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Cultural Competence in the Care of Childbearing Families

Cultural Competence in the Care of Childbearing Families. Mary Lou Moore, PhD, RNC, FAACE, FAAN Merry-K. Moos, BSN, FNP, MPH. Immigration to the U.S. 1 million immigrants come to the U.S. each year (U.S. INS, 1991) . More than half are women of childbearing age (U.S. INS, 1991) .

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Cultural Competence in the Care of Childbearing Families

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  1. Cultural Competence in the Care of Childbearing Families Mary Lou Moore, PhD, RNC, FAACE, FAAN Merry-K. Moos, BSN, FNP, MPH

  2. Immigration to the U.S. • 1 million immigrants come to the U.S. each year (U.S. INS, 1991). • More than half are women of childbearing age (U.S. INS, 1991). • 1 in every 10 persons in the United States is foreign-born (National Center for Cultural Competence, 1999).

  3. African American Indian/ Asian/Pacific American--12.1% Alaska Native Islander Hispanic--11.5% Hispanic Asian/Pacific Islander--3.8% Non- African Hispanic American American white Indian/Alaska Native--0.7% Non-Hispanic (Population Estimates and Projections, 2000) White--71.9% U.S. Population

  4. What is Cultural Competence? • Providing services, supports and assistance: • That are responsive to beliefs, interpersonal styles, attitudes, language and behaviors of individuals with the greatest likelihood of ensuring maximum acceptance and participation • That demonstrate respect for individual dignity, personal preference and cultural differences (Developmental Disabilities and Bill of Rights Act of 2000)

  5. Importance of Cultural Competence • U.S. demographics are changing. • Health disparities exist between ethnic groups in the United States. • Regulatory mandates require increased, documented cultural competence. • Cultural competence enriches professional nursing practice.

  6. What is Culture? • Culture is a distinct way of life that characterizes a particular community of people. • Culture includes shared practices, beliefs, values and customs passed through generations. • Culture provides a sense of identity • (“I belong”).

  7. Dimensions of Culture • Values • World view • Disease etiology • Time orientation • Personal space • Family organization • Power structure

  8. Acculturation • Integration into mainstream culture • Affected by age at time of arrival in a new setting, reason for moving to a new setting and residence in a predominantly ethnic neighborhood • Generally takes three generations in the United States (Spector, 2000)

  9. Ethnocentrism • Ethnocentrism is the belief that one’s own culture is best. • Providers must be mindful of their own ethnocentrism.

  10. Cultural Perspectives • Emic perspective–Of an insider or member of the culture • Etic perspective–Of an outsider or observer of the culture

  11. Cultural Traditions • A functional tradition enhances an individual’s health and well-being. • A neutral tradition neither enhances nor harms an individual’s health and well-being. • A non-functional tradition is potentially harmful to an individual.

  12. Cultural Characteristics • Individual vs. group identity • Decision-making • Eye contact • Being polite • Family • Hot and cold • Small talk

  13. Cultural Characteristics (Continued) • Evil spirits • Father’s participation at birth • Male health care providers • Pregnancy as a healthy, natural state

  14. Food Guide Pyramid From USDA & DHHS, 2002

  15. Populations and Conditions • African American–Sickle cell disease • Amish–PKU, hemophilia B • Greek–Thalassemia • Jewish–Tay-sachs, Gaucher’s disease • Native American–Type 2 diabetes mellitus • Note: Conditions not limited to a single population group.

  16. Ways to Relate to Other Cultures • Common practices • Avoiding people from other cultures • Refusing to recognize cultural differences • Recognizing differences, but feeling own way is superior (ethnocentrism) • Best practice • Acknowledging and seeking to understand cultural differences

  17. Where were you born? How long have you lived in the United States? Who are your major support people? What languages do you speak and read? What are your religious practices? What are your food preferences? What is your economic situation? Cultural Assessment

  18. What does childbearing represent to you? How do you view childbearing? Are there any maternal precautions or restrictions? Is birth a private or social experience? How would you like to manage labor pain? Who will provide labor support? Who will care for the baby? Do you use contraception? Childbearing Assessment

  19. Assessment Techniques • Use a conversational approach. • Ask open-ended questions. • Integrate cultural and childbearing assessments. • Listen with interest. • Remain nonjudgmental.

  20. Interpreters and Translators • Interpreters communicate verbally. • Should be female • Should not be a family member • Translators work with written • communication.

  21. Expectations for Interpreters • Maintain strict confidentiality. • Interpret everything the woman says without editorializing or paraphrasing. • Either party may interrupt or seek additional information.

  22. Ethical Issues • Group needs vs. individual needs • Refusal of treatment • Informed consent • Truthfulness • Morality

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