Individual and Social influences

Culture

Shared values, beliefs, traditions, practices, language, and customs passed across generations.

Subculture

A group within a larger cultural group that has distinct values or practices.

Example of Subculture

Asian American culture includes Korean, Japanese, Filipino, Chinese, Vietnamese, etc., with differences in language, health practices, and family roles.

Cultural Influence on Health

Affects acceptance of medical advice, diet, health literacy, family roles, and communication styles.

Hot-Cold Theory of Health

Illness results from imbalance; restored through diet, herbs, acupuncture.

Spiritual Health Belief

Illness influenced by spiritual well-being and rituals.

Family Roles in Healthcare

Decision-making and caregiving often determined by culture.

Religious Influence on Care

May affect end-of-life decisions and dietary restrictions.

Nursing Action with Religious Diets

Collaborate with dietitian, client, and family to ensure culturally appropriate meals.

Transcultural Nursing

Nursing care that incorporates cultural values, beliefs, and practices.

Founder of Transcultural Nursing

Madeleine Leininger.

Goal of Transcultural Nursing

Provide meaningful, culturally congruent care to improve safety and quality.

Health Disparities

Differences in health outcomes linked to social, economic, or environmental disadvantage.

Systemic Racism (CDC)

Serious public health threat affecting mental and physical health.

Black Americans Health Risk

Shorter life expectancy (about 4 years less than White Americans).

HIV Disparity

Black Americans 6 times more likely to die from HIV than White Americans.

Hispanic Health Disparity

Higher rates of end-stage kidney disease from diabetes.

Barriers in Hispanic/Latino Population

Language barriers, poverty, lack of insurance, limited preventive care.

Protective Factor in Hispanic Culture

Strong family support (familismo).

LGBTQIA Health Concern

Discrimination and lack of provider education contribute to health inequities.

ANA Position

Condemns discrimination based on sexual orientation and gender identity.

Cultural Competence

Ability to effectively provide care within client's cultural context and address health inequalities.

AACN Five Core Competencies

Apply social/cultural knowledge, Use evidence-based data, Promote safe quality outcomes, Advocate for social justice, Engage in continuous development.

Marianne Jeffreys Model

Cultural competence is continuous and increases nurse confidence.

Cultural Awareness

Self-examination of one's own biases and background.

Cultural Humility

Lifelong self-reflection and learning; partnership with client.

Explicit Bias

Conscious prejudice.

Implicit Bias

Unconscious prejudice.

Stereotyping

Generalizing traits to a group; leads to poor outcomes and nonadherence.

Cultural Diversity

Differences in beliefs, values, race, age, gender identity, religion, SES, etc.

Cultural Safety

Client determines if care environment feels safe; addresses power imbalance.

Leininger Sunrise Model

Focuses on religion, education, politics, technology, social factors.

Three Nursing Actions in Leininger Model

1. Preservation/Maintenance — Support beneficial cultural practices 2. Accommodation/Negotiation — Adapt care to align with culture 3. Repatterning/Restructuring — Modify harmful practices.

Giger & Davidhizar Model

Six cultural phenomena: 1. Biological variations 2. Communication 3. Space 4. Time 5. Social organization 6. Environmental control.

Purnell Model

12 cultural domains; assesses global society → community → family → individual.

Campinha-Bacote Model

Five constructs: 1. Cultural awareness 2. Cultural skill 3. Cultural knowledge 4. Cultural encounter 5. Cultural desire.

Health Literacy

Ability to obtain, process, and understand health information to make decisions.

Interpreter Services

Required when language barrier exists; improves safety and equity.

Healthy People 2030 Goal

Eliminate health disparities, achieve health equity, improve health literacy.

Six Principles of Quality Care

1. Safety 2. Effectiveness 3. Patient-centeredness 4. Timeliness 5. Efficiency 6. Equity.

Why Diverse Workforce Matters

Reduces health disparities and improves equity.

CLAS Standards

National standards for culturally and linguistically appropriate services.

Things that impair culturally competent care

Stereotyping, Implicit bias, Lack of interpreter, Ignoring family decision-maker, Power imbalance, Failure to assess health beliefs.

Medicare

Federal insurance for age ≥65, certain disabilities, or end-stage kidney disease.

Medicare Coinsurance

20% out-of-pocket unless supplemental (Medigap).

Medicaid

Federal/state insurance for low-income individuals; covers long-term care and premiums.

CHIP

Provides low-cost insurance for children whose families earn too much for Medicaid.

Nursing Intervention for Low Literacy

Use plain language, teach-back method, visual aids.

Air Pollution

Linked to stroke, lung cancer, heart disease.

Environmental Poisoning

Lead, asbestos, contaminated water exposure.

Flint, Michigan

Lead-contaminated water crisis example.

Higher Pollution Exposure

More common in communities of color.

Blue-Collar Workers

Higher exposure to hazardous environments.

Occupational Hazards

Noise, chemicals, heat, smoke.

Occupational Health Nurse

Prevents injury and promotes workplace safety.

OSHA

Federal agency regulating workplace safety.