Cultural Competence: Cultural Care

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Cultural Competence: Cultural Competence: Cultural CareCultural Care

Chapter 3Chapter 3

2Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care

ObjectivesObjectives

Discuss the demographic profile of the United States.Discuss the demographic profile of the United States.

Describe the National Standards for Culturally and Describe the National Standards for Culturally and Linguistically Appropriate Services.Linguistically Appropriate Services.

Discuss the background of the Heritage Assessment.Discuss the background of the Heritage Assessment.

Describe the methods for conducting the Heritage Describe the methods for conducting the Heritage Assessment.Assessment.

Provide examples of traditional health and illness beliefs Provide examples of traditional health and illness beliefs and practices.and practices.

Discuss the steps to cultural competence.Discuss the steps to cultural competence.



Health:Health:

““The balance of the person, both within one’s The balance of the person, both within one’s beingbeing——physical, mental and/or spiritualphysical, mental and/or spiritual——and and in the outside worldin the outside world——natural, communal, natural, communal, and/or metaphysical, is a complex, and/or metaphysical, is a complex, interrelated phenomenon (Spector, 2004)interrelated phenomenon (Spector, 2004)



Illness:Illness:

The loss of the person’s balance, within one’s The loss of the person’s balance, within one’s beingbeing——physical, mental and/or spiritualphysical, mental and/or spiritual——and and in the outside worldin the outside world——natural, communal, natural, communal, and/or metaphysical.and/or metaphysical.



Demographic Profile of the Demographic Profile of the United StatesUnited States

Total population passed 300 million in the autumn of Total population passed 300 million in the autumn of 2006.2006.

1 out of 3 US residents was in a group other than 1 out of 3 US residents was in a group other than single-race non-Hispanic white.single-race non-Hispanic white.

““Minority” or “emerging majority” population totaled Minority” or “emerging majority” population totaled 98 million people.98 million people.

Hispanics largest and fastest growing group.Hispanics largest and fastest growing group.

Second largest population is blacks.Second largest population is blacks.

Followed by Asians, American Indians and Alaska Followed by Asians, American Indians and Alaska Natives, Native Hawaiians and other Pacific Natives, Native Hawaiians and other Pacific Islanders.Islanders.



In comparison to the population In comparison to the population as a whole:as a whole:

Emerging majority groups tend to be younger, Emerging majority groups tend to be younger, with lower median ages and higher with lower median ages and higher proportions of the population under the age proportions of the population under the age of 18 years.of 18 years.

The non-Hispanic, single-race, white The non-Hispanic, single-race, white population has an older median age and a population has an older median age and a smaller proportion of the population under the smaller proportion of the population under the age of 18 years.age of 18 years.



There isThere is——

One birth every 8 secondsOne birth every 8 seconds

One death every 13 secondsOne death every 13 seconds

One international migrant (net) every 30 One international migrant (net) every 30 secondsseconds

Therefore our country gains one person every Therefore our country gains one person every 11 seconds11 seconds



Categories of interest to health Categories of interest to health care providerscare providers

Legal permanent residentsLegal permanent residents

Naturalized citizensNaturalized citizens

Undocumented aliensUndocumented aliens

Refugees, asylees, and paroleesRefugees, asylees, and parolees

Legal nonimmigrant residentsLegal nonimmigrant residents


National Standards for Culturally National Standards for Culturally and Linguistically Appropriate and Linguistically Appropriate

Services in Health CareServices in Health Care



First and Landmark StandardFirst and Landmark Standard

““Health care organizations should ensure that Health care organizations should ensure that patients receive from all staff members patients receive from all staff members effective, understandable and respectful care effective, understandable and respectful care that is provided in a manner compatible with that is provided in a manner compatible with their cultural health beliefs and practices and their cultural health beliefs and practices and preferred language”preferred language”

Source: National Standards for Culturally and Linguistically Appropriate Services in Health Care, Final Report, March 2001, pp. 7-20, Washington, Source: National Standards for Culturally and Linguistically Appropriate Services in Health Care, Final Report, March 2001, pp. 7-20, Washington, DC: Office of Minority Health, DHHS, Order-1800-444-6472.DC: Office of Minority Health, DHHS, Order-1800-444-6472.



Linguistic CompetenceLinguistic Competence

Title VI of the Civil Rights Act of 1964: Services Title VI of the Civil Rights Act of 1964: Services cannot be denied to people of limited English cannot be denied to people of limited English proficiency.proficiency.

According to the 2000 census, 47 million Americans According to the 2000 census, 47 million Americans over 5 years of age speak a language other than over 5 years of age speak a language other than English in their homes.English in their homes.

