Chapter 21: Cultural Competence

Assessment questions r/t culture

birthplace of client, parents, and grandparents # of years in this country ethnic affiliation primary, secondary language what contributes to good/bad health origination of illness plan for health restoration support person

Cultural Generalizations -Russian

Bad news is traditionally not given to patients. Patients and families may ask for new treatments or procedures.

religion

a strong belief in a supernatural power or powers that control human destiny

Socialization (Community) -a group of people having a ___________ or identity. -The concept includes physical, social, and symbolic characteristics that connect people within a group.

-common interest

___________ begins with the recognition of cultural differences. However, a person needs more than just awareness of those differences in order to interact effectively across cultures.

Cultural sensitivity

-________ is the belief that a person's character or ability is determined by race and that one race is superior or inferior to another. -________ are most likely to engage in discrimination, persecution, and violence against those they deem to be members of inferior races

-Racism -racists

Cultural Concepts: 1 -A _________ is a statement, idea, or principle that has a broad application; drawn from many factors; only a beginning point; we should gather more info to verify whether a generalized statement is appropriately applied to a person/group -tend to be applied broadly in regard to common beliefs, behaviors, and patterns shared by a particular culture. -may be applied when traits that are fairly consistent across cultures can be identified within a particular group, but ______________ -ex: nurse taking care of a Middle-Eastern woman goes directly to the pts husband for consent for treatment when the woman prefers to make her own health care decisions. To avoid the negative impact of generalization, the nurse must assess each pts preferences to account for individual differences

-generalization -individual differences should never be forgotten.

cultural awareness

An in-depth self-examination of one's own background, recognizing biases, prejudices, and assumptions about other people

Cultural Generalizations -Chinese

Some tend to engage in more formal conversation and relationships. They may believe that hot and cold food items treat disease. -beliefs: Strong sense of personal honor; perceived loss of respect can have devastating effects; the hierarchical family structure; accommodation as opposed to confrontation; Coining and cupping are common health care practices; Concept of keeping yin (cold) and yang (hot) balances through lifestyle practices, dietary intake, and alternative therapies, such as acupuncture; Shame associated w/ mental disorders.

Cultural maintenance

Helps people of a particular culture retain and/or preserve relevant care values so that they can maintain their sense of well-being, recover from illness, or face handicaps and/or death.

Oppression

•system of advantages and disadvantages tied to membership in social groups •Leads to limited access to healthcare, housing, education, employment, and legal services

ethnohistory

significant historical experiences of a particular group

social organizations

family unit/ nuclear

4) Integrated: -cultures are patterned systems - foundation of culture includes 3 structural elements that work together to keep culture strong:

-1: infrastructure provides the basic necessities of life. -2: social structure determines how people interact with one another. -3: superstructure, or worldview, provides a belief system that helps people identify themselves, their society, and the world around them. -if 1 part changes, the other parts change as well

Which is a characteristic of ethnicity? Select all that apply. A) Group customs B) Skin color C) Group beliefs D) Gender roles E) Common language

-A) Group customs (The customs of the group help define the individuals' similarity, part of the basis of ethnicity) -B) Skin color (Ethnicity may be related to a person's skin color, but it is not delineated by it) -C) Group beliefs (are a core component of a particular ethnicity, bonding its members) -E) Common language (such as Spanish, is a characteristic that denotes a group's ethnicity)

Morphology

-Asians generally have a smaller body stature than Anglo-Americans, African Americans, and Mexicans -African Americans and Latinos may be more comfortable with a higher body mass index than Anglo-Americans and Asians.

When people are judged on the basis of prejudices or stereotypes and are treated differently, they are victims of discrimination, which can take many forms:

-unequal access: (Minorities discouraged from living in certain neighborhoods. Women and minorities getting unequal access to employment, education, and social services. Mentally ill denied housing or employment based on the unfounded belief they will harm others) -exclusion: (Women and minorities excluded from upper-management positions in the workforce. Social clubs that exclude people based on race, gender or religion) -application of justice: (In some countries, jailing of homosexuals simply because of their sexual orientation. Higher probability of receiving the death penalty for African-Americans convicted of first-degree murder.)

