Foundations Exam #3 CH: 21, 22, 23

Leininger suggests three 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 re-patterning or restructuring

Four basic elements of culture are recognized

Culture is - learned - symbolic - shared - integrated

To assess, evaluate, and support a patient's spirituality, the best action a nurse can take is to ?

Determine the patient's perceptions and belief system.

Social Structures

Determines how people interact with one another

Which action by an individual best demonstrates enculturation?

Enculturation is the process whereby a culture is passed from generation to generation. Sharing cultural expectations with younger family members

The person's identification with or membership in a race, national, or cultural group and observation of the group's customs, beliefs, and language.

Ethnicity

What is spirituality?

Expressing meaningful aspects of self

Spiritual Assessment Framework: FICA

F: Faith and belief I: Importance of faith C: Faith community involvement A: Address spirituality

The belief beyond self that is based on trust and life experience rather than scientific data

Faith

Pettigrew maintains that nursing care that fails to recognize a patient's spiritual needs as a part of holistic care is unethical and defies the ethical concept of ________

Fidelity

Transcultural 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.

Emic Perspective

Focuses on the local, indigenous, and insider's culture

Etic Perspective

Focuses on the outsider's world, and especially on professional views

Rituals

Formal, stylized, repetitive, and stereotypical actions performed in special places at special times.

Define: Ethnicity

Is the person's identification with or membership in a race, national, or cultural group and observation of the group's customs, beliefs, and language. •is based on cultural similarities and differences within a society or nation. •Similarities occur with members of the same group; differences occur between members of the group and others. •Ethnicity may include a reference to skin color because group membership often is based on national origin, which may encompass a particular race. •Ethnicity is frequently a central consideration in providing culturally appropriate nursing care.

Enculturation

Is the process whereby a culture is passed from generation to generation.

When caring for patients, the nurse must understand the difference between religion and spirituality. Religious care helps individuals

Maintain their belief systems and worship practices

Culture is based on __________

symbols

Race

is a socially constructed concept that tends to group people by common descent, heredity, or physical characteristics.

Giger and Davidhizar's Transcultural Assessment Model is a framework for collecting data related to six cultural domains:

-Communication - Space - Social orientation - Time - Environmental control - Biologic variation

Generalizations

A statement, idea, or principle that has a broad application. Generalizations typically infer or draw conclusions from many factors. Generalizations are a beginning point; one should gather more information to ascertain whether a generalized statement is appropriately applied to an individual or group.

Faith

A belief beyond self that is based on trust and life experience rather than scientific data.

Cultural Openness

A lifelong stance that promotes cultural self-awareness and continuing development of transcultural skills. We will always need to continue to learn

Acculturation

A mechanism of cultural change achieved through the exchange of cultural features resulting from first-hand contact between groups.

Stereotype

A set of fixed ideas, often unfavorable, about members of a group •Stereotypes can be viewed as an ending point, because no attempt is made to learn whether a perception or belief applies to a particular person. •The acceptance of stereotypes ignores the individuality of people within a cultural group. •In the patient-nurse relationship, there is no place for stereotypes. •The nurse needs to interview and assess each patient with an open mind to obtain accurate information for planning culturally competent care.

If you were the nurse caring for a Chinese patient, what would be an appropriate question to determine religious practices?

Are there any religious practices I need to know about to help care for you?

The Rule of Descent

Arbitrarily assigns a race to a person based on a societal dictate that associates social identity with ancestry. This practice divides society and perpetuates disparities in health care.

The process by which individuals from one cultural group merge with, or blend into, a second group is known as

Assimilation

Spiritual Distress

Belief or value system disruption Patients are at high risk for spiritual distress in certain health situations that threaten their meaning and sense of purpose in life. Patients may have spiritual needs when learning of a life-changing diagnosis or experiencing a health crisis. These situations require that patients reflect on meaning and purpose in life, personal values, and the way their decisions affect others

Atheist

Believes that God or higher powers do not exist

Agnostic

Believes that the nature or existence of God is unknowable

Health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. These disparities are often exacerbated by

Bias Stereotyping Prejudice

The four C's of culture

Call: What do you call your problem (What do you think it wrong) Caused: What do you think caused your problem? Cope: How do you cope with your condition? Alternative treatments? Concerns: How serious do you think it is, or what do they fear?

Spiritual Assessment Framework: HOPE

H: Sources of hope, meaning, comfort, strength, peace, love, and connection O: Organized religion P: Personal spirituality and practice E: Effects on medical care and end-of-life issues

The confidant expectation of a positive outcome in the face of challenging circumstances

Hope

The foundation of culture includes three structural elements that work together to keep the culture strong:

Infrastructure Social structure Superstructure

Spiritual Care

Nursing practice is a mutual, purposeful, interactive process between a nurse and a patient, which may include family, to promote the patient's spiritual health. Nurses provide spiritual care when they recognize the interconnectedness of the physical, cultural, and spiritual realms and actively seek to understand and provide for each patient's holistic needs.

To be a culturally competent nurse, there are many factors to understand about a patient

Nutrition Dietary needs Spirituality and religion Health beliefs Socioeconomic level

Superstructure

Or worldview, provides a belief system that helps people identify themselves, their society, and the world around them.

