NCM-120j-Module.docx

![](media/image2.png)**Ateneo de Zamboanga University** **College of Nursing** **NCM120j - Decent Work Employment and Transcultural Nursing** **Course Module** **Prepared by: Ma. Christina B. Celdran, PhD, RN** **Course Description:** This course will introduce the theory and concepts in transcultural nursing and the role of culture in understanding and caring for diverse clients in healthcare settings. It will provide an overview of the influence of culture on healthcare practices and in the delivery of nursing care for individuals, groups, and communities. The course is designed to assist nursing students in learning about culture, belief systems, values, and practices that are specific to identified cultures to better understand and provide nursing care that is both culturally competent and culturally sensitive in nature. - Various cultures and concepts of health and illness will be examined; special emphasis will be placed on providing health care in the Philippine Setting. - Culture will also be defined as behavior and established norms found in diverse healthcare settings. Understanding the "culture of nursing" institutional norms, behaviors, and communication patterns is critical to the students' transition into the workplace. - Students will gain self-awareness of their racial, ethnic, and cultural background as a prerequisite for eliciting and responding to clients, needs. **Cross-cultural communication** will be addressed to provide the student with skills to negotiate cultural differences between clients and providers around health and illness issues. **Chapter 1 Decent Work Employment** - Conditions of work - Safety and remuneration - Respect for the physical and mental integrity of the workers in the exercise of his/he employment - Opportunities for work that is productive - Delivers a fair income - Security in the workplace - Social protection for families - Better prospects for personal development and social integration - Freedom for people to express their concerns - Organize and participate in the decisions that affect their lives - Equality of opportunity and treatment for all women and me - Decent work **sums up the aspirations** of people in their working lives. It involves opportunities for work that is productive and delivers a fair income= Job Creation -- no one should be barred from their desired work due to lack of employment opportunities- - The type of work that is assigned to the employee - Can refer to the basic daily tasks carried out as part of a job and can refer to other non-routine tasks that may be required. - The [nature of an employee\'s work] is best defined as [the type of work that is assigned to the employee ] - The nature of this work may be [summed up in the employee\'s title.] - For example: Head nurse is supervises his/her ward but also does task of a ward staff nurse. - **The nature of this work** may be [summed up in the employee\'s title.] - Refers to the quality of performance, relative to others with jobs of a similar nature. - Related to level of employment. - May be graded objectively, or perceived in a more subjective manner by your managers. - Complexity of the job performed by employees and the nature of the job are also **directly related** - Most organizations are structured and in different ways - Most of the complex work is performed by managers and executives - The nature of these roles and their work is typically more complex than of the entry-level positions. - **Duration -** the time period of employment during which period you will remain an employee - **Pay Structure -** salary and perks given as part of being employed - **Pay slip -** lists deductions gross salary and the in-hand salary an employee get. - **Income Tax -** a type of tax that governments impose on income generated by businesses and individuals within their jurisdiction. - the [nature and/or existence of] activities that an employee is required to perform. - The employer establishes the terms and conditions of the employment contract, which should be structured according to the legal provisions set by Philippine labor laws and regulations. 1. **Regular or Permanent Employment** - Is when an employee performs activities that are usually necessary or desirable in the usual business or trade of the employer. - Enjoy the benefit of security of tenure provided by the Philippine constitution - Cannot be terminated for causes other than those provided by law and only after due process is given to them. 2. **Contracting** - Also know as **Term or Fixed Employment** - Is when the employee renders service for a definite period of time and the employment contract must be terminated after such period expires - Determined by the commencement and termination of the employment relationship - Fixed-term Employment is highly regulated and subjected to the following criteria: - Be voluntarily and knowingly agreed upon by the parties without any force, duress or improper pressure being brought to bear upon the employee and absent any vices of consent; or - It satisfactorily appears that the employer and the employee dealt with each other on more or less equal terms with no dominance exercised by the former over the latter 3. **Project Employment** - Defined when an employee is hired for a specific project or undertaking and the employment duration is specified by the scope of work and/or length of the project. - A project employee may acquire the status of a regular employee when they are continuously rehired after the completion of the project 4. **Seasonal Employment** - Is when the work to be performed is only for a certain time or season of the year and the employment is only for that duration. ◦ Common practice to retail, food and beverage, hospitality and other related industries as augmentation to workforce. 5. **Casual Employment** - When an employee performs work that is not usually necessary or primarily related to the employer's business or trade. - The definite period of employment should be made known to the employee at the time they started rendering service - Rules, procedures and stipulations that employees must abide by as part of their contract. - Breaking conditions of employment can result in disciplinary procedures or dismissal. - **Art 83**: The normal hours of work of any employee shall **not exceed eight (8)** hours a day. - Health personnel in cities and municipalities with a population of at least one million (1,000,000) or in hospitals and clinics with a bed capacity of at least one hundred (100) shall hold regular office hours for eight (8) hours a day, for five (5) days a week, exclusive of time for meals - except where the exigencies of the service require that such personnel work for six (6) days or forty-eight (48) hours, in which case, they shall be entitled to an additional compensation of at least thirty percent (30%) of their regular wage for work on the sixth day. **Republic Act 7305 Magna Carta of Public Health Workers** **Salaries to be Paid in Legal Tender. (SEC. 19 (MAGNA CARTA OF PUBLIC HEALTH WORKERS)** - Salaries of public health workers shall be paid in legal tender of the Philippines or the equivalent in checks **Art. 84. Hours worked.** - Hours worked shall include - \(a) all time during which an employee is required to be on duty or to be at a prescribed workplace; and - \(b) all time during which an employee is suffered or permitted to work. - Rest periods of short duration during working hours shall be counted as hours worked. **Art. 85. Meal Periods**. Subject to such regulations as the Secretary of Labor may prescribe, it shall be the duty of every employer to give his employees not less than sixty (60) minutes time-off for their regular meals **Art. 86. Night shift differential.** - Every employee shall be paid a night shift differential of not less than ten percent (10%) of his regular wage for each hour of work performed between ten o'clock in the evening and six o'clock in the morning. **Art. 87**. **Overtime work.** - Work may be performed beyond eight (8) hours a day provided that the employee is paid for the overtime work, an additional compensation equivalent to his regular wage plus at **least** **twenty-five percent (25%)** thereof. - Work performed beyond eight hours on a **holiday or rest day shall be paid an additional** compensation equivalent to the rate of the first eight hours on a holiday or rest day plus at **least thirty percent (30%)** thereof. **Art. 88**. **Under time not offset by overtime.** - Under time work on any particular day shall not be offset by overtime work on any other day. - Permission given to the employee to go on leave on some other day of the week shall not exempt the employer from paying the additional compensation required. **Art. 89. Emergency overtime work**. Any employee may be required by the employer to perform overtime work in any of the following cases: **Art. 90. Computation of additional compensation**. **Art. 91. Right to weekly rest day.** **Art. 92. When employer may require work on a rest day**. The employer may require his employees to work on any day: **Art. 93. Compensation for rest day, Sunday or holiday work**. *Although I'm not being paid to take calls on my days off, my supervisor says that if she needs to, she can call me at home and I'd have to come to work. Is this legal?* - Your employer is probably taking this tack because of staffing shortages, but you may not be obligated to take calls. ***Unless you were hired with this commitment clearly understood***, as in an employment agreement, your employer can't force you to take call with or without compensation. Carefully review the written job description you received when you accepted your current position to see if you missed any fine print. - If the supervisor continues to intimidate you, speak to someone in your facility's human resources department regarding your rights to refuse the call. If your employer remains unreasonable, look for work elsewhere. **Art. 94. Right to holiday pay.** **Art. 95. Right to service incentive leave** - - - - **Art. 99. Regional minimum wages.** The minimum wage rates for agricultural and non-agricultural employees and workers in each and every region of the country shall be those prescribed by the Regional Tripartite Wages and Productivity Boards. (As amended by Section 3, Republic Act No. 6727, June 9, 1989). **PAYMENT OF WAGES** **Art. 102. Forms of payment.** - No employer shall pay the wages of an employee by means of promissory notes, vouchers, coupons, tokens, tickets, chits, or any object other than legal tender, even when expressly requested by the employee. - Payment of wages by check or money order shall be allowed when such manner of payment is customary on the date of effectivity of this Code, or is necessary because of special circumstances as specified in appropriate regulations to be issued by the Secretary of Labor and Employment or as stipulated in a collective bargaining agreement. **Art. 103. Time of payment.