Transcultural care practice_07


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  • African American women are more likely than European American women to die from breast cancer, despite having a lower incidence of the dis.
    Infant mortality rates are 2.5 times greater for African Americans and 1.5 times greater for Native Americans than for European Americans.
  • Flaskerud, J., Lesser, J., Dixon, E., Andersn, N., Conde, F., Kim, S., et al (2002). Health disparities among vulnerable populations: Evolution ofknowledge over five decades in Nursing Research publications. Nursing Research, 51 (2), 74-85.
  • Brach & Fraser, (2000).
  • Narayanasamy, A. (2003). Transcultural nursing : How do nurses respond to cultural needs? British Journal of Nursing 12(3): 185-94.
    Equal access – racial discrimination, racial harassment and oppression -> stress and psychological trauma
    Respect for cultural beliefs & practice – work from the client’s perspectives, enables client empowerment.
    Religious beliefs – holidays, diet regulations, complementary health care practice, use of amulet, number of 4 (death); 13 (unlucky)
    Communication needs
    Leininger, 1995 – Components of a cultural assessment : communication, time orientation, space, pain, religious beliefs, taboos, customs, dietary practices, health practices, family, view of death
  • Pain – stoic pt, nice patient, don’t admit to be in pain to avoid being ashamed or bring shame to others, afraid of become addicted.
    Time orientation – be late, -> frustrate health care givers; using the preventive methods,
    Space – touch, touch the opposite sex; proxemics, situation, social comfortable level,
    Fluid – ice water or hot tea
    Family – definition of family, nuclear Vs. extended; or community leader to make the decision; who is the care giver; independence or family interdependence; dying of the pat should be told or not, how much you can count on advance directive;
  • Taking time to locate a translator
    Interpreter may interpret rather than translate a pt’s problem
    Family interpreter –fabricate a new problem to save embarrassment in the presence of a family member
    Body stances, proximities, gestures, listening styles, eye contact
    Under crisis – pts with ESL might experience difficulty in understanding English, yell out their primary language …
  • Cultural safety -> trust, and therapeutic Rs
    Respect the pt as an unique individual with needs which are influenced by cultural beliefs an values. This will enable pts to maintain their self-respect leading to better self-esteem.
    Culture safety can be achieved by creating a caring environment in which cultural adaptation takes place between nurses and pts.
  • Cultural–specific and generic-cultural competence: development of knowledge and skills related to a particular ethnic group as well as insights into the beliefs and values that operate within clients’ culture
    Culture-generic competence is the ability to acquire knowledg and skills that are transferable across ethic groups. And culture-specific competence is about possession of knowledge and skills unique to a particular ethnic group.
    Education aspect – re-examination of one’s own attitudes
    Recruitment – 30 % minority with 13% of minority health care providers
  • Biological variations – Thalathemia –
    Environmental controls – how they can manage factors in his environment along with the system
    Time – present oriented -> don’t care about the appointment
    Social organization –
    Japan –small gap between rich and poor, has high percentage of smokers but a low percentage of mortality from smoking. Bezruchka (2001) advocated redistribution of wealth as a solution to health disparities
  • Cultural awareness – 1) self exam one’s own prejudices & biases towards other culture. 2) indepth exploration of one’s own cultural background
    Cultural knowedge -
  • Cultural blind syndrome -> unconscious incompetence
    Conscious incompetent = know that but not know how to interact with clients from different cultures
    Conscious competent = deliberate in applying the cultural knowledge & principle but may not feel comfortable. Conscious about not being politically right
  • *Health Resources and Service Administration Bureau of Health Professions. The registered nurse population: National sample survey of registered nurses- March 2000. Rockville, MD: US Dept of Health & Human Services 2001.
    Primary dimensions of diversity – age, ethnicity, gender, mental/physical characteristics, race,
    Secondary dimensions of diversity – education, family status, organizatinal role and level, religion, first language…
  • Frusti, D.K. Niesen, K,.M.Campion, J.K. (2003). Creating a culturally competent organization. Use of the diversity competency model. Journal of Nursing Administration, 33(1), 31-38.
    Drivers – the organization leads and responds to internal and external forces
    Linkages – the organization integrates diversity throughout all levels of the workplace
    Culture – creates a work environment that reinforces behaviors
    Measurements – evaluates and improves for continuous progress and business results.
