Chapter 9

A nurse implementing the principles of intersectionality will focus on what patient characteristic A. Values B. Illness C. Health D. Experiences

D. Experiences -intersectionality is a research and policy model used to study the complexities of peoples lives and experiences

A mother is concerned about her child's flu like symptoms. You learn from the health assessment that the mother uses the "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 fruit 4. Eggs

Eggs

Unconscious bias

refers to a bias we are unaware of and that happens outside our control, which is influenced by our personal background, cultural environment, and personal experiences

Clarify

If a patient cannot remember or accurately repeat your instructions clarify your information and allow him or her to teach it back again

Recommendations

Must involve the patient

Acknowledge

Not only the differences between the two perceptions of the problem but also the similarities

We are responsible for implicit bias and must recognize and acknowledge

Our actions as they impact our behavior, decisions and patient centered care provided

Culture

Refers to the learned and shared beliefs, values, norms, and traditions of a particular group , which guide our thinking, decisions and actions

When making an accurate assessment of an individuals unique characteristics and world view be sure to avoid

Stereotypes or unwarranted generalizations about ay particular group- this prevents an accurate assesment of individual

If you learn that an individual believes in a "hot" and "cold" balance when choosing to eat

Support your patients practices, and adapt this information into the patients dietary plan

The core measures are

key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs

In addition to improving standard or care the core measures

Are intended to reduce health disparities

Limited access to health care is one social determinant of health care that

Contributes to health disparities

Effective communication is a critical skill in

Culturally competent care and helps you engage a patient and family in respectful, patient centered dialogue

The nurse learns about cultural issues involved in the patient's healthcare belief system and enables patients and families to achieve meaningful and supportive care. Which concept is the nurse demonstrating A. Marginalized care B. Health care disparity C. Transcultural nursing D. Culturally congruent care

D. Culturally congruent care

intersectionality is a research and policy model used to study the complexities of

peoples lives and experiences

Clarify and check again

If teach-back uncovers a misunderstanding, explain things again using a different approach. Ask patients to teach-back again until they are able to correctly describe the information in their own words. If they parrot your words back to you, they may not have understood.

emic world view, etic world view

In any intercultural encounter there is an insider perspective (______) and an outsider perspective (________ )

Oppression occurs at

Individual and group experiences

Examples of marginalized groups

include people who are gay, lesbian, bisexual, or transgender; people of color; people who are physically or mentally challenged; and people who are not college educated.

presence

is a person-to-person encounter conveying a closeness and sense of caring

Intersectionality

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

Caring

is a universal phenomenon influencing the ways in which people think, feel, and behave in relation to one another

stereotype

is an assumed belief regarding a particular group

ethic of care

is concerned with relationships between people and with a nurse's character and attitude toward

Cultural skill

is the ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patient's presenting problem, as well as accurately conducting a culturally based physical assessment

cultural competence

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

Marginalized groups

more likely to have poor health outcomes and die at an earlier age because of a complex interaction among their -individual behaviors, -environment of the communities in which they live -the policies and practice of health care and governmental systems -clinical care they receive

Culturally congruent care

or transcultural care emphasizes the need to provide care based on an individual's cultural beliefs, practices, and values; therefore, effective communication is a critical skill in culturally competent care and helps you engage a patient and family in respectful, patient-centered dialogue

Cultural awareness

process of conducting a self-examination of one's own biases towards other cultures and the in-depth exploration of one's cultural and professional background

transcultural

the concept of care as the domain that sets nursing apart from other health care disciplines

Ethnic / cultural identity

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

Cultural knowledge

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

transformative

the relationship influences both the nurse and the patient for better or for worse

health disparity

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

Acculturation can lead to stress when

The values of the transitioning culture differ from the accepted traits of another

Conflict arises when health care provides interpret behavior of patients though

Their own world view lens instead of trying to uncover the world view that guides the behavior of their patients

Plan your approach

Think about how you will ask your patient to teach back in a shame free way

cultural assessment

Thus the nurse needs to conduct a comprehensive _______ to understand how the patient's religious values will affect her willingness to receive care

Listen

To patients perception of the problem

Intersectionality is a way of

Understanding and analyzing our complex world by looking at the human

To reinforce your teaching

Use handouts, pictures, models

Caring beliefs and practice questions include

Which caregivers do you seek when you are sick and how different is what we do from what your family does when you are sick?

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?

Workers who have a high school education

Explain

Your perception of the problem

core measures

_______ are a set of evidence-based, scientifically researched standards of care

Culturally congruent care (transcultural care)

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

Stage one of stereotyping

- there is an activation of a stereotype when the individual is categorized into a social group -when this occurs , beliefs and prejudices come to mind about what members of that particular group are like

Medicine and herb for hot treatments

-Anise -aspirin -castor oil -cinnamon -garlic -ginger root -iron -penicillin

Cold treatments (food)

-Barley water -chicken -dairy products -fresh vegetables -fruits -honey

Examples of marginalized care groups include people who are

-LGBQT - people of color -people who are physically or mentally challenged -people who are not college educated

Hot Treatments (Food)

-beef -cereals -chili peppers -chocolate -eggs -liquor -onions

Medicine and herbs for cold treatments

-bicarbonate of soda -milk of magnesia -sage

Hot conditions

-constipation -diarrhea -fever -infection -kidney problems -rash -sore throat

Types of disparities often interrelated and influenced by the conditions and social context in which people live are

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

Marginalization places or keeps someone in a

-powerless or an unimportant position within a society or group

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 your 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. Mothers history of breast cancer 4. Lack of transportation 5. Woman's age

1. Medicaid insurance 4. Lack of transport 5. Woman's age

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. 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. 4. Ensure that interpreters are competent in medical terminology. 5. Provide language assistance to all patients who speak limited English or are deaf.

