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Culture and Cultural Competence

HLSC 112 Culture and Cultural Competence

on 21 October 2014

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Transcript of Culture and Cultural Competence

Culture and Cultural Competence
Culture/Language Influences
Health, healing, wellness belief systems
How illness, disease, and their causes perceived by patient/consumer and provider
Behaviors of patients/consumers seeking health care, their attitudes toward providers compromising access/care for those of other cultures
The Myth of Equity:
Fairness means equal treatment for all
The Myth of Sameness:

Shares client's ethnicity/language provide effective health care
The Myth That Cultural Differences Are a Problem:
Culture/diversity viewed as barriers to overcome
The Myth That Everything Must Be Acceptable:
Holds a cultural value must be accepted
The Myth That Generalizations Are Unacceptable:
Generalizations help, no stereotypes
The Myth That Familiarity Equals Competence:
Familiar with a culture doesn't make one competent
Originate from Haiti (Island between Cuba & Puerto Rico)
Haitian population in the U.S. is approximately 830,000 or 0.3% of population.
Six Reasons Culture Competence
1. Respond to the current and projected demographic changes in the United states
2. Eliminate long-standing disparities in the health status of people of diverse racial, ethnic, and cultural backgrounds
3. To improve the quality of services and health outcomes
4. To meet legislative, regulatory, and accreditation mandates
5. To gain a competitive edge in the market place
6. To decrease the likelihood of liability/malpractice claims

Helps in decreasing Health care differences
Eight Principles include:
Define culture broadly
Value clients' cultural beliefs
Recognize complexity in language interpretation
Facilitate learning between providers and communities
Involve the community in defining and addressing service needs
Collaborate with other agencies
Professionalize staff hiring and training
Institutionalize cultural competence
By: Inderpreet Bassi
Carissa Villatana
Morina Sysouvanh

A set of guidelines (both explicit or implicit) individuals use to view the world and tell them what behaviors are appropriate
Is shared, learned, dynamic, and evolutionary
Associated with race and ethnicity
Examples : culture of poverty, culture of cancer survivors, the culture of rurality, the culture of chronic illnesses
Myths of Culture/Diversity
Racial/Ethnicity Classification
Culture Awareness/Sensitivity
Cultural Awareness: appreciation of external signs of culture
Cultural Sensitivity: one's personal attitude towards others of different cultures
Began in 1950s with Madeline Leininger
Formal area of study/ practice focused on comparative human-caring differences
Similarities of beliefs, values, and patterned lifeways of cultures
Provides a culturally congruent, meaningful and beneficial health care to people
8 Factors Development Transcultural Nursing
Increase in immigration/migration
Expectations nurses/healthcare providers to provide appropriate care for diverse cultures
Increase use of technologies caring/curing with different responses/effects on diverse cultures
Increased signs of cultural conflicts, cultural clashes, cultural imposition practices between nurses and those from diverse cultures
Increase number of nurses who travel/work all over world
Legal defense suits against nurses resulting from cultural negligence, cultural ignorance, cultural imposition practices in working with diverse cultures
Rise in gender and issues and rights of special groups
Growing trend to care for people, whether well or ill, in their familiar or particular living and working environments
Worldwide organization for nurses/others interested in advancing Transcultural Nursing
Goals include
To advance cultural competencies for nurses worldwide
To advance the scholarship (substantive knowledge) of the discipline
To develop strategies for advocating social change for cultural competent care
To promote a sound financial non-profit corporation (www.tcns.org)
Health Disparities
Impact: Changing Demographics
Race, ethnicity, culture divide health/health care of population US
3 Common Themes:
Disparities common, big contributor-uninsurance
Disparities aren't decreasing
Some disparities require particular attention i.e. cancer, heart failure, pneumonia
Addressing Health Disparities:
Healthy People 2020: national document addresses health disparities
2 Main Goals used to define health disparities:
Achieve health equity, eliminate disparities, and improve the health of all groups
Promote quality of life, healthy development, and healthy behaviors across all life stages
Efforts to address disparities requires nurses to incorporate creative interventions culturally competent for these populations
American Indian or Alaska Native
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacfic Islander
2010 US Census approx.
US population racial/ethnic minorities
Discrepancies Western culture uses biomedical model diverse society
Mismatch with clients and health care needs/services

