Chapter 9: Culture Competence

what are some ways to use the teach-back technique?

- Please explain it - What will you tell your wife about the changes we made today? - Please review what we talked about

what are some social determinants of health?

- age - race - ethnicity - socioeconomic status - access to nutritious food - transportation resources - religion - sexual orientation - level of education - literacy level - disability

describe cultural encounter

- communicate in a way that generates a wide variety of responses - send and receive verbal and nonverbal communication appropriately - continuously interact with patients to validate, refine, or modify existing values, beliefs, and practices about a cultural group

how does the teach-back method help a patient with limited health literacy?

- confirms learning - identifies explanations and communication strategies patient commonly understands

what are the principles when utilizing an interpreter?

- ensure interpreters are competent in medical terminology and understand i confidentiality - do not use family members - speak in first person to the patient - have the interpreter sit next to or slightly behind the patient - speak in short sentences and wait for the interpreter to convey them - avoid using jargon, acronyms, and jokes

what are examples of marginalized groups?

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

describe cultural desire

- have the motivation to engage patients so that you understand them from a cultural perspective - establish a caring relationship - be open and flexible with others - use the LEARN model L: listen E: explain A: acknowledge R: recommendations N: negotiate

what is the difference between illness and disease?

- illness is the way in which individuals and families react to disease - disease is a malfunctioning of biological or psychological processes

describe cultural skill

- includes collecting a culturally based nursing history, performing a culturally based physical assessment, and using teach-back - provide language assistance resources - inform all of the availability of language assistance - ensure the competence of those providing language assistance - provide easy-to-understand materials in local languages - assess health literacy

what are some disparities in health care?

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

describe cultural awareness

- requires a self-examination of one's biases toward other cultures and in-depth exploration of one's own cultural and professional background - gain cultural knowledge by taking the time to learn about the beliefs and values of other cultures - do not form biases or stereotypes

Health care organizations 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

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.

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.

Which statement made by a new graduate nurse about the teachback technique requires intervention and further instruction by the nurse's preceptor? 1. "After teaching a patient how to use an inhaler, I need to use the teach-back technique to test my patient's technique." 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."

1.

what are the five concepts in the cultural competence model?

1. cultural awareness 2. cultural knowledge 3. cultural skill 4. cultural encounter 5. cultural desire

Which of the following is an example of a patient with 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 a chronic disease 4. A family who relies on public transportation 5. A patient who has had a history of smoking for 10 years

2,3,5

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.

A mother is concerned about her child's flulike symptoms. You learn from the health assessment that the mother practices 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.

which step of the LEARN model is this behavior? The nurse notes that she has learned that fathers can visit mothers at any time in both Serbia and the United States.

A

health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. these disparities are often exacerbated by which of the following? (select all that apply) A. implicit bias B. stereotyping C. prejudice D. unconscious bias

A,B,C,D

An outsider's perspective in an intercultural encounter A. etic world view B. world view C. cultural desire D. intersectionality E. emic world view

A.

what type of cultural competency assesses social, cultural, and biophysical factors that influence client treatment and care? A. cultural skills B. cultural desire C. cultural awareness D. cultural knowledge

A.

which measures taken by the health care organizations would create an inclusive environment for clients belonging to the LGBT community? (select all that apply) A. identify the basis of their appearance B. make sure they have access to unisex bathrooms C. ensure that gender-inclusive language is used while talking D. ask them directly about their gender to avoid presumtpions

B,C,D

A nurse is using an interpreter to communicate with a client. Which of the following actions should the nurse use when communicating with a client and family members? (select all that apply) A. talk to the interpreter about the family while the family is in the room B. determine client understanding several times during the conversation C. look at the interpreter when asking the family questions D. use lay terms if possible E. do not interrupt the interpreter and the family as they talk

B,D,E

A nurse is discussing the plan of care for a client who reports following Islamic practices. Which of the following statements by the nurse indicates culturally responsive care to the client? A. "I will make sure the menu includes kosher options." B. "I will ask the client if they want to schedule some times to pray during the day." C. "I will avoid discussing care when the client's family is around." D. "I will make sure daily communion is available for this client."

B.

Factor that shapes how people perceive others and how they relate to reality A. etic world view B. world view C. cultural desire D. intersectionality E. emic world view

B.

the nurse is caring for a French speaking only client. which action by the nurse may impede the communication between the nurse and the client? (select all that apply) A. introducing the interpreter to the client B. determining the interpreter's qualifications C. looking at the interpreter during conversation with the client D. asking the client's family members to serve as interpreters

C and D

A nurse enters the room of a client who is crying while reading from a religious book and asks to be left alone. Which of the following actions should the nurse take? A. contact the hospital's spiritual services B. ask what is making the client cry C. ensure no visitors or staff enter the room for a short time period D. turn on the television for a distraction

C.