  • Transcultural care practice_07

    1. 1. N3036- Transcultural Nursing Diverse Populations and Health Care
    2. 2. Globalization : Q: How to define globalization? A: Princes Diana’s death Q: How come? A: An English princess with an Egyptian boy- friend crashes in a French tunnel, in a German car with a Dutch engine, driven by a Belgian who was pissed on Scottish whiskey, followed closely by an Italian paparazzi, on Japanese motorcycles, treated by an American doctor, using Brazilian medicines. And this is sent to you by a Israeli, using Bill Gates’
    3. 3. Health Disparities  Infant mortality,  Cancer screening and management,  Cardiovascular disease,  Diabetes,  HIV/AIDS,  Immunization
    4. 4. Problems with Health Disparities - with cultural factors Flaskerud, J. et al (2002) – a review of 79 articles in the past 5 decades:  Ignorance of certain groups (indigenous peoples)  Inappropriate lump together ie. Hispanic members of disparate groups with their own cultural identity eg., Prerto Ricans, Mexicans, Cubans, Dominicans
    5. 5. Impact of Cultural Competency  More successful patient education  Increases in pt’s health care seeking behavior  More appropriate testing and screening  Fewer diagnostic errors.  Avoidance of drug complications  Greater adherence to medical advice  Expanded choices and access to high-quality clinicians.
    6. 6. Transcultural Nursing- Leininger, 1997  Definition- A formal area of study and practice focused on comparative holistic culture care, health and illness patters of people with respect to differences and similarities in their cultural values, beliefs, and lifeways with the goal to provide culturally congruent, competent and compassionate care
    7. 7. Cultural needs  Equal access to treatment and care  Respect for cultural beliefs and practices  Leininger, (1995) & Narayanasamy, (2003)  Religious beliefs, taboos, customs  Dietary, personal care needs, daily routines  Dying needs  Communication needs  Cultural safety needs,
    8. 8. Cultural needs (Cont’d)  Pain  Health practice  Time orientation  Space  Family
    9. 9. Equal access to treatment and care  Ethnicity  racial discrimination,  racial harassment and  oppression  Secondary problems  stress  psychological trauma
    10. 10. Communication needs  Barrier  Impede early detection  delay prompt treatment and care  Forms  Language  Non-verbal communication  Translation services  Interpreters  Family interpreters  Health condition – acute illness & crisis
    11. 11. Cultural safety needs  Engage clients as partners  Respect & rapport -> self-esteem  Cultural negotiation & culture compromise
    12. 12. Transcultural Care Practice  Initiative  Enthusiasm  Commitment of individuals and groups  Strategic planning  Organization & coordination of services  Funding  Education  Recruitment & research
    13. 13. Giger-Davidhizar (2002) - Assessment Model Culturally Unique Individual Biological Variations Environmental Controls Time Social Organization Space Communication
    14. 14. ACCESS Model – Narayanasamy, 2002  Assessment  Communication  Culture negotiation and compromise  Establishing respect and rapport  Sensitivity  Safety
    15. 15. Campinha-Bacote’s Cultural Competence Model  Cultural awareness  Cultural skill  Cultural knowledge  Cultural encounters  Cultural desire
    16. 16. Purnell’s Model  Macro level – global society, community, family, individual, health  Cultural domains – overview, communication, family roles, workforce issues, biocultural ecology, high- risk behaviors, nutrition, pregnancy & childbearing practices, death rituals, spirituality, health care practice/practitioners  Cultural consciousness  Unknown phenomenon
    17. 17. Culturally Competent Organization  Ethnic minorities accounts for one fourth of the nation’s population  In 2020, it will be near to 40%  10% of RNs in the US are from racial/ethnic minority background (2000)*
    18. 18. Organizational Diversity Competence Model (Frusti, Niesen, Campion, 2003) Commitment Drivers measurements Linkages Culture
    19. 19. Negotiation Process  Listen: to the client’s perspective  Teach: from your knowledge in language appropriate for client & family  Compare: similarities & differences, disagree but do not devalue client’s view  Compromise:  if client treatment not harmful, promote  If harmful, explain harm and suggest alternatives