Gender and Orientation:
What is the gender/gender identity/sexual orientation preference?
Health Beliefs and Practices:
Does the patient prefer a same-gender health care provider?
What about the same ethnicity or racial background?Are there restrictions imposed by modesty that must be respected?
What are the patient's beliefs on health, illness, pain, and death?
Does the patient have any hygiene beliefs [e.g., body odor may not be a sign of poor hygiene and
instead may be common to the culture]?
What are the patient's attitudes toward mental illness?
Is there a main family member who is responsible for all health-related decisions?
Faith-Based Influences:
Is there a religion or greater being that the patient follows?
Are there death-related rituals that must be implemented?
Is sharing health-related information with members of the religion approved for spiritual purposes or prayer?
Is fasting a part of the patient's
spiritual beliefs?
Communication:
What is the patient's primary language?
How well is English understood, both verbally and written?
Would an interpreter be helpful?
Role of Family Members:
Who makes the decisions?
What is the patient's attitude toward children?
Is physical affection demonstrated to others?
Community Support [Beyond the Family]
Are there any cultural groups that may have an influence on the patient?
Are there friends, coworkers, or
others in the social community who may have an influence on the patient?
Dietary Practices
Are there any forbidden foods or cultural rites of preparation required for certain foods?
Are there any foods that hold special meaning associated with special circumstances?
Are there any foods with special healing properties?
If fasting is a part of spiritual beliefs, how often does the patient practice periods of fasting?
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Terms in this set [34]
Transcultural nursing
-Madeline Leininger-founder of transcultural nursing, died 2012; wanted to make clear that different type of care for different people with cultural
-Addresses differences and similarities between cultures and how they relate to healthcare
-Definitions of
culture-
-Ethnicity-relating to large groups of people classified according to racial, religious, linguistic......characteristics
Leininger's definition of culture
having knowledge of a culture before trying to help a client or family is analogous to having knowledge of anatomy and physiology; patient-centered, addresses differences, not impose our own preferences; learned and shared beliefs and lifestyle practices and transmitted lifestyle practices....
Cultural humility
-Critical step!
-Address own cultural knowledge deficit
[1] Explore patient's needs from a cultural perspective
[2] Explore own cultural beliefs
[3] Identify conflict
[4] Examine how we can give care despite conflicts
-Learning how different cultures and subcultures work helps us become better nurses
Subculture examples
-Nurses
-Physicians
-Age [infants, toddlers, adolescents, college kids]
-Gender
-Sexual orientation
-Geographic location
-Disability-based
-Illness-based
Increased Diversity
-Population getting older-increasing faster than any other age group [over 65]
-Age-related changes
--Physical-hearing, vision,
chronic conditions, polypharmacy
--Cognitive-dementia, Alzheimer's, social isolation
**May need to modify testing environment-eliminate extraneous noise, eliminate distractions, large print, etc.
Ethnocentrism
Tendency to judge others according to our own cultures and beliefs
Cultural imposition
Tendency of individual to impose their beliefs, patterns, culture on others of a different culture
Cultural blindness
You see all cultures the same
Cultural shock
Shock when being in a different culture for the first time
Cultural competence
To deliver culturally
competent care:
-self-knowledge
-need to become culturally sensitive to others and be aware, may vary between ethnic groups and subcultures
-what nurse brings with her and has learned from their own experiences
-different experiences help us with this
-positive change
AACN Essentials
-essentials have made it clear that nursing educators need to integrate cultural competence into the curriculum by providing experiences to interact with different cultures
Joint Commission
requires all healthcare institutions provide evidence that they are trying to procvide culturally competent care
Cultural brokerage
learning to navigate healthcare system in order to advocate for our patient
Approaches to cultural competence
-know person biases and attitudes, prejudices
-build knowledge and cultural competence through experience and asking questions
-tailor nursing care to fit patient's cultural values through cultural assessment
-caution not to stereotype
-address agency policies
Cultural related assessments
-Gender roles-who is dominant figure, what role does
family play
-Gender identity-
-Sexual orientation-
-Language and communication-big one! Adult can specify if other person [s/be adult] can act as translator; silence or lack of eye contact can mean sign of respect, discomfort, stubbornness depending on culture
-Orientation to space & time-comfort level with touching and personal space
-Food & nutrition
-Socioeconomic-some cultures will avoid eye contact if of lower socioeconomic status
?'s and conversation starters
"Forgive me, I was wondering if I could ask you a few questions?"
