally congruent care, or care that fits a person's life patterns, values, and system of meaning, provides meaningful and beneficial nursing care. Marginalized groups are populations left out or excluded. Health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications. Transcultural nursing is a comparative study of cultures in order to understand their similarities (culture that is universal) and the differences among them (culture that is specific to particular groups).

A nurse is caring for an immigrant with low income. Which information should the nurse consider when planning care for this patient? A.There is a decreased frequency of morbidity. B.There is an increased incidence of disease. C.There is an increased level of health. D.There is a decreased mortality rate.

Correct answer B: Rationale: Populations with health disparities (immigrant with low income) have a significantly increased incidence of disease or increased morbidity and mortality when compared with the general population. Although Americans' health overall has improved during the past few decades, the health of members of marginalized groups has actually declined.

Which action indicates the nurse is meeting a primary goal of culturally competent care for patients? A.Provides care to transgender patients B.Provides care to restore relationships C.Provides care to patients that is individualized D.Provides care to surgical patients

Correct answer: A rationale: Although cultural competence and patient-centered care both aim to improve health care quality, their focus is slightly different. The primary aim of cultural competence care is to reduce health disparities and increase health equity and fairness by concentrating on people of color and other marginalized groups, like transgender patients. Patient-centered care, rather than cultural competence care, provides individualized care and restores an emphasis on personal relationships; it aims to elevate quality for all patients.

A nurse is designing a form for lesbian, gay, bisexual, and transgender (LGBT) patients. Which design should the nurse use? A.Use partnered rather than married. B.Use mother rather than father. C.Use parents rather than guardian. D.Use wife/husband rather than significant other.

Correct answer: A rationale: Include LGBT-inclusive language on forms and assessments to facilitate disclosure, knowing that disclosure is a choice impacted by many factors. For example, provide options such as "partnered" under relationship status. For parents, use parent/guardian, instead of mother/father. Use neutral and inclusive language when talking with patients (e.g., partner or significant other), listening and reflecting patient's choice. Remember that some LGBT patients are also legally married.

Storytelling

Storytelling ØHelps identify the real problems affecting a patient's health status and find culturally appropriate ways to intervene •Storytelling can be the basis of the nurse's culturally sensitive approach to gather patients' health information and learn about and experience patients' cultural values and beliefs. •Nurses should consider using storytelling to promote authentic communication that will bring a voice to patients' concerns and assist in finding meaningful, culturally competent health solutions. •By identifying what matters most to the patient through intentional dialogue, nurses can assist in the transformation of the current health care system to a patient-centered system that links nursing practice with nursing knowledge and bridges the health disparity gap, one patient at a time.

Culture Sensitivity

•Being aware that cultural differences and similarities exist and that they can have an effect on behavior, values and learning. •It also means to be aware and tolerant of these differences and acknowledging them when interacting with others. •Cultural sensitivity is being aware that there are cultural differences and similarities, and they can have an effect on behavior, values and learning. It also requires that we are aware and tolerant of these differences in our daily interactions with others. •We experience cultural sensitivity by using neutral language-both verbal and nonverbal-in a way that reflects sensitivity and appreciation for the diversity of other people. It is communicated when words, phrases, use of distance, anything that the patient may interpret t as impolite or offensive is intentionally avoided. So it is expressed through behaviors that are considered polite and respectful. •Cultural sensitivity is important because it allows us to effectively function in other cultures, allows us to respect and value other cultures, and can reduce cultural barriers between healthcare providers and their patients.

Sterotyping

•Categorizing individuals or groups of people into an oversimplified or standardized image or idea. •It's when you assume that a belief or characteristic is shared by all in one class, culture or ethic group. •Stereotyping is categorizing individuals or groups of people into an oversimplified or standardized image or idea. So, it's when you assume that a belief or characteristic is shared by all in one class, culture or ethic group. •Prejudice is often associated with stereotyping. This is an unjustified negative attitude based on a person's group membership. There is evidence that suggests bias, prejudice, and stereotyping by healthcare providers leads to differences in care. •A healthcare provider who fails to recognize individuality within a group is jumping to conclusions about the individual or family.

Physiologic Characteristics

•Certain racial groups are more prone to specific diseases and conditions. •Examples include: -Keloids -Lactase deficiency and lactose intolerance -Sickle cell anemia -Colon cancer •Certain racial/ethnic groups are more prone to specific diseases and conditions. A few examples include: •A keloid, which is that growth of extra scar tissue that occurs where the skin has healed after an injury; they are most common in cultures with darkly pigmented skin. •Lactose is a type of sugar found in milk and other dairy products. When your body isn't able to digest this milk sugar you develop intolerance. This condition is very common among adults with Asian, African, or Native American heritage. •Sickle cell anemia is far more common in African-Americans than any other group. •Colorectal cancer also disproportionately affects the Black community, where the rates are the highest of any racial/ethnic group in the US. African Americans are about 20% more likely to get colorectal cancer and about 40% more likely to die from it than most other groups.

