CHAPTER 1 NURSING TODAY

CHAPTER 9: CULTURAL COMPETENCE

Key Self-Reflection Questions

• Am I aware of my prejudices and biases, as well as the presence of racism and other ‘isms’?

• Do I know how to conduct a culturally specific history, physical, mental health, medication, and spiritual assessment in a culturally sensitive manner?

• Do I have knowledge regarding different cultures’ worldview, the field of biocultural ecology, and the importance of addressing social determinants of health?

• Do I engage in encounters with people from cultures different from mine and am I committed to resolving cross-cultural conflicts?

• Do I genuinely want to engage in the process of competemility?

Understanding Culture

• Definition: Culture encompasses the learned and shared beliefs, values, norms, and traditions of a specific group, guiding thoughts, decisions, and actions.

  • Reference: Giger and Haddad, 2021

Unconscious Bias

• Definition: Unconscious bias refers to biases of which individuals are unaware, influenced by background, cultural environment, and personal experiences.

Culturally Congruent Care

• Culturally congruent care: Care tailored to the individual’s cultural beliefs, practices, and values.

• Cultural competence: Professional health care should be culturally sensitive, appropriate, and competent to address diverse healthcare needs.

Worldview

• Components:

  • Emic: Insider perspective on culture.

  • Etic: Outsider perspective on culture.

• Avoid stereotyping; treat each person as an individual.

Health Disparities

• Definition: A specific type of health difference related to social, economic, and environmental disadvantage (ODPHP, 2021).

• Health disparity relates to conditions under which people are born, grow, live, work, and age (WHO, 2020).

• Marginalized groups often experience poorer health outcomes and shorter lifespans.

Racial, Ethnic, and Cultural Identity

• Elements include:

  • Racial identity

  • Ethnic identity

  • Cultural identity

  • Acculturation

  • Assimilation

  • Cultural respect

Disease and Illness

• Illness: Personal and familial response to disease.

• Disease: Biological or psychological dysfunction.

• Culture shapes individual definitions of illness.

• Importance of evidence-based standards of care (Core measures).

Cultural Competemility Model (by Campinha-Bacote)

• Components:

  • Awareness

  • Skill

  • Knowledge

  • Encounter

  • Desire

Cultural Awareness and Knowledge

• Self-examination: Acknowledging personal biases and exploring one's cultural background.

• Cultural awareness: Educating oneself about the beliefs and values of diverse cultures.

  • Covers health-related beliefs, disease incidence, prevalence, and treatment efficacy.

Identifying Health Problems

• Cultural awareness aids in identifying patient health problems and developing culturally suitable interventions.

• Tools include:

  • Storytelling

  • Iceberg analogy

  • Comprehensive cultural assessment.

Cultural Skill

• Skills required for effective patient care:

  • Collecting patient history

  • Assessing health literacy

  • Conducting culturally based physical assessments

  • Implementing teach-back methods and using plain language

  • Working with interpreters

Cultural Encounter and Desire

• Cultural encounter goals:

  • Facilitate communication that elicits diverse responses.

  • Interact to evaluate and modify existing beliefs about cultural groups.

• Cultural desire: Motivation to engage with patients to enhance cultural understanding.

• Incorporates the LEARN Model to improve communication and empathy.

CHAPTER 9: CULTURAL COMPETENCE

Key Self-Reflection Questions

• Am I aware of my prejudices and biases, as well as the presence of racism and other ‘isms’?

• Do I know how to conduct a culturally specific history, physical, mental health, medication, and spiritual assessment in a culturally sensitive manner?

• Do I possess comprehensive knowledge regarding different cultures’ worldviews, the field of biocultural ecology, and the importance of addressing social determinants of health in patient care?

• Do I engage in meaningful encounters with individuals from cultures different from mine, and am I committed to resolving cross-cultural conflicts that may arise?

• Do I sincerely want to engage in the ongoing process of competemility, a blend of competence and humility in cultural interactions?

Understanding Culture

• Definition: Culture encompasses the learned and shared beliefs, values, norms, and traditions of a specific group. It guides thoughts, decisions, and actions, influencing how individuals interpret experiences and interact socially.

• Reference: Giger and Haddad, 2021

Unconscious Bias

• Definition: Unconscious bias refers to biases that individuals are unaware of, shaped by their background, cultural environment, life experiences, and societal influences. These biases can impact healthcare delivery and patient interactions in implicit ways.

