Lecture 9 Flashcards
What is unconscious bias and what influences it?
Bias we are unaware of and that happens outside our control. Influenced by our personal background, experiences, and cultural environment.
What is implicit bias?
Bias that we are aware is present. Influenced by the same things that influence unconscious bias.
What is culturally congruent care?
Care provided based on an individual’s cultural beliefs
What is cultural competence?
to provide appropriate culturally sensitive care related to the patient’s beliefs, practices, and cultural and linguistic needs of diverse patients
describe changing demographics.
Prediction: by 2060 minorities will make up 32% of the US population
Culture is associated with…
Norms, values, and traditions passed down through generations
In addition to norms, values, and traditions, culture is also perceived to be the same as what?
-Ethnicity
-Race
-Nationality
-Language
A more contemporary view of culture acknowledges many other facets such as…
- Gender
- Sexual orientation
- Location
- Class
- Immigration status
What is oppression?
system of advantages and disadvantages tied to our membership in social groups
What does oppression impact?
It impacts an individual’s access to resources such as:
* healthcare
* housing
* education
* employment
* legal services
what is an intersectionality?
the crossing of two separate but related factors that play into oppression. e.g. being black and a woman or being gay and a trans
What is the difference between disease and illness?
Illness is the subjective perception of the patientdisease is physiological dysfunction that the doctor treats
How does culture play into peoples perceptions of disease?
People tend to react differently to diseases based on their unique cultural perspectives
Describe the effect that the lack of cultural diversity among healthcare providers has on people.
The lack of cultural diversity among healthcare providers often frustrates patients and providers, fostering a lack of trust, lack of adherence, and poor health outcomes.
Describe Emic and Etic world views in intercultural encounters
In any intercultural encounter there is an insider perspective (Emic) and an outsider perspective (Etic)
When does conflict arise from healthcare related intercultural interactions?
Conflict arises when healthcare providers interpret the behaviors of patients through their own world view
What must HCPs do to prevent conflict associated with intercultural interactions?
They need to discover and uncover the perspective of their patient
who developed the theory of transcultural nursing?
Madeleine Leininger
How is transcultural nursing defined?
The comparative study of cultures to understand their similarities (culture that is universal) and the difference among them (culture that is specific to particular groups
What is the goal of transcultural nursing?
- Provide culturally congruent care
(care that fits a person’s life patterns, values, and system of meaning.)
Rather than instructing all patients to always take their medications at the same set times during a day, you learn their lifestyle patterns, eating habits, sleep habits, and beliefs about medications then try to plan a dosage schedule to fit each patient’s needs. this is an example of what?
Transcultural nursing
What is a health disparity?
Differences among populations in the:
* availability
* accessibility
* quality of healthcare services
What does parity mean?
Equality
What are social determinants of health?
Conditions in which people are born, grow, live, work and age that affect ones health
Why are people from marginalized groups more likely to have poor health outcomes and die at an earlier age?
Because of the interaction between individual genetics and behaviors, public and health policy, community and environmental factors, and quality of healthcare
What are some examples of social determinants of health?
- Income and wealth
- Family and household structure
- Social support
- Education
- Occupation
- Discrimination
- Neighborhood conditions
- Social institutions
What groups are more likely to be impacted by healthcare disparities?
- Blacks
- Asians
- Hispanics
- low and middle income groups
- the uninsured
- LGBT community
what are two social determinants that contribute to health disparities?
- Poor access to healthcare
- healthcare system and HCPs (inadequate resources, poor patient-provider communication, a lack of culturally competent care, fragmented delivery of care, inadequate access to language services)
disparities in access to care, quality of care, preventative health, health education, and available resources to enable self-management when patients are outside of the healthcare setting contribute to what?
poor population health
As a nurse, valuing each patient’s unique needs does what?
improves the overall safety and quality of care and helps to eliminate health disparities
according to the slides, intersectionality states that:
each of us are at the intersection of two categories: Privilege and oppression (I dont know what this means…)
according to the Iceberg analogy:
most aspects of a person’s world view are hidden
understanding the different levels of oppression and where you stand helps you to…
develop culturally competence
what are some characteristics of culturally competent organizations?