This represented an increase of 15 million people This represented an increase of 15 million people over the numbers documented by the 1990 census.over the numbers documented by the 1990 census.

Certain states require that providers offer language Certain states require that providers offer language assistance in health care settings: California, assistance in health care settings: California, Massachusetts, and New York.Massachusetts, and New York.



Cultural CompetenceCultural Competence

Culturally sensitiveCulturally sensitive

Culturally appropriateCulturally appropriate

Culturally competentCulturally competent



Culturally SensitiveCulturally Sensitive

Possessing basic knowledge of and Possessing basic knowledge of and constructive attitudes toward diverse cultural constructive attitudes toward diverse cultural populationspopulations



Culturally AppropriateCulturally Appropriate

Applying underlying background knowledge Applying underlying background knowledge necessary to provide the best possible health necessary to provide the best possible health carecare



Culturally CompetentCulturally Competent

Understanding and attending to total context Understanding and attending to total context of patient’s situation including of patient’s situation including Immigration statusImmigration status

Stress factorsStress factors

Social factorsSocial factors

Cultural similarities and differencesCultural similarities and differences



HeritageHeritage



Heritage ConsistencyHeritage Consistency

The degree to which a person’s lifestyle The degree to which a person’s lifestyle reflects his or her traditional heritagereflects his or her traditional heritage



Heritage Consistency ContinuumHeritage Consistency Continuum

Traditional: living within the norms of the Traditional: living within the norms of the traditional culturetraditional culture

Modern: acculturated to the norms of the Modern: acculturated to the norms of the dominant societydominant society



CultureCulture

The thoughts, communications, actions, The thoughts, communications, actions, beliefs, values, and institutions of racial, beliefs, values, and institutions of racial, ethnic, religious or social groups.ethnic, religious or social groups.



Characteristics of CultureCharacteristics of Culture

LearnedLearned

SharedShared

AdaptedAdapted

DynamicDynamic



EthnicityEthnicity

Describes a group united by Describes a group united by Common geographic originCommon geographic origin

Migratory statusMigratory status

ReligionReligion

RaceRace

LanguageLanguage

Shared values, traditions, or symbolsShared values, traditions, or symbols

Food preferencesFood preferences



ReligionReligion

The belief in a divine or superhuman power or The belief in a divine or superhuman power or powers to be obeyed and worshipped as powers to be obeyed and worshipped as creator/ruler of the universecreator/ruler of the universe

A system of beliefs, practices, and ethical A system of beliefs, practices, and ethical valuesvalues

A shared experience of spiritualityA shared experience of spirituality



Health-Related Behaviors Health-Related Behaviors Affected by ReligionAffected by Religion

MeditatingMeditating

Exercising/physical fitnessExercising/physical fitness

Sleep habitsSleep habits

VaccinationsVaccinations

Willingness to undergo physical examinationWillingness to undergo physical examination

PilgrimagePilgrimage

Truthfulness about how you feelTruthfulness about how you feel



Health-Related Behaviors Health-Related Behaviors Affected by Religion (cont.)Affected by Religion (cont.)

Maintenance of family viabilityMaintenance of family viability

Hoping for recoveryHoping for recovery

Coping with stressCoping with stress

Genetic screening and counselingGenetic screening and counseling

Living with a disabilityLiving with a disability

Caring for childrenCaring for children



SocializationSocialization

The process of being raised within a culture The process of being raised within a culture and acquiring the characteristics of that and acquiring the characteristics of that group.group.



Related TermsRelated Terms

AcculturationAcculturation——the process of adapting to the process of adapting to acquiring another cultureacquiring another culture

AssimilationAssimilation——the process by which a person the process by which a person develops a new cultural identity and becomes develops a new cultural identity and becomes like the members of the dominant culturelike the members of the dominant culture



Time OrientationTime Orientation

Focus on the pastFocus on the past

Focus on the presentFocus on the present

Focus on the futureFocus on the future


Heritage AssessmentHeritage Assessment



Indicators of Heritage Indicators of Heritage ConsistencyConsistency

Childhood in country of origin or immigrant Childhood in country of origin or immigrant neighborhood of like ethnic groupneighborhood of like ethnic group

Extended family support of traditional activitiesExtended family support of traditional activities

Frequent visits to the old country or old neighborhoodFrequent visits to the old country or old neighborhood

Family home is within the ethnic community to which Family home is within the ethnic community to which he or she belongshe or she belongs

Participation in ethnic cultural eventsParticipation in ethnic cultural events

Raised in an extended family settingRaised in an extended family setting



Indicators of Heritage Indicators of Heritage Consistency (cont.)Consistency (cont.)

