1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 10 Cultural Competency and Social Issues in Nursing and Health Care

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Key Concepts  Demographic and sociocultural variations of diverse groups  Variations in biological, social, environmental, and communications phenomena  Education, practice, and research issues that influence culturally competent care

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Population Trends  Immigration laws have increased the number of immigrants.  By the mid-21st century, minority populations will outnumber the white population.  The number of adults older than 65 years of age is increasing.  The number of adults who live past 85 years of age has increased.

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Impact of People Living Longer  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

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Federally Defined Minority Groups  African-Americans  Hispanics  American Indian/Alaskan Native  Asian/Pacific Islanders

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Health Disparities  Life expectancy for whites is 75.2 years; for African-Americans, 69.6 years  Causes of death for minority groups  Cancer  Cardiovascular disease and stroke  Chemical dependency  Diabetes  Homicides and accidents  Infant mortality

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Marginalized Populations  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.)

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Changing Economics and Downsizing  Joblessness  Homelessness  Poverty  Limited access to health care

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Poverty  Higher costs and lower wages for minority groups  More minorities lack health care  Residential segregation  Substandard housing  Unemployment  Poor physical and mental health  Poor self-image

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Violence  The United States has the fifth highest homicide rate in the world.  Businesses, churches, and schools have become sites for random acts of violence.  Unemployment is associated with violence.

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Attitudes Toward Culturally Diverse Groups  Hate  Contempt  Tolerance  Respect  Celebration

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. A Continuum of Intensity of the Range of Attitudes Toward Culturally Diverse Groups

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Need for Diversity in Health Care Force  Consumer demand  Lack of diversity and ethnic representation  Minorities inhibited from having nursing careers  Better recruitment efforts by other disciplines

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Current Status of Diversity in Health Care Workforce  Highest representation—African-Americans  Lowest representation—Native Americans

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Recruitment and Retainment of Minorities in Health Care Workforce  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

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Recruitment and Retainment of Minorities in Health Care Workforce  After World War II—National efforts by NACGN  Southern nursing schools segregated by law  Northern nursing schools segregated by custom Brown v. Board of Education—1954  Recruitment in the 1960s and 1970s  Many efforts to recruit economically disadvantaged  Sealantic Fund—Rockefeller Foundation  “Breakthrough to Nursing”

17. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Recruitment and Retainment of Minorities in Health Care Workforce  Recruitment in the 1990s  American Nurses Foundation report—“Strategies for Recruitment, Retention and Graduation of Minority Nurses in Colleges of Nursing”  Chi Eta Phi

18. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Recruitment and Retainment of Minorities in Health Care Workforce  Recommendations of the American Academy of Nursing’s expert panel on cultural competence (1995)  Consciousness raising  Mentoring  Consultation

19. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Reasons for Cultural Competence  Nurse’s culture often differs from client’s.  Culturally incompetent care is more costly.  Culturally incompetent care is ineffective.  Specific objectives for persons in different cultures as outlined by Healthy People 2000 must be met.

20. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Principles for Culturally Competent Care  Care designed for specific client  Care based on uniqueness of person’s culture  Care includes empowerment strategies.  Care is provided with sensitivity for the uniqueness of the client.

21. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Cultural Competence in Nursing Education  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

22. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Anglo-American Values Contrasted With Those of Other Cultures  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

23. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Anglo-American Values Contrasted With Those of Other Cultures  Competition vs. cooperation  “Future” vs. “past” orientation  “Action” vs. “being” oriented  Informality vs. formality  Directness vs. indirectness  Practicality vs. idealism  Materialism vs. spiritualism

24. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Environmental Control (mastery over nature)  Belief that one can overcome the natural forces of nature  Anticipate good results from medicine or surgery  Caucasians are likely to subscribe to this view.

25. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Environmental Control (subject to nature)  Belief that one has little control over what happens  May not be compliant with treatments  African-Americans and Mexican-Americans

26. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Environmental Control (harmony with nature)  Illness represents disharmony.  Rely on naturalistic remedies because medications are seen as only relieving symptoms  Asians and Native Americans

27. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Biologic Variations  Body build and structure  African-Americans have denser bones and larger teeth than Caucasians.  Genetic variations  African-Americans have lower serum cholesterol.  Skin  Variations in amount of melanin  Susceptibility to disease  Native Americans have greater incidence of strep throat and gastroenteritis.

28. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Social Organization  Nuclear families  Single-parent families  Extended families

29. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Communication Issues  Direct eye contact  Formality  Agreement  Interpreters

30. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Space  People’s attitudes and comfort level regarding personal space  Vast cultural differences in comfort level associated with distance between persons

31. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Time  Present-oriented  Past-oriented  Future-oriented

32. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Practice Issues Related to Cultural Competence  Minority populations less knowledgeable about specific health problems  Minority populations underestimate prevalence of cancer.  Obtain fewer screening tests  Diagnosed at later stages

33. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Education and Certification  Transcultural, cross-cultural, and international nursing programs are increasing.  Transcultural Nursing Society offers certification as a transcultural nurse.

34. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. International Marketplace  Nurses are engaging in clinical practice, education, research, administration, and consultation in hundreds of foreign countries.  No one organization provides leadership to these nurses.

35. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Professional Journals Devoted to Cultural Issues  The Journal of Transcultural Nursing  Western Journal of Medicine  Cross-Cultural Issues  Journal of Cultural Diversity  Journal of Multicultural Nursing

36. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Issues  International marketplace  Research

37. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Health Care Facilities’ Responsibility for Cultural Care  Provide resources for education and practice  Employ or consult transcultural clinical specialists  Offer continuing education programs about cultural issues

38. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Recommended Standards for Culturally and Linguistically Appropriate Health Care Services (CLAS)  Promote and support attitudes, behaviors, knowledge, and skills  Comprehensive management strategy  Recruit, retain, and promote culturally competent staff  Require and arrange ongoing cultural education  Provide clients access to bilingual staff  Inform of rights to interpreter service

39. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Recommended Standards for Culturally and Linguistically Appropriate Health Care Services (CLAS)  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

40. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Recommended Standards for Culturally and Linguistically Appropriate Health Care Services (CLAS)  Ongoing self-assessment of cultural competence  Develop procedures to address cross-cultural ethical and legal conflicts  Prepare an annual progress report related to CLAS

41. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Cultural Assessment  Cultural self-assessment  Cultural client assessment  Cultural client nutrition assessment  Cultural beliefs about sickness and cures

42. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Cultural Beliefs About Sickness  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”