Week 5: Culture and Client Education

What is Cultural Competency?

The ability to understand, communicate, and interact effectively across cultures. It involves self-awareness, appreciation of cultural differences, and the skills to navigate diverse cultural settings.​

What are the 5 components of Cultural Competence?

• Self Awareness

• Cultural Knowledge

• Cultural Skill

• Cultural Encounter

• Cultural Desire

What is Cultural Awareness?

Self-reflection on one's own biases towards diverse cultures while examining one's own cultural identity and professional background. This is the first step to becoming more culturally competent. 

What is the first step in order to be culturally comptent?

Cultural Awareness

What is Cultural Knowledge?

Actively pursue and acquire a solid foundation of knowledge about culturally diverse populations. 

What is Cultural Skill?

Gather culturally relevant client data and perform culturally sensitive physical assessments.

What is Cultural Encounter?

Engage directly with clients from diverse cultures through face-to-face interactions and meaningful encounters to prevent stereotyping.​ 

What is Culture Desire?

A genuine desire to become culturally aware, informed, and skilled through meaningful cultural engagement.

What is Culture?

Learned and shared beliefs, values, norms, and traditions of a particular group, which guide thinking, decision-making, and actions.

What is Implicit Bias (Unconscious Bias)?

A bias that we are unaware of and that happens outside of our control, which is influenced by our personal background, cultural environment, and personal experiences.

They are prejudices and stereotypes that we act upon without intending to do so. This type of thinking requires little effort but is often prone to error.

Driving, talking, and cleaning is example of what term?

Implicit Bias (Unconscious Bias)

What are Explicit Bias?

A bias that we are aware is present and are responsible for. We must recognize and acknowledge our actions as they impact behavior, decisions, and patient-centered care provided

It is slow, logical, effortful, conscious thought, where reason dominates.

Feeling threatened by another group and delivering hate speech. What term is this?

Explicit Bias

What is Stereotyping?

An assumed belief regarding a particular group that we must avoid.

Assuming that all people from a certain country are rude. What is this?

Stereotyping

What is Cultural Identity?

Its how individuals identify consciously or unconsciously with those with whom they feel a common bond because of similar traditions, behaviors, values, and beliefs.

What is Acculturation?

Occurs when an individual or group transitions from one culture and develops traits of another culture but still retains unique cultural markers of the original culture.

A couple born and raised in Japan recently moved to the United States and have adapted to a new cultural norm in preparation for the birth of their first baby. What is term this?

Acculturation

What is Assimilation?

The process by which an individual adapts to the host’s cultural values and no longer prefers the components of the original culture.

After this process, there is no identifiable minority culture.

After immigrating to the United States, a young adult changes the way they dress and behave to fit into the new culture. What term is this?

Assimilation

What is Enculturation?

The process by which an individual learns the traditional context of a culture and assimilates its practices and values.

A hispanic grandmother teaches her granddaughter about their culture and customs. What term is this?

Enculturation

What is Ethnocentrism?

The evaluation of other cultures according to preconceptions originating within one’s own culture.

A nurse states that she treats all clients just as she would want to be treated. What term is this?

Ethnocentrism

What is Cultural Humility?

A respectful, open-minded approach to other cultures that involves self-reflection, recognizing one's limitations, biases, and committing to lifelong learning.

Which Competencies outline Standard 9: Respectful and Equitable Practice

• Respect client decisions without bias.

• Participate in life-long learning to understand cultural preferences, worldviews, choices, and decision-making processes of diverse clients.

• Serve as a role model and educator for cultural humility and the recognition and appreciation of diversity and inclusivity.

• Demonstrate respect, equity, and empathy in actions and interactions with all clients.

• Reflect upon personal and cultural values, beliefs, biases, and heritage.​

What are the 7 areas that nurse must consider for a “Cultural Assessment”

• History of Current Health Problem

• Health Beliefs and Practices

• Faith-Based Influences or Special Rituals

• Language and Communication

• Parenting Styles and Family Roles

• Sources of Support Beyond the Family

• Dietary Practices

What are the 4 C’s that must be considered when establishing a problem?

• Call

• Cope

• Concerns

• Caused

What are the requirements the nurses must follow when using an interpreter?