A nurse is caring for two clients who report following the same religion. Which of the following information should the nurse consider when planning care for these clients? A. members of the same religion share similar feelings about their religion B. a shared religious background generates mutual regard for one another C. the same religious beliefs can influence individuals differently D. the nurse and client should discuss the differences and commonalities in their beliefs

C.

The motivation of a health care professional to "want to" engage in cultural competency A. etic world view B. world view C. cultural desire D. intersectionality E. emic world view

C.

A nurse is caring for a client who tells the nurse that based on religious values and mandates, a blood transfusion is not an acceptable treatment option. Which of the following responses should the nurse make? A. "I believe in this case you should really make an exception and accept the blood transfusion." B. "I know your family would approve of your decision to have a blood transfusion." C. "Why does your religion mandate that you cannot receive any blood transfusions?" D. "Let's discuss the necessity for a blood transfusion with your spiritual leaders and come to a reasonable solution."

D.

A policy model that describes factors and power structures that shape and influence life A. etic world view B. world view C. cultural desire D. intersectionality E. emic world view

D.

which step of the LEARN model is this behavior? The nurse shares her perception of the woman's experiences as a patient.

E

Insider's perspective in an intercultural encounter A. etic world view B. world view C. cultural desire D. intersectionality E. emic world view

E.

which step of the LEARN model is this behavior? The nurse attends to the patient and listens to her story about hospitals in Serbia.

L

describe the LEARN model when practicing cultural desire

L: listen to the patient's perception of the problem. be nonjudgmental and use encouraging comments E: explain your perception of the problem A: acknowledge not only the differences between the two perceptions of the problem but also the similarities. build on the similarities R: recommendations must involve the patient N: negotiate a treatment plan

which step of the LEARN model is this behavior? The nurse asks the patient how she can maintain bed rest when she returns home

N

which step of the LEARN model is this behavior? The nurse involves the patient in a discussion of the treatment options for her condition.

R

occurs when an individual or group transitions from one culture and develops traits of another culture

acculturation

the process in which the individual adapts to the host's cultural values and no longer prefers the components of the origin culture

assimilation

a set of evidence-based, scientifically researched standards of care which aim to hold health care providers accountable for considering patient's unique cultural perspectives to provide safe quality care

core measures

component of the cultural competence model: the process of conducting a self-examination of one's own biases toward other cultures and the in-depth exploration of one's cultural and professional background - awareness of racism

cultural awareness

component of the cultural competence model: the motivation of a health care professional to "want to" engage in the process of becoming culturally aware, culturally knowledgeable, and culturally skillful in seeking cultural encounters

cultural desire

component of the cultural competent model: 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 provider's existing belief about a cultural group and to prevent stereotyping

cultural encounter

component of the cultural competence model: the process in which a health care professional seeks and obtains a sound educational base about culturally diverse groups - focuses on health-related beliefs and cultural values, care practices, and disease incidence and prevalence

cultural knowledge

as opposed to cultural competence, is critical to reducing disparities and improving access to high-quality health care that is respectful and responsive to the needs of the diverse patient

cultural respect

refers to the learned and shared beliefs, values, norms, and traditions of a particular group, which guides thinking, decisions, and actions - passed down through generations

culture

an insider perspective

emic world view

what is culturally congruent care?

emphasizes the need to provide care based on an individual's cultural beliefs, practices, and values

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

ethnic and cultural identity

an outsider perspective

etic world view

what is cultural competence?

health care must be culturally sensitive, culturally appropriate, and culturally competent

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

health disparity

the degree to which individuals have the capacity to obtain, process, and understand basic health information and the services needed to make appropriate health decisions

health literacy

refers to a bias that you are aware of

implicit bias

a research and policy model used to study the complexities of people's lives and experiences

intersectionality

how is intersectionality used?

it looks at how being marginalized affect people's health and access to care

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

linguistic competence

people who are more likely to have poor health outcomes and die earlier because of a complex interaction among their individual behaviors, environment, policies, and the clinical care they receive

marginalized groups

a formal and informal system of advantages and disadvantages tied to membership in social groups, reinforced by societal norms, biases, interactions, and beliefs

oppression

one's self identification with or or more social groups in which a common heritage with a particular racial group is shared

racial identity

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

social determinants of health

an assumed belief regarding a particular group

stereotype

refers to a bias that you are unaware of; happens out of your control - actions are influenced by personal experiences

unconscious bias