Cultural Competency
According to the "Health literacy and patient safety" video, what percent of patients did not understand instructions to "take medications on an empty stomach"?
42%
True or False? The cultural pre-competence stage is a stage health care providers should feel comfortable staying for a while because it means they are recognizing the need to provide culturally and linguistically appropriate care.
False
In the "Health literacy and patient safety" video, did Mr. Day know that the term "hypertension" means the same thing as "high blood pressure" when the doctor asked him and broke down the word into "hyper" and "tension"?
No, he reads at a 2nd-grade level was not able to explain the term correctly
Josepha Campinha-Bacote's background is in _______________.
Nursing
According to Gail Price-Wise: "There is no such thing as first impressions. All first impressions were made by the age of 14. All impressions that we have after that are second impressions."
False
All Indians like to be in close proximity to another person when talking to them. True False
False
Leininger encouraged health care providers to obtain the patient's own explanatory model about his/her sickness.
False
According to the "Health literacy and patient safety" video, patients are often embarrassed to admit they can't read, leading them to find ways to hide this fact from others and avoid getting the correct information from the medical professionals.
True
Which of the following is NOT likely if someone asked the Lees when Lia's illness began? their explanation would be long it would likely begin with the first beginning of the world. the story would go back a few hundred generations all of the above are true
all of the above are true
How are cultural competence and patient-centeredness similar?
both emphasize the importance of seeing the patient as a unique individual
What did doctors report as the biggest barrier to treating Hmong patients?
cultural barrier
Which of the following was NOT said by Dan Murphy?
"The best thing I could have given Lia's mother was compassion, and I wasn't giving her any and I knew that I wasn't giving her any...There was just too much aggravation. It was like banging your head against a wall constantly and not making any headway..." (Neil said this)
According to Jessica Dere, identifying an individual as a particular culture can lead to inaccurate and possibily harmful stereotypes.
True
Who agreed with the Lee family that what ultimately caused "the big one" and put Lia into a vegetative state was all of the medicine Lia had been given?
Dr Terry Hutchinson
According to "Health literacy and patient safety", what is the "Brown Bag Test"?
It is a review of a patient's medicine where the patient is encouraged to bring in all their medications and supplements to their medical visit and review what/how they are taking them with a medical staff member to identify errors
According to Jessica Dere, the rewards of the culturally informed approach include: greater open mindedness, increased understanding of experiences different from one's own, and decreased stereotyping.
True
Of the 40+ medical professionals Anne Fadiman spoke with who had been involved in Lia's medical care, how many asked the Lee family what they thought caused Lia's illness?
1
According to the "Health literacy and patient safety" video, what percent of people did NOT understand when their next appointment was scheduled.
26%
What was the purpose of the study reported in the McClure et al. article? A. to assess the health literacy level of publicly available patient education materials for people with sickle cell disease B. to examine the cultural appropriateness of patient education materials for people with sickle cell disease A & B None of the above
A&B
In the "Health literacy and patient safety" video, Mrs. Cordell-Seiple was not embarrassed to say she couldn't read and understand the pile of paperwork that was given to her prior to her procedure. Therefore, she refused to sign it.
False
Which of the following is not true according to Dwight Conquergood? Traditional medical care would continue to be rejected by Hmong until Western medicine practitioners are able to recognize that they don't hold all the knowledge Working with the Hmong has to be a productive and mutually invigorating dialog, with neither side winning out. a person can receive both Hmong herbs and conventional medical treatment all of the above are true
all of the above are true
Pick the option that correctly lists the components of the Cultural Competence Continuum in the correct order:
Cultural destructiveness, cultural incapacity, cultural blindness, cultural pre-competence, cultural competence, cultural proficiency
According to Campinha-Bacote, what is cultural skill?
Cultural skill is the ability to collect relevant cultural data regarding the patient's presenting problem.
True or False? Cultural competency only occurs at an individual level.
False
Of the many cultural differences between western medicine and Hmong culture, what was the most relevant one when Lia was in a vegetative state after coming back from Fresno?
It is taboo in Hmong culture to predict death
After "the big one" why did the Lee family believe Lia was transferred to Valley Children's Hospital in Fresno?
The doctors at MCMC were going on vacation
What does Dr. Kleinman mean when he says that the term "compliance" implies moral hegemony?
The term implies that the western medicine world has dominance over the patient
According to Havi Carel and Richard Pettigrew: what looks like small unconscious biases add up to a significant disadvantage and unequal outcomes.
True
It is important for health professionals to not just understand what cultural competence is, but to have a process to achieve it.
True
Which of the following is a contributing factor behind the Lee family's lack of adherence to Lia's prescribed medicine? Lia's parents didn't understand the directions Lia's parents didn't want to give her the drugs because they thought they may be causing some of her seizures
Both
According to Gail Price-Wise: "When people are learning about the field of cultural competence, their job is to learn about the foods, the traditions, the holidays, the dress, the rituals, the religious customs, etc... of the different cultures because this is THE MOST important part of cultural competence."