• Provide language assistance resources (e.g., trained medical interpreters, qualified translators) at no cost to the client to facilitate timely access to healthcare services.

• Inform all individuals of the availability of language assistance services in their preferred language verbally and in writing.

• Do not use untrained individuals (e.g., family members) or minors as interpreters.

• Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the area served.

A grandma who is 72 years old is at hospital to receive medication after her surgery. The grandmother only speaks French and has one of their relatives interpret the nurses medical instructions. What is wrong with this situation?

They are using the client’s family member as an interpreter

• Family members may include their own perceptions or opinions in the translation.

• ​Use a professional medical interpreter provided by the hospital and not family!

True or False

Should a medical interpreter stand by the nurse when interpreting discharge instructions to the client.

False

• Have the interpreter sit next to the client

True or False

When a nurse is talking through with an interpreter, they should speak in a first person tone (“I” statements).

True

True or False

The nurse should always be be talking directly to the interpreter.

False

• Speak directly to the client, not the interpreter.

True or False

Nurses should speak in short sentences and then wait for the interpreter to convey them to client

True

True or False

The nurse often time needs to use jargons, acronyms, or jokes to the interpreter for the client to feel safe.

False

• Do not use jargon, acronyms, or jokes

True or False

While the interpreter is giving medical instructions, its okay for the nurse to interrupt the conversation whenever they please

False

• Do not interrupt the interpreter.

True or False

A nurse must always ask the client for feedback and clarification on regular intervals

True

True or False

A nurse must be observant of the client nonverbal and verbal behaviors

True

What are Social Determinants of Health (SDOH)?

• An individual’s health is significantly influenced by their living conditions and environment.​ These influences are referred to as social determinants of health (SDOH).​

• SDOH are external factors that can greatly affect overall well-being.

Poverty, Limited access to nutritious food, inadequate healthcare services, poor air quality, and exposure to violence is an example of what?

Social Determinants of Health (SDOH)

What are Health Disparities?

Are preventable differences in a population’s ability to achieve optimal health.

Example: Poor health status, disease risk factors, poor health outcomes, and limited access to healthcare are the types of disparities that are often interrelated and influenced by the social context in which people live.

What are the five overarching goals of Health People 2030’s?

• Healthcare Access and Quality

• Neighborhood and Built Environment

• Social and Community Context

• Economic Stability

• Education Access and Quality

How is the goal of “Economic Stability” meet in Healthy People 2030?

This goal is reached through employment programs, career counseling, and high-quality childcare, so more people can find and keep jobs.

• Additionally, policies are needed to help people pay for food, housing, healthcare, and education to improve health and well-being

How is the goal of “Education Access and Quality” meet in Healthy People 2030?

Focuses on providing high-quality educational opportunities for children and adolescents through interventions.

• The stress of living in poverty can also affect a child’s brain development, making it harder for them to do well in school

How is the goal of “Healthcare Access and Quality” meet in Healthy People 2030?

Focuses on improving health by helping people get timely, high-quality healthcare services.

• Strategies to increase insurance coverage rates are critical to ensuring more people get important healthcare services, like preventive care and treatment for chronic illnesses

How is the goal of “Neighborhood and Built Environment” meet in Healthy People 2030?

Focuses on improving health and safety in the places where people live, work, learn, and play

• Some interventions to improve this issue could be adding sidewalks and bike lanes, additional green space, and designated smoking areas. Living in an area with violence, unsafe air or water, and other health and safety risks can impact our health.

How is the goal of “Social and Community Context” meet in Healthy People 2030?

Focuses on helping people get the social support they need in the places where they live, work, learn, play, worship, and age

• Relationships and interactions with family, friends, co-workers, and community members can have a major impact on our health and well-being. Positive relationships at home, at work, and in the community can help reduce some of the negative impacts of unsafe neighborhoods and discrimination.

What is the goal of Cod of Ethics: Provision 9?

Provision 9 of the American Nurses Association’s (ANA) Code of Ethics indicates nurses must work to promote social justice, eliminate health inequities, and support human flourishing.

•  Includes influencing policies, legislation, and systems that affect health and well-being

What does “Assertion of Nursing Values” means?

