1. Sample Question Example of the most vulnerable group is:
Smokers who use chewing tobacco as well as cigarettes
Substance abusers who test positive for human immunodeficiency virus (HIV)
Persons with limited access to care because they live in a rural area
New mothers needing information about baby and child care
B is correct answer. Multiple risk factors are present in substance abusers, including Hepatitis and HIV.

2. Sample Question
Which demonstrates the removal of a barrier to health care?
Discrimination against certain groups
Treatment of pets at the same facility
Provision of free food at a food bank
Providing services for a rural population by using a mobile clinic
D is correct answer. Barriers to access are policies and financial, geographic, or cultural features of health care that make services difficult to obtain or so unappealing that people do not want to seek care. Examples of removing barriers include providing extended clinic hours, low-cost or free health services for people who are uninsured or underinsured, transportation, mobile vans, and professional interpreters which can help improve access to care

3. Diversity may be one of the most difficult things to live with, but also one of the most dangerous things to live without.
Anonymous

4. Leslie Womeldorf, MSN, MEd, RN N415 Community Health
Culture & Diversity
Leslie Womeldorf, MSN, MEd, RN
N415 Community Health

5. Course-Specific Objectives
Recognize variations in health beliefs, family orientation, and health practices among selected cultures.
Discuss the components of a cultural assessment as part of holistic care.
Differentiate culture, religion, and spirituality
Analyze components of cultural competence and nursing interventions that foster client cultural congruity.
Identify strategies for developing a culturally competent client-nurse relationship

6. Assumptions Closely held
Often the prevailing social, political, cultural, or professional ways of acting
Unnoticed
Unquestioned
Presumed to be held by others
Structure our way of seeing reality, govern our behavior, and describe how relationships should be ordered
Diversity Walk activity – any surprises?

7. What is…
Culture – (Leininger) set of beliefs, value, assumptions about life, widely held among a group of people
Religion – belief in a god or group of gods, organized system of beliefs, rules used to worship
Spirituality – each person defines it for him/herself. Process of re-formation, one’s vital spirit or soul.
Stanhope, p. 141, terminology

8. Ethnicity identifies with:
Ethno-relativity Ability to conceive of different points of view & to respect beliefs of a culture different from ones’ own. Ethnicity Self-identifying groups based on beliefs concerning shared culture & history
Ethnicity identifies with:
Race
Nationality
Cultural group
Customs
Beliefs
Language
REACH: (Racial & Ethnic Approaches to Community Health project) The REACH program is a vital part of CDC’s efforts to end racial and ethnic health gaps in the United States. REACH gives funds to state and local health departments, tribes, universities, and community-based organizations. Awardees use these funds to build strong partnerships to guide and support the program’s work. (2017) Retrieved from

9. What is Cultural Competence?

10. Why be Culturally Competent?
ANA Code of Ethics
Provisions
Joint Commission requirement
National CLAS Standards
Healthy People 2020
The Joint Commission. (2011). Take 5 with TJC: Why patient-centered communications matters. {Podcast}. Retrieved from

11. What will Cultural & Diversity Competence do for Client & Provider?
Increases respect & trust
Promotes inclusion & community involvement with health issues
Client & family take responsibility for health
Improves efficiency of care & outcomes
Reduces legal risk if provider has unintentional barriers to care

12. To Achieve Cultural Competence
Understand your own personal biases.
Understand major components of culture
Learn about customs of commonly encountered cultures.
Respect & support client's unique cultural beliefs.
Continued…

13. Achieving Cultural Competence
Provide care that is client-centered
Do not assume other cultures are similar to his/her own.
Maintain non-judgmental approach and openness
Develop skills to reinforce, negotiate,& assist client to achieve his/her optimal health

14. Use of an Interpreter Knowledge of health-related terminology
Health materials in client’s primary language
Consider client’s preference when selecting interpreter (gender, age, dialect)
Clarify interpreter’s role
Observe nonverbal cues
Caution using:
Interpreter from client’s community
Family member(s) as interpreter
ATI p.16
Stanhope – p

15. How To’s of Cultural Assessment
Look & listen.
Explain reasons for studying culture are practical, not just curiosity.
Discover if there are any special protocols.
Put client above the need to obtain information.
Address social amenities before the information-gathering.

16. Culturally Focused-Assessments
Biologic variation
Communication
Personal space
Perception of time
Health beliefs
Pain response
Family/social patterns
Nutritional patterns
Religion/spirituality
Death/dying practices

17. Explanatory Model: Quick Assessment
What do you call the problem?
What do you think has caused the problem?
Why do you think it started when it did?
What do you think the sickness does? How does it work?
How severe is the sickness? Will it have a short or long course?
What kind of treatment do you think the client should receive?
What are the chief problems the sickness has caused?
What do you fear most about the sickness?
The explanatory model, developed by Arthur Kleinman (psychiatrist and medical anthropologist) reveals how people make sense of their illness and their experiences of it. Eight open-ended questions designed to elicit the patient’s explanatory model.

18. Reference & Resources
Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care. (2010). The Joint Commission. Retrieved from
Center for Linguistic and Cultural Competency in Health Care. (2016). CLCCHC. Retrieved from
Cultural Competence for Health Care Providers. (2009). Jefferson Center for Interprofessional Education. Retrieved from
Culture Vision. ( ). PSU-HMC infonet. Ed Retrieved from
Fadiman, A. (1997). The sprit catches you and you fall down. New York, NY: Farrar, Strous, and Giroux.
REACH. (2017). CDC Division of Community Health. Retrieved from
Spector, R. (2016). Cultural diversity in health and illness (9th Ed.). Upper Saddle River, NJ: Pearson Education, Inc.
Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th Ed.). Maryland Heights, MO: Elsevier.
Stempniak, M. (2017). Reducing barriers to care by improving cultural competency. H&HN. Retrieved from
The Joint Commission.(2011). Take 5 with TJC: Why patient-centered communications matters. {Podcast}. Retrieved from
The Joint Commission. (2011). Advancing effective communication, cultural competence, and patient- and family-centered care for the LGBT community. TJC. Retrieved from