cultural competence Культурная компетентность. what is culture? Что...

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

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


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)


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,

cultural competence Культурная компетентность. what is culture? Что...

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