** - Wages shall be paid **at least once every two (2) weeks or twice a month** at intervals not exceeding sixteen (16) days. - If on account of **force majeure** or circumstances beyond the employer's control, payment of wages on or within the time herein provided cannot be made, the employer shall pay the wages immediately after such force majeure or circumstances have ceased. - No employer shall make payment with less frequency than once a month. - The payment of wages of employees engaged to perform a task that cannot be completed in two (2) weeks shall be subject to the following conditions, in the absence of a collective bargaining agreement or arbitration award: - That payments are made at intervals not exceeding sixteen (16) days, in proportion to the amount of work completed; - That final settlement is made upon completion of the work. **WORKING CONDITIONS FOR SPECIAL GROUPS OF EMPLOYEES** - grant to any pregnant woman employee who has rendered an aggregate service of at least six (6) months for the last twelve (12) months, maternity leave of at least two (2) weeks prior to the expected date of delivery and another four (4) weeks after normal delivery or abortion with full pay based on her regular or average weekly wages - The employer may require from any woman employee applying for maternity leave the production of a medical certificate stating that delivery will probably take place within two weeks. - Provided, further, That upon separation of the public health workers from services, they shall be entitled to all accumulated leave credits with pay - Health workers are the backbone of health systems. To perform effectively they need secure jobs, fair pay, safe a healthy working conditions, adequate education continuing professional development, career opportunities, equal treatment and social protection for themselves and their families. - Working conditions and income remain common key motivations for individual health workers to move abroad, including: - dissatisfaction with working conditions - as excessive workloads - long hours of work - poor work relations and professional development and recognition **Benefits:** 1. Wages and compensations Benefits - - - - - - - - Leave Service - - - De Minimis Benefits 2.. Mandatory Government contributions - SSS/GSIS - Philhealth - Pagibig Employee minimum wage **OVERTIME PAY** **Premium Pays** - **Regular Holidays -** It refers to fixed dates like Christmas Day, Independence Day, or New Year's Day. However, National Heroes Day and Holy Week are considered regular holidays despite changing dates. - **Special Holidays -** also known as **Special Non-Working Holidays**, they fall on flexible dates, depending on the circumstance. - **Double Holidays -** this is a rare occurrence wherein a regular holiday and a special holiday fall on the same day. **13^th^ Month Pay** - The 13 month pay is often mistaken as the Christmas Bonus, but technically, it's a monetary bonus mandated by law. - The Christmas bonus is only a voluntary gesture from the employers. - According to the law, the 13 month pay is given either in 2 installments (May and December) or in full before December 24. **Separation Pay** - Separation pay is also part of the Labor Code and is given to employees terminated from the company. - The only exception are those terminated because of misconduct or crime involvement. **2 types of Separation Pay** - **1/2 Month Pay per Year of Service** -- an employee is eligible for separation pay with the value of one-half (1/2) month pay for every year of service if the separation from the service is because of retrenchment to save the company from pitfalls, closure or termination of the operations due to bankruptcy and other bad instances, and grave illness incurable within 6 months or harmful for co-workers. - **One-Month Pay per Year of Service** -- an employee is eligible for a separation pay worth of one month per year of service if the termination of the contract is because of: installation of devices or machines that reduce the number of labors, redundancy, or when there is excessive manpower, impossible reinstatement to the former position because of significant reasons. **Retirement Pay** Upon the age of **60 years or more**, an employee who has served at the establishment for at least five years may be granted a retirement pay equivalent to at least one-half month of salary for every year of service. A fraction of at least six months is considered as one whole year. As stipulated by the DOLE National Wages and Productivity Commission, *"The minimum retirement pay shall be equivalent to one-half (1/2) month salary for every year of service, a fraction of at least six (6) months being considered as one (1) whole year."* - Included in the one-half pay are 15 days salary based on the latest salary rate, cash equivalent of 5 days of service incentive leave, one-twelfth (1/12) of the 13th month pay. **Leave benefits** - Service Incentives Leave - Parental Leaves - Maternal - Paternal - Solo parent - Special Leave Benefits for Women - Bereavement Leave - De Minimis Benefits Mandatory Government Contributions **SSS -- Social Security System** - The benefits given by SSS are for sickness, maternity, disability, retirement benefit (pension), death cash grant, funeral grant, and salary loan. **PhilHealth** - This serves as a health insurance program for private employees providing financial aid and service privileges for health care. - PhilHealth has removed the previous salary brackets, creating a new condensed contribution table with P10,000 as the salary floor and P40,000 as the ceiling. The computation starts at 2.75% of the basic salary per month, and the payment is shared by employer and employee. - Inpatient benefits (hospitalization, facility fees, and physician/surgeon fees) - Outpatient benefits (day surgeries, radiotherapy, hemodialysis, outpatient blood transfusion, primary care benefits) - Z benefits (financial/medical aid for the patients with cancer and in need of surgeries) - SDG related (Malaria package, HIV-AIDS package, anti-Tuberculosis treatment, voluntary surgical contraception procedures, and animal bites treatment) **PAGIBIG** - Also known as the **Home Development Mutual Fund** (HDMF) - Pag-IBIG is another form of national savings program and the financing office for affordable shelter. - the total contribution is shared between you and the employer. The highest compensation per month subjected to Pag-IBIG contribution is P5,000 and it means that the employer and employee will pay P100 each as the maximum contribution. - Pag-IBIG lets you have the following benefits: housing loan, multi-purpose loan, calamity loan, secured savings. **Health, Safety and Social Welfare Benefits** **Art. 156. First-aid treatment**. - Every employer shall keep in his establishment such first-aid medicines and equipment as the nature and conditions of work may require, in accordance with such regulations as the Department of Labor and Employment shall prescribe. - The employer shall take steps for the training of a sufficient number of employees in first-aid treatment. **Art. 157. Emergency medical and dental services** - It shall be the duty of every employer to furnish his employees in any locality with free medical and dental attendance and facilities consisting of: - Full time Registered Nurse -- exceeds 50 but not more than 200 - Full time RN, part time Physician and dentist and an emergency clinic -- exceeds 200 but not more than 300 - Full time Physician, Dentist and RN as well as Dental clinic and an infirmary or emergency hospital with one bed capacity per 100 employees, when the number of employees exceeds 300 **Art. 160. Qualifications of health personnel.** - The physicians, dentists and nurses employed by employers shall have the necessary training in industrial medicine and occupational safety and health. The Secretary of Labor and Employment, in consultation with industrial, medical, and occupational safety and health associations, shall establish the qualifications, criteria and conditions of employment of such health personnel **Art. 161. Assistance of employer** - It shall be the duty of any employer to provide all the necessary assistance to ensure the adequate and immediate medical and dental attendance and treatment to an injured or sick employee in case of emergency **EMPLOYEES' COMPENSATION AND STATE INSURANCE FUND** **Art. 166. Policy.** The State shall promote and develop a tax-exempt employees' compensation program whereby employees and their dependents, in the event of work-connected disability or death, may promptly secure adequate income benefit and medical related benefits. **Disability** - An employee who sustains an injury or contracts sickness resulting in **temporary total disability** shall, for each day of such a disability or fraction thereof, be paid by the System an income benefit equivalent to **ninety percent** of his average daily salary credit - Subject to the following conditions: the daily income benefit shall **not be less than Ten Pesos** nor **more than Ninety Pesos**, nor paid for a continuous period longer than **one hundred twenty days,** except as otherwise provided for in the Rules, and the System shall be notified of the injury or sickness. - For **sickness or sustains an injury resulting** in his **permanent total disability** shall, for **each month until his death**, be paid by the System during such a disability, an amount **equivalent to the monthly income benefit, plus ten percent** thereof **for each dependent child**, but not exceeding five, beginning with the youngest and without substitution: - Provided, That the monthly income benefit shall be the new amount of the monthly benefit for all covered pensioners, effective upon approval of this Decree. - The monthly income benefit shall be guaranteed for five years, and shall be suspended if the employee is gainfully employed, or recovers from his permanent total disability, or fails to present himself for examination at least once a year upon notice by the System, except as otherwise provided for in other laws, decrees, orders or Letters of Instructions. **Death** - Funeral benefit of **20,000 pesos** regardless of number of monthly contributions, given to the person who spent for the funeral\ -- Monthly pension or lump-sum cash benefit for the legal spouse and legitimate, illegitimate or legally adopted children younger than 21 years old (up to 5 children), and older children with permanent disabilities - That the monthly income benefit shall be guaranteed for five years: - Provided, further, That if he has no primary beneficiary, the System shall pay to his secondary beneficiaries the monthly income benefit but not to exceed sixty months - Provided, finally, That the minimum death benefit shall not be less than fifteen thousand pesos. - For members who died in a workplace accident or due to an occupational illness, additional **Employee Compensation benefits** are given to beneficiaries. - **PAG-IBIG or HOME DEVELOPMENT MUTUAL FUND (HDMF)** - The death benefit amount is a percentage of the Total Provident Benefits. The Provident total is the sum of the member's monthly contributions, employers' contributions for the member and dividends - **OWWA (For OFWs)** - **Burial benefit** of 20,000 pesos\ **Insurance benefit** of 100,000 pesos if death is due to natural cause or 200,000 pesos if death is due to accident **UNFAIR LABOR PRACTICES** - Law Protecting Workers - Labor law - Magna Carta for Public Health workers - Salary Standardizing Law - GSIS/SSS/PhilHealth/Unified ID System **Chapter 2 CONTINUING PROFESSIONAL DEVELOPMENT** - Accountable to the public for the quality of nursing care it provides - Assume a lifelong commitment to learning - Beginning of a lifelong process of enriching one's SKA - Maintenance of safe and competent practice through continued learning - Assimilation of knowledge and skills - Proficiency - Ethical and moral values - Provides and ensures the continuous education of registered