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Cultural Competency and Healthcare

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Brittany Stroud

on 18 February 2013

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Transcript of Cultural Competency and Healthcare

photo credit Nasa / Goddard Space Flight Center / Reto Stöckli Ashley Jones, Emily Hicks, David Cox, Brittany Stroud Cultural Competency In Healthcare What Is Cultural Competency? Richmond, Va Statistics African Americans Asian LGBT Caucasian The health status of white people is often used as the “baseline” on which other racial and ethnic groups are measured (CDC, 2012). Hispanic General Guidelines INTERPRETERS
Interpreters should not be a member of the patient's family
Look at the patient when asking questions
Same-sex interpreters
If possible, get "in-person" interpretation “Cultural competence includes the ability to work effectively across cultures in a way that acknowledges and respects the culture of another person” (Wilson, 2011) Population by culture in Richmond, Va

African American: 106,192

White: 91,905

Hispanic: 13, 038

Asian: 5,876

Lesbian/Gay/Transgender:
1.Likely homosexual households in Richmond, VA (counted as self-reported same-sex unmarried-partner households) (Citydata.com, 2012)
2.Lesbian couples: 0.3% of all households
3.Gay men: 0.4% of all households4.“It is estimated that 3.5% of Americans identify as gay, lesbian, or bisexual, while 0.3% are transgender (The Joint Commission, 2012).” Health Disparities History: African American Distrust in Healthcare What You Can do as a Healthcare Provider! 1) Aknowledge the uniqueness and historical oppression of the African American race

2) Establish trust and be respectful

3)Optimize the positive influences of religion while minimizing the negative ones

4) Understand African American food preferences

5) Use touch when appropritate

6) Involve the patients family into the plan of care

7) Ask how African Americans wish to be addressed

8)Have some basic knowledge of biologic and drug metabolism differences Health Disparities of the Hispanic Community Low income and education Cultural Values/Preferences Respect, patience, understanding, and kindness
Family
Trust
Faith (Catholic) How to Care for a Hispanic Patient 1) Address patient formally
2) Sit close to the patient
3) Use indirect eye contact
-Direct eye contact may be intimidating
4) Avoid exposure to extreme temperatures
5) Provide patient education in Spanish
6) Use professional interpreters
-Same sex as patient to avoid anxiety about embarrassing topics
7) Use the words "death" and "dying" at end of life
-Hispanic patients may not be familiar with commonly used
phrases like "passing on" and they do not translate well Obesity Cancer AIDS Diabetes Mellitus Hypertension Infant Mortality lack of insurance low income / poverty Language barriers may lead to excessive ordering of medical tests to determine diagnoses, misunderstanding of provider’s intentions and instructions, lack of understanding of medication use (Escarce, J. & Kapur, K., 2006). Inadequate, unhealthy housing Obesity High uninsured rates High rates of HIV positive Establish relationship with provider
Bilingual provider when embarrassing topic
Folk healing as first line treatment (hot/cold)
End of life care BE KNOWLEDGEABLE
Do research
Be aware of different cultural values
Be open minded
If you do not know preferences, ASK! Health Disparities Social/Legal Discrimination Environmental Issues Mental Health Housing Chronic Illness Healthcare Services High risk behaviors Cultural Values/Preferences Absence of judgment
Honesty
Respect
Privacy -Frankness - develop rapport with patient
-Use preferred name and pronouns when addressing the patient How to Care for LGBT patients Understand your own attitudes and beliefs
Be honest
Ask questions
Educate yourself about key issues involving LGBT
Additional screening may be required
Work with your setting to create non-biased forms
Use appropriate language
Realize the Importance of Life Planning

The National Gay and Lesbian Taskforce (NGLTF) 88.4 percent of nurses in the healthcare field are white (Berman, Snyder, Kozier, & Erb, 2008, p. 313) There is a sharp division between the care of white Americans and minority Americans (The Commonwealth Fund, 2008). Health disparities Heart Disease Obesity Mental Health Disorders Cultural Values/Preferences Caucasian men are taught to be "tough" - Do not seek healthcare until condition is BAD Death-denying I-centered Individualistic
Competitive
Equal rights of genders
Self-reliance
Technology-dependent
Independence and freedom
Materialistic
Youth and beauty valued Active partipant in care
Eye contact
Honesty Case Study The nurse was reviewing the chart of an 18-year old patient named George Walsh. The chart notes state that George is undergoing a sex-change from male to female. This morning, George walked into the clinic for a routine physical for
admission to college. The nurse noticed that George has shoulder-length hair and is wearing dangling earrings with eye-shadow. George speaks in a high voice and is wearing high-heels. The nurse prepares the patient for the clinic visit. 1.What is the first thing the nurse should ask
when beginning the visit? a.Good morning, how would you like to be addressed?

b.How’s it going today George?

c.Tell me why you are here Mr. Walsh.

