Culture and the Nursing Process

Sunrise Model

Developed to depict the essential component of Leininger's Theory of Cultural Care Diversity and Universality - human beings are inseparable from their cultural background and social structure, world view, history, and environmental context. - 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 or separated.

Cultural Competence

integration of a person's knowledge, attitudes, beliefs, skills, and encounters with those of people from different cultures - lifelong process - intentional effort needed

Cultural Domain: Biologic Variation

Expressed by physical differences among various cultures ex. skin color

The nurse completed discharge teaching with an Asian male. The patient's wife arrived and was upset that she was not present for the teaching. Which consideration did the nurse fail to realize? Environmental Lifespan Language Family

Family

Diversity Consideration in Care Planning

Family Gender Culture, ethnicity, religion Morphology

Cultural Domain: Environmental Control

Focuses on cultural health practice, values, and how a culture defines health and illness. - Health practice may be viewed as efficacious, neutral, dysfunctional, or uncertain.

Giger and Davidhizar's Transcultural Assessment Model

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

Which model is demonstrated when nurses collect information about the six cultural domains? Primary Nursing Care Model Giger and Davidhizar's Transcultural Assessment Model The Sunrise Model Galanti's C's of Culture

Giger and Davidhizar's Transcultural Assessment Model

The nurse is assessing an African American patient who states that her illness was caused by conflict with her brother. By discussing this belief with the patient, the nurse is assessing which domain? Spirituality Gender roles Mental health Health beliefs

Health beliefs

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.

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.

Which cultural issue is the patient most likely to hide from the nurse? Food preferences Views on end-of-life care Illiteracy Role in the family

Illiteracy

4 C's of Culture

Mnemonic to aid in providing culturally responsive, patient-centered health assessment and care 1. Call - What do you call your problem? 2. Caused - What do you think caused your problem? 3. Cope - How do you cope with your condition? 4. Concerns - What are your concerns regarding the condition and/or treatment?

The nurse alerts the health care provider about a female patient's cultural preference for only female health care providers for examination. Which cultural behavior is being demonstrated by the nurse? Openness Stereotype Awareness Gender bias

Openness

Culturally Congruent 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

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.

When assessing the patient, the nurse asks, "What is your role in the family unit?" Which cultural domain is the nurse assessing? Communication Space Social orientation Environmental control

Social orientation

The nurse observes a surgeon explaining a surgical procedure in English to a patient she knows to only understand Spanish and getting her to sign the consent form (written in English). What action should the nurse take based on this observation? Document her observations in the patient's chart. Recognize that obtaining consent is the responsibility of the surgeon, not the nurse. Speak with the surgeon and offer to find a Spanish interpreter. Ask the patient's English-speaking son to explain the procedure to the patient.

Speak with the surgeon and offer to find a Spanish interpreter.

Health Beliefs in African Americans

llness represents disharmony and conflict in aspects of a person's life. Beliefs tend to fall in three categories: - Impaired relationships - Environmental hazards - Divine punishment Older African Americans from the south may have a distrust of traditional health care.

Cultural Domain: Social Orientation

manner in which a cultural group organizes itself around the family group. Examples: - Gender equality - Socioeconomic level - Body odor - Nutritional needs - Spirituality and religious organization

Linguistic Competence

needed to offer appropriate care and responses to patients with culturally diverse backgrounds. - Culturally and linguistically competent nurses can more effectively respond to the needs of the patients and communities they serve

Cultural Domain: Space

expressed by the degree of comfort observed, proximity to others, body movement, and one's perception of space.

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

Which tenets promote patient-centered care based on knowledge of the patient's culture, according to Leininger (2002)? Select all that apply. Cultural maintenance Cultural fixation Cultural immersion Cultural care accommodation Cultural care repatterning

Cultural Maintenance Cultural care accommodation Cultural care repatterning

Strategies for Planning Culturally Competent Care

Cultural Maintenance Culture care accommodation or negotiation Cultural care re-patterning or restructuring

The nurse is caring for a Native American patient newly diagnosed with lung cancer, who smokes his own tobacco. Which of the Leininger's strategies is most recommended for the nurse? Cultural care accommodation Cultural care restructuring Cultural care negotiation Cultural maintenance

Cultural care restructuring

The nurse is working with a Jehovah's Witness patient who is refusing blood transfusion, despite low hemoglobin. The nurse does not agree with her decision but she respects her patient's religion. Which behavior is the nurse demonstrating? Cultural competence Cultural awareness Hidden bias Transcultural awareness

Cultural competence

Cultural Domain: Communication

The way people communicate, such as through facial expressions, body posture, eye behaviors, and the use of touch can have a multitude of meanings among various cultures

Cultural Competence is predicated on awareness of interaction of:

Three cultures 1. Nurse's personal self 2. Health care delivery system 3. Patient's Culture

Cultural Domain: Time

Time orientation varies by culture, generally in the context of past, present, or future. - Different cultures tend to emphasize one period of time over the others. - past orientation: tend to look to traditional approaches to health and healing, rather than to new approaches, procedures, and medications. -- If it worked for their ancestor, it will work for them - present orientation: less likely to embrace preventative health care. Their orientation is to the "here and now," and people in these cultures often use the way they are feeling during the present time to dictate future health practices - future orientation: tend to structure time rigidly, adhering to a time-structured schedule as a way of life.

