PCC-1 Exam 3 Module 8 Flashcards
Cultural Competencies
- Respecting a patient’s health beliefs and understanding the effect of the patient’s beliefs on health care delivery
- Shifting a model of understanding a patient’s experience from a disease happening in the patient’s organ systems to that of an illness occurring in the context of culture
- Ability to elicit a patient’s explanation of an illness and its causes
- Ability to explain to a patient the health care provider’s perspective on the illness and its perceived causes
- Being able to negotiate a mutually agreeable, safe, and effective treatment plan
Reiteration from Mrs. Campbell’s notes of the 5 competencies:
- Respecting a patient’s health beliefs as valid and understanding the effect of the patient’s beliefs on health care delivery
- Shifting a model of understanding a patient’s experience from a disease happening in his or her organ systems to that of an illness occurring in the context of culture (biopsychosocial context)
- Ability to elicit a patient’s explanation of an illness and its causes (patient’s explanatory model)
- Ability to explain to a patient in understandable terms the health care provider’s perspective on the illness and its perceived causes
- Being able to negotiate a mutually agreeable, safe, and effective treatment plan
Health Disparities
Health disparity (inequality/gap) A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage
Health disparities are the differences among populations in the incidence, prevalence, and outcomes of health conditions, diseases, and related complications.
Health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g., screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications.
Addressing health disparities:
New standards
Focus on cultural competency, health literacy, and patient- and family-centered care
Recognize that valuing each patient’s unique needs improves the overall safety and quality of care and helps to eliminate health disparities.
African-Americans, Asians, & Hispanics less likely that non-Hispanic whites to see PCP regularly
Less care available to people in low- and middle-income groups compared with high-income groups
Uninsured people ages 0-64 years less likely to have regular PCP than those with private/public ins.
Subgroups of LGBT community have more chronic health conditions and a higher prevalence & earlier onset of disabilities than heterosexuals
6 QSEN Competencies
- ) patient centered care
- ) teamwork and collaboration
- ) evidence-based practice
- ) quality improvement/assurance
- ) safety
- ) informatics
Cultural Assessment models with explanation
Camphina-Bacote’s models of cultural competency has five interrelated components:
Cultural Awareness: an in depth self examination of one own’s background, recognizing biases, prejudices, and assumptions about other people
Cultural knowledge: : Sufficient comparative knowledge of diverse groups, including the values, health beliefs, care practices, world view, and bicultural ecology commonly found within each group
Cultural Skills:
Ability to assess social, cultural, and biophysical factors that influence patient treatment and care
Cultural encounters: Cross-cultural interactions that provide opportunities to learn about other cultures and develop effective intercultural communication
Cultural desire: The motivation and commitment to caring that moves an individual to learn from others, accept the role as a learner, be open to and accepting of cultural differences, and build on cultural similarities
Cultural Competency
Defined as the enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients. Culturally competent organizations: Value diversity Conduct a cultural self-assessment Manage the dynamics of difference Institutionalize cultural knowledge Adapt to diversity
Expanding the original focus on interpersonal skills, many of the current approaches to cultural competency now also focus on:
All marginalized groups and not just immigrants
Prejudice, stereotyping, and social determinants of health
The health system, communities, and institutions.
You broaden your understanding of the world by learning about other people’s world views, which determines how people perceive others, how they interact and relate to reality, and how they process information. Cultural competency is dynamic and takes time to develop.
Blanchet and Pepin on cultural competencies
Blanchet and Pepin: depends on experience & interactions with patients and fellow clinicians
Building a relationship with the other
Working outside the usual practice framework
Reinventing practice in action
Blanchet and Pepin have recently described the processes involved in the development of cultural competence among registered nurses and undergraduate student nurses. Clinical experience and interactions with patients and fellow clinicians help to build cultural competency.
Cultural Competencies Cultural Responsive Care
Nurses should accommodate each client’s cultural beliefs and values whenever possible, unless they are in direct conflict with essential health practices. The goal is to provide culturally competent care.
Culturally sensitive – nurses are knowledgeable about the cultures prevalent in the area of practice.
Culturally appropriate – nurses apply their knowledge of the client’s culture to their care delivery
Culturally competent – nurses understand and address the entire cultural context of each client within the realm of the care they deliver.
Culturally responsive – should encourage client decision-making by introducing self-empowering strategies.
Culturally imposition – understanding and awareness of their own (nurses) culture and any culture biases that might affect care delivery.
Linguistic Competencies
Linguistic competence is the ability of an organization and its staff to communicate effectively and convey information in a manner that is easily understood by diverse audiences. These audiences include people of limited English proficiency, those who have low literacy skills or are not literate, individuals with disabilities, and those who are deaf or hard of hearing.