professionals with the latest trends in the profession brought by modernization - Raises and maintains the highest standard and quality of practice of the profession - Makes the profession globally competitive - Promotes the general welfare and safety of the public - Planned programs provided by the employing agency - Improvement of professional practice - Fullest development of the nurse as a nurse - Train and retrain employees to improve performance and communication ability **FORMAL STUDIES LEADING TO DEGREE COURSES** **Baccalaureate Degree in Nursing** - Graduates of the 2-year program will have to enroll in the regular BSN course under the new curriculum **Graduate Education In Nursing** - Leading to master's degree - Nurses capable of improving nursing care through advancement of nursing theory - Graduates: critical, self-directed practitioner, professional leader, productive contributor to nursing **Doctoral Degree Program** - Prepare nurses to become administrators, research specialists, consultants of nursing service, education programs, hospital services - Consider competencies - Quality of professional experience - Quality of scholarship - Ability to do creative writing - Driven and ability to take criticisms - Resolve conflicting recommendations - Retain self-control **National Professional Nursing Organizations** - Phil Nurses Association - Association of Nursing Service Administrators of the Phil - National League of Phil Govt Nurses - NEPRA Guild - Critical Care Nurses Association of the Phil - Psychiatric Nursing Specialists - Occupational Health Nurses Association of the Phil - Operating Room Nurses Association of the Phil **CPD units** - refers to the process of tracking and documenting the skills, knowledge and experience formally and informally as you work, beyond any initial training - It's a record of what you experience, learn and then apply - **The Continuing Professional Development Program Management Committee** (CPD-PMC) of the Professional Regulation Commission clarifies that Continuing Professional Development (CPD) as mandatory requirement in the renewal of professional license under Section 10 of R.A. 10912, otherwise known as the CPD Law of 2016, shall be implemented after the effectivity of the Implementing Rules and Regulations (IRR) of R.A. 10912 which will be in March 2017. - Thereafter, the CPD Council for each regulated profession shall issue its Operational Guidelines to implement the general IRR for its profession. - However, for those professionals whose Professional Regulatory Laws require CPD credit units prior to the renewal of Professional Identification Cards (PICs), or the professional license, compliance with CPD remains mandatory. **How many CPD units are required for Nurses? [15 UNITS]** - Registered and licensed professionals shall complete the required units every three (3) years - Any excess CUs earned shall not be carried over the next three-year period except credited units earned for doctorate and master's degrees or specialty trainings which shall only be credited once during the compliance period. - Credit units may be earned by professionals who participate in programs that emanate from the PRB for the development of the profession. REQUIREMENTS FOR INACTIVE NURSES RETURNING TO PRACTICE - Nurses who were inactive for 5 years are required to undergo one-year didactic training and 3 months of practicum **Philippine Qualification Framework** - It is a quality assured national system for the development, recognition and award of qualifications based on standards of knowledge, skills and values acquired in different ways and methods by learners and workers of the country - It refers to the formal certification that a person has successfully achieved specific learning outcomes relevant to the identified academic, industry or community requirements. A Qualification confers official recognition of value in the labor market and in further education and training. - To adopt national standards and levels of learning outcomes of education - To support the development and maintenance of pathways and equivalencies that enable access to qualifications and to assist individuals to move easily and readily between the different education and training sectors and between these sectors and the labor market - To align domestic qualification standards with the international qualifications framework thereby enhancing recognition of the value and comparability of Philippine qualifications and supporting the mobility of Filipino students and workers. - Learners - Workers - Professionals - Assessment - Investigation - Preparation - Commitment - Retention - Transition - At this stage, you should focus on **self-awareness** and **getting feedback** from other people about your strengths and weaknesses. - Taking self-assessment tests or working with a career coach can help you move through this phase with more ease. - At this stage, you start to become more aware of all of the options available to you. If you're feeling confused or overwhelmed, then you're probably doing it right. - During this stage, you should begin networking and talking to professionals that are a few years ahead of you. They can offer guidance on what worked for them and the steps they took to identify their career path. - It's important to have a positive attitude and keep an open mind during the investigation stage. You may be surprised by the opportunities that sound interesting to you. - Once you reach the preparation stage, you're working in your chosen profession and beginning to gain more knowledge and skills. You're also starting to set career goals and think about your future. - This stage is one of the most exciting because you've finally gained some clarity and are beginning to make forward momentum. - Many people at this stage realize that they still aren't working in their ideal position, but that's normal. This stage is about building the experience you need to move to the next point in your career. - Once you reach the commitment stage, you've narrowed in on the type of work you want to do and you have a specific action plan for moving forward. You're focused on finding new opportunities and taking on additional responsibilities at work. - It's important not to lose focus or become distracted at this point in your journey. Instead, take the time to lean into your network and focus on career development. - By now, you're a respected professional within your industry, and other people look to you as a leader. Your knowledge and experience have made you a proven expert within your field. - It feels great to reach the retention stage, but there are downsides as well. Many people get comfortable at this stage, relax and stop trying to grow and progress further. - It's essential to keep growing, improving your skill sets and staying current with industry standards. And you should continue looking ahead and anticipating future career milestones - At this point, it's time to transition to the next phase of your career. The transition stage is an uncomfortable point to be at because it can feel like you are starting over from scratch. Fortunately, you've already built the resiliency and self-awareness you need to figure out what your next move is. A. **Establishing an effective counseling relationship**. - B. **Determining current motivation for career planning**. - C. **Building relevance for career planning.** - D. **Exploration** - Exploration helps clients discover ways to implement aspects of their vision while concomitantly attending to issues of meaning and personal context. This is most effectively done by capitalizing on the renewed sense of energy and hope that arises during initiation. While formal assessment and occupational information sources may be useful, informal strategies tend to produce more meaningful, more accurate, and more enduring results. These include information interviewing, relational networking, job shadowing, and work experience. E. **Decision-making** - Decision-making has one dominant issue: *How to select the most appropriate option from the range of alternatives discovered to date*. - Formal decision-making models and strategies may be useful; however, these strategies by themselves rarely leave clients with a good feeling for the decision. Most clients are more comfortable with decisions which "emerge" as a result of engagement in the career planning process. When initiation and exploration have been thorough, a "right choice" crystallizes for most clients. Formal strategies may then be used to confirm a choice, rather than determine a choice. 2. **Preparation** - The **five processes model** has been used with a variety of groups (e.g., Native Canadians in northern communities, street kids in urban settings, inmates of correctional facilities, youth in schools, adults in transition). - These groups often reported disenchantment and disillusionment with available career planning services. - However, the initiation exercises excited them, increasing their hope and nurturing their dreams. This excitement led to vigorous and thorough exploration\--even the most reticent clients were captivated by processes which allowed them to explore their passions in meaningful ways. Having found a focus for their passion, they were more committed to planning ways to realize their dreams and were more likely to follow through with their plans. Because they understood each process as it developed, they became less reliant on formal counseling. The seeds of self-sufficiency and adaptability were planted. - The dynamic nature of the occupational scene demands a dynamic system for career planning interventions; one that attends to issues of client uniqueness and personal meaning. By focusing on the critical career planning processes, counselors allow themselves the flexibility to attend to unique client needs - A job board is a useful tool for nurses during a job search. Job boards are websites that employers can use to post job openings with information about the position and the requirements needed to apply. Candidates can typically apply to the job through the job board\'s website or they can go to the employer\'s website to fill out an application. Job boards can be a general website that includes a large number of job opportunities, or they can be a specialized job board that includes posting for specific types of work within a field. - You can look for nursing job boards that provide information specifically about nursing jobs available. To register for job boards, sign up for an account through the job boards website. Typically, you\'ll need to create a username and password, and supply an email address. - During a job search, it\'s important to check the qualifications in the job posting to ensure that you are qualified. - Some nursing jobs may require specialized certifications and education, which legally require employers to only hire nurses that meet those qualifications. - If you are interested in a nursing job that requires a specific certification, research the required certification to learn what you need to do to obtain it and how long it takes to complete. - Most individuals can complete nursing certifications within two to four years. - Many job boards and job search websites allow you to enable job alerts, which means you can get notified whenever a new job becomes available. - Since many hospitals and healthcare facilities often post several new jobs at once, you can filter your job alerts to only notify you of jobs