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Cultural Cultural CompetenceCompetence
Культурная компетентность
What is culture?What is culture? Что такое культура?Что такое культура?
Refers to the learned, shared and transmitted values, beliefs, norms, and ways of specific individuals or groups that guide their thinking, decisions, and actions and patterned ways (Leininger, 2001)
What is Cultural What is Cultural Competence?Competence?Что такое культурная Что такое культурная компетентность?компетентность?
A process in which the nurse involved with the client and family continuously strives to provide culturally competent care
(Campinha-Bacote)
Cultural Competence Model
Five components/steps: Awareness Knowledge Skill Encounter Desire
Campinha-Bacote, 2010Campinha-Bacote, 2010
Cultural Competence Cultural Competence ModelModel Модель культурной Модель культурной компетентностикомпетентности1. Cultural Awareness
• A process of self–examination of one’s own biases towards other cultures and an exploration of one’s cultural and professional background.
• A process of being aware of the existence of documented racism and other “isms” in health care deliveryo self assessment/reflection
2. Cultural Knowledge2. Cultural Knowledge
Defined as a process in which a nurse seeks and obtains a sound educational base about culturally diverse groups.
Knowledge to focus on integration of specific issues: health-related beliefs practices, cultural values, disease incidence and prevalence, genetic implications related to drugs,
Know current realities of communities Trends, minority groups, marginalized groups, health disparities/risks, economic & social factors
Knowledge R/T Knowledge R/T PopulationsPopulationsImmigration laws have increased the
# of immigrantsBy mid 21st century minority
populations will outnumber whole population
# of adults who live past 85 years of age has increased & will increase◦Baby Boomer (1945-1965) 2029 - The last
of the boomers will turn 65. 65+ population projected to double to 71.5 million by 2030
Knowledge ActivityTurn to your neighbors and form
a group of 3-4Complete matching of terms to
build your knowledge base
Knowledge: Value Knowledge: Value OrientationsOrientations
◦Cultures have a value system that teaches behaviors by setting norms◦ Health beliefs and practices tend to
reflect a culture’s value system May impact health prevention/education
focus and compliance with treatment plan
• Value orientations can be identified for most persons within a particular cultural group BUT remember…will find diversity within any cultural group
Cultural Value Cultural Value OrientationsOrientationsCultural factors that vary and
affect health◦ Identified by Giger and Davidhizer (2004)
Include:Environment
Biological Variations
Social Organization
Communication
Space
Time
Consider…Consider…Space
◦ Personal comfort◦ Boundaries and rules
Social Organization◦ Family unit defined◦ Decision maker
Communication◦ Formal & informal◦ Verbal & non-verbal◦ Importance of silence◦ Facts vs. stories
orientation◦ Need for interpreter
Consider…Consider…Time Orientation
◦ Past-Present-Future viewpoint
◦ Impacts belief regarding: Change of behaviors Appointment punctuality Health promotion &
illness prevention strategies
Ability to be “present”
Somali HeritageSomali HeritageSomali gov.
collapsed in Africa – refugees to US
Time orientation not part of culture but enculturates over time to time Orientation
MuslimGender
preference
3. Cultural Skill • Ability to collect relevant data
through the interview process
oNeed to know how communication styles and meanings may impact this process
oNon-verbal communication plays a significant role in many cultures
oIdentify potential barriers to effective communication process
oNurse must know when there is a need for a formally trained interpreter in order to avoid potential problems with a non-English/ESL speaking client
4. Cultural Encounter • Process in which the nurse
seeks opportunities to engage in cross-cultural interactions directly or indirectly
• Nurses gain experience from directly working with clients or learning from others who have
5. Cultural Desire oGenuine and sincere
desire to work effectively with minority clients and their families
oDesire to travel and interact with culturally diverse grps
oCampinha-Bacote (2007) sees encounters as the pivotal construct of Cultural Competence!
Campinha-Bacote, 2010Campinha-Bacote, 2010
CDC Populations - RACECDC Populations - RACEWhiteAsian American,Black or African American,Hispanic or Latino,Native Hawaiian and Other
Pacific Islander,American Indian and Alaska
Nativewww.cdc.gov/minorityhealth/populations/REMP/definitions
RACERACEThe census
Bureau predicts by 2060, white Americans will comprise 50% of US population
White people have origins from Europe, The middle East, or North Africa
White People comprise 70% of US population in 2000 census
Anglo AmericansAnglo AmericansPersonal control
vs fateChange vs.
traditionTime vs human
interactionIndividualism vs
group welfareSelf help vs
cooperation
Action vs being oriented
Future vs past orientation
Informality vs formality
Materialism vs spiritualism
Practicality vs idealism
Anglo AmericansAnglo AmericansPersonal control
vs fateChange vs.
traditionTime vs human
interactionIndividualism vs
group welfareSelf help vs
cooperation
Action vs being oriented
Future vs past orientation
Informality vs formality
Materialism vs spiritualism
Practicality vs idealism
Hispanic or LatinosHispanic or LatinosHispanic 2013 = 17
%of US pop.Largest Ethnic grp
in US Mexican(64%),
Puerto Rican(9.4%, Salvodoran, Cuban Dominican, Gualemalan
Risks: ↑ B/P, heart, diabetes,obesity, lactose intolerant
Mexican AmericanMexican AmericanLanguage dialectsSpace – closerTime is relative and
present orientedSeveral formal
names - so ask & address formally
Traditional roles Family is a priority.
