Health Disparities

Patients with language barriers or poor levels of health literacy use healthcare services differently compared with patients with higher health literacy and may experience poorer outcomes. Patients with low health literacy are less likely to access preventive services, such as mammograms and influenza vaccinations; are less knowledgeable about their chronic conditions, making them less able to adequately manage disease; have higher hospital admissions and emergency room visits; and have lower medication management capacity

How do language barriers and low health literacy affect health?

Minority groups continue to have a greater incidence of preventable disease, death, and disabilities compared to nonminorities.

How does race affect health?

Lack of health insurance and high health care costs Language barriers Lack of transportation Provider-patient communication Biased clinical decision making Patient's mistrust and refusal

What are common avoidable and unacceptable health disparities?

Be an active listener Avoid appearing rushed Be formal with greetings until instructed otherwise Take greeting cues from the patient Speak slowly and clearly; do not speak loudly with exaggerated mouthing Explain why you are asking specific questions Give reasons for treatments Repeat questions as needed Provide written instructions in the patient's preferred language Obtain interpreter if needed

What are strategies for being a culturally competent communicator?

Ensure patients are comfortable before interviewing them. Maintain appropriate physical distances while also observing for cues. Be aware of cultural differences. Be aware of physical objects that may be a barrier to comfort. Make sure that the patient's physical environment is arranged to ensure safety, security, confidentiality, and familiarity.

What are strategies in terms of ensuring that space is taken into cultural consideration?

Ask the following questions: Are you at risk for any disease or genetic disorders? Are you satisfied with your weight? Are you active? What is your normal exercise pattern? Do you protect your eyes and skin from the sun? From possible injuries? Do you have any medication or food allergies? Has anyone in your family had any major illnesses? What do you eat to stay healthy? What do you eat when you are ill? Are there certain foods you do not eat? Why? Do certain foods cause you to become ill? What are they? Who purchases the food in your household? Who prepares the food in your household? Incorporate the following actions: Teach about biological variations that may pertain to the patient. Determine and respect usual eating patterns whenever possible. Teach good nutrition habits, taking into account patient preferences

What are strategies to assess and be sensitive to a patient's biological variations?

Ask the following questions: Who makes the decisions in your household? Who takes care of money matters, does the cooking, or is responsible for childcare? Who decides when it is time to visit a healthcare provider? Who lives in your household? Incorporate the following actions: Observe the use of touch between family members. Let family members decide where they want to stand or sit for comfort.

What are strategies to assess and be sensitive to a patient's social organization?

Ask the following questions to understand patients' time orientation: Are you normally on time for appointments? Are there any routines you need to follow? What time do you usually eat your meals? Take your bath? Incorporate the following actions: Have a clock in the patient's room. Assess for orientation and reorient to time as needed. Prepare patients before a procedure or test. Give time options when appropriate (e.g., "Would you like to take a walk now or in an hour?").

What are strategies to assess and be sensitive to a patient's time orientation?

•Encourage collaborations across communities and sectors •Empower individuals toward making informed health decisions •Measure the impact of prevention activities

What are the 3 goals of the healthy people initiative?

The possession of adequate financial resources for day-to-day living expenses and to pay for healthcare services greatly impacts an individual's ability to obtain healthcare

What are the effects of economic instability?

No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance." This law is also relevant to supportive services in healthcare, such as medical translators and language resources.

What is Title VI of the Civil Rights Act of 1964?

Bias that is blatant, purposeful, targeted, and intentional, intended to demonstrate that negative aspects of an individual or group are true

What is a conscious/explicit bias?

Health difference that is closely linked with social, economic, or environmental disadvantages. Any difference in health outcome that is related to bias, injustice, exclusion, marginalization, and social determinants

What is a health disparity?

stereotyping or discriminating based on someone's age

What is ageism?

Subconscious bias that is visible through subtle behaviors

What is an implicit bias?

An opinion that is unfair or prejudicial in some way

What is bias?

The realization and recognition that personal beliefs and values impact cultural health beliefs and potentially the view of those who are different

What is cultural awareness?

The ability of health careproviders and organizations to effectively deliver healthcare services that meet the social, cultural, and linguistic needs of patients. Culturally competent care means that nurses learn about each patient and tailor nursing actions to the individual patient and the patient's needs.

What is cultural competence?

An understanding, thoughtfulness, and kindness that leads to inclusiveness and equity

What is cultural sensitivity?

An integrated pattern of human behavior that includes thoughts, communications, languages, practices, beliefs, values, customs, courtesies, rituals, manners of interacting, roles, relationships, and expected behaviors of a racial, ethnic, religious, or social group; the ability to transmit the above to succeeding generations; is dynamic in nature.

What is culture?

The perception of oneself as belonging to one or more ethnic groups, including a commitment to cultural customs and ritual

What is ethnicity?

the end result of negative stereotyping (e.g., assuming all males who are transitioning to a female act a certain way) It can lead to gender discrimination or the unequal treatment of the patient.

What is gender bias?

How a person views him or herself

What is identity?

The physical differences that groups and cultures consider socially significant, such as skin color, hair texture, and eye shape or color

What is race?

Sexuality or sexual orientation is linked with gender identity and refers to which individuals a person chooses for romantic and sexual encounters.

What is sexuality?

Leininger's Culture Care and Universality Theory explains that nurses must first know the patients they are caring for—individual patterns, beliefs, practices, and personal expressions. The nurse is then informed and able to provide care that is congruent with the belief systems of the patients.

What is the Culture Care Diversity and Universality Theory?

The CLAS focus is respect and responsiveness, which translates into respecting the wholeness of each individual and responding to each individual's needs, preferences, and desires in order to provide services that reflect an individual's culture and language preferences.

What is the focus of Center for Culturally and Linguistically Appropriate Services (CLAS)?

Shows the factors and conditions that influence care. The concept of a sunrise is one that is most fitting to represent the process of cultural awakening; the rising sun begins first with a dim light but soon becomes bright. In a similar way, the professional nurse may begin with little cultural knowledge but strives to become aware and to expand knowledge and practice to better develop culturally focused interventions for the most vulnerable patients

What is the sunrise model?

Nursing theorist Madeline Leininger based the Transcultural Nursing (TCN) cultural assessment model on a humanistic approach that broadly supports individuals, organizations, communities, and societies and linking caring within the context of culture.

What is the transcultural nursing model?

acknowledges that nurses meet and care for patients who are different from themselves, and these differences may present a challenge.

What is transcultural nursing?

When an individual is afraid and demonstrates hatred or exhibits an attitudinal orientation of hostility against non-natives in a given population

What is xenophobia?