Examples of Different Cultures
Two distinct categories of Haitians
Mulatto (Color): Members of the upper class (mainly spoke French)
Lower class: Mostly black and spoke the Haitian Creole language (a combination language of multitribe slaves of Africa).
Today, Creole is the official language of Haiti (Colin & Paperwalla, 2008).
Haitian Men & Women
Men: Head of household
-Primary income provider
-Decision maker
-Sexual initiator

Women: Oversee the household
(Dash, 2001)

Haitian Characteristics
Openly demonstrative in their emotions
Typically speak loudly
Hold a close personal space, but may ignore teritorial space

(Colin & Paperwalla, 2008)
Diet & Lifestyle
Drinking alcohol and cigarette smoking is culturally approved
Diet high in carbohydrates and fat
Weight loss seen as a sign of illness
Haitian Superstitions
Fear of a loved one not actually dying, but becoming a zombie
Beliefs of Voodooism co-align with other religious beliefs
Illness can be perceived as punishment for being evil or occurring from spirits (Corrine, Bailey, Valentine, Mortantus, & Shirley, 1992)
Hispanic is a term commonly used in the United States to designate all those who speak spanish
Includes people from Puerto Rico, Cuba, Mexico, Latin America and other countries
Mexican Religious Beliefs
Believe in a divine power that has ultimate control of their lives and that one must accept what God gives (Berry, 2002, p.365)
Majority of Mexican Americans are Roman Catholics
Pictures and statues with a religious theme are evident in many of their homes
Mexican Families
Family is very important to Mexican Americans, they are mostly collectively oriented
The elderly are valued and respected, their knowledge about health information often takes precedence over that of professional healthcare providers (Berry, 2002)
Younger generations often have the obligation to care for the older generations
Family extends beyond immediate circle to include fictive kin or
compadres, friends who are chosen for special occasions (Berry, 2002)
Strong or aggressive masculine pride
Idea that Mexican men have strangth, valor, and self-confidence (Zoucha & Zamarripa, 2008)
Mexican culture typically view males as dominant and females as passive
Mexican Characteristics
Many are sensitive to confrontation and difference of opinion, and will shun all those challenges, especially in the workplace
Truth is often tempered with with diplomacy and tact (Zoucha & Zamarripa, 2008)
1. This is known as one's personal attitude towards others of different cultures:
a. Cultural Competency
b. Cultural Awareness

c. Cultural Sensitivity
d. Culture
2. Myths of Culture/Diversity include all of these except:
a. The Myth of Equity
b. The Myth of Sameness

c. The Myth that Cultural Differences are accepted
d. The Myth that Generalizations Are Unacceptable
3. Culture and Language Influences include all of these except:
a. Health, healing, wellness belief systems
b. How illness, disease, and their causes perceived by patient/ consume/provider

c. Environment and job you work at
d. Behaviors of patients./consumers seeking healthcare, their attitudes toward providers compromising access/care for those of other cultures
4. An example of a culture would include which one of these:
a. Culture of poverty
b. Culture of cancer survivors
c. Culture of rurality
d. Culture of Chronic illnesses

e. all of these
f. none of these
Larsen, D. Pamala., Lubkin, Morof. Ilene. Chronic Illness: Impact And Intervention Eighth Editon. (2013).

Berry, A.(2002). Culture care of the Mexican American family. In M. Leininger & M. R. McFarland (Eds.), Transcultural nursing: Concepts, theories, research and practice (3rd ed.,pp. 363-373). New York: McGraw Hill.

Colin, J.M., & Paperwalla, G. (2008). People of Haitian heritage. In L. Purnell & B Paulanka (Eds.), Transcultural health care: A culturally competent approach (3rd ed., pp. 231-247). Philadephia: F.A. Davis.
Education and physicians are highly valued in Japan
The illiteracy rate is only 1%
Nearly 95% of students in Japan complete the 12th grade, with calculus being part of the mandatory junior high school curriculum
Japanese Communication
Japanese culture is relatively non-eye contact
It's a non-touch culture; mostly between adults
Most ideal pattern of communication in Japanese society is silent communication
Japanese Fun Fact
Japanese immigrants are the only group to refer to themselves by the generation in which they were born: issei refers to first generation immigrants; nisei, to second generation immigrants; sansei, to third generation immigrants; yonsei, the fourth generation; gosei, the fifth generation; and rokusei, the sixth generation
Common Stereotypes
To categorize those from the Far East and Southeast Asia broadly as Asians, versus Japanese, Chinese, Korean, Malaysian, Vietnamese, Thai, and so forth
8. Which of the following is the most ideal pattern of communication in Japanese society?
A. Non-eye contact communication
B. Non-touch communication
C. Silent communication
D. Written communication

