Chapter 2

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Cultural Competence: Cultural Competence: Cultural CareCultural Care

Chapter 2Chapter 2


Chapter 2: Cultural Competence: Cultural CareChapter 2: Cultural Competence: Cultural Care

Cultural CompetencyCultural Competency

Who are you meeting for the first time?Who are you meeting for the first time? Where does the patient come from?Where does the patient come from? What is his or her heritage?What is his or her heritage? What is his or her cultural background: What is his or her cultural background:

ethnicity and religion?ethnicity and religion?

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Cultural Competency (cont.)Cultural Competency (cont.)

Does the patient understand, speak, and read Does the patient understand, speak, and read English?English?

What language does her or she understand, What language does her or she understand, speak, and read?speak, and read?

What is his or her health and illness beliefs What is his or her health and illness beliefs and practices?and practices?

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ObjectivesObjectives

Demographic profile of United StatesDemographic profile of United States National Standards for Culturally and Linguistically National Standards for Culturally and Linguistically

Appropriate ServicesAppropriate Services Background of Heritage AssessmentBackground of Heritage Assessment Methods for conducting Heritage AssessmentMethods for conducting Heritage Assessment Traditional health and illness beliefs and practicesTraditional health and illness beliefs and practices Steps to cultural competenceSteps to cultural competence

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Health and IllnessHealth and Illness

Health:Health: Balance of a person is a complex, interrelated Balance of a person is a complex, interrelated

phenomenon:phenomenon:• Within one’s being: physical, mental, spiritualWithin one’s being: physical, mental, spiritual

• In outside world: natural, communal, metaphysicalIn outside world: natural, communal, metaphysical

Illness:Illness: Loss of a person’s balance:Loss of a person’s balance:

• Within one’s being: physical, mental, spiritualWithin one’s being: physical, mental, spiritual

• In outside world: natural, communal, metaphysicalIn outside world: natural, communal, metaphysical

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Demographic Profile ofDemographic Profile ofUnited StatesUnited States

Total population passed 300 million in 2006Total population passed 300 million in 2006 1 out of 3 residents are in a group other than 1 out of 3 residents are in a group other than

single-race, non-Hispanic whitesingle-race, non-Hispanic white Minority, or emerging majority populations total 98 Minority, or emerging majority populations total 98

million peoplemillion people Hispanics: largest and fastest growing groupHispanics: largest and fastest growing group Blacks: second largest populationBlacks: second largest population Asians, American Indians, Alaska natives, Native Asians, American Indians, Alaska natives, Native

Hawaiians, and other Pacific Islanders make up Hawaiians, and other Pacific Islanders make up the third largest part of the populationthe third largest part of the population

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Demographic Profile ofDemographic Profile ofUnited States (cont.)United States (cont.)

Emerging majority groups tend to be:Emerging majority groups tend to be: YoungerYounger Lower median agesLower median ages Higher proportions under 18 years oldHigher proportions under 18 years old

Dominant, non-Hispanic, single-race, white Dominant, non-Hispanic, single-race, white population is:population is: Older median ageOlder median age Smaller proportion under 18 years oldSmaller proportion under 18 years old

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Demographic Profile ofDemographic Profile ofUnited States (cont.)United States (cont.)

One birth every 8 secondsOne birth every 8 seconds One death every 13 secondsOne death every 13 seconds One international migrant (net) every 30 One international migrant (net) every 30

secondsseconds Net gain of one person every 11 secondsNet gain of one person every 11 seconds

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Immigration Immigration

Categories of Interest to Health Care Categories of Interest to Health Care ProvidersProviders Legal permanent residentsLegal permanent residents Naturalized citizensNaturalized citizens Undocumented aliensUndocumented aliens Refugees, asylees, and paroleesRefugees, asylees, and parolees Legal nonimmigrant residentsLegal nonimmigrant residents

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Immigration (cont.)Immigration (cont.)

Many new immigrants have only minimal Many new immigrants have only minimal understanding of:understanding of: Modern health care delivery systemModern health care delivery system Modern medical and nursing practices and Modern medical and nursing practices and

interventionsinterventions English languageEnglish language

It is imperative that the nurse’s care be It is imperative that the nurse’s care be tailored to meet the person’s perceived needstailored to meet the person’s perceived needs

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National StandardsNational Standards

National Standards for Culturally and National Standards for Culturally and Linguistically Appropriate ServicesLinguistically Appropriate Servicesin Health Carein Health Care First and Landmark StandardFirst and Landmark Standard

• Health care organizations should ensure that patients Health care organizations should ensure that patients receive from all staff members effective, understandable receive from all staff members effective, understandable and respectful care that is provided in a manner and respectful care that is provided in a manner compatible with their cultural health beliefs and practices compatible with their cultural health beliefs and practices and preferred language*and preferred language*

*Source: National Standards for Culturally and Linguistically Appropriate Services in Health Care, *Source: National Standards for Culturally and Linguistically Appropriate Services in Health Care, Final Report, March 2001, Washington, DC: Office of Minority Health, DHHSFinal Report, March 2001, Washington, DC: Office of Minority Health, DHHS

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National Standards (cont.)National Standards (cont.)

