WEEK 1: Chapter 3 Key Points A Relational Approach to Cultural and Social Considerations in Health Assessment

Question 1

Relational Approach

Answer 1

This guide will help you enter all nursing situations—including health assessments—as an inquirer, inquiring into people’s experiences, how they understand their health and well-being, how they manage current and evolving states of health/illness/contexts, and how people’s health and your nursing care are shaped in relation to wider contexts.

Focusing your attention on the 3 levels simultaneously will enable you to conduct a comprehensive health assessment in a manner that is safest for all involved and to serve as a basis for responsive and effective nursing actions.

This approach prompts you to ask:

1.) How do my social, cultural, and professional backgrounds shape my ability to relate to the various people I encounter in my nursing practice (including my assumptions)?

2.) How do the backgrounds of patients shape their health and their responses to assessment?

Question 2

Relational Approach: Intrapersonal

Answer 2

Considering what is going on within an individual patient that you are assessing

-what is important to them

-what they might be overlooking

-what others, such as family, might be experiencing

-paying attention to yourself, as a care provider, might be focusing on and why

Question 3

Relational Approach: Interpersonal

Answer 3

Considering how a person is experiencing “being assessed”

-Feelings, thoughts, pain, stimulation of senses, etc.

Question 4

Relational Approach: Contextual

Answer 4

Considering what is happening around people and their circumstances contributes to the reason for being assessed and the findings of that assessment.

-The structure and conditions of our society that influence a person’s health and well-being and their intrapersonal & interpersonal responses

Question 5

Relational Approach: Uses Two Lenses

Answer 5

-Viewing health and assessment through two distinct yet interconnected perspectives: the biomedical and relational lenses.

*A biomedical lens focuses on health and disease’s physical and biological aspects, such as anatomy, physiology, and pathology.

*A relational lens considers the patient’s lived experiences, social determinants of health, and interactions between the patient and healthcare providers.

Question 6

Relational Approach: Gender Filter

Answer 6

-Acknowledges the influence of gender identity, roles, and expectations on health and healthcare experiences.

-It recognizes that gender is a social construct that intersects with other factors, such as culture, socioeconomic status, and power dynamics.

Promotes inclusive and non-judgmental care by considering how gender norms and biases might shape a patient’s health behaviors, access to care, and outcomes.

Question 7

Relational Approach: Decolonizing Filter

Answer 7

-Challenges the dominance of Western biomedical perspectives and acknowledges the historical and ongoing impacts of colonization on Indigenous and other marginalized populations.

-Advocates for incorporating Indigenous knowledge, practices, and values into healthcare to address health inequities and systemic racism.

Encourages listening to and validating patients’ experiences, particularly those from communities historically marginalized by the healthcare system.

Question 8

CULTURE

Answer 8

An inherently complex dimension of people’s lives. It is a universal phenomenon that shapes the health and well-being of every person.

-Health care providers must learn about their patients and their contexts to understand how to address their health needs.

-Assuming that people act in specific ways because of their culture is known as culturalism.

Question 9

Ethnicity

Answer 9

Encompasses many aspects of an individual’s country of origin, identity, ancestry, family history, languages spoken, and possibly their religion.

-Ethnic groups are individuals who identify with others based on a shared heritage, culture, language, or religious affiliation.

Question 10

Culturalism

Answer 10

Conceptualizing culture in narrow terms may lead to wrong assumptions about patients’ values and beliefs about health care.

-To prevent culturalism, a critical cultural perspective can examine culture as a relational aspect of individuals that shifts and changes over time, depending on an individual’s history, social context, past experiences, gender, professional identity, and more.

-Within the critical culture perspective, healthcare providers must consider how values, beliefs, customs, and practices intersect with broader social determinants and the power relations that shape health and healthcare.

Question 11

Racialization

Answer 11

Racialization is “a process by which ethno-racial groups are categorized, stigmatized, inferiorized, and marginalized as the ‘other.”

Racialization is closely linked to culturalism and discrimination.

Question 12

Discrimination

Answer 12

Refers to the unfair or prejudicial treatment of individuals or groups based on characteristics such as race, ethnicity, gender, age, sexual orientation, religion, or socioeconomic status.

Can manifest in unequal access to care, biased attitudes or behaviors from healthcare providers, or systemic policies that disadvantage certain groups.

It contributes to health inequities and can undermine trust in the healthcare system.

Question 13

Cultural Sensitivity

Answer 13

Being aware of and respectful of cultural differences, beliefs, and practices requires healthcare providers to recognize and avoid actions or words that could be offensive or dismissive to individuals from diverse backgrounds.

It helps providers build trust and rapport with patients by respecting their cultural values and preferences.

Question 14

Cultural Competence

Answer 14

The ability of healthcare providers to deliver effective care to patients with diverse cultural backgrounds. It involves acquiring knowledge, skills, and attitudes that enable providers to understand, respect, and address cultural differences in healthcare practices.

Key Components:
-Awareness of one’s own biases and assumptions.