you\'re interested in or qualified for. - This is an essential part of your job search since you can know as soon an employer posts a new opening. - Being one of the first applicants for a job posting can set you apart from other candidates and may make you more likely to get the job if the employer is looking to hire someone quickly. - When looking for a new job, it\'s important to utilize your network to help you find job opportunities. - Throughout school and work experience, individuals typically build up a network of connections within their field. Establishing connections is useful in career advancement, learning new skills and finding job openings. - Many employees find out about new job openings within a company before job boards have a job posting, so you can ask contacts within your network, like nurses, doctors or hospital faculty, to see if they are aware of any job opportunities. - An added benefit of networking is that your contacts may keep you in mind if they find out about a job at a later time and inform you of any job openings they find out about. - Volunteering is a great way to build up your network, gain experience and learn about job opportunities. During your job search, volunteering can allow you to hear about job openings you might not have heard about otherwise. - If an employer is looking to fill a position within a healthcare facility internally, they may feel compelled to hire a volunteer that already has experience within their organization. - To find volunteer opportunities, look online for healthcare facilities, clinics or hospitals that you feel are a good fit for you to work in, and check if they are accepting volunteers. Many healthcare facilities accept volunteer nurses to do blood work and administrative work. - When scanning job board sites, you may find it useful to have a set of keywords to focus on so that you can find jobs that are the right fit for you. Using keywords can help narrow your search and ensure that you are finding job posting that you are qualified for. For example, since nurses can typically work overnight hours, you may search for the keyword \"first shift\" if you want to work during the daytime instead of nighttime. Some job sites allow you to enter keywords into the search bar that allows you to search for jobs using your chosen keywords. - A job fair is an event where employers and recruiters can meet potential employees and give information out about their company. - Nurses can use a job fair to find healthcare facilities that are actively hiring. - Employers at job fairs typically offer handouts, business cards and leaflets about their organization to job seekers so that they have a way of contacting employers. - Many healthcare organizations host job fairs for hospitals and clinics to hire a large staff within a short period of time, so nurses may have a good chance of learning about potential job opportunities at job fairs. - Job searches can often take several months, and it may seem like it\'s taking too long to find a new nursing job. - It\'s important to stay positive when looking for jobs, especially since nursing is a field that requires patience and empathy. - Try to use any discouragement you might feel and channel it as motivation to continue searching for jobs. - It\'s important to show employers that you are eager and excited to start a new job, while also remaining calm and understanding the longer job search process. - When conducting a job search, it\'s important to apply for several jobs at different companies, instead of only applying for a few jobs. - Applying for several jobs can increase your chances of getting an interview. - For example, if you are applying for one job a day, you might get an interview after applying for a month straight. Though, if you are applying to five jobs a day, you may be more likely to get an interview after two weeks, since you are increasing the rate that you\'re sending out applications. - Try to find as many jobs openings within healthcare facilities as possible, so that your likelihood of getting an interview and securing a position is higher. - Your résumé is one of the most important documents you will ever prepare. It is a statement of your **abilities, skills, achievements, and aspirations**. Essentially, it is an advertisement where you are the product --- your own personal marketing tool. - Contact Information - Professional summary - Work history - Skills - Education - What is a portfolio development? - Portfolio development is the process by which a student documents and demonstrates college-level competencies (knowledge and skills) acquired in environments and agencies outside the traditional higher education classroom. - While you are developing your résumé, it is important to keep in mind: - The average amount of time employers spend reviewing your résumé is 6 seconds. That is not a lot of time to communicate your strengths, skills, and goals. Therefore, it is important to clearly and concisely capture their attention. - **Résumés are fluid** - that is, they are never \"done.\" You will be adding, editing, and reformatting throughout your working life. Sometimes you will need to tailor your résumé to a specific field or even a particular job in a specific company. - **Résumés are also individualized** --- what works for your roommate will not necessarily work for you, and that\'s a good thing. You want your résumé to reflect your **unique abilities, skills, achievements**, and **aspirations**. - A résumé alone will never get you a job. The primary function of your résumé is to convince an employer to interview you. It is the interview that will hopefully lead you to the job offer. - Then make a list of your: - Significant [**accomplishments**](https://www.myperfectresume.com/career-center/resumes/how-to/quantify-your-accomplishments) from previous jobs. - Soft, hard and technical skills and match them to the required skills in the job ad. - Employers' names, dates of hire, locations, job titles and responsibilities. - Educational credentials such as a college degree, certifications or licenses. - Volunteer work. - Awards and honors. - **Tailor each resume you write to the target job to make it most effective** - Now that you've prepared your information, here's a secret on how to create a resume that many job seekers overlook: You have to choose a suitable [**resume format**](https://www.myperfectresume.com/resume/formats) before you can begin to write a resume. - How to choose the best resume format? There are three standard formats. Each uses the same resume sections but organizes them differently, so choose one that works best for your work experience level and your professional goals. - What kinds of **skills, experience**, and **background** are important to potential employers in your field? - What **attributes** do you have that would be of interest to a potential employer? - Research jobs that interest you. - Look at the **job requirements** that occur most frequently for people at your experience level (co-op/internship, entry level, experienced, etc.). Hunt for key words and phrases that are common to the industry. Visit professional organization websites. Get to know what skills and attributes employers are looking for in a candidate. - What do you have to offer an employer? - How do your experiences and abilities complement the industry research you did? - **Highlight your skills, strengths, and accomplishments that fit the expectations and needs of jobs in your field.** - Remember to examine all facets of your life: work, volunteer, and activities. After all, managing the basketball team for four years might be more relevant than your paid job at the convenience store. **SECTIONS IN A RESUME** - [Contact Information](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) - [Job Objective](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) - [Educational Background](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) - [Honors and/or Awards](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) - [Skills](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) - [Relevant Coursework](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) - [Experience](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) - [Activities and/or Professional Associations](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) - [Volunteer Experience](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) **Contact information:** - Make sure your contact information is up-to-date and easy to find. Always put it at the top, in the header. - Here's what to include in your resume contact information: - Full name - Phone number - Professional email address - City and ZIP code - A link to your professional social media account, website or portfolio if you have them. - Use a [**resume summary**](https://www.myperfectresume.com/career-center/resumes/how-to/summary) if you have [**work experience**](https://www.myperfectresume.com/career-center/resumes/how-to/perfect-work-history) and you are not changing industries or jobs. - When making a resume, use a [**resume objective statement**](https://www.myperfectresume.com/career-center/resumes/how-to/objective-statement) if you are a first-time job seeker, changing careers, returning to work after a long absence, or applying for a new job (such as a managerial role) in the same company. - Whether you use a summary or an objective, it must be compelling, concise, and clear. - Format this resume section by listing jobs in reverse-chronological order, with the current or latest position at the top and display. Here's how to create a resume work experience section. You'll need: - **Your title** - **Company name** - **Company location (city and state)** - **Dates of employment (month and year)** - **Three-to-five bullet points with your top work achievements and duties** [**Educational Background**](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) - List your education in reverse chronological order. Include the degree you earned or are currently pursuing, your major(s), your date of graduation or anticipated graduation date and the name and city of your school. Listing your high school is optional for co-op, but not recommended unless it is a very prestigious or well-known high school or a field-related charter school. If you took college courses while in high school, that information can be included. Since in most cases you were not pursuing a specific degree, you can just put \"Major: General Studies.