Effective care: positive outcomes and Effective care: positive outcomes and satisfaction for patientsatisfaction for patient

Respectful care: considers values, Respectful care: considers values, preferences, and expressed needs of patientpreferences, and expressed needs of patient

Cultural and linguistic competence: congruent Cultural and linguistic competence: congruent behaviors, attitudes, and policies that come behaviors, attitudes, and policies that come together in a system among professionals together in a system among professionals that enables work in cross-cultural situationsthat enables work in cross-cultural situations

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Linguistic CompetenceLinguistic Competence

Title VI of Civil Rights Act of 1964: Title VI of Civil Rights Act of 1964: Services cannot be denied to people of limited Services cannot be denied to people of limited

English proficiencyEnglish proficiency 47 million Americans over 5 years of age 47 million Americans over 5 years of age

speak a language other than English in their speak a language other than English in their homeshomes An increase of 15 million people over 1990 censusAn increase of 15 million people over 1990 census

Some states require providers to offer Some states require providers to offer language assistance in health care settings:language assistance in health care settings: California, Massachusetts, and New YorkCalifornia, Massachusetts, and New York

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Linguistic Competence (cont.)Linguistic Competence (cont.)

People with limited ability to speak, read, People with limited ability to speak, read, write, and understand English encounter write, and understand English encounter countless barriers that limit access to critical countless barriers that limit access to critical public health, hospital, and other medical and public health, hospital, and other medical and social services to which they are legally social services to which they are legally entitledentitled

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Cultural CompetenceCultural Competence

Culturally sensitive:Culturally sensitive: Possessing basic knowledge of and constructive Possessing basic knowledge of and constructive

attitudes toward diverse cultural populationsattitudes toward diverse cultural populations Culturally appropriate:Culturally appropriate:

Applying underlying background knowledge Applying underlying background knowledge necessary to provide the best possible health carenecessary to provide the best possible health care

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Cultural Competence (cont.) Cultural Competence (cont.)

Culturally competent:Culturally competent: Understanding and attending to total context of Understanding and attending to total context of

patient’s situation including: patient’s situation including: • Immigration statusImmigration status

• Stress factorsStress factors

• Social factorsSocial factors

• Cultural similarities and differencesCultural similarities and differences

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HeritageHeritage

CultureCulture EthnicityEthnicity Religion and SpiritualityReligion and Spirituality SocializationSocialization

AcculturationAcculturation AssimilationAssimilation BiculturalismBiculturalism

Time OrientationTime Orientation

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Heritage (cont.)Heritage (cont.)

Heritage consistency:Heritage consistency: Degree to which a person’s lifestyle reflects his or Degree to which a person’s lifestyle reflects his or

her traditional heritageher traditional heritage Heritage consistency continuum:Heritage consistency continuum:

Traditional: living within norms of traditional cultureTraditional: living within norms of traditional culture Modern: acculturated to norms of dominant Modern: acculturated to norms of dominant

societysociety

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Culture:Culture: Thoughts, communications, actions, beliefs, Thoughts, communications, actions, beliefs,

values, and institutions of racial, ethnic, religious, values, and institutions of racial, ethnic, religious, or social groupsor social groups

Characteristics of cultureCharacteristics of culture• LearnedLearned

• SharedShared

• AdaptedAdapted

• DynamicDynamic

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EthnicityEthnicity Describes a group united by: Describes a group united by:

• Common geographic originCommon geographic origin

• Migratory statusMigratory status

• ReligionReligion

• RaceRace

• LanguageLanguage

• Shared values, traditions, or symbolsShared values, traditions, or symbols

• Food preferencesFood preferences

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Religion:Religion: Belief in divine or superhuman power, or powers Belief in divine or superhuman power, or powers

to be obeyed and worshipped as creator/ruler of to be obeyed and worshipped as creator/ruler of universeuniverse

System of beliefs, practices, and ethical valuesSystem of beliefs, practices, and ethical values Shared experience of spiritualityShared experience of spirituality

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SocializationSocialization Process of being raised within a culture and Process of being raised within a culture and

acquiring characteristics of that groupacquiring characteristics of that group Related terms:Related terms:

• Acculturation: process of adapting to and acquiring Acculturation: process of adapting to and acquiring another cultureanother culture