-Understanding the cultural contexts of patients’ health beliefs and behaviors.

-Adapting care to meet patients’ cultural and linguistic needs.

Question 15

Cultural Safety

Answer 15

It goes beyond cultural competence by focusing on healthcare’s power dynamics and systemic inequities. It emphasizes creating an environment where patients feel safe, respected, and free from discrimination or marginalization.

Key Features:
-Recognizing the historical and systemic roots of health disparities, particularly in Indigenous and marginalized communities.

-Encouraging patients to define what “safe care” means to them.

-Advocating for systemic changes to address inequities and promote inclusivity.

Question 16

Health inequality

Answer 16

Refers to measurable differences in health outcomes or access to healthcare across different population groups. These differences are often due to variations in factors such as age, gender, geography, or socioeconomic status.

Characteristics:
-Not always avoidable or unfair (e.g., age-related health differences).

-Reflects disparities in health conditions, life expectancy, or healthcare utilization.

Question 17

Health Inequity

Answer 17

Refers to avoidable, unfair, and unjust differences in health outcomes and access to healthcare services. These disparities are driven by systemic factors like social, economic, and political inequalities.

Characteristics:
-Rooted in social determinants of health (e.g., poverty, racism, discrimination).

-Reflects a failure to provide equitable opportunities for health and well-being.

Question 18

Spirituality

Answer 18

An individual’s search for meaning, purpose, and connection in life may or may not be tied to religious beliefs. It is a deeply personal and often dynamic aspect of life that can influence one’s health and well-being.

Spirituality is an important consideration in holistic care, as it can affect coping mechanisms, recovery, and overall quality of life.

Question 19

Indigenous Populations in Canada

Answer 19

-Indigenous peoples in Canada, including First Nations, Inuit, and Métis, have faced systemic oppression, colonization, and intergenerational trauma, which have significantly impacted their health and well-being.

-Indigenous populations experience barriers to healthcare access, including geographic isolation, systemic racism, and lack of culturally safe care.

-Social determinants of health, such as poverty, inadequate housing, and limited access to education, further exacerbate these inequities.

Question 20

Gender and Sexual Diversity

Answer 20

-Gender identity refers to an individual’s deeply felt sense of being male, female, both, neither, or anywhere along the gender spectrum.

-Sexual orientation describes whom a person is attracted to romantically, emotionally, or sexually, including but not limited to heterosexual, homosexual, bisexual, and asexual orientations.

-Gender-diverse and sexually diverse individuals often face stigma, discrimination, and barriers to healthcare.

-They may experience higher rates of mental health issues, substance use, and delayed access to care due to fear of bias or judgment.

Question 21

Gender-Inclusive Language

Answer 21

-Avoid gendered terms unless relevant (e.g., use “partner” instead of “husband” or “wife”).

-Use a patient’s chosen name and pronouns, which may differ from those listed in legal documentation.

-Replace terms like “pregnant woman” with inclusive language such as “pregnant individual” to respect nonbinary and transgender people.

Question 22

Practice Imperative 1: Conduct Culturally Safe Health Assessments

Answer 22

1.) Create a Safe Environment
-Use welcoming body language, tone, and demeanor.

-Ensure the physical space is inclusive and accessible, such as displaying multicultural materials or using inclusive language on forms.

2.) Engage in Active Listening
-Encourage patients to share their perspectives on health, illness, and care.

-Ask open-ended questions like, “What does being healthy mean to you?” or “Are there specific practices you follow that are important to your well-being?”

3.) Gather a Culturally Relevant Health History
-Include questions about cultural health beliefs, traditional practices, dietary preferences, and the use of alternative or complementary therapies.

-Assess the influence of family, community, and spiritual or religious beliefs on health decisions.

4.) Adapt Communication Styles:
-Use interpreters if there are language barriers, avoiding reliance on family members for translation.

-Be mindful of nonverbal communication, as gestures, eye contact, or physical touch may have different meanings across cultures.

5.) Incorporate Cultural Practices:
-When appropriate and feasible, integrate traditional healing methods or practices into the care plan.

-Collaborate with community leaders, elders, or cultural liaisons if additional support is needed.

6.) Address Social Determinants of Health:
-Recognize and document factors such as housing, income, education, and access to healthcare that may impact the patient’s health.

-Advocate for equitable access to resources to reduce barriers.

Question 23

Practice Imperative 2: Pay attention to the Social and Economic Context of Patients’ and Families’ Lives

Answer 23

Consider how people are managing their:

-employment/unemployment
-housing
-childcare
-care of relatives
-financial resources
-transportation
-access to healthcare services
-“How are things going for you?”

Question 24

Practice Imperative 3: Intentionally Work to Build Trust and Create Safety

Answer 24

A trusting patient-provider relationship is essential to the provision of quality of care. Consider asking contextually appropriate trust-building questions:

“What do you think might be happening to you?”

“What kinds of things have you found helpful?”

“What Nation or community are you from?”

“In what country were you born?”

“How many years have you been in Canada?”

“What languages are you most comfortable speaking?”