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Cultural Competence: Cultural Care. Chapter 3. Objectives. Discuss the demographic profile of the United States. Describe the National Standards for Culturally and Linguistically Appropriate Services. Discuss the background of the Heritage Assessment. - PowerPoint PPT Presentation
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Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Cultural Competence: Cultural Competence: Cultural CareCultural Care
Chapter 3Chapter 3
Slide 3-2Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
ObjectivesObjectives
Discuss the demographic profile of the United States.Discuss the demographic profile of the United States.
Describe the National Standards for Culturally and Describe the National Standards for Culturally and Linguistically Appropriate Services.Linguistically Appropriate Services.
Discuss the background of the Heritage Assessment.Discuss the background of the Heritage Assessment.
Describe the methods for conducting the Heritage Describe the methods for conducting the Heritage Assessment.Assessment.
Provide examples of traditional health and illness beliefs Provide examples of traditional health and illness beliefs and practices.and practices.
Discuss the steps to cultural competence.Discuss the steps to cultural competence.
Slide 3-3Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Health:Health:
““The balance of the person, both within one’s The balance of the person, both within one’s beingbeing——physical, mental and/or spiritualphysical, mental and/or spiritual——and and in the outside worldin the outside world——natural, communal, natural, communal, and/or metaphysical, is a complex, and/or metaphysical, is a complex, interrelated phenomenon (Spector, 2004)interrelated phenomenon (Spector, 2004)
Slide 3-4Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Illness:Illness:
The loss of the person’s balance, within one’s The loss of the person’s balance, within one’s beingbeing——physical, mental and/or spiritualphysical, mental and/or spiritual——and and in the outside worldin the outside world——natural, communal, natural, communal, and/or metaphysical.and/or metaphysical.
Slide 3-5Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Demographic Profile of the Demographic Profile of the United StatesUnited States
Total population passed 300 million in the autumn of Total population passed 300 million in the autumn of 2006.2006.
1 out of 3 US residents was in a group other than 1 out of 3 US residents was in a group other than single-race non-Hispanic white.single-race non-Hispanic white.
““Minority” or “emerging majority” population totaled Minority” or “emerging majority” population totaled 98 million people.98 million people.
Hispanics largest and fastest growing group.Hispanics largest and fastest growing group.
Second largest population is blacks.Second largest population is blacks.
Followed by Asians, American Indians and Alaska Followed by Asians, American Indians and Alaska Natives, Native Hawaiians and other Pacific Natives, Native Hawaiians and other Pacific Islanders.Islanders.
Slide 3-6Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
In comparison to the population In comparison to the population as a whole:as a whole:
Emerging majority groups tend to be younger, Emerging majority groups tend to be younger, with lower median ages and higher with lower median ages and higher proportions of the population under the age proportions of the population under the age of 18 years.of 18 years.
The non-Hispanic, single-race, white The non-Hispanic, single-race, white population has an older median age and a population has an older median age and a smaller proportion of the population under the smaller proportion of the population under the age of 18 years.age of 18 years.
Slide 3-7Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
There isThere is——
One birth every 8 secondsOne birth every 8 seconds
One death every 13 secondsOne death every 13 seconds
One international migrant (net) every 30 One international migrant (net) every 30 secondsseconds
Therefore our country gains one person every Therefore our country gains one person every 11 seconds11 seconds
Slide 3-8Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Categories of interest to health Categories of interest to health care providerscare providers
Legal permanent residentsLegal permanent residents
Naturalized citizensNaturalized citizens
Undocumented aliensUndocumented aliens
Refugees, asylees, and paroleesRefugees, asylees, and parolees
Legal nonimmigrant residentsLegal nonimmigrant residents
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
National Standards for Culturally National Standards for Culturally and Linguistically Appropriate and Linguistically Appropriate
Services in Health CareServices in Health Care
Slide 3-10Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
First and Landmark StandardFirst and Landmark Standard
““Health care organizations should ensure that Health care organizations should ensure that patients receive from all staff members patients receive from all staff members effective, understandable and respectful care effective, understandable and respectful care that is provided in a manner compatible with that is provided in a manner compatible with their cultural health beliefs and practices and their cultural health beliefs and practices and preferred language”preferred language”
Source: National Standards for Culturally and Linguistically Appropriate Services in Health Care, Final Report, March 2001, pp. 7-20, Washington, Source: National Standards for Culturally and Linguistically Appropriate Services in Health Care, Final Report, March 2001, pp. 7-20, Washington, DC: Office of Minority Health, DHHS, Order-1800-444-6472.DC: Office of Minority Health, DHHS, Order-1800-444-6472.
Slide 3-11Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Linguistic CompetenceLinguistic Competence
Title VI of the Civil Rights Act of 1964: Services Title VI of the Civil Rights Act of 1964: Services cannot be denied to people of limited English cannot be denied to people of limited English proficiency.proficiency.
According to the 2000 census, 47 million Americans According to the 2000 census, 47 million Americans over 5 years of age speak a language other than over 5 years of age speak a language other than English in their homes.English in their homes.
