Cultural Considerations MHCommunity PP

7/25/2019 Cultural Considerations MHCommunity PP

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Cultural

Considerations/Competencyfor Community/MentalHealth Nursing

Ashley Walker & Elizabeth eli!


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What is Cultural Competenc

Cultural competence is the abilitunderstand# appreciate# and $ork $indi%iduals from cultures other tha

your o$n 'e$is ()*+


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our components to Cultura

Competence ,here are four components of cultural competence-

Cultural awareness:

Ability to understand patients. uniue cultural needs

You must examine your own cultural biases toward people

cultures are diferent rom yours


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our components to cultura

competence Cultural knowledge:

,he process of learning key aspects of a group.s culture#especially relating to health and health care practices

Patients are the best source o inormation about their cult

Assess patients or cultural traits based on generalizedunderstanding o their culture

Do not make assumptions! The degree o acculturation aramong indiiduals


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competence Cultural skill:

Ability to collect rele%ant cultural data

earn assessment skills or diferent cultural groups" includbelies and practices


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competence Cultural encounter:

0irect cross1cultural interactions bet$een people from cultdi%erse backgrounds

#reate opportunities! $nteract with predominant cultural g


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Ask 2ourself3

What does being culturally competent mean to me apatients 4 ser%e"

Which cultural competency model and/or assessmenis most useful to me# gi%en my patient population"

As 4 gain cultural kno$ledge and skills# ho$ can 4 uskno$ledge to impro%e my patients. healthcare outcoand assist in reducing healthcare disparities forunderser%ed populations"

5ersey1Matusiak 67*


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Healthcare 0isparities

Healthcare disparities are ineualities inhealthcare access# uality# and/or outcomesbet$een groups 5ersey1Matusiak 67*+

0i8erences in healthcare1seekingbeha%iors

Cultural beliefs

Health practices 'inguistic barriers

0egree of trust in healthcare pro%iders

%actors that in&uence these disparities'education" housing" nutrition" biologicalactors" economics" and socio(politicalpower)

:Children from poor families are o%elikely than children from high1income!perience poor communication $ithhealthcare pro%iders=

:Hispanics ha%e a rate of A409 moretimes higher than that of non1Hispan

:?lack children ha%e the greatest pr

hospitalization for asthma=

:Asian adults are 67< more likely thadults to lack immunization against p

:?lacks and persons of lo$er socioecstatus ha%e higher rates of death fro

*urses are at the ront lines o conrhealthcare disparities +,ersey(-atus


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What practice issues are related

cultural competence" Provider barriers- barriers that healthcare pro%iders may ha%e#

including lack of information about a culture.s customs regardinghealthcare+

System barriers- those that e!ist in an agency+ ,he agency.s struand policies are not designed to support cultural di%ersity @er$ek

E!ample- :an American 4ndian family may $ish to spend the night in the 4C$ith a critically ill family member+ Ho$e%er# the room does not ha%e a cot toon# and the $aiting room is not large enough to accommodate all the familypresent to support the patient+ ,he community in $hich the hospital is locatlarge American 4ndian opulation+=

What can you# as a nurse# do"


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D

As an ad%ocate for your patients and their familiesD

4nter%ene through acti%ities such as oining a hospital commfocused on hospital redesign

oint out the need for space for family members to stay the

near their lo%ed ones+ $n this way" you are supporting the needs o the cultural di

in your community


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Mnemonic for Assessing and 4mpro

Cultural Competence @er$ekh ) Consider your o$n cultural biases and ho$ this a8ects your nurs

Bnderstand the need to recognize cultural implications in planninimplementing nursing care

'earn ho$ to utilize cultural assessment tools

,reat patients $ith dignity and respect

Bse sensiti%ity in pro%iding culturally competent care

Fecognize opportunities to pro%ide speciGc cultural1based nursin

E%aluate your o$n pre%ious encounters $ith patients from other and backgrounds


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Models for Cultural Compete

,he rocess of Cultural Competence in the 0eli%ery oHealthcare 9er%ices# this model helps determine yourcultural competency+

A$areness

9kill 5no$ledge

Encounters

0esire


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,he urnell Model for Cultura

Competence

uter rims represent global society# community

4nterior di%ided into I( sections representing I( Bse these domains as a frame$ork for cultur


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,he Jiger and 0a%idhizar

,ranscultural Assessment Mod

Transcultural nursing is that focuses on the compara

and analysis of cultures and su'e$is ()*+ 1oal'disco%er

rele%ant facts that can guidein pro%iding culturally approp ,his model identiGes si! cultural phenomen

assess i


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9pector.s Health ,radition

Model 0epicts a continuum of cultural beliefs that range fr

being traditional to patterns that reKect acculturatio

Acculturation: e8orts to adopt or modify one.s o$nculture $hile making contact and integrating into an

culture+


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?e careful3

Although many cultural competency models are a%ausing them may pro%ide narro$ deGnitions of culturput an o%eremphasis on race and ethnicity+

ocusing on race and ethnicity e!clude biological#

psychological# religious# economical# and political fa$hich are all aspects of one.s cultural e!perience+


