HealthStream Regulatory Script
Cultural Competence: Background and Benefits
Release Date: August 2010
HLC Version: 603
Lesson 1: Introduction
Lesson 2: Cultural Competence
Lesson 3: Clinical and Legal Significance of Cultural Competence
Lesson 4: Theory of Cultural Competence
Lesson 5: Practice of Cultural Competence
Lesson 1: Introduction
1001
Introduction
Welcome to the introductory lesson on the background and
benefits of cultural competence.
This lesson provides the course rationale, goals, and outline.
As your partner, HealthStream strives to provide its customers with excellence in
regulatory learning solutions. As new guidelines are continually issued by regulatory
agencies, we work to update courses, as needed, in a timely manner. Since
responsibility for complying with new guidelines remains with your organization,
HealthStream encourages you to routinely check all relevant regulatory agencies
directly for the latest updates for clinical/organizational guidelines.
If you have concerns about any aspect of the safety or quality of patient care in your
organization, be aware that you may report these concerns directly to The Joint
Commission.
Point 1 of 4
2
1002
Course Rationale
The United States is culturally diverse:
• More than 28 million Americans were born outside of the
United States.
• Forty-seven million Americans do not speak English at
home.
• Over 300 different languages are spoken in the United
States.
Healthcare providers will see patients from many backgrounds.
Learning about how to give culturally competent care will allow you
to:
• Optimize your care for all patients
• Maintain compliance with laws and recommendations
This is the first course in a two-part series on cultural competence.
Point 2 of 4
1003
Course Goals
After completing this course, you should be able to:
• Describe the clinical outcomes associated with cultural
competence
• Detail the outcomes associated with lack of cultural
competence
• Identify laws and recommendations about cultural
competence
• Recognize key terms related to cultural competence
• Recall “typical” characteristics of selected cultural groups
NO IMAGE
Point 3 of 4
1004
Course Outline
This introductory lesson gave the course rationale and goals.
Lesson 2 will introduce culturally competent care.
Lesson 3 will discuss the clinical and legal aspects of cultural
competence.
Lesson 4 will cover the theory of cultural competence.
Lesson 5 will discuss the practice of cultural competence.
Point 4 of 4
Lesson 2: Cultural Competence
2001
Introduction
Welcome to the lesson introducing cultural competence.
This lesson will define cultural competence. It also will introduce
culturally competent care and using cultural understanding.
Point 1 of 6
2002
Cultural Competence
In the healthcare setting, cultural competence refers to the
ability to provide optimal medical care to members of various
cultural groups.
This ability rests on a set of:
• Attitudes
• Skills
• Policies
• Practices
This set of qualities makes it easier for providers to:
• Understand their patients
• Communicate with their patients
The end result is optimal care for all patients.
Point 2 of 6
2003
The Culturally Competent Provider
Providers must be able to provide healthcare to:
• Patients who do not speak English
• Patients from different cultures
Providers must understand the patient’s:
• Values
• Beliefs
• Attitudes
• Practices
• Communication patterns
Point 3 of 6
2004
Using Cultural Understanding
Providers use their understanding of the patient’s culture to:
• Improve medical care
• Correct disparities [ glossary] in health status
Failure to provide culturally competent care leads to:
• Less-than-optimal care for many patients
• Elevated rates of disease and mortality among certain
populations
Point 4 of 6
2005
Review
Select the answer that best fits the question.
Correct answer: B
Cultural competence refers to the ability to provide medical care to
different cultural groups. Providing culturally competent care leads
to health disparities.
a. True
b. False
Feedback for A: Incorrect. Culturally competent care leads
to optimal health care for all patients.
Feedback for B: Correct. Culturally competent care leads to
optimal health care for all patients.
Point 5 of 6
2006
Summary
You have completed the lesson on culturally competent care.
NO IMAGE
Remember:
• Cultural competence refers to the ability to provide medical
care to different cultural groups.
• Providers need a set of attitudes, skills, policies, and
practices to more effectively communicate with their
patients.
• Providers need to understand the patient’s values, beliefs,
attitudes, behaviors, and practices.
• Providing culturally competent care leads to better patient
care.
Point 6 of 6
Lesson 3: Clinical and Legal Significance
3001
Introduction
Welcome to the lesson on the clinical and legal significance of
culturally competent care.
This lesson will discuss the benefits of cultural diversity as well as
applicable laws and regulations.
Point 1 of 17
3002
Cultural Competence and the Practice of Medicine Today
Cultural competence is a necessity.
Unfortunately, many providers guide their delivery of care by:
• Stereotypes
• Biases
As a result, racial and ethnic minorities tend to receive lower
quality care than similar non-minorities. This can have health
consequences.
Point 2 of 17
3003
Cultural Competence and Quality of Care (1)
In what ways do minorities receive lower quality care?
CLICK TO REVEAL
Lack of cultural competence can lead to:
• Lack of medical care
• Misdiagnosis
• Inappropriate testing
• Suboptimal disease screening
Lack of medical care
Cultural minorities may choose not to seek medical care.
They may fear being misunderstood or treated
disrespectfully.
Click on each to learn more.