This represented an increase of 15 million people This represented an increase of 15 million people over the numbers documented by the 1990 census.over the numbers documented by the 1990 census.
Certain states require that providers offer language Certain states require that providers offer language assistance in health care settings: California, assistance in health care settings: California, Massachusetts, and New York.Massachusetts, and New York.
Slide 3-12Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Cultural CompetenceCultural Competence
Culturally sensitiveCulturally sensitive
Culturally appropriateCulturally appropriate
Culturally competentCulturally competent
Slide 3-13Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Culturally SensitiveCulturally Sensitive
Possessing basic knowledge of and Possessing basic knowledge of and constructive attitudes toward diverse cultural constructive attitudes toward diverse cultural populationspopulations
Slide 3-14Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Culturally AppropriateCulturally Appropriate
Applying underlying background knowledge Applying underlying background knowledge necessary to provide the best possible health necessary to provide the best possible health carecare
Slide 3-15Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Culturally CompetentCulturally Competent
Understanding and attending to total context Understanding and attending to total context of patient’s situation including of patient’s situation including Immigration statusImmigration status
Stress factorsStress factors
Social factorsSocial factors
Cultural similarities and differencesCultural similarities and differences
Slide 3-16Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
HeritageHeritage
Slide 3-17Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Heritage ConsistencyHeritage Consistency
The degree to which a person’s lifestyle The degree to which a person’s lifestyle reflects his or her traditional heritagereflects his or her traditional heritage
Slide 3-18Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Heritage Consistency ContinuumHeritage Consistency Continuum
Traditional: living within the norms of the Traditional: living within the norms of the traditional culturetraditional culture
Modern: acculturated to the norms of the Modern: acculturated to the norms of the dominant societydominant society
Slide 3-19Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
CultureCulture
The thoughts, communications, actions, The thoughts, communications, actions, beliefs, values, and institutions of racial, beliefs, values, and institutions of racial, ethnic, religious or social groups.ethnic, religious or social groups.
Slide 3-20Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Characteristics of CultureCharacteristics of Culture
LearnedLearned
SharedShared
AdaptedAdapted
DynamicDynamic
Slide 3-21Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
EthnicityEthnicity
Describes a group united by Describes a group united by Common geographic originCommon geographic origin
Migratory statusMigratory status
ReligionReligion
RaceRace
LanguageLanguage
Shared values, traditions, or symbolsShared values, traditions, or symbols
Food preferencesFood preferences
Slide 3-22Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
ReligionReligion
The belief in a divine or superhuman power or The belief in a divine or superhuman power or powers to be obeyed and worshipped as powers to be obeyed and worshipped as creator/ruler of the universecreator/ruler of the universe
A system of beliefs, practices, and ethical A system of beliefs, practices, and ethical valuesvalues
A shared experience of spiritualityA shared experience of spirituality
Slide 3-23Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Health-Related Behaviors Health-Related Behaviors Affected by ReligionAffected by Religion
MeditatingMeditating
Exercising/physical fitnessExercising/physical fitness
Sleep habitsSleep habits
VaccinationsVaccinations
Willingness to undergo physical examinationWillingness to undergo physical examination
PilgrimagePilgrimage
Truthfulness about how you feelTruthfulness about how you feel
Slide 3-24Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Health-Related Behaviors Health-Related Behaviors Affected by Religion (cont.)Affected by Religion (cont.)
Maintenance of family viabilityMaintenance of family viability
Hoping for recoveryHoping for recovery
Coping with stressCoping with stress
Genetic screening and counselingGenetic screening and counseling
Living with a disabilityLiving with a disability
Caring for childrenCaring for children
Slide 3-25Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
SocializationSocialization
The process of being raised within a culture The process of being raised within a culture and acquiring the characteristics of that and acquiring the characteristics of that group.group.
Slide 3-26Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Related TermsRelated Terms
AcculturationAcculturation——the process of adapting to the process of adapting to acquiring another cultureacquiring another culture
AssimilationAssimilation——the process by which a person the process by which a person develops a new cultural identity and becomes develops a new cultural identity and becomes like the members of the dominant culturelike the members of the dominant culture
Slide 3-27Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Time OrientationTime Orientation
Focus on the pastFocus on the past
Focus on the presentFocus on the present
Focus on the futureFocus on the future
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Heritage AssessmentHeritage Assessment
Slide 3-29Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Indicators of Heritage Indicators of Heritage ConsistencyConsistency
Childhood in country of origin or immigrant Childhood in country of origin or immigrant neighborhood of like ethnic groupneighborhood of like ethnic group
Extended family support of traditional activitiesExtended family support of traditional activities
Frequent visits to the old country or old neighborhoodFrequent visits to the old country or old neighborhood
Family home is within the ethnic community to which Family home is within the ethnic community to which he or she belongshe or she belongs
Participation in ethnic cultural eventsParticipation in ethnic cultural events
Raised in an extended family settingRaised in an extended family setting
Slide 3-30Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Indicators of Heritage Indicators of Heritage Consistency (cont.)Consistency (cont.)
