INTRO Exam 2: Cultural competence
meliorism
-the belief that the world can be made a better place. -we tend to want to fix a problem as as soon as possible and make the pain or illness go away.
what are the goals of the Transcultural Nursing Society
-to advance cultural competence for nurses worldwide -to advance the scholarship (substantive knowledge) of the discipline -develop strategies for advocating social change for cultural competent care
standardization
-treat similar the same -when patients present with the flu, there are standard protocols followed in treating them
what is culture care values, beleifs, and practices are influenced by what?
-world view -language -philososphy -religion -spirituality -kinship -social -political -legal -educational -economic -technological -ethnohistorical -environmental contexts
barriers to effective communication 1. description of changing subjects and topics 2. why should you not do this?
1. ) Many times this is done because the nurse feels uncomfortable with a topic. 2.) This conveys that what the client is talking about is not important. The nurse might do this to talk about a topic of interest to the nurse rather than the client.
barrier to effective communication: 1. description of stereotyping 2. why should you not do this
1. ) Offering generalized and oversimplified beliefs about groups of people that are based on experiences too limited to be valid. 2.) These responses categorize clients and negate their uniqueness as individuals.
1. what is the plane tree model? 2. what does it promote? 3. what does it do for the pt, family and caregivers?
1. a "patient-centered, holistic approach to providing patient care 2. mental, emotional, spiritual, social, and physical healing. 3. It empowers patients and families through the exchange of information and encourages healing partnerships with caregivers.
steps to conduct a root cause anylysis
1. define problem 2.collect data 3. identify possible causal factors - what events led up to it 4.identify the root cause 5.recommend and implement solutions
what are the three phases of the nurse-patient relationship
1. orientation: introductory phase 2. working: accomplishes tasks toward goals 3. Termination: ends with relationship contructivly
1. cultural competency 2. what does cultural competency imply
1. the ability to look at someone else's culture and embrace what's different and recognize what you could do to provide better care 2. there is a capacity to function effectively as an individual and organization in the context of cultural beliefs behaviors and needs
barriers to effective communication: 1.. description of being defensive 2. why should you not do this
1.) Attempting to protect others or services from negative comments. 2.) Prevents clients from expressing concerns and block communication.
barriers to effective communication: 1. description of challenging 2. why should you not do this?
1.) These statements force the client to justify or prove their statement or point of view. 2.) Nurse isn't considering client's feelings.
barriers to effective communication: 1. description of being judgmental 2. why should you not do this
1.) These statements give the nurse's opinion, moralize, or imply the nurse's values. 2.) These statements imply that the nurse's opinions and values are the best and the client should think the same.
what is the goal of avoiding stereotypes
Accept all patients as individuals of dignity and worth who deserve the best nursing care possible
therapeutic communication: 1. purpose of silence
Allows client time to formulate thoughts. Don't use too much or client will think you are not interested or are not listening
what are they 5 functions of patient centered medical home care
COMPREHENSIVE CARE accountable for meeting large majority of physical and mental health care needs including prevention and wellness, acute/chronic care a place where a pt can go to take care of any problem they have. by providing this service your primary care provider is more aware of whats going on PT CENTERED A relationship base place that was oriented to pt's whole person. it is sensitive to each need Medical home is learning about the patients preferences and the best way to implements a plan of care COORDINATED CARE specialty care hospitals home health community service this is essential when transitioning a pt from the hospital ACCESSIBLE CARE primary care medical home provides shorter waiting time more acessable medical care enhanced in person hours around the clock telephone access to health care team, alternative methods of communication QUALITY AND SAFETY commitment to quality and quality of improvement EPB clinical decision support joint comissoin requires organization to report incidence so error can be prevented in future
barrier to effective communication 1. examples of changing topics and subjects
Client: "I'm separated from my wife. Do you think I should have sexual relations with another woman?" Nurse: "I see that you're 36 and that you like gardening. This sunshine is good for my garden."
barrier to effective communication 1. examples of giving advice
Client: "Should I move from my home to a nursing home?" Nurse: "If I were you, I'd go to a nursing home, where you'll get your meals cooked for you."
barrier to effective communication: 1. examples of being defensive
Client: "Those night nurses must just site around and talk all night. They didn't answer my light for over an hour." Nurse: "I'll have you know we literally run around on nights. You're not the only client, you know."