\" Transfer students should list previous schools. While there are no definitive rules, a 3.0 GPA and above is notable and should be mentioned in this section. - - - List any honors (Dean's List, honor societies, scholarships awarded, etc.) and the year in which you received them. It is acceptable to list honors and awards that you received both in high school and college. If the source of the award is not clear, spell it out (Community Service Corps versus CSC.) As you gain more honors at the college level, you can begin to eliminate your high school achievements, keeping those that are particularly unique. - This category can be used to note relevant skills that may be important to a potential employer. For example, experience with tax forms, computer languages, familiarity with laboratory equipment, technical knowledge of cameras/editing equipment, CPR and other certifications, and travel experience can be essential to some positions. - - [**Relevant Coursework**](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) - List six to ten courses by name that relate specifically to your major or career goals. The purpose is to convince potential employers that you possess the fundamental skills for the position. When listing courses, write out the name of the course so that it is descriptive. For example, Economics I and II should be listed as Microeconomics and Macroeconomics. Do not refer to courses as 101, 201, etc. Rather, use Roman numerals (Ex., Civil Engineering I, II, III) if necessary. - For the majority of graduating seniors and professionals, it will not be necessary to include a listing of coursework. Instead, if you have acquired skills from coursework that you would like to emphasize consider adding to the resume a "Special Skills" or "Qualifications Statement" and then include statements that highlight the specific skill or ability. [**Experience**](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) - List all of those experiences which demonstrate your knowledge, accomplishments, skills, and strengths. It is important not to limit your experience to just \"paid\" jobs. Often your unpaid accomplishments (chaired the local blood drive, developed a website for a recreational baseball league) are as important as your time spent working at the mall. Some examples of relevant experience are the Freshman Engineering Design Project, Interior Design projects, film/photo projects, volunteer experiences, and significant high school activities. - Keep in mind that every work and academic experience you have do not need to go under one general \"Experience\" section. Experiences can also be divided into separate sections such as \"Relevant Experience\" and \"Other Experience.\" The distinction between these sections allows you to compile all field and industry related experiences into one section (\"Relevant Experience\") which highlights your discipline related abilities for a prospective employer. Then, you can include additional work experiences in \"Other Experience\" which can demonstrate your overall work ethic and skills gained from other experiences, projects, and activities. [**Activities and/or Professional Associations**](https://drexel.edu/scdc/professional-pointers/application-materials/resumes/writing/) - Your activities and volunteer experiences are a good way to highlight those skills that are difficult to quantify but still very important to potential employers, e.g. leadership, ability to work in a team, and time management. Organizational memberships and elected offices can also demonstrate those qualities. List the activity, your participation if significant, (e.g. president, group leader), and the dates that you participated. Start with your most recent activities and moving in reverse chronological order. - Volunteer experience is important to list on a resume because employers are interested in learning about your contributions to your community. Depending upon the duration of your service, level of commitment, and relevance to your career field you may choose to list such experiences in different ways. You may choose to briefly mention an experience in the Activities Section (see Walk for the Cure example above.) If there are skills which are important to a potential employer, you may choose instead to expand the description of what you did into an Experience Section. 1. **Chronological Resume** - - - - - - - - - Professionals with a solid work history related to the job being applied for - Job seekers without employment gaps 2. **Functional Resume** - This type of resume focuses on transferable skills, aptitudes, and qualities that were learned in one setting, but are useful in a variety of situations. - The functional, or skills-based, resume focuses on your skills and experience more than your job history. - The [**functional resume format**](https://www.myperfectresume.com/resume/formats/functional) highlights your skills and training, focusing on the abilities that can make you a great addition to the team, even if you're applying for your first job. - **This format is excellent for first-time job seekers**, people changing careers or those with employment gaps. - This kind of resume is useful for someone whose background may not directly match the job for which they are applying. - **Functional Resume** - One drawback of this resume is that it can be difficult to follow the sequence of your work history. **3. Combination Resume** - Also known as the hybrid resume, the [**combination resume format**](https://www.myperfectresume.com/resume/formats/combination) combines the functional and chronological resume formats. - This resume format is used to emphasize skills acquired through past work experience. - This resume places an equal emphasis on your work history as well as your skills. - **The primary difference between a chronological resume and the combination resume is the order in which work experience appears.** - It's ideal for mid-level job seekers who want to know how to write a resume for a job when [**switching to a different industry**](https://www.myperfectresume.com/career-center/resumes/how-to) or reentering the workforce.On this resume format, the employer's name, location, and position title are listed together with the job description. Alongside or just above the employment listing is a header that may say something like \"communication,\" \"administrative,\" or \"technical.\" - The top of the resume includes your skills and qualifications relevant to the job you are applying for. Below that is your chronological work history. - Your work history is not the main focus so it doesn't take up a lot of space. - This format offers the best of both worlds. You can accentuate your skills and show off your related work history. - **A combination resume works best for:** - Professionals with relevant skills and experience and employment gaps - Professionals changing careers **4. Mini resume** - The mini resume is useful if you are attending a networking event or meeting with a variety of recruiters. - This resume takes the form of a small business card that gives a brief overview of your work experience. - If you want to show your skills and history but know that the recipient is busy, this resume format is ideal. - A mini resume is a brief summary of your career highlights and qualifications. - It only contains the information *most specific *to the job and industry. - They are straightforward networking tools that easily answer the question, "So what type of work are you looking for?" - Mini resumes have been known to fit on a business card or postcard. They are easier to read than a full-length resume and provide more information than a business card. - **A mini resume works best for:** - In-person networking events. - A chronological (or reverse chronological) resume focuses on your work history. - A functional (or skills-based) resume focuses on your skills.\ A combination (or hybrid) resume combines your skills and work history - An infographic (or networking) resume is great for in-person or digital networking. - A mini resume fits your key information on a business card-sized document. - A profile resume includes a resume summary (or professional summary). - A tailored (or targeted) resume is customized to a specific job. ADDITIONAL RESUME GUIDELINES - In general, limit your resume to one full page as a co-op student and even as a recent graduate. Experienced professionals or graduate level students may extend to two full pages. Depending on your industry, a curriculum vitae (CV) may be used and are generally three pages or more. - Proofread your resume for spelling, punctuation, and grammatical errors. Then have another person proofread your resume for additional errors. Do not rely solely on a spell check program. - Be proud of your accomplishments, but never exaggerate or falsify information (e.g., inflated GPA, fabricated work experience). Employers will check your references and background information. - Do not list a desired salary or previous salary history. - Do not write the word "Resume" at the top or the date you wrote your resume. - Avoid abbreviations (State abbreviations are acceptable). - A photo of yourself or personal information including height, weight, eye/hair color, marital status, religious affiliation, social security number, or visa status/nationality should not be included on your resume. This may automatically invalidate your candidacy, as it is illegal for employers in the United States to consider these factors when making hiring decisions. - If distributing your resume electronically, be sure your resume has an appropriate, clear filename. It is recommended that you include your full name and the word \"resume\" to make it easy for managers or recruiters to find and reference your resume. For example, a filename could be \"JohnSmithResume.pdf." - Including references or listing \"References available upon request\" is not necessary on your resume; it is understood that you will supply references if an employer requests them. You should have a prepared [references sheet](https://drexel.edu/scdc/Extras/LinkItems/Reference%20Samples/) that contains your contact information and the names, addresses, phone numbers, and email addresses of at least three professional and/or personal references. You should obtain permission from your references before listing them on your references sheet and identify their preferred contact information (personal vs. work or school). - Use Correct Tenses. If the dates of an activity have an end date, write about them in the past tense. If you are currently involved in an activity or experience, or if an experience is ongoing, use the present tense. Maintain consistent tenses within each separate entry. **What is a College Graduate Resume** - A **college graduate resume is an entry-level resume** that showcases the **skills, experience** and **education** of a recent college graduate. - Since most recent college grads lack professional job experience, these resumes **prioritize** *education, internships, training* and *transferrable skills* to show the potential of a job seeker. **JOB INTERVIEW** - **Types of interviews** - [Structured Interviews](https://drexel.edu/scdc/professional-pointers/interviewing/) - [Unstructured Interviews](https://drexel.edu/scdc/professional-pointers/interviewing/) - [Problem-Solving or Case Interviews](https://drexel.edu/scdc/professional-pointers/interviewing/) - [Stress Interviews](https://drexel.edu/scdc/professional-pointers/interviewing/) - [Behavioral Interviews](https://drexel.edu/scdc/professional-pointers/interviewing/) - [Panel Interviews](https://drexel.edu/scdc/professional-pointers/interviewing/) - [Group Interviews](https://drexel.edu/scdc/professional-pointers/interviewing/) - **Remote Interviewing** - Beyond the format of the interview, how you are asked to interview --- in person, by phone, or by video conference --- also can have an impact on how you prepare for your interview. Consider the following information if asked to complete a remote interview. - [Phone Interviews](https://drexel.edu/scdc/professional-pointers/interviewing/) - [Video Conference Interviews](https://drexel.edu/scdc/professional-pointers/interviewing/) - [Pre-Recorded Video Interview](https://drexel.edu/scdc/professional-pointers/interviewing/) - Your goal during an interview is to convince the employer that you are the best candidate for the job. In order to accomplish this, you must be able to clearly and articulately convey that you