Predominant religion is Roman Catholic
Folk health providersShow respect and
include family- ? Eye contact
Direct confrontation disrespectful
Ask before touching but usually very tactile
BarriersBarriers
Language Barriers These impede communication and ability to express thoughts & feelings
Foreign languages, dialects, and idioms, slang, street talk are all types of barriers that may impede communication in the U.S. families even have own informal language!
Differences related to socio-economic status effect communication style (Ruby Payne; Bridges Out of Poverty)
National Standards for National Standards for Cultural CompetenceCultural Competence
Culturally & Linguistically Appropriate Services (CLAS) Developed by the U.S. Department of Health
and Human Services, Office of Minority Health
With intent to ensure that the recipients of health care services are provided equitable and effective treatment
The standards address the inequities that exist
in the provision of health care services to the people of color
Russian AmericansRussian AmericansLanguage is
Russia but many speak English
Time orientation – on time or early
Medication hording
Use eye contact except with government officials
Use TouchDo not interpret eye
contact as aggressive or loud tone
Health = absence of disease
Hospital stays in Russia 3 weeks.
Warmth =+ Stoical with painFolk practices
Consider…Consider…Biological Variations
◦ Cultural characteristics and genetic differences
◦ Review family health history
and health risks factors Impacts types of drugs
various groups respond best to.
RACE: African Am. Or RACE: African Am. Or BlackBlack
In 2012, the population of African Americans including those of more than one race was estimated at 44.5 million, making up 14.2% of the total U.S. population. In 2060 projects will be 18.4%
RACE: African Am. Or RACE: African Am. Or BlackBlackDiffer based on
socioeconomic grp, sub culture
Language: EnglishNonverbal
importantClose personal
spaceExtended families
important
Headed by single-parent woman but varies
Risks: Sickle cell, ↑ B/P, heart, Cancer. diabetes, lactose intolerant, obesity,
Genetic differences in response to drugs for ↑ /P
Transcultural Transcultural Communication BarriersCommunication Barriers
Lack of Knowledge The failure to understand cultural
differences in values, behaviors and communication styles is a common stumbling block for nurses
Each culture dictates what “normal” behavior is when one is sick
Will learn this in DON curriculum and throughout nursing career
Barriers to Cultural Barriers to Cultural CompetencyCompetency
Fear and Distrust Fear, dislike and distrust are emotions that erupt when people from different cultures first meet
What other emotions may play a part in initial interactions?
How do we overcome this initial reaction?
Barriers to Cultural Barriers to Cultural CompetencyCompetency Racism
Most nurses find it hard to believe that racism even exists in the world of nursing Individual
Against biological characteristics
Cultural Heritage superiority
Institutional At one time black nurses were not allowed to
join the ANA
Barriers to Cultural Barriers to Cultural CompetencyCompetency
Bias and Ethnocentrism The belief that one’s own culture or traditions are better than those of other cultures
Attitudes toward western medicine constitute one of the biggest barriers to transcultural communication between American nurses and their clients/families You, the nurse, must admit that biases exist in
order to overcome & advocate for clients
Barriers to Cultural Barriers to Cultural CompentencyCompentency Stereotyping
Assigning certain beliefs and behaviors to groups without recognizing individuality Unsubstantiated assumption that all people
of a certain racial and ethnic group are alike This is especially harmful when negative traits
imposed on all members of a cultural group (example - all Native Americans are
alcoholics)
Barriers to Cultural Barriers to Cultural CompetencyCompetency
Cultural Blind Spot Syndrome Just because client looks and
behaves much as you do - do not assume no cultural differences (are all Caucasians alike? Are all Asian Americans alike)
Remember all patients are individuals with unique characteristics and personal histories
Barriers to Cultural Barriers to Cultural CompetencyCompetency Ritualistic Behavior
These allow nurses to remain in control of situations without individualizing care
We need to ask ourselves which nursing care rituals really have a scientific basis for following them Movement behind evidenced-based practice –
do we practice based on accumulated scientific knowledge? … What is the Best Practice!
Barriers to Cultural Barriers to Cultural CompentencyCompentency
Different Perceptions & Expectations
Cultural, behavioral, and language differences between nurses, patients and patients families … can lead to:Greater probability that patients will
misunderstand nursing care and instructions
Often cultures vary in perception of health promotion and disease prevention
Cultural home remedies - often 1st treatment of choice
ResourceResourceCampinha-Bacote J. (1998, 2002,
2010) The process of cultural competence in the delivery of healthcare services.
Munoz, C. & Luckmann, J. (2005). Transcultural communication in nursing. Clifton Park, New Jersey: Delmar.
Website ResourcesWebsite ResourcesCDC websitesU.S. Dept of Health and Human
Services, Office of Minority Affairs◦ CLAS National Standards◦ http://minorityhealth.hhs.gov
Early Childhood Research Institute◦ CLAS information and education◦ www.clas.uiuc.edu
Transcultural Nursing Society◦ http://www.tcns.org
People having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Pacific Islanders
RACE: Pacific Islanders/RACE: Pacific Islanders/
Asian AmericanAsian American2010 Census
4.8% but by 2050 can rise to 9.2%
Asian +Pacific Islanders top causes of death include: Cancer, Heart, Stroke, Unintentional injuries, diabetes
Chinese, Filipinos, Asian Indian, Vietnamese, Koreans, Japanese
American Indian/Alaska American Indian/Alaska NativesNativesU.S. Census
Bureau in 2011 = 1.6% of the U.S. total population.
29% lacked health insurance
Top 5: Heart disease, cancer, unintentional injuries, diabetes, Liver & Cirrhosis,