Unit 9- Cultural Competence/Spiritual Health

1. Health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. These disparities are often exacerbated by: A. bias. B. stereotyping. C. prejudice. D. all of the above.

D. all of the above.

Emic world view

insider or native perspective

What does the FICA assessment tool stand for?

F - faith, belief I - importance and influence C - community A - address

Cultural awareness

process of conducting an self-exam of one's own biases toward other cultures and in-depth exploration of one's cultural and professional background. Involves being aware of the existence of documented racism and other "isms" in healthcare.

Cultural encounter

process that encourages health care professionals to directly engage in face to face cultural interactions and other types with culturally diverse patients.

Cultural competence

professional health care must be culturally sensitive, appropriate, and competent to meet the multifaceted health care needs of each person, family, and community.

Ethnic Identity

a person's identification with a racial or ethnic group

Culture

learned and shared beliefs, values, norms, traditions of a particular group which guides are thinking, decisions, and actions.

Etic

Application of constructs external to a culture to discover universal characteristics common to all cultures

What is Blanchet and Pepin's ideas of cultural competency?

building a relationship with the other Working outside the usual practice framework Reinventing practice in action

Oppression

form and informal system of advantaged and disadvantages tied to membership in social groups, reinforced by societal norms, biases, interactions, and beliefs

Etic world view

outsider perspective

Cultural respect

recently brought about by the national institutes of health. Similar definition as cultural competence but is critical to reducing health disparities and improving access to high-quality health care that is respectful and responsive to the needs of the diverse patient.

Hope

refers to an energizing source that has orientation to future goals and outcomes

Intersectionality

research and policy model used to study the complexities of people's lives and experiences. Looks how being marginalized affects people's health and access to care.

Cultural Marginality

situations and feelings of passive betweenness when people exist between two different cultures.

Cultural Assessment

systematic and comprehensive examination of the cultural care values, beliefs, and practices of individuals, families, and communities

cultural imposition

tendency of some to impose their beliefs, practices, and values on another culture because they believe that their ideas are superior to those of another person or group

Agnostic

the belief of no known ultimate reality

Transcendence

the belief that a force outside of and greater than the person exists beyond the material world.

Ethnic and Cultural Identity

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

Ethics

the principles of right and wrong that guide an individual in making decisions

Assimilation

the process in which the individual adapts to the host's cultural values and gives up their original identity and develops a new cultural identity.

What dietary regulations does Native americans have?

individual tribal beliefs influence food practices

self-awareness

involves identifying and understanding one's own cultural identity

Spiritual Well-being

meaning and purpose, sense of peace or fulfillment, and connectedness with others and God or a higher power.

marginalized groups

more likely to have poor health outcomes and die at an earlier age because of a complex interaction between individual genetics and behaviors; public and health policy; community and environmental factors; and quality of health care

Cultural desire

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

Acculturation

occurs when an individual or group transitions from one culture and develops traits of another culture. "Adapts to that culture"

Racial identity

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

Biculturalism

partial identification with two cultures

Health disparity

particular type of health difference that is closely linked with social, economic, and/or environmental change. Poor health status, disease risk factors, poor health outcomes, and limited access to health care are types of disparities often interrelated and influenced by conditions and social context.

Cultural knowledge

process in which a health care professional seeks and obtains a sound educational base about culturally diverse groups.

Meaning and purpose in life

to find the meaning and purpose in both positive and negative life events

Unconscious/Implicit Bias

unconscious bias- refers to a bias we are unaware of and happens outside our control, influenced by personal background, cultural environment, and personal experiences. Implicit bias- same but we are aware of the bias that is present.

stereotype

an assumed belief regarding a particular group

Emic

approach to understand the culture from within (insider's viewpoint)

Spirituality

awareness of one's inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself. Key point: Spirituality is linked to self transcendence.

Health Literacy

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

Holistic view

enables you to establish a helping role and a healing relationship

What dietary regulations does the religion Jehovah's Witness have?

Avoid food prepared with or containing blood

You are in the process of admitting an ethnically diverse patient. To plan culturally competent care, you will conduct a cultural assessment that includes: A. biocultural history B. ethnohistory. C. negotiation. D. ethnocentrism.

B. ethnohistory.

What dietary regulations does the religion Christianity have?

Baptists, Evangelicals, and Pentecostals discourage the use of alcohol and caffeine. Catholics fast on ash wednesday and good friday. Some do not eat meat on Fridays during lent.

Social Determinants of Health

The conditions in which people are born, grow, live, work, and age. Shaped by resources at global, national, and local levels

Linguistic competence

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

Cultural skill

ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patient's presenting problem and a culturally based physical assessment

health disparities

adverse affects on groups of people who have been systematically experienced greater obstacles to health based on racial, ethic, culture, religion, socioeconomic status, gender, age, mental health, disability, etc

Faith

allows people to have firm beliefs despite lack of physical evidence

Connectedness

being intrapersonally connected within oneself; interpersonally connected with others and the environment; and transpersonally connected with God, or an unseen higher power.

