Cultural Competence in Healthcare

• Culture and ethnicity are important considerations in healthcare
• Cultural competence involves providing culturally congruent care

Key Topics

• World diversity
• U.S. diversity
• Migration
• Healthcare equity
• Title VI of the Civil Rights Act of 1964
• The Joint Commission
• Accreditation standards for culturally competent care

Culture

• Culture is a shared pattern of attitudes, beliefs, self-definitions, norms, roles, and values
• Culture occurs among those who share a language, way of communicating, or live in a defined geographic region
• Culture includes practices that people share and that define them as a collective

Ethnicity and Race

• Ethnicity is based on common ancestry, leading to shared values and beliefs
• Ethnicity is influenced by both culture and common ancestry
• Ethnic Identity is a powerful determinant of one's identity
• Race is influenced by physical or biological characteristics

Characteristics of Culture

• Culture is learned through enculturation
• Culture is symbolic, including language
• Culture is shared, involving things like gender roles
• Culture is integrated, such that a change in one part impacts the whole

Cultural Concepts

• Generalizations: broad statements about a group
• Stereotypes: oversimplified and often negative beliefs about groups
• Prejudice: preconceived judgments about groups
• Discrimination: actions based on prejudice
• Disparity: differences in outcomes
• Health disparity: differences in health outcomes
• Race: a social construct based on perceived physical traits
• Racism: prejudice, discrimination, or antagonism directed against someone of a different race based on the belief that one's own race is superior

Acquisition of Cultural Identity

• Acculturation is the exchange of cultural features through direct contact between groups
• Assimilation is when individuals from one group merge with a second group
• Diffusion involves borrowing traits between two cultures
• Ethnocentrism is viewing one’s own culture as superior and judging others by one's own standards
• Socialization occurs through family, community, school, and spiritual institutions
• Rituals also play a role in cultural identity

Enculturation Example

• A high school student from the United States spends a summer abroad with a family in Switzerland, learning norms, values, and behaviors of another culture

Transcultural Nursing

• The goal is to provide culturally congruent care
• Transcultural nurses can be specialists, generalists, or consultants
• Transcultural nurses function in diverse clinical practice settings
• Transcultural nurses are committed to cultural openness
• Madeleine Leininger developed:
  • The Sunrise Model
  • The Theory of Cultural Care Diversity and Universality

Cultural Competence

• Cultural competence means interacting with and appreciating people of different cultures and beliefs
• It can be individual and organizational
• Cultural sensitivity begins with recognizing cultural differences
• Cultural competency in nursing requires underlying acceptance of patient’s health beliefs
• Adapting care is necessary to meet the unique needs and perspectives of each individual

Cultural Competence Elements

• Culturally congruent care is essential
• It involves multidimensional cultural competencies
• It requires balancing multiple cultures which includes the nurse, the healthcare system and the patient

Cultural Competence and the Nursing Process

• Key components of assessment
• The Transcultural Theory and Assessment Model
• The Transcultural Assessment Model

Assessment Considerations

• Biological variations
• Environmental control
• Time
• Social orientation
• Communication
• Space
• Culturally unique individual

Additional Areas for Consideration

• Health disparities
• Family dynamics
• Ethics
• Spirituality
• Communication
• Stress and coping
• Fatigue
• Mood and affect

Assessment in the Nursing Process

• Includes consideration of:
  • Nutritional needs
  • Health beliefs
  • Socioeconomic level

Collecting a Nursing History

• Avoid assumptions
• Listen carefully
• Rephrase for clarity
• Stay respectful and nonjudgmental

Linguistic Competence

• The ability to communicate effectively and convey information so diverse audiences can easily understand

Audiences to Consider

• Those with limited English proficiency
• Those with disabilities
• Those who are deaf or hard of hearing
• Those with low literacy skills or who are not literate

National CLAS Standards

• (Culturally and Linguistically Appropriate Services) set of standards
• All healthcare organizations must provide:
  • Language assistance
  • Information about the availability of language assistance
  • Competent individuals to provide language assistance
  • Print and multimedia materials in languages commonly used by the served population

Working with Interpreters

• Use only qualified interpreters
• Ensure interpreters are competent in medical terminology
• Ensure interpreters know about confidentiality and impartiality
• Position interpreters close to the patient

Communication Considerations

• Culture influences how feelings are expressed verbally and nonverbally
• Consider aspects like:
  • Touch
  • Facial expressions
  • Eye contact and movement
  • Body posture

Care Plan Development

• Must include professional action and decision-making strategies
• Involves:
  • Cultural maintenance
  • Cultural care accommodation or negotiation
  • Cultural care repatterning or restructuring

Culturally Competent Nurses

• Nurses utilize culturally relevant information when assessing, diagnosing, planning, and implementing care for diverse patients
• Language and linguistics is important
• Include individualized care
• Community referrals are important

Assessing Health Literacy

• Health literacy includes the capacity to obtain, process, and understand basic health information
• Watch for behaviors that indicate a literacy deficit
• Assessment tools include:
  • The Short Assessment of Health Literacy in Spanish and English
  • The Rapid Estimate of Adult Literacy in Medicine—Short Form