• Assimilation: process of developing a new cultural Assimilation: process of developing a new cultural identity and becoming like members of dominant cultureidentity and becoming like members of dominant culture

• Biculturalism: dual pattern of identification and often of Biculturalism: dual pattern of identification and often of divided loyaltydivided loyalty

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Time OrientationTime Orientation Focus on pastFocus on past

• Traditions and ancestors play important role in person’s Traditions and ancestors play important role in person’s lifelife

Focus on presentFocus on present• Little attention paid to past or future; concerned with Little attention paid to past or future; concerned with

now, and future perceived as vague or unpredictablenow, and future perceived as vague or unpredictable

Focus on futureFocus on future• Progress and change highly valued; person may express Progress and change highly valued; person may express

discontent with both past and presentdiscontent with both past and present

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Heritage AssessmentHeritage Assessment

Indicators of heritage consistencyIndicators of heritage consistency Childhood occurred in country of origin or Childhood occurred in country of origin or

immigrant neighborhood of like ethnic groupimmigrant neighborhood of like ethnic group Extended family support of traditional activitiesExtended family support of traditional activities Frequent visits to old country or old neighborhoodFrequent visits to old country or old neighborhood Family home within ethnic community to which Family home within ethnic community to which

they belongthey belong Participation in ethnic cultural eventsParticipation in ethnic cultural events Raised in extended family settingRaised in extended family setting

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Heritage Assessment (cont.)Heritage Assessment (cont.)

Indicators of heritage consistency (cont.)Indicators of heritage consistency (cont.) Regular contact with extended familyRegular contact with extended family Name not anglicizedName not anglicized Educated in parochial schoolEducated in parochial school Social activities primarily with members of ethnic Social activities primarily with members of ethnic

communitycommunity Knowledge of language and culture of originKnowledge of language and culture of origin Expresses pride in heritageExpresses pride in heritage

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Health-Related BeliefsHealth-Related Beliefsand Practicesand Practices

Health-Related Behaviors Affected by Health-Related Behaviors Affected by ReligionReligion MeditatingMeditating Exercising/physical fitnessExercising/physical fitness Sleep habitsSleep habits VaccinationsVaccinations Willingness to undergo physical examinationWillingness to undergo physical examination PilgrimagePilgrimage Truthfulness about how patient feelsTruthfulness about how patient feels

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Health-Related BeliefsHealth-Related Beliefsand Practices (cont.)and Practices (cont.)

Health-Related Behaviors Affected by Health-Related Behaviors Affected by Religion (cont.)Religion (cont.) Maintenance of family viabilityMaintenance of family viability Hoping for recoveryHoping for recovery Coping with stressCoping with stress Genetic screening and counselingGenetic screening and counseling Living with a disabilityLiving with a disability Caring for childrenCaring for children

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Health-Related BeliefsHealth-Related Beliefsand Practices (cont.)and Practices (cont.)

Differing views of epilepsy:Differing views of epilepsy: Uganda: contagious, untreatableUganda: contagious, untreatable Greece: source of family shameGreece: source of family shame Mexican-American community: evidence of Mexican-American community: evidence of

physical imbalancephysical imbalance Hutterites: evidence of having endured trial by Hutterites: evidence of having endured trial by

GodGod

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Developmental CareDevelopmental Care

Culture affects choices parents make for Culture affects choices parents make for children regarding:children regarding: Presumed cause of illnessPresumed cause of illness First treatment triedFirst treatment tried Acceptability of treatments offered by cliniciansAcceptability of treatments offered by clinicians

For older patients, culture is likely toFor older patients, culture is likely to Define their family responsibilitiesDefine their family responsibilities Affect their view and knowledge of health care Affect their view and knowledge of health care

systems used by dominant culturesystems used by dominant culture

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Traditional Causes of IllnessTraditional Causes of Illness

BiomedicalBiomedical Assumes cause and effectAssumes cause and effect Views the body as a machineViews the body as a machine Life can be divided into partsLife can be divided into parts Endorses germ theoryEndorses germ theory

NaturalisticNaturalistic Forces of nature must be kept in balanceForces of nature must be kept in balance Embraces idea of opposing categories or forcesEmbraces idea of opposing categories or forces

• Yin and yang, hot and coldYin and yang, hot and cold

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Traditional CausesTraditional Causesof Illness (cont.)of Illness (cont.)

MagicoreligiousMagicoreligious Supernatural powers predominate in area of Supernatural powers predominate in area of

health and illnesshealth and illness• Examples include voodoo, witchcraft, and faith healingExamples include voodoo, witchcraft, and faith healing

Healing and cultureHealing and culture In addition to seeking help from health care In addition to seeking help from health care

providers, patients may also seek help from folk or providers, patients may also seek help from folk or religious healers religious healers

Hispanics or American Indians may believe that Hispanics or American Indians may believe that cure is incomplete unless healing of body, mind, cure is incomplete unless healing of body, mind, and spirit are all carried outand spirit are all carried out

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Traditional CausesTraditional Causesof Illness (cont.)of Illness (cont.)