Misdiagnosis
Patients can be misdiagnosed if they are not understood.
This is most likely in patients with limited English
proficiency (LEP). [glossary]
Inappropriate testing
Providers may not order needed tests if they do not
understand the patient’s symptoms. Alternatively, providers
may overcompensate by ordering too many tests.
Suboptimal disease screening
Some diseases are associated with certain minority
groups. The physician must be aware of this to offer
appropriate screening.
Point 3 of 17
3004
Cultural Competence and Quality of Care (2)
Other problems include:
• Noncompliance
• Reaction to drugs
• Conflicting drugs
Click on each to learn more.
CLICK TO REVEAL
Noncompliance
Cultural minorities may not follow the advice of medical
providers. They may not trust or understand the provider’s
instructions fully. This can cause problems in the correct
usage of medications or other treatments.
Reaction to drugs
Racial and ethnic background may affect how a patient
responds to a drug. Most drug doses are based on studies
of Caucasian patients.
Conflicting drugs
Patients may be using traditional remedies. This may lead
to harmful drug interactions.
wjPoint 4 of 17
3005
Cultural Competence and Health Disparities
Cross-cultural health disparities may result when care is not
culturally competent.
For example:
• African-Americans are at increased risk for:
o Breast, lung, and colorectal cancer mortality
o Infant mortality
o Flu mortality
o Heart-disease mortality
o Diabetes
o HIV/AIDS
o Obesity
• Native Americans are at increased risk for:
o Infant mortality
o Flu mortality
o Colorectal-cancer mortality
o Obesity
• Hispanics/Latinos are at increased risk for:
o Diabetes
o HIV/AIDS
Point 5 of 17
3006
Potential Benefits of Cultural Competence: Clinical (1)
What are the potential benefits of cultural competence in the
healthcare setting?
Benefits include:
• More successful patient education
• Increased likelihood that minorities will seek healthcare
• Fewer diagnostic errors
• More appropriate diagnostic testing and screening
• Fewer harmful drug interactions
• Greater patient compliance
• Expanded choices and access to high-quality clinicians
• Equality of healthcare outcomes
Point 6 of 17
3007
Quality of Care, Health Disparities, and Clinical Outcomes: Summary
Effects of Culturally Competent and Non-Competent Care
on Cultural Minority Patient Health
Cultural Competence
Lack of Cultural Competence
Increased likelihood that minorities will seek healthcare
Lack of medical care
Fewer diagnostic errors
Misdiagnosis
More appropriate testing and screening
Inappropriate testing and suboptimal disease screening
Greater patient compliance
Noncompliance
Fewer harmful drug interactions
Drug reactions and interactions
Equalization of cross-cultural health disparities
Health disparities
Expanded choices and access to high-quality clinicians
Limited healthcare choices
More successful patient education
Limited/ineffective patient education
Point 7 of 17
3008
Potential Benefits of Cultural Competence: Legal and Regulatory
Cultural competence also improves compliance with relevant laws
and recommendations.
These include:
• Title VI of the Civil Rights Act of 1964
• The Joint Commission
• U.S. Department of Health and Human Services (HHS)
Office of Minority Health (OMH) recommendations for
national standards on culturally and linguistically [glossary]
appropriate services (CLAS)
Let’s take a closer look at each.
Point 8 of 17
3009
Title VI
Title VI of the Civil Rights Act of 1964 requires any health- or
social- service organization that receives federal funding to provide
language assistance to any patient with limited English proficiency
(LEP).
Language assistance assures that:
• The LEP patient is able to communicate relevant
information to the provider.
• The provider is able to understand the LEP patient.
• The LEP patient is able to understand all necessary
information. This includes a description of services and
benefits available.
• The LEP patient is able to receive eligible services.
Point 9 of 17
3010
The Joint Commission Position
The Joint Commission considers culturally competent care an
important healthcare safety and quality issue.
Many standards address issues related to culturally competent
care. Those directly addressing cultural competence include:
• Standard RI.01.01.01
• Standard RI.01.01.03
Other standards provide organizational supports for culturally
competent care.
Let’s take a closer look at Standards RI.01.01.01 and RI.01.01.03.
Point 10 of 17
3011
The Joint Commission Position: Standard RI.01.01.01
The Joint Commission Standard RI.01.01.01 states that an
organization should respect a patient’s rights. This includes their
cultural:
• Values
• Beliefs
• Preferences
Patients also have a right to:
• Personal dignity
• Religious or other spiritual practices
Point 11 of 17
3012
The Joint Commission Position: Standard RI.01.01.03
Standard RI.01.01.03 addresses a patient’s right to effective
communication.
Element 1 of this standard states that written information about
patient rights must be appropriate to :
• The population served
• The language of the patient
• The patient’s ability to understand
Element 2 addresses provision of interpretation and translation
services, if needed.
Element 3 requires hospitals to meet the communication needs of
a patient with hearing, speech, vision, or cognitive impairments.
Point 12 of 17
3013
The Joint Commission Position: Hospitals, Language, and Culture Study
CLICK TO REVEAL
In January 2004, The Joint Commission
started a project on cultural
competence. Over a 30-month period,
they collected data from 60 different
hospitals. The ability of these hospitals
to address patient language and culture
issues was determined.
