1. Culturally Competent Health Care for Refugee Children Terri Morse, MS, RN-BC, FNP-C Susan Mahar, MS, RN, PNP-BC

3. Objectives Identify tools available to use during a cultural assessment Demonstrate knowledge of the health care practices of local cultural groups Create a health care plan to meet your patients cultural needs

5. Upstate New York Refugee Arrivals 2012 BRIA FFY 2012

7. Top 5 Upstate Counties with Refugee Arrivals in 2012 BRIA FFY 2012

9. Jean Watson To care for someone, I must know who I am. To care for someone, I must know who the other is. To care for someone, I must be able to bridge the gap between myself and the other.

11. Stereotype vs. Generalization A Stereotype is an ending, no attempt is made to learn whether the individual in question fits the statement. A Generalization is a beginning point, it indicates common trends but further information is needed to ascertain whether the statement is appropriate to a particular individual. Galanti, G.A. (1991)

13. The Culture of Western Medicine Meliorism – make it better Dominance over nature – take control Activism – do something Timeliness – sooner than later Therapeutic aggressiveness – stronger = better Future orientation – plan, newer = better Standardization – treat similar the same

15. Kleinman’s Explanatory Model The following questions elicit the patient’s perception of their illness: What caused the illness? Why did it start when it did? What does the illness do to you? How severe is the illness? What problems has the illness caused you? What do you fear most about the illness? What treatments do you think you need? How will you benefit from the treatment?

17. SOMALI BURMESEBURMESE BHUTANESEBHUTANESE

18. Cultural Diversity in Health Care Make It Better Control Over Nature Do Something Intervene Now Strong Measures Plan Ahead – Recent is Best Standardized – Treat Everyone the Same Accept with Grace Balance /Harmony with Nature Wait & See Cautious Deliberation Gentle Approach Take Life as it Comes – “Time Honored” Individualize – Recognize Differences “Cultural Competence”

20. LEARN Model Listen with sympathy and understanding to the patient’s perception of the problem (Utilize Kleinman’s Model) Explain your perceptions of the problem Acknowledge and discuss differences and similarities Recommend treatment Negotiate agreement

22. KnowledgeSkill Desire AwarenessEncounters Campinha-Bacote (1991) EDK SA

23. Our Future