Cultural Competency in Healthcare

Chapter 1 Foundations

• Health care providers are responsible for establishing and maintaining effective relationships with their clients.
• Effective communication, mutual respect, and shared trust are essential for a good client-professional relationship.
• Clinicians must be careful about disclosing personal information to clients.
• Financial, emotional, and physical boundaries are the responsibilities of health professionals.
• Touch is an important element in the healing relationship.
• Threat to dignity may lead to client anxiety during a medical visit.
• Introducing yourself appropriately and demonstrating warmth and concern are common courtesies.
• Medical examinations may involve taking a history, asking personal and social questions, and inquiries around spiritual beliefs and values.
• Trust, respect, and compassion are essential elements of healing, but they can be affected by different factors such as risk and uncertainty which create anxiety among clients.
• The involvement of third-party payers can potentially threaten the trust between clients and health care professionals.
• Health care providers must consider clients as consumers who rely on lawsuits to attain the desired outcomes but this can threaten the ability for clients and providers to trust each other..
• A dilemma requires careful consideration of the interests involved and finding the solution that balances them.
• Ethics are a set of moral principles that guide behavior.
• Four basic ethical principles are autonomy, beneficence, non-maleficence, and justice.

Chapter 2 Recognizing Attitudes, Beliefs, and Values

• Health care professionals must treat all individuals with respect and dignity.
• Codes of ethics provide a list of professional values and describe ethical responsibilities.
• Recognizing personal biases and how they might influence treatment relationships is important.
• Learning self-awareness includes identifying one's strengths and limitations, as well as personal values that are developed at a young age by the influence of parents, family, society, schools, and culture.
• Biases, such as overt and covert prejudices, can affect interactions with clients and colleagues.
• Becoming aware of biases can help avoid inappropriate or incorrect judgments of others.
• Understanding values, such as strong religious beliefs, honesty, and importance of taking care of family, as well as socioeconomic status and culture is important to be effective health care practitioners.
• Examining and understanding one's own values and the values of clients and colleagues is important for effective practice.

Chapter 3 Multicultural Perspective

• Race is generally understood to be determined by genetically inherited traits, which are identifiable by skin color, facial features, and hair color or texture.
• Ethnicity describes people of similar backgrounds who identify with one another and choose to live or socialize together.
• Characteristics of ethnicity include geographic origin, migration history, race, language, dialect, religion, spiritual beliefs, shared traditions, values, symbols, occupation, and socioeconomic status.
• Culture is a pattern of learned beliefs, shared values, and behaviors.
• Culture includes language, styles of communication, practices, customs, and views on roles and relationships.
• Acculturation is the process of adapting to the traits of a larger, normative culture.
• Assimilation is when the arriving group is totally absorbed into the dominant society; the original culture disappears.
• Ethnocentrism refers to the tendency of favoring in-groups while disfavoring out-groups.
• Worldview reflects a person's understanding of the world, values, beliefs, and communication styles.
• Social organization and relationships, time orientation, activity orientation, use of space, and communication styles are examples of cultural dimensions that comprise worldview.
• Health beliefs and practices are also influenced by culture as well as the expected behavior from both healthcare providers and clients in dealing with illness, injury and disability.
• The culture of medicine has potential cross-cultural components: the native health care provider's culture, the client's culture and the majority culture of the health care system.
• Cultural competence requires knowing about and communicating with clients from different groups and recognizing their specific beliefs, and understanding how age, gender, social background, and educational levels in addition to ethnicity can affect those beliefs.

Chapter 4 Making Connections

• Communication is the interpretation of meaning from interpersonal relationships.
• Communication extends beyond verbal information, including body movements, expressions, and subconscious mechanisms.
• Demonstrating caring and empathy is important, but it is often lacking in medical encounters.
• Empathy is the ability to recognize another's situation and emotions.
• Using effective communication skills can enhance motivation of clients and promote adherence to treatment protocols.
• Effective communication and skills like active listening, vocabulary, and paralanguage like tone, pitch, volume, and speed can lead to better outcomes for clients within the therapeutic relationship.
• Client-centered language focuses on clients' abilities, needs, and desires rather than impairments.
• Practices of mindfulness and active listening can enhance the relationship between client and provider.
• Reflecting on own attitudes and approaches, and asking "How are you feeling?" to clients are critical elements in building a strong relationship.