Mnemonics
LEARN: Listen, Explain, Acknowledge, Recommend, Negotiate
RESPECT: Rapport, Empathy, Support, Partnership, Explanations, Cultural Competence, Trust
ETHNIC: Explanation, Treatment, Healers, Negotiate, Intervention, Collaboration
C-LARA: Calm, Listen, Affirm, Respond, Add
Nonverbal Behaviors
ATI pg. 191
5 Spiritual constructs
Self-transcendence: a sense of authentically connecting to one’s inner self. It is a positive force. It allows people to have new experiences and develop new perspectives that are beyond ordinary physical boundaries. Examples of transcendent moments include the feeling of awe when holding a new baby or looking at a beautiful sunset.
Connectedness: being intrapersonally connected within oneself; interpersonally connected with others and the environment; and transpersonally connected with God, or an unseen higher power. Through connectedness patients move beyond the stressors of everyday life and find comfort, faith, hope, and empowerment, and religion
Faith: allows people to have firm beliefs despite lack of physical evidence. It enables them to believe in and establish transpersonal connections. Although many people associate faith with religious beliefs, it exists without them. Also, a belief in or a relationship with a higher power
Hope: has several meanings that vary on the basis of how it is being experienced; it usually refers to an energizing source that has an orientation to future goals and outcomes. Also, includes anticipation and optimism and provides comfort during times of crisis.
Religion – is a system of beliefes practiced outwardly to express one’s spirituality.
Religion – is a system of beliefes practiced outwardly to express one’s spirituality.
The concept of spiritual well-being has two dimensions. One dimension supports the transcendent relationship between a person and God or a higher power. The other dimension describes positive relationships and connections that people have with others.
Spiritual distress is a challenge to belief systems or spiritual well-being. It often arises as a result of catastrophic events. The client can display hopelessness and decreased interactions with others.
Factors of a spiritual assessment
Faith/Belief
Ask about a religious source of guidance
Understand the patient’s philosophy of life
Life and self-responsibility: ask about a patient’s understanding of illness limitations or threats and how the patient will adjust
Connectedness: ask about the patient’s ability to express a sense of relatedness to something greater than self
Life satisfaction
Culture: ask about faith and belief systems to understand culture and spirituality relationships
Fellowship and community: ask about support networks
Ritual and practice: ask about life practices used to assist in structure and support during difficult times
Vocation: ask whether illness or hospitalization has altered spiritual expression
Spiritual rituals
Death rituals – vary with each culture. The nurse should facilitate whenever possible.
Pain – may need alternative to numeric pain scales. Explore the meaning of pain.
Nutrition – Allow family to bring food from home as long as they meet dietary restrictions. Communicate food intolerances/allergies to staff.
Communication – Establish rapport, use approved interpreters, use nonverbal communication with caution, apologize if beliefs or traditions are violated.
Family patterns- identify, communicate, and include those in the family who are seen as having the authority to make family decisions.
Culture ad life transitions – assess for rituals associated with birth, puberty, pregnancy, childhood, dying, and death.
Repatterning- Accommodate the client’s belief as much as possible but attempt to repattern that belief to be compatible with health promotion while respecting the client and family and cultural differences.
The Joint Commission requires that an interpreter be available in health care facilities in the client’s language (2010). Use only a facility-approved medical interpreter. Do not use the client’s family or friends, or a non-designated employee or interpreter.
Nursing Diagnosis related to Spirituality
Exploring the patient’s spirituality sometimes reveals responses to health problems that require nursing intervention or the existence of a strong set of resources that allow the patient to cope effectively.
Analyze data to find risk factors or patterns of defining characteristics and select appropriate nursing diagnoses.
[Review Box 36-4, Nursing Diagnostic Process: Readiness for Enhanced Spiritual Well-Being, with students.]
Three nursing diagnoses accepted by NANDA International pertain specifically to spirituality. Readiness for Enhanced Spiritual Well-Being is based on defining characteristics that show a person’s ability to experience and integrate meaning and purpose in life through connectedness with self and others.
Accurate selection of diagnoses requires critical thinking. Review and analyze all concrete data (e.g., religious rituals and sources of fellowship), your assessment of previous patient experiences, your own spirituality, and your appraisal of the patient’s spiritual well-being. Commonly patients have multiple nursing diagnoses
Potential diagnoses Anxiety Ineffective Coping Complicated Grieving Hopelessness Powerlessness Readiness for Enhanced Spiritual Well-Being Spiritual Distress Risk for Spiritual Distress Risk for Impaired Religiosity
Nursing Interventions related to spiritual needs
Health promotion: involves giving attention, answering questions, having an encouraging attitude, and expressing a sense of trust, “being with rather than doing for”
Supportive healing relationship: mobilize hope, provide interpretation of suffering that is acceptable to patient, help patient use resources
