Chapter 9 Cultural Awareness Copyright © 2021, Elsevier Inc. All Rights Reserved. Introduction Culture refers to the learned and shared beliefs, values, norms, and traditions of a particular group, which guide our thinking, decisions, and actions. Unconscious bias Implicit bias Culturally congruent care Cultural competence Changing demographics Copyright © 2021, Elsevier Inc. All Rights Reserved. 2 World View World view Emic Etic Avoid stereotyping Treat the individual See every patient encounter as crosscultural Copyright © 2021, Elsevier Inc. All Rights Reserved. 3 Health Disparities Health disparity Social determinants of health A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage (ODPHP, 2016) The conditions in which people are born, grow, live, work, and age (WHO, 2019) Marginalized groups Gay, lesbian, bisexual, or transgender; people of color; people who are physically and/or mentally challenged; and people who are not college educated Copyright © 2021, Elsevier Inc. All Rights Reserved. 4 Intersectionality (1 of 2) A research and policy model used to study the complexities of people’s lives and experiences Describes the forces, factors, and power structures that shape and influence life Each of us is at the intersection of two categories: Privilege Oppression • Formal and informal system of advantages and disadvantages tied to membership in social groups, reinforced by societal norms, biases, interactions, and beliefs Copyright © 2021, Elsevier Inc. All Rights Reserved. 5 Intersectionality (2 of 2) Iceberg analogy Most aspects of a person’s world view are hidden Understanding the different levels of oppression and where you stand helps you develop cultural competence. Copyright © 2021, Elsevier Inc. All Rights Reserved. 6 Racial, Ethnic, and Cultural Identity Cultural competence or cultural respect Meaningful and useful care strategies based on knowledge of the cultural heritage, beliefs, attitudes, and behaviors of those to whom they render care Racial identity Ethnic identity Cultural identity Acculturation Assimilation Copyright © 2021, Elsevier Inc. All Rights Reserved. 7 Disease and Illness Illness The way in which individuals and families react to disease Culture affects how an individual defines the meaning of illness. Disease Malfunctioning of biological or psychological processes Copyright © 2021, Elsevier Inc. All Rights Reserved. 8 Case Study (1 of 7) Mrs. Tao is 27 years old and immigrated to the United States from China 3 years ago. She is in the hospital because she gave birth to a baby girl yesterday. She is breastfeeding her baby and plans to go home tomorrow. Jenny is a 23-year-old nursing student assigned to care for Mrs. Tao. Jenny knows that it is important to provide education to Mrs. Tao, so she will be able to take care of her daughter at home. Copyright © 2021, Elsevier Inc. All Rights Reserved. 9 Core Measures Key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs Intended to reduce health disparities All patients regardless of cultural and socioeconomic status are to be treated equally because the standard of care applies to all. Copyright © 2021, Elsevier Inc. All Rights Reserved. 10 A Model of Cultural Competence Campinha-Bacote Cultural awareness Cultural knowledge Cultural skill Cultural encounters Cultural desire Transcultural care is culturally congruent when it fits a person’s life patterns, values, and system of meaning. Copyright © 2021, Elsevier Inc. All Rights Reserved. 11 Quick Quiz 1 (1 of 2) 1. 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. Copyright © 2021, Elsevier Inc. All Rights Reserved. 12 Quick Quiz 1 (2 of 2) Answer: D. all of the above. Copyright © 2021, Elsevier Inc. All Rights Reserved. 13 Cultural Awareness and Knowledge (1 of 3) Cultural awareness Self-examination of one’s biases toward other cultures and an in-depth exploration of one’s own cultural and professional background Stereotypes Cultural knowledge Learning or becoming educated about the beliefs and values of other cultures and diverse ethnic groups • Health-related beliefs and cultural values • Disease incidence and prevalence • Treatment efficacy Copyright © 2021, Elsevier Inc. All Rights Reserved. 