Two reports have been published:
• Exploring Cultural and
Linguistic Services in the
Nation’s Hospitals (in 2007)
• One Size Does Not Fit All:
Meeting the Health Care Needs
of Diverse Populations (in
2008)
Click on each report for information
about the recommendations each
makes for hospitals.
Exploring Cultural and Linguistic Services in the Nation’s Hospitals
This report recommends that hospitals should:
• Consider establishing a centralized program for language and culture
• Have policies regarding the provision of language services
• Assess interpreter proficiency in the target language and English
• Train staff and physicians about accessing services
• Improve dialogue
• Implement uniform data collection
One Size Does Not Fit All: Meeting the Health Care Needs of Diverse
Populations
This report recommends that hospitals should:
• Identify the needs of the population they serve
• Assess how well the needs of patients are being met
• Bring together people from across the hospital to discuss cultural and
language issues
• Implement a continuous process of assessment, monitoring, and evaluation of
needs and services
• Implement practices for building a foundation of cultural competence
• Implement practices for collecting and using data to improve services
• Implement practices for accommodating the needs of specific populations
• Implement practices for establishing internal and external collaborations
Point 13 of 17
3014
CLAS Standards
The U.S. Department of Health and Human Services Office of
Minority Health has 14 recommendations for national standards on
culturally and linguistically appropriate services (CLAS).
These recommendations address:
• Culturally representative staffing
• Staff education and training
• Language-assistance services and materials
• Organizational self-assessment
• Data collection
• Cross-cultural conflict and grievance processes
The goals are to:
• Correct healthcare disparities
• Improve medical services
The CLAS standards for language assistance (Standards 4, 5, 6,
7) are required for hospitals receiving federal funding.
Point 14 of 17
3015
Review
Drag and drop each of the terms in the word
bank to its proper place in the table.
Cultural competence is
characterized by:
Effective communication
Thorough understanding of
individual patients
Willingness to learn
Lack of cultural competence is
characterized by:
Use of stereotypes
Biased delivery of healthcare
Making assumptions about patients
Point 15 of 17
3016
Review
Select the answer that best fits the question.
Correct answer: D
Which of the following requires or recommends that hospitals
provide language assistance to LEP clients:
a. CLAS standards
b. Title VI of the Civil Rights Act of 1964
c. The Joint Commission standards on cultural competence
d. All of the above
Feedback for A: Not quite. All of these require or
recommend that hospitals provide assistance to clients that
have problems speaking English.
Feedback for B: Not quite. All of these require or
recommend that hospitals provide assistance to clients that
have problems speaking English.
Feedback for C: Not quite. All of these require or
recommend that hospitals provide assistance to clients that
have problems speaking English.
Feedback for D: Correct. All of these require or recommend
that hospitals provide assistance to clients that have
problems speaking English.
Point 16 of 17
3017
Summary
You have completed the lesson on the clinical and legal
significance of cultural competence.
NO IMAGE
Remember:
• Cultural competence is often lacking in the practice of
medicine today. This leads to adverse patient outcomes
and health inequality.
• Delivering medical services in a culturally competent way
has many benefits for patients.
• Title VI of the Civil Rights Act requires any health- or
social- service organization that receives federal funding to
provide effective language assistance to LEP
patients/clients.
• The Joint Commission requires accredited hospitals to
respect a patient’s rights and dignity.
• The OMH released national standards on culturally and
linguistically appropriate services (CLAS). CLAS 4-7 are
requirements.
Point 17 of 17
Lesson 4: Theory of Cultural Competence
4001
Introduction
Welcome to the lesson on theory of cultural competence.
This lesson will include a discussion of values, worldview, time
orientation, and traditional social structure. The culture of western
medicine will also be reviewed.
Point 1 of 17
4002
Understanding Patients
How can healthcare providers understand their patients?
Useful information includes the patient’s healthcare-related:
• Beliefs
• Attitudes
• Behaviors
• Practices
Many of these arise from the patient’s underlying:
• Values
• Worldview
• Time orientation
• Traditional social structure
Let’s take a closer look at each of these four underlying
characteristics.
Point 2 of 17
4003
Understanding Patients: Values
A value is anything important to an individual or a culture.
For example, in the United States, we tend to value:
• Money
• Freedom
• Privacy
• Health/fitness
• Physical appearance
Values drive behavior. Understanding a patient’s values can help
you understand his or her behavior.
Understanding allows you to respond to a patient’s behavior in a
respectful, effective way.
Point 3 of 17
4004
Understanding Values: An Example
Mr. C is a 45-year-old patient under the care of Nurse Jones.
Mr. C’s family members wish to participate in his care.
Nurse Jones responds with irritation and annoyance. She does not
understand why the C family does not abide by visiting hours. They
do not understand the importance of self-care for the patient.
Mr. C explains that his family values family loyalty and duty. He
tells Nurse Jones that his wife and children would feel guilt and
dishonor if they did not assist him.
Nurse Jones now understands that the C family is not ignoring her
instructions. She can find ways to allow the family to help the
patient.