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9tereotyping


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A%oid 9tereotyping

Stereotype- an o%er1generalized %ie$point that members of a speciGcculture# race# or ethnic group are alike and share the same %alues and'e$is ()*+

9tereotyping does not take into account the indi%idual di8erences tha$ithin a culture+

9tereotyping can distract from the most important aspects of care- dea rapport and getting to kno$ and understand the patients you ser%e+

Cultural competency models are good to use# howeer"they can.t subfor good interpersonal and patient1centered communication that lets yestablish a trusting relationship $ith your patients 5ersey1Matusiak


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Cultural and 9piritual Assessment- What are cuand spiritual beliefs about illness and cures

atients $ill ha%e di8erent responses to illness based on their o$n cultuspiritual beliefs+ ?ut remember# don.t stereotype a patient based on his cultural or spiritual background3

Many people of di8erent cultures use complementary# alternati%e# or intmodalities that can a8ect their health status @er$ekh );*+

Complementary therapies- those that are used in conunction $ithmainstream treatments+ e!+- acupuncture# yoga# aromatherapy*

Alternative therapies- those that are used instead of mainstream medtherapies+ e!+- special teas# spiritual healing*

Integrative therapies- those for $hich there is some scientiGc basis foe!+- biofeedback Ldeep breathing# guided imagery# etc+*


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Culture1bound 9yndromes

Culture-boundsyndromes- illnesses oraictions that arerecognized only $ithin a

cultural group+ ,hese canbe e!pressed throughpsychologic or physicalsymptoms 'e$is >7*+


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Cultural Minorities

:Minorities= non1$hites* may be %ulnerable to a %ariety ofdisad%antages# including po%erty and limited opportunities foreducation and obs Halter O(*+

reuent %ictims of bias# discrimination# and racism+

:Make sure you understand the role that factors such as po%er

homelessness# unemployment# immigration status# and lack ofsupport play in determining access and uality of healthcare fpatients# regardless of race and ethnicity+= 5ersey1Matusiak 6

Aoid stereotyping!


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Cultural Minorities

4n the B+9+# the incidence of mental health disordersamong cultural and racial minority groups is similarthat among $hites ithe poor and other %ulnerablepopulations $ithin the minority groups are e!cluded

E!ample of %ulnerable populations include homeless#institutionalized# children in foster care# and %ictims of trau 4f people in these %ulnerable populations are included# the

incidence of mental health problems among minorities incre

,he higher incidence of mental health problems is related topo%erty not ethnicity Halter O(*+


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Cultural Minorities

eople $ho li%e in po%erty are(1> times more likely to de%elopmental illness than those $holi%e abo%e the po%erty line+

4n (7II# O+;< of non1Hispanic $hites li%ed inpo%erty

I(+>< of Asians li%ed belo$ the po%erty line+

(6+>< of 'atino1Hispanic Americans li%ed belo$the po%erty line+

(P+< of blacks and African Americans li%edbelo$ the po%erty line+

o%erty is associated $ith othe

9carce educational and eopportunities associa

substance abuse an

oor persons are subedaily struggle for sur%

takes a toll on ment


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Cultural Minorities

9ome people from cultural minoritiesha%e reported that they percei%ed biasand e!perienced culturallyuncomfortable care from healthcarepro%iders+

,his makes them less likely to seek

medical ser%ices in the future+ According to a report by the 4nstitute of

Medicine" 2ne3ual Treatment'#onronting 4acial and 5thnic

Disparities in 6ealthcare#

:?ias and discrimination taint the healthcare system# resulting in further stresseson the mental health or those in minoritygroups instead of deli%ering the helpthey need 9medley et at+# (77>*=


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FeKect

Are you a$are of any biases or pre1concei%ed notions you may hto$ard di8erent cultures# races# or ethnicities"

What can you# as a future nurse# do to reduce the stigma of Men4llness"

Ho$ can you become an ad%ocate for the cultural aspects of you

community" Femember that de%eloping cultural competence takes time and

practice+ What are some $ays that you can enhance your compein cultural care" ,hink of $ays that you can e!pose yourself to dcultures+ 9eek opportunities+


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Ruestions

What is the leading determinant of a patient.s heath

A+ ?eha%ior

?+ amily history of disease

C+ Home and $ork en%ironment

0+ ,ype and uality of medical care recei%ed


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Ruestions

What is the leading determinant of a patient.s heath

A !ehavior

?+ amily history of disease

C+ Home and $ork en%ironment

0+ ,ype and uality of medical care recei%ed


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Ruestions

4n identifying patients at the greatest risk for health disparitienurse $ould note that

A+ patients $ho li%e in urban areas ha%e readily a%ailable accehealth care ser%ices

! cultural di"erences e#ist in patients$ ability to

communicate with their HCPC+ a patient recei%ing care from a HC of a di8erent culture $ha%e decreased uality of care

0+ men are more likely than $omen to ha%e their cardio%asculdisease symptoms ignored by their healthcare pro%ider


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Ruestions

orcing one.s o$n cultural beliefs and practices onanother person is an e!ample of

A+ stereotyping

?+ ethnocentrism

C+ cultural relati%ity

0+ cultural imposition


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Ruestions

orcing one.s o$n cultural beliefs and practices onanother person is an e!ample of

