Transcript Chapter 10 Cultural Competency and Social Issues in

Chapter 10
Cultural Competency and
Social Issues in Nursing
and Health Care
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Key Concepts
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Demographic and sociocultural variations of
diverse groups
Variations in biologic, social, environmental, and
communications phenomena
Education, practice, and research issues that
influence culturally competent care
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Population Trends
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Immigration laws have increased the number of
immigrants
By mid-21st century, minority populations will
outnumber the white population
Number of adults older than 65 years is
increasing
The number of adults who live past 85 years of
age has increased
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Effect of People Living Longer
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Increased opportunity to develop chronic illness
Social isolation and depression resulting from
loss of family and friends
Primary care providers faced with promoting
maximum functional status and identifying risks
to health and independence
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Federally Defined Minority Groups
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African Americans
Hispanics
American Indian/Alaskan Native
Asian/Pacific Islanders
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Health Disparities
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Life expectancy for whites is 78 years; for
African Americans, 72.7 years
Causes of death for minority groups
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Cancer
 Cardiovascular disease and stroke
 Chemical dependency
 Diabetes
 Homicides and accidents
 Infant mortality
• In African Americans the death rate is 2x higher than in
whites
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Marginalized Populations
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Gays
Lesbians
Older adults
Recent immigrants from countries such as
Russia, Rwanda, and Afghanistan (their lives
and health care needs are often kept secret, and
they are often voiceless)
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Changing Economics
and Downsizing
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Joblessness
Homelessness
Poverty
Limited access to health care insurance and
health care
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High cost of insurance and lower wages make it
difficult for minority groups to rise out of poverty and
access health care
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Poverty
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Higher costs and lower wages for minority
groups
More minorities lack health care and live in
higher percentage poverty
Residential segregation
Substandard housing
Unemployment
Poor physical and mental health
Poor self-image
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Violence
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Businesses, churches, and schools have become sites
for random acts of violence
Unemployment is associated with violence
Homicide is the second leading cause of death among
Americans 15-24 years of age
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Leading cause of death in African American males 15-34 years
of age
Intimate partner violence is greatest cause of injury in
women 15-24 years of age, across all ethnic, racial,
socioeconomic, and educational groups
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Attitudes Toward
Culturally Diverse Groups
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Hate
Contempt
Tolerance
Respect
Celebration
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A Continuum of Intensity of the Range of
Attitudes Toward Culturally Diverse Groups
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1. Barriers to mainstream health care include lack of
transportation and disrespectful treatment for a group
of economically deprived, underserved individuals
living in a remote area accessible only by water
transportation. A mobile clinic provides blood pressure
screening, minor first aid, and blood glucose checks.
This group of individuals is best described as:
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B.
C.
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Marginalized
Stereotyped
Enculturated
Assimilated
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Need for Diversity in
Health Care Force
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Consumer demand
Lack of diversity and ethnic representation
Minorities inhibited from having nursing careers
Better recruitment efforts by other disciplines
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Current Status of Diversity
in Health Care Workforce
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Highest representation—Blacks or African
Americans
Lowest representation—American Indians
Men in nursing represent a minority
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Recruitment and Retention of
Minorities in Health Care Workforce
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Before World War II: National Association of
Colored Graduate Nurses (NACGN)
During World War II: Cadet Nurse Corps had 2
black recruiters who recruited from 82 black
colleges
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Recruitment and Retention of
Minorities in Health Care Workforce
(cont'd)
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After World War II—National efforts by NACGN
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Southern nursing schools segregated by law
Northern nursing schools segregated by custom
Brown v. Board of Education—1954
Recruitment in the 1960s and 1970s
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Many efforts to recruit economically disadvantaged
 Sealantic Fund—Rockefeller Foundation
 “Breakthrough to Nursing”
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Recruitment and Retention of
Minorities in Health Care Workforce
(cont'd)
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Recruitment in the 1990s
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American Nurses Foundation report: “Strategies for
Recruitment, Retention and Graduation of Minority
Nurses in Colleges of Nursing”
Chi Eta Phi
• National African-American nursing society with chapters
throughout the country
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Nursing shortage reports
• American Hospital Association, Robert Wood Johnson
Foundation, Joint Commission, and Association of Academic
Health Centers
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Reasons for Cultural Competence
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Nurse’s culture often differs from client’s
Culturally incompetent care is more costly
Culturally incompetent care is ineffective
Meet specific objectives for persons in different
cultures as outlined by Healthy People 2000
Disparities in health and health care
Nursing is committed to social justice
Global infectious disease epidemics
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Cultural Competence
in Nursing Education
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Beliefs and practices of various cultural groups
Disease prevalence and mortality rates
Cultural factors related to situations, such as
birth and death
Specific culture-bound syndromes
Roles and responsibilities of family members
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Cultural Competence
in Nursing Education (cont'd)
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The Essentials of Baccalaureate Education for
Professional Nursing Practice Cultural Competencies
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Apply knowledge of social and cultural factors that affect nursing
and health care across multiple contexts
Use relevant data sources and best evidence in providing
culturally competent care
Promote achievement of safe and quality outcomes of care for
diverse populations
Advocate for social justice
Participate in continuous cultural competence development
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Anglo-American Values Contrasted
with Those of Other Cultures
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Personal control vs. fate
Change vs. tradition
Time vs. human interaction
Human equality vs. hierarchy, rank, and status
Individualism vs. group welfare
Self-help vs. cooperation
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Anglo-American Values Contrasted
with Those of Other Cultures
(cont'd)
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Competition vs. cooperation
“Future” vs. “past” orientation
“Action” vs. “being” oriented
Informality vs. formality
Directness vs. indirectness
Practicality vs. idealism
Materialism vs. spiritualism
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Environmental Control
(Mastery Over Nature)
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Belief that one can overcome the natural forces
of nature
Anticipate good results from medicine or surgery
Whites likely to subscribe to this view
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Environmental Control
(Subject to Nature)
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Belief that one has little control over what
happens
May not be compliant with treatments
African Americans and Mexican Americans
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2. A nurse is assessing a Chinese child and notices
5-inch, perfectly circular ecchymoses on the body.