Chapter 5 Motivation, Adherence, and Collaborative Treatment Planning

• Motivated clients are actively involved in therapeutic interventions and show better outcomes when adhering well to treatment regimens.
• Factors affecting therapeutic adherence includes patient-related factors, social/economic factors, therapy-related factors, condition-related factors, and health system-related factors.
• Difficulty can be because the client is "not open to therapy" or therapist blame.
• Clients' locus of control, self-efficacy, self-esteem greatly influence their motivation and adherence to treatment.
• Factors causing low self-esteem include anxiety, social relationship difficulties, and body image issues.
• Strategies for improving motivation include: modifying health behaviors, Trans-Theoretical model for health behavior change, Five A's behavioral intervention protocol and Motivational Interviewing
• Health belief model in relation to perceived ability to make a change with client's health status.
• Goal setting is crucial in helping clients achieve long-term success.
• Strategies for enhancing motivation and adherence requires use of support groups, feedback and follow up, and education and empowerment along with client-centered strategies.

Chapter 6 Loss/Grief, Coping and Family

• Perinatal loss involves a loss of dreams, confidence in the ability to create, and deliver healthy babies and loss of parental roles.
• Understanding loss and grief requires acknowledging that loss may often lead to additional losses, losses that can be sudden, gradual, anticipated, or total.
• Understanding Grief and Loss involves the process of the three interdependent elements that influence outcome: the pain of the loss of attachment, the loss of having what was once had before the loss, and the deterioration of cognitive capabilities including problem-solving.
• Different types of Grief include anticipatory grief, conventional grief, prolonged grief, complicated grief and suppressed grief.
• Psychological signs of grief include an initial shock and disbelief followed by sorrow, anger, guilt, despair, sadness, depression, denial, fear, and regret.
• Physical signs associated with grief reaction can include fatigue, sighing, hyperventilation, feeling of physical emptiness, and a lump in the throat.

Chapter 8 Coping

• Coping is defined as thoughts and behaviors used to manage internal and external stress.
• The three steps in the coping process are primary, secondary, and tertiary appraisal.
• Primary appraisal is when a person evaluates the stress; secondary appraisal is when a person thinks about ways to cope, while tertiary appraisal is when coping options are put into action
• Cognitive reframing seeks out the positive meaning in a situation that may be threatening or negative.
• Problem-focused coping is geared toward solving problems and adjusting circumstances.
• Emotion-focused coping involves controlling and managing emotions in challenging situations
• Health professionals need to encourage appropriate coping strategies in clients, help clients access resources, and make referrals as needed for further support and treatment.

Chapter 9 Disability

• Disability is defined as the absence of health, and injury, and is not just limited to impairments, but by society’s refusal to accept those impairments and make accommodations.
• Developmental disabilities may negatively impact the child and their family by causing unhealthy relationships between child and parents.
• This can cause problems in siblings that may include lower social competence, low self-esteem, and shyness, along with complaints of somatic complaints, poor peer relations, delinquency, loneliness and isolation, and anxiety and depression.
• There are many factors which affect people with disabilities such as different life experiences compared to those without disabilities, inability to participate in similar social events, physical challenges/ problems, cognition and communications problems and psychosocial issues.
• The onset of disability can occur at any point in a person's life, but the incidence greatly increases with age due to chronic health conditions and natural changes occurring in the aging process up to death.
• People with disabilities represent the largest minority group in the United States with the latest estimate standing at 54.4 million, equivalent to 1 in every 19 U.S. citizens.
• Types of losses that can occur in those with disabilities are sudden, gradual, anticipated, or total.
• Issues with returning to work following a disability can include social, emotional, physical and financial barriers.