Cultural competence lecture notes (completed)

CULTURAL COMPETENCE

OBJECTIVES

By the end of this lecture, you should be able to:

  • Describe steps toward developing cultural competence

  • Identify major components of cultural assessment

  • Describe ways in which culture influences an individual and family

  • Describe the relationship of sociocultural background to health and illness

  • Discuss selected cultural groups’ health beliefs, health practices, illness beliefs, and common health problems

HEALTH DISPARITIES AND HEALTH CARE

  • Health Care Disparities:
      - Differences among populations in the availability, accessibility, and quality of health care services

  • Addressing Health Care Disparities:
      - Adoption of new standards focusing on cultural competency, health literacy, and patient- and family-centered care
      - Recognizing and valuing each patient’s unique needs enhances the overall safety and quality of care while aiding in the elimination of health disparities

CULTURE CONCEPTS

  • Culture:
      - Defined as the “thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups”

  • Intersectionality:
      - The notion that individuals belong to multiple social groups simultaneously, which changes within varying social and political contexts

  • Oppression:
      - A formal or informal system of advantages or disadvantages linked to our membership in social groups

CULTURAL CARE CONCEPTS

  • Cultural Competence:
      - Defined as the process of acquiring specific knowledge, skills, and attitudes necessary for providing culturally congruent care

  • Cultural Encounter:
      - An intervention where the nurse interacts directly with patients from culturally diverse backgrounds

  • Cultural Desire:
      - The intrinsic motivation of a healthcare professional to engage in the process of becoming culturally competent voluntarily

CULTURALLY CONGRUENT CARE

  • Transcultural Nursing:
      - A comparative study of cultures to comprehend their similarities and differences

  • Culturally Congruent Care:
      - Care that aligns with a person's life patterns, values, and meanings
      - Important to differentiate between disease (biomedical understanding) and illness (patient's lived experience)

TRANS-CULTURAL NURSING

  • Transcultural Communication Requires:
      - Linguistic Skills: Involving effective communication across different languages
      - Culturally Congruent Interpretation: Understanding behaviors within the cultural context
      - Listening Skills: Essential for realizing patient needs
      - Observation Skills: To identify non-verbal cues and preferences

COMPONENTS OF CULTURAL COMPETENCE

  • Campinha-Bacote’s Model:
      - Consists of five interrelated components:
        - Cultural Awareness
        - Cultural Knowledge
        - Cultural Skills
        - Cultural Encounters
        - Cultural Desires

CULTURALLY AND LINGUISTICALLY APPROPRIATE STANDARDS

  • Respect a patient’s healthcare beliefs as valid

  • Understand how these beliefs impact healthcare delivery

  • Shift from a biomedical viewpoint (disease) to a contextual view (illness)

  • Be able to elicit a patient's perspective on illness and its causes

  • Effectively communicate the provider’s perspective in understandable terms

  • Negotiate a mutually agreeable, safe, and effective treatment plan

CULTURALLY COMPETENT ORGANIZATIONS

  • Value diversity within the organization

  • Conduct cultural self-assessments

  • Manage the dynamics of differences among patients and staff

  • Institutionalize cultural knowledge and adapt to diversity in care practices

CULTURALLY COMPETENT CARE

  • Defined as culturally congruent care fitting individual values and life patterns

  • Requires nurses to possess adequate knowledge, skills, and attitudes in care delivery

  • Necessitates self-awareness of the nurse’s culture and biases, alongside knowledge of diverse cultures

LINGUISTIC COMPETENCE

  • Ability to communicate effectively to diverse audiences in an understandable manner

  • Resources should be tailored to a reading level of 6th grade or lower

  • Involves ongoing initiatives to improve health literacy and implement the teach-back method

LANGUAGE ACCESS SERVICES

  • Healthcare organizations must provide free language assistance to patients with limited English proficiency:
      - Bilingual staff and interpreter services must be readily available
      - These services are required at all hours of operation and throughout all points of contact
      - Patients must be informed of their right to language assistance in their preferred language both verbally and in written form
      - Family and friends should not act as interpreters to ensure accuracy and confidentiality

HEALTH LITERACY

  • Defined as the ability to obtain, process, and understand necessary health information for informed decision-making

  • Low Health Literacy Implications:
      - Associated with increased mortality risk for seniors
      - Poorer medication management capabilities
      - Difficulty in interpreting labels