14 Cultural Awareness and Knowledge (2 of 3) Storytelling Helps identify the real problems affecting a patient’s health status and find culturally appropriate ways to intervene World view of providers and patients Iceberg analogy tool Conduct a comprehensive cultural assessment These deeply held values reside “underneath the iceberg.” Copyright © 2021, Elsevier Inc. All Rights Reserved. 15 Cultural Awareness and Knowledge (3 of 3) Copyright © 2021, Elsevier Inc. All Rights Reserved. 16 Case Study (2 of 7) Jenny teaches Mrs. Tao that it is important to drink fluids to replace fluids lost during birth and to facilitate production of breast milk. Jenny then gives Mrs. Tao a fresh pitcher of ice water and suggests that Mrs. Tao drink at least 8 ounces of water every hour. Copyright © 2021, Elsevier Inc. All Rights Reserved. 17 Cultural Skill (1 of 2) The summary of the domains of culture is a framework for the information you might choose to include in a nursing history. Collecting a patient history Linguistic competence Provide 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 Copyright © 2021, Elsevier Inc. All Rights Reserved. 18 Cultural Skill (2 of 2) Assessing health literacy The degree to which individuals have the capacity to obtain, process, and understand basic health information and the services needed to make appropriate health decisions 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 Copyright © 2021, Elsevier Inc. All Rights Reserved. 19 Teach-Back and Plain Language Plain language Teach-back Confirms patient understands teaching Working with interpreters Copyright © 2021, Elsevier Inc. All Rights Reserved. 20 Cultural Encounter and Desire Cultural encounter goals: Communicate in a way that generates a wide variety of responses Interact to validate, refine, or modify existing values, beliefs, and practices about a cultural group Cultural desire Having the motivation to engage patients so that you understand them from a cultural perspective LEARN Model Copyright © 2021, Elsevier Inc. All Rights Reserved. 21 Case Study (3 of 7) Several hours later, Jenny checks Mrs. Tao’s water pitcher and notices that Mrs. Tao did not drink any of it. Jenny adds new ice to the pitcher and explains again to Mrs. Tao the importance of drinking fluids. Mrs. Tao nods that she understands. Jenny leaves Mrs. Tao, expecting that she will drink the ice water. Copyright © 2021, Elsevier Inc. All Rights Reserved. 22 Case Study (4 of 7) Mrs. Tao's husband comes in to visit his wife at noon. Jenny decides to ask Mrs. Tao an openended question. “Please help me understand why you aren’t drinking your water.” Mr. Tao replies, “My wife needs to avoid cold during the next 30 days to return the balance between yin and yang to her body. She needs the warm energy force of yang right now, so she cannot drink cold water.” Copyright © 2021, Elsevier Inc. All Rights Reserved. 23 Case Study (5 of 7) Jenny then asks a question, “According to your beliefs, what beverages can you drink?” Mrs. Tao replies that she prefers to drink hot tea right now. Jenny then asks a contrast question, “Would you prefer hot herbal tea, or is hot decaffeinated tea better for you?” Mrs. Tao replies, “I would like some hot herbal tea, please.” Copyright © 2021, Elsevier Inc. All Rights Reserved. 24 Case Study (6 of 7) Jenny gives Mrs. Tao a cup of herbal tea and conveys Mrs. Tao's preferences to the cafeteria. Mrs. Tao drinks three cups of hot tea in the next hour. Copyright © 2021, Elsevier Inc. All Rights Reserved. 25 Case Study (7 of 7) Upon doing some reading about the Chinese culture, Jenny finds out that the yin-yang (hotcold) theory is important and influences what a patient eats and drinks, especially during pregnancy, following delivery, and in times of illness. Jenny uses cultural care concepts to provide education about breastfeeding to Mrs. Tao. Copyright © 2021, Elsevier Inc. All Rights Reserved. 26 Quick Quiz 2 (1 of 2) 2. 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. Copyright © 2021, Elsevier Inc. All Rights Reserved. 27 Quick Quiz 2 (2 of 2) Answer: B. ethnohistory. Copyright © 2021, Elsevier Inc. All Rights Reserved. 28
