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Cultural Competence

Cultural Competence . July 2008. The ACE Cultural Competence Committee. Margaret M. Andrews, PhD, RN, CTN, FAAN Lauren Clark, PhD, RN, FAAN Katherine Foss, MS, RN Sandie Kerlagon, MS, RN Jo Keuhn, RN, BS (Original Date: 2004).

Updated on Apr 03, 2019

• new nurses
• affluent wealthy gay
• healthcare provider
• ace cultural competence committee
• directness
• candid discussions

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Cultural Competence

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1. Cultural Competence July 2008

2. The ACE Cultural Competence Commission Margaret M. Andrews, PhD, RN, CTN, FAAN Lauren Clark, PhD, RN, FAAN Katherine Foss, MS, RN Sandie Kerlagon, MS, RN Jo Keuhn, RN, BS (Original Date: 2004)

3. Cultural Competence in Clinical Settings: An Introduction for New Nurses

4. What is Culture? A definition: Leninger (1985) describes culture equally: 'the values, behavior, norms, and practices of a detail group that are learned and shared and that guide thinking, decisions and actions in a patterned style' Or more simply: the luggage each of u.s. carries around for our lifetime (Spector, 2003)

5. Civilisation determines…. • Who is good for you & ill • What people recollect causes health & illness • What healers are sought to preclude and care for disease • What treatments are used • Advisable sick part behavior • How long a person is ill & when he/she has recovered

6. Cultural and Linguistic Competence • the ability of health care providers and wellness care organizations to empathise and respond effectively to the cultural and linguistic needs brought by the patient to the wellness care encounter. U.S. Department of Health & Man Services, 2003

7. Cultural Competence 1 two Cultural Sensation Cultural Noesis & Skill Campinha-Bacote, 2008 3 Cultural Meet

8. Cultural Competence • Begins with agreement of own self • Includes cognition of diverse cultural characteristics • Includes an agreement of cultural characteristics • Requires application of cultural noesis and agreement in the healthcare setting

9. Socioeconomic status Sexual Orientation Handicap/Inability Occupation Age Poverty The Homeless The Affluent/Wealthy Gay, Lesbian, Bisexual, Transgender Deaf/Hearing Impaired Blind/Visually Impaired Nurses, War machine Adolescents, Elderly Non-ethnic CulturesSelected Examples The Culture of…..

10. Avert STEREOTYPING We must not presume that all people of a certain civilisation attach to all aspects of their culture. The healthcare provider must identify which aspects are appropriate for each patient during the access process.

11. Cultural Cess • is a "systematic appraisal or examination of individuals, groups, and communities equally to their cultural behavior, values & practices to decide explicit needs & intervention practices within the cultural context of the people being evaluated." Leininger & McFarland, 2006

12. Explanatory Models • Explain why we are sick to other people and to ourselves to make sense of our misfortune • Example: "You lot have a terrible cold!" "You're right—Information technology is because I got run downward and then went outside without a coat yesterday. That'due south why I'yard sick."

13. Explanatory Model Questions • What is the patient's ethnic affiliation? • Who are the patient'due south major support persons and where do they live? • With whom should we speak about the patient's health or illness? • What are the patient's primary and secondary languages, and speaking and reading abilities? • What is the patient's economical situation? Is income adequate to run into the patient's and family's needs? (Lipson & Dibble, 2005)

14. Spirituality & Religion

15. Spirituality refers to a subjective feel of the sacred, whereas organized religion involves subscribing to a set of beliefs or doctrines that are institutionalized.

