Week 3: RN Equality + Diversity - Cultural Competence in Nursing

• Nursing care requires a holistic approach, considering the diverse backgrounds of patients.
• Culturally competent care ensures safe, respectful, and ethical nursing practices.
• Culturally competent care reduces health disparities and improves patient outcomes.
• Madeline Leininger developed the Theory of Culture Care Diversity and Universality.
• Theory emphasizes nurses who understand and incorporate cultural beliefs, values, and practices into patient care.
• American Nurses Association (ANA) Standard 9 highlights the importance of cultural humility and social equity in nursing.

Cultural Awareness

• Cultural awareness involves understanding and recognizing cultural differences in values, beliefs, and traditions.

Implicit Bias vs. Explicit Bias

• Implicit bias includes unconscious attitudes affecting patient interactions.
• Implicit bias examples involve gender or racial bias.
• Explicit bias refers to conscious beliefs that may lead to discrimination.
• Biases can lead to inadequate assessments and disparities in treatment.
• Nurses must conduct self-assessments to minimize bias and improve care.
• Cultural diversity includes differences in age, gender, ethnicity, socioeconomic status, religion, disability, and sexual identity.

Influence of Culture on Health Care

• Culture affects health beliefs, decision-making, and treatment acceptance.
• Nurses must adapt communication and care to meet patients' cultural needs.

Cultural Competence

• Cultural competence involves the ability to respect, understand, and respond to diverse patient needs.

Key Elements of Cultural Competence

• Emic Knowledge: Insider's cultural perspective.
• Etic Knowledge: Outsider's viewpoint on culture.
• Purnell Model and Leininger's Sunrise Enabler consist of tools to assess cultural needs.

Nursing Actions for Cultural Competence

• Use open-ended questions about cultural preferences.
• Avoid assumptions based on stereotypes.
• Provide language-appropriate resources.
• Utilize certified interpreters, not family members.

Health Disparities

• Health disparities are unequal health outcomes among different populations due to social, economic, and environmental barriers.

Examples of Health Disparities

• African American women have higher obesity rates.
• Hispanic population has higher rates of being underinsured.
• Asian Americans have a higher risk of chronic hepatitis B.

Factors Contributing to Health Disparities

• Limited access to healthcare includes lack of transportation and insurance.
• Socioeconomic status (low income) affects health choices.
• Discrimination and bias affect the quality of care.
• Language barriers decrease understanding of treatment options.

Health Equity, Equality, and Literacy

• Health equity ensures fair access to healthcare for all individuals.
• Health equality ensures everyone receives the same resources.
• Health equality may not address individual needs.

Health Literacy

• Personal Health Literacy: A patient's ability to understand health information.
• Organizational Health Literacy: Healthcare providers ensure information is accessible and understandable.

Strategies to Improve Health Literacy

• Use plain language in patient education.
• Provide visual aids and interpreters.
• Support community-based health education programs.

Caring for Vulnerable Populations

• Vulnerable populations are groups at higher risk for poor health outcomes due to limited access to resources.
• Older adults, immigrants, low-income individuals and LGBTQ+ individuals.

Examples of Vulnerable Populations

• Older adults: Increased physical disabilities and chronic conditions.
• Immigrants: Language barriers and lack of health insurance.
• Low-income individuals: Struggles with affording medication and healthcare.
• LGBTQ+ individuals: Higher mental health risks due to stigma and discrimination.

Demographics, Health Status, and Socioeconomic Factors

Demographics

• Age, language, race, and ethnicity affect access to preventive care.

Health Status

• Chronic conditions and disabilities limit ability to seek consistent treatment.

Socioeconomics

• Income, education and employment determine health literacy and affordability.

Addressing Health Disparities as a Nurse

• Assess Cultural Needs: Ask about dietary restrictions, religious beliefs, and traditional healing practices; incorporate culturally appropriate interventions.
• Advocate for Equitable Care: Help patients navigate the healthcare system; work with community programs to improve access.
• Improve Communication: Use ISBARR for clear communication; utilize certified interpreters.

Leininger's Sunrise Enabler Model

• Cultural and Social Structure Dimensions influence one's view of health and illness.
• Factors Affecting Health include technology, religion, social structure, economy, and education.
• Central Core Influences involve beliefs about illness, treatment, and healing.
• Healthcare Practices cover folk (traditional) care vs. modern medical care.
• Three Modes of Culturally Competent Care: Preservation & Maintenance, Accommodation & Negotiation, and Repatterning & Restructuring.
• Preservation & Maintenance supports patients in keeping cultural traditions.
• Accommodation & Negotiation modifies care to align with cultural beliefs.
• Repatterning & Restructuring encourages new practices for better health outcomes.

Practical Applications for Nurses

• Certified medical interpreters should be used to prevent miscommunication.
• Do NOT use family members due to potential inaccuracies.
• Provide written materials in the patient's primary language.
• Conduct self-assessments to identify implicit biases.
• Participate in diversity and inclusion training.
• Approach all patients with cultural humility.
• Help bridge gaps in care for vulnerable groups.
• Educate patients on available resources (financial aid, transportation).
• Support policies that promote health equity.