Point 4 of 17
4005
Understanding Patients: Worldview (1)
A person’s worldview consists of his or her basic
assumptions about the nature of reality.
Most people believe their worldview without question. This can
lead to ethnocentrism [glossary].
Ethnocentrism is the belief that:
• One’s own way is right and natural
• Other ways are inferior, unnatural, uncivilized, etc.
The opposite of ethnocentrism is cultural relativism [glossary].
Cultural relativism:
• Looks at behavior and beliefs in their cultural context
• Accepts that other ways may be different, but equally valid
Point 5 of 17
4006
Understanding Patients: Worldview (2)
Western healthcare tends to be ethnocentric. It is assumed that:
• Western approaches to healing are best
• Other methods are not to be trusted or accepted
Cultural competence demands cultural relativism. Healthcare
providers must be willing to:
• Acknowledge the validity of other methods
• Incorporate traditional or folk medicine into treatment plans
as needed
Point 6 of 17
4007
Understanding Worldview: An Example
According to the worldview of Western medicine, infection is
caused by microorganisms.
Ms. P believes that her bacterial pneumonia is the result of an
imbalance of “hot” and “cold” in her body.
Western medicine would insist that antibiotics can cure bacterial
pneumonia.
But, antibiotics are unlikely to help Ms. P:
• Ms. P may not take the antibiotics because she believes
that they will not help.
• Even if Ms. P takes antibiotics, she may not reach a true
state of healing. She will not believe she has corrected the
underlying problem of heat/cold imbalance.
In other words, a patient’s beliefs must always be considered.
Accommodating beliefs while treating the body will:
• Help ensure compliance
• Help ensure full healing
Point 7 of 17
4008
Understanding Patients: Time Orientation
Time orientation has two aspects:
• Emphasis on past, present, or future
• Attention to clock time
Let’s take a closer look at each.
Point 8 of 17
4009
Time Orientation: Past, Present, or Future
Persons with a past-time orientation tend to:
• Be traditional
• Do things the way they have always been done
Persons with a present-time orientation tend to:
• Look to today
• Make few plans or provisions for the future
Persons with a future-time orientation tend to:
• Place trust and faith in technologic innovations
• Plan for the future
Point 9 of 17
4010
Past, Present, or Future Time: An Example
Western healthcare tends to be future-focused. Preventive
medicine is emphasized. Follow-up care is given. New techniques
and medications are adopted.
Patients with a more present focus may not comply with
preventative health measures. For example, it may be difficult for
them to remember to take medication each day.
Point 10 of 17
4011
Time Orientation: Clock Time
Some people pay careful attention to the passage of time,
according to the clock.
Others mark time by activities.
Western healthcare is clock-focused. For example, you are late for
your 10:15 appointment if you arrive at 11:00.
Patients who are not clock-focused would consider both 11:00 and
10:15 “mid-morning.” They would not worry about being late.
Point 11 of 17
4012
Understanding Patients: Social Structure
In terms of power, authority, and opportunity, a social structure
may be egalitarian or hierarchical [glossary}.
In an egalitarian society, such as the United States, all people are
inherently equal.
In a hierarchical society, people are not equal. Social status is
based on characteristics such as age, sex, lineage, or occupation.
Point 12 of 17
4013
Understanding Social Structure: An Example
In Western healthcare, all competent adult patients have equal
authority and power to make healthcare decisions for themselves.
In a hierarchical structure:
• Husbands may make healthcare decisions for their wives
and children.
• A patient may expect the provider to make treatment
decisions for him or her.
Social structure is often related to religious belief.
Point 13 of 17
4014
Understanding Social Structure: Family Structure
A patient’s family structure may determine who makes healthcare
decisions. There are seven family structures:
• Traditional Nuclear Family
• Nuclear Dyad Family
• Extended Family
• Skip Generation Family
• Alternative Family
• Single Parent Family
• Reconstituted or Blended Family
A family structure may also be:
• Matriarchal
• Patriarchal
CLICK TO REVEAL
A traditional nuclear family is composed of a married
man and woman and their biological or adopted child or
children.
A nuclear dyad consists of a man and woman only.
An extended family is composed of two or more adults
from different generations. Children, aunts, uncles,
cousins, grandparents, etc. may be included.
In a skip generation family, children are raised by their
grandparents.
An alternative family is composed of a same-sex couple
and children.
A single parent family is composed of a single adult and
their children.
A reconstituted or blended family is composed of two
parents, their biological or adopted children, and their
children from previous marriages or relationships.
In a matriarchal family, the family head is a female.
In a patriarchal family, the family head is male.
Point 14 of 17
4015
Review
Select the answer that best fits the question.
Correct answer: B
Which of the following best supports the development of cultural
competence?
a. Ethnocentrism
b. Cultural relativism
c. Future time orientation
d. Observed family behavior
Feedback for A: Incorrect. Cultural competence demands
acceptance that other ways are equally valid. The correct
answer is B.
Feedback for B: Correct. Cultural competence demands
acceptance that other ways are equally valid.
Feedback for C: Incorrect. Cultural competence demands
acceptance that other ways are equally valid. The correct
answer is B.