A+ stereotyping

?+ ethnocentrism

C+ cultural relati%ity % cultural imposition


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Ruestions

Which statement most accurately describes culturalfactors that may a8ect health"

A+ 0iabetes and cancer rates di8er by cultural/ethnigroups

?+ Most patients Gnd that religious rituals help themduring times of illness

C+ ,here are limited ethnic %ariations in physiologicresponses to medications

0+ 9ilence during a nurse1patient interaction usuallymeans that the patient understands the instructions


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Ruestions

Which statement most accurately describes cultural factors tmay a8ect health"

A %iabetes and cancer rates di"er by cultural&ethnic g

?+ Most patients Gnd that religious rituals help them during illness

C+ ,here are limited ethnic %ariations in physiologic responsemedications

0+ 9ilence during a nurse1patient interaction usually means tpatient understands the instructions+


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Ruestions

When communicating $ith a patient $ho speaks alanguage that the nurse does not understand# it isimportant to Grst attempt to

A+ ha%e a family member translate

?+ use a trained medical interpreter

C+ use speciGc medical terminology so there $ill be mistakes

0+ focus on the translation rather than non%erbalcommunication


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Ruestions

When communicating $ith a patient $ho speaks alanguage that the nurse does not understand# it isimportant to Grst attempt to

A+ ha%e a family member translate

! use a trained medical interpreter

C+ use speciGc medical terminology so there $ill be mistakes

0+ focus on the translation rather than non%erbalcommunication


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Ruestions

As part of the nursing process# cultural assessment accomplished by

A+ udging the patient.s cultural %alues based onobser%ations

?+ seeking guidance from a nurse from the patient.scultural background

C+ using a cultural assessment guide as part of the nprocess

0+ relying on the nurse.s pre%ious e!perience $ithpatients from that cultural group


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Ruestions

As part of the nursing process# cultural assessment accomplished by

A+ udging the patient.s cultural %alues based onobser%ations

?+ seeking guidance from a nurse from the patient.scultural background

C using a cultural assessment guide as part o' nursing process

0+ relying on the nurse.s pre%ious e!perience $ithpatients from that cultural group


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Ruestions

Nurses play an important role in reducing health disparitiesimportant mechanism to do this is to

A+ discourage use of e%idence1based practice guidelines

?+ insist that patients adhere to the Healthy eople (7(7guidelines

C+ teach patients to use the 4nternet to Gnd resources relatetheir health

% engage in active listening and establish relationshippatients and 'amilies


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Ruestions

What is the Grst step in de%eloping cultural competence"

A+ Create opportunities to interact $ith a %ariety of cultural

! (#amine the nurse$s own cultural background) valubelie's about health and health care

C+ 'earn about a multitude of folk medicines and herbal

substances that di8erent cultures use for self1care+

0+ 'earn assessment skills for di8erent cultural groups# inclcultural beliefs and practices and physical assessments


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Ruestions

2ou are caring for Maria# a patient $ho states that s:ghost sickness+= Which is the appropriate nursingresponse"

A+ :4 ha%e no idea $hat Sghost sickness. is+=

?+ :Ho$ does Sghost sickness. make you feel"= C+ :.Jhost sickness. is not listed in the manual of

psychiatric disorders+=

0+ :'et.s talk about $hy you belie%e in e%il spirits+=


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Ruestions

2ou are caring for Maria# a patient $ho states that s:ghost sickness+= Which is the appropriate nursingresponse"

A+ :4 ha%e no idea $hat Sghost sickness. is+=

! *How does +ghost sickness$ make you 'eel,

C+ :.Jhost sickness. is not listed in the manual ofpsychiatric disorders+=

0+ :'et.s talk about $hy you belie%e in e%il spirits+=


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Ruestions

Which nursing actions demonstrate cultural competence" 9ethat apply+

A Planning mealtime around the patient$s prayer sche

! Advising a patient to visit with the hospital chaplain

C .esearching 'oods that a lacto-ovo-vegetarian patien

eat % Providing time 'or a patient$s spiritual healer to visi

E+ rdering standard meal trays to be deli%ered three times


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Feferences

Halter# M+ (7I)*+ Cultural 4mplications for sychiatric Mental HeNursing+ 4n oundations of psychiatric mental health nursing- clinical approach+ Pth ed+*+ 9t+ 'ouis# Missouri- 9aunders/Else

5ersey1Matusiak# J+ n+d+*+ Culturally competent care- Are $e theNursing(7I(# )O16(+ doi-I7+I7OP/7I+NBF9E+7777)I7>7;+)O7>

'e$is# 9+ (7I)*+ Health 0isparities and Culturally Competent CaMedical1surgical nursing- Assessment and management of clinicaproblems Oth ed+# pp+ (>1>)*+ 9t+ 'ouis# Missouri- Else%ier Mo

@er$ekh# T+ (7I(*+ Cultural and 9piritual A$areness+ 4n Nursing ,ransition and trends Pth ed+*+ 9t+ 'ouis# Missouri- 9aunders E

Documents

Cultural Considerations MHCommunity PP