Diversity, equity, and disparities

Copyright and Content Overview

  • Copyright: Content is from Wolters Kluwer Health, Lippincott Williams & Wilkins, covering various aspects of culture, diversity, equity, and disparities in healthcare as part of Taylor's Fundamentals of Nursing, with additions from Paula Wyman, MSN, RN, CNL, CMSRN.

Culture: Definitions and Concepts

  • Definition of Culture (Merriam Webster):

    • Customary beliefs, social forms, and material traits of a social group.

    • Characteristic features of everyday existence shared by people in a place or time, e.g., popular culture, regional culture.

  • Culture in an Institution or Organization:

    • Set of shared attitudes, values, goals, and practices defining a corporation (e.g., corporate culture focused on profit).

  • Culture in Fields or Activities:

    • Associated values, conventions, or social practices (e.g., studying the impact of technology on print culture).

  • Taylor's View on Culture:

    • Shared system of beliefs, values, and behavioral expectations.

    • Provides social structure and defines interactions within families and communities.

    • Apparent in attitudes and institutions unique to each culture.

True/False Questions on Culture

  • Question: Does culture include beliefs, habits, likes/dislikes, customs, and rituals learned from family?

    • Answer: A. True.

    • Rationale: Culture encompasses learned behaviors, values, and rituals.

Subcultures

  • Definition of Subculture (Taylor):

    • Large group with distinct ethnic, occupational, or physical traits not common in the larger culture.

  • Definition of Subculture (Merriam Webster):

    • An ethnic, regional, social, or economic group exhibiting distinguished behaviors within an embracing culture.

  • Health Care as a Culture:

    • True Statement: The health care system is a culture of its own, with nursing as its largest subculture.

    • Answer: A. True.

Cultural Diversity

  • Elements of Diversity:

    • Varying cultures, racial/ethnic origin, religion, physical size, age and gender, sexual orientation, disability, socioeconomic status, geographical location.

Factors Influencing Health Disparities

  • Key Factors:

    • Racial and ethnic groups

    • Poverty

    • Gender and age

    • Mental health

    • Educational level

    • Disabilities

    • Sexual orientation

    • Health insurance and access to care.

Identifying Prejudices

  • Key Concepts:

    • Stereotyping: Assumption all members of a cultural group think or act alike (positive or negative).

    • Cultural Blindness: Ignorance to cultural differences.

    • Cultural Imposition: Belief that all should adopt the majority culture (cultural assimilation).

    • Ethnocentrism: Belief in the superiority of one's own beliefs and practices.

Culture Conflict and Shock

  • Culture Conflict:

    • Occurs when people recognize differences and may respond by ridiculing others' beliefs for security.

  • Culture Shock:

    • Psychological discomfort felt when placed in a different culture.

The Culture of Poverty

  • Characteristics:

    • Feelings of despair and resignation.

    • Unstable family structures, abandonment, or abuse.

    • Decline in self-respect and community involvement.

Elements of Cultural Competence

  • Core Elements:

    • Self-awareness regarding one’s culture.

    • Knowledge and understanding of patients' cultures.

    • Acceptance of cultural differences.

    • Avoiding assumptions of shared beliefs with patients.

    • Openness to cultural encounters.

    • Accepting responsibility for cultural competency.

Factors Affecting Culturally Diverse Interactions

  • Key Influencers:

    • Cultural backgrounds of participants.

    • Beliefs and expectations about health care.

    • Context of cultural encounters.

    • Agreement level between belief systems.

Guidelines for Culturally Competent Nursing Care

  • Strategies:

    • Develop cultural self-awareness of personal beliefs and values.

    • Gain knowledge of diverse cultures and practices.

    • Accommodate cultural practices non-judgmentally.

    • Respect cultural beliefs, family roles, and treatment options.

    • Seek cultural educational support for positive healthcare relationships.

Health Disparities Influencing Factors

  • Repeated Key Factors:

    • Racial and ethnic groups

    • Poverty

    • Gender and age

    • Mental health

    • Educational level

    • Disabilities

    • Sexual orientation

    • Health insurance and access to care.

Health and Illness Influencing Factors

  • Human Dimensions:

    • Basic human needs

    • Various human dimensions affecting health

    • Self-concept

    • Risk factors respective to health conditions.

Cultural Influences on Health Care

  • Key Factors Influencing Care:

    • Physiologic variations

    • Pain reactions

    • Mental health considerations

    • Gender roles

    • Language and communication barriers

    • Space and time orientation

    • Nutritional beliefs

    • Family support systems

    • Socioeconomic factors.

Characteristics of Chronic Illness

  • Defining Aspects:

    • Permanent changes in health.

    • Irreversible alterations in anatomy and physiology.

    • Necessitates extensive patient education for rehabilitation.

    • Requires long-term care and support.

The Human Dimensions Affecting Health

  • Dimensions:

    • Physical: genetics, age, development.

    • Emotional: mental responses affecting bodily functions.

    • Intellectual: cognition influenced by education and experience.

    • Environmental: impacts from sanitation, climate, pollution.

    • Sociocultural: influenced by economic levels, lifestyle, family, and culture.

    • Spiritual: individual beliefs and values influencing health.

