RN Engage 2.0 - Inclusion, Equity, and Diversity

Diversity, Cultural Awareness, and Cultural Competence

• Holistic nursing care requires skills and knowledge to care for diverse populations.
• Culturally competent care demonstrates sensitivity and ethical nursing practice.
• Understanding of cultural differences helps reduce health disparities and provide equitable care to vulnerable populations.
• Madeline Leininger's Theory of Culture Care Diversity and Universality emphasizes transcultural nursing to serve clients of various backgrounds.
• ANA's Standard 9 highlights the importance of cultural humility and social equity in nursing practice.
• Culture includes communication, language, beliefs, values, customs, and institutions of social groups.
• Cultural awareness involves understanding differences in perceptions, beliefs, traditions, and values.
• Self-assessment aids in recognizing personal biases for enhanced cultural awareness.
• Explicit bias is conscious, while implicit bias is unconscious and affects perceptions and interactions.
• Biases can negatively impact client care and contribute to healthcare disparities.
• Cultural diversity includes differences in age, ethnicity, gender identity, location, language, religion, and socioeconomic status.

Cultural Diversity and Inclusion

• Cultural diversity exists within and among cultural groups.
• Cultural influences affect health practices and the words used to describe illness.
• Communication techniques should be congruent between nurse and client.
• Understanding cultural beliefs and practices improves client outcomes.
• Family involvement can benefit client care when cultural needs are recognized.
• Inclusion embraces individual differences, welcoming and respecting all individuals.
• Diverse individuals are embraced and able to thrive in an inclusive environment.

Cultural Competence

• Cultural competence involves open communication and feedback between clients and nurses.
• It requires appreciating, accepting, and respecting individual cultural influences.
• Emic knowledge is an insider's perspective, while etic knowledge is an outsider's viewpoint.
• Integrating emic and etic knowledge leads to culturally competent and holistic care.

Health Disparities and Social Determinants

• Health disparities are differences in health outcomes among different populations.
• Health disparities can negatively affect access to care.
• Transportation and health insurance status can be factors in health disparities
• Social determinants of health impact health, quality of life, and well-being.
• Healthy People initiatives focus on reducing health disparities, achieving health equity, and improving health for all.
• Examples of health disparities include higher rates of obesity in African American females, underinsurance among Hispanics, and chronic hepatitis B in Asian Americans.

Factors Affecting Access to Care

• Transportation access, healthcare accessibility, and health insurance coverage are factors.
• Religion, location, sensory deficits, disabilities, socioeconomic status, race, ethnicity, gender, sexual orientation, and limited education are also factors.

Equity, Equality, and Health Literacy

• National CLAS standards, strive to improve quality, and eliminate healthcare disparities.
• Health equity attains the highest level of health for all individuals by valuing all people and addressing inequalities.
• Health equality distributes the same resources to everyone, but may not ensure fair distribution.
• Health care workers need to adjust for individual needs to provide equitable and equal care.
• Health literacy includes personal and organizational health literacy.
• Personal health literacy enables individuals to obtain, process, and comprehend health information.
• Organizational health literacy helps individuals understand and use health information and services.

Improving Health Literacy

• Provide understandable information and services.
• Collaborate to familiarize individuals with their health information.
• Share information through trusted messengers.
• Use certified interpreters for different languages.

Vulnerable Populations

• Vulnerable populations face higher risks for poor health outcomes.
• Vulnerable populations face barriers to social, economic, and environmental resources.
• Examples include immigrants, older adults, marginalized ethnic groups, individuals in poverty, clients with chronic illnesses, and veterans.
• They have increased risks for illnesses, environmental chemical exposure, and public health emergencies, such as the COVID-19 pandemic.
• Demographics, health status, and socioeconomic factors affect vulnerable populations.

Demographic Factors

• Demographics like age, language, household type, population density, race, ethnicity, and sexuality influence risks.
• Older adults are more vulnerable due to physical disabilities and dependence.
• Language barriers decrease health literacy and communication.
• Population density affects the spread of infection and illness.
• Racial and ethnic groups face negative health outcomes due to factors like discrimination.
• Intersectionality involves multiple, simultaneous disparities that increase stress and risky behaviors.

Health Status Factors

• Chronic conditions and disabilities negatively affect vulnerable populations.
• Obesity, diabetes, and hypertension increase risks for complex health issues.
• Disabilities impact access to insurance, healthcare, and activities of daily living.
• Health insurance increases access to care; lack of insurance creates financial barriers.

Socioeconomic Factors

• Socioeconomic factors like education, employment, income, and poverty impact vulnerable populations.
• Lower incomes and poverty limit educational opportunities and decrease health literacy.
• Employment status affects access to basic needs and healthcare.
• Employer-provided health insurance is common, but job loss limits access.