Four basic characteristics of culture are recognized. Culture is:

1)Learned 2)Symbolic 3)Shared 4)Integrated

cultural skills

Ability to assess social, cultural, and biophysical factors that influence patient treatment and care

Leininger's Transcultural Caring

Caring is an essential human need. Caring helps an individual or group improve a human condition. Caring helps to protect, develop, nurture, and sustain people. culturally congruent care; fits personal life patterns and meanings generated by identity

Which method is demonstrated when an individual blends into another cultural group? A) Immigration B) Generalization C) Acculturation D) Assimilation

D) Assimilation -Assimilation is the process by which an individual blends into a different cultural group. It facilitates change within the culture over time in language, technology, food, clothing, and so on.

Cultural Generalizations -African American

Family networks are valued. Religious communities actively seek to influence lifestyle and political preferences. Some African Americans have a distrust of health professionals as a consequence of historical injustices. -beliefs: Illness represents disharmony and conflict in aspects of a person's life; Beliefs tend to fall in 3 categories: 1. Impaired relationships, 2. Environmental hazards, 3. Divine punishment; OA from south may have a distrust of traditional health care.

_________ is needed to offer appropriate care and responses to patients w/ culturally diverse backgrounds; helps RN respond to needs of pts and communities they serve; Nurses skilled at cross-cultural communication, including verbal and non-verbal communication, communication dialects, and communication styles within various cultural groups, constitute valuable resources for health care agencies serving highly diverse populations. -National Culturally and Linguistically Appropriate Standards (CLAS)

Linguistic competence

European Americans

Nuclear families/ Extended families English Noncontact people except southern countries FUTURE over present oriented Risks: BREAST CA, HEART DISEASE, DM

Cultural care re-patterning or restructuring

Respects the patient's cultural values and beliefs while helping patients reorder, change, or modify their lives and adopt new, different, and beneficial health care patterns.

Cultural Generalizations -Muslim

Some may demonstrate passivity in the presence of an authority figure. Same-gender caregivers are preferred for most personal care.

de facto discrimination

The harsher treatment that minorities may face from law enforcement agencies or the judicial system is an example. It is unlawful and illegal but continues to happen.

de jure discrimination

The once legal practice of segregation in the United States is an example. Although no longer legal, the unequal treatment of blacks and whites was sanctioned by law.

health disparity

a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage -Health status, disease risk factors, poor outcomes, limited access

The _________ of a particular group of people are manifestations of culture.

art, literature, costumes, customs, language, religion, and religious rituals

Environment control

cultures way to define health

communication

different language silence, non-verbal language

space

personal space

Socialization (School) -official place a society's accumulated knowledge and skills are _____________ -people learn to interact with peers outside their immediate social circle. These peers are often from diverse backgrounds.

-imparted from one generation to the next.

-_____________ is the complex integration of a person's knowledge, attitudes, beliefs, skills, and encounters with those of people from different cultures -a lifelong process -cultural sensitivity and cultural congruent care. -awareness, knowledge, skill, encounter, desire

Cultural Competence

American Indian

Folk medicine, Shawman - traditional healer Family oriented respect TRADITION Space has NO BOUNDARIES PRESENT oriented Risks: ACCIDENTS, CV DISEASE, DM, CIRRHOSIS increased incidence of alcoholism, healing methods include restoring balance, SAGE in ceremonies, clarify communication, obtain input from family eye contact = disrespectful

Cultural Generalizations -Amish

Health care costs are shared by members of the community. Some Amish may use herbal products and remedies, for both prevention and treatment.

Cultural Generalizations -Hispanic/Latino

Traditionally present-oriented, viewing time as relative to the situation. They may use spiritual amulets, religious medallions, or rosary beads. -beliefs: May not seek medical care due to distrust, poverty, or problems with immigration status; prefer traditional healing practices; Traditional diagnoses and treatments may be categorized as "hot" or "cold" ; Hypertension may be considered a hot disorder that would be treated with cold therapies.

time

past, present, future oriented may be late for appointments

family

-In traditional Asian cultures, wives and children take care of a sick husband or father. -Self-care is valued among most American families.