True/False Questions Regarding Health Dimensions

  • Question: Keeping in touch with neighbors fosters a community feeling, is this emotional dimension?

    • Answer: B. False.

    • Rationale: It's promoting one's sociocultural dimension instead.

Health Promotion and Illness Prevention

  • Levels of Prevention:

    • Primary: Promotes health and prevents disease (e.g., immunization, education).

    • Secondary: Early detection of disease (e.g., screenings).

    • Tertiary: Rehabilitation post illness diagnosis (e.g., support groups).

Preventive Care Examples

  • Question: Identify a nursing activity promoting secondary prevention.

    • Correct Answer: B. Performing a blood pressure screening.

    • Rationale: Early detection of diseases like heart disease exemplifies secondary prevention.

Models of Health and Illness

  • Key Models:

    • Health Belief Model: Based on perceptions of disease threat.

    • Health Promotion Model: Illustrates person-environment interaction promoting health.

    • Health-Illness Continuum: Visualizes health as a dynamic continuum from wellness to death.

    • Agent-Host-Environment Model: Concepts addressing health interaction variables.

Health Illness Continuum Detailed

  • Continuum Features:

    • Conceptualizes a person's health as dynamic.

    • Represents wellness and death at extremes, illustrating adaptability to changes.

The Health Belief Model (Rosenstock)

  • Components:

    • Individual perceptions of susceptibility and seriousness of diseases.

    • Perceived benefits of health actions.

    • Influencing demographics and physiopsychological factors.

The Health Promotion Model (Pender)

  • Core Aspects:

    • Reflects individual interactions with the environment in pursuit of health.

    • Predicts health behaviors through individual characteristics and experiences.

    • Emphasizes the outcome of health-related behavior to attain positive health.

Revised Health Promotion Model

  • Additions:

    • Activity-related affect.

    • Commitment to a health action plan.

    • Immediate competing demands and preferences.

Summary of Risk Factors for Illness

  • Identified Risk Factors:

    • Age

    • Genetic predispositions

    • Physiologic factors

    • Health habits and lifestyle choices

    • Environmental influences.

Overview of Culture and Health Disparities

  • Source: Content from Wolters Kluwer Health, Lippincott Williams & Wilkins, with additions from Paula Wyman.

Culture: Definitions

  • Culture: Shared system of beliefs, values, and behavioral expectations (Taylor); customary beliefs, social forms, and traits of a social group (Merriam Webster).

    • Includes learned beliefs, habits, likes/dislikes, customs, and rituals inherited from family.

Subcultures

  • Subculture: Large group with distinct traits not common in the larger culture (Taylor); an ethnic, regional, social, or economic group (Merriam Webster).

    • The healthcare system is a culture, with nursing as its largest subculture.

Cultural Diversity & Disparities

  • Elements of Diversity: Varying cultures, racial/ethnic origin, religion, physical size, age, gender, sexual orientation, disability, socioeconomic status, geographical location.

  • Health Disparities Factors: Racial/ethnic groups, poverty, gender/age, mental health, educational level, disabilities, sexual orientation, health insurance, and access to care.

Identifying Prejudices

  • Stereotyping: Assuming all members of a group think/act alike.

  • Cultural Blindness: Ignorance of cultural differences.

  • Cultural Imposition: Belief that all should adopt the majority culture.

  • Ethnocentrism: Belief in the superiority of one's own culture.

Culture Conflict and Shock

  • Culture Conflict: Discord when people recognize differences, leading to ridicule.

  • Culture Shock: Psychological discomfort in a new culture.

The Culture of Poverty

  • Characteristics: Despair, unstable family structures, decline in self-respect and community involvement.

Cultural Competence & Nursing Care

  • Elements of Cultural Competence: Self-awareness, knowledge of patient cultures, acceptance of differences, avoiding assumptions, openness to encounters, responsibility for competency.

  • Guidelines for Nursing Care: Develop cultural self-awareness, gain knowledge of diverse cultures, accommodate practices non-judgmentally, respect beliefs, seek educational support.

  • Influences on Health Care: Physiologic variations, pain reactions, mental health, gender roles, language, space/time orientation, nutrition, family support, socioeconomic factors.

Health & Illness

  • Chronic Illness: Permanent changes, irreversible alterations, requires extensive education, and long-term care.

  • Human Dimensions Affecting Health: Physical, emotional, intellectual, environmental, sociocultural, spiritual.

    • Example: Fostering community feeling with neighbors is a sociocultural dimension.

Health Promotion and Illness Prevention

  • Primary Prevention: Promotes health, prevents disease (e.g., immunization).

  • Secondary Prevention: Early disease detection (e.g., screenings, like blood pressure screening).

  • Tertiary Prevention: Rehabilitation after diagnosis (e.g., support groups).

Models of Health and Illness

  • Health Belief Model: Perceptions of disease threat and benefits of action.

  • Health Promotion Model (Pender): Person-environment interaction; predicts health behaviors, revised to include activity-related affect, commitment to a plan, and competing demands.

  • Health-Illness Continuum: Dynamic view of health from wellness to death.

  • Agent-Host-Environment Model: Addresses variables in health interaction.

Risk Factors for Illness

  • Identified Factors: Age, genetic predispositions, physiologic factors, health habits/lifestyle, environmental influences.