who was the transcultural nursing society founded by
Dr. Madeleine Leningr
who originated the term "therapeutic use of self" and when
Hildegard Peplau
therapeutic communication: 1. purpose of minimal encourager
Indicate active listening to client and interest in what client is saying They prompt client to continue with what was being said.
therapeutic communication 1. purpse of broad openings
Initiates conversation; puts the client in control of the content
what is the goal of self awareness:
Nurses can distinguish their own emotional needs from their patients' needs and get their own emotional needs met outside the nurse-patient relationship
therapeutic communication: 1. purpose of restating or reflection of content
Provides feedback, letting the client know that the nurse understood the message; lets the client know that the nurse is attentive
therapeutic communication: 1. purpose of clarigying
Puts client's ideas into a simple statement; makes the client's ideas explicit
therapeutic communication: 1. purpose of summarizing
The goal is to help client explore significant content and emotional themes. Helps move from one phase of the interaction to another.
self determination act
a law that requires health care institutions to provide information about advance health care directives to adult patients upon their admission to the healthcare facility.
what is culture
a pattern of learned behavior and values that are reinforced through interactions of members of a particular group
what is another concept of providing pt centered medical care
a pt centered medical home
what must nurses do in resepect to the consumer (pt's)
balance: -pt needs -pt inclusion -pt opinions
what do interpreters bridge
communication between english and non english speakers and communication between hearing and non hearing individualrs
therapeutic use of self
describes the ability of a caregiver to use his or her personality "consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions,"
what is the key to cultural competence
developing awareness of culture
factors that promote effective communication
dispositional traits rapport builders
what is a good way to begin development of cultural competence
do a cultural self assessment to assess your own beleifs
developing self- awareness is basic to...
effective interpersonal relationships
regression
ego defense mechanism that occurs as a reaction to stress
how do you polish your specific skills of cultural competence
engage in cross- cultural encounters ( encounters you have with people from other cultures)
ethnocentrism
evaluation of other cultures according to preconceptions originating in the standards and customs of one's own culture.
when an interpreter is needed who should you not use
family members they might not have a medical vocabulary
what is a root cause analysis
helps people answer the question of why the problem occurred in the first place. It seeks to identify the origin of a problem using a specific set of steps, with associated tools, to find the primary cause of the problem
transcultural nursing
how professional nursing interacts with the concept of culture.
learning theorys
knowle - adult learning theory health belief model
as your cultural competence increases, your _______ increases
knowledge
while we want to something and do it now, other cultures...
may take a wait and see approach and are more cautious and deliberate in treatment options
u.s. medicine is aggressive and uses strong measure for treatment, other cultures...
may use a much more gentler traditions
therapeutic communication: 1.) examples of silence
not breaking the quiet
patient center medical home
not simply a place but a model of org. ogf primary care that delivers 5 core functions of primary health care
disparities in health care
pour cultural competency
sequencing questions
put things in order "at first it was rash and then a spread to arm and then it became red and inflamed"
open ended questions
questions that cant be answered with yes or no "what brought you to the hospital" "how are you feeling today"
validating questions
questions use to validate a concern " it sounds like you consider this a very serious problem
clarifying questions
questions you ask to make sure that you understand what they are saying
reflective questions
repeating something patient said to get more out of them, they will elaborate
define cultural competence
set of congruent behaviors, practices, attitudes and policies that come together in a system or agency or among professionals, enabling effective work to be done in cross-cultural situations
Therapeutic communication: 1.) example of listening
silence eye contact attitude of being fully present
therapeutic aggressiveness
stronger is better
while we may plan ahead and see the most recent treatments as the best other cultures...
take life as it comes - time honored
what should leader ship do for patient centered care
that everything in the culture is focused on pt and family centered care -pracitsed everywhere in the hospital at the individual pt level, and microsystem level and accross the organization
ethnicity
the fact or state of belonging to a social group that has a common national or cultural tradition.
accultration
the process of adopting the cultural traits or social patterns of another group.
what is madeleine leininger's definition of culture?
the sum total of the way of living: values beliefs standards language thinking patterns behavioral norms communications styles, etc. -guide decisions and actions of group through time
world view
the way people tend to lok out upon the world or their universe to form a picture or value stance about life or the world around them
therapeutic communication: 1.) examples of restating or reflection
"Are you saying you were angry when your wife had to work late?"