16. Major World Religions

17. U.S. Religions • 354,194 Congregations • > ane,200 Denominations Yearbook of American & Canadian Churches, 2002

18. Monk Spiritual & Religious Healers Curandero/a Shaman Priest Elder Medicine Human Medicine Woman Rabbi Bishop

19. Religion & spirituality in healing…. • Prayer, Chants • Pilgrimages • Fasting • Amulets or talismans • Healing rituals • Anointing with oil • Sacraments • Laying on of hands

20. Religion, Wellness & Culture • Research demonstrates positive health outcomes for people with strong spiritual and religious behavior • Congruent with holistic philosophical beliefs well-nigh human nature • Dietary & lifestyle practices frequently promote wellness & prevent illness (e.g., lower incidence of eye illness amongst Mormons & Seventh-solar day Adventists) • Guides moral & ethical decision making

21. Symbols of Ethnoreligious Identity • Shrines with Buddha, candles, incense, and various artifacts (Buddhist) • Presence of prayer chaplet (Muslim) • Amulets and talismans (charms) to ward off illness or bring good health (Mexican, Puerto Rican, & many African groups) • Rosaries, religious medals, statues, votive candles (Catholics) • Presence of mezuzza (small instance containing torah passages on parchment--usually hung in doorway)

22. Include Religious & Spiritual Factors in Cultural Assessment • Health-related beliefs & practices, east.g., diet, medications, medical & surgical procedures • Religious agenda & holy days • Healing practices • Religious network for providing spiritual & emotional support for sick & dying members. • Spiritual & religious healers

23. Avert scheduling medical appointments during holidays Avoid disruption to holy days (such equally fasting during Ramadan) Religious, Cultural & Civic Holidays

24. Promoting Effective Cross-Cultural Communication..... Ever ask, "By what proper name may I phone call you?"

25. What do Express-English Speakers Want? Speaking one's native language is…. • Easier when feeling sick • More comfy • More accurate

26. What is unsafe exercise with Express-English speakers? • Using family members every bit interpreters • Recruiting advertisement hoc (or untrained) interpreters • Writing instructions in English language Interpreter errors cause medical errors (Levine, JAMA, 2006)

27. Why not use a family unit fellow member as an interpreter? • Function for Civil Rights(OCR) Policy Guidance (2000)states that untrained "interpreters": • May not understand the concepts or official terminology they are asked to interpret or translate • Obstruct the menstruum of confidential data to the provider. • Fail to disclose intimate details of personal and family life; Clinicians, too, refrain from candid discussions with untrained interpreters nowadays.

28. Requirements in Using a Translator • Use approved Interpreter Services OR • Utilise the Interpreter Phone

29. Using Appropriate Interpreter Services in Clinical Care • Speak with Charge Nurse for assistance • Phone call Operator to place call • ane-800 number • Client lawmaking/ID • Request language

30. Directness in Clinical Encounters • Americans value directness: • "Spit information technology out" • "Say what'southward on your mind" • Languages that depend on subtle contextual cues: • Infer meaning • Imply, but do not state, the bespeak (Japanese, Standard arabic)

31. Directness and Subtlety • "Peradventure" or "That would be difficult" is probably a polite "no" • Avert yep/no questions • Phrase your inquiry as a multiple choice question

32. Nonverbal Communication • Facial expressions, trunk language, & tone of vocalism play a much greater role in cultures where people adopt indirect communication & talking around the issue.

33. Gestures and Facial Expressions • Some other culturally influenced aspect of communication is the demonstration of emotion, such as joy, affection, anger, or upset. • Almost Koreans, for instance, are taught that laughter & frequent grin brand a person appear unintelligent, so they adopt to wear a serious expression. • While Americans widen their eyes to evidence acrimony, Chinese people narrow theirs. • Vietnamese, conversely, consider anger a personal matter, non to be demonstrated publicly.

34. Grinning & laughter may exist signs of embarrassment & confusion on the role of some Asians. Talking with 1'southward easily is more common in southern Europe than in northern Europe. A direct stare by an African American or Arab is not meant as a challenge to your authority, while dropped optics may be a sign of respect from Latino or Asian patients & coworkers.

35. Gestures • Use gestures with care, every bit they can accept negative meanings in other cultures. • Thumbs-up and the OK sign are obscene gestures in parts of South America & the Mediterranean. • Pointing with the index finger and beckoning with the hand as a "come here" sign are seen as rude in some cultures much as snapping ane's fingers at someone would be viewed in the U.s.a..

