Unit 3 NR222 CHAPTER 9: CULTURAL AWARENESS

linguistic competence

-ability of an organization and its staff to communicate effectively and convey information in a manner that is easily understood by diverse audiences.

linguistic competence-

-ability of an organizations and its staff to communicate effectively and convey information in a manner that is easily understood by diverse audiences.

cultural skills

-ability to assess social, cultural, and biophysical factors that influence patient treatment and care.

use a patient's explanatory model instead of a traditional biomedical model to reveal your patient's views on illness.

-an effective approach to patient assessment is to _____.

cultural awareness

-an in-depth self examination of one's own background, recognizing biases, prejudices, and assumptions about other people.

cultural encounter

-an intervention that involves a nurse directly interacting with patients from culturally diverse backgrounds.

culture

-associated with norms, values, and traditions passed down through generations. -same as ethnicity, race, nationality, and language

culturally competent

-becoming ____ is an ongoing long-term process for a health care provider.

culturally competent health care providers and organizations

-can contribute to elimination of health disparities.

culturally congruent care

-care that fits a person's life patterns, values, and system of meaning. -patterns and meaning are generated by people themselves rather than from predetermined criteria. -example: rather than instructing all patients to always take their medication at the same times during a day, you learn their lifestyle patterns, eating habits, and beliefs about medications and then try to plan a dosage schedule that fits each patient's needs.

transcultural nursing

-comparative study of cultures to understand their similarities and the differences among them. -goal is to provide culturally congruent care

health care system and providers

-contribute to the problem of health disparities as a result of inadequate resources, poor patient- provider communication, lack of culturally competent care, fragmented delivery of care, and inadequate access to language services.

cultural encounters

-cross-cultural interactions that provide opportunities to learn about other cultures and develop effective intercultural communications.

world view

-determines how people perceive others, how they interact and relate to reality, and how they process information. -the way people tend to look out upon the world or their universe to form a picture or value stance about life of the world around them.

healthcare disparities

-differences among populations in the availability, accessibility, and quality of health care services aimed at prevention, treatment, and management of diseases and their complications. -example: screening, diagnostic, treatment, management and rehabilitation

cultural competency

-enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients. -allows systems, agencies, and groups of professionals to function effectively to understand the needs of groups accessing health information and health care and thus help eliminate health care disparities and ultimately health disparities.

health literacy

-encompasses both health literacy and limited english proficiency. -the ability to obtain, process, and understand health information needed to make informed health decisions.

oppression

-formal and informal system of advantage and disadvantages tied to our membership in social groups, such as those at work, at school, and families. -it impacts individual's access to resources such as health, care, housing education, employment, and legal services

marginalization

-groups are left out (limited access or exclusion from facets of the society such as political system, labor market, positions of power)..

social inequality

-groups have unequal access to resources, services, and positions.

disparities

-in the access to quality of health care, preventive health, and health education contribute to poor population health.

matrix of domination

-instead of thinking about race, gender, immigration status, class, and other axes of identity as descriptive categories only, it is important to understand them within the context of the larger system of power and privilege the permeates society.

culture desire

-involves a natural inclination to engage in the cultural competence process that is characterized by passion, commitment, and caring.

cultural desire

-is the motivation of a health care professional to "want to"-- not "have to" -- engage in the process of becoming culturally competent. -characterized by passion, commitment, and caring.

core measures

-key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs. -such as screening for depression and controlling high blood pressure are consistent with national health priorities.

core measures

-key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs. -such as screening for depression and controlling high blood pressure are consistent with the national health priorities.

overinclusions and underinclusions

-many groups have been overlooked in research and the design of interventions.

marginalized group

-more likely to have poor health outcomes and die at an earlier age because of a complex interaction between individual genetics and behaviors; public and health policy; community and environmental factors; and quality of health care.

cultural desire

-motivation and commitment to caring that moves an individual to learn from others, accept the role as a learner, be open to and accepting of cultural differences, and build on cultural similarities.

social location

-one's place in society is based on membership in a social group that determines access to resources. -gender, race, class, sexual orientation -not based on biology but on the meaning that society constructs and gives to one's social group.