Nurses must uphold and advocate for core nursing values like compassion, respect, and equity

A nurse speaks at a community forum about the importance of equitable access to prenatal care for underserved populations. Which term is this demonstrating?

• Assertion of Nursing Values

• Commitment to Society

• Advancing the Nursing Vision of a Good and Healthy Society

• Challenges of Structural Oppression: Racism and Intersectionality

• National Policies, Programs, and Legislation

Assertion of Nursing Values

What does “Commitment to Society” mean?

Nurses have a responsibility to contribute to the health and well-being of society as a whole.

A school nurse organizes a vaccination awareness campaign to improve public health in the local community. Which term is this demonstarting?

• Assertion of Nursing Values

• Commitment to Society

• Advancing the Nursing Vision of a Good and Healthy Society

• Challenges of Structural Oppression: Racism and Intersectionality

• National Policies, Programs, and Legislation

Commitment to Society

What does “Advancing the Nursing Vision of a Good and Healthy Society” mean?

Nurses help shape a society where everyone has the opportunity to live a healthy life

A nurse collaborates with local leaders to develop a mobile health clinic for rural areas lacking access to care. Which term is this demonstrating?

• Assertion of Nursing Values

• Commitment to Society

• Advancing the Nursing Vision of a Good and Healthy Society

• Challenges of Structural Oppression: Racism and Intersectionality

• National Policies, Programs, and Legislation

Advancing the Nursing Vision of a Good and Healthy Society

What does “Challenges of Structural Oppression: Racism and Intersectionality” mean?

Nurses must recognizes and challenge systemic barriers like racism, sexism, and other forms of discrimination

A nurse educator integrates anti-racism training into the nursing curriculum to prepare students for inclusive practice. Which term is this demonstrating?

• Assertion of Nursing Values

• Commitment to Society

• Advancing the Nursing Vision of a Good and Healthy Society

• Challenges of Structural Oppression: Racism and Intersectionality

• National Policies, Programs, and Legislation

Challenges of Structural Oppression: Racism and Intersectionality

What does “National Policies, Programs, and Legislation” mean?

Nurses advocate for laws and policies that improve health outcomes and reduce disparities

A nurse joins a national nursing association’s policy committee to support legislation that expands Medicaid coverage. Which term is this demonstrating?

• Assertion of Nursing Values

• Commitment to Society

• Advancing the Nursing Vision of a Good and Healthy Society

• Challenges of Structural Oppression: Racism and Intersectionality

• National Policies, Programs, and Legislation

National Policies, Programs, and Legislation

The Institute for Medicine (IOM) defines six domains for quality healthcare. What are they?

• Safe

• Effective

• Patient-Centered

• Timely

• Efficient

• Equitable

IOM Domain

Safe

Healthcare should avoid harm to clients form

IOM Domain

Effective

Healthcare should provide services based on scientific knowledge to all who could benefit and refrain from providing services to those not likely to benefit (avoiding underuse and misuse, respectively).

IOM Domain

Patient-Centered

Healthcare should provide care that is respectful of and responsive to individual preferences, needs, and values and ensure that the client’s values guide all clinical decisions

IOM Domain

Timely

Healthcare should reduce waits and sometimes harmful delays for both those who receive and those who give care.

IOM Domain

Efficient

Healthcare should avoid waste, including waste of equipment, supplies, energy, ideas, and resources

IOM Domain

Equitable

Healthcare should provide care that does not vary inequality because of personal characteristics such as geographic location and socioeconomic status

What strategies are used to improve SDOH?

• Upstream Factors

• Midstream Factors

• Downstream Factors

What are Upstream Factors?

Are foundational social, economic, and environmental conditions that shape health outcomes, and they often lead to significant health disparities. Addressing early factors.

• Looks at the root causes—like housing, nutrition, and income—that affect whether individuals get sick in the first place. By addressing these early factors, we can help individuals stay healthier and reduce the need for medical treatment later.

• Nurses help shape upstream factors by contributing to health policy at local, state, and national levels.

What are Midstream Factors?

Are specific nonmedical acute resource needs.

• Homelessness, food insecurity, limited access to education, and trauma can prevent individuals from reaching their best health.