Cultural Awareness

•Cultural Awareness involves the ability to stand back from ourselves and become aware of our cultural values and beliefs. Why do we do things the way we do them? What is our world view? Why do we react in that particular way? •There is a document on blackboard to help you find your cultural self-awareness and world view. •Cultural Awareness is the foundation of communication, and it involves the ability of standing back from ourselves and becoming aware of our cultural values, beliefs and perceptions. Why do we do things in that way? How do we see the world? Why do we react in that particular way? •Cultural awareness becomes central when we have to interact with people from other cultures. People see, interpret and evaluate things in a different ways. What is considered an appropriate behavior in one culture is frequently inappropriate in another one. Misunderstandings arise when I use my meanings to make sense of your reality. Cultural awareness becomes a major concern when we must interact with people from other cultures. People see, interpret and evaluate things in a different ways. What is considered an appropriate behavior in one culture is frequently inappropriate in another one. Misunderstandings arise when I use my views to make sense of your life. This is why nurses and other healthcare professionals should first identify their own cultural biases and biases relate to people whose beliefs are different. Now we do not expect you to know and understand all cultures of the world, you should develop an awareness of those cultural belief systems that are prevalent in the communities where you live and practice. •Cultural awareness is a journey that involves letting go of personal assumptions about another person, regardless of race, ethnicity or color. Once we reach that awareness, we can then start the process of becoming culturally competent — an important element in the nursing profession

Culture Self Assessment

•Cultural competency is a process and takes time. It involves developing awareness, acquiring knowledge, and practicing skills. •Nurses should complete a cultural self assessment before caring for culturally diverse patients •This assessment includes answering questions such as: -Am I aware of my personal biases and prejudices toward cultural groups different from mine? -Do I have the skill to conduct a cultural assessment in a sensitive manner? -Do I have knowledge of the patient's worldview? -How many encounters have I had with patients from diverse cultural backgrounds? -What is my genuine desire to be culturally competent? •Healthcare providers should do a cultural self assessment •Everyone holds biases about human behavior. Becoming more aware of your biases and attitudes is the first step in providing patient-centered culturally competent care. •You should spend time reflecting on what you learned, formally and informally, throughout your life about health, illness, the health care system, gender roles, sexual orientation, race, ability, age, family, and many other issues as a part of your commitment to becoming a culturally competent nurse. •It is helpful to think about cultural competence as a lifelong process of learning about others and also about yourself. This is key information to have at your disposal as you begin your career. •There are many questions nurses need to ask themselves when completing this assessment. You can find a copy of a self-assessment on blackboard.

Culture Competency

•Cultural competency is the ability to effectively deliver health care services that meet the social, cultural, and language needs of our patients. •The primary aim of cultural competence care is to reduce health disparities and increase health equity and fairness by concentrating on people of color and other marginalized groups, like transgender patients. •Culturally congruent care is care that fits a person's life patterns, cultural values, world view and practices. •A person's world view is the way they see and understand the world, especially regarding issues such as politics, philosophy, and religion. •Transcultural nursing is a comparative study of cultures in order to understand their similarities (culture that is universal) and the differences among them (culture that is specific to particular groups).

Med Terms

•Cultural competency: the ability of providers to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. •Culturally congruent care: application of evidence-based nursing in agreement with the cultural values, beliefs, worldview, and practices of the client •World view: a mental model of reality - a comprehensive framework of ideas & attitudes about the world, ourselves, and life, a system of beliefs, a system of personally customized theories about the world and how it works

Food and Nutrition

•Food preferences and how foods are prepared are often related to culture. Patients in a hospital or long-term care often do not have a choice in foods. •This can be a cause for weight and health changes in a patient.

