Cultural Competence in the Care of Childbearing Families

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Cultural Competence in the Care of Childbearing Families Mary Lou Moore, PhD, RNC, FAACE, FAAN Merry-K. Moos, BSN, FNP, MPH

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Cultural Competence in the Care of Childbearing Families. Mary Lou Moore, PhD, RNC, FAACE, FAAN Merry-K. Moos, BSN, FNP, MPH. Immigration to the U.S. 1 million immigrants come to the U.S. each year (U.S. INS, 1991) . More than half are women of childbearing age (U.S. INS, 1991) . - PowerPoint PPT Presentation

Transcript of Cultural Competence in the Care of Childbearing Families

Page 1: Cultural Competence  in the Care of Childbearing Families

Cultural Competence

in the Care of Childbearing

Families

Mary Lou Moore, PhD, RNC, FAACE, FAAN

Merry-K. Moos, BSN, FNP, MPH

Page 2: Cultural Competence  in the Care of Childbearing Families

© 2002, March of Dimes

Immigration to the U.S.• 1 million immigrants come to the

U.S. each year (U.S. INS, 1991).• More than half are women of

childbearing age (U.S. INS, 1991).• 1 in every 10 persons in the United

States is foreign-born (National Center for Cultural Competence, 1999).

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U.S. Population

AfricanAmerican--12.1%

Hispanic--11.5%

Asian/PacificIslander--3.8%

AmericanIndian/AlaskaNative--0.7%

Non-HispanicWhite--71.9%

(Population Estimates and Projections, 2000)

American Indian/

Alaska NativeAsian/Pacific

Islander

Hispanic

African

American

Non-Hispanic

white

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© 2002, March of Dimes

What is Cultural Competence?

(Developmental Disabilities and Bill of Rights Act of 2000)

Providing services, supports and assistance:

– That are responsive to beliefs, interpersonal styles, attitudes, language and behaviors of individuals with the greatest likelihood of ensuring maximum acceptance and participation

– That demonstrate respect for individual dignity, personal preference and cultural differences

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Importance of Cultural Competence• U.S. demographics are changing.• Health disparities exist between

ethnic groups in the United States.• Regulatory mandates require

increased, documented cultural competence.

• Cultural competence enriches professional nursing practice.

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© 2002, March of Dimes

What is Culture?• Culture is a distinct way of life that

characterizes a particular community of people.

• Culture includes shared practices, beliefs, values and customs passed through generations.

• Culture provides a sense of identity (“I belong”).

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Dimensions of Culture• Values• World view• Disease etiology• Time orientation• Personal space• Family organization• Power structure

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Acculturation• Integration into mainstream

culture• Affected by age at time of arrival in

a new setting, reason for moving to a new setting and residence in a predominantly ethnic neighborhood

• Generally takes three generations in the United States (Spector, 2000)

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Ethnocentrism• Ethnocentrism is the belief that

one’s own culture is best.• Providers must be mindful of their

own ethnocentrism.

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Cultural Perspectives • Emic perspective–Of an insider or

member of the culture• Etic perspective–Of an outsider or

observer of the culture

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Cultural Traditions• A functional tradition enhances an

individual’s health and well-being.• A neutral tradition neither

enhances nor harms an individual’s health and well-being.

• A non-functional tradition is potentially harmful to an individual.

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Cultural Characteristics• Individual vs. group identity• Decision-making• Eye contact• Being polite• Family• Hot and cold• Small talk

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© 2002, March of Dimes

Cultural Characteristics (Continued)

• Evil spirits• Father’s participation at birth• Male health care providers• Pregnancy as a healthy, natural

state

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© 2002, March of Dimes

Food Guide Pyramid

From USDA & DHHS, 2002

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© 2002, March of Dimes

Populations and Conditions• African American–Sickle cell disease• Amish–PKU, hemophilia B• Greek–Thalassemia• Jewish–Tay-sachs, Gaucher’s disease• Native American–Type 2 diabetes

mellitus

Note: Conditions not limited to a single population group.

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Ways to Relate to Other Cultures• Common practices

– Avoiding people from other cultures– Refusing to recognize cultural

differences– Recognizing differences, but feeling

own way is superior (ethnocentrism)

• Best practice– Acknowledging and seeking to

understand cultural differences

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Cultural Assessment• Where were you

born?• How long have you

lived in the United States?

• Who are your major support people?

• What languages do you speak and read?

• What are your religious practices?

• What are your food preferences?

• What is your economic situation?

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Childbearing Assessment• What does

childbearing represent to you?

• How do you view childbearing?

• Are there any maternal precautions or restrictions?

• Is birth a private or social experience?

• How would you like to manage labor pain?

• Who will provide labor support?

• Who will care for the baby?

• Do you use contraception?

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Assessment Techniques• Use a conversational approach.• Ask open-ended questions.• Integrate cultural and childbearing

assessments.• Listen with interest.• Remain nonjudgmental.

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Interpreters and Translators•Interpreters communicate

verbally.– Should be female– Should not be a family member

•Translators work with written communication.

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Expectations for Interpreters• Maintain strict confidentiality.• Interpret everything the woman

says without editorializing or paraphrasing.

• Either party may interrupt or seek additional information.

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Ethical Issues• Group needs vs. individual needs• Refusal of treatment• Informed consent• Truthfulness• Morality