Transcript Cultural Competence

Cultural Competence
Культурная компетентность
What is culture?
Что такое культура?

Refers to the learned, shared and
transmitted values, beliefs, norms, and
ways of specific individuals or groups that
guide their thinking, decisions, and actions
and patterned ways (Leininger, 2001)
What is Cultural Competence?
Что такое культурная
компетентность?
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A process in which the
nurse involved with the
client and family
continuously strives to
provide culturally
competent care
(Campinha-Bacote)
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Cultural
Competence Model
Five components/steps:
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Awareness
Knowledge
Skill
Encounter
Desire
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Campinha-Bacote, 2010
Cultural Competence Model
Модель культурной
компетентности
1. Cultural Awareness
A process of self–examination of one’s
own biases towards other cultures and
an exploration of one’s cultural and
professional background.
• A process of being aware of the
existence of documented racism and
other “isms” in health care delivery
•
o self assessment/reflection
2. Cultural Knowledge
Defined as a process in which a nurse seeks and
obtains a sound educational base about culturally
diverse groups.
Knowledge to focus on integration of specific
issues: health-related beliefs practices, cultural
values, disease incidence and prevalence, genetic
implications related to drugs,
Know current realities of communities
 Trends, minority groups, marginalized
groups, health disparities/risks, economic
& social factors
Knowledge R/T Populations
Immigration laws have increased the # of
immigrants
 By mid 21st century minority populations
will outnumber whole population
 # of adults who live past 85 years of age
has increased & will increase
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◦ Baby Boomer (1945-1965) 2029 - The last of the
boomers will turn 65. 65+ population projected to
double to 71.5 million by 2030
Knowledge Activity
Turn to your neighbors and form a group
of 3-4
 Complete matching of terms to build
your knowledge base
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Knowledge: Value Orientations
◦ Cultures have a value system that
teaches behaviors by setting norms
◦ Health beliefs and practices tend to reflect a
culture’s value system
 May impact health prevention/education focus and
compliance with treatment plan
• Value orientations can be identified for most
persons within a particular cultural group BUT
remember…will find diversity within any cultural group
Cultural Value Orientations
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Cultural factors that vary and affect
health
◦ Identified by Giger and Davidhizer (2004)
Include:
Environment
Biological Variations
Social Organization
Communication
Space
Time
Consider…
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Space
◦ Personal comfort
◦ Boundaries and rules
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Social Organization
◦ Family unit defined
◦ Decision maker
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Communication
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Formal & informal
Verbal & non-verbal
Importance of silence
Facts vs. stories orientation
Need for interpreter
Consider…
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Time Orientation
◦ Past-Present-Future
viewpoint
◦ Impacts belief regarding:
 Change of behaviors
 Appointment punctuality
 Health promotion & illness
prevention strategies
 Ability to be “present”
Somali Heritage
Somali gov. collapsed
in Africa – refugees
to US
 Time orientation not
part of culture but
enculturates over
time to time
Orientation
 Muslim
 Gender preference
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3. Cultural Skill
• Ability to collect relevant data through the
interview process
oNeed to know how communication styles and meanings
may impact this process
oNon-verbal communication plays a significant role in
many cultures
oIdentify potential barriers to effective communication
process
oNurse must know when there is a need for a formally
trained interpreter in order to avoid potential problems
with a non-English/ESL speaking client
4. Cultural Encounter
• Process in which the nurse seeks
opportunities to engage in crosscultural interactions directly or
indirectly
• Nurses gain experience from
directly working with clients or
learning from others who have
5. Cultural Desire
o Genuine and sincere desire
to work effectively with
minority clients and their
families
o Desire to travel and interact
with culturally diverse grps
o Campinha-Bacote (2007) sees
encounters as the pivotal
construct of Cultural
Competence!
Campinha-Bacote, 2010
CDC Populations - RACE
White
 Asian American,
 Black or African American,
 Hispanic or Latino,
 Native Hawaiian and Other Pacific
Islander,
 American Indian and Alaska Native
www.cdc.gov/minorityhealth/populations/
REMP/definitions
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RACE
White people have
origins from Europe,
The middle East, or
North Africa
 White People
comprise 70% of US
population in 2000
census
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The census Bureau
predicts by 2060,
white Americans will
comprise 50% of US
population
Anglo Americans
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Personal control vs
fate
Change vs. tradition
Time vs human
interaction
Individualism vs
group welfare
Self help vs
cooperation
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Action vs being
oriented
Future vs past
orientation
Informality vs
formality
Materialism vs
spiritualism
Practicality vs
idealism
Anglo Americans
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Personal control vs
fate
Change vs. tradition
Time vs human
interaction
Individualism vs
group welfare
Self help vs
cooperation
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Action vs being
oriented
Future vs past
orientation
Informality vs
formality
Materialism vs
spiritualism
Practicality vs
idealism
Hispanic or Latinos
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Hispanic 2013 = 17 %of
US pop.
Largest Ethnic grp in US
Mexican(64%), Puerto
Rican(9.4%, Salvodoran,
Cuban Dominican,
Gualemalan
Risks: ↑ B/P, heart,
diabetes,obesity, lactose
intolerant
Mexican American
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Language dialects
Space – closer
Time is relative and
present oriented
Several formal names
- so ask & address
formally
Traditional roles
Family is a priority.