teach back

-ongoing process of asking patients for feedback through explanation or demonstration and presenting information in a new way until you feel confident that you communicated clearly and that you patient has full understanding of the information presented.

health disparity

-particular type of health difference that is closely linked with social, economic and/or environmental disadvantages. -inequality of differences between the health status of a disadvantaged group such as people with ow incomes and wealth and an advantaged group such as people with high incomes and wealth.

explanatory model

-patients views about health and illness and its treatment. -five questions: etiology, time and mode of onset symptoms, pathophysiology, course of illness, recommended treatment.

a person's culture and life experience

-shape his or her world view about health, illness, and health care.

cultural knowledge

-sufficient comparative knowledge of diverse groups, including the values, health beliefs, care practices, world view, and bicultural ecology commonly found within each group.

social determinant of health

-the conditions in which people are born are born, grow, live, work and age... shaped by the distributions of money, power and resources at global, national, and local levels. -examples: income and wealth, family and household structures, social support, education, occupation, discrimination, neighborhood conditions, and social institutions.

cultural assessment

-to understand patient's world view, including how her religious values affected her willingness to receive care. -obtain accurate information from a patient that allows you to formulate a mutually acceptable and culturally relevant plan of acre for each health problem of a patient. -example: the patient's deeply held religious beliefs about removing a body part are not obvious by assessing for a religious preference.

intersectionality

-we all belong to multiple social groups within changing social and political contexts.

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 understanding." 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."

1

How can a nurse work on developing cultural awareness? (Select all that apply.) 1. Reflect on his or her past learning about health, illness, race, gender, and sexual orientation 2. Develop greater self-knowledge about personal biases 3. Recognize consciously the multiple factors that influence his or her own world view 4. Engage in an in-depth self-examination of his or her own background 5. Learn as many facts as possible about an ethnic group

1 2 3 4

Which of the following are considered social determinants of health? (Select all that apply.) 1. Lack of primary health care providers in a zip code 2. Poor-quality public school education that prevents a person from developing adequate reading skills 3. Lack of affordable health insurance 4. Employment opportunities that do not provide paid vacation or sick leave 5. The number of times a person exercises during a week 6. Neighborhood safety that prevents a person from walking around the block or socializing with neighbors outside of his or her home

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Which of the following changes can help create a more inclusive environment for lesbian, gay, bisexual, and transgender (LGBT) patients? (Select all that apply.) 1. Explicitly including sexual orientation and gender identity into nondiscrimination policies 2. Displaying art that reflects LGBT community 3. Modifying health care forms to provide opportunities for gender identity and sexual orientation disclosure 4. Not asking patients about their gender identity and sexual orientation to avoid making them uncomfortable 5. Ensuring access to unisex or single-stall bathrooms

1 2 3 5

A patient is admitted through the emergency department (ED) after a serious car accident. The nurse assesses the patient and quickly learns that he speaks little English. Spanish is his primary language. The nurse speaks some Spanish. Which interventions would be appropriate at this time? (Select all that apply.) 1. The nurse requests a professional interpreter. 2. Since this is an emergent situation, the nurse will interpret and identify the patient's priority needs. 3. The nurse determines the interpreter's qualifications and makes sure that the interpreter can speak the patient's dialect. 4. The nurse uses short sentences to explain the treatments provided in the ED. 5. The nurse directs questions to the patient by looking at the patient instead of at the interpreter.

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Which of the following are examples of problems with the health care system that contribute to health disparities? (Select all that apply.) 1. A health care provider assumes that the patient missed two appointments because the patient does not care about his or her health and does not inquire about the reasons for missed visits. 2. The discharge nurse at a hospital uses Teach Back with a patient to ensure that she has communicated the discharge instructions clearly. 3. A community hospital lacks an adequate staff of social workers who are able to ensure patients' access to resources they need to take care of their health. 4. A hospital discharges a patient without ensuring that the patient has a primary care provider and has made a follow-up appointment. 5. A nurse uses a family member as an interpreter to explain the patient's medications. 6. The hospital conducts quality improvement without stratifying data by race, ethnicity, language, socioeconomic status, sexual orientation, and other axes of social group identities.

