Week ThreeCultural Assessment, Mental Status, General Survey, Vital Signs

Chapters 2, 5, & 9

Cultural Competence: Cultural Care

Chapter 2

Objectives

• Demographic profile of United States• National standards for Culturally &

Linguistically Appropriate Services• Background of Heritage Assessment• Methods for conducting Heritage

Assessment• Traditional health & illness beliefs &

practices• Steps to cultural competence

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?• Does the patient understand, speak, and read

English?• What language does the pt understand, speak,

and read?• What are his or her health and illness beliefs

and practices?

Demographic Profile of United States

• Total Population > 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– Hispanics: largest & fastest growing group– Blacks: second largest population– Asians, American Indians, Alaska natives, Native

Hawaiians, & other Pacific Islanders make up the 3rd largest part of the population

Demographic Profile of United States (cont.)

• Emerging majority groups:– Younger– Lower median ages– Higher proportions under 18 yo

• Dominant, non-Hispanic, single-race, white population is:– Older median age– Smaller proportion under 18 yo

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

National Standards

• National Standards for Culturally & Linguistically Appropriate Services in Health Care– First & Landmark care

• Health care organizations should ensure that patients receive from all staff members effective, understandable & respectable care that is provided in a manner compatible with their cultural health & beliefs & practices & preferred language*

*Source: National Standards for Culturally and Linguistically Appropriate Services in heatlh Care, Final Report, March 2001. Washington DC: Office of Minorty Health, DHHS

National Standards for Culturally and Linguistically Appropriate Services in Health Care

• 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.

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

– Language assistance in the health care settings is required by some states• CA, MA, NY

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

• Culturally competent:– Understanding and attending to total context

of a patient’s situation

Heritage

• Culture• Ethnicity• Religion & Spirituality• Socialization

• Acculturation• Assimilation• Biculturalism

• Time Orientation

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: accultrated to norms of dominant

society

Heritage (cont.)

• Culture: the thoughts, communications, actions, beliefs, values, and institutions of racial, ethnic, religious, or social groups.– Learned from birth– Shared– Adapted– Dynamic

 

Heritage (cont.)

• Ethnicity: – pertains to a social group within the social

system that claims to possess variable traits

• The Melting Pot

Heritage (cont.)

• Religion: – the belief in a divine or superhuman power

or powers to be obeyed and worshipped as the creator/ruler of the universe.

**Plays a significant role in how people practice their health care.

Spirituality- borne out of each person’s unique life experience

*Personal effort to find purpose & meaning in life

Heritage (cont.)

• Socialization: – the process of being raised within a culture

and acquiring the characteristics of that group.

• Acculturation• Assimilation• Biculturalism

Concepts-Heritage

• Time Orientation– Focus on the past

• Traditions and ancestors play important role in person’s life

– Focus on the present• Little attention paid to past or future;

concerned with now; future perceived as vague or unpredictable

– Focus on the present• Progress and change highly valued; possible

discontent with both past and present

Heritage Assessment

• What are some indicators of heritage consistency?– Childhood occurred in country of origin or

immigrant neighborhood of like ethnic groups– Extended family support or traditional activities– Frequent visits to old country/neighborhood– Family home within ethnic community to which

they belong– Participation in ethnic cultural events– Raised in extended family setting

Heritage (cont.)

• Indicators continued:– Regular contact with extended family– Educated in parochial school– Social activities primarily with members of

ethnic community– Knowledge of language & culture of origin– Expresses pride in heritage

Cultural Factors that Aid Understanding of Patients

• Health beliefs and practices– How do they define illness?– How is death expressed?

Cultural Factors that Aid Understanding of Patients

• Health:– Balance of a person is a complex,

interrelated phenomenon: • Within one’s being: physical, mental, spiritual• In outside world: natural, communal, metaphysical

• Illness:– Loss of a person’s balance:

• Within one’s being: physical, mental, spiritual• In outside world: natural, communal, metaphysical

Cultural Factors that Aid Understanding of Patients

• Religious influences and special rituals– Is this a religious patient?– Is there a significant person the patient

goes to for guidance?– Does this patient celebrate events?

(communion)– Health-Related behaviors affects by

Religion

Developmental Cultural Care

• Culture affects the decisions families make: • 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 & knowledge of health care

systems used by dominant culture

Traditional Causes of Illness

• Biomedical• Assumes cause & 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

Traditional Causes of Illness (cont.)

• Magicoreligious• Supernatural powers predominate in area of

health & illness» Examples include voodoo, witchcraft, and faith

healing

• Healing & Culture• Patients may seek help from both HCP & folk

or religious healers• Hispanics & American Indians may believe that

cure is incomplete unless healing of body, mind, & spirit are all carried out

Traditional causes of Illness (cont.)

• Folk Healers• Hispanic: curandero, espiritualista, yerbo, or

sabedor• Black: Hougan, spiritualists, old lady• American Indian: shaman, medicine

man/woman• Asian: herbalists, acupuncturists, bone setters• Amish: braucher

Transcultural Expressions of Illness

• Transcultural expression of pain

– Expectations, manifestations, & management of pain are all embedded in a cultural context

– Highly personal experience

Transcultural Expressions of Illness (cont.)

• Culture-bound Syndromes

– Condition that is culturally defined• Some have no equivalent in a biomedical,

scientific perspective• Anorexia nervosa & bulimia are examples of

cultural aspects of illness in dominant cultural population in North America

Transcultural Expressions of Illness (cont.)

• Culture & treatment• Alternative/complementary interventions are

gaining recognition from HCP in health care systems

• Culture & disease prevalence• Disparity continues in deaths/illnesses

experienced by racial and ethnic populations• Abnormal biocultural variations may be genetic

or acquired

Cultural Care

• Dietary practices– Does the family like to eat?– Are meals the center of family

entertainment?– How is food prepared?– Are there periods requiring fasting?

Steps to Cultural Competence

• Understand one’s own heritage-based values, beliefs, attitudes & 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 & community resources available to you as the RN and the patient

Ways to Develop Cultural Competency & Sensitivity

Demonstrate R.E.S.P.E.C.T• Realize & examine own cultural beliefs

– Recognize cultural diversity exists– Recognize that cultural definitions of

health/illness differ– Don’t expect all members of a culture to behave

the same

• Examine pts within a cultural context– Respect the unfamiliar– Be willing to modify care in keeping with

patient’s culture

Ways to Develop Cultural Competency & Sensitivity

Demonstrate R.E.S.P.E.C.T• Select simple questions and speak slowly• Pace questioning throughout the 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

Review Questions

1. Before determining whether cultural practices are helpful, harmful, or neutral, nurses must first understand:

A) the logic of the traditional belief systems.B) the beliefs of the patients family.C) their personal belief models.D) the risk of disease in the patients ethnic group.

Review Questions

2. What symptom is greatly influenced by a person’s cultural heritage?

A) hearing lossB) pain

C) breast lumpD) food intolerance

Resources:

• Jarvis, C. (2012). Physical examination and health assessment (6th ed.). Philadelphia: W. B. Saunders

• http://www.evolve.elsevier.com