Which statement relates more to Latin culture rather than Asian culture? Traditional diagnoses and treatments are categorized as "hot" or "cold." There is an emphasis on accommodation rather than confrontation. There is a strong respect for the hierarchical family structure. A strong sense of personal honor and perceived loss can be devastating.

Traditional diagnoses and treatments are categorized as "hot" or "cold."

What facet of nursing is being considered when nurses focus on human caring-associated differences and similarities among the beliefs, values, and patterned ways of cultures? Cultural sensitivity Cultural awareness Cultural competence Transcultural care

Transcultural care

Which statement by the nurse when giving report on a Middle Eastern patient shows cultural competence? "He missed breakfast and I offered him a sausage biscuit." "You'll notice that he doesn't tell his wife anything about his illness; I think they are having problems." "He doesn't wear deodorant but he has a fever, so you may notice a slight odor despite his morning bath." "He doesn't talk much; he usually just nods to let you know he understands."

"He doesn't wear deodorant but he has a fever, so you may notice a slight odor despite his morning bath."

Transcultural Nursing: Nursing Roles

- Act as specialists, generalists, and consultants. - Assist others to become sensitive to, and knowledgeable about, diverse cultures. - Identify cultures that are neglected or misunderstood. - Help health care systems assess how they serve, or fail to serve, diverse cultures in a community.

Culturally Responsible Hand Offs

- Before patient discharge, nurses must identify community providers that will meet the patient's cultural and linguistic needs. - Transferring relevant information regarding the patient's language, ethnic, religious, and spiritual needs is critical to ensuring positive patient outcomes. - Collaboration with patient decision makers, including family members and spiritual advisers, is especially important during end-of-life care. Collaborative palliative care promotes treatment that is sensitive to patient values and personal beliefs.

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.

Transcultural Nursing: Practice Settings

- Diverse clinical practice settings - Schools of nursing

Home Care Considerations: Culture

- Family roles, typical family household and structures, and dynamics in the family, particularly communication patterns - Patterns of daily living, including work and leisure activities - Health beliefs and practices related to disease causation, treatment of illness, folk practices, and faith healers - Extended family kinship and social networks, including friends, neighbors, and significant others, and their influence on health and illness - Nutritional practices and how they relate to cultural factors and health

Steps to delivering culturally congruent and competent nursing care

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

Nursing interventions when patients speak a different language

- Using a professional interpreter - Avoiding the use of abbreviations and acronyms - Using a slower speech pattern to enhance the patient's ability to comprehend - Avoiding speaking loudly to the patient - Limiting the use of jargon, slang, and humor

Health Beliefs in Latinos

- May not seek medical care due to distrust, poverty, or problems with immigration status. - May prefer traditional healing practices. - Traditional diagnoses and treatments may be categorized as "hot" or "cold." Ex. Hypertension may be considered a hot disorder that would be treated with cold therapies.

Transcultural Nursing: Goals

- Provide culturally congruent, meaningful, and beneficial health care. - Provide knowledgeable, competent, and safe care to people of diverse populations.

Health Beliefs in Asians

- Strong sense of personal honor; perceived loss of respect can have devastating effects. - Belief in the hierarchical family structure. - Emphasis on 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 with mental disorders.

Which model is applied when the nurse assesses the coping strategies of a patient from a different culture? King's model Self-Care Theory Sunrise model 4 C's of culture

4 C's of culture

Which nursing model or theory holds the basic tenet that people are connected to their cultural backgrounds, social constructs, world-views and environmental context? Galanti's 4 Cs of culture Leininger's sunrise model Giger and Davidhizar's transcultural assessment model Orem's self-care theory

Leininger's sunrise model

Founder and Central leader of transcultural nursing

Madeleine Leninger

Which nursing action shows cultural competence? Giving a sponge bath to an American male with a broken femur Explaining to a Mexican patient's husband that the decision to have surgery is hers alone Discussing appropriate weight guidelines with an overweight African American woman Teaching an Asian male's adolescent daughter how to change his dressing

Teaching an Asian male's adolescent daughter how to change his dressing

Cultural Sensitivity

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.