36. American civilization by and large expects people to stand about an arm's length autonomously when talking in a business organisation state of affairs. • Any closer is reserved for more than intimate contact or seen as aggression. • In the Centre East, however, it is normal for people to stand up shut plenty to feel each other's breath on their faces.

37. Touch on • Different rules about who can be touched & where. • A handshake is generally accepted as a standard greeting in business, withal the kind of handshake differs. • Northward America = hearty grasp • United mexican states = softer concord • Asia = soft handshake with the second mitt brought upward nether the first is a sign of friendship & warmth

38. Bear on • Religious rules may use to appropriate touch. • Touching betwixt men & women in public is non permitted by some orthodox religions, so a handshake would not be appropriate. • Ideas virtually respect are conveyed through bear on • Touching the head, even tousling a kid's pilus every bit an affectionate gesture, would be considered offensive by many Asians. • If you need to touch someone for purposes of an examination, explicate the purpose & procedure earlier you lot begin.

39. Topics Advisable for Discussion • What is adequate for nurse and patient to hash out? • Many Asian groups regard feelings as too private to exist shared. • Latinos generally appreciate inquiries about family members, while most Arabs & Asians regard feelings every bit too personal to discuss in business situations. • In social conversations, Filipinos, Arabs, & Vietnamese might find information technology completely acceptable to ask the price y'all accept paid for something or how much you earn, while most Americans would consider that beliefs rude.

40. Inappropriate Conversation Topics • Even a seemingly innocuous comment on the weather is off limits in the Muslim world, where natural phenomena are viewed as Allah's will, not to be judged by humans. • This points to another aspect that relates to privacy. • To many newcomers, Americans seem naively open. Discretion and purposeful advice help usa guess when to converse and when to be silent.

41. Privacy • Discussing personal matters outside the family is seen equally embarrassing by many cultures. • Thoughts, feelings, & problems are kept to oneself in most groups outside the dominant American civilization. • Privacy boundaries may have implications when medical problems are exacerbated by personal or family problems.

42. Saving face up…. • In Asia, the Eye East, & to some extent Latin America, one's dignity must be preserved at all costs. • Death is preferred to loss of face up in traditional Japanese civilisation, hence the suicide ritual, hara-kiri, as a final way to restore honor. • Any embarrassment can pb to loss of face, fifty-fifty in the dominant American culture. • To exist criticized in forepart of others, publicly snubbed, or fired, would be humiliating in most any civilisation. • Seemingly harmless behaviors can be demeaning to some patients.

43. The Culturally Competent Clinician Attitudes of the Culturally Competent Clinician Understanding: Acknowledging that there can be differences between our Western and other cultures' healthcare values and practices. Empathy: Being sensitive to the feeling of being different. Patience: Understanding the potential differences between our Western and other cultures' concept of fourth dimension and immediacy. Ability: To laugh with oneself and others. Trust: Investment in building a relationship with patients, which conveys a delivery to safeguard their well-beingness.

44. Non-Exact Communication All cultures have rules, oft unspoken, most who touches whom, when & where.

45. Nonverbal Advice(~65% of all communication) • Touch • Facial expressions • Centre movements • Body posture

46. Modesty

47. Cultural Perspectives on Modesty • Patients may prefer clinicians of the same gender • May exist taboo for males to examine or treat females (e.thou., Middle Eastern groups) • In some Asian & Hispanic cultures, older adults may believe that infirmary gowns cause disease by exposing them to common cold drafts (related to yin/yang & hot/cold theories of disease)

48. Hurting and Cultural Competence

49. Hurting and Civilization • Hurting is an abstract concept which tin can be referred to as: A personal individual awareness A stimulus that signals harm A blueprint of behavior to protect from harm

50. Pain Experience • Pain is a universal human experience, just pain reactions are unique to the private and includes thoughts, feelings, reactions, expectations and by experiences associated with pain. • The experience of pain can also be described in physiologic, psychosocial, economic and spiritual contexts.

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