False
In the "Health literacy and patient safety" video, Mrs. Irwin knew why she was taking the medications that were prescribed to her by her physician. She took them although she did NOT trust her doctor.
False
True or False: Cultural awareness includes the process of developing a better understanding of other cultures' values and health-related beliefs.
False
True or False: Health disparities are are getting a lot of attention today because they represent issues that have recently developed. True
False
True or False: Individuals with low health literacy always have difficulties reading or writing in general.
False
True or False: Most of the education materials reviewed in the McClure et al study were written at a 8th-12th grade reading level. Eighth grade reading level is recommended so some of the materials were well done.
False
True or False? A dietitian needs to understand all of the nutrition-related characteristics of diverse cultures.
False
True or False? Once a person has had an interaction with five or six people of a specific culture, they will have enough experience to be an expert in providing care to individuals of that culture.
False
How many US Adults have trouble with basic literacy and matematical skills used in daily life?
More than half
Which of the following is not included when obtaining cultural knowledge? Health-related beliefs and cultural values Disease incidence and prevalence Self-assessment of cultural background Treatment efficacy
Self-assessment of cultural background
Why did Neil feel he had to report Lia's parents to Child Protective Services?
The degree to which Lia's parents were not complying with her medicine regimen was so dangerous (lia could have irreversible brain damage or die) that Neil felt it fell under the realm of child neglect.
According to the "Healthy literacy and patient safety" video, there are solutions for patients who are not health literate and the burden of this solution falls on:
The health professionals to create a 'shame-free environment' and adopt an attitude of helpfulness
Select all of the differences between txiv neebs and doctors:
Trix Neebs never had to ask questions; doctors asked a lot of questions, many of which were very intimate about sexual and excretory habits. Trix Neebs came to a sick persons house and would spend sometimes as much as 8 hours with them; whereas doctors require sick people to go to a hospital and only see them for a few minutes Txiv neebs always included the soul in their treatment; doctors never ask about a person's soul Trix neebs never undressed their patients; doctors ask patients to take off all their clothes When patients don't get well after seeing a Txiv neeb, the blame is on the spirits not the Txiv neeb because the Txiv neeb is merely a negotiator (in fact, the Txiv neeb may be more highly regarded when illnesses get worse because this means they are battling particularly dangerous spirits); when patients do not get better after seeing a doctor, the blame is placed on the doctor Txiv neebs gave immediate diagnoses; doctors required lots of testing and had to take body fluids from patients before diagnosing (and sometimes still weren't able to diagnose)
According to the "Health literacy and patient safety" video, it is common for patients to sign a consent form that they don't understand and undergo a procedure. Then after the procedure, they undergo an adverse outcome that might have been one of the risks listed in the paperwork. There are legal cases clearly showing that these individuals can sue successfully in this setting because they did not truly give informed consent
True
True or False: Assessing a patient's health literacy doesn't have to be a formal process.
True
True or False: Cultural competence is a process.
True
What is the title of seminal report from the Institute of Medicine that spurred the study and practice of culturally competent care forward?
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
Many doctors describe their process of convincing the Lee family to follow their specified medical protocol. According to Dr. Kleinman, was this the wrong approach?
Yes, this model of coercion should have been replaced with a model of mediation to help negotiate a plan of care in which both parties compromise
A substantial amount of space (even whole chapters) is spent discussing Hmong history. Why is this so important to understanding medical treatment for Hmongs? Helps us understand the mistrust they have of individuals or institutions with power exemplifies their stubbornness and resilience Hmong believe it is important to go as far back as possible to explain something All of the above
all of the above
Lia died at age 30, in 2012 (over a decade after the book was written). She lived in a vegetative state for 26 years. It is possible this could have been prevented. Her story exemplifies the importance of culturally competent care why today cultural competence training is required why medical professionals need to be aware of their bias, be willing to listen to their patient's explanation for their illness and wishes for treatment, and be willing to compromise to determine the care plan most likely to succeed all of the above
all of the above
True or False? Cultural desire is something people either have or they don't have, and if they don't have it they can never be culturally competent
false
Campinha-Bacote describes cultural competence as: the ability of healthcare providers to appreciate and understand their clients' values, beliefs, life ways, practices, and problem-solving stategies. including cultural awareness, knowledge, skill, encounters, and desires. emphasizing the idea of effectively operating in different cultural contexts tolerating diverse groups
including cultural awareness, knowledge, skill, encounters, and desires.
In Hmong culture, those with what Western Medicine would describe as epilepsy are...
seen as having an illness of distinction, with their seizures evidence that they have power to perceive what others cannot
What is the Hu Plig ceremony?
soul calling ceremony that occurs the 3rd day after birth. Until performed, the baby is not considered a full member of the human race
What is the overall goal of trying to provide culturally competent care?
to improve the quality of care given and increase the likelihood that patients will adhere to care plans to improve overall health outcomes and reduce health disparities
True or false? When a translator is unavailable, it is fine to use the patient's family members or friends as translators.
False
True or false? You can assume that a patient from Caribbean descent will always be late to appointments.