1 3 4 5 6

CAMPINHA-BACOTE'S FIVE MODEL OF CULTURAL COMPETENCY:

1. cultural awareness 2. cultural knowledge 3. cultural skills 4. cultural encounters 5. cultural desire

GOALS OF CULTURAL ENCOUNTER (CAMPIN-BACOTE 2011)

1. generate a wide varieties and to send and receive both verbal and nonverbal communication accurately and appropriately 2. continuously interact with patients from culturally diverse backgrounds in order to validate, refine, or modify existing values, beliefs, and practices and to develop cultural desire, awareness, skill, and knowledge.

PRINCIPLES OF CULTURALLY COMPETENT ORGANIZATION:

1. value diversity 2. conduct a cultural self-assessment 3. manage the dynamics of difference 4. institutionalize cultural knowledge 5. adapt to diversity

Match the following definitions with the key terms related to intersectionality. 1. Under inclusion 2. Social inequality 3. Social location a. Groups have unequal access to resources, services, and positions. b. A group has been overlooked in research and the design of interventions. c. One's place in society is based on membership in a social group that determines access to resources.

1b 2a 3c

In the United States, there has never been a president of Asian or Hispanic culture. This is an example of: 1. Social inequality 2. Marginalization 3. Under inclusion 4. Social location

2

When you care for a patient who does not speak English, it is necessary to call on a professional interpreter. Which of the following are proper principles for working with interpreters? (Select all that apply.) 1. Expect the interpreter to interpret your statements word-for-word so there is no misunderstanding by the patient. 2. If you feel an interpretation is not correct, stop and address the situation directly with the interpreter. 3. Pace a conversation so there is time for the patient's response to be interpreted. 4. Direct your questions to the interpreter. 5. Ask the patient for feedback and clarification at regular intervals.

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A new nurse is caring for a hospitalized obese patient who is homeless. This is the first time the patient has been admitted to the hospital, and the patient is scheduled for surgery. Which of the following is a universal skill that will help the nurse work effectively with this patient? 1. The nurse shifts her focus to understanding the patient by asking her, "Describe for me the course of your illness." 2. The nurse tells the patient, "Your choices of foods and unwillingness to exercise are adding to your health problems." 3. The nurse asks the patient, "Tell me about the main problems you have had with your health from not having a home." 4. The nurse explains, "Because you have obesity, it is important to know the effects it has on wound healing because of reduced tissue perfusion."

3

A nurse has worked in a home health agency for a number of years. She goes to visit a patient who has diabetes and who lives in a public housing facility. This is the first time the nurse has cared for the patient. The patient has four other family members who live with her in the one-bedroom apartment. Which of the following, based on Campinha-Bacote's (2002) model of cultural competency, is an example of cultural awareness? 1. The nurse begins a discussion with the patient by asking, "Tell me about your family members who live with you?" 2. The nurse asks, "What do you believe is needed to make you feel better?" 3. The nurse silently reflects about how her biases regarding poverty can influence how she assesses the patient. 4. The nurse uses a therapeutic and caring approach to how she interacts with the patient.

3

During an encounter with an elderly patient, the nurse recognizes that a thorough cultural assessment is necessary because the patient has recently come to the United States from Russia and has never been hospitalized before. The nurse wants to discuss cultural similarities between herself and the patient. Which step of the LEARN mnemonic is this? 1. Listen 2. Explain 3. Acknowledge 4. Recommend treatment 5. Negotiate agreement

3

A nurse is preparing to perform a cultural assessment of a patient. Which of the following questions is an example of a contrast question? 1. Tell me about your ethnic background. 2. Have you had this problem in the past? 3. Where do other members of your family live? 4. How different is this problem from the one you had previously?

4

1. social inequality 2. overinclusion and underinclusion 3. marginalization 4. social location 5. matrix or domination

KEY CONCEPT OF INTERSECTIONALITY: