Culturally Competent Healthcare Organizations

Creating Culturally Competent Healthcare Organizations

• A culturally competent organization provides services respectful of and responsive to clients' cultural and linguistic needs.
• Cultural competence considers age, culture, ethnicity, gender, language, race, religion, sexual preference, gender identity, and socioeconomic status.
• Health disparities are preventable differences in disease burden, injury, violence, or opportunities to achieve optimal health experienced by disadvantaged populations due to social, economic, geographic, or environmental factors.
• Health disparities adversely affect groups facing greater obstacles to health.
• Key factors contributing to health disparities are access to the healthcare system and quality of care received.
• Racism, including internalized, interpersonal, and structural forms is present in society and healthcare settings and contributes to health inequities.
• Institutional racism, which includes differential access to health insurance, can unintentionally create inequitable structures.
• Organizational culture includes goals, norms, values, and practices that guide behavior within the organization.
• Inclusive workplaces are characterized by active community involvement and staff committed to cultural competence, diversity, and mutual respect.
• Developing culturally competent organizations involves attention to governance, internal evaluation, staff competence, the care environment, linguistic competence, community involvement, partnerships, and culturally congruent services.

Transcultural Perspectives in Childbearing

• Culture significantly shapes beliefs and behaviors of childbearing families during pregnancy.
• The global population's mobility introduces new cultural approaches to health and childbirth, blending expectations and practices.
• Childbearing is a universal experience influenced by cultural norms, values, and socioeconomic factors.
• Preferences towards wellness over hospital setting when childbearing can be present in the U.S.
• A birthing plan documents preferred actions for childbirth.
• Maternal morbidity and maternal mortality experiences health disparities.
• Home births are a safe option.
• Cultural and social variables influence fertility, including reproductive health, residence patterns, diet, religion, history of abortion/venereal disease, and birth interval regulation.
• Societal factors influencing reproductive rights and population control include contraceptive methods, emergency contraception, and religious beliefs.
• During pregnancy, customs and beliefs dictate activity, behavior, and lifestyle through prescriptive (positive) and restrictive (negative) beliefs.
• Awareness of biologic variations resulting from genetics and environment is important.
• Cultural variations cover parental activity, food taboos/cravings, prenatal care, obstetric testing interpretation and preparation for childbirth.
• Cultural attitudes influence methods of dealing with labor pain, delivery positions, birth locations, family roles, and expectations of healthcare practitioners.
• Postpartum practices strengthen the mother and infant by focusing on dietary customs, activity levels, taboos, and rituals.
• Breastfeeding is affected by societal trends, religious beliefs, work activities, cultural beliefs, social support, access to information, and past experiences.
• Domestic violence is a significant healthcare threat for pregnant people and their unborn children and may result in stress, poor lifestyle habits, and delayed prenatal care.
• Nurses should employ good assessment skills, form trusting relationships, provide patient education, and show concern and respect to pregnant people.

Transcultural Perspectives in the Nursing Care of Children

• Family and community influence children’s cultural development.
• Travel, technology, immigration, and adoption influence a child’s culture.
• Family is a key influence in a child’s cultural development, with kinship and social factors affecting beliefs and expressions.
• A nurse should address biological, legal, and social definitions in addition to the child’s perspective.
• Family expectations vary concerning physical contact, child roles, communication, coping strategies, and education.
• Cultural perspectives influence parenting styles and methods of discipline, comparing nonviolent discipline versus corporal punishment.
• Refugees seek refuge or asylum.
• Differences between the expectations and beliefs of the home country and destination country can lead to tension as well as economic and assimilation issues
• Children can be Bicultural, multicultural, or multiracial.
• Cultural health practices may be misinterpreted as abuse or neglect if not understood.
• Children with disabilities may experience impairments in function, activity, or participation.
• Nutrition is important for children's growth, and is part of cultural healing remedies.
• Nurses should inquire about adverse childhood experiences, and advocate for policies and resources to address these.
• Nurses can advocate for access to activity and healthy foods.
• Poverty is a significant barrier to healthy growth and development.

