Cultural Awareness in Healthcare

Importance of Cultural Awareness

• Cultural awareness is understanding cultural differences and their effects on healthcare.
• Cultural awareness results in better communication, respect, understanding, and improved patient trust and healthcare results.
• Cultural assessment tools aid in rapidly grasping key cultural aspects impacting care.

Emerging Demographic Trends

• There are noted differences in age, poverty, and household composition.
• Higher numbers of relatives residing together are seen in minority groups, on average.
• Lower education and income correlate with a higher likelihood of disability, regardless of race.
• Larger and multigenerational families are more evident in minority groups.

Social Determinants of Health (SDH)

• SDH include nutritious food, water, education, safe homes/neighbourhoods, and freedom from racism.
• Poverty is the primary influence on health status and SDH.

Culture-Related Concepts

• Culture encompasses attitudes, beliefs, self-definitions, norms, and values.
• Ethnicity is a social group sharing geographic origin, religion, language, values, and traditions.
• Ethnic identity is self-identification with a particular ethnic group.

Importance of Cultural Assessment

• Recognize that groups of people do not fit into a one-size-fits-all box.
• Self-awareness of one's own culture is critical in assessing others.
• All humans possess individuality, regardless of culture.

Religion and Spirituality

• Spirituality is a broad term that encompasses something larger than one's existence and belief in transcendence.
• Religion is an organized belief system assisting in meeting individual spiritual needs.
• These concepts can be interrelated but do not have to exist simultaneously and may exert influence on decision-making; individuals define their feelings and beliefs.

Traditional Treatments and Folk Healers

• Each culture may have its own healers and folk remedies.
• Inquire about and acknowledge herbal or folk treatments to understand cultural practices and beliefs.

Alternative/Traditional Therapies:

• Acupuncture
• Biofeedback
• Chiropractic manipulation
• Hypnosis
• Tai Chi
• Yoga

Transcultural Expression of Illness

• Pain expression exists within a cultural context.
• Pain must be clinically assessed at the individual level.
• Silent suffering may be a factor in some groups.
• Always assess your patient first.

Becoming a Culturally Competent Practitioner

• It's a complex and multifaceted process that changes over time.
• Culturally sensitive: Having basic knowledge and constructive attitudes toward diverse populations.
• Culturally appropriate: Applying background knowledge to improve health outcomes.
• Culturally competent: Understanding and attending to the contextual aspects of care, including awareness of immigration status.

Immigration Status and Assessment

• Some healthcare seekers have immigration concerns.
• Assure patients that nurses are in health field first.
• Immigration concerns can prevent full disclosure, requiring sensitive handling.

Cultural Assessment

• Don't assume, ask about cultural beliefs.
• Domains of interest: heritage, health, family roles, spirituality, death, and providers.

Spiritual Assessment

• Start the conversation with questions or statements, such as the patient's religious or spiritual preferences or asking if they would like to have clergy/chaplains visit.

Gender Identity

• A patient's gender may be male, female, or non-binary.
• Transgender considerations: assess present gender, gender at birth and be cognizant of pronouns, if in doubt, ask.

Interpretation

• Interpretation services must be used for official encounters.
• Patients have the legal right to materials in their language and translation systems must be accessible.
• Official interpretation is necessary for accuracy in clinical and legal matters with clinical, legal, or procedural aspects.

Cranial Nerves

• Cultural consideration: coustic (hearing, balance).
• CN IX: Glossopharyngeal (swallowing, taste).
• CN X: Vagus (swallowing, speech, autonomic functions
• CN XI: Spinal Accessory (shoulder shrug, head turn).
• CN XII: Hypoglossal (tongue movement)
• Identify clinical testing techniques for all cranial nerves.

Eye Assessments

• PERRLA: Pupils Equal, Round, Reactive to Light and Accommodation.
• Tests CN II (optic) & III (oculomotor)
• Assess direct & consensual light reflex, accommodation.

Assessment Techniques related to strokes

• Know assessment techniques and normal vs. abnormal findings related to strokes.
• Normal: Symmetrical movement, speech, strength.
• Abnormal: Unilateral weakness, facial droop, slurred speech, confusion, dizziness, balance issues.
• FAST assessment: Face drooping, Arm weakness, Speech difficulty, Time to call 911.

Infantile Reflexes

• Differentiate infantile reflexes as defined in text and course resources.
• Rooting: Turns head toward stimulus.
• Moro: Startle reflex.
• Palmar grasp: Grasps object in the palm.
• Babinski: Toes fan out when sole is stroked (abnormal after 2 years old).

Deep Tendon Reflexes (DTRs)

• Understand deep tendon reflexes (DTRs), why they are assessed, and how they are assessed.
• Tests the integrity of spinal cord & PNS flick in the wrist.
• Graded 0-4+ (2+ is normal, 4+ is hyperreflexive, 0 is absent).
• Common DTRs: Biceps, triceps, patellar, Achilles.
• Understand objective assessment effects anticipated, based on affected brain region.

Cranial Bones

• Frontal: Personality, motor function, speech (Broca's area).
• Parietal: Sensation.
• Occipital: Vision.
• Temporal: Hearing, memory (Wernicke's area).
• Cerebellum: Balance, coordination.
• Brainstem: Vital functions (breathing, HR, BP).

Tremors

• Rest Tremors: "Pill rolling."
• Intention tremor: Voluntary movements worsen, Ex: trying to drink a glass of water.
• Fasciculations: Twitching of eye muscle.

Neurological Disorders

• Bell's Palsy:
• Affects: CN-7: facial
• Signs: Unilateral facial weakness, unknown cause, symptoms mimic CVA.
• Parkinsonian Symptoms:
• Signs: Shuffling gate, impaired swallowing, shaking hands.
• Seizures: Pt often see: "aura" before seizure. What brought a seizure: Fever, alcohol, disease. Document: Start and stop time, where is shakiness.