have the specific skills and strengths for which the employer is looking. The best way to increase your likelihood of effectively responding to interview questions is through advanced preparation. Before an interview, you should prepare your responses to standard interview questions and practice speaking them out loud. **RESIGNATION LETTER** - Your resignation letter should include all the essential details to help your manager plan for a timely handover of your duties and provide for your smooth exit. Use the following steps to prepare and format a professional resignation letter: - Review your employee handbook for your company\'s resignation policy. Find out the stipulated notice period and the right person to submit your resignation letter to. You may also find the required notice period in your appointment letter under the terms of service section. Contact your human resources department if you need any further help or information. - Include the following information in the header: your contact information, the submission date, the intended recipient and the company information. - Address the recipient with a proper salutation followed by the person\'s title and last name. For example, "Dear Mr. Gupta." If you are adding any suffix as a sign of respect, such as "Ji," you may either use the first name or the last name of the recipient without any title such as "Mr." or "Ms." For example, just say "Dear Guptaji" instead of "Dear Mr. Guptaji." If you do not wish to mention the name, you may simply say "Dear Sir" or "Dear Madam." - Offer your resignation formally in a clear sentence. You may write, "I hereby offer my resignation as Head Nurse, medical unit ward 5" - Include your intended last working day with the company. The number of days between the date you submit your resignation letter and your intended date of departure should match with the stipulated notice period, which usually ranges between 30 to 90 days. - If your notice period is shorter than that specified in your terms of appointment, you should have prior approval from your manager or HR department. - Your employer will usually like to know the reason for your leaving the company. Although it\'s not mandatory, it\'s advisable to specify an honest reason for your departure from the company. So, whether you are leaving to follow your passion in a different field or to take a break for higher studies, make it a point to mention it in your resignation letter. **TRANSCULTURAL NURSING** **Chapter 1 Historical and Theoretical Foundations of Transcultural Nursing** **Introduction to Transcultural Nursing** - People may have different frames of reference and varied preferences regarding their health and health care needs. - Plan and deliver culturally appropriate and competent care - Nurses must understand - language of culture, culturally appropriate care, and cultural competence and the various aspects of culture that should be explored for each patient Concept of culture, relationship to health care beliefs and practices Goal of TCN -- Scientific & Humanistic Body of Knowledge = - CULTURE- SPECFIC - CULTURE UNIVERSAL NURSING CARE DEFINITION OF TERMS: **Culture- Specific** - -Particular values , beliefs & patterns of behavior, special or unique to a group & don't tend to be shared with other cultures **Culture- Universal** - - Commonly shared values, norms, behaviors & life patterns similarly held among cultures about human behavior & lifestyle **Culture** - Norms / practices of a particular group that are learned and shared and transmitted values, beliefs, norms & lifeways of a particular group of people that guide thinking, decisions, and actions in a patterned way - blue print provides the broadest & most comprehensive means to know, explain, predict people's lifeways over time & in diff geographic locations - Influence a person's definition of health & illness & appropriateness to self treat or sufficiently ill/SICK **Cultural Values**- Individual\'s desirable or preferred way of acting or knowing something that is sustained over a period of time and which governs actions or decisions **Sub-Culture** - Groups that have values & norms that are distinct from those held by majority w/ in a wider society **Ethnicity**- Perception of one-self & a sense of belonging to a particular ethnic group **Race** - Group of people who share genetically transmitted traits **Culturally Diverse Nursing Care** - Refers to variability of nursing approaches needed to provide Culturally Appropriate Care that incorporates an individual's cultural values, beliefs, and practices including sensitivity to the environment from which the individual comes and to which the individual may ultimately return **Culturally Competent Nursing Care -** Effective, individualized care that demonstrates respect for the dignity, personal rights, preferences, beliefs, and practices of the person receiving care, while acknowledging the biases of the caregiver and preventing these biases from interfering with the care provided **Cultural Nursing Assessment -** A systematic appraisal or examination of individuals, families, groups, and communities in terms of their cultural beliefs, values, and practices **Culturally Congruent Nursing Care** - refers to those cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are tailor- fit with an individual's, groups or institution's cultural values, beliefs and lifeways in order to provide meaningful, beneficial, satisfying care that leads to health and well-being **Cultural congruence** -- central in the theory of Culture Care Diversity & Universality. **HISTORY OF TRANSCULTURAL NURSING** **Madeleine M. Leininger -** foundress of Transcultural Nursing, noted cultural differences between patients and nurses while working with emotionally disturbed children - Experience led to study clinical difference in perception of the care - She recognized that health and illness states are strongly influenced by culture and formulated the theory of Transcultural Nursing - Established in 1991 'Culture Care Diversity And Universality: **A Theory of Nursing'** - During the 1950s, Madeleine Leininger worked in a child guidance home and while she recognized the importance of focusing on "care" early on - she was also surprised to observe stark differences in child behavioral patterns based on differing cultural backgrounds. - The ideas sparked by her conclusion paved the way for Leininger to expand nurses' knowledge and understanding of diverse cultures that were lacking in healthcare at this time. - Her endeavor to enhance patient care and well-being through a culturally competent nursing education would later be coined as the **Transcultural Theory Concept** - Uses culture to understand behavior - All cultures are not alike - Culture influences all spheres of life. It defines health, illness and search for relief from disease or distress. - Each person viewed as unique with differences that are respected - Cultural competence is important in nursing. - Cultural competence is a combination of culturally congruent behaviors, practice attitudes and policies that allow nurses to work effectively in cross cultural situation. - Factor that established TCN framework - A marked increase in the migration of people within and between countries world wide - A rise in multicultural identifies, with people expecting their cultural belief, values, and lifeways to be understood and respected by nurses and other health care providers. - Increased use of health care technology sometimes conflicts with cultural values of clients. - Worldwide there are cultural conflicts, clashes, and violence that have an impact health care as more cultures interact with one another. **Factor that established TCN framework** - An increase in legal suits resulting from cultural conflict, negligence, ignorance, and imposition of health care practices. - An increase in the number of people travelling and working in many different parts of the world. - Rise in feminism and gender issues, with new demands on health care systems to meet the needs of woman and children - An increased demand for community and culture based health care services in diverse environmental contexts. **MODELS OF TCN** - To help develop, test and organize the emerging body of knowledge in Transcultural Nursing, it is necessary to have a conceptual framework from which various theoretical statements can emerge. - There are two popular models widely used in the field - Leininger's Sunrise Model - The Giger and Davidhizar: 'Transcultural Assessment Model' - The model is based on the concept of culture care and shows 3 major nursing modalities that guide nursing judgments and activities to provide 'Culturally Congruent Care' **3 major modalities are:** 1\) Cultural Care Preservation/ Maintenance 2\) Cultural Care Accommodation/Negotiation 3\) Cultural Care Repatterning /Reconstructing 1\. **Cultural Care Preservation or Maintenance** Is also known as maintenance. It includes those assistive, supporting, facilitative, or enabling professional actions and decisions that help people of a particular culture to retain and/or preserve relevant care values so that they can maintain their well-being, recover from illness, or face handicaps and/or death. 2\. **Cultural Care Accommodation or Negotiation**\ Cultural care accommodation, also known as negotiation, includes those assistive, supportive, facilitative, or enabling creative professional actions and decisions that help people of a designated culture to adapt to or negotiate with others for a beneficial or satisfying health outcome with professional care providers. 3\. **Culture Care Repatterning or Restructuring** Culture care repatterning or restructuring includes those assistive, supporting, facilitative, or enabling professional actions and decisions that help clients reorder, change, or greatly modify their lifeways for new, different, and beneficial health care pattern while respecting the clients' cultural values and beliefs and still providing a beneficial or healthier lifeway than before the changes were established with the clients. (Leininger, 1991) **Why is the sunrise model important?