therapeutic communication: 1. examples of minimal encourager
"Go on." "Uh-huh." "Go on, I'm listening."
therapeutic communication: 1. Examples of giving recognition
"I notice you're wearing a new dress. You look very nice." "What
barrier to effective communication: 1.examples of probing
"I'm here to listen. I can't help you if you won't tell me everything." "Tell me the secrets you keep from your family."
nonverbal communication
-Facial expressions -Posture, gait -Gestures -General physical appearance -Mode of dress and grooming -Sounds -Silence
self-awareness: avoiding stereotypes:
-Prejudices and attitudes that are biased toward clients
dispositional traits
-Warmth and friendliness -Openness and respect -Empathy -Honesty, authenticity, trust -Caring -Competence -Genuineness
culture
-a pattern of learned behavior and values that are reinforced through social interactions of members of a particular group -the sum total of the way of living; includes
when should pt centered care be deliverd
-at the right time -right level -right place
future orientation
-plan; newer = better -research is constantly being done to develop new treatments and meds
barriers to effective communication: 1. why should you be careful not to belittle a pt
1. Gives the message that you have not listened carefully. Makes client feel that the nurse is ignoring the importance of the problem.
therapeutic communication : 1. purose of focusing
Directs conversation back to an area of importance; explores a topic in depth
therapeutic communication: 1. purpose of giving recognition
It is a superficial level of communication, but it indicates attention to the client.
therapeutic communication: 1. purpose of informing
Provides facts or recommendations
the plane tree model:
it makes there room more homey, warm and welcoming for the pt
directing questions
or comments: move a conversation into an area that you want to explore more
while we want to "make it better" others cultures
will accept with grace
therapeutic communication: 1. examples of focusing
"Let's go back to the situation at school, where you felt uncomfortable in class."
therapeutic communicatoin: 1. examples of summarizing
"So far we have talked about..."
what are the IOM rules for redesigning patient care
- its base on continuous health relationship -care is customized according to pt needs and values -patient is source of control -knowledge is shared and flows freely
primary drivers in the IOM model for exceptional pt experience
- leadership : focus on pt and fam. -hearts and minds : fully engaged in commitment to pt centered care -respectful partnership w/ pt -reliable care: focus on quality around the clock -evidence base care
therapeutic use of self in the nurse-patient relationship
- nurses need to learn what the nurse - patient relationship really means -nurses therapeutic use of self -care must be patient-center -communication is critical
what are the factors involved in self-awareness
- reflective practice -avoiding stereotypes
what are the qualifications of working with interpreters
-Bilingual, bicultural, understands English medical vocabulary -Comfort in the medical setting -understands significance of the health problem -Preserves confidentiality
what are the 6 core elements of providing pt centered care
-Education and shared knowledge: pts need to know everything about there condition, they need to be educated -Involvement of family and friends: do not have restricted visiting hours to be with them as much as possible, they are an important role in the healing process, they might be able to notice when there is a problem -Collaboration and team management: this is important for quality and safety of the pt care -Sensitivity to spirituality and nonmedical issues: concern for inner most aspects of pt. what they view as important, what gives them peace of mind -Respect for patient needs/preferences -Accessibility of information: being able to know what is going on with their health, all pts have a right to review there medical record
what blocks communication
-Failure to perceive the patient as a human being -Failure to listen -Inappropriate comments and questions -Using clichés -Using closed questions -Using questions containing the words "why" and "how" -Using questions that probe for information -Using leading questions -Using comments that give advice -Using judgmental comments -Changing the subject -Giving false assurance -Using gossip and rumors -Using aggressive interpersonal behavior
Nurse- Pt relationship: the Orientation phase
-Getting to know you - begins development of trust - there are four tasks: 1. trust - enables participation 2. treat- each other as individuals 3. identification- of major probs/needs 4. approximate length of relationship will be estimated
what are the basic components of assertiveness
-Having empathy -Describing one's feelings or the situation -Clarifying one's expectations -Anticipating consequences
How can a nurse be non-judgemental?
