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. • Describe the methods for conducting the Heritage Assessment. • Provide examples of traditional health and illness beliefs and practices. • Discuss the steps to cultural competence.
Health: • “The balance of the person, both within one’s being—physical, mental and/or spiritual—and in the outside world—natural, communal, and/or metaphysical, is a complex, interrelated phenomenon (Spector, 2004)
Illness: • The loss of the person’s balance, within one’s being—physical, mental and/or spiritual—and in the outside world—natural, communal, and/or metaphysical.
Demographic Profile of the United States • Total population passed 300 million in the autumn of 2006. • 1 out of 3 US residents was in a group other than single-race non-Hispanic white. • “Minority” or “emerging majority” population totaled 98 million people. • Hispanics largest and fastest growing group. • Second largest population is blacks. • Followed by Asians, American Indians and Alaska Natives, Native Hawaiians and other Pacific Islanders.
In comparison to the population as a whole: • Emerging majority groups tend to be younger, with lower median ages and higher proportions of the population under the age of 18 years. • The non-Hispanic, single-race, white population has an older median age and a smaller proportion of the population under the age of 18 years.
There is— • One birth every 8 seconds • One death every 13 seconds • One international migrant (net) every 30 seconds • Therefore our country gains one person every 11 seconds
Categories of interest to health care providers • Legal permanent residents • Naturalized citizens • Undocumented aliens • Refugees, asylees, and parolees • Legal nonimmigrant residents
National Standards for Culturally and Linguistically Appropriate Services in Health Care
First and Landmark Standard • “Health care organizations should ensure that patients receive from all staff members effective, understandable and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language” 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.
Linguistic Competence • Title VI of the Civil Rights Act of 1964: Services cannot be denied to people of limited English proficiency. • According to the 2000 census, 47 million Americans over 5 years of age speak a language other than English in their homes. • This represented an increase of 15 million people over the numbers documented by the 1990 census. • Certain states require that providers offer language assistance in health care settings: California, Massachusetts, and New York.
Cultural Competence • Culturally sensitive • Culturally appropriate • Culturally competent
Culturally Sensitive • Possessing basic knowledge of and constructive attitudes toward diverse cultural populations
Culturally Appropriate • Applying underlying background knowledge necessary to provide the best possible health care
Culturally Competent • Understanding and attending to total context of patient’s situation including • Immigration status • Stress factors • Social factors • Cultural similarities and differences
Heritage Consistency • The degree to which a person’s lifestyle reflects his or her traditional heritage
Heritage Consistency Continuum • Traditional: living within the norms of the traditional culture • Modern: acculturated to the norms of the dominant society
Culture • The thoughts, communications, actions, beliefs, values, and institutions of racial, ethnic, religious or social groups.
Characteristics of Culture • Learned • Shared • Adapted • Dynamic
Ethnicity • Describes a group united by • Common geographic origin • Migratory status • Religion • Race • Language • Shared values, traditions, or symbols • Food preferences
Religion • The belief in a divine or superhuman power or powers to be obeyed and worshipped as creator/ruler of the universe • A system of beliefs, practices, and ethical values • A shared experience of spirituality
Health-Related Behaviors Affected by Religion • Meditating • Exercising/physical fitness • Sleep habits • Vaccinations • Willingness to undergo physical examination • Pilgrimage • Truthfulness about how you feel
Health-Related Behaviors Affected by Religion (cont.) • Maintenance of family viability • Hoping for recovery • Coping with stress • Genetic screening and counseling • Living with a disability • Caring for children
Socialization • The process of being raised within a culture and acquiring the characteristics of that group.
Related Terms • Acculturation—the process of adapting to acquiring another culture • Assimilation—the process by which a person develops a new cultural identity and becomes like the members of the dominant culture
Time Orientation • Focus on the past • Focus on the present • Focus on the future
Indicators of Heritage Consistency • Childhood in country of origin or immigrant neighborhood of like ethnic group • Extended family support of traditional activities • Frequent visits to the old country or old neighborhood • Family home is within the ethnic community to which he or she belongs • Participation in ethnic cultural events • Raised in an extended family setting
Indicators of Heritage Consistency (cont.) • Regular contact with the extended family • Name not anglicized • Educated in a parochial school • Social activities primarily with other members of the ethnic community • Knowledge of language and culture of origin • Expresses pride in heritage
Differing views of the same disease: Epilepsy • Uganda: contagious, untreatable • Greece: source of family shame • Mexican-American community: evidence of physical imbalance • Hutterites: having endured a trial by God
Developmental Care • Culture affects the choices parents make for children regarding • The presumed cause of an illness • The first treatment tried • The acceptability of treatments offered by clinicians • For older patients, culture is likely to • Define their family responsibilities • Affect their knowledge of the systems used by the dominant culture
Biomedical • Assumes cause and effect • Views the body as a machine • Life can be divided into parts • Endorses germ theory
Naturalistic • Forces of nature must be kept in balance • Embraces the idea of opposing categories or forces • Yin/Yang • Hot/Cold
Magicoreligious • Supernatural powers predominate in the area of health and illness • Examples include voodoo, witchcraft, and faith healing
Folk Healers • Hispanic: curandero, espiritualista, yerbo, or sabedor • Black: hougan, spiritualist, old lady • American Indian: shaman, medicine woman, medicine man • Asian: herbalists, acupuncturists, bone setters • Amish: braucher
Steps to Cultural Competence • Understanding one’s own heritage-based cultural values, beliefs, attitudes, and practices • Identifying meaning of “health” to the patient • Understanding how the health care system works • Acquiring knowledge about the social backgrounds of one’s patients • Becoming familiar with the languages, interpretive services, and community resources used by (and available to) your patients and yourself
R = Realize that you must know the heritage of yourself and your patient. E = Examine the patient within the cultural context. S = Select questions that are simple and speak them slowly. P = Pace questioning throughout the exam. E = Encourage patient to discuss meaning of health and illness with you. C = Check patient’s understanding and acceptance of recommendations. T = Touch the patient within the boundaries of his or her heritage. R.E.S.P.E.C.T.
In the current health care environment, what is the most important influence on the success of an interaction? • The patient’s awareness of the nurse’s heritage • The nurse’ awareness of the patient’s heritage • The degree to which the patient and nurse share heritage • The patient’s willingness to assimilate into the dominant culture
At the ends of the Heritage Consistency Continuum are the terms • Traditional and modern • Traditional and progressive • Bound and modern • Bound and progressive