Health disparity and Healthcare Disparity:

•Health Disparities: differences in the health status of different groups of people •Health Care Disparities: differences in the ability to access health care, use the health care system, or receive quality and culturally competent care. •Healthy People 2020 defines a health dis-par-it-y as "a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. •Health disparities are the differences among populations in the incidence, prevalence, and outcomes of health conditions, diseases and related complications, •Health disparities negatively affect groups of people who have regularly experienced greater obstacles to health based on their racial or ethnic group; their religion; their socioeconomic status; their gender; their age; their mental health; their disability; their sexual orientation or gender identity; their geographic location. The term health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications

Reaction to Pain

•Healthcare researchers have discovered that many of the expressions and behaviors exhibited by people in pain are culturally prescribed. •Nursing care for patients in pain should be individualized, but •important culture-sensitive considerations include the following: -Recognize that culture is an important component of individuality -each person holds various beliefs about pain -Respect the patient's right to respond to pain in whatever manner is culturally and individually appropriate -Never stereotype a patient's perceptions or responses to pain based on the persons' culture •Box 44-4 on page 1068 has some important information about assessing pain in culturally diverse patients—be sure to review this box. •Healthcare researchers have discovered that cultural factors influence beliefs, behavior, views and emotions, all of which have important implications on health. Culture influences what people see as 'normal' and 'abnormal', determining the cause of illness or pain. These behaviors are learned at home at an early age. Most of us tend to do what our family's do as far as dealing with pain. I know here in the south tough guys are taught to "suck it up'' or "walk it off" from a very young age. I hear it on the ballfield every day after some has been hit with a wild pitch. Then their teammates congratulate them for "taking one for the team" This is teaching these kids to work through the pain. So you can see the relationship between pain and ethnicity is shaped by experience, learning and culture. •A cultural group's acceptance of pain as a normal part of life will determine whether pain is seen as a problem that requires a clinical solution. Many times your patients will not complain of pain. •Nursing care for patients in pain should be individualized, but there are some important culture-sensitive considerations including: •The nurse should recognize that culture is an important component of individuality and that each person holds various beliefs about pain •Respect the patient's right to respond to pain in whatever manner is culturally and individually appropriate for them and Never stereotype a patient's perceptions or responses to pain based on their culture

Gender role

•In many cultures either the man or woman is the dominant figure and generally makes decisions for the family. •Knowing who is the dominant member of the family is an important consideration when planning nursing care. •The size of the family unit, family member roles, and decision maker powers, as well as who talks to the healthcare provider are all based on culture. •Knowing who the dominant member of the family is can be really important when planning nursing care. •If the husband or father is the only one to make decision and you have the wife and child in the ER they are not going to agree to any procedure until the person with decision making powers gets there.

Psychological Characteristics

•In most situations, a person interprets the behaviors of another person in terms of her or his own familiar culture.

Cultural Diversity

•Is the cultural variety and differences that exist in the world, a society or an institution. •It is having a group of diverse people in one place. •People working or living together that have different cultures. •So we have already said the things you do and the practices you were taught from a young age influence who you become. Culture is a broad term that encompasses beliefs, values, norms, behaviors, and overall can be understood as our "way of being." When you go out into the world, you will come into contact with people from different backgrounds and walks of life. It's a good rule of thumb to honor cultural diversity with your actions. So, what is cultural diversity and why does it matter? • Cultural Diversity is the existence of a variety of cultural groups within a society. It can and should also refer to having different cultures respect each other's differences. • Cultural diversity is important because our country, workplaces, and schools increasingly consist of various cultural, racial, and ethnic groups. We can learn from one another, but first we must have a level of understanding about each other in order to allow teamwork and cooperation. •So what does cultural diversity look like?? •In a workplace it might mean having a multilingual team, having a diverse range of ages working together, having policies that are insistently against discrimination, etc. •In a school it might mean having students from all over the world, being accepting of all religious practices and traditions that students part take in, supporting but nit requiring students to share their cultures with one another, etc. •Diversity in health care includes these concepts and is also about understanding the mindset of a patient within a larger context of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities.

Orientation to time and space

•Personal space is the area around a person regarded as part of the person. This area, individualized to each person and to different cultures and ethnic groups, is the area others should not intrude during personal interactions. •Western cultures tend to view time as linear, with a definitive beginning and end. Western people structure their lives and businesses, by milestones and deadlines. Failure to meet them could be interpreted as having a poor work ethic or being incompetent. •Other cultures may perceive that time occurs more in cycles and is endless. More importance is placed on doing things right and maintaining harmony, rather than worrying about getting things done "on time." •Personal space is also a concept that we need to think about. This is the area around a person regarded as part of the person. This area is individualized to each person and to different cultures and ethnic groups. It is the area others should not intrude upon ** during personal interactions.

