Chapter 9: Cultural Competence (week 1)

Question 1

Culture

Answer 1

Refers to the learned and shared beliefs, values, norms and traditions of a particular group, which guide our thinking, decisions, and actions

Question 2

Unconscious bias

Answer 2

Unconscious bias refers to a bias we are unaware of and that happens outside our control, which is influenced by our personal background, cultural environment, and personal experiences. Unconscious bias typically directs one to make quick judgments and assessments of people and situations.

Question 3

Implicit bias

Answer 3

An implicit bias is similar to unconscious bias; however, we are aware of the bias that is present. We are responsible for implicit bias and must recognize and acknowledge our actions as they impact our behavior, decisions, and patient-centered care provided.

Question 4

Culturally congruent care

Answer 4

Culturally congruent care or transcultural care emphasizes the need to provide care based on an individual’s cultural beliefs, practices, and values.

Question 5

Cultural competence

Answer 5

Cultural competence means that health care must be culturally sensitive, culturally appropriate, and culturally competent to meet the multifaceted health care needs of each person, family, and community. The goal of delivering cultural care is to utilize research findings to provide culturally specific care that is safe and beneficial to the well-being of the diverse population.

Question 6

The changing demographics of the U.S. population create challenges for the health care system and health care providers. By the year 2060, the U.S. Census Bureau (2020) predicts what will occur?

Answer 6

• The percentage of racial and ethnic minority groups in the United States is expected to climb to 32% of the population.
• The fastest-growing racial ethnic group in the United States is people whose ancestry is from two or more races, and this group is projected to grow by 200% by 2060.
• The next fastest–growing is the Asian population, which is projected to double, followed by the Hispanic population.
• The population age 65 years and over will increase from 49 million in 2016 to 95 million by the year 2060.

Question 7

What shapes an individual’s or groups worldview

Answer 7

Historical/culture and social realities
This determines how they interact and relate to reality and how they process information

Culture: shared experiences and commonalities that have developed and continue to evolve

Socialization: through family, friends, community, peers, schooling, etc…

Question 8

Define worldview

Answer 8

Worldview is a set of assumptions that begins to develop during childhood and guides how one sees, thinks about, experiences, and interprets the world

Question 9

What 2 perspectives are present in any intercultural encounter

Answer 9

insider perspective (emic worldview)
Outsider perspective (etic worldview)

Question 10

Sterotype

Answer 10

an assumed belief regarding a particular group. It is easy to stereotype various cultural groups based off of general information about their ethnic values, practices, and beliefs. It is vital to avoid stereotypes or unwarranted generalizations about any particular group. Avoiding stereotypes prevents an inaccurate patient assessment. Instead, approach each person individually, and ask questions to gain a better understanding of a patient’s perspective and needs.

See every patient encounter as cross-cultural.

Question 11

What 2 phases does stereotyping occur

Answer 11

1. First phase - phase there is an activation of a stereotype when an individual is categorized into a social group. When this occurs, beliefs and prejudices come to mind about what members of that particular group are like. Stereotypical views eventually occur without awareness automatically.
2. Second phase - people use these activated beliefs and feelings when they interact with individuals. Research shows that health care providers activate these stereotypes or unconscious biases routinely when communicating with and providing care to minority individuals. As a result, diagnoses and treatments of patients may be biased even in the absence of the practitioner’s intent or awareness.

Question 12

How does Healthy People 2030 define health disparity and provide different types

Answer 12

a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage”.

Poor health status, disease risk factors, poor health outcomes, and limited access to health care are types of disparities that are often interrelated and influenced by the conditions and social context in which people live

Question 13

Social determinants of health

Answer 13

conditions in which people are born, grow, live, work, and age that affect health functioning and quality of life outcomes. The Healthy People 2030 initiative identifies five categories of social determinants: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. Social determinants of health are mostly responsible for health disparities seen with and between countries. It is important that you understand how patients’ cultural factors and their social determinants of health influence their health disparities. Health care disparities are a public health concern because of the adverse effects on communities.

Question 14

Marginalized groups

Answer 14

people who are in marginalized groups are more likely to have poor health outcomes and die earlier because of a complex interaction among their individual behaviors, environment of the communities in which they live, the policies and practices of health care and governmental systems, and the clinical care they receive. Examples of marginalized groups include people who are LGBTQ+, people of color, people who are physically or mentally challenged, and people who are not college educated. Nursing intersects with a variety of people from different cultures; therefore, the awareness of marginalization is critical.

Question 15

Intersectionality

Answer 15

Intersectionality is a research and policy model for studying the complexities of people’s lives and experiences. The model looks at how being marginalized affects people’s health and access to care. It serves to describe the forces, factors, and power structures that shape and influence life. Intersectionality is a way of understanding and analyzing our complex world by looking at the human experience. Each of us is at the intersection of two categories: privilege and oppression

Question 16

What is the oppression category of intersectionality

Answer 16

. Oppression is a formal and informal system of advantages and disadvantages tied to membership in social groups, reinforced by societal norms, biases, interactions, and beliefs. In contrast, a patient experiencing privilege has no difficulty accessing these resources. Individuals who support the theory of intersectionality believe that we must each determine how privileged and how oppressed we are to understand ourselves, the people around us, and the choices we make. Learning about a culture includes becoming familiar with the heritage of the people and understanding how discrimination, prejudice, and oppression can influence beliefs upheld in everyday life. Then as health care providers, we are better able to identify the nature or source of a patient’s health care problems and how best to find solutions.