Folk HealersFolk Healers Hispanic: curandero, espiritualista, yerbo, or Hispanic: curandero, espiritualista, yerbo, or

sabedorsabedor Black: hougan, spiritualist, old ladyBlack: hougan, spiritualist, old lady American Indian: shaman, medicine woman, American Indian: shaman, medicine woman,

medicine manmedicine man Asian: herbalists, acupuncturists, bone settersAsian: herbalists, acupuncturists, bone setters Amish: braucherAmish: braucher

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Transcultural Expressions of Transcultural Expressions of IllnessIllness

Transcultural expression of painTranscultural expression of pain Expectations, manifestations, and management of Expectations, manifestations, and management of

pain are all embedded in a cultural contextpain are all embedded in a cultural context Pain has been found to be a highly personal Pain has been found to be a highly personal

experience, depending on cultural learning, the experience, depending on cultural learning, the meaning of the situation, and other factors unique meaning of the situation, and other factors unique to the personto the person

Silent suffering has been identified as the most Silent suffering has been identified as the most valued response to pain by health care valued response to pain by health care professionalsprofessionals

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Transcultural Expressions of Transcultural Expressions of Illness (cont.)Illness (cont.)

Culture-bound syndromesCulture-bound syndromes Condition that is culturally definedCondition that is culturally defined

• Some have no equivalent in a biomedical, scientific Some have no equivalent in a biomedical, scientific perspectiveperspective

• Anorexia nervosa and bulimia are examples of cultural Anorexia nervosa and bulimia are examples of cultural aspects of illness in dominant cultural population in North aspects of illness in dominant cultural population in North AmericaAmerica

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Culture and treatmentCulture and treatment First effort at treatment is often self-careFirst effort at treatment is often self-care Home treatment attractive for accessibility, Home treatment attractive for accessibility,

particularly for people from rural or sparsely particularly for people from rural or sparsely populated areaspopulated areas

Home treatment may mobilize person’s social Home treatment may mobilize person’s social support network and provide a caring environment support network and provide a caring environment in which to convalescein which to convalesce

Alternative or complementary interventions are Alternative or complementary interventions are gaining recognition from health care professionals gaining recognition from health care professionals in health care systemin health care system

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Culture and disease prevalenceCulture and disease prevalence Disparity continues in deaths and illnesses Disparity continues in deaths and illnesses

experienced by racial and ethnic populationsexperienced by racial and ethnic populations• Diseases are not distributed equally among all segments Diseases are not distributed equally among all segments

of populationof population

Abnormal biocultural variations may be genetic or Abnormal biocultural variations may be genetic or acquiredacquired• Information about disease prevalence for racial and Information about disease prevalence for racial and

ethnic groups provides focus for assessment regarding ethnic groups provides focus for assessment regarding increased probability that particular conditions may occurincreased probability that particular conditions may occur

• Nurses must be certain that they have gathered data Nurses must be certain that they have gathered data needed to support or refute suspicionsneeded to support or refute suspicions

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Steps to Cultural CompetenceSteps to Cultural Competence

Understand one’s own heritage-based Understand one’s own heritage-based values, beliefs, attitudes, and practicesvalues, beliefs, attitudes, and practices

Identify meaning of “health” to patientIdentify meaning of “health” to patient Understand how health care system worksUnderstand how health care system works Acquire knowledge about social backgrounds Acquire knowledge about social backgrounds

of patientsof patients Become familiar with languages, interpretive Become familiar with languages, interpretive

services, and community resources available services, and community resources available to nurses and patientsto nurses and patients

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Cultural Care NursingCultural Care Nursing

Cultural care nursing is goal to strive forCultural care nursing is goal to strive for It is a long trajectoryIt is a long trajectory

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RESPECTRESPECT

RRealize you must know heritage of yourself and ealize you must know heritage of yourself and patientpatient

EExamine patient within cultural contextxamine patient within cultural context SSelect simple questions and speak slowlyelect simple questions and speak slowly PPace questioning throughout examace questioning throughout exam EEncourage patient to discuss meaning of health ncourage patient to discuss meaning of health

and illness with youand illness with you CCheck patient’s understanding and acceptance of heck patient’s understanding and acceptance of

recommendationsrecommendations TTouch patient within boundaries of his or her ouch patient within boundaries of his or her

heritageheritage

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Chapter 2

Healthcare

Transcript of Chapter 2