** - The Sunrise Model is relevant because it enables nurses to develop critical and complex thoughts about nursing practice. These thoughts should consider and integrate cultural and social structure dimensions in each specific context, besides nursing care's biological and psychological aspects. Madeleine Leininger's Sunrise Model. **Assumptions**:\ The following are the assumptions of Madeleine Leininger's theory: - Different cultures perceive, know, and practice care differently, yet there are some commonalities about care among all world cultures. - Values, beliefs, and practices for culturally related care are shaped by, and often embedded in, "the worldview, language, religious (or spiritual), kinship (social), political (or legal), educational, economic, technological, ethnohistorical, and environmental context of the culture. - While human care is universal across cultures, caring may be demonstrated through diverse expressions, actions, patterns, lifestyles, and meanings. - Cultural care is the broadest holistic means to know, explain, interpret, and predict nursing care phenomena to guide nursing care practices. - All cultures have generic or folk health care practices, that professional practices vary across cultures, and that there will be cultural similarities and differences between the care-receivers (generic) and the professional caregivers in any culture. - Care is the distinct, dominant, unifying, and central focus of nursing, and while curing and healing cannot occur effectively without care, care may occur without a cure. - Care and caring are essential for humans' survival and their growth, health, well-being, healing, and ability to deal with handicaps and death. - Nursing, as a transcultural care discipline and profession, has a central purpose of serving human beings in all areas of the world; that when culturally based nursing care is beneficial and healthy, it contributes to the well-being of the client(s) -- whether individuals, groups, families, communities, or institutions -- as they function within the context of their environments. - Nursing care will be culturally congruent or beneficial only when the nurse knows the clients. The clients' patterns, expressions, and cultural values are used in appropriate and meaningful ways by the nurse with the clients. - If clients receive nursing care that is not at least reasonably culturally congruent (that is, compatible with and respectful of the clients' lifeways, beliefs, and values), the client will demonstrate signs of stress, noncompliance, cultural conflicts, and/or ethical or moral concerns. **Analysis\ **In Leininger's nursing theory, it was stated that the nurse would help the client move towards amelioration or improvement of their health practice or condition. - This statement would be of great difficulty for the nurse because instilling new ideas in a different culture might present an intrusive intent for the "insiders." - Culture is a strong set of practices developed over generations that would make it difficult to penetrate. The whole activity of immersing yourself within a different culture is time-consuming to understand their beliefs and practices fully. Another is that it would be costly on the part of the nurse. **The Giger and Davidhizar Transcultural Assessment Model** - This model was developed in 1988 in response to the need for nursing students in an undergraduate program to assess and provide care for patients that were culturally diverse. - ![](media/image5.png)Giger and Davidhizar have identified six cultural phenomena that vary among cultural groups and affect health care - Minimized time needed to conduct comprehensive assessment to provide culturally competent care Metaparadigm for Transcultural Assessment Model - Transcultural nursing & culturally diverse nursing - Culturally competent care - Culturally unique individuals - Culturally sensitive environment - Health & health status based on culturally specific illness & wellness behaviors **Transcultural nursing** - Viewed as culturally competent practice field- client centered & researched --focused - Nurses carefully discerns personal cultural beliefs & values to separate from patient's beliefs & values. - Nurse must remember each individual is unique & a product of past experiences, beliefs & values that have been learned and passed down from one generation to the next - Nurse is not culturally FREE but culturally DETERMINED ( Stokes (1991) **Cultural Competence** - Health care professional develops awareness of one's existence, sensation, thoughts, & environment without letting these factors have undue effects on those for whom care is provided - Purnell & Paulanka (1998) - Requires continuous skills, practices & attitudes seeking to help nurses transform interventions into positive health outcomes **Culturally Unique Individuals -** One is product of past experiences, cultural beliefs & cultural norms - Cultural expressions become patterned responses = give each individual a unique identity **Culturally Sensitive Environment -**Various cultural groups have wide-ranging beliefs about man\'s relationship with the environment - Knowledge of culturally relevant information = nurse planning & implementing a individualized treatment plan / nursing care plan **= UNIQUE FOR EACH PATIENT** **How Student Nurses Utilize the Transcultural Assessment Model** 1. **Communication("communicare")** - Make common, share, participate, or impart - The means by which culture is transmitted and preserved. Verbal and nonverbal patterns of communication vary across cultures, and if nurses do not understand the client's cultural rules in communication, the client's acceptance of a treatment regimen may be jeopardized - Embraces the entire realm of human interaction & behavior, holistic process of human interaction and conduct - The use and preservation of communication takes several forms - verbal, nonverbal, and written - and differs in terms of expression, language and dialect, voice tone and volume, context, emotional implication, facial expression, gestures, and body language, space or other symbols - - - **Non verbal communication** - **Touch**- A powerful form of communication & maybe used to bridge distances bet nurse & the client \- Other cultures are characterized by a "do not touch me" way of life \- for others it's a taboo - **Gestures-** emblems serve the same functions as words ( ie: thumbs --up; come here) - **Postures** - provides important messages about receptivity -**Attentive posture**-- leaning toward a person -**Closed posture** - Facial Expression & Eye Contact - Eye contact- conveying interest, active engagement, honesty - Disrespect or aggression , challenges authority --( asia, middle east, Africa) - Prolonged staring - sexual interest - Occulistics ( eye rolling) - when someone speaks or behaves in a manner regarded as inappropriate - Facial expression- fixed in a hard stare with upper lids lowered & Eyebrows drown down \- smile = happiness or negative emotions (orient) \- less facial expression- (Irish, English & Northern Europe **2. Space** - Humans vary greatly in their comfort level related to personal space. Some of these spatial concerns are related to personal preferences, while others are a reflection of cultural principles. - Student nurses must be aware of their patients' comfort level related to body distance during conversation, proximity to family members, perception of space, eye contact, and personal and cultural touch practices Distance between individuals when they interact. All communication occurs in the context of space. There are four distinct zones of interpersonal space: 1)inmate zone (extends up to 1 ½ feet), 2)personal distance (extends from 1 ½ to 4 feet), 3)social distance (extends from 4 to 12 feet) 4)public distance (extends 12 feet or more) **3. Social Organization** - The social group organizations with which clients and families may identify. - Family structure and organization, religious values and beliefs and role assignments may all relate to ethnicity and culture - Many social barriers, such as unemployment, underemployment, homelessness, lack of health insurance, and poverty can also prevent people from entering the health-care system - Humans often learn and adopt cultural beliefs through social organization. Individuals from culturally diverse backgrounds will all manifest different degrees of acculturation into the beliefs of their dominant culture. - In some circumstances, cultural values stem from the opinion of elders or patriarchs, while others place value on position in family. In this context, student nurses need to factor in geography, socioeconomic status, religious affiliation, gender and sexual orientation, as well as age and life cycle status 4**. Time Orientation:** - Important aspect of interpersonal communication. Some cultures are considered future oriented, others present oriented, and still others past oriented - Attitudes about time vary widely among cultures and can be a barrier to effective communication between nurses and patients. Concepts of time and punctuality are culturally determined, as is the concept of waiting - Health care providers in our culture, time and promptness are extremely important. - Patients expected to arrive at an exact time for an appointment---despite the fact that they may have to wait for health care providers who are running late. - Many countries and cultures are oriented with a focus on the past. These cultures value tradition and doing things as their predecessors have done. This can lead to reluctance in accepting new technology or treatments. - Some cultures stress the present and may seem relatively unconcerned with the future. These individuals may disregard preventative measures and may show up late or miss appointments (Giger & Davidhizar, 2004). 5**. Environmental control** - Ability of person to control nature and to plan and direct factors in the environment - Some groups perceive man as having mastery over nature; others perceive humans to be dominated by nature, while others see harmonious relationships between humans and nature - Environment encompasses relevant system and processes that affect individuals - A patient\'s attitude toward his treatment and prognosis is influenced by whether he generally believes that man has some control over events (like Asian American & American Indians ) or - More fatalistic and believes that chance and luck determine what will happen (Hispanic and Appalachian patients ) - Provide information in a nonjudgmental way and respect their fatalistic beliefs - Environmental control can be explained in the patient's ability, within their cultural system, to plan activities that control their environment as well as their perception of personal control over factors in the environment - Examples of assessment factors which play a role in environmental control are locus of control, folk medicine, and health beliefs. - Student nurses need to understand that these issues play an extremely vital role in the way patients define illness and wellness, utilize health care resources and respond to health associated experiences **6. Biologic variations** - When assessing a patient's cultural underpinnings, biological variations need to be evaluated carefully to avoid stereotypes and discrimination. - Nursing examples include diseases related to specific ethnic groups as well as rural versus urban health. - Student nurses must remember the uniqueness of individuals and that a person's association with an ethnic group does not mean that the individual patient will follow the socially accepted definition of his/her biological foundation - Body structure, - Skin color - Other visible physical characteristics - Enzymatic and genetic variations - Electrocardiographic patterns -- ex: African American men INVERTED T waves - Susceptibility to disease -- increased or decreased incidence of a particular disease maybe genetically determined - Nutritional preferences and deficiencies - includes habits & patterns ( food choices) - Psychological characteristics - **Conclusions** As a challenging health care environment results from new technologies, scientific advances, and cultural diversity, today's student nurses are faced with uncertainty, unknown boundaries and unfamiliar practice questions. It is crucial that student nurses understand their personal values, culture, and biases, as well as those of their occupation through knowledge and reflection of cultural assessment tools. This reflection will foster cultural awareness and promote competent practices that will allow student nurses to give safe, patient centered care. **Chapter 2 - Cultural Beliefs and Cultural Values** **Social Organization** - Refers to the family (nuclear, single- parent, or extended family), & the social organizations (religious or ethnic) with which patients & families