What is Cultural Competency?

being respectful of and responsive to the health beliefs, practices, and cultural/linguistic needs of diverse patients.

Culturally competent care

conveying acceptance for the patient's health beliefs while sharing information, encouraging self-efficacy, and strengthening the patient's coping resources

ethnicity

common ancestry that leads to shared values and beliefs

Teach back

A method of teaching in which the patient verbalizes information that he or she has learned. It is a confirmation of how well the nurse explains concepts to patients.

What are some factors influencing spirituality?

Acute illness: need a new way to cope with new realities. Anger is common in this situation. Chronic illness: Creates feelings of powerlessness. Terminal illness: fears of physical pain, independence, isolation, unknown. Affects those that are around the person as well. Near-death experience: psychological phenomenon of people who either have been close or recovered after being declared dead.

Ethnocentrism

Belief in the superiority of one's nation or ethnic group.

Atheist

Belief that there is no existence of God

Key attributes of culture

Culture is learned through families/group members Culture is changeable and adaptive Cultural values, beliefs, and behaviors are shared by all within a group

What dietary regulations does the religion Russian Orthodox Chruch have?

Followers observe fast days and "no-meat" rule on wednesdays and fridays. During lent all animal products, diary and butter are forbidden.

What dietary regulations does the religion Mormonism have?

Members abstain from alcohol and caffeine

What are some examples of Ancillary services in the health care team?

Pharmacists OT UAP (unlicensed assistive personnel)

What dietary regulations does the religion Buddhism have?

Some are vegetarians and do not use alcohol. Many fast on Holy Days.

What dietary regulations does the religion Judaism have?

Some observe the kosher dietary restrictions. (avoid pork and shellfish, do not prepare and eat milk and meat at the same time)

What dietary regulations does the religion Hinduism have?

Table 35.2 Some are vegetarians. Belief is to not kill any living creature.

Enculturation

The person learns norms, values, and behaviors of their own culture, similar to socialization

Self-Transcendence

a sense of authentically connecting to one's inner self

Core measures

a set of evidence-based, scientifically researched standards of care. Intended to reduce health disparities.

inner strength

a source of energy that instills hope, provides motivation and confidence in decisions, promotes connections with others and a positive outlook on life

5. 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

10. The nurse is caring for a 50-year-old woman visiting the outpatient medicine clinic. The patient has had type 1 diabetes since age 13. She has numerous complications from her disease, including reduced vision, heart disease, and severe numbness and tingling of the extremities. Knowing that spirituality helps patients cope with chronic illness, which of the following principles should the nurse apply in practice? (Select all that apply.) 1. Pay attention to the patient's spiritual identity throughout the course of her illness. 2. Select interventions that you know scientifically support spiritual well-being. 3. Listen to the patient's story each visit to the clinic, and offer a compassionate presence. 4. When the patient questions the reason for her long-time suffering, try to provide answers. 5. Consult with a spiritual care adviser, and have the adviser recommend useful interventions.

1, 3

2. 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

The nurse should recognize which attributes and criteria are concepts of spirituality? (select all that apply) 1. Spirituality is universal. 2. Physical illness does not impact the spirit. 3. Spirituality manifests whether a person acts on personal beliefs or not. 4. Nurses should be aware of local community-based religious organizations. 5. Family and culture impact spiritual beliefs.

1, 4, 5 Spirituality is universal. All individuals, even those who profess no religious belief, are driven to derive meaning and purpose from life. Illness impacts spirituality in a variety of ways. Some patients and families will draw closer to God or however they conceive that Higher Power to be in an effort to seek support, healing, and comfort. Others may blame and feel anger toward that Higher Power for any illness and misfortune that may have befallen a loved one or their entire family. Still others will be neutral in their spiritual reactions. There has to be willingness on the part of patient and/or family to share and/or act on spiritual beliefs and practices. The nurse needs to be aware that specific spiritual beliefs and practices are impacted by family and culture. Community-based religious organizations can provide supportive care to families and patients and nurses need to be aware of these resources.

9. Which statement made by a new graduate nurse about the teach-back 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. "After teaching a patient how to use an inhaler, I need to use the teach-back technique to test my patient's technique."

The nurse is caring for a patient who has just had a near-death experience (NDE) following a cardiac arrest. Which intervention by the nurse best promotes the spiritual well-being of the patient after the NDE? 1. Allowing the patient to discuss the experience 2. Referring the patient to pastoral care 3. Having the patient talk to another patient who had an NDE 4. Offering to pray for the patient

1. Allowing the patient to discuss the experience

What is Campinha-Bactoe's model of cultural competency?

1. Cultural awareness. (aware of "isms") 2. Cultural knowledge (health related beliefs and cultural values, disease incidence, and treatment efficacy) 3. Cultural Skill (cultural data about pt's problem) 4. Cultural encounter (directly engage with other cultures) 5. Cultural Desire (motivation/want to engage in becoming more culturally aware)

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. It fits the patient's valued life patterns and set of meanings.