Feedback for D: Incorrect. Cultural competence demands
acceptance that other ways are equally valid. The correct
answer is B.
Point 15 of 17
4016
Review
Drag and drop each of the terms in the word
bank to its proper place in the table.
A person with a…
Past-time orientation
Present-time orientation
Future-time orientation
Tends to:
Do things the way they have always
been done.
Look to today.
Trust technological innovations.
Point 16 of 17
4017
Summary
You have completed the lesson on theory of cultural competence.
NO IMAGE
Remember:
• A value is anything important to an individual or culture.
• A person’s worldview consists of his or her basic
assumptions about the nature of reality.
• Western medicine tends to be ethnocentric. Cultural
competence demands cultural relativism.
• Time orientation has two aspects: emphasis on past,
present, or future, and level of attention to clock time.
• A social structure may be egalitarian or hierarchical.
• Cultural values, worldview, time orientation, and social
structure can shape healthcare-related attitudes, beliefs,
behaviors, and practices.
• You need to understand a patient’s values, worldview, time
orientation, and social structure to provide quality patient
care.
Point 17 of 17
Lesson 5: Practice of Cultural Competence
5001
Introduction
Welcome to the lesson on the practice of cultural competence.
This lesson will discuss stereotypes, generalizations, and
characteristics of selected cultural groups.
Point 1 of 22
5002
Culture Groups
Let’s look at how cultural characteristics influence a patient’s
healthcare-related attitudes and behaviors.
Important note:
The cultural characteristics given are generalizations. They
indicate common trends and patterns.
Generalizations should NEVER be used to stereotype. Do not
assume that the patient fits the generalizations assigned to his or
her culture group!
Point 2 of 22
5003
Culture Groups: African-American (1)
Religion is important in the lives of African-Americans. Patients
should be given time and privacy to pray. Clergy should be allowed
to participate in the patient’s care.
The head-of-household is often a woman. Other relatives and
friends may be included in the patient’s extended family.
African-Americans tend to have a present-time orientation.
Providers should emphasize the importance of prevention.
Point 3 of 22
5004
Culture Groups: African-American (2)
African-Americans may refer to “high blood” or “low blood.” You
need to determine what symptom the patient is describing. You
also must be sure that you use words the patient understands. Be
sure you both have a common understanding of the words used to
describe medical conditions.
The tradition of herbal remedies is strong in the African-American
culture. Ask patients if they are taking any herbal remedies. This
will avoid drug interactions.
Remember! These are generalizations. They should not be used to stereotype any
patient. These also are selected examples only.
Point 4 of 22
5005
Culture Groups: Anglo-American (1)
Anglo-American patients expect to be informed of the details of
their condition. They value direct eye contact, privacy, and
emotional control. They may expect nurses to provide
psychosocial [glossary] care.
Patients in this culture group generally make healthcare decisions
for themselves. Parents make decisions for their minor children.
They value self-care.
Poverty may lead to a present-time orientation. These patients
may not comply with preventive medical advice.
Middle- and upper-class Anglo-Americans tend to have a future
focus. They are likely to comply with preventative medical advice.
Point 5 of 22
5006
Culture Groups: Anglo-American (2)
Anglo-Americans often prefer biomedicine. [ glossary] They also
may use alternative approaches. Ask about herbal remedies and
other complementary medicine.
Patients in this group expect an aggressive approach to treatment.
They assume that treatment will focus on killing germs. They may
demand antibiotics, even when unnecessary.
Remember! These are generalizations. Do not stereotype any individual patient.
These also are selected examples only.
Point 6 of 22
5007
Culture Groups: Asian (1)
To show respect, Asian patients may avoid eye contact with the
provider. They also may agree with their provider.
Agreement does not always indicate understanding. Agreement
may not indicate an intention to comply with the treatment plan.
Avoid yes or no questions. Ask for responses that demonstrate
understanding. Always stress the importance of compliance.
Men may make healthcare decisions for their wives. Family
members will expect to be involved in treatment decisions and
patient care. Allow family to care for the patient as much as
possible.
Point 7 of 22
5008
Culture Groups: Asian (2)
Asian patients may not express pain. Pain medication should be
offered when appropriate. This should be done even if the patient
does not request it.
Family members may wish to protect a patient from hearing a poor
prognosis or terminal diagnosis. Ask the patient which family
member(s) should receive information about his or her condition.
Coining [glossary] and cupping [glossary] are traditional medical
practices in many Asian cultures. They should not be mistaken for
signs of abuse.
Remember! These are generalizations. Do not stereotype any patient. These also
are selected examples only.
Point 8 of 22
5009
Culture Groups: East Indian
East Indians may consider direct eye contact rude or disrespectful.
Silence may indicate acceptance or approval.
Family members are likely to take over the activities of daily living
for a patient. Unless patient self-care is medically necessary, allow
this expression.
The Sikh religion forbids cutting or shaving head or facial hair.
Consult with patients before surgical prep.
Remember! These are generalizations. Do not stereotype any patient. These also
are selected examples only.