Which are characteristics of culture? A) Symbolism B) Inherited C) Learned D) Shared E) Integrated

-A) Symbolism (Culture is based on symbols) -C) Learned (learned by growing up with traditions) -D) Shared (sharing of traditions and beliefs through generations) -E) Integrated (an integrated system with infrastructure, social structure, and superstructure)

gender

-Gender roles differ among cultural groups. -Women in Latino cultures often adhere to the wife/mother/housewife role. -Men are the decision makers in traditional Mexican and Indian cultures.

-the founder and central leader of transcultural nursing is _________________, who discovered major cultural differences among children and parents in a psychiatric unit. •She was among the first to realize the need to address _______ as a critical and missing dimension of care. -___________: Gender, race, age, and class are embedded within the social structure; Biology, emotions, and other dimensions are studied from a holistic view and are not fragmented

-Madeleine Leininger -culture -Sunrise Model

Culture, Ethnicity, and Religion

-Orthodox and some conservative Jewish patients require a kosher diet. -Jehovah's Witnesses refuse blood transfusions. -Seventh Day Adventists regard the body as a temple and typically do not eat meat or consume caffeine, alcohol, or tobacco products.

Cultural Concepts: 3 -_________ is the process of devaluing an entire group because of assumed behavior, values, or attribute -is demonstrated when people apply group stereotypes to individuals and assume that all people within a group will act in a predetermined manner. -"labeling" a group based on pts appearance or on previous interactions w/ similar ethnicity/culture -ex: A nurse taking care of an African American patient decides to forgo teaching about exercise because she thinks all African Americans are lazy.

-Prejudice

-_______ is a socially constructed concept that tends to group people by common descent, heredity, or physical characteristics -___________ arbitrarily assigns a race to a person on the basis of a societal dictate that associates social identity with ancestry. In some states, if people have any ancestors of minority descent, no matter how remote, they are classified as a member of that minority

-Race -rule of descent

-_________ are formal, stylized, and repetitive actions performed in special places at special times. These actions are used to inform others about the beliefs and traditions of a culture. -translate into enduring messages, values, and sentiments; ex: religious activities, such as _____________.

-Rituals -praying, baptizing, fasting, singing, meditating, and reading the Torah, Bible, or Koran

-__________ is the process of being reared and nurtured within a culture and acquiring its characteristics. The process usually occurs within the structure of a group that influences the health care behaviors and beliefs of its members and can directly and indirectly affect the administration of health care by the nurse. -Socialization occurs on many different levels: within __________________.

-Socialization -families, communities, schools, and spiritual or religious groups

Nurses should be aware of both helpful and detrimental concepts that can affect patient care. The concepts that affect cultural competence are:

1) Generalization 2) Stereotypes 3) Prejudice 4) Discrimination 5) Race

Which question should the nurse ask a patient to elicit the patient's ethnicity? A) "What racial, national, or cultural group do you identify with?" B) "What part of the world or geographic region are you from?" C) "What is your native language or dialect?" D) "What customs or rituals do you observe regarding illness?"

A) "What racial, national, or cultural group do you identify with?" -This question allows nurse to identify patient's ethnic identity.

What is the belief that one's own culture is superior to those of other cultures? A) Ethnocentrism B) Ethnicity C) Discrimination D) Prejudice

A) Ethnocentrism -Ethnocentrism is the belief, based on one's own cultural values, that one's own culture is superior to those of others.

nursing diagnoses r/t culture

Anxiety communication, verbal, impaired decisional conflict fear noncompliance social interaction impaired spiritual distress

Which situation is an example of ethnocentrism? A) The Chinese immigrant is absorbed into Western culture and loses aspects of her home culture. B) The Chinese immigrant seeks Western health care treatments in addition to traditional Chinese remedies. C) The nurse tells the patient that cupping will not help her get well because the only reliable treatment for her illness is antibiotics. D)The nurse assumes all Asian patients prefer Eastern medicine practices to Western medicine.

C) The nurse tells the patient that cupping will not help her get well because the only reliable treatment for her illness is antibiotics. -Ethnocentrism is the belief that one's own culture is superior to that of another while using one's own cultural values as the criteria by which to judge others. The nurse tells the patient that her cultural practice will not work, believing that only Western medicine will help her.