Which of the following is an example of a patient with a health disparity (Select all that apply) 1. A patient who has a homo 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 has a history of smoking for 10 years

2. A patient unable to access primary care services 3. A patient living with a chronic disease 5. A patient who has a history of smoking for 10 years

Unconscious bias refers to

A bias we are unaware of and that happens outside our control, which is influences by our personal background , culture environment, and personal experiences

Negotiate

A treatment plan, considering that it is beneficial to incorporate selected aspects of the patients culture into the plan

During a nursing assessment a patient displayed several behaviors. Which behavior suggest the patient may have a health literacy problem? A. Patient has difficulty completing a registration form at a medical office B. Patient asks for written information about a health topic C. Patient speaks Spanish as primary language D. Patient states unfamiliarity with a newly ordered medicine

A. Patient has difficulty completeing a registration form at a medical office

A nurse is providing care to a culturally diverse population. Which action indicates that the nurse is successful in the role of providing culturally congruent care A. provides care that fits the patient's valued life patterns and set of meanings B. Provides care that is based on meanings genereated by predetermined criteria C. Provides care that makes the nurse the leader in determining what is needed D. Provides care that is the same as the values of the professional health care system

A.provides care that fits the patient's valued life patterns and set of meanings

A stereotype is an

Assumed belief regarding a particular group

A nurse is teaching patients about health care information. Which patient will the nurse assess closely for health literacy? A. A patient 35 years old B. A patient with a chronic illness C. A patient with a college degree D. A patient with a high school diploma

B. A patient with a chronic illness

Cold conditions

Cancer Cold, flu Earaches Headaches Joint pain Menses Pneumonia Stomach cramps

In any intercultural encounter there is a

Insider perspective ( Emic world view ) Outsider perspective (Etic world view)

The second goal in cultural encounter is to continuously

Interact with patients from culturally diverse backgrounds to validate refine, or modify existing values, beliefs, and practices about a cultural group

compassion

Interventions need to be taught and practiced early in nursing education and emphasized in all clinical practice settings

Culturally congruent care, or care that fits a persons

Life patterns, values, and system of meaning provides meaningful and beneficial nursing care

Attempts at humor are often

Lost in interpretation

unconscious bias typically directs one to

Make quick judgements and assessments of people and situations

Linguistic competence

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

Cultural skills

The ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patients presenting problem , as well as accurately conducting a culturally based physical assessment

Social determinants of health

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

Health literacy

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

Becoming more aware of your biases and attitudes about human behavior is

The first step in providing patient centered care leading to culturally competent care

In the transition of acculturation there will be an adaption to

The new cultures, -traditions, -customs, -language

The mnemonic LEARN represents

The process of -listening -explaining -acknowledging -recommending -negotiating

A nurse is assessing a patients ethnic history. Which question should the nurse ask? A. What language do you speak at home? B. How different is your life here from back home? C. Which caregivers do you seek when you are sick? D. How different is what we do from what your family does when you are sick?

b. How different is your life here from back home? An ethnohistory question is the following: how different is your life here from back home?

Racial identity

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

Working with interpreters

-look at the patient instead of interpreter -speak in short sentences then wait for interpreter to convey it -avoid using jargon, acronyms, or jokes -avoid attempts at humor -ask the patient for feedback and clarification at regular intervals -be observant of the patients nonverbal and verbal behaviors -at the end of the conversation thank both the patient and interpreter

Stereotyping occurs in two cognitive phases

1. There is an activation of a stereotype when an individual is categorized into a social group 2. People use these activated beliefs and feelings when they interact with individuals

D, A, E, C, B

10. Match the cultural concepts on the left with the correct definitions on the right 1. Etic world view __________ 2. World view __________ 3. Cultural desire __________ 4. Intersectionality __________ 5. Emic world view __________ a. Factor that shapes how people perceive others and how they relate to reality b. Insider's perspective in an intercultural encounter c. A policy model that describes factors and power structures that shape and influence life d. An outsider's perspective in an intercultural encounter e. The motivation of a health care professional to "want to" engage in cultural competency

4A,1B,2C,3D

10. Match the following caring behaviors with their definitions. 1. Knowing 2. Being with 3. Doing for 4. Maintaining belief a. Sustaining faith in the other's capacity to get through an event or transition and face a future with meaning b. Striving to understand an event as it has meaning in the life of the other c. Being emotionally present to the other d. Doing for the other as he or she would do for self if it were at all possible

1,4,5

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, 3

2. Before implementing touch, what does a nurse need to know about touch? (Select all that apply.) 1. Some cultures may have specific restrictions about non-skill-based touch. 2. Touch is a type of verbal communication. 3. Touch can successfully influence a patient's level of comfort. 4. There is never a problem with using touch at any time. 5. Touch only reduces physical pain.

