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1

Cultural Competence

is the ability to apply knowledge and skills need to provide high quality, evidence based practice care to clients of diverse backgrounds and beliefs to overcome barriers and access resources promoting health and wellness

2

Basic characteristics of cultural competence

-valuing diversity
-capacity for cultural self-assessment
-awareness of different dynamics present when cultures interact
-knowledge about different cultures
-adaptability in providing nursing care that reflects an understanding of cultural diversity

3

AACN's 5 competencies for providing culturally competent care

1. apply knowledge of social and cultural factors that affect nursing and health care across multiple contexts
2. use relevant data sources and best evidence
3. promote achievement of safe and quality outcomes of care for diverse populations
4. advocate for social justice
5. participate in continuous cultural competence development

4

LEARN Model (American Medical Student Association)

-Used as a tool for developing cultural competency
-LISTEN to the client's perception of the problem
-EXPLAIN your perception of the problem and of the treatment ordered by the physicians
-ACKNOWLEDGE and discuss the differences/similarities between both perceptions
-REVIEW ordered treatments while remembering the client's cultural parameters
-NEGOTIATE agreement. Assist the client in understanding the medical treatments ordered by the physician and have the client help make decisions about those treatments as appropriate

5

Purnell's model of cultural competence

-identifies how individuals, families, communities, and the global society all possess 12 domains of culture:

-overview, inhabited localities, topography
-communication
-family roles/organization
-workforce issues
-biocultural ecology
-high risk behaviors
-nutrition
-pregnancy/childbearing practices
-death rituals
-spirituality
-healthcare practices
-healthcare practitioners

6

Prejudices

prejudgments about cultural groups or vulnerable populations that are unfavorable or false because they have been formed without background knowledge and context upon which to form an accurate opinion

7

Using an interpreter

-many clients do not speak english
-having bilingual nurses available is one strategy to a address the language barrier
-when possible, use an interpreter to translate and provide meaning behind the words
-avoid using a family member as an interpreter
-if possible, use an interpreter of the same gender as the client
-avoid medical jargon
-address your questions to the client, not the interpreter
-as one short question at a time
-speak slowly and distinctly, but not loudly
-provide written materials in the client's language if possible

8

Terms and Language: Culturally sensitive

-possession of basic knowledge
-constructive attitudes towards diversity

9

Terms and Language: Culturally appropriate

-application of underlying background knowledge
-knowledge must be possessed to provide best care

10

Terms and Language: Culturally competent

attend the total context of the individuals situation

11

Terms and Language: Discrimination

restriction of justice, rights, privileges when dominant groups reinforce rules that limit opportunities for others

12

Terms and Language: Minority

individuals or group who are outside of dominant group

13

Terms and Language: Multiculturalism

many subcultures coexisting within a given society

14

Terms and Language: ethnic groups

individuals with common characteristics (nationality, language)

15

Terms and Language: Enculturation

cultural transmission from adults to children

16

Terms and Language: Assimilation

adapting to and integrating characteristics of dominant culture

17

Terms and Language: Acculturation

accepting the majority group's culture as ones own

18

Terms and Language: biculturalism

dual pattern of identification (take what you consider the best of both cultures)

19

How do we, as future nurses, become culturally competent?

-Develop cultural humility
-Recognize your own biases (first, know thyself!)
-Value diversity
-Become knowledgeable about different cultures
-Acknowledge differences without stereotyping
-Be culturally sensitive
-Apply your knowledge
-Improve communication
-Access resources which promote health and wellness

20

12 Standards for culturally competent nursing care

-Social Justice
-Critical Reflection
-Knowledge of cultures
-Culturally competent practice
-Cultural competence in health care systems and organizations
-Client advocacy and empowerment
-Multicultural Workforce
-Education and training in culturally competent care
-Cross-cultural Communication
-Cross-cultural Leadership
-Policy Development
-Evidence-based practice and research

21

Complementary therapies

refers to any of a diverse array of practices, therapies, and supplements that are not considered part of conventional or traditional medicine

-used in addition to conventional medicine

22

Alternative therapies

use of these diverse therapies instead of conventional therapies

23

Touch

-americans can use touch during conversation between intimate partners or family members
-italian and latin americans can view frequent touch as a sign of cancer, interest, and warmth
-native americans view touch as a form of aggression

24

Vulnerable Populations

-Groups of people in our culture who are at greater risk for diseases and reduced lifespan due to lack of resources and exposure to more risk factors
-Clients from vulnerable populations are more likely to develop health problems because they have the greatest number if risk factors and the fewest options for managing those risk.