Discrimination

Policies and practices that harm a group and its members •According to Kottak, discrimination may be de facto (practiced, but not legally sanctioned) or de jure (legally sanctioned). •An example of de facto discrimination is the harsher treatment that minorities may face from law enforcement agencies or the judicial system. This discrimination is unlawful and illegal but continues to happen. •Two examples of discrimination de jure are the once-legal practices of segregation in the United States and apartheid in South Africa. •Although these practices are no longer legal, in both instances the unequal treatment of blacks and whites was sanctioned by law. •Each group had different rights and privileges, a situation that fostered prejudices and discrimination. •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.

Parish Nursing

Provide holistic care by focusing on the mind, body, and spirit in addition to community wellness Roles: health adviser and educator, health advocate, liaison to faith and community resources, coordinator of volunteers, and developer of support groups

Religion

Provides a structure for understanding spirituality and involves rites and rituals within a faith community. •Many people find meaning and purpose—that is, express their spirituality—through religion. •Most religions celebrate life events such as birth, marriage, and death with rituals such as baptism, marriage ceremonies, and funerals. •Religious rituals provide a framework for honoring life events. •Religion can provide a process of discerning meaning and purpose during crises, particularly crises involving health. Therefore, religious faith rituals are important in promoting health.

Infrastructure

Provides the necessities of life

Which action by a health care facility would demonstrate a commitment to providing culturally competent care?

Providing continuing education events focused on delivery of linguistic services

What are the three levels of culture?

Purnell described three levels of culture: •(1) At the tertiary level, culture is visible to outsiders and is reflected in observable attributes and behaviors; •(2) at the secondary level, members of a particular group know the rules of behavior and other defining characteristics and can articulate them; and •(3) at the primary level, the group rules are known by all, observed by all, implicit, and taken for granted.

Which action by the nurse is essential to providing culturally congruent care?

Recognize one's own personal cultural heritage, patterns, and biases

Define: Culture

Refers to the learned, shared, and transmitted knowledge of values, beliefs, and ways of life of a 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.

Spiritual Assessment Framework: SPIRIT

S: Spiritual belief system P: Personal spirituality I: Integration and involvement in a spiritual community R: Ritualized practices and restrictions I: Implications for medical care T: Terminal-events planning (advance directives)

Which strategy would most help an English-speaking nurse to communicate with a patient for whom English is a second language?

Slow down when speaking to articulate more clearly

The dimension of the human self that thinks, contemplates, and explores the meaning and purpose in life

Spirit

The disruption in the belief or value system of a person is considered ?

Spiritual Distress

Some nursing diagnoses that may be written for patients exhibiting spiritual needs include:

Spiritual Distress related to chronic illness as evidenced by expressions of hopelessness and statements indicating concern over the recent inability to pray Impaired Religiosity related to illness as evidenced by difficulty adhering to religious dietary customs and expressions of emotional distress over special diet restrictions Readiness for Enhanced Religiosity as evidenced by rejecting harmful customs and seeking reconciliation with previously estranged family members

What is transcendence?

Spiritual growth over time

The expression of meaning and purpose in life; the expression of the innermost self

Spirituality

Prayer

Spoken or unspoken communication with a higher power. The specific mode of praying is often influenced by the person's religious or faith belief system.

The Joint Commission identified health care for people of diverse cultures

The Joint Commission has identified health care activities within every step of the nursing process to ensure enhanced communication with people of diverse cultures: •On a patient's admission to a health care facility, patient information regarding language preference; race; ethnicity; cultural, spiritual, and religious beliefs; and dietary needs and restrictions is to be assessed and documented in the electronic health record. •Throughout treatment, changes in patient communication status, changes in patient dietary needs or restrictions, and accommodations for patient cultural, religious, and spiritual beliefs are to be noted and addressed. •During discharge planning and community agency referral, patient communication needs are to be met to ensure a smooth transition and enhanced patient outcomes.

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.

Cultural Competence

The complex integration of a person's knowledge, attitudes, beliefs, skills, and encounters with those of people from different cultures

Hope

The confident expectation of a positive outcome in the face of challenging circumstances.

Spirit

The dimension of the human self that thinks, contemplates, and explores the meaning and purpose in life.

Spirituality

The expression of meaning and purpose in life. It is the expression of the innermost self.

Assimilation

The process by which individuals from one cultural group merge with, or blend into, a second group.

Socialization

The process of being reared and nurtured within a culture and acquiring its characteristics. The family is the basic unit of society in all cultures. Community is defined as a group of people having a common interest or identity.

Reflection

The process of contemplating experiences, sometimes even life-changing experiences, and searching for meaning in those events.

Prejudice

The process of devaluing an entire group because of assumed behavior, values, or attributes. People demonstrate prejudice when they apply group stereotypes to individuals and assume that all people within a group will act in a predetermined manner Prejudice includes "labeling" groups or cultures—for example, as lazy or materialistic. Nurses are guilty of prejudicial thinking if they anticipate certain patient behavior based on a patient's appearance or on previous interactions with people of similar ethnicity or culture.

Transcendence

The process of moving beyond who one is in the moment and toward the person one will become in the future.

Cultural Sensitivity

The recognition of the often pronounced differences among cultures

Culturally Congruent Care

The use of culturally based knowledge in sensitive, creative, safe, and meaningful ways to promote the health and well-being of individual people or groups and improve their ability to face death, disability, or difficult human life conditions

Racism

Unfounded belief that race determines a person's character or ability and that one race is superior or inferior to another.

Symbols

are signs, sounds, clothing, tools, customs, beliefs, rituals, and other items that represent meaningful concepts.