-Nurses acknowledge all patients' rights to be different and express these differences -Nurse conveys acceptance to patients
what are the interviewing techniques
-Open-ended questions or comments -Closed questions or comments -Validating questions or comments: -Clarifying questions or comments: -Reflective questions or comments: -Sequencing questions or comments -Directing questions
how do you develop nursing skills
-Sit when communicating with a patient -Be alert and relaxed and take your time -Keep the conversation as natural as possible -Maintain eye contact if appropriate -Use appropriate facial expressions and body gestures -Think before responding to the patient
healthy people 2020 goal
-achieve health equity eliminate disparities improve health of all groups
self-management of care: what is the inclusion in plan of care (pt/family ed)
-cannot be delegated -there are barriers to effective teaching
leninger's culture care theory
-caring is essence of nursing and unique to nursing. -care is essential to curing and healing, for there can be no curing without caring
what are multiple factos and activities that are included in patient centered care:
-cultural awareness- what influences your own world view - cultural knowledge - being aware of a pt's world view -skills and interventions - need to be culturally congruent - cultural encounters: enables new forms of community and collective identity between you and your pt's -cultural desire: the motivation of a health care profession to want to engage in the process of becoming culturally competent
what are some ways to demonstrate culterally conrugents skills and interventions
-culture assessment - obtain accurate info from a pt that allows you to formulate an acceptable and culturally rel. plan. -linguistic competence - ability of an org. and staff to communicate effectively and convey info in a manner that is easily understood by diverse audiences -Healthy literacy - you need to est. what your pt. health literacy is; ability to obtain, process and understand health info need to make informed health decisions -teach back - instruct pt to demonstrate there understanding of what you have taught them.
what doe the knowledge of a patients culture do for a nurse
-directs the nurse in understanding behaviors and planning appropriate approaches to problems -culture may guide the patient's response to health care providers and their interventions
activism
-do something -we tend to not want nature to take its course, but prefer to take an active role in treatment of illness.
characteristics of the helping relationship
-dynamic -purposeful and time limited -person providing assistance is professionally accountable for the outcomes
how do the IOM characterize patient center care?
-identify, respect, care about pt's differences, values, preferences, and needs - listen/communicate w/ pt -share decision making and management -advocate disease prevention/health promotion of health lifestyles including a focus on population health
techniques of therapeutic communication
-listening -silence -broad openings -restating or reflection gf content -clarifying -reflection -focusing -information - confrontation -minimal encourager -giving recognition -summarizing
who are the consumers/customers
-macro consumers (government/insurers) -micro consumers (patients)
if you have poor cultural competency what could it lead to
-medical errors -poor quality of care
what are factors that are standard for healthcare in western medecine
-meliorism -dominance over nature -activism -timeliness -therapeutic aggressiveness -future orientation -standardization
nurse - pt relationship: termination phase
-nurse and pt take on those activities that enable them to end the relationship in a therapeutic manner -positive and neg. feelings often accompany the termination process -positive feelings about gains made -negative feelings of sadness, anger, fear ( must be discussed toward acceptance)
Nurse-pt relationship: working phase
-nurse/pt take tasks outlined in phase 1 -pt's may exhibit alternating periods of intense effort and periods of resistance to change -might display regression: often proceeds positive change
what are the obvious manifestations of culture
-religion -ethnicity -national origin -gender
therapeutic communication: 1.purpose of listining
Permits the client to be heard; conveys interest in what the client is saying
rapport builders
-Comfortable environment -Privacy -Confidentiality -Patient vs. task focus -Utilization of nursing observations -Optimal pacing -Providing personal space
factors influencing communication
-Developmental level -Gender -Sociocultural differences -Roles and responsibilities -Space and territoriality -Physical, mental, and emotional state -Environment
therapeutic communicaiton: 1.) examples of clarifying
"Are you saying you want to move out of your apartment?" "Could you explain more about that to me?"
therapeutic communication: 1.) examples of refelction
"So you start feeling depressed when no one calls you over the weekend."
barrier to effective communication: 1. example of belittling
"That was 10 years ago. That shouldn't bother you now." "You shouldn't feel that all men are bad."
barrier to effective communication: 1. example of being judgmental
"That's good (bad)." "You shouldn't do that."
therapetuci communication: 1. examples of informing
"The medication must be taken every day."
therapeutic communication: 1.) examples of broad openings
"What's been going on?" "Tell me what's been on your mind."