Culturally Congruent Care

• Culturally congruent care: This is a framework for providing care that is tailored specifically to an individual's cultural beliefs, practices, and values. It acknowledges the patient as a whole person.

• Cultural competence: This encompasses the healthcare professional's ability to deliver care that is culturally sensitive, appropriate, and responsive to the diverse healthcare needs of patients from different backgrounds.

Worldview

• Components of Worldview:

  • Emic: The insider perspective on culture; understanding from within the culture itself.

  • Etic: The outsider perspective on culture; analyzing from an external viewpoint.

• Avoid stereotyping and ensure that every individual is treated as a unique person with distinct experiences and identities.

Health Disparities

• Definition: A specific type of health difference that is closely linked to social, economic, and environmental disadvantages, as recognized by ODPHP, 2021.

• Health disparities relate to the conditions under which people are born, grow, live, work, and age, according to WHO, 2020. Marginalized groups often encounter systemic barriers that lead to poorer health outcomes and shorter lifespans.

Racial, Ethnic, and Cultural Identity

• Elements of identity include:

  • Racial identity: How one identifies based on physical traits.

  • Ethnic identity: Cultural identity associated with a specific ethnic group.

  • Cultural identity: How one engages with their cultural heritage and practices.

  • Acculturation: The process of adopting cultural traits from another ethnic group.

  • Assimilation: The process in which individuals from one culture adopt the practices of another culture, often losing their original cultural identity.

  • Cultural respect: Acknowledging and honoring the beliefs and practices of different cultures.

Disease and Illness

• Illness: Refers to the personal and familial perceptions of experiencing disease. It's shaped by cultural interpretations and social context.

• Disease: A clearly defined biological or psychological dysfunction, recognized through medical definitions.

• Culture significantly shapes individual definitions and perceptions of illness, emphasizing the need for culturally sensitive healthcare delivery.

• Importance of evidence-based standards of care (Core measures) in guiding treatment decisions.

Cultural Competemility Model (by Campinha-Bacote)

• Components:

  • Awareness: Recognizing one's own cultural background and biases.

  • Skill: Developing the ability to assess health literacy and conduct culturally relevant assessments.

  • Knowledge: Gaining comprehensive awareness about different cultures’ health-related beliefs, disease prevalence, and treatment methods.

  • Encounter: Engaging meaningfully with individuals from diverse backgrounds to learn and adapt.

  • Desire: The intrinsic motivation to enhance understanding and communication across cultures.

Cultural Awareness and Knowledge

• Self-examination: Vital in acknowledging personal biases and exploring one's cultural background, which informs patient interactions.

• Cultural awareness: Ongoing education about the beliefs, values, and practices of diverse cultures, especially those that affect health care.

• Covers important elements such as health-related beliefs, incidence and prevalence of diseases, and the efficacy of treatments associated with different cultural groups.

Identifying Health Problems

• Cultural awareness significantly aids healthcare professionals in identifying health problems among patients, paving the way for culturally suitable interventions.

• Tools available to practitioners include:

  • Storytelling: Utilizing patient narratives to understand cultural contexts regarding health.

  • Iceberg analogy: Recognizing that visible symptoms (above the water) only represent part of the problem; deeper cultural issues often lie beneath.

  • Comprehensive cultural assessment: A systematic approach to exploring and understanding patients’ cultural backgrounds.

Cultural Skill

• Skills essential for effective patient care include:

  • Collecting comprehensive patient histories while being sensitive to cultural contexts.

  • Assessing health literacy among diverse populations.

  • Conducting culturally relevant physical assessments with consideration of cultural beliefs about health and body.

  • Implementing teach-back methods for patient understanding and using plain language to ensure effective communication.

  • Working competently with interpreters to bridge any communication gaps.

Cultural Encounter and Desire

• Cultural encounter goals: To facilitate open communication that draws out diverse responses and beliefs, allowing for an evaluation and modification of existing beliefs about cultural groups.

• Cultural desire: The motivation to actively engage with patients to enhance mutual understanding and empathy, which is integral to improving healthcare outcomes. Incorporates the LEARN Model (Listen, Explain, Acknowledge, Recommend, Negotiate) to foster effective communication and empathy with patients.