Questions regarding religious/spiritual beliefs
"At times many people draw on spiritual beliefs to help them, is there anything the nurses can do to help you with your spiritual needs? Is there a religious leader I can call for you?"
Questions regarding healthcare team
"We all want to be polite and respectful to you. How would you like to be addressed? Are there certain courtesies you would like us to practice?"
Questions regarding customs
"Are there special beliefs or customs that you would like to keep related to treating this condition?" "How does your family think this illness should be treated?"
Global context of nursing
"What impact does the illness have on your family?"
"With whom should we discuss your care?"
"Is there someone you would like to help you make decisions?"
Questions regarding communication
"What language would you prefer to receive information in?"
Information Disclosure
-Right to information-we feel patient has right to know, but need to take ethical approach and find out who is dominant figure/who we should talk to about patient care
-Promote open dialogue
Models of cultural assessment
-Various models, but throughout all communication is the most important
Ex.: How do we communicate tx may prolong,
but won't cure or as a result of this tx you won't be able to have more children
Leininger's Sunrise Model
stresses the importance of providing culturally congruent nursing care [meaningful and beneficial health care tailored to fit the patient's cultural values, beliefs, and lifestyles] through culture care accommodation and culture care restructuring
Explanatory Model
Developed in 1978
-has helped nurses obtain basic information through open-ended questions
-how would you describe the problem that brought you in
The LEARN Model
Listen carefully to what they're saying and observe nonverbals
Explain perception "I understand..."
Acknowledge and discuss similarities and differences
Recommend a plan of action
Negotiate a
plan of care that is mutually acceptable
Goal
-Cultural competence-effective individual, respect for dignity, rights, practices
-Cultural safety-can express opinions freely; don't challenge or deny them
-Integrate spiritual needs-ask if they have spiritual needs we can help them with
Causes of illness
-Biomedical/scientific-what
most healthcare settings base their practice on
-Naturalistic/holistic-Native Americans, Asians; Ex.: yin yang, cold/hot balance
-Personalistic/Magico-Religious-supernatural forces dominate; Ex.: voodoo, withcraft
Pharmacogenetics
*see article on BB
=field that seeks to unravel the genetic underpinnings of variable drug responses
Ex.: Different ethnic groups respond differently to antiHTN and
Beta-blockers [higher dose needed for African Americans]; start with lower dose of Warfarin for Asians
Nursing considerations
-Space and distance-personal space differences
-Eye contact-different meanings
-Time-some punctual, some punctuality not important; present-oriented
-Poverty-
-Touch-
-Holiday observances-
-Diet-
Nursing diagnosis
Social
interaction impaired r/t knowledge deficit
Spiritual distress
Readiness for enhanced spiritual well-being
Impaired verbal communication r/t difficulty expressing thoughts verbally
Could be due to:
-Aphasia
-Inability to speak language of caregiver
-Side effects of medication
-Cultural differences
American Indian
-Restoring balance and
harmony
-Traditional: herbs, plants, healers
-Cause of illness can be spiritual
-Respect for older members
-Diabetes, alcohol and domestic violence are increasing
Asian--Chinese
-Yin and yang: yin female negative energy; yang male positive energy. Must be in harmony for health.
-herbs, acupuncture and acupressure used in addition to or instead of western medicine
-Western: Acute illness, Easter
medicine: Chronic illness
-Older members viewed with self-esteem
-Family responsible for care of elders
-Traditional head of household is father
Hispanic
-Fastest growing minority in U.S.
-Good health is God's reward for living good like, treating body with respect and praying
-illness can be punishment from God
-Religious medals work to prevent illness
-Believed in the theory of hot and
cold in describing illness
-May use alternative healthcare, folk, healer and home remedies.
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