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Predominant religion is
Roman Catholic
Folk health providers
Show respect and
include family- ? Eye
contact
Direct confrontation
disrespectful
Ask before touching but
usually very tactile
Barriers
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Language Barriers
 These impede communication and
ability to express thoughts & feelings
 Foreign languages, dialects, and idioms, slang,
street talk are all types of barriers that may
impede communication in the U.S.
 families even have own informal language!
 Differences related to socio-economic status
effect communication style
 (Ruby Payne; Bridges Out of Poverty)
National Standards for Cultural
Competence
 Culturally & Linguistically Appropriate
Services (CLAS)
 Developed by the U.S. Department of Health and
Human Services, Office of Minority Health
 With intent to ensure that the recipients of health
care services are provided equitable and
effective treatment
 The standards address the inequities that exist in the
provision of health care services to the people of
color
Russian Americans
Language is Russia
but many speak
English
 Time orientation –
on time or early
 Medication hording
 Use eye contact
except with
government officials
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Use Touch
Do not interpret eye
contact as aggressive or
loud tone
Health = absence of
disease
Hospital stays in Russia 3
weeks.
Warmth =+
Stoical with pain
Folk practices
Consider…
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Biological Variations
◦ Cultural characteristics and
genetic differences
◦ Review family health history
and health risks factors
 Impacts types of drugs various
groups respond best to.
RACE: African Am. Or Black
In 2012, the population of African Americans
including those of more than one race was estimated
at 44.5 million, making up 14.2% of the total U.S.
population. In 2060 projects will be 18.4%
RACE: African Am. Or Black
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Differ based on
socioeconomic grp,
sub culture
Language: English
Nonverbal important
Close personal space
Extended families
important
Headed by singleparent woman but
varies
 Risks: Sickle cell, ↑
B/P, heart, Cancer.
diabetes, lactose
intolerant, obesity,
 Genetic differences
in response to drugs
for ↑ /P
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Transcultural Communication
Barriers
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Lack of Knowledge
 The failure to understand cultural
differences in values, behaviors and
communication styles is a common stumbling
block for nurses
 Each culture dictates what “normal” behavior
is when one is sick
 Will learn this in DON curriculum and throughout nursing
career
Barriers to Cultural Competency
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Fear and Distrust
 Fear, dislike and distrust are emotions that
erupt when people from different cultures
first meet
 What other emotions may play a part in initial
interactions?
 How do we overcome this initial reaction?
Barriers to Cultural Competency
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Racism
 Most nurses find it hard to believe that
racism even exists in the world of nursing
 Individual
 Against biological characteristics
 Cultural
 Heritage superiority
 Institutional
 At one time black nurses were not allowed to join the
ANA
Barriers to Cultural Competency
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Bias and Ethnocentrism
 The belief that one’s own culture or
traditions are better than those of other
cultures
 Attitudes toward western medicine constitute
one of the biggest barriers to transcultural
communication between American nurses and
their clients/families
 You, the nurse, must admit that biases exist in order to
overcome & advocate for clients
Barriers to Cultural Compentency
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Stereotyping
 Assigning certain beliefs and behaviors to
groups without recognizing individuality
 Unsubstantiated assumption that all people of a certain
racial and ethnic group are alike
 This is especially harmful when negative traits imposed on all
members of a cultural group
(example - all Native Americans are alcoholics)
Barriers to Cultural Competency
 Cultural Blind Spot Syndrome
 Just because client looks and behaves much
as you do - do not assume no cultural
differences (are all Caucasians alike? Are all
Asian Americans alike)
 Remember all patients are individuals with
unique characteristics and personal histories
Barriers to Cultural Competency
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Ritualistic Behavior
 These allow nurses to remain in control
of situations without individualizing care
 We need to ask ourselves which nursing care
rituals really have a scientific basis for
following them
 Movement behind evidenced-based practice – do
we practice based on accumulated scientific
knowledge? … What is the Best Practice!
Barriers to Cultural Compentency
 Different
Perceptions &
Expectations
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Cultural, behavioral, and language differences between
nurses, patients and patients families … can lead to:
 Greater probability that patients will
misunderstand nursing care and instructions
 Often cultures vary in perception of health
promotion and disease prevention
 Cultural home remedies - often 1st treatment of
choice
Resource
Campinha-Bacote J. (1998, 2002, 2010)
The process of cultural competence in
the delivery of healthcare services.
 Munoz, C. & Luckmann, J. (2005).
Transcultural communication in nursing.
Clifton Park, New Jersey: Delmar.
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Website Resources
CDC websites
 U.S. Dept of Health and Human Services,
Office of Minority Affairs
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◦ CLAS National Standards
◦ http://minorityhealth.hhs.gov
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Early Childhood Research Institute
◦ CLAS information and education
◦ www.clas.uiuc.edu
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Transcultural Nursing Society
◦ http://www.tcns.org
RACE: Pacific Islanders/
People having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other
Pacific Islands. Pacific Islanders
Asian American
2010 Census 4.8%
but by 2050 can rise
to 9.2%
 Asian +Pacific
Islanders top causes
of death include:
Cancer, Heart,
Stroke, Unintentional
injuries, diabetes
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Chinese, Filipinos,
Asian Indian,
Vietnamese, Koreans,
Japanese
American Indian/Alaska Natives
U.S. Census Bureau
in 2011 = 1.6% of
the U.S. total
population.
 29% lacked health
insurance
 Top 5: Heart disease,
cancer, unintentional
injuries, diabetes,
Liver & Cirrhosis,
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