  • Vulnerable Populations:
      - Elderly individuals over 65 years
      - Immigrants
      - Low-income individuals
      - Those without a GED or high school diploma
      - Individuals with chronic mental and/or physical health conditions

TEACH-BACK

  • A method confirming communication clarity by prompting the patient to explain or demonstrate their understanding

  • Requires presenting information in various ways until confidence in the patient’s understanding is established

  • Proficiency in this method necessitates practice:
      - Plan the approach carefully
      - Utilize handouts, visuals, models, etc. for clarity
      - Clarify information and summarize key points

CULTURAL CONTEXT OF HEALTH, ILLNESS, AND CARING

  • Health, illness, and caring possess unique meanings across different cultures

  • Cultural groups define and interpret experiences relevant to birth, illness, and death based on their context

  • Distinctions between Western and non-Western cultures:
      - Western Cultures: Focus on scientific investigation and a biomedical perspective
      - Non-Western Cultures: Advocate for holistic understandings of health and illness

CULTURAL ASSESSMENT

  • Defined as a systematic and comprehensive examination of the cultural care values, beliefs, and practices within individuals, families, and communities

  • Aims to gather information aiding nurses to deliver culturally competent care

COMPONENTS OF CULTURAL ASSESSMENT

  • Includes various aspects such as:
      - Open-ended, focused, and contrast questioning
      - Ethnohistory
      - Sexual orientation and gender identity considerations
      - Understanding of social organization
      - Socioeconomic status
      - Bicultural ecology and associated health risks
      - Language and communication preferences
      - Caring beliefs and practices

CONSIDERATIONS WHILE PROVIDING CARE

Family Patterns

  • Decision-making processes

  • Gender-role behaviors

  • Family values and systemic dynamics

  • Naming systems and their significance

Communication Style

  • Verbal Communication:
      - Language used
      - Cultural values influencing speech

  • Nonverbal Communication:
      - Silence
      - Facial expressions
      - Body posture and space utilization

Space Orientation

  • Awareness of personal space preferences

  • Understanding cultural norms around physical proximity

Time Orientation

  • Recognition of cultural differences in the perception of time

Eye Contact

  • Respecting cultural variations in the significance of eye contact

Touch

  • Awareness of cultural norms determining acceptability of touch.

NUTRITIONAL PATTERNS

  • Considerations regarding available food, dietary preferences, and preparation methods

  • Understanding health beliefs surrounding nutrition and religious dietary practices

BIOLOGICAL VARIATIONS

  • The differential effects of medications among various ethnic or cultural groups

  • Considering genetic predispositions that may affect health care delivery

COMPLEMENTARY AND ALTERNATIVE THERAPIES

  • Inclusion of culturally specific practices and treatments in care

CASE STUDY

Context of Mrs. Tao

  • Mrs. Tao is a 27-year-old immigrant from China, recently given birth to a baby girl

  • Importance of breastfeeding and post-partum hydration emphasized

Educational Intervention by Jenny (the Nurse)

  • She educates Mrs. Tao on increasing fluid intake post-birth to support breastfeeding, suggesting at least 8 ounces of water every hour

Follow-Up Interaction

  • Jenny observes the water pitcher is untouched and reinforces the importance of hydration

  • Asks an open-ended question for insight into Mrs. Tao's drinking habits
      - Mr. Tao explains the cultural belief in avoiding cold (to balance Yin and Yang post-delivery)

Adjusting Care According to Beliefs

  • Jenny adapts care based on cultural understanding, asking what beverages Mrs. Tao can drink instead

  • After discussing alternatives, she provides hot herbal tea, aligning with Mrs. Tao's preferences

  • Ensures continued provision of appropriate fluids through communication with the cafeteria

Cultural Understanding in Nursing Practice

  • Jenny utilizes knowledge of Chinese cultural practices impacting health beliefs (Yin-Yang relationship) in providing effective education for breastfeeding

IMPLICATIONS FOR NURSING PRACTICE

  • Prioritize culturally competent care

  • Approach patients and families with cultural sensitivity and awareness

  • Foster negotiated partnerships with patients and families in care planning

  • Empower families and social networks to enhance patient support

QUICK QUIZ

  • Health disparities can be defined as unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups, often exacerbated by:
      1. Bias
      2. Stereotyping
      3. Prejudice
      4. All of the above