d.What are you wearing? Correct Answer: A 2.The patient asks to be addressed as “Gigi”.
The nurse continues with Gigi’s interview and reason for visit. In completing the patient’s history,
the nurse asks about sexual activity.
What is the best way for the nurse to
ask about this topic? a.Who have you had sex with?

b.Are you sexually active? If so, can you tell me about your recent partners?

c.When’s the last time you had sex?

d.Do you have sex? Correct Answer: B 3.After finishing Gigi’s interview and history,
the nurse feels nervous about asking the patient
to undress, not knowing preferences of the patient.
What step can the nurse take to
facilitate communication? a.Ask Gigi if shorts are ok

b.Don’t address it and have the physician deal with the clothing

c.Ask Gigi, “I would like you to get undressed for the exam, do you prefer shorts or a gown to put on over your undergarments?”

d.Put both shorts and gown on the patient table and exit the room Correct Answer: C 4.When Gigi is on the way out of the office,
the nurse realizes she forgot to educate
Gigi on regular screening.
The nurse catches up with Gigi and educates on the
appropriate topics for transgender patients.
What are important details to include in
education of a transgender patient? a.Information about transitioning successfully, including the management of side effects from hormones and surgical procedures

b.Lab test results, as the patient may be anemic

c.Watching height and weight because obesity is a significant risk with sex change

d.Regular visits to the healthcare provider may be necessary to manage diet Correct Answer: A ...MOST IMPORTANTLY, NEVER ASK
HOW LONG HAVE YOU KNOWN! Health Disparities Cultural Preferences Treatment steps

1.Try family remedies first: Cupping, coining, pinching techniques.

2.Shamans, monks, traditional healers or faith healers are second to be consulted. The are perceived as better because they know the culture and have the skills to heal

3.Mainstream health providers last resort. Believed to be less credible and effective. Cultural mismatch present. Gender Discrimination Mental Health Cervical Cancer and HPV Review Questions 1.You are assessing a Hispanic woman in the mother-infant care setting. You want to respect the preferences and values of the patient by practicing cultural competence. The new nurse on the unit asks you what cultural competence is. You reply, “Cultural competence is:

a.Using cultural assessment tools”

b.Being aware of how culture affects health care”

c.Knowing everything about all of the cultures in the world”

d.The ability to work effectively across cultures in a way that acknowledges and respects the culture of another person” Correct Answer: D 2.Why is cultural competency important to practice in healthcare, especially in the Richmond, VA area?

a.Because the population of Richmond, VA is very diverse and includes multiple different cultures with different values and preferences

b.Because of the amount of teen mothers in the area

c.Because the LGBT community needs help getting access to health care and realizing what gender they are

d.Because the nurses in the hospital currently are not competent and need to be replaced 3.What is a historical reason that African Americans distrust healthcare workers and the healthcare system?

a.The Health Disparities Act

b.Poor access to care and lack of education

c.The Tuskegee Syphilis Study

d.The Cancer Control Study Correct Answer: C 4.What is one way to be culturally competent in everyday healthcare with patients?

a.Ask their family to tell you in English what they need

b.Look up what they need in a medical textbook

c.Show the patient pictures and have them point to what they need

d.Use an interpreter other than a family member to find out exactly what the patient needs Correct Answer: D Cultural Competency - Definitions to know! 1) Cultural knowledge – knowing worldviews and frameworks (Campinha-Bacote,
2011)
2) Cultural awareness – being aware of one’s own culture/values and how they affect
health care (Starr & Wallace, 2011)
3) Cultural sensitivity – recognition of one’s own personal attitudes/values and other’s attitudes/values that reflect cultural backgrounds (Starr & Wallace, 2011)
4) Cultural skill – cultural assessment tools (Campinha-Bacote, 2011)
5) Cultural encounters – exposure and practice in care of patients with different cultural
values (Campinha-Bacote, 2011)
6) Health Equity – “The state of a populations health that occurs when no inequalities
exist in access to and receipt of health information, prevention, and treatment services,
and end of life care” (Wilson, 2011). Why is it important for you to know.....? 1) The Healthy People 2020 goals for promoting health and preventing disease are specifically aimed at narrowing the gap in health disparities (Wilson, 2011)

2) When cultural beliefs and practices are not accessed and taken into consideration by the healthcare providers, delivery of care may be inappropriate (Wilson, 2011)

3) Understanding culture helps eliminate the gap between inadequate and holistic care(Wilson, 2011)

4) New policies such as The Patient Protection and Affordable Care Act, signed into law in March of 2010, has the goal of reducing health disparities through making the healthcare system more accessible for most Americans by the year 2014 (Wilson, 2011). Correct Answer: A The End Questions? Substance Abuse Diabetes Hepatitis B Cultural Values Cultural Myth
Family
Spiritual Mixed Views towards U.S Health Professionals.
Positive

Negative Implications For Culturally Competent Care of the Asian Patient
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