-likely to be older, living in poverty, homeless, in abusive relationships, mentally ill, chronically ill, or children

25

People may be made vulnerable by:

-Financial circumstance
-Place of residence
-Education
-Age
-Functional status
-Development status
-Inability to communicate
-Chronic or terminal illness
-Disability
-Sexual Orientation
-Immigration status
-Prisoners

26

Spirituality

the human experience that seeks to transcend self and find meaning and purpose through a connection with others, nature, and/or a Supreme Being

-also highly subjective

27

Religion

organized, communal approach to spirituality

28

Cues to spiritual or religious preference may be revealed by:

-environment, behavior, verbalization, affect and attitude, interpersonal relationships

29

Assessment of client

-Faith/beliefs
-Perception of life and self-responsibility
-Satisfaction with life
-Culture
-Fellowship and the client’s perceived place in the community
-Rituals and practices
-Incorporation of spirituality within profession or workplace
-Client expectations for health care in relation to spirituality (Traditional vs. Alternative paths, such as shamans, priests, prayer)

30

FICA is an acronym that can help a nurse to ask appropriate spirituality questions

F- Faith or beliefs
EX: What spiritual beliefs are most important to you?

I- Implications or influence
EX: How is your faith affecting the way you cope now?

C- Community
EX: Is there a group of like-minded believers with whom you regularly meet?

A- Address
EX: How would you like your health care team to support you spiritually?

31

Holy Days

-days set aside for religious observances
-may require fasting, extended prayer
-sabbath
-high holy day

32

Spiritual Rituals

holy days, birth rituals, prayer, death rituals, dietary rituals

33

Birth Rituals: Buddhism

-Can refuse on holy days
-Can refuse analgesics or strong sedatives

34

Birth Rituals: Christianity

some baptize infants at birth

35

Birth Rituals: Hinduism

-do not prolong life
-personal hygiene and cleanliness are valued

36

Birth Rituals: Islam

-Women must be cared for by female providers, especially during childbirth
-Women often must wear head and/or body covering when in the presence of males who are not immediate family
-Have strict rules regarding hand washing
-Must pray five times a day facing mecca

37

Rituals: Jehovah's witnesses

Might not accept blood transfusions, even in life threatening situations

38

Birth Rituals: Judaism

on the eighth day after birth, males are circumcised

39

Birth Rituals: mormonism

children are baptized at age 8 by immersion

40

Spiritual health

spiritual health or spiritual well-being is manifested by a feeling of being "generally alive, purposeful, and fulfilled"

41

Individuals nurture their spiritual health in many ways:

-development of inner self (inner dialogue with a higher power through prayer, meditation, etc...)
-focus on the outer world

42

Transcendent presence

-transcendence is the capacity to reach out beyond oneself, to extend oneself beyond personal concerns and to take on broader life perspectives, activities, and purposes
-involves an individual's recognition that there is something other or greater than self

43

Spiritually Appropriate Nursing Care

-assess the patient's spiritual needs
-support the patient's religious practices and consider how these practices may affect nursing care
-help the patient continue with spiritual practices
-assist patients with prayer
-religion and medical care

44

Religion and Medical Care: Judaism

-On 8th day after birth, males are circumcised
-some practice a kosher diet
-at death, someone stays with the body and a burial society prepares the body
-Bury dead ASAP (within 24 hours if possible)
-use all care necessary to extend life

45

Religion and Medical Care: Islam

-women must be cared for by female providers
-women often must wear head/body covering when in presence of males
-must pray 5 times a day facing Mecca
-clients avoid alcohol and pork
-clients can fast during ramadan
-dying body faces Mecca

46

Religion and Medical Care: Roman Catholicism

-generally participates in western medicine
-anointing of the Sick (last rites)
-fasting during lent

47

Religion and Medical Care: Christianity

-some baptize infants at birth
-some wish to receive the Holy Communion
-some give last rites

48

Religion and Medical Care: Hinduism

-do not prolong lie
-personal hygiene and cleanliness are valued
-some are vegetarians
-generally believe they have more than one life
-ceremonial rites for dying immediately after death

49

Religion and Medical Care: Buddhism

-generally prefer eastern medicine
-may use traditional therapies
-can refuse analgesics or strong sedatives
-some are vegetarian
-clients can request a priest to deliver last rites

