1. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Cultural Competence: Cultural Care Chapter 2

2. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Cultural Competency  Who are you meeting for the first time?  Where does the patient come from?  What is his or her heritage?  What is his or her cultural background: ethnicity and religion? Slide 2-2

3. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Cultural Competency (cont.)  Does the patient understand, speak, and read English?  What language does her or she understand, speak, and read?  What is his or her health and illness beliefs and practices? Slide 2-3

4. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Objectives  Demographic profile of United States  National Standards for Culturally and Linguistically Appropriate Services  Background of Heritage Assessment  Methods for conducting Heritage Assessment  Traditional health and illness beliefs and practices  Steps to cultural competence Slide 2-4

5. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Health and Illness  Health:  Balance of a person is a complex, interrelated phenomenon: Within one’s being: physical, mental, spiritual Within one’s being: physical, mental, spiritual In outside world: natural, communal, metaphysical In outside world: natural, communal, metaphysical  Illness:  Loss of a person’s balance: Within one’s being: physical, mental, spiritual Within one’s being: physical, mental, spiritual In outside world: natural, communal, metaphysical In outside world: natural, communal, metaphysical Slide 2-5

6. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Demographic Profile of United States  Total population passed 300 million in 2006  1 out of 3 residents are in a group other than single-race, non-Hispanic white  Minority, or emerging majority populations total 98 million people  Hispanics: largest and fastest growing group  Blacks: second largest population  Asians, American Indians, Alaska natives, Native Hawaiians, and other Pacific Islanders make up the third largest part of the population Slide 2-6

7. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Demographic Profile of United States (cont.)  Emerging majority groups tend to be:  Younger  Lower median ages  Higher proportions under 18 years old  Dominant, non-Hispanic, single-race, white population is:  Older median age  Smaller proportion under 18 years old Slide 2-7

8. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Demographic Profile of United States (cont.)  One birth every 8 seconds  One death every 13 seconds  One international migrant (net) every 30 seconds  Net gain of one person every 11 seconds Slide 2-8

9. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Immigration  Categories of Interest to Health Care Providers  Legal permanent residents  Naturalized citizens  Undocumented aliens  Refugees, asylees, and parolees  Legal nonimmigrant residents Slide 2-9

10. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Immigration (cont.)  Many new immigrants have only minimal understanding of:  Modern health care delivery system  Modern medical and nursing practices and interventions  English language  It is imperative that the nurse’s care be tailored to meet the person’s perceived needs Slide 2-10

11. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care National Standards  National Standards for Culturally and Linguistically Appropriate Services in Health Care  First and Landmark Standard Health care organizations should ensure that patients receive from all staff members effective, understandable and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language* Health care organizations should ensure that patients receive from all staff members effective, understandable and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language* *Source: National Standards for Culturally and Linguistically Appropriate Services in Health Care, Final Report, March 2001, Washington, DC: Office of Minority Health, DHHS Slide 2-11

12. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care National Standards (cont.)  Effective care: positive outcomes and satisfaction for patient  Respectful care: considers values, preferences, and expressed needs of patient  Cultural and linguistic competence: congruent behaviors, attitudes, and policies that come together in a system among professionals that enables work in cross-cultural situations Slide 2-12

13. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Linguistic Competence  Title VI of Civil Rights Act of 1964:  Services cannot be denied to people of limited English proficiency  47 million Americans over 5 years of age speak a language other than English in their homes  An increase of 15 million people over 1990 census  Some states require providers to offer language assistance in health care settings:  California, Massachusetts, and New York Slide 2-13

14. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Linguistic Competence (cont.)  People with limited ability to speak, read, write, and understand English encounter countless barriers that limit access to critical public health, hospital, and other medical and social services to which they are legally entitled Slide 2-14

15. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Cultural Competence  Culturally sensitive:  Possessing basic knowledge of and constructive attitudes toward diverse cultural populations  Culturally appropriate:  Applying underlying background knowledge necessary to provide the best possible health care Slide 2-15

16. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Cultural Competence (cont.)  Culturally competent:  Understanding and attending to total context of patient’s situation including: Immigration status Immigration status Stress factors Stress factors Social factors Social factors Cultural similarities and differences Cultural similarities and differences Slide 2-16

17. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Heritage  Culture  Ethnicity  Religion and Spirituality  Socialization  Acculturation  Assimilation  Biculturalism  Time Orientation Slide 2-17

18. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Heritage (cont.)  Heritage consistency:  Degree to which a person’s lifestyle reflects his or her traditional heritage  Heritage consistency continuum:  Traditional: living within norms of traditional culture  Modern: acculturated to norms of dominant society Slide 2-18

19. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Heritage (cont.)  Culture:  Thoughts, communications, actions, beliefs, values, and institutions of racial, ethnic, religious, or social groups  Characteristics of culture Learned Learned Shared Shared Adapted Adapted Dynamic Dynamic Slide 2-19

20. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Heritage (cont.)  Ethnicity  Describes a group united by: Common geographic origin Common geographic origin Migratory status Migratory status Religion Religion Race Race Language Language Shared values, traditions, or symbols Shared values, traditions, or symbols Food preferences Food preferences Slide 2-20

21. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Heritage (cont.)  Religion:  Belief in divine or superhuman power, or powers to be obeyed and worshipped as creator/ruler of universe  System of beliefs, practices, and ethical values  Shared experience of spirituality Slide 2-21

22. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Heritage (cont.)  Socialization  Process of being raised within a culture and acquiring characteristics of that group  Related terms: Acculturation: process of adapting to and acquiring another culture Acculturation: process of adapting to and acquiring another culture Assimilation: process of developing a new cultural identity and becoming like members of dominant culture Assimilation: process of developing a new cultural identity and becoming like members of dominant culture Biculturalism: dual pattern of identification and often of divided loyalty Biculturalism: dual pattern of identification and often of divided loyalty Slide 2-22

23. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Heritage (cont.)  Time Orientation  Focus on past Traditions and ancestors play important role in person’s life Traditions and ancestors play important role in person’s life  Focus on present Little attention paid to past or future; concerned with now, and future perceived as vague or unpredictable Little attention paid to past or future; concerned with now, and future perceived as vague or unpredictable  Focus on future Progress and change highly valued; person may express discontent with both past and present Progress and change highly valued; person may express discontent with both past and present Slide 2-23

24. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Heritage Assessment  Indicators of heritage consistency  Childhood occurred in country of origin or immigrant neighborhood of like ethnic group  Extended family support of traditional activities  Frequent visits to old country or old neighborhood  Family home within ethnic community to which they belong  Participation in ethnic cultural events  Raised in extended family setting Slide 2-24

25. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Heritage Assessment (cont.)  Indicators of heritage consistency (cont.)  Regular contact with extended family  Name not anglicized  Educated in parochial school  Social activities primarily with members of ethnic community  Knowledge of language and culture of origin  Expresses pride in heritage Slide 2-25

26. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Health-Related Beliefs and Practices  Health-Related Behaviors Affected by Religion  Meditating  Exercising/physical fitness  Sleep habits  Vaccinations  Willingness to undergo physical examination  Pilgrimage  Truthfulness about how patient feels Slide 2-26

27. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Health-Related Beliefs and Practices (cont.)  Health-Related Behaviors Affected by Religion (cont.)  Maintenance of family viability  Hoping for recovery  Coping with stress  Genetic screening and counseling  Living with a disability  Caring for children Slide 2-27

28. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Health-Related Beliefs and Practices (cont.)  Differing views of epilepsy:  Uganda: contagious, untreatable  Greece: source of family shame  Mexican-American community: evidence of physical imbalance  Hutterites: evidence of having endured trial by God Slide 2-28

29. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Developmental Care  Culture affects choices parents make for children regarding:  Presumed cause of illness  First treatment tried  Acceptability of treatments offered by clinicians  For older patients, culture is likely to  Define their family responsibilities  Affect their view and knowledge of health care systems used by dominant culture Slide 2-29

30. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Traditional Causes of Illness  Biomedical  Assumes cause and effect  Views the body as a machine  Life can be divided into parts  Endorses germ theory  Naturalistic  Forces of nature must be kept in balance  Embraces idea of opposing categories or forces Yin and yang, hot and cold Yin and yang, hot and cold Slide 2-30

31. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Traditional Causes of Illness (cont.)  Magicoreligious  Supernatural powers predominate in area of health and illness Examples include voodoo, witchcraft, and faith healing Examples include voodoo, witchcraft, and faith healing  Healing and culture  In addition to seeking help from health care providers, patients may also seek help from folk or religious healers  Hispanics or American Indians may believe that cure is incomplete unless healing of body, mind, and spirit are all carried out Slide 2-31

32. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Traditional Causes of Illness (cont.)  Folk Healers  Hispanic: curandero, espiritualista, yerbo, or sabedor  Black: hougan, spiritualist, old lady  American Indian: shaman, medicine woman, medicine man  Asian: herbalists, acupuncturists, bone setters  Amish: braucher Slide 2-32

33. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Transcultural Expressions of Illness  Transcultural expression of pain  Expectations, manifestations, and management of pain are all embedded in a cultural context  Pain has been found to be a highly personal experience, depending on cultural learning, the meaning of the situation, and other factors unique to the person  Silent suffering has been identified as the most valued response to pain by health care professionals Slide 2-33

34. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Transcultural Expressions of Illness (cont.)  Culture-bound syndromes  Condition that is culturally defined Some have no equivalent in a biomedical, scientific perspective Some have no equivalent in a biomedical, scientific perspective Anorexia nervosa and bulimia are examples of cultural aspects of illness in dominant cultural population in North America Anorexia nervosa and bulimia are examples of cultural aspects of illness in dominant cultural population in North America Slide 2-34

35. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Transcultural Expressions of Illness (cont.)  Culture and treatment  First effort at treatment is often self-care  Home treatment attractive for accessibility, particularly for people from rural or sparsely populated areas  Home treatment may mobilize person’s social support network and provide a caring environment in which to convalesce  Alternative or complementary interventions are gaining recognition from health care professionals in health care system Slide 2-35

36. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Transcultural Expressions of Illness (cont.)  Culture and disease prevalence  Disparity continues in deaths and illnesses experienced by racial and ethnic populations Diseases are not distributed equally among all segments of population Diseases are not distributed equally among all segments of population  Abnormal biocultural variations may be genetic or acquired Information about disease prevalence for racial and ethnic groups provides focus for assessment regarding increased probability that particular conditions may occur Information about disease prevalence for racial and ethnic groups provides focus for assessment regarding increased probability that particular conditions may occur Nurses must be certain that they have gathered data needed to support or refute suspicions Nurses must be certain that they have gathered data needed to support or refute suspicions Slide 2-36

37. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Steps to Cultural Competence  Understand one’s own heritage-based values, beliefs, attitudes, and practices  Identify meaning of “health” to patient  Understand how health care system works  Acquire knowledge about social backgrounds of patients  Become familiar with languages, interpretive services, and community resources available to nurses and patients Slide 2-37

38. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care Cultural Care Nursing  Cultural care nursing is goal to strive for  It is a long trajectory Slide 2-38

39. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 2: Cultural Competence: Cultural Care RESPECT  Realize you must know heritage of yourself and patient  Examine patient within cultural context  Select simple questions and speak slowly  Pace questioning throughout exam  Encourage patient to discuss meaning of health and illness with you  Check patient’s understanding and acceptance of recommendations  Touch patient within boundaries of his or her heritage Slide 2-39