Cultural Competence
in the Care of Childbearing
Families
Mary Lou Moore, PhD, RNC, FAACE, FAAN
Merry-K. Moos, BSN, FNP, MPH
© 2002, March of Dimes
Immigration to the U.S.• 1 million immigrants come to the
U.S. each year (U.S. INS, 1991).• More than half are women of
childbearing age (U.S. INS, 1991).• 1 in every 10 persons in the United
States is foreign-born (National Center for Cultural Competence, 1999).
© 2002, March of Dimes
U.S. Population
AfricanAmerican--12.1%
Hispanic--11.5%
Asian/PacificIslander--3.8%
AmericanIndian/AlaskaNative--0.7%
Non-HispanicWhite--71.9%
(Population Estimates and Projections, 2000)
American Indian/
Alaska NativeAsian/Pacific
Islander
Hispanic
African
American
Non-Hispanic
white
© 2002, March of Dimes
What is Cultural Competence?
(Developmental Disabilities and Bill of Rights Act of 2000)
Providing services, supports and assistance:
– That are responsive to beliefs, interpersonal styles, attitudes, language and behaviors of individuals with the greatest likelihood of ensuring maximum acceptance and participation
– That demonstrate respect for individual dignity, personal preference and cultural differences
© 2002, March of Dimes
Importance of Cultural Competence• U.S. demographics are changing.• Health disparities exist between
ethnic groups in the United States.• Regulatory mandates require
increased, documented cultural competence.
• Cultural competence enriches professional nursing practice.
© 2002, March of Dimes
What is Culture?• Culture is a distinct way of life that
characterizes a particular community of people.
• Culture includes shared practices, beliefs, values and customs passed through generations.
• Culture provides a sense of identity (“I belong”).
© 2002, March of Dimes
Dimensions of Culture• Values• World view• Disease etiology• Time orientation• Personal space• Family organization• Power structure
© 2002, March of Dimes
Acculturation• Integration into mainstream
culture• Affected by age at time of arrival in
a new setting, reason for moving to a new setting and residence in a predominantly ethnic neighborhood
• Generally takes three generations in the United States (Spector, 2000)
© 2002, March of Dimes
Ethnocentrism• Ethnocentrism is the belief that
one’s own culture is best.• Providers must be mindful of their
own ethnocentrism.
© 2002, March of Dimes
Cultural Perspectives • Emic perspective–Of an insider or
member of the culture• Etic perspective–Of an outsider or
observer of the culture
© 2002, March of Dimes
Cultural Traditions• A functional tradition enhances an
individual’s health and well-being.• A neutral tradition neither
enhances nor harms an individual’s health and well-being.
• A non-functional tradition is potentially harmful to an individual.
© 2002, March of Dimes
Cultural Characteristics• Individual vs. group identity• Decision-making• Eye contact• Being polite• Family• Hot and cold• Small talk
© 2002, March of Dimes
Cultural Characteristics (Continued)
• Evil spirits• Father’s participation at birth• Male health care providers• Pregnancy as a healthy, natural
state
© 2002, March of Dimes
Food Guide Pyramid
From USDA & DHHS, 2002
© 2002, March of Dimes
Populations and Conditions• African American–Sickle cell disease• Amish–PKU, hemophilia B• Greek–Thalassemia• Jewish–Tay-sachs, Gaucher’s disease• Native American–Type 2 diabetes
mellitus
Note: Conditions not limited to a single population group.
© 2002, March of Dimes
Ways to Relate to Other Cultures• Common practices
– Avoiding people from other cultures– Refusing to recognize cultural
differences– Recognizing differences, but feeling
own way is superior (ethnocentrism)
• Best practice– Acknowledging and seeking to
understand cultural differences
© 2002, March of Dimes
Cultural Assessment• Where were you
born?• How long have you
lived in the United States?
• Who are your major support people?
• What languages do you speak and read?
• What are your religious practices?
• What are your food preferences?
• What is your economic situation?
© 2002, March of Dimes
Childbearing Assessment• What does
childbearing represent to you?
• How do you view childbearing?
• Are there any maternal precautions or restrictions?
• Is birth a private or social experience?
• How would you like to manage labor pain?
• Who will provide labor support?
• Who will care for the baby?
• Do you use contraception?
© 2002, March of Dimes
Assessment Techniques• Use a conversational approach.• Ask open-ended questions.• Integrate cultural and childbearing
assessments.• Listen with interest.• Remain nonjudgmental.
© 2002, March of Dimes
Interpreters and Translators•Interpreters communicate
verbally.– Should be female– Should not be a family member
•Translators work with written communication.
© 2002, March of Dimes
Expectations for Interpreters• Maintain strict confidentiality.• Interpret everything the woman
says without editorializing or paraphrasing.
• Either party may interrupt or seek additional information.
© 2002, March of Dimes
Ethical Issues• Group needs vs. individual needs• Refusal of treatment• Informed consent• Truthfulness• Morality
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