Point 9 of 22
5010
Culture Groups: Hispanic/Latino (1)
Hispanic/Latinos place high value on:
• Direct eye contact
• Friendly physical contact
• Friendly interpersonal interaction
It is appropriate to maintain a friendly manner with Latino patients.
Ask patients about their families and interests before focusing on
health-related issues.
Children are highly valued and loved. Allow family members to
spend as much time as possible with pediatric patients.
The oldest adult male is the decision-maker. However, important
decisions involve the family.
Point 10 of 22
5011
Culture Groups: Hispanic/Latino (2)
Hispanic/Latinos may refuse hospital foods that would upset their
hot/cold body balance. Offer alternatives.
Many traditional Mexican foods are high in salt and fat. Be certain
to discuss nutrition. This is very important for diabetics and
hypertensives [glossary].
Hispanic/Latino patients may use herbal remedies. Ask before
prescribing medication.
Remember! These are generalizations. Do not stereotype any patient. These also
are selected examples only.
Point 11 of 22
5012
Culture Groups: Middle Eastern (1)
Your Middle Eastern patients may believe that communication is
two-way. You may need to share information about yourself first.
Then you can receive information from the patient.
Sexual segregation is an important aspect of Middle Eastern
culture. Assign same-sex caregivers and interpreters.
Middle Eastern men may answer for their wives. Women may
allow their husbands to make healthcare decisions for the family.
Point 12 of 22
5013
Culture Groups: Middle Eastern (2)
Islam is important to the majority of Middle Eastern people. Allow
time and privacy to pray. Be aware that these patients believe that
personal health is in the hands of Allah. Middle Eastern patients
may avoid taking an active role in their own healthcare.
Middle Easterners may expect all treatment plans to involve a
prescription for medication.
Remember! These are generalizations. Do not stereotype any patient. These also
are selected examples only.
Point 13 of 22
5014
Culture Groups: Native American (1)
Patients in this group may communicate through anecdotes and
metaphors [glossary]. During a conversation, the patient may
pause for an extended length of time. This indicates careful
consideration of the question or issue. Do not press the patient for
an answer. Avoid direct eye contact. Do not speak loudly.
Any illness concerns the entire family. Healthcare decisions may
be made by the male head of the family, the female head of the
family, or the patient.
Native Americans tend not to have a clock-focused time
orientation.
Point 14 of 22
5015
Culture Groups: Native American (2)
Native American patients may be stoic [glossary] about pain. Offer
pain medication when appropriate.
If a patient wears a medicine bag, [glossary] do not treat the bag
casually. Do not remove it without asking the patient.
Traditional healing may be an important part of any treatment plan.
Accommodate traditional healers. Allow traditional rituals whenever
possible. Never touch or casually admire a ritual object.
Remember! These are generalizations. Do not stereotype any patient. These also
are selected examples only.
Point 15 of 22
5016
Culture Groups: Russian/Eastern European (1)
When caring for patients in this cultural group, be firm and
respectful. Make direct eye contact.
Russians tend to have a high threshold for pain. They also may be
stoic about pain. Offer pain medication when appropriate.
Food is appreciated. A good appetite is admired. Patients and
family members may offer small gifts of food or chocolate. Accept
these to avoid appearing rude.
Point 16 of 22
5017
Culture Groups: Russian/Eastern European (1)
Russian and/or Eastern European patients may not feel
comfortable with too many personal questions. They may be
suspicious of providers who take notes.
Smoking, excessive use of alcohol, and lack of exercise may be
problematic.
Remember! These are generalizations. Do not stereotype any patient. These also
are selected examples only.
Point 17 of 22
5018
The Culture of Western Medicine
Let’s now take a brief look at the culture of Western medicine:
• Western healthcare tends to standardize definitions of
health and illness. Technology is believed to be allpowerful.
• The practice of Western medicine stresses health
maintenance and disease prevention.
• Western healthcare providers are systematic and
methodical. They like promptness, organization, and
efficiency. They dislike tardiness, chaos, and inefficiency.
• Use of jargon is common in Western healthcare.
• Western healthcare providers recognize and adhere to a
hierarchical system. The provider’s status is based on
education, experience, and professional accomplishments.
• Western healthcare observes certain routines.
Point 18 of 22
5019
Review
Select the answer that best fits the question.
Correct answer: A
Not all patients within a given cultural group fit the generalizations
applicable to that group.
a. True
b. False
Feedback for A: Correct. Generalizations indicate common
trends and patterns. But, each patient is unique.
Generalizations should NEVER be used to stereotype any
patient.
Feedback for B: Incorrect. Generalizations indicate
common trends and patterns. But, each patient is unique.
Generalizations should NEVER be used to stereotype any
patient.
Point 19 of 22
5020
Review
Drag and drop each of the terms in the word
bank to its proper place in the table.
The following characteristic of
Western healthcare…
Desire for efficiency
Value placed on promptness
Emphasis on preventive medicine
Belief in the value and efficacy of
modern technology and
biomedicine
…may conflict with the following
characteristic of certain patients:
Use of long pauses during
conversation, to indicate careful
consideration
Lack of attention to clock-time
Present-time orientation
Belief in the value and efficacy of
traditional/folk medicine
Point 20 of 22
5021
Summary
You have completed the lesson on practice of cultural
competence.