Cultural Influences on Healthcare

•Physiologic Characteristics •Psychological Characteristics •Reactions to Pain •Gender roles •Language and communication •Orientation to space and time •Food and nutrition •Socioeconomic Factors

Culturally competent care

•Providing culturally competent care means that care is planned and implemented in a way that is sensitive to the needs of individuals, families, and groups from diverse populations within society. -Cultural Assessment -Cultural Self Assessment •Culturally competent care requires health professionals to be sensitive to the differences between groups and plan care that reflects that sensitivity toward each person's beliefs and world view. Healthcare providers should also acknowledge the attitudes and meanings attached to emotional events such as depression, pain, and disability. •To provide culturally competent care we need to preform both a cultural assessment on our patients and cultural self-assessment on our self •Becoming more aware of your biases and attitudes about human behavior is the first step in providing patient-centered care, leading to culturally competent care. It is helpful to think about cultural competence as a lifelong process of learning about others and also about yourself.***

Socioeconomic Factors

•Research suggests that both physical and mental health are associated with Socioeconomic status(SES). •In particular, studies suggest that lower SES is linked to poorer health outcomes. •Poor health may in turn decrease an individual's capacity to work, thus reducing their ability to improve their SES. •Research suggests that both physical and mental health are associated with Socioeconomic status(SES). •There are many studies out that suggest a lower socioeconomic status is linked to poor health outcomes. •People in poor health may not be able to work and cannot improve their socioeconomic status -this becomes a vicious cyclic.

What is culture?

•Shared system of beliefs, values, and behavioral expectations that provide social structure for daily living.

Term Culture

•The term culture refers to a learned and shared system of beliefs, values, norms, behavioral expectations and traditions of a particular group, that provide social structure for daily living; guide our thinking, decisions, and actions. •Culture also refers to ways of relating to one another, language and manner of speaking, work and lifestyle practice, social relationships, values, religious beliefs and rituals, and expression of thoughts and emotions. •Culture is a learned behavior, however, it is constantly changing in response to environmental, biological, political, and social influences.

COMPETENCIES

•These five competencies identify the key elements considered essential for nursing graduates to provide culturally competent care according to the AACN. 1.Apply knowledge of social and cultural factors that affect nursing and health care across multiple contexts. 2.Use relevant data sources and best evidence in providing culturally competent care. 3.Promote achievement of safe and quality outcomes of care for diverse populations. 4.Advocate for social justice, including commitment to the health of vulnerable populations and the elimination of health disparities. 5.Participate in continuous cultural competence development (AACN, 2008).

Language and Communication

•To avoid misinterpretation of questions and answers, it is important to use an interpreter who understands the healthcare system. •When caring for culturally and ethnically diverse patients it is important to perform a transcultural assessment of communication. •Culture also influences how people expresses themselves including the terminology or jargon they use and how they view nonverbal messages. This includes eye contact, touch and even the space between people while communicating. •Some cultures view touch as invasive and not caring, some view eye contact as a sign of honesty and others may view it as aggressive and hostile. Some have different tolerances for the distance between them and the person they are communicating with. •If a patient needs an interpreter, try not to ask the patient's family members and friends. A trained medical interpreter is the best option to help with communication to avoid misinterpretation of the medical questions and answers. •When doing an assessment of communication you want to ask questions like: •What language the patient speaks at home? What other languages does the patient speak or read? What language would the patient prefer to communicate in? •Even if your patient knows English remember that the stress of illness may cause patients to use a more familiar language and to temporarily forget some English.

Cultural Bias

•To give an advantage to one cultural over another. •To ignore the differences between cultures and impose understanding based on the study of one culture to other cultures. •To think one culture has precedence of the other. •Cultural bias is the tendency for people to judge the outside world through a narrow view based on your own culture. •This causes you to give an advantage to one cultural over another; ignore the differences between cultures; and to think that one culture maybe more important than other cultures. Cultural bias leads to discrimination and racism. •When you as the nurse hold a bias toward an individual patient or group of patients, it is very difficult to provide patient-centered care. •We all have some type of bias that is culturally driven. •Sometimes these biases are called an unconscious biases because we are unaware of it. They happen outside our control, and are influenced by our personal background, cultural environment, and personal experiences. •Healthcare providers should do a cultural self assessment to find any hidden biases and help them become culturally competent caregivers.

Cultural Assessment

•When caring for patients from a different culture, it is important to find out how they want to be treated based on their cultural values and beliefs. •An effective way to identify specific factors that influence a patient's behavior is to perform a cultural assessment. •Culturally competent care begins with a cultural assessment that forms the foundation for the plan of care. When you assess your patients' cultural beliefs, values, and practices you are better able to individualize care and reach those positive outcomes that everyone wants • A cultural assessment: •*helps you identify the patient's cultural understanding of the health problem and how what is normal in their culture may affect the plan of care •* identifies patient beliefs, values, and practices that could help with or interfere with nursing interventions; •* helps the nurse better understand the patient. •Using a cultural assessment, helps develop an individualized plan of care that honors the patient's culture and lifestyle. The patient is more likely to follow a plan of care based on their beliefs, values, and practices.