False
True or False? One of the most important aspects of cultural skill is being able to speak with the patient in the same language when doing the cultural assessment.
false
Among Hmong culture, what is the most common cause of illness?
soul loss
True or False? Once someone is culturally proficient he/she no longer needs to worry about cultural competence.
False
Jessica Dere says that her students always have an initial excitement that culture matters but are often quickly overwhelmed by the complexity of culture. Which two things does she suggest to her students to help handle the complexities of culture?
Take a stance of informed curiosity & ask different questions differently
True or False: Patient-centeredness and cultural competence are the same thing.
False
Cultural competence is the intersection of which of the following constructs (Select all of them)?
Cultural awareness cultural desire cultural encounter cultural skill cultural knowledge
According to Gail Price-Wise: only certain races or cultures have prejudice against others and need to manage their own prejudice.
False
What is one of the main reasons why an institution may not make progress in becoming more culturally competent? the majority of individudals in the organization don't see the importance the organization serves a homogenous group of people Limited resources people don't like change
Limited resources
According to Havi Carel and Richard Pettigrew, in the resume study where resumes were assigned stereotypically white names and stereotypically black names, the results showed:
Resumes that had stereotypically white names received 50% more call backs than resumes that had stereotypically black names.
According to Havi Carel and Richard Pettigrew: Implicit bias is prejudice that is unconscious or automatic. It functions below the level of consciousness. People are not always aware that they have these types of biases, and people are not always aware of the effects that they are having on their behavior and on the way they treat other people.
True
Which of the following is NOT a critical factor in the provision of culturally competent care: understanding individuals from within their cultural context incorporating culturally based beliefs about the etiology of disease considering patients' attitudes toward seeking medical care accepting patients' beliefs all of the above are critical factors
all of the above are critical factors
Which of the following were recommended to help decrease the literacy level of educational material to be more appropriate?
use short instead of long terms when possible (for example, doctor instead of physician) make sentences short use common words instead of technical terms (for example, high blood pressure instead of hypertension) make sure writing is action-oriented instead of passive
True or False: All encounters are cultural encounters.
True
True or False: Low health literacy due to being from a non-dominant culture can be fixed by using a translator.
False
True or False: Sickle cell disease is highly prevalent among Hispanics. Low literacy levels are also prevalent among Hispanics.
False
What is the stage on the Cultural Competence Continuum that refers to scenerios in which all people are viewed the same without taking into consideration that cultural differences matter?
Cultural blindness
Which is not an assumption of the Caminha-Bacote Model of Cultural Competency?
Cultural competence is an event, not a process.
Which is NOT a potential result of low health literacy? Medication errors Low rates of treatment adherance due to poor communication between providers and patients Ineffective management of chronic conditions, due to inadequate self-care skills Poor responsiveness to public health emergencies Lower mortality
Lower mortality
Which of the following is not disrespectful in Hmong culture? friendly eyecontact address the oldest male present when discussing treatment options touch the head of an adult beckon with a crooked finger
address the oldest male present when discussing treatment options
What is the one form of Western medical care readily accepted by the Hmong?
antibiotics
What is the definition of health literacy?
the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
Select all of the following reasons Hmong patients are more costly than other patients at MCMC the large number of Hmong patients necessitated MCMC to hire bilingual staff Hmong patients require additional time and attention The majority are on medicare Hmong utilize hospital services substantially more than other populations
the large number of Hmong patients necessitated MCMC to hire bilingual staff Hmong patients require additional time and attention The majority are on medicare
What is the purpose of a cultural assessment?
to obtain correct information from a person that can be used to develop a culturally relevant treatment plan for the patient. This will make it more likely that the treatment plan will "work."
Kleinman suggests a series of open-ended questions to ask patients. What is the main goal of these questions?
to obtain the patient's explanation of his/her illness
True or False? Treatment efficacy refers to understanding how different cultural groups respond differently to treatments.
true
According to Gallagher, what makes you more likely to respond to a patient compassionately instead of judgementaly?
understanding the patient's view point
All the people whose pictures were shown in the exercise by Gail Price-Wise remind you of someone you have known in the past or someone you have seen on TV.
True
At four years old, The "big one" was Lia's __________ admission to the hospital.
16th
True or False: Culture can impact how individuals reports and prioritize their symptoms
True
True or False? It is considered a norm in many Hispanic cultures for females to seek the advice of males regarding health care decisions.
True
True or false? Institutions or individuals providing care that is not culturally or linguistically aappropriate could face legal action or lose accreditation.
True
Which of the following is true about a paradigm shift? paradigm shifts just happen overtime paradigm shifts are small changes to how things are typically done paradigm shifts take intentional effort from agents of change who are devoted to shifting how people think paradigm shifts happen quickly
paradigm shifts take intentional effort from agents of change who are devoted to shifting how people think
Which is not a rationale for cultural competence:
projected decrease in diversity in the United States
The cultural encounter in the vignette between the nurse and Mrs. Lee was _________________?
deliberate
Developing sacred encounters __________________________.
requires the health care provider to be at their best and completely focused on the patient
