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Failure to respond to the health care needs and preferences of culturally and linguistically diverse individuals may:

Increase barriers to equitable access to care
Inhibit effective communication in patient/nurse relationship
Create obstacles in gathering assessment data, limiting the development and implementation of effective treatment plans.


Cultural Competence is guided by four principles

1. Care is designed for the specific patient.

2.Care is based on the uniqueness of the patient’s culture and includes cultural norms and values. ****

3.Care includes self-empowerment strategies to facilitate patient decision making in health behavior.

4. Care is provided with sensitivity and is based on the cultural uniqueness of the patient.


Cultural Skill?

Nursing ability to effectively integrate cultural awareness and cultural knowledge when conducting a cultural assessment.

Use the findings to meet those needs of culturally diverse patients.


Cultural desire?

The nurses’ intrinsic motivation to want to engage in the four constructs necessary to provide culturally competent care.


Cultural conflict?

A perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual’s cultural practice because of unfamiliarity with the practice.


Guide to Working Effectively 
with Immigrants in the community?

1. first know yourself
2. get to know the families and their health behaviors
3. learn about the communities that interact with your clinical setting.
4. Get to know some of the traditional practices and remedies used by families and communities.
5. Learn how a community deals with common illnesses or other health events.
6. Imagine the view point of the patient, family and the community.


What are the two phases of the cultural nursing assessment?

two phases.

1. data collection
2. organization


What factors affect health literacy with

" Numeracy skills"

-Measuring medications
-Calculating blood glucose
-Understanding nutrition labels


What factors affect health literacy with

" Health Knowledge and information"

Limited or inaccurate knowledge regarding information about the body and nature and cause of disease

Lack of knowledge between lifestyle factors (such as diet and exercise) and health outcomes


Why is health literacy important ?** on test

One of the strongest predictors of health status

Stronger predictor of an individual’s health status than income, employment status, education level, and ethnicity

*Note: Education is a poor surrogate for health literacy


Red flags for low literacy?

-Frequently missed appointments
-Incomplete registration forms
-Non-compliance with medication
-Unable to name medications, explain -purpose or dosing
-Identifies pills by looking at them,
-but not reading labelIdentifies pills by looking at them, but not reading label
-Unable to give coherent, sequential history
-Ask fewer questions
-Lack of follow-through on tests or referrals

-Will read it “later”
-Forgot “my glasses”
-Holds material upside down


Who is at risk for health literacy?

Older adults

Lower income levels

Lack of high school diploma or GED

Minority ethnic groups

Non-English speaking immigrants

*HL not equal to years of education


What is the universal approach to health literacy?

Structuring the delivery of care as if everyone may have limited health literacy

You cannot tell by looking
Higher literacy skills ≠ understanding
Anxiety can reduce ability to manage health information
Everyone benefits from clear communications


How do you improve the usability of health information?

Recommended reading level: 5th to 6th grade
Average reading level is 8th grade (USA Today)
Above 8th grade level is difficult for most of population

Use graphics & pictures

Avoid jargon
“Chest pain” vs. “angina”
“Keep bones strong” vs. “prevents osteoporosis”

Follow KISS Principle
Keep it short and simple
Emphasis desired behavior not medical facts
Emphasize 1-3 key points
Use 1-2 syllable words

Use bullets vs. paragraphs

Have plenty of white space

Reflect audience’s age, language, cultural norms, literacy skills
Check translation


7 tips for clinicians

Use plain language

Limit information (3-5 key points)

Be specific and concrete, not general

Demonstrate, draw pictures, use models


Teach-Back (confirm understanding)

Be positive, hopeful, empowering