Cultural Competence: Cultural Care

1. Cultural Competence: Cultural Care Chapter 3

2. Objectives • Discuss the demographic profile of the United States. • Describe the National Standards for Culturally and Linguistically Appropriate Services. • Discuss the background of the Heritage Assessment. • Describe the methods for conducting the Heritage Assessment. • Provide examples of traditional health and illness beliefs and practices. • Discuss the steps to cultural competence.

3. Health: • “The balance of the person, both within one’s being—physical, mental and/or spiritual—and in the outside world—natural, communal, and/or metaphysical, is a complex, interrelated phenomenon (Spector, 2004)

4. Illness: • The loss of the person’s balance, within one’s being—physical, mental and/or spiritual—and in the outside world—natural, communal, and/or metaphysical.

5. Demographic Profile of the United States • Total population passed 300 million in the autumn of 2006. • 1 out of 3 US residents was in a group other than single-race non-Hispanic white. • “Minority” or “emerging majority” population totaled 98 million people. • Hispanics largest and fastest growing group. • Second largest population is blacks. • Followed by Asians, American Indians and Alaska Natives, Native Hawaiians and other Pacific Islanders.

6. In comparison to the population as a whole: • Emerging majority groups tend to be younger, with lower median ages and higher proportions of the population under the age of 18 years. • The non-Hispanic, single-race, white population has an older median age and a smaller proportion of the population under the age of 18 years.

7. There is— • One birth every 8 seconds • One death every 13 seconds • One international migrant (net) every 30 seconds • Therefore our country gains one person every 11 seconds

8. Categories of interest to health care providers • Legal permanent residents • Naturalized citizens • Undocumented aliens • Refugees, asylees, and parolees • Legal nonimmigrant residents

9. National Standards for Culturally and Linguistically Appropriate Services in Health Care

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

11. Linguistic Competence • Title VI of the Civil Rights Act of 1964: Services cannot be denied to people of limited English proficiency. • According to the 2000 census, 47 million Americans over 5 years of age speak a language other than English in their homes. • This represented an increase of 15 million people over the numbers documented by the 1990 census. • Certain states require that providers offer language assistance in health care settings: California, Massachusetts, and New York.

12. Cultural Competence • Culturally sensitive • Culturally appropriate • Culturally competent

13. Culturally Sensitive • Possessing basic knowledge of and constructive attitudes toward diverse cultural populations

14. Culturally Appropriate • Applying underlying background knowledge necessary to provide the best possible health care

15. Culturally Competent • Understanding and attending to total context of patient’s situation including • Immigration status • Stress factors • Social factors • Cultural similarities and differences

16. Heritage

17. Heritage Consistency • The degree to which a person’s lifestyle reflects his or her traditional heritage

18. Heritage Consistency Continuum • Traditional: living within the norms of the traditional culture • Modern: acculturated to the norms of the dominant society

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

20. Characteristics of Culture • Learned • Shared • Adapted • Dynamic

21. Ethnicity • Describes a group united by • Common geographic origin • Migratory status • Religion • Race • Language • Shared values, traditions, or symbols • Food preferences

22. Religion • The belief in a divine or superhuman power or powers to be obeyed and worshipped as creator/ruler of the universe • A system of beliefs, practices, and ethical values • A shared experience of spirituality

23. Health-Related Behaviors Affected by Religion • Meditating • Exercising/physical fitness • Sleep habits • Vaccinations • Willingness to undergo physical examination • Pilgrimage • Truthfulness about how you feel

24. Health-Related Behaviors Affected by Religion (cont.) • Maintenance of family viability • Hoping for recovery • Coping with stress • Genetic screening and counseling • Living with a disability • Caring for children

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

26. Related Terms • Acculturation—the process of adapting to acquiring another culture • Assimilation—the process by which a person develops a new cultural identity and becomes like the members of the dominant culture

27. Time Orientation • Focus on the past • Focus on the present • Focus on the future

28. Heritage Assessment

29. Indicators of Heritage Consistency • Childhood in country of origin or immigrant neighborhood of like ethnic group • Extended family support of traditional activities • Frequent visits to the old country or old neighborhood • Family home is within the ethnic community to which he or she belongs • Participation in ethnic cultural events • Raised in an extended family setting

30. Indicators of Heritage Consistency (cont.) • Regular contact with the extended family • Name not anglicized • Educated in a parochial school • Social activities primarily with other members of the ethnic community • Knowledge of language and culture of origin • Expresses pride in heritage

31. Differing views of the same disease: Epilepsy • Uganda: contagious, untreatable • Greece: source of family shame • Mexican-American community: evidence of physical imbalance • Hutterites: having endured a trial by God

32. Developmental Care • Culture affects the choices parents make for children regarding • The presumed cause of an illness • The first treatment tried • The acceptability of treatments offered by clinicians • For older patients, culture is likely to • Define their family responsibilities • Affect their knowledge of the systems used by the dominant culture

33. Theories of Causation

34. Biomedical • Assumes cause and effect • Views the body as a machine • Life can be divided into parts • Endorses germ theory

35. Naturalistic • Forces of nature must be kept in balance • Embraces the idea of opposing categories or forces • Yin/Yang • Hot/Cold

36. Magicoreligious • Supernatural powers predominate in the area of health and illness • Examples include voodoo, witchcraft, and faith healing

37. Folk Healers • Hispanic: curandero, espiritualista, yerbo, or sabedor • Black: hougan, spiritualist, old lady • American Indian: shaman, medicine woman, medicine man • Asian: herbalists, acupuncturists, bone setters • Amish: braucher

38. Steps to Cultural Competence • Understanding one’s own heritage-based cultural values, beliefs, attitudes, and practices • Identifying meaning of “health” to the patient • Understanding how the health care system works • Acquiring knowledge about the social backgrounds of one’s patients • Becoming familiar with the languages, interpretive services, and community resources used by (and available to) your patients and yourself

39. R = Realize that you must know the heritage of yourself and your patient. E = Examine the patient within the cultural context. S = Select questions that are simple and speak them slowly. P = Pace questioning throughout the exam. E = Encourage patient to discuss meaning of health and illness with you. C = Check patient’s understanding and acceptance of recommendations. T = Touch the patient within the boundaries of his or her heritage. R.E.S.P.E.C.T.

40. In the current health care environment, what is the most important influence on the success of an interaction? • The patient’s awareness of the nurse’s heritage • The nurse’ awareness of the patient’s heritage • The degree to which the patient and nurse share heritage • The patient’s willingness to assimilate into the dominant culture

41. At the ends of the Heritage Consistency Continuum are the terms • Traditional and modern • Traditional and progressive • Bound and modern • Bound and progressive