• Nurses working in places like public health departments or community clinics help address these issues by screening clients for social challenges, such as a lack of housing or food. They use this information to connect clients with government and community resources that can support their needs and help prevent illness. Nurses focus on preventing disease and meeting social needs

What are Downstream Factors?

Focuses on treating diseases and managing chronic conditions after they have developed.

• Nurses are often involved in this type of care in settings like hospitals, urgent care clinics, and even clients’ homes—places where healthcare is actively delivered.

What is the main goal of Patient Education?

The goal of patient education is to help individuals stay as healthy as possible. When patients take an active role in their care and make informed decisions, it leads to safer, more patient-centered care.

What are the 3 levels of Prevention?

• Primary Prevention

• Secondary Prevention

• Tertiary Prevention

What is Primary Prevnetion?

Prevent disease before it starts

What is the role of a nurse who is using Primary Prevention?

Teach healthy habits and skills

• School

• Clinics

• Homes

• Community Screenings

These are common settings for which level of prevention?

Primary Prevention

• Teaching nutrition

• Exercise

• Prenatal classes

• Vaccine schedules

These are an example of which level of prevention?

Primary

What is Secondary Prevention?

Find problems early and treat them quickly

What is the role of a nurse using Secondary Prevention?

Screen, educate, and support recovery

• Clinics

• Hospitals

• Community screenings

These are the common settings for which level of prevention?

Secondary Prevention

• Blood Pressure checks

• Glucose screenings 

• Teaching after acute illness

These are an example of which level of prevention?

Secondary

What is Tertiary Prevention?

Support rehabilitation and long-term adaptation

What is the role of a nurse using Tertiary Prevention?

Help patients manage chronic conditions and regain function

• Rehabilitation

• Long-term care

• Home Health

These are common settings for which level of prevention?

Tertiary Prevention

• Teaching activities of daily living skills after a stroke or heart attack

This is an example of which level of prevention?

Tertiary

How is teaching and learning a two-way process for patient care?

• The nurse teaches in a way the patient can understand.

• The patient learns, practices, and applies the information.

  • The nurse checks for understanding and adapts the teaching if needed.

Many intrapersonal factors influence a patient's readiness to learn and understand the content, such as:

• attitudes

• anxiety

• physical symptoms

• education

• health literacy

• personal values

A patient's ability to learn is shaped by factors such as:

• emotional and physical health

• education level

• cultural background

• health-related values

• developmental stage

• previous knowledge and experiences

What is the Teach-back Method?

Its a way to check patient understanding by asking the patient to state in their own words what they need to know or do about their health.

• way to confirm that you have explained things in a manner that patients understand.

The teach-back method of evaluation can be used by all patients in any setting and helps:

• improve patient understanding and adherence to instructions

• decrease call-backs and hospital readmissions

• improve patient satisfaction and outcomes

What are the 3 Domains of Learning

• Cognitive Learning

• Affective Learning

• Psychomotor Learning

What is Cognitive Learning domain?

Understanding facts, concepts, and information

The patient explains why they need to complete their full antibiotic course. What domain of learning is this?

Cognitive

What is Affective Learning domain?

Changes in attitudes, values, motivation, or feelings​

The patient expresses willingness to stop smoking after discussing health risks. What domain of learning is this?

Affective

What is Psychomotor Learning domain?

• Hands-on physical skills and motor activities

• Return demonstration

The patient demonstrates how to correctly perform a finger-stick blood glucose check.​ Which domain of learning is this?

Psychomotor

What are the 10 Learning Styles

Readiness to Learn

Motivation

Prior Knowledge

Active Participation

Feedback

Repetition and Practice

Simple —---> Complex

Culture and Language

Age and Development

Environment

What is learning style is Readiness to Learn?

Make sure the patient is calm, comfortable, and emotionally ready before teaching

Hand-on: Ask the patient to rate their stress on a scale of 1-10 before teaching. What learning style is this?

Readiness to Learn

What is learning style is Motivation?

Explain why the information matters and how it helps the patient’s health

Visual: Show a chart of progress (e.g. blood pressure improvements or weight loss) What learning style is this?

Motivation