50

Religion and Medical Care: Jehovah's Witness

-might not accept blood transfusions
-clients avoid foods having or prepared with blood

51

Religion and Medical Care: House of Yahweh

-kosher diet
-abstain from pork, shellfish, and blood
-ritual ablutions
-private/public/corporate prayer

52

Spiritual Distress

-refers to a challenge to one's spiritual well-being or to the belief system that provides strength, hope, and meaning to life

53

Factors that can contribute to spiritual distress: Physiological problems

-having a medical diagnosis of a terminal disease
-experiencing pain
-loss of body part/function
-miscarriage/stillbirth

54

Factors that can contribute to spiritual distress: Treatment related outcomes

-recommendation for blood transfusion
-abortion
-surgery
-dietary restrictions

55

Factors that can contribute to spiritual distress: Situational concerns

-death or illness of significant other
-inability to practice one's spiritual rituals
-feelings of embarrassment when performing spiritual rituals

56

Interdisciplinary Teams

-Nurses are an integral member of the inter professional team
-Interprofessional Personnel
-Health care provider, lab tech., OT, pharmacist, PT, radiologic tech, registered dietician, respiratory therapist, social worker, speech language pathologist, spiritual support staff

57

Interdisciplinary Teams: Health care provider

-Ex. medical doctors, physician assistant, advanced practice nurse
-Role: diagnose, assess, treat disease and injury
-When to contact: call provider about medication, change in condition

58

Interdisciplinary Teams: Laboratory Technician

-Role: obtain specimens of body fluids; preform diagnostic tests
-Ex. When provider needs a CBC immediately

59

Interdisciplinary Teams: Occupational Therapist

-Role: assist patient to regain activity of daily living, especially motor skills of the upper extremities
-Ex. helping a client relearn to use an eating utensil

60

Interdisciplinary Teams: Pharmacist

-Role: provides and monitors medication
-Ex. can help PT understand medications, can clarify questions

61

Interdisciplinary Teams: Physical therapist

-Role: rehabilitation that focuses on lower extremities
-Ex: helping client re-learn to walk

62

Interdisciplinary Teams: Radiologic Technologist

-Role: x-rays, imaging procedures
-Ex. helps client after fall to see if bones are broken

63

Interdisciplinary Teams: Registered Dietician

-Role: assess, plan for, and educate regarding nutritional needs; designs special diets; supervises meal preparation
-Ex: helps client diagnosed with diabetes

64

Interdisciplinary Teams: Respiratory therapist

-Role: breathing treatments; evaluates respiratory therapist
-Ex. a client who experiences shortness of breath and needs a nebulizer treatment

65

Interdisciplinary Teams: Social worker

help with after hospital care; helps with insurance; can take care of a family; can follow a family a year after a death

66

Interdisciplinary Teams: Speech Language Pathologist

Role: help with speech, language, and swallowing
Ex. Client has trouble swallowing after a trauma

67

Interdisciplinary Teams: Spiritual Support Staff

Role: provides spiritual care (pastor, rabbi, priest); gives emotional support
Ex. When patient asks for prayer or spiritual help

68

Various Definitions of Health: Nightingale

a state of being well and using every power the individual possesses to the fullest extent

69

Various Definitions of Health: WHO

a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity

70

Various Definitions of Health: ANA

dynamic state of being in which the developmental and behavioral potential of an individual is realized to the fullest extent possible

71

Wellness

a state of well-being

72

Basic aspects of wellness are

self responsibility, an ultimate goal, a dynamic growing process, daily decision making in the areas of nutrition, stress management, physical fitness, preventive health care, and emotional health, whole being of the individual

73

7 components of wellness

-the environmental component
-the occupational component
-the intellectual component
-the spiritual component
-the physical component
-the emotional component
-the social component

74

Illness

a highly personal state in which the individuals physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished

75

Acute illness

severe symptoms of relatively short duration

76

Chronic illness

lasts for an extended period of time, usually 6 months or longer; slow onset; periods of remission and exacerbation

77

Disease

an alteration in normal body functions that reduces the capacities or shortens the normal life span

78

Health Promotion: Healthy People emphasizes health promotion and disease prevention: 4 goals

-attain high quality, longer lives free of preventable disease, disability, injury, and premature death
-achieve health equity, eliminate disparities, and improve the health of all groups
-create social and physical environments that promote good health for all
-promote quality of life, healthy development, and healthy behaviors across all life stages