Ethical, Legal, and Professional Practice: -core measures

CMS, TJC-hold healthcare providers accountable for considering unique cultural perspectives; must provide safe quality care

cultural encounters

Cross-cultural interactions that provide opportunities to learn about other cultures and develop effective intercultural communication communication and skills

__________ care uses culturally-based knowledge in sensitive, creative, safe, and meaningful ways to promote the health and well-being of individuals or groups and improve their ability to face death, disability, or difficult life conditions; ex: when RN learns about a patient's culture and incorporates it into the plan of care.

Culturally congruent

Which describes the concept of generalization? A) An end-point that is applicable to all individuals in a cultural group. B) Used to anticipate certain behaviors in given particular situations. C) A set of fixed ideas about members of a certain group. D) Statements, ideas, or principles that have a broad application.

D) Statements, ideas, or principles that have a broad application. -Generalizations can be useful when traits are similar across cultures; however, individual differences between cultures must always be kept in mind.

Cultural care accommodation or negotiation

Helps people of diverse cultures adapt to or negotiate with others for beneficial or satisfying health outcomes with professional care providers.

cultural knowledge

Information, skills, attitudes, conceptions, beliefs, values, and other mental components of culture that people socially learn during enculturation. sensitivity and respect

biological variations

Physical, biological, and physiological differences that exist and distinguish one racial group from another. body build, genetics, skin color

Cultural Generalizations -Japanese

Prayers are commonly practiced at the bedside of a dying patient. Doctors are seen as authority figures, so patients and their families may hesitate to ask questions.

African Americans

Single-parent family Large, extended family networks strong CHURCH affiliations close personal space PRESENT oriented Risks: HTN, SICKLE CELL ANEMIA, HEART DISEASE, ESOPHAGUS and STOMACH CA flexible timing, female may be HOH, clarify communications - don't assume they understand, respect alternate treatments

social determinants of health

The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels

Non-nursing models for cultural assessment include the _______________.

Transcultural Theory and Assessment Model; 4 C's of Culture; and Giger and Davidhizar's Transcultural Assessment model

social determinants of health include:

age race ethnicity socioeconomic status access to nutritional food transportation resources religion sexual orientation level of education literacy level disability (physical and cognitive) geographical location

Asian americans

family hierarchial structure value LOYALTY large extended family networks use of SILENCE, nonverbal Noncontact people PRESENT oriented Risks: HTN, LIVER, STOMACH CA Use of herbs, acupuncture, limit eye contact, little touch, may want to be care for by person of the same sex

Some cultural tendencies that should be taken into consideration during the planning stage of the nursing process are:

family; gender; Culture, Ethnicity, and Religion; Morphology

Ethical, Legal, and Professional Practice: -Admission assessment to health care facility

language preference; race; ethnicity; cultural; spiritual; and religious beliefs, dietary needs & restrictions: document in electronical health record

•Leininger suggests 3 types of professional action and decision-making strategies that promote patient-centered care based on a nurse's knowledge of a patient's culture:

•Cultural maintenance •Cultural care accommodation or negotiation •Cultural care repatterning or restructuring

Socialization (Spirituality/Religion) -profoundly impacted by spiritual and religious institutions. These institutions can_________ in impoverished communities and less developed countries.

- greatly influence health beliefs and often provide an entry point for health care access

Which statement about culture is true? A) Members are delineated by geographic boundaries. B) Individual thinking is influenced by cultural beliefs. C) Groups identify themselves based on similar traits. D) Practices remain stable and rarely change over time.

-B) Individual thinking is influenced by cultural beliefs. -A person's culture influences the way a person thinks and makes decisions; it also impacts the patterns of actions the person takes.

4 C's of Culture

-Call: What do you call your problem? -Caused: What do you think caused your problem? -Cope: How do you cope with your condition? -Concerns: What are your concerns regarding the condition and/or treatment?

-_______ refers to the learned, shared, and transmitted knowledge of values, beliefs, and moral ways of life of a particular group that generally are transmitted from one generation to another and influence the individual person's thinking, decisions, and actions in patterned or certain ways -has a family and group component that is learned and is __________ biologically

-Culture -not transmitted

Transcultural Theory and Assessment Model

-Developed by Madeleine Leininger. -First tool developed for nurses to assess a patient's culture and evaluate the impact of culture on nursing care. -Since the development of this tool, other nursing models have been developed to assist nurses in providing culturally congruent and competent care.