The nurse realizes that this finding is indicative of:
A. Child abuse
B. Pinching to relieve headaches
C. Cupping to remove colds and coughs
D. Beating to remove evil spirits
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Environmental Control
(Harmony with Nature)
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Illness represents disharmony
Rely on naturalistic remedies because
medications seen as only relieving symptoms
Asians and American Indians
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Biologic Variations
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Body build and structure
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Genetic variations
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African Americans have lower serum cholesterol
Skin
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African Americans have denser bones, larger teeth than whites
Variations in amount of melanin
Susceptibility to disease
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American Indians have greater incidence of strep throat and
gastroenteritis, highest incidence of diabetes
Japanese Americans have lower incidence of cardiovascular and
renal disease but higher rates of stress-related diseases
Mexican Americans have higher rates of diabetes and obesity
and use less preventive care
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Social Organization
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Nuclear families
Single-parent families
Extended families
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Communication Issues
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Direct eye contact
Formality
Agreement
Interpreters
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Space
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People’s attitudes and comfort level regarding
personal space
Vast cultural differences in comfort level
associated with distance between individuals
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Asians believe touching strangers is inappropriate
Mexican Americans tend to be comfortable with less
space
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Time
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Present-oriented
Past-oriented
Future-oriented
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Practice Issues Related
to Cultural Competence
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Minority populations less knowledgeable about
specific health problems
Minority populations underestimate prevalence
of cancer
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Obtain fewer screening tests
Diagnosed at later stages
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Education and Certification
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Transcultural, cross-cultural, and international
nursing programs increasing
Transcultural Nursing Society offers certification
as a transcultural nurse
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International Marketplace
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Nurses engaging in clinical practice, education,
research, administration, and consultation in
hundreds of countries
No one organization provides leadership to
these nurses
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Professional Journals
Devoted to Cultural Issues
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The Journal of Transcultural Nursing
Western Journal of Medicine
Cross-Cultural Issues
Journal of Cultural Diversity
Journal of Multicultural Nursing
International Journal of Nursing Studies
International Nursing Review
Journal of Holistic Nursing
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Issues
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International marketplace
Research
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Individual behavioral responses to normal life process
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Pregnancy
Birth
Death
Human Growth and Development
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Responsibility for Cultural Care By
Health Care Facilities
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Provide resources for education and practice
Employ or consult transcultural clinical
specialists
Offer continuing education programs about
cultural issues
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Recommended Standards for
Culturally and Linguistically Appropriate
Health Care Services (CLAS)
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Promote and support attitudes, behaviors,
knowledge, and skills
Comprehensive management strategy
Recruit, retain, promote culturally competent
staff
Require and arrange ongoing cultural education
Provide clients access to bilingual staff
Inform of rights to interpreter service
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Recommended Standards for
Culturally, Linguistically Appropriate
Health Care Services (CLAS) (cont'd)
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Translate and make available patient education
material and signage
Ensure appropriate interpreter services
Ensure that primary language and race/ethnicity
are incorporated into the organization’s
management information system
Collect and use appropriate data and assess
needs and resources of the community
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Recommended Standards for
Culturally, Linguistically Appropriate
Health Care Services (CLAS) (cont'd)
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Ongoing self-assessment of cultural competence
Develop procedures to address cross-cultural
ethical and legal conflicts
Prepare an annual progress report related to
CLAS
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Cultural Assessment
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Cultural self-assessment
Cultural client assessment
Cultural client nutrition assessment
Cultural beliefs about sickness and cures
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Cultural Beliefs About
Sickness and Cures
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Mal ojo: “evil eye”
Susto: “fright sickness”
Bilis: “a disease brought on by anger”
Empacho: “sharp pains brought on by food
lodged in the intestinal tract”
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