RNSG 1471 Health Care Concepts 1 Cultural Aspects of Health and Illness

Transcultural Nursing Focuses on care, health, illness patterns of people with similarities and differences in cultural belief, values, practices

Culture Not restricted to race, ethnicity Refers to integrated patterns of behavior acquired over time (e.g., beliefs, values, customs, norms, habits, language, thoughts) Learned within family unit, generation, and/or other social organizations

Cultural Diversity Differences among people; may or may not be visible Race – visible physical characteristics (e.g., skin tone, head shape, hair texture) Ethnicity –common group social customs, values, beliefs A child from Nepal living in the United States. The child has a black dot on her forehead to protect her from the “evil eye.”

Cultural Competence Respecting all differences; not letting one’s own biases influence others Understanding/responding effectively to cultural and linguistic needs of patients Joint Commission and NPSGs require cultural differences be respected

Cultural Sensitivity Aware of, respects; appreciation of cultural differences Avoid biased/offensive language and actions when interacting with diverse cultures Avoid stereotyping

Health Care Disparities Differences in incidence of health care problems among minority racial/ethnic groups when compared with white majority Contributing factors – socioeconomic status, individual discrimination, access to care, language barriers

Healthy People 2020 Health promotion initiatives reflect assessments of major risks to health and wellness Changing public priorities Emerging issues related to U.S. health preparedness and prevention

Purnell’s Domains of Culture Culture overview and communication Homelessness Family and workplace issues Lesbian, gay, bisexual, transgender health Biologic ecology Nutrition Spirituality

Homeless Most avoid health care Prone to CV disease, hypertension, diabetes mellitus, high cholesterol, infections Compensate for limited time Limit number of visits needed

Communication Language is largest barrier for non-English-speaking patients Interpreters must be available in health care facilities Determine which forms of patient communication are acceptable

Family & Workplace Issues Family and gender roles influence plan of care Assess who makes decisions in the family Include questions about sexual identity/activity in health assessment

LGBT Health Many fear prejudice; hesitant to seek medical care Establish patient’s gender identity; do not make assumption based on appearance Ask questions about sexual identity

Biological Ecology Biologic variations, health disparities, drug metabolism differences Common biological variation relates to adult body size and type (e.g., dwarfism)

Dwarfism Height below 4’ 10” Disproportionate or proportionate Results from genetic mutation, hormone imbalance

Ethnopharmacology Study of effect of ethnicity on how drugs work in the body Absorption Distribution Metabolism Excretion

Nutrition Part of comprehensive health assessment Respect patient’s food preferences/beliefs Assess rituals and customs

Spirituality Involves behaviors that give purpose to life, provide individual strength Joint Commission requires all health care facilities to address patients’ spiritual needs Chaplain is part of health care team

Health Care Practices and Practitioners Assess patient’s health promotion and maintenance practices Determine whether patient is able to afford health care Use of alternative health care systems and healers Folk health beliefs

Health Care Obstacles Transportation difficulties High cost of care Fear and distrust of health care workers Poor communication between patients and professionals

Folk Health Left: “Hand of God” amulet to protect the wearer from the “evil eye.” Right: Within the Mexican-American folk medicine system, the curandero is the folk healer.

Audience Response System Questions Chapter 4 Audience Response System Questions 22

Question 1 What nursing priority ensures that culturally competent care is provided to a homeless patient admitted for an infected foot? Contact the case manager to secure a shelter bed upon discharge. Provide education regarding foot care to prevent re-infection. Help the patient choose a diet high in protein. Provide empathetic and clear communication when assessing the patient’s needs. Answer: D Rationale: The primary approach to caring for a homeless patient is to establish trust. Many of these patients have experienced discrimination and therefore do not trust nurses or other health care professionals. When talking with a homeless patient, avoid discriminatory language and do not make assumptions. Take time to communicate, empathize, and show concern to build trust and assess the patient’s needs (Billings & Kowalski, 2008; Jones et al., 2009).

Question 2 What is the fastest growing ethnic group in the United States? Asian Americans African Americans Hispanic/Latino Americans American Indian Answer A Rationale: In 2008, the number of minority populations in the United States accounted for 31% of the total population; Hispanic/Latinos are the largest minority group at over 15%; the African-American population represents about 12%. Asian Americans are currently the fastest growing group at 5% of the U.S. population (http://nces.ed.gov/pubs2010).

Question 3 Which question illustrates the first step of becoming culturally competent? “Do I have the skill to conduct a cultural assessment?” “How many face-to-face encounters have I had with patients from diverse cultural backgrounds?” “Do I have knowledge of my patient’s world view?” “Am I aware of my own personal biases and prejudices toward cultures that are different from my own?” Answer: D Rationale: Becoming culturally competent first requires you to examine your feelings and experiences regarding diversity, starting with an understanding of your own heritage. Then, you will need to learn more about specific cultural differences so you can develop an appreciation for the values and beliefs of both patients and staff co-workers. According to the Campinha-Bacote ASKED Model for Cultural Competence, the first step in becoming culturally competent is being aware of one’s own personal biases and prejudices toward cultures that are different from one’s own.