Transcultural Perspectives in the Nursing Care of Adults

• Developmental tasks/crises are normal transitions in adulthood.
• A health/illness situational crisis involves coping with a sudden life-threatening illness.
• Transitions are health or illness events requiring lifestyle modifications.

Cultural Influences on Adulthood

• Physiologic affects can include hormonal changes, menopause, and loss of sexual potency.
• Psychosocial affects can include stages of life, divorce, remarriage, and career changes.
• Each culture has chronologic standards for appropriate adult behavior.
• Social age: culture defines what is considered appropriate in each stage of the life cycle.
• Young adult: independence, role changes
• Middle adult: career, family matters
• Developmental tasks are responses to life situations involving physiologic, psychological, spiritual, and sociologic changes.
• Adult life transitions are influenced by culture, impacting career success, social and civic responsibility, marriage, raising children, and changing roles.
• Situational transitions often occur when a serious illness is diagnosed, or other traumatic events occur to individuals and their families.
• Caregiving occurs when a (typically) unpaid person, usually a family member, helps another family member who has a chronic illness or disease.
• Culture and ethnicity can influence beliefs, attitudes, and perceptions related to caregiving.

Transcultural Perspectives in the Nursing Care of Older Adults

• Longer lifespans among baby boomers necessitate improved gerontological nursing care.
• Culturally appropriate care delivery should be available and affordable.
  • The “young-old” are 65 to 74 years old
  • The “middle-old” are 75 to 84 years
  • The “oldest-old” are ≥85 years
• Culturally meaningful preventative education, chronic illness management, care coordination, case management, and hospice care improves holistic nursing care of older adults
• Health disparities influence health and healthcare due to income, insurance, access, residence, and individual decisions.
• Biologic factors include race/ethnicity, age, sex/gender, and genetics.
• Race and ethnicity correlates multimorbidity, life expectancy, and health disparities.
• Social determinants of health relate to environmental context, including food access, transportation, safety, and living arrangements.
• Aging in place provides a familiar setting, independence, finances and positive impact on health outcomes
• In regards to immigrating population, important connections include, length of time spent, proximity to family members, network of friends from country's of origin, and connections with ethnic, social, and health-related institutions.
• Economic influences can involve decreased monies for basic needs.
• Personal health literacy relates to the “degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others”
• Clear communication facilities healthcare literacy.
• Social support includes affective support (expressions of respect and love), affirmational support (endorsement), and tangible support (aid).
• Nursing care addresses social isolation and loneliness by providing congruent holistic care.
• Traditional care practices may be used concurrently with or instead of biomedical approaches by many older adults.
• Spirituality involves a personal phenomenon, while religion relates to doctrine and rituals.
• Well-being and disability and illness care expressions rely on intensive personal health service, health maintenance and coordinated services for community dwelling older adults.
• Provide culturally and spiritually congruent palliative and end-of-life care.

Transcultural Perspectives in Mental Health Nursing

• Mental health and mental illness form a continuum.
• Mental health is a state of well-being, where a person can cope with daily stressors productively.
• Mental health vulnerabilities are situations that impact their state of mental health and mental illness.
• The COVID-19 pandemic worsened mental health and psychological well-being.
• The COVID-19 pandemic highlighted the co-occuring pandemics; a lack of understanding the risk factors and transmissibility of the virus, cultural diversity and adherence failure.
• Stigma is a barrier to seeking care.
• Culturally sensitive communication can be inhibited by unsuccessful interaction and failure to adapt to patient needs.
• Reasons to immigrate include socio-political threats, war, civil unrest/violence, and climate-related hazards.
• Trauma from physical/sexual violence, immigration detention, family separation and acculturation create stress.
• Mental health is affected by thinking too much, crying easily, and somatic concerns.
• Common disorders include mood, anxiety, and trauma-related disorders.
• Provide culture-informed and trauma-informed care, grounded in evidence-based principles, to improve screening, assessment, and quality of care.
• Depression can manifest itself with physical symptoms.

Multiple Choice Answers

1. b
2. a, d