Regular contact with the extended familyRegular contact with the extended family

Name not anglicizedName not anglicized

Educated in a parochial schoolEducated in a parochial school

Social activities primarily with other members of the Social activities primarily with other members of the ethnic communityethnic community

Knowledge of language and culture of originKnowledge of language and culture of origin

Expresses pride in heritageExpresses pride in heritage



Differing views of the same Differing views of the same disease: Epilepsydisease: Epilepsy

Uganda: contagious, untreatableUganda: contagious, untreatable

Greece: source of family shameGreece: source of family shame

Mexican-American community: evidence of Mexican-American community: evidence of physical imbalancephysical imbalance

Hutterites: having endured a trial by GodHutterites: having endured a trial by God



Developmental CareDevelopmental Care

Culture affects the choices parents make for Culture affects the choices parents make for children regardingchildren regarding The presumed cause of an illnessThe presumed cause of an illness

The first treatment triedThe first treatment tried

The acceptability of treatments offered by cliniciansThe acceptability of treatments offered by clinicians

For older patients, culture is likely toFor older patients, culture is likely to Define their family responsibilitiesDefine their family responsibilities

Affect their knowledge of the systems used by the Affect their knowledge of the systems used by the dominant culturedominant culture


Theories of CausationTheories of Causation



BiomedicalBiomedical

Assumes cause and effectAssumes cause and effect

Views the body as a machineViews the body as a machine

Life can be divided into partsLife can be divided into parts

Endorses germ theoryEndorses germ theory



NaturalisticNaturalistic

Forces of nature must be kept in balanceForces of nature must be kept in balance

Embraces the idea of opposing categories Embraces the idea of opposing categories or forcesor forces Yin/YangYin/Yang

Hot/ColdHot/Cold



MagicoreligiousMagicoreligious

Supernatural powers predominate in the area Supernatural powers predominate in the area of health and illnessof health and illness

Examples include voodoo, witchcraft, and Examples include voodoo, witchcraft, and faith healingfaith healing



Folk HealersFolk Healers

Hispanic: curandero, espiritualista, yerbo, or Hispanic: curandero, espiritualista, yerbo, or sabedorsabedor

Black: hougan, spiritualist, old ladyBlack: hougan, spiritualist, old lady

American Indian: shaman, medicine woman, American Indian: shaman, medicine woman, medicine manmedicine man

Asian: herbalists, acupuncturists, bone Asian: herbalists, acupuncturists, bone setterssetters

Amish: braucherAmish: braucher



Steps to Cultural CompetenceSteps to Cultural Competence

Understanding one’s own heritage-based cultural Understanding one’s own heritage-based cultural values, beliefs, attitudes, and practicesvalues, beliefs, attitudes, and practices

Identifying meaning of “health” to the patientIdentifying meaning of “health” to the patient

Understanding how the health care system worksUnderstanding how the health care system works

Acquiring knowledge about the social Acquiring knowledge about the social backgrounds of one’s patientsbackgrounds of one’s patients

Becoming familiar with the languages, Becoming familiar with the languages, interpretive services, and community resources interpretive services, and community resources used by (and available to) your patients and used by (and available to) your patients and yourselfyourself



R.E.S.P.E.C.T.R.E.S.P.E.C.T.

R = Realize that you must R = Realize that you must know the heritage of yourself know the heritage of yourself and your patient.and your patient.

E = Examine the patient E = Examine the patient within the cultural context.within the cultural context.

S = Select questions that are S = Select questions that are simple and speak them simple and speak them slowly.slowly.

P = Pace questioning P = Pace questioning throughout the exam.throughout the exam.

E = Encourage patient to E = Encourage patient to discuss meaning of health discuss meaning of health and illness with you.and illness with you.

C = Check patient’s C = Check patient’s understanding and understanding and acceptance of acceptance of recommendations.recommendations.

T = Touch the patient within T = Touch the patient within the boundaries of his or her the boundaries of his or her heritage.heritage.



In the current health care environment, what In the current health care environment, what is the most important influence on the is the most important influence on the

success of an interaction?success of an interaction?

A.A. The patient’s awareness of the nurse’s The patient’s awareness of the nurse’s heritageheritage

B.B. The nurse’ awareness of the patient’s heritageThe nurse’ awareness of the patient’s heritage

C.C. The degree to which the patient and nurse The degree to which the patient and nurse share heritageshare heritage

D.D. The patient’s willingness to assimilate into the The patient’s willingness to assimilate into the dominant culturedominant culture



At the ends of the Heritage Consistency At the ends of the Heritage Consistency Continuum are the termsContinuum are the terms

A.A. Traditional and modernTraditional and modern

B.B. Traditional and progressiveTraditional and progressive

C.C. Bound and modernBound and modern

D.D. Bound and progressiveBound and progressive

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