Health Equity and Culture

Discuss diversity, cultural awareness, and cultural competence as they relate to client care.
Describe how the concept of implicit bias relates to the pattern of personal knowing.
Discuss health disparities related to diverse groups of individuals or populations.
Explore the role of the nurse when caring for clients and families from diverse populations.
Explore nursing strategies that promote the delivery of culturally inclusive/appropriate care to clients and their families.

Cultural Care Knowledge: Identified lack of cultural care knowledge as a barrier for nurses.
Transcultural Education: Introduced transcultural education, research, and practice as a formal field of study for nursing.
Theory of Culture Care Diversity and Universality:
  - Developed in the 1950s and published in the 1980s.
  - Posits that nurses will encounter and must successfully serve clients from all backgrounds and cultures.
  - Emphasizes the need for nurses to actively incorporate the patient’s values, beliefs, and background into every step of the nursing process.

Respectful and Equitable Practice:
- Stressed the importance of nurses applying cultural humility and social equity within their practice.

Culture: The integration of human behaviors including communication, language, actions, beliefs, values, customs, and institutions of racial, religious, social, and ethnic groups.
Cultural Awareness: Encompasses the ability and willingness to investigate and understand the differences between the nurse’s own culture and those in other cultures; enhanced by personal knowing and self-assessment.
Explicit Bias: Derived from our conscious thoughts and beliefs.
Implicit Bias: Involuntary attitudes or associations that impact our perceptions, actions, decisions, and interactions with others unconsciously.
Implicit Bias Test: Sample available from Learning for Justice.

Defined (from Dossey & Keegan, pp. 60-61):
  - The nurse’s awareness of wholeness and self, potentially impacted by personal experiences and memories.
  - Insights may occur with reflective practice and influence the nurse's capability to focus on the client’s needs.
  - Personal reflection raises questions about oneself and the impact on cultural awareness.

Cultural Diversity: Refers to a broad range of individual, population, and social characteristics that include age, ethnicity, gender identity, geographics, language, religious beliefs, and socioeconomic status.
Inclusive Care: Involves creating an environment that embraces differences, allowing individuals to bring their whole selves and identities, promoting a climate of safety.
Video Resource: Encouragement to watch an Inclusive Care video from Dean Suzanne Burke-Lehman (not assessed).

Emic Knowledge: A cultural insider’s perspective on a culture.
Etic Knowledge: An outsider’s viewpoint on a culture.
Cultural Competence Definition: The ability to incorporate effective nursing care with both emic and etic knowledge, appreciating, accepting, and respecting all individuals' cultural influences, beliefs, customs, and values.

Definition: Health outcomes that may differ among certain populations or vulnerable client groups compared to those in the majority or dominant population.
Impact: Can negatively affect populations experiencing health obstacles, particularly concerning accessing care.
Social Determinants of Health (SDOH): Factors affecting a person’s health, quality of life, and well-being, contributing to health disparities or inequities.
Healthy People 2030: A U.S. Government initiative focusing on eliminating health disparities, achieving health equity, and attaining health literacy to improve health for all individuals.

National CLAS Standards: Blueprint for healthcare organizations to advance health equity, improve quality, and eliminate healthcare disparities.
Health Equity: Attaining the highest level of health for all individuals.
Health Equality: The distribution of the same resources, including opportunities to all individuals within a population.
Differentiation: Health equity and equality are different; equal distribution does not guarantee fair and nondiscriminatory distribution of resources.
Nursing Implications: How nurses can identify and accommodate individual client needs for equitable and equal care.

Personal Health Literacy: The extent to which an individual can obtain, process, and comprehend basic health information.
Organizational Health Literacy: The extent to which organizations equitably assist people in understanding, finding, and using information and services for informed health-related decisions.
Action Steps for Improvement:
  - Provide information that is comprehensible (e.g., at a 5th-grade reading level).
  - Assist individuals in familiarizing themselves with their personal health information.
  - Collaborate with trusted messengers for information dissemination.
  - Utilize certified medical interpreters for communication with those speaking different languages.

Defined: Groups at a higher risk for poor health outcomes due to barriers in social, economic, and environmental resources:
  - Immigrants.
  - Older adults.
  - Marginalized ethnic groups.
  - Individuals in poverty.
  - Persons with chronic illnesses.
  - Individuals facing housing insecurity.
  - Veterans.
  - Clients speaking a different language.
  - LGBTQ+ individuals.

Assessment: Consider cultural assessment tools such as the Sunrise Enabler from M. Leininger.
Nursing Steps:
  - Diagnosis.
  - Plan.
  - Intervention.
  - Evaluation.