Cultural Concepts: 4 -_________ refers to policies and practices that harm a group and its members. -There are two types:

-Discrimination -de facto (practiced, but not legally sanctioned) & de jure (legally sanctioned).

-__________ is a shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics -is pts identification w/ or membership in a particular _________; and observation of the groups customs, beliefs, and language -based on cultural similarities (w/ with members of the same group) & differences (b/w between members of group and others) within a society or nation -may include a reference to ___________ bc group membership often is based on national origin, which may encompass a particular race -is characterized by shared _________________. -is primarily _____, whereas culture is learned.

-Ethnicity -racial, national, or cultural group -skin color -cultural heritage, ancestry, history, and physical appearance -inherited

Giger and Davidhizar's Transcultural Assessment Model

-Framework for collecting data related to 6 cultural domains: 1.Communication 2. Space 3. Social orientation 4. Time 5.Environmental control 6. Biologic variation

acculturation

-The adoption of cultural traits, such as language, by one group under the influence of another. -mechanism of cultural change achieved through the exchange of cultural features resulting from firsthand contact between groups -occurs when separate groups come together and one or both groups' cultures change over time, but both groups remain distinct. -cultural changes in language, technology, food, clothing, music, and other aspects. -Pidgin: a mixed language that develops to facilitate communication between members of different groups who come in contact with one another, usually as a result of trade or colonialism. It blends the basics of English with the grammar and pronunciations of the native language.

-__________ nursing focuses on human caring-associated differences and similarities among the beliefs, values, and patterned life ways of cultures to provide culturally congruent, meaningful, and beneficial health care. -____________, a lifelong stance that promotes cultural self-awareness and continuing development of transcultural skills -focuses on worldwide cultures and comparative cultural caring, health, & nursing

-Transcultural -cultural openness

Socialization (Family) -The family is the _______ unit of society in all cultures. -________, a family is a social unit that works together to meet material needs. -__________, a family is a social unit that interacts within the larger society. -family unit is where personality develops and subgroup relationships, such as that between parent and child, are created.

-basic -Economically -Sociologically

Daily life is affected by ______________ for everyone throughout the world. Thousands of ethnic and cultural groups are recognized globally and within individual countries and regions. As an example, Algeria has a population made up of only two primary ethnic groups, whereas the Democratic Republic of the Congo has more than 200 African ethnic groups represented

-culture and ethnicity

1) Learned: -not biologically inherited; it is acquired by _____________. -____________is the process where a culture is passed from generation to generation; begins at birth; child is taught what family responsibly and contributions are expected consciously & unconsciously through interactions w/ them -can be taught ________ (hand on) or __________ (observation)

-growing up in a particular society and being exposed to traditions -Enculturation -directly; indirectly

Ethnicity & Culture Assessment: -Nurses are required to collect data regarding the patient's ___________ when the patient is admitted to a health care facility. -___________ nursing as a specialty seeks to address the multifaceted aspects of ethnicity and culture; nurses need to achieve increasing levels of cultural competence throughout their careers in order to provide unbiased, holistic care.

-language and ethnic, cultural, spiritual, and dietary preferences -Transcultural

2)Symbolic -Culture is based on symbols; symbols are: -__________ is the most important symbol of a culture because words are used to represent objects and ideas. -Images like _______ are non-verbal symbols that represent shared ideas or beliefs; ex: the American Red Cross uses a single red cross on a field of white as a symbol of its relief efforts. -mention of certain symbols automatically conjures up ______.

-signs, sounds, clothing, tools, customs, beliefs, rituals, and other items that represent meaningful concepts -Language -flags -images and associations

Cultural Concepts: 2 -A _________ is a set of fixed ideas, often unfavorable, about members of a group. -ending point, because no attempt is made to learn whether a perception or belief applies to a particular person. -Unfair discrimination and persecution can be the result

-stereotype

ethnocentrism

-the belief that one's own culture is superior to that of another, while using one's own cultural values as the criteria by which to judge other cultures -ex: some western medical practitioners believe that their approach to health and healing is far superior to that of non-Western practitioners. -Leininger says: lead to cultural imposition, or imposed actions that are based on the dominant culture's view of what works best.