Health Disparities Related to Sexuality and Gender Identity

• Clients have diverse sexuality and gender identities.
• Transgender people have a gender identity different from their assigned sex at birth.
• Marginalized sexual groups include lesbian, gay, bisexual, and questioning individuals.
• These populations face prejudice, stigma, and discrimination.
• Marginalized youth are vulnerable to bullying, violence, depression, substance use, STIs, and suicide.
• These experiences affect schooling, employment, relationships, and health outcomes.

Role of the Nurse with Diverse Populations

• Cultural awareness informs health assessment considerations.
• Cultural health assessments collect data on cultural attitudes, beliefs, values, and customs.
• Assessments are time-intensive but essential for culturally competent care.
• The nurse should start collecting these data at the beginning of the first client encounter to help the nurse engage in open communication, gain client cooperation, and obtain accurate information regarding the client to enhance the client’s health outcome
• Holistic nursing care can take place throughout the remaining steps of the nursing process with these cultural health assessments
• Cultural health assessments gather data about a client's culture and its effect on health.
• Data should be collected early to foster open communication and cooperation.
• Thorough assessments enable holistic nursing care.

Communication Strategies

• For hearing loss, face the client and speak clearly.
• Use a certified medical interpreter when there is a language barrier.
• Family members may not be appropriate interpreters due to lack of medical terminology knowledge.
• Nurses should still maintain eye contact with the client even with an interpretor.
• A nurse is using a medical interpreter, they should address and maintain eye contact with the client during the conversation.

Cultural Assessment Tools

• Nurses can use cultural assessment tools to gather information, which impacts client care.
• The Purnell Model assesses cultural attributes across 12 domains.
• Leininger’s Sunrise Enabler visually portrays elements of the Theory of Culture Care Diversity and Universality.
• Leininger’s Sunrise Enabler assists nurses in providing culturally congruent care to enhance health and well-being of all clients at all stages of life
• Leininger’s Sunrise Enabler includes demographics
• Leininger’s Sunrise Enabler have five categories that are interrelated

Leininger's Sunrise Enabler Categories

• The upper level resembles rising sun rays
• The rays of the sun represent the basic elements of the assessment
• The central core includes: Influencers, care expressions, patterns, and practices and holistic health, well-being, disability, illness, dying, and death
• The focus on the individual, families, groups, communities, or institutions in diverse health contexts
• The three modes of care decisions and actions

Demographic Information

• Standard demographic information is necessary as part of the cultural health assessment
• Client’s name and gender can be different from the one that is on their birth certificate or insurance information
• A client’s race, ethnicity, and cultural background provides information the nurse can use to look upstream and identify risk factors for health disparities

Upper Level of Sunrise Enabler

• Resembles rising sun rays, representing cultural and social structures dimensions that create a worldview of culture

Rays of the Sun

• Technological factors
• Religious, spiritual, and philosophical factors
• Kinship and social factors
• Cultural values, beliefs, and lifeways
• Biological factors
• Political and legal factors
• Economic factors
• Educational factors

Technological Factors

• Determining whether a client has access to technology including a phone, internet, or computer is necessary to help determine their access to health care.

Religious, Spiritual, and Philosophical Factors

• It is important to determine a client’s religion or spirituality allows the nurse to assess or investigate the needs of that specific religion or spirituality beliefs as they intersect with the client’s health care needs

Kinship and Social Factors

• Marital status can be looked at as: single, separated, married, divorced, or widowed

Cultural Values, Beliefs, and Lifeways

• Gaining knowledge regarding the client’s values, beliefs, and lifeways or way of living enhances the nurse’s ability to provide holistic care by understanding what is important for the client.

Biological Factors

• Biological factors affects the client for any personal or family history regarding physical and mental illnesses, hereditary and genetic conditions, and their impacts on the client’s life.

Political and Legal Factors

• Political and legal factors can also impact a client's health care
• An individual's political views can influence their values and beliefs, which, as a result, can affect their health behaviors.
• Legal status, such as being an undocumented immigrant, often results in lack of preventive care.

Economic Factors

• Economic factors involve education level, employment status, income status, and community situations.

Educational Factors

• Health literacy is affected by educational factors such as determining the level of education that the client has completed.

Central Core of Sunrise Enabler

• Comprises the interactions among the basic elements.

Categories of the Central Core

• Influencers
• Care expressions, patterns, and practices
• Holistic health, well-being, disability, illness, dying, and death

Focus on the Individual

• This category includes the client’s folk (generic) care, integrative care practices, and professional care–cure practices.

Three Modes of Care

• These modes are similar to the purposes of client education—namely, health promotion and illness prevention; restoration or maintenance of health; and adaptation to permanent illness or injury.
• Culture care preservation and maintenance
• Culture care accommodation and/or negotiation
• Culture care repatterning and restructuring

Holistic nursing requires skills to care for diverse populations with sensitivity. Cultural competence reduces health disparities and provides equitable care. Understanding cultural differences and self-assessment enhances cultural awareness.