may identify. - Social environment in which people grow up & live plays an essential role in cultural development & identification - Children learn their culture's responses to life events from family & its ethnoreligious groups. - Socialization process is inherent part of heritage - Cultural, religious & ethnic background - Cultural behavior, or how one acts, in certain situations, is socially acquired, not genetically inherited. - Patterns of cultural behavior are learned through a process called **["enculturation"(]** also referred to as ["socialization")] - Patterns of cultural behaviors are important to nurses because they provide explanation for behaviors related to life events - Life events that are significant transculturally include birth, death, puberty, childbearing, childrearing, illness and disease **Ethnocentrism** - Perception that one's own way is the best - Nurses must remain cognizant to the fact that their ways are not necessarily the best - A lay person's ideas are not "ignorant" or inferior - influence one's health care behavior & consequently one's health status - The meaning a nurse places on life can affect relationships with client **Ethnicity** - Refers to groups whose members share a common social & cultural heritage passed on to each successive generation - A sense of identity - Group of people that share a common & distinct racial, national, linguistics, or cultural heritage **Concept of Time** - Attitudes to time may differ between different cultures in often quite significant ways 1. **Time Orientation** - One way of looking at cultural attitudes to time is in terms of **time orientation**, a cultural or national preference toward past, present, or future thinking. - The time orientation of a culture affects how it values time, and the extent to which it believes it can control time. - Time perception is based on a society's values 4. **Types of Cultural Time Orientation & Time Perception** 1. **Values & Norms --** this is how time-orientation is learned - Just as [values](https://successacrosscultures.com/2017/12/30/cultural-values-what-divides-us-what-defines-us/) and [norms](https://successacrosscultures.com/2018/01/13/cultural-norms-what-are-they-and-how-do-they-relate-to-values/) are a culture's learned behaviors, so is time perception. - Time perception is based on a [society's values](https://successacrosscultures.com/2017/12/02/values-what-are-they-how-do-they-shape-culture/). those from monochronic cultures value relationships above all else. So, if they miss a deadline in lieu of putting time into a family matter, it's a nonissue. - So, just as children learn values -- such as the importance of [family](https://successacrosscultures.com/2018/06/15/10-cultural-universals-the-role-of-family-in-culture/) -- during their [primary socialization](https://successacrosscultures.com/2017/09/16/primary-socialization-iv-conditioning/), so they are oriented toward a specific time cognitivism based on those values 2. ![](media/image7.png) **Time Orientation** - **Past** -- the past and the present are interchangeable in past-oriented cultures. They often do not fully grasp elapsed time. - **Time-line** -- this type of time cognitivity is a detail-oriented linear concept of time. However, time-line cognitivity does not lend itself to multitasking. - **Present** -- you might think of a thrill-seeker when you think of present-oriented cognitivity. These are low-risk aversion cultures. - **Future** -- the goal-setting, forward-thinking cultures are future-oriented. Those with future-oriented cognitively look at the bigger picture and follow their plans through to achieve that picture. - What is affected by time orientation? - Communication, particularly the content of what's being communicated, as well as the urgency and frequency of communication **Transcultural Health Domains** **Health traditions** - Beliefs and traditions of community members have a profound effect on health of the community - Influence the types of food, recreational activities, and health services available - Traditional health-related beliefs and practices among different ethnic groups fall into three groups: - **(1)** beliefs that result in no harmful health effects - \(2) beliefs that may produce beneficial health outcomes - \(3) beliefs and traditions which have serious, harmful health outcomes Tr**aditional health maintenance** - Traditional ways of maintaining HEALTH are the active, everyday ways people go about living & attempting to stay well -- ordinary functioning within society by: - Wearing proper clothing - Food eaten & methods for preparing it (combination eaten in ;may & may not be eaten - Reading & crafts, games, music **Traditional etiology** - Protection of health lies in the ability to understand cause of a given illness or set of symptoms. - Illness is most often attributed to the "evil eye" - A belief that someone can project harm by gazing or staring at another's property or person - Philippines - cast through the eye or mouth - Mediterranean -- avenging power of God - Italy - a malevolent force like a plaque & warded off by amulets - Illness can also be attributed to people who have the ability to make others ill : - Witches & practitioners of voodoo - Envy, hate & jealousy - Jewish culture- *dyabuk* -- portrayed as a 'wandering, disembodied soul which enters another person's body & holds fast" **Health protection** - Health may be protected by external controls like: - Avoid people who can bring it about by the evil eye - Avoidance of "*envidia"* - *Avoidance of those who can cast the spell* **Traditional Practices Used in Protection Of Health** - use of protective objects- worn, carried, hung in homes - use of substance that are ingested in certain ways & amounts or eliminated, hung in homes - practices of religion- burning candles, rituals of redemption \* prayer **Healing traditions** - Refers to health practices, approaches, knowledge and beliefs incorporating healing and wellness while using ceremonies; plant, animal or mineral-based medicines; energetic therapies; or physical/hands on techniques **Familial healing traditions** - Traditional healing refers to health practices, approaches, knowledge and beliefs incorporating healing and wellness while using ceremonies; plant, animal or mineral-based medicines; energetic therapies; or physical/hands on techniques **Chapter 3 - Culturally Competent Health Care and\ Cultural Diversity in Health Care** - The provision of culturally competent patient- and family-centered care is an ethical imperative and professional mandate - Describing nurses\' perspectives on challenges and barriers to providing culturally competent care is the first step in helping redesign care delivery practices **Cultural competence in health care** - A culturally competent healthcare system is one that acknowledges value of culture, incorporates the assessment of cross-cultural relations, recognizes the potential impact of cultural differences, expands cultural knowledge, and adapts services to meet culturally unique needs. - Understand potential impact that cultural differences on healthcare delivery How patients perceive symptoms and health conditions When and how patients seek care Patients' expectations of care Patients' preferences regarding procedures or treatments Patients' willingness to follow doctor recommendations or treatment plans Who patients believe should participate in making healthcare decisions **The Need for Cultural Competence in Health Care** - Differences between healthcare providers and patients can affect communication - impact both clinicians' & patients' decisions regarding treatment - inadvertently deliver lower-quality care - Cultivating skills that improve cross-cultural communication can play an important role in delivering equitable care. **Language accessibility** - Keep patients from accurately describing their symptoms and providers from explaining diagnoses - Language barriers can also create unsafe and inappropriate situations - Ex: clinicians may rely on abusive spouses to interpret for their battered partners **Cultural Competence with Cultural Humility** - Recognizes the limits of people's knowledge of others - Acknowledges that even people who have cultivated their cultural awareness can still have unintentional, unconscious biases about cultures other than their own - Cultural humility involves an ongoing process of self-evaluation - Exploration of and reflecting on their own beliefs and behaviors = improve awareness of implicit biases, foster an approach to patients characterized by openness & curiosity about each new patient. **Goals of Cultural Competence in Health Care** - Aims to break down barriers that get in the way of patients' receiving care they need - Ensures improved understanding between patients and healthcare providers - Culturally and Linguistically Appropriate Services,(CLAS)- -respond to individual preferences and needs of each patient - Effective - Understandable - Respectful **Importance of Cultural Competence in Health Care** - Results in more patient participation and engagement, fostering respect & improved understanding leading to: - Increased patient safety - Reduced inefficiencies - Reduced care disparities - Decreased costs **Improved Patient Outcomes** - Cultural competence improves communication, which keeps patients safer - Allows healthcare providers to collect accurate medical information - Encourages active dialogues in which patients and providers can ask questions, correct misunderstandings, and build trust - Absence of culturally competent care can lead to preventable mistakes and adverse events **Promote Awareness and Education to Improve Cultural Competence in Health Care** - Promoting awareness and education plays a key role in improving cultural competence in health care. To develop cultural competence, healthcare professionals need to identify their beliefs and build an awareness of their culture. This gives them a basis to improve their cross-cultural awareness. - Cross-cultural awareness makes healthcare providers more open to unfamiliar attitudes, practices, or behaviors; improves collaboration with patients and helps them respond with flexibility **Benefits of cross-cultural awareness:** ** ** Improved rapport Tailored treatment plans Improved patient attendance and compliance **Barriers to Cultural Competence in Health Care** 1. **Adequate Knowledge of an Organization's Cultural Competence** - Address cultural competence, healthcare organizations need to first gauge their current performance. This involves answering questions such as: - Where does the organization fall short in providing language accessibility? - Where do care disparities exist within the system? - Without knowing where disparities exist, leadership can't properly channel its energy and resources - collect data about their patients' races, language preferences, sexual orientations, ethnicities & track disparities Patient surveys 2. **Putting Cultural Competence into Action** To put cultural competence into action, healthcare organizations must create an institutional framework that: - Demonstrates culturally competent practices - Cultivates cross-cultural awareness and communication - Maintains a diverse workforce 3. **Providing interpreter services** - improve communication between patient and provider 4. **Recruiting and retaining professionals with minority backgrounds** - A successful recruitment strategy

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