9. Culture of Poverty impacts which of the following?
A. cost of care, health literacy, and focus on surviving from one day to the next
B. The amount of travel in ones life
C. A decrease in chronic health issues such as substance abuse, smoking, and incarceration
CLAS Standards
In 2000, the U.S. Department of Heath and Human Services Office of Minority Health release 14 national standards for culturally and linguistically appropriate services (CLAS) as a means to address and correct inequities in the provision of health care to culturally and ethnically diverse groups.
10. How are the different cultures ( Haitian and Mexican) different in their views and the way they are viewed?
A. Haitians are referred to as Mulattos whereas Mexicans are referred to as Machismos
B. In both cultures, the women are more dominant and hold most of the authority
C. Haitians don't have too many superstitions whereas the Mexican society actively participates in voodooism
Nurses must be aware of various things such as: gestures, language, and body stance, etc.

Language barriers can effect the patient's health needs and treatment.

Nurses must give attention to all aspects if client care.
1.) Assess your personal beliefs surrounding persons from different cultures.

2.)Assess communication variables from a cultural perspective.

3.)Plan care based on the communicated needs and cultural background.

4.)Modify communication approaches to meet cultural needs.

5.)Understand that respect for the patient and communicated needs are central to the therapeutic relationship.
6.)Communicate in a nonthreatening manner.

7.)Use validating techniques.

8.)Be considerate and reluctant when the subject involves sexual matters.

9.)Adopt special approaches when the patient speaks a different language.

10.)Use interpreters to improve communication.
Can serve as a way to represent a world object, place, or concept.

Universal symbols on signs are rare.

Originated in Mexico City, and were used to identify destinations.

28 symbols developed, 17 understood by 87% of a study group of 300

Participants were from four different language groups: English, Spanish, Indo-European, and Asian.
Health Assessment
Health care professionals must understand certain cultural behaviors related to their physical assessment.
Professional Education
Education about different cultures is needed for cultural competency.

Some resources include
The National Technical Assistance Center at the University of Hawaii
The National Center for Cultural Competence at Georgetown University
The Commonwealth Fund
Measuring Cultural Competence from a Patient's Perspective
Five Components:

Patient- provider communication

Respect for patient preferences and shared decision making

Experiences leading to trust or distrust

Experiences of discrimination

Linguistic competency
Culturally Congruent Care:

"Those cognitive based assistive, supportive, facilitative, or enabling acts or decisions that are tailor made to fit with individual, group, or institution cultural values, beliefs, and lifeways in order to provide or support meaningful beneficial and satisfying healthcare or well-being services" (Leininger, 1991, p.49).
Pieces of the Puzzle
Components of the Puzzle
Cultural Diversity
: is ever changing; varies in quality and quantity.
Components of the Puzzle
Cultural Awareness
: a reality to be contemplated and a corresponding capacity for processing knowledge.

Cultural Sensitivity
: attitude about one's own person and others

Cultural Competence
: the action that is taken in response to diversity, awareness, and sensitivity.

The Client
5. Which is not one of the 5 components of "culturally congruent care"?
a.) cultural diversity
b.) cultural awareness
d.) cultural competence
e.) client

6. According to the guidelines for communication, health care professionals must understand certain cultural behaviors related to their ____________.
a.) character
b.) patient's cultural background.
c.) professional education
d.) physical assessment

7. Which list of components are apart of the Commonwealth fund's "patient's perspective of measuring cultural competence"?
a.) provider education, shared decision making, linguistic competence
b.) experiences of discrimination, patient-provider communication, experiences leading to trust or distrust
c.) cultural diversity, cultural sensitivity, and linguistic competency.
d.) None of the above.

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