Regular contact with the extended familyRegular contact with the extended family
Name not anglicizedName not anglicized
Educated in a parochial schoolEducated in a parochial school
Social activities primarily with other members of the Social activities primarily with other members of the ethnic communityethnic community
Knowledge of language and culture of originKnowledge of language and culture of origin
Expresses pride in heritageExpresses pride in heritage
Slide 3-31Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Differing views of the same Differing views of the same disease: Epilepsydisease: Epilepsy
Uganda: contagious, untreatableUganda: contagious, untreatable
Greece: source of family shameGreece: source of family shame
Mexican-American community: evidence of Mexican-American community: evidence of physical imbalancephysical imbalance
Hutterites: having endured a trial by GodHutterites: having endured a trial by God
Slide 3-32Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Developmental CareDevelopmental Care
Culture affects the choices parents make for Culture affects the choices parents make for children regardingchildren regarding The presumed cause of an illnessThe presumed cause of an illness
The first treatment triedThe first treatment tried
The acceptability of treatments offered by cliniciansThe acceptability of treatments offered by clinicians
For older patients, culture is likely toFor older patients, culture is likely to Define their family responsibilitiesDefine their family responsibilities
Affect their knowledge of the systems used by the Affect their knowledge of the systems used by the dominant culturedominant culture
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Theories of CausationTheories of Causation
Slide 3-34Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
BiomedicalBiomedical
Assumes cause and effectAssumes cause and effect
Views the body as a machineViews the body as a machine
Life can be divided into partsLife can be divided into parts
Endorses germ theoryEndorses germ theory
Slide 3-35Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
NaturalisticNaturalistic
Forces of nature must be kept in balanceForces of nature must be kept in balance
Embraces the idea of opposing categories Embraces the idea of opposing categories or forcesor forces Yin/YangYin/Yang
Hot/ColdHot/Cold
Slide 3-36Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
MagicoreligiousMagicoreligious
Supernatural powers predominate in the area Supernatural powers predominate in the area of health and illnessof health and illness
Examples include voodoo, witchcraft, and Examples include voodoo, witchcraft, and faith healingfaith healing
Slide 3-37Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Folk HealersFolk Healers
Hispanic: curandero, espiritualista, yerbo, or Hispanic: curandero, espiritualista, yerbo, or sabedorsabedor
Black: hougan, spiritualist, old ladyBlack: hougan, spiritualist, old lady
American Indian: shaman, medicine woman, American Indian: shaman, medicine woman, medicine manmedicine man
Asian: herbalists, acupuncturists, bone Asian: herbalists, acupuncturists, bone setterssetters
Amish: braucherAmish: braucher
Slide 3-38Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
Steps to Cultural CompetenceSteps to Cultural Competence
Understanding one’s own heritage-based cultural Understanding one’s own heritage-based cultural values, beliefs, attitudes, and practicesvalues, beliefs, attitudes, and practices
Identifying meaning of “health” to the patientIdentifying meaning of “health” to the patient
Understanding how the health care system worksUnderstanding how the health care system works
Acquiring knowledge about the social Acquiring knowledge about the social backgrounds of one’s patientsbackgrounds of one’s patients
Becoming familiar with the languages, Becoming familiar with the languages, interpretive services, and community resources interpretive services, and community resources used by (and available to) your patients and used by (and available to) your patients and yourselfyourself
Slide 3-39Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
R.E.S.P.E.C.T.R.E.S.P.E.C.T.
R = Realize that you must R = Realize that you must know the heritage of yourself know the heritage of yourself and your patient.and your patient.
E = Examine the patient E = Examine the patient within the cultural context.within the cultural context.
S = Select questions that are S = Select questions that are simple and speak them simple and speak them slowly.slowly.
P = Pace questioning P = Pace questioning throughout the exam.throughout the exam.
E = Encourage patient to E = Encourage patient to discuss meaning of health discuss meaning of health and illness with you.and illness with you.
C = Check patient’s C = Check patient’s understanding and understanding and acceptance of acceptance of recommendations.recommendations.
T = Touch the patient within T = Touch the patient within the boundaries of his or her the boundaries of his or her heritage.heritage.
Slide 3-40Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
In the current health care environment, what In the current health care environment, what is the most important influence on the is the most important influence on the
success of an interaction?success of an interaction?
A.A. The patient’s awareness of the nurse’s The patient’s awareness of the nurse’s heritageheritage
B.B. The nurse’ awareness of the patient’s heritageThe nurse’ awareness of the patient’s heritage
C.C. The degree to which the patient and nurse The degree to which the patient and nurse share heritageshare heritage
D.D. The patient’s willingness to assimilate into the The patient’s willingness to assimilate into the dominant culturedominant culture
Slide 3-41Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: Cultural Competence: Cultural CareChapter 3: Cultural Competence: Cultural Care
At the ends of the Heritage Consistency At the ends of the Heritage Consistency Continuum are the termsContinuum are the terms
A.A. Traditional and modernTraditional and modern
B.B. Traditional and progressiveTraditional and progressive
C.C. Bound and modernBound and modern
D.D. Bound and progressiveBound and progressive
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