79

A variety of programs can be used to promote health

-information dissemination
-health risk appraisal and wellness assessment programs
-lifestyle and behavior change programs
-environmental control programs

80

Factors Affecting Health: external variables

individuals can usually control their health behaviors and can choose healthy or unhealthy activities

81

Factors Affecting Health: internal variables

individuals have little or no choice of their genetic makeup, age, sex, culture, and sometimes their geographic environment

82

Internal variables include:

biological dimension, psychological dimension, cognitive dimension

83

Physical fitness

is described as the ability to carry out daily tasks with vigor and alertness, without undue fatigue, and with ample energy to enjoy leisure time pursuits and respond to emergencies

84

Benefits of physical activity

-improved mood/health
-reduce risk of heart disease
-make bones and muscles strong
-reduce risk of some illnesses
-improving stability and reducing risk of falls in elderly

85

Physical activity

bodily movement produced by skeletal muscle contraction that increases energy expenditure

86

Types of exercise:

isotonic, isometric, isokinetic, aerobic, anaerobic

87

Types of exercise: Isotonic

-dynamic exercises
-muscle shortens to produce muscle contraction and active movement
-running, walking, swimming, cycling, ADLs
-increase muscle tone, mass, and strength and maintain joint flexibility

88

Types of exercise: Isometric

-static or setting exercises
-muscles contract without moving the joint (muscle length does not change)
-produce a mild increase in heart rate and cardiac output

89

Types of exercise: Isokinetic

-resistive exercises
-muscle contraction or tension against resistance (can be isotonic or isometric)
-individual moves (isotonic) or tenses (isometric) against resistance

90

Types of exercise: Aerobic

-amount of O2 taken into the body is greater than that used to perform the activity
-goal is to work up to and sustain a target heart rate
-talk test: should experience labored breathing but still be able to carry on conversation

91

Types of exercise: Anaerobic

-muscles cannot draw out enough O2 from bloodstream and anaerobic pathways are used to provide additional energy for a short time
-weight lifting, sprinting

92

Oral Health: Lifespan Considerations

-teeth usually appear 5-8 months after birth
-by age 2 usually have all temporary teeth (lost at age 6 or 7)
-by age 25, most individuals have all permanent teeth
-incidence of periodontal disease increases during pregnancy
-teeth turn yellowish as part of the aging process

93

Promote Oral Health Throughout Lifespan

-dental hygiene begins when first tooth erupts
-at 18 months, brush childs teeth with soft tooth brush (start with water and use toothpaste later)
-fluoride is very important for preschoolers and school age kids
-initial dental visit at age 2 or 3
-oral health problems are more prevalent in older adults but not caused by aging

94

Family

two or more individuals who are joined together by marriage, blood, or adoption, and are residing in the same household

95

Nuclear Family

two parents and their offspring

96

Plaque

invisible soft film that adheres to the enamel surface of teeth

97

Tartar

visible, hard deposit of plaque and dead bacteria that forms at gum lines

98

Gingivitis

red swollen gums

99

Pyorrhea

advanced periodontal disease, teeth are loose and pus is evident

100

Clients at risk for bad oral care/teeth problems

those that are depressed, illiterate, dehydrated, have NG tubes, are receiving O2

101

Extended family

relatives of nuclear family

102

two career family

both partners are employed

103

single parent family

usually experience higher rates of poverty

104

Binuclear family

post divorce family in which biological children are members of two nuclear households

105

Roles within a healthy, functional family unit

-caring, nurturing, educating children
-maintaining continuity of society by transmitting family's knowledge, customs, traditions, etc. to children
-receiving and giving love

106

Boundaries

Invisible lines that define the amount of contact allowable among family members and between the family and outside systems

-Clear: firm yet flexible
-Rigid: isolated from one another w/little room for negotiation
-Diffuse: everyone is in everyone's business

107

Parenting styles

Authoritarian- strict, what parent says goes, punishment often
Authoritative- preferred, set limits but are more democratic
Permissive-few controls or restraints on child behavior
Indifferent-do not display much interest in their kids

108

Factors that shape family development

-parent child interaction, family size, sibling relationship, boundaries, family cohesion, resiliency, family coping mechanisms, emotional availability, family flexibility, family communication patterns, parenting styles

109

Family Centered Care

partnership between nurses and families that consider the health of the family as a unit in addition to the health of individual family members

-always think of the patient and the patient's family
-it is a nurses job to help family get resources to help them cope with he stressors of another family member's illness or disease