NO IMAGE
Remember:
• Generalizations indicate common trends and patterns
within a group. They should never be used to stereotype
an individual.
• Use generalizations as a starting point to:
o Help understand various culture groups
o Learn more about the unique values, beliefs, and
practices of each patient
Point 21 of 22
5022
References
•
U.S. Census Bureau. Population profile of the United States. Available at:
http://www.census.gov/population/www/pop-profile/profile2000.html. Accessed April 13,
2010.
•
The provider’s guide to quality and culture. Available at:
http://erc.msh.org/mainpage.cfm?file=7.0.htm&module=provider&language=English&ggroup=&mgrou
p. Accessed April 13, 2010.
Joint Commission. Facts about the Hospitals, Language and Culture: A Snapshot of the Nation
(HLC) study. Available at: http://www.jointcommission.org/AboutUs/Fact_Sheets/facts_hlc.htm.
Accessed April 13, 2010.
•
•
•
•
•
Office of Minority Health. National standards on culturally and linguistically appropriate
services (CLAS). Available at:
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15. Accessed April 13,
2010.
Galanti G. Cultural diversity in healthcare. Available at: http://www.ggalanti.com/index.html.
Accessed April 13, 2010.
Spector RE. Cultural Diversity in Health and Illness. 5th edition. Upper Saddle River:
Prentice Hall. 2000.
James C, Thomas M, Lillie-Blanton M, Garfield R. Key facts: Race, ethnicity, and medical
care, 2007 update. Henry J. Kaiser Family Foundation Report. Available at:
http://www.kff.org/minorityhealth/6069.cfm. Accessed April 13, 2010.
Please remember that compliance is the responsibility of each organization. Provision of this list
does not imply that the content of this course wholly or partially addresses the guidelines and
references provided here.
Point 22 of 22
Course Glossary
#
Term
Definition
coining
using a coin(usually with heated oil) to vigorously rub the skin in a prescribed manner, causing a
mild dermabrasion, with the goal of releasing excess force or "wind" from the body, hence
restoring balance
placing small, heated glasses on the skin, forming a suction that leaves a red circular mark, with the
goal of drawing out a bad force
inequality or difference
limited English proficiency; used to describe people who do not speak English fluently
Joint Commission on the Accreditation of Healthcare Organizations
having to do with language
the belief that one’s way of doing things is the only right way
the belief that other ways may be different from one’s own, but equally valid in their
cultural context
a type of social organization that assumes the equality of all people, in which every
individual has an equal opportunity to obtain resources and the esteem of others in
leadership activities
a social structure in which there are ordered groupings of people
make worse
cupping
disparity
LEP
JCAHO
linguistic
ethnocentrism
cultural relativism
egalitarian
hierarchical
exacerbate
psychosocial
biomedicine
hypertensive
anecdote
metaphor
stoic
medicine bag
involving both psychological and social aspects
the branch of medical science that applies biological and physiological principles to clinical
practice
a patient with high blood pressure
short account of an incident
a figure of speech in which an expression is used to suggest a similarity between two
different things
seeming unaffected by pleasure or pain
a magical object used to control and direct supernatural forces; a charm
Pre-Assessment
1. Providing culturally competent care can lead to all of the following EXCEPT: a. Improved medical care b. Optimal care for patients c. Decreased rates of disease and mortality among certain populations d. Increased disparities in health status Correct: D Rationale: Providers use their understanding of the patient’s culture to correct disparities in health status. 2. Mrs. Petrovich arrives at the clinic for care. She speaks broken English with a heavy accent. Which of the following statements are true about her medical care? a. She will receive the same level of care as any other patient. b. She risks having a misdiagnosis due to communication misunderstanding. c. She will be non‐compliant because she does not trust the care providers. d. All of these statements are true. e. Only B and C are true. Correct: B Rationale: Lack of cultural competence can lead to misdiagnosis if they are not understood. This is most likely in patients with Limited English Proficiency (LEP). Cultural minorities may not follow the advice of medical providers. They may not trust or understand the provider’s instructions fully. 3. Title VI of the Civil Rights Act of 1964 mandates that any health or social service agency that receives federal funding must: a. Provide language assistance to any patient with limited English proficiency (LEP). b. Provide emergency medical care to all patients regardless of their ability to pay. c. Make hiring and firing decisions without regard to race, color, or gender. d. All of the above e. None of the above Correct: A Rationale: Title VI of the Civil Rights Act of 1964 requires any health or social service agency that receives federal funding to provide language assistance to any patient with limited English proficiency. 4. Which of the following statements recognizes the appropriate view for providing culturally competent care? a. Cultural relativism: incorporating traditional or folk medicine into Western medicine treatment plans may be beneficial. b. Cultural relativism: our treatments are the most advanced and the only ones that are effective. c. Ethnocentrism: our treatments are the most advanced and the only ones that are effective. d. Ethnocentrism: incorporating traditional or folk medicine into Western medicine treatment plans may be beneficial. Correct: A Rationale: Cultural competence demands cultural relativism. Healthcare providers must be willing to incorporate traditional or folk medicine into treatment plans as needed. 