Question 17

What are the ladders of oppression and cultural competence

Answer 17

Question 18

What is the iceberg analogy

Answer 18

Most aspects of a person’s world view are hidden

Question 19

Cultural competence

Answer 19

a dynamic, fluid, continuous process whereby an individual, system, or health care agency finds meaningful and useful care strategies based on knowledge of the cultural heritage, beliefs, attitudes, and behaviors of those to whom they render care”. Cultural competence is challenging to achieve, but it begins with one’s ongoing development, while gaining an awareness of individual racial, ethnic, and cultural identity. That awareness prepares you to better understand patients within the context of their own racial, ethnic, and cultural identity.

Question 20

Racial identity vs ethnic identity

Answer 20

Racial identity is based on one’s self-identification with one or more social groups in which a common heritage with a particular racial group is shared. Racial identity and ethnic identity are both components of self-concept that place the focus on being part of a cultural group. Although racial identity and ethnic identity demonstrate the differences between race and ethnicity, they have a shared history, values, and bonds. Research frequently treats racial and ethnic identities as interchangeable.

Question 21

Acculturation

Answer 21

acculturation occurs when an individual or group transitions from one culture and develops traits of another culture

Question 22

ASsimilation

Answer 22

process in which the individual adapts to the host’s cultural values and no longer prefers the components of the origin culture.

Question 23

Define illness

Answer 23

the way in which individuals and families react to disease
Culture affects how an individual defines the meaning of illness

Question 24

Disease

Answer 24

malfunctioning of biological or psychological processes. Most health care providers in the United States are primarily educated to treat disease, whereas most individuals seek health care because of their experience with illness.

Question 25

Core Quality Measures Collaborative

Answer 25

Set of core measures which aim to hold health care providers accountable for considering patient’s unique cultural perspectives to provide safe quality care

Key quality indicators that help health care institutions improve performance, increase accountability and reduce costs

Intended to reduce health disparities

Question 26

Campinha-Bacote’s Model of cultural competence

Answer 26

five interrelated constructs:

1. cultural awareness
2. cultural knowledge
3. cultural skill - ability to conduct a cultural assessment of a patient
4. cultural encounters
5. cultural desire.

Question 27

Cultural awareness

Answer 27

Self-examination of one’s biases toward othercultures and an in-depth exploration of one’s owncultural and professional background

Question 28

Cultural knowledge

Answer 28

Learning or becoming educated about the beliefs andvalues of other cultures and diverse ethnic groups

The health care provider must focus on these specific issues: (1) health-related beliefs and cultural values, (2) disease incidence and prevalence, and (3) treatment efficacy.

Question 29

What is one way to understand a patient’s cultural perspective

Answer 29

Storytelling - this helps identify real problems affecting a patient’s health status and find culturally appropriate ways to intervene

Question 30

What are the three levels of worldview

Answer 30

1. Expressed as behavior
2. Learned and
3. largely subconcious

Question 31

How do nurses use cultural skill during practice

Answer 31

Collecting a culturally based nursing history, performing a culturally based physical assessment, and using teach-back with plain language are cultural skills that take practice and require you to apply your cultural awareness and knowledge. It takes time to gather a comprehensive, culturally based nursing history.

Question 32

What do all U.S Health care organizations have to follow when collecting a patient history

Answer 32

*Linguistic competence is the ability to communicate effectively and convey information in a manner that is easily understood by diverse audiences.
*Provide language assistance resources (e.g., trained medical interpreters, qualified translators, telecommunication devices for the deaf) for individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.
* Inform all individuals of the availability of language assistance services clearly and in their preferred language verbally and in writing.
* Ensure the competence of individuals providing language assistance. Do not use untrained individuals and/or minors as interpreters.
* Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area

Question 33

Health literacy

Answer 33

the degree to which individuals have the capacity to obtain, process, and understand basic health information and the services needed to make appropriate health decisions and can be a problem for anyone. It is important to understand that even people with good literacy skills find that understanding health care information is a challenge.W

Question 34

What technique can be used following any patient instructions given

Answer 34

Teach Back technique by asking open ended questions

Question 35

Define cultural encounter. What are the 2 goals of cultural encounter

Answer 35

Whenever you directly interact with patients from culturally diverse backgrounds, this interaction is a cultural encounter and has two goals. One goal is to communicate in a way that generates a wide variety of responses and to send and receive both verbal and nonverbal communication accurately and appropriately in each culturally different context. The second goal is to continuously interact with patients from culturally diverse backgrounds to validate, refine, or modify existing values, beliefs, and practices about a cultural group.

Question 36

Cultural desire

Answer 36

refers to having the motivation to engage patients so that you understand them from a cultural perspective.

Question 37

What model can help you care for patients that have completely different values and morals

Answer 37

L.E.A.R.N Model
* Listen to the patient’s perception of the problem. Be nonjudgmental and use encouraging comments, such as “Tell me more” or “I understand what you are saying.”

• Explain your perception of the problem.
• Acknowledge not only the differences between the two perceptions of the problem but also the similarities. Recognize the differences but build on the similarities.
• Recommendations must involve the patient.
• Negotiate a treatment plan, considering that it is beneficial to incorporate selected aspects of the patient’s culture into the plan.