barrier to effective communication: 1. examples of sterotyping
"What's the matter, cat got your tongue?" "Most people don't have pain after this type of surgery."
therapeutic communication: 1. examples of confrontation
"You say you're upset, but you are laughing."
barrier to effective communication 1. examples of giving reassurance
"You'll feel better soon." "I'm sure everything will be OK." "Don't worry."
what are the less obvious manifestations of culture
-Age -Education -Educational Status -Mobility (including handicaps)
how do you develop conversation skills
-Control the tone of your voice -Be knowledgeable about the topic of conversation -Be flexible -Be clear and concise -Avoid words that might have different interpretations -Be truthful -Keep an open mind
what is the mission of TCNS (transcultural Nursing Society)
-enhance the quality of culturally congruent, competent and equitable care that results in improved health and well being for people world-wide
close ended questions
used when getting a health history, yes or no questions, more direct questions
forms of communication
verbal nonverbal
when is a root cause analysis done?
when a problem needs to be solved and the cause of which is unknown
what does pt centered care do for the pt and the health institue
- CMS all cause readmission rates have decreased over past three years: 2011-21%; 2012-20%; and first two quarters of 2013-18% - Average length-of-stay decreased from 4.0 days in CY 2011 to 3.6 days in CY 2013 -Decreased mortality rate -Greater employee engagement as well as improvement in retention
Self-Awareness: Reflective Practice
- Taking time to focus on own thoughts and feelings - Understand how these can affect behaviors toward patients
timeliness
-sooner than later, don't want to wait -therapeutic aggressiveness -stronger = better
how do you acquire cultural competence
-start with awareness -grow in knowledge -it is enhanced with specific skills -polished through cross-cultura encounters
barriers to effective communication
-stereotyping -agreeing or disagreeing -being defensive -challenging -probing -changing topic and subjects - giving reassurance -being judgmental -giving advice -belittling
dominance over nature
-take control -we believe that medical practices can dominate nature and we can control the illness through medical practices.
barriers to effective communication: 1. description of giving reassurance 2. why should you not do this
1. These are often clichés and other statements meant to comfort client. 2. These statements block the feelings and thoughts of the client. Everything might not end up well.
barriers to effective communication 1. description of probing 2. what are these responses considered? 3. what questions are often considered probing
1. These statements fail to respect the clients' decisions regarding privacy of feelings and thoughts. 2. prying. 3. Asking "why" is often probing.
barriers to effective communication: 1. description of giving advice 2. why should you not do this
1. These statements tell the client what to do. 2. This can backfire if the nurse gives advice and it does not work out well. Advising makes the nurse rather than the client responsible for the outcome.
barrier to effective communication: 1. description of agreeing or disagreeing 2.) why should you not do this
1.)Agreeing and disagreeing imply the client is either right or wrong and that the nurse is in a position to judge this. 2.) These responses deter clients from thinking through their position and may cause them to become defensive.
barrier to effective communication: 1.examples of agreeing or disagreeing
Client: "I don't think Dr. Galeano is a very good doctor. He doesn't seem interested in his patients." Nurse: "Dr. Galeano is head of the department of surgery and is an excellent surgeon."
barrier to effective communication: 1.examples of challenging
Client: "I felt nauseated after that pill." Nurse: "Surely you don't think I gave you the wrong pill?"
therapeutic communication: 1. purpose pf confrontation
Presents contradictions and inconsistencies
therapeutic communication: 1. purpose of relfection
Presents themes that have emerged through a series of interactions. Helps clients focus on feelings and allows the nurse to communicate empathy.
related nursing theories
Watsons- caring theory orem - self care theory leninger - culteral diversity theory knowing differences among people cultures peplaue - interpersonal relations theory unique quality of nurse pt relationships that help there health
what do nursing standards support
advocacy consumerism
if a nurse recognizes pt values and preferences what should it lead to
an increase in collaboration
while we want to control nature, other cultures...
believe in a balance of harmony with nature
the u.s. is big on standardization - treat everyone that same, other cultures...
believe in individualized care and recognize differences among people
the best representation of patient centered care
the plane tree model the pt is the key essential element of the model they want to make the pt as comfortable as possible families are welcome
assimilation
the process by which a person or a group's language and/or culture come to resemble those of another group