5. Mr. Jackson is being treated for hypertension and has been instructed to take his antihypertensive medication every morning at 9:00 am. The clinic nurse discovers that Mr. Jackson takes his medication when he thinks about it or when he decides to get out of bed, whatever time that may be. He is demonstrating: a. Past‐time orientation b. Present‐time orientation c. Future‐time orientation d. Clock‐time orientation Correct: B Rationale: Patients with a more present focus may not comply with preventative health measures, as they do not view them as helpful or useful. Non‐compliance with preventative health recommendations such as taking medication for chronic illness may result. 6. In terms of power, authority, and opportunity an egalitarian society believes that sex, age, lineage, and occupation indicate social status. a. True b. False Correct: B Rationale: In an egalitarian society, such as the United States, all people are inherently equal. 7. The head of the household in the African‐American culture is often a woman. This family structure is known as: a. A Matriarchal family b. A Patriarchal family c. A Reconstituted family d. None of the above Correct: A Rationale: In a matriarchal family the family head is a female. 8. Your Asian patient nods her head as you describe her treatment regimen. From this behavior you can be sure that she understands and will comply with the treatment plan. a. True b. False Correct: B Rationale: To show respect, Asian patients may agree with their provider. Agreement does not always indicate understanding or indicate an intention to comply with the treatment plan. 9. Which culture may consider direct eye contact rude or disrespectful? a. Hispanic/Latino b. East Indian c. Anglo‐American d. None of the above. Correct: B Rationale: East Indians may consider direct eye contact rude or disrespectful. 10. Behaviors that would be expected of a Western medicine healthcare provider include: a. Prompt responses to questions and concerns b. Use of technology for diagnosis and treatment of conditions c. Prescribing medication for treatment of diseases such as infection or chronic illness d. All of the above e. None of the above Correct: D Rationale: In Western medicine, technology is believed to be all powerful. Healthcare providers like promptness, organization, and efficiency. The practice of Western medicine stresses health maintenance and disease prevention. Final Exam
11. Which of the following are necessary for the provider to understand in order to provide culturally competent care? a. The patient’s language b. The patient’s socioeconomic status c. The patient’s values, beliefs, and attitudes d. None of the above Correct: C Rationale: Providers need to understand the patient’s values, beliefs, attitudes, behaviors, and practices to provide culturally competent care. 12. Lack of cultural competence can lead to: a. Lack of medical care b. Misdiagnosis due to misunderstanding c. Inappropriate testing d. Suboptimal disease screening e. All of the above Correct: E Rationale: Lack of cultural competence can lead to all of the outcomes listed. 13. Health care agencies must provide language assistance to all patients when the agency is federally funded. a. True b. False Correct: A Rationale: Title VI of the Civil Rights Act of 1964 requires any health or social service agency that receives federal funding to provide language assistance to any patient with limited English proficiency. 14. Which of the following statements recognizes the appropriate view for providing culturally competent care? a. Cultural relativism: incorporating traditional or folk medicine into Western medicine treatment plans may be beneficial. b. Cultural relativism: our treatments are the most advanced and the only ones that are effective. c. Ethnocentrism: our treatments are the most advanced and the only ones that are effective. d. Ethnocentrism: incorporating traditional or folk medicine into Western medicine treatment plans may be beneficial. Correct: A Rationale: Cultural competence demands cultural relativism. Healthcare providers must be willing to incorporate traditional or folk medicine into treatment plans as needed. 15. The Joint Commission does not have standards for culturally competent care, but the expectation is that you will provide it. a. True b. False Correct: B Rationale: The Joint Commission has two standards that specifically address culturally competent care. 16. Your patient arrives for a 10:30 am appointment at 11:15 am. He is intentionally being rude and uncaring about your schedule. a. True b. False Correct: B Rationale: Some people are not clock‐focused and would consider both 10:30 and 11:15 am as mid‐morning. This patient would not worry about being late. 17. Joseph and Roxanne are raising their grandchildren. This is indicative of which family structure? a. Nuclear dyad family b. Extended family c. Skip generation family d. Alternative family Correct: C Rationale: In a skip generation family, children are raised by their grandparents. 18. Generalizations about a patient’s culture should be used to help provide culturally competent care. a. True b. False Correct: B Rationale: Generalizations should never be used to stereotype. Do not assume that the patient fits the generalizations assigned to his or her culture group. 19. Patients from which cultural group would expect you to ask about their families and interests and to maintain a friendly manner before focusing on health‐related issues? a. Middle Eastern b. Anglo‐American c. Eastern European d. Hispanic/Latino Correct: D Rationale: Hispanic/Latinos place high value on friendly interpersonal interaction. It is appropriate to maintain a friendly manner with Latino patients. 20. The practice of Western medicine recognizes and adheres to a hierarchical system. In this system, which characteristics support a provider’s status? a. Education and experience b. Professional accomplishments c. Earning potential d. A and B e. A and C f. B and C g. All of the above Correct: D Rationale: In Western medicine, the provider’s status is based on education, experience, and professional accomplishments.