The ability of an organization and its staff to communicate effectively and convey information in a manner that is easily understood by diverse audiences. 1. Linguistic competence 2. Cultural assessment 3. Culturally congruent care 4. cultural competence

1. Linguistic competence

3. 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. Patient has difficulty completing a registration form at a medical office.

4. A nurse is caring for a patient who is Muslim and has diabetes. Which of the following items does the nurse need to remove from the meal tray when it is delivered to the patient? 1. Small container of vanilla ice cream 2. A dozen red grapes 3. Bacon and eggs 4. Garden salad with ranch dressing

3. Bacon and eggs

This involves a natural inclination to engage in the cultural competence process that is characterized by passion, commitment, and caring. 1. cultural competent care 2. Cultural assessment 3. Cultural Desire 4. Health care disparities

3. Cultural Desire

5. A 44-year-old male patient has just been told that his wife and child were killed in an auto accident while coming to visit him in the hospital. Which of the following statements are assessment findings that support a nursing diagnosis of Spiritual Distress related to loss of family members? (Select all that apply.) 1. "I need to call my sister for support." 2. "I have nothing to live for now." 3. "Why would my God do this to me?" 4. "I need to pray for a miracle." 5. "I want to be more involved in my church."

2, 3

7. A nurse is preparing to teach an older adult who has chronic arthritis how to practice meditation. Which of the following strategies are appropriate? (Select all that apply.) 1. Encourage family members to participate in the exercise. 2. Have patient identify a quiet room in the home that has minimal interruptions. 3. Suggest the use of a quiet fan running in the room. 4. Explain that it is best to meditate about 5 minutes 4 times a day. 5. Show the patient how to sit comfortably with the limitation of his arthritis and focus on a prayer.

2, 3, 4

1. 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

These are key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs. 1. Health literacy 2. Core measures 3. Cultural desire 4. Cultural encounters

2. Core measures

6. A patient has just learned she has been diagnosed with a malignant brain tumor. She is alone; her family will not be arriving from out of town for an hour. The nurse has been caring for her for only 2 hours but has a good relationship with her. What is the most appropriate intervention for support of her spiritual well-being at this time? 1. Make a referral to a professional spiritual care adviser. 2. Sit down and talk with the patient; have her discuss her feelings and listen attentively. 3. Move the patient's Bible from her bedside cabinet drawer to the top of the over-bed table. 4. Ask the patient whether she would like to learn more about the implications of having this type of tumor.

2. Sit down and talk with the patient; have her discuss her feelings and listen attentively.

A comparative study of cultures to understand their similarities and the differences among them. 1. linguistic competence 2. transcultural nursing 3. culturally congruent care 4. Cultural competence

2. transcultural nursing

8. A nursing student is developing a plan of care for a 74-year-old-female patient who has spiritual distress over losing a spouse. As the nurse develops appropriate interventions, which characteristics of older adults should be considered? (Select all that apply.) 1. Older adults do not routinely use complementary medicine to cope with illness. 2. Older adults dislike discussing the afterlife and what might have happened to people who have passed on. 3. Older adults achieve spiritual resilience through frequent expressions of gratitude. 4. Have the patient determine whether her husband left a legacy behind. 5. Offer the patient her choice of rituals or participation in exercise.

3, 4, 5

9. A nurse used spiritual rituals as an intervention in a patient's care. Which of the following questions is most appropriate to evaluate its efficacy? 1. Do you feel the need to forgive your wife over your loss? 2. What can I do to help you feel more at peace? 3. Did either prayer or meditation prove helpful to you? 4. Should we plan on having your family try to visit you more often in the hospital?

3. Did either prayer or meditation prove helpful to you?

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. Workers who have a high school education

This is defined by the National Institute of Health as the enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients. 1. Linguistic competence 2. cultural assessment 3. culturally congruent care 4. Cultural competence

3. culturally congruent care

3. Which statement made by a patient who is recovering after recently experiencing third-degree burns shows connectedness? 1. "My pain medicine helps me feel better." 2. "I know I will get better if I just keep trying." 3. "I see God's grace and become relaxed when I watch the sun set at night." 4. "I feel so much closer to God after I read my Bible and pray."

4. "I feel so much closer to God after I read my Bible and pray."

7. 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. Eggs

What is the SWB scale?

Has 20 questions that assess a patient's relationship with God and his/her sense of life purpose and life satisfaction.

Culturally congruent care

aka transcultural care emphasizes the need to provide care based on an individual's cultural beliefs, practices, and values. Effective communication needed in order to provide this.

Inner Peace

fosters calm, positive, and peaceful feelings despite life experiences of chaos, fear, and uncertainty

What dietary regulations does the religion Islam have?

consumption of pork and alcohol is prohibited. Followers fast during the month of Ramadan.

Communication

verbal and nonverbal communication patterns are determined by cultural norms