assimilation

-the social process of absorbing one cultural group into harmony with another -gives up own identity to take on the dominant culture -individuals from one cultural group merge with a second group. Members of one group, usually the minority group, enter into and become a part of a second group through continuous social interaction. -melting pot process and regarded this process as a natural and necessary aspect of immigrant adaptation to life in a new country -intergroup (intercultural) marriage -ex: Chinese speaking women comes to America and marries man; she learns English, changes maiden name, adopts US culture

3) Shared: -People who grow up together typically have shared ________. These shared attributes are passed down generations through teaching and sharing of ideas, traditions, and rituals. -is the ________ that makes the actions of a person intelligible to other group members -A shared element found in all cultures is that __________

-values, beliefs, ideals and expectations -"common denominator" -gender roles are assigned to men and women

Delivering Culturally Congruent and Competent Care Leininger and McFarland have outlined 10 steps in the delivery of culturally congruent and culturally competent care. Follow these steps to deliver culturally congruent and culturally competent nursing care:

1. Gain knowledge of pts culture from reliable literature & transcultural nursing courses. 2. Be familiar with 1s own cultural heritage, patterns, & biases that may interfere w/ assessment & understanding of pt. 3. Use theoretical perspectives to guide cultural assessment. 4. Know some common phrases in pts language & work w/ interpreters. 5. Show respect & interest in pts culture. 6. Be observant of the environmental context in which the pt interaction takes place. 7. As pt shares emic or etic data, reflect on & check meaning of data w/ pt. 8. Make pt an active co-participant in assessment to collect credible & accurate data. 9. Identify specific & general cultural care values, beliefs, & needs related to generic (emic) and professional (etic) data for possible integrated culturally congruent care. 10. Use assessment findings in sensitive, knowing, creative, & meaningful ways so that beneficial and satisfying outcomes are forthcoming.

"All Asians eat fish and rice" is an example of which concept that affects cultural competency? A) Generalization B) Stereotyping C) Racism D) Discrimination

A) Generalization -A generalization is a broad statement about the behaviors, beliefs, and common customs of a culture. -B: A stereotype is a set of fixed ideas, often unfavorable, about members of a group. -C: Racism is the belief that a person's character or ability is determined by their race; and one race is superior to another. -D: Discrimination is policies or practices that harm a group and its members.

Which outcome is an effect of stereotyping when planning care for a patient? A) Misperceptions about the patient, resulting in a unsuitable plan of care B) Development of a plan of care that is holistic. C) Development of a culturally-sensitive plan of care D) Simplification of the care planning process

A) Misperceptions about the patient, resulting in a unsuitable plan of care -Stereotyping can adversely affect the plan of care, because it allows for misperceptions about the patient.

Which example describes discrimination? A) Classifying all homeless people as "crazy" B) Assuming a male patient is "stoic" because the patient is Hispanic C) Stating all white people are "superior" D) Withholding pain medication from a drug addict

D) Withholding pain medication from a drug addict =This is an example of discrimination, the practice of treating members of a particular group less fairly than others. -A: This is an example of prejudice, the practice of devaluing a group of people. -B: This is an example of a stereotype, a fixed idea about members of a group. -C: This is an example of racism, the holding of a false belief that a particular race is superior or inferior.

LEARN model

L: listen: person's perception of the problem, be nonjudgemental E: explain: your perception of the problem A: acknowledge: difference & similarities b/w perceptions R: recommend: must involve patient N: negotiate: treatment plan, considering its beneficial to incorporate selected aspects of pt's culture into the plan

cultural assessment

examination of cultural care values, beliefs, and practices of individuals, families, and communities used to provide culturally congruent care builds a trusting relationship shows genuine interest in clients take your time// may need interpreter

Hispanic Americans

folk medicine, healers Nuclear families, extended networks Strong CHURCH affiliations value physical appearance PRESENT oriented Risks: DM, HTN, CV DISEASE, CAD

cultural imposition

make unfair use of your own values when caring for people of different culture -- culturally blind using own customs as a guide when dealing with patients

In the US, the 2010 census identifies a population of ___________; not including Hispanics or Latinos of all races, w/ 2.9% of people identifying w/ 2 or more races

more than 6 different races

Ethical, Legal, and Professional Practice: -Discharge planning & community agency referral

pt. communication needs are to be met to ensure a smooth transition & enhanced pt. outcomes

cultural competence

the ability to interact effectively with people of different cultures