D, B, A, E, C

4. A nurse desires to communicate with a young woman who is Serbian and who has limited experience with being in a hospital. The nurse has 10 years of experience caring for Serbian women. The patient was admitted for a serious pregnancy complication. Apply the LEARN model and match the nurse's behaviors with each step of the model. 1. L ___________ 2. E ___________ 3. A ___________ 4. R __________ 5. N __________ a. The nurse notes that she has learned that fathers can visit mothers at any time in both Serbia and the United States. b. The nurse shares her perception of the woman's experiences as a patient. c. The nurse asks the patient how she can maintain bed rest when she returns home. d. The nurse attends to the patient and listens to her story about hospitals in Serbia. e. The nurse involves the patient in a discussion of the treatment options for her condition.

1,2,4,5

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.

2,3,4

5. Which of the following are strategies for creating work environments that support nurse caring interventions? (Select all that apply.) 1. Increasing technological support 2. Improving flexibility for scheduling 3. Providing opportunities to discuss care 4. Promoting autonomy of practice 5. Encouraging increased input concerning nursing functions from health care providers

3

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

4

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

1

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."

Health disparity is defined as

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

Intersectionality is

A research and policy model used to study the complexities of peoples lives and experiences

implicit bias

An ______ is similar; however, we are aware of the bias that is present

Cultural respect

As opposed to cultural competence; 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

Cultural awareness also involves

Being aware of the existence of documented racism and other "isms" in health care delivery

Intersectionality is a model that looks at how

Being marginalized affects peoples heath and access to care

Cultural beliefs, values, and practices are learned from

Birth, first in home, then in church or other places where people congregate and then in educational and other social settings

A result of stereotyping is a

Diagnoses and treatment of patient being biases even in the sense of the practitioners intent or awareness

"Chunk and check"

Do not wait until the end of the visit to initiate teach back -chunk out information into small segments and have the patient or caregiver teach it back *repeat several times during a visit

Cultural competence is a

Dynamic, fluid , continuous process whereby an individual, system, or health care agency finds meaningful and useful care strategies based on knowledge of the cultural heritage, beliefs, attitudes, and behaviors of those to whom they render care

The core measures are a set of

Evidence based, scientifically researched standards of care

Oppression is a

Formal and informal system of advantages and disadvantages tied to membership in : -social groups -reinforced by societal norms -biases -interactions -beliefs

One goal of cultural encounter is to communicate in a way that

Generates a wide variety of responses and to send and receive both verbal and nonverbal communication accurately and appropriately in each culturally different context

IOM defines quality health care as

Health care that is safe, effective , patient centered, timely, efficient and equitable or fair

A cultural encounter aims to

Modify a health care providers existing belief about a cultural group and to prevent possible stereotyping

Teach back is

Not intended to test a patient but rather to confirm the parity of your communication

Acculturation

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

Stage two of stereotyping

People use these activated beliefs and feelings when they interact with individuals -research shows that health care providers activate these stereotypes or unconscious biases routinely when communicating with and providing care to minority individuals

Start slowly and use teach back consistently

Practice, once it is part of your routine it can be done without awkwardness

Cultural competence means that

Professional healthcare must be culturally sensitive, culturally appropriate, and culturally competent to meet the multifaceted healthcare needs of each person, family, and community

Culture also refers to ways of

Relating to one another, language and manner of speaking, work and lifestyle practice, social relationships, values, religious beliefs and rituals, and expression of thoughts and emotions

An implicit bias

Similar to unconscious bia however we are aware of the bas that is present0PP ...

Cultural desire

The motivation of a health care profession to "want to" and not "Have to" engage in the process of becoming culturally aware, culturally knowledgeable, and culturally skillful in seeking cultural encounters

A Korean woman request seaweed soup for her first meal after giving birth. This request puzzles her nurse. What kind of world view is this?

The nurse has an emic world view of professional postpartum care but is an outsider to the Korean culture - the patient has a etic worldview of American professional postpartum care and assumes that the seaweed soup is available because in her cultural beliefs it beneficiary after giving birth

Assimilation

The process in which the individual adapts to the hosts cultural values and no longer prefers the components of the origin culture

acculturation

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

Comforting

The use of touch is one _______ approach that reaches out to patients to communicate concern and support

Use the show me method

When prescribing new medicines or changing a dose research shows that even when patients correctly say when and how much medicine they will take many will make mistakes when asked to demonstrate

2,3,5

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

marginalized groups

______ are more likely to have poor health outcomes and die earlier because of a complex interaction among their individual behaviors, environment of the communities in which they live, the policies and practices of health care and governmental systems, and the clinical care they receive

ethnic and cultural

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

Oppression

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

cultural respect

_________ 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

Cultural encounter

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

Cultural awareness requires a

a self examination of one's biases toward other culture's and an in depth exploration of one's own culture and professional background