- Value diversity
- Conduct a cultural self-assessment
- Manage the dynamics of difference
- Institute cultural knowledge
- Adapt to diversity
what does developing cultural diversity allow systems, agencies, and groups of professionals to do?
function effectively to understand the needs of groups accessing health information and healthcare which helps to eliminate healthcare disparities and health disparities.
Describe the Culturally and Linguistically Appropriate Standards (CLAS)
- Intended to advance health equity, improve quality, and help eliminate healthcare disparities
- Offers trained language assistance services
- Offers handouts in the patient’s language
what did the early stages of cultural competency focus on?
focused on the cultural barriers between healthcare providers educated in western health care practices and immigrants arriving from non-western parts of the world
What are the cultural competency skills (5) that are universal and can work effectively with patients from any culture?
- Respecting a patients health belief as valid and understanding the effect of the patient’s belief’s on healthcare delivery
- Shifting a model of understanding a patient’s experience from a disease happening in his or her body to that of an illness occurring in the context of culture (biopsychosocial context)
- Ability to get a patient’s explanation of an illness and its causes (Patient’s explanatory model)
- Ability to explain to a patient in understandable terms the healthcare provider’s perspective on the illness and its perceived causes
- Being able to negotiate a mutually agreeable, safe, and effective treatment plan
Expanding the original focus on interpersonal skills, many of the current approaches to cultural competency now also focus on:
- All marginalized groups
- Prejudice, stereotyping, and social determinants of health
- The health system, communities, and institutions
What is involved with collecting a patient history?
- Linguistic competence
- Providing language assistance resources
- Inform all of the availability of language assistance
- Ensure competence of those providing language assistance
- Provide print/multimedia materials in local languages
What is involved with assessing health literacy?
assess patients ability to obtain, process, and understand basic health information and the services needed to make appropriate health decisions
What is involved with a culturally based physical assessment?
- Knowledge about a patient directs your physical assessment
- Learn to anticipate physical findings based on a patient’s cultural health practices
What is linguistic competence?
The ability of an organization and its staff to communicate effectively and convey info in a manner that is easily understood by diverse audiences
What do diverse audiences associated with linguistic competence include?
Those with:
* Limited english proficiency
* Those who have low literacy skills or none at all
* Individuals with disabilities
* Those who are deaf or have a hard time hearing
Healthcare organizations nationwide are subject to federal civil rights laws. How does this tie into linguistic competency?
These laws outline requirements for the provision of language access services
when should you use a patient’s family members to interpret for you or other healthcare providers?
Never.
What is health literacy?
ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions
what are common methods of determining a patient’s health literacy?
- Rapid Estimate of Adult Literacy in Medicine (REALM)
- Test of Functional Health Literacy in Adults (TOFHLA)
How can you deliver health related information and make sure the patient understands?
- Communicate clearly
- Use the teach-back technique
What kind of questions should you avoid during teach-back interventions?
Avoid close-ended questions like ‘Do you understand?’ or ‘Do you have any questions?’
What kind of questions should you ask during teach-back interventions?
Ask open-ended questions like ‘Will you explain it back to me so I can be sure that I have explained correctly?’
What are cultural encounters? what do they have the potential for? what do they enable?
- interventions that involve a nurse directly interacting with patients from culturally diverse backgrounds.
- They have the potential for conflict.
- They enable new forms of community and collective identity.
How can story-telling help in a cultural encounter?
helps identify the real problems affecting a patient’s health status and find culturally appropriate ways to intervene
Campinha-Bacote describes two goals of a cultural encounter, what are they?
- to generate a wide variety of responses and to send and receive both verbal and non-verbal communication accurately and appropriately
- to continuously interact with patients from culturally diverse backgrounds in order to validate, refine, or modify existing values, beliefs, and practices and to develop cultural desire, awareness, skill, and knowledge
what is a challenge of cultural encounters?
being able to show compassion, especially if cross-cultural conflict develops
It is easy to avoid cultural encounters with patients. what are some of the factors that contribute to that?
- Time
- Our personal discomfort in communicating with others who are different
- focus on physical care
Health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. These disparities are often exacerbated by:
A. bias.
B. stereotyping.
C. prejudice.
D. all of the above.
D
You are in the process of admitting an ethnically diverse patient. To plan culturally competent care, you will conduct a cultural assessment that includes:
A. biocultural history.
B. ethnohistory.
C. negotiation.
D. ethnocentrism.
B
