1. The Cultural Context Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health Nursing, 5/e Mary Jo Clark 9 CHAPTER

2. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Understanding Culture Enhances effective care Modify elements that impede effective health care Modify health care systems to better meet client needs

3. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Culture (Refer to Table 9-1) Ways of thinking and acting developed by a group of people Permits them to interact effectively with environment Permits them to address concerns common to the human condition Generally unique, stable, and enduring

4. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Race Artificial categorization Based on genetic inheritance and physical characteristics Does not adequately address the diversity of the U.S. population

5. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Nationality  One’s country of birth or a country adopted for permanent residence

6. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Ethnicity Aggregate of cultural practices, social influences, religious pursuits, and racial characteristics Shape the distinctive identity of a relatively homogenous community

7. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Influences of Culture on Health Direct effects –Dietary practices –Practices intended to promote health and prevent illness –Practices to restore health when ill

8. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Influences of Culture on Health (continued) Indirect effects –Definitions of health and illness –Acceptability of health care programs and providers –Cultural influences on compliance with health or illness regimens

9. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Cultural Competence (Refer to Table 9-5) A dynamic, fluid, continuous process Find meaningful and useful care delivery strategies Based on knowledge of cultural heritage, beliefs, attitudes, and behaviors

10. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Models of Cultural Competence ASKED –A: Cultural awareness –S: Cultural skill in collecting relevant cultural data –K: Cultural knowledge of differences and similarities –E: Cultural encounters –D: Cultural desire and motivation to practice in a culturally competent manner

11. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. BE SAFE Model B: Barriers to the use of biomedical care such as prejudice, SES, stigma E: Ethics: consideration of differences in ethical conceptualizations in the culture S: Sensitivity: lack of provider bias, stigma, cultural imposition A: Assessment of physical, emotional, spiritual, social, mental, and occupational factors affecting health F: Facts about the cultural beliefs, values, and practices E: Encounters: knowledge of behavioral dos and don’ts, communication.

12. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Culturally Competent Community Care Interpersonal caring Cultural sensitivity Cultural knowledge Cultural skill.

13. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Individual Cultural Competence Awareness of cultural perspectives Individual perspective does not influence interactions with others Knowledge and understanding of another culture Acceptance of and respect for other cultures Conscious process of adaptation of care to the cultural context

14. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Health System Cultural Competence Recognize complexities involved in language interpretation Aware of need to consider linguistic variation within cultural groups Facilitate learning between providers and communities Involve communities in defining and addressing health care needs Foster interagency collaboration

15. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Barriers to Cultural Competence Recognizing clinical differences among cultural groups Communication among cultural groups Incorporating elements of culture in the plan of care Developing trust among members of different cultures

16. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Addressing Stereotypes Held By Providers Viewing cultures as “them”, not “me” Confusing race, ethnicity, and culture Misdiagnosing ethnic medical concerns Cultural mismatches

17. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Cultural Assessment Guided by four basic principles –View culture in the context in which it was developed –Examine underlying premise of culturally determined behavior –Examine meaning of behavior in the cultural context –Recognize intracultural variation

18. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Conducting a Cultural Assessment Use personal insight and research to gain knowledge Interview colleagues who are members of the culture Live within the culture

19. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Guidelines for Cultural Assessment Look and listen before asking questions Explore how the group feels about being studied Discover any special protocols Foster human relations

20. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Guidelines for Cultural Assessment (continued) Put individual needs before the need to obtain information Look for similarities rather than differences Locate group leaders Be aware of acceptable or offensive questions

21. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Cultural Assessment Considerations Biophysical Psychological Physical environmental Sociocultural Behavioral Health system dimensions

22. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Biophysical Assessment Attitudes about maturation and aging Age composition of cultural group Genetic inheritance and physical differences Physiologic function: –Prevalent health problems –Attitudes to body parts and functions –Perceptions of health, illness, and disease causation –Culture-bound syndromes

23. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Psychological Considerations Importance of group versus individual goals Attitudes toward change Attitudes toward mental health and mental illness

24. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Physical Environmental Mastery over environment Beliefs about harmonious relationships with external environment Perceptions of space and time: –Personal space –Future-oriented versus past- or present- oriented

25. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Sociocultural Relationships with supernatural Interpersonal roles and relationships Relationships with health care providers Socioeconomic status

26. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Sociocultural (continued) Sexuality and reproduction Coming of age Marriage Immigration Death

27. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Behavioral/biophysical Considerations Dietary practices Consumption patterns Health-related behaviors

28. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Health System Dimensions Health of population groups Design of health systems Health care providers Health care practices

29. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Rationale for Culturally Competent Care Increase in diverse populations Increase in home care where cultural factors are influential Increase in health disparities among ethnic cultural minorities

30. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Benefits of Culturally Competent Care Promotes appropriate and accurate diagnoses Improves compliance with treatment recommendations Reduces delays in care-seeking and use of services Enhances client/provider communications Enhances compatibility of biomedical and traditional health care

31. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Leininger’s Transcultural Nursing Preservation –Maintain cultural resources that promote health or assist in recovery Accommodation –Adjust or adapt client or provider actions –Facilitate interactions to positively influence health Repatterning –Change attitudes or behaviors of providers or clients

32. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Resources Cross-cultural Health Care Diversityrx, a resource for cross-cultural health care with a focus on policy, aims to improve the quality of health care for minority, immigrant, and ethnically diverse communities. Search databases, read federal standards for multicultural health care, and link to other groups interested in cultural competence in health care. Includes resources for medical interpretation.Cross-cultural Health Care

33. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Resources National Center for Cultural Competence at Georgetown University Another cross-cultural advocacy group with a focus on policy. Learn about health disparities among racial and ethnic groups, read the latest research findings, and find out how to implement organizational cultural competence.National Center for Cultural Competence

34. Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Resources Childless Family No Kidding provides social support for the family who choose to not have children.Childless Family The Population Connection The Population Connection is a nonprofit organization working to slow population growth.The Population Connection