Chapter 9 Creating Culturally Competent Health Care Organiz

Chapter 9:
Creating Culturally Competent Health Care Organizations
Copyright © 2016 Wolters Kluwer Health | Lippincott Williams
& Wilkins
Copyright © 2020 Wolters Kluwer • All Rights Reserved
1
Defining a Culturally Competent Health Care Organization #1
A culturally competent organization is an organization that
provides services that are respectful of and responsive to the
cultural and linguistic needs of the clients they serve.
2
Defining a Culturally Competent Health Care Organization #2
Cultural competence includes providing respectful care that is
consistent with cultural health beliefs of the clients and family
members, with consideration of:
Age, culture, ethnicity, gender, language, race, religion, sexual
preference, gender identity, and socioeconomic status

3
Question #1
Is the following statement true or false?
To be culturally competent, an organization should provide
respectful care that is consistent with cultural health beliefs of
the clients, family members, and staff.
4
Answer to Question #1
True
Rationale: Humans need care to survive, thrive, and grow.
According to Leininger (1996), organizations need to
incorporate universal care constructs, including respect and
genuine concern for clients and staff.
5

The Need for Culturally Competent Organizations: External
Motivations
The need for culturally competent organizations has been
recognized by many external agencies, including:
Transcultural Nursing Society (TCNS)
American Nurses Association (ANA)
Sigma Theta Tau International (STTI)
American Organization of Nurse Executives (AONE)
The Joint Commission
The Institute of Medicine (IOM)
National Standards for Culturally and Linguistically
Appropriate Services in Health Care (CLAS Standards)
6
The Need for Culturally Competent Organizations: Eliminating
Health Disparities #1
Racial and ethnic disparities influence unequal health care
treatment.
Disparities in health are “a particular type of health difference
that is closely linked with social, economic, and/or
environmental disadvantage” (Healthy People, 2020).
7
The Need for Culturally Competent Organizations: Eliminating

Health Disparities #2
Key factors in achieving good health outcomes include:
Access (getting into the health care system)
Quality care (receiving appropriate, safe, and effective health
care in a timely manner)
8
Question #2
Which of the following would support Access and Quality of
Care issues in eliminating health disparities?
Universal health care coverage
Organizational culture
Joining TCNS
External auditing of health care organizations (e.g., Joint
Commission)
B. Organizational culture
Rationale: Organizational culture is one area that may influence
both cultural competence and health disparities. Individuals
must deliver culturally competent health care that focuses on
risk reduction, vulnerability reduction, and promotion and
protection of human rights.

10
Assessing Organizational Culture #1
Organizational culture: the goals, norms, values, and practices
of an organization in which people have goals and try to achieve
them in beneficial ways.
11
An organization’s culture:
Consists of shared beliefs, assumptions, perceptions, and norms
leading to specific patterns of behaviors
Results from an interaction among many variables including
mission, strategy, structure, leadership, and human resource
practices
Is self-reinforcing; once in place, it provides stability and
changes are resisted by organizational members
12

An inclusive workplace is characteristic of a caring
organization.
Inclusive workplaces:
Encourage members of the workforce to become active in the
community and participate in state and federal programs
Draws staff members who are committed to cultural competence
and who value diversity and mutual respect for differences
13
Assessment tools:
The Magnet Hospital Recognition Program for Excellence in
Nursing Services
Evidence-based practice
Leininger’s culture care model
Andrews’ assessment tool
14
Building Culturally Competent Organizations #1
Specific areas are critical to fostering culturally competent
health care organizations:
Governance and administration
Board members, mission/vision/values, budget

Internal evaluation of adherence to cultural competence
standards
Availability, accessibility, affordability, acceptability, and
appropriateness
15
Fostering culturally competent health care organizations:
Staff competence
Organizational support, orientation, and ongoing education
Physical environment of care
Assessment of environment and barriers
16
Fostering culturally competent health care organizations (cont.):
Linguistic competence
Complete, accurate, timely, unambiguous, and understood by
the patient
Community involvement
Partnerships
Culturally congruent services and programs
Design and implement effective programs

17
Question #3
Building culturally competent organizations may result in
increased patient satisfaction rates.
18
True
Rationale: Research found that inpatients reported higher
satisfaction with hospitals that had greater cultural competency.
19
Overcoming the Barrier of Institutional Racism in Health Care
Institutional racism is defined as differential access to goods,
services, and opportunities based on race, including differential

access to health insurance.
More often done unintentionally.
Cultural differences must be acknowledged and celebrated.
The strategies outlined build culturally competent health care
organizations.
20
Chapter 10:
Transcultural Perspectives in Mental Health Nursing
Copyright © 2016 Wolters Kluwer Health | Lippincott Williams
& Wilkins
1
Transcultural Perspectives in Mental Health Nursing #1
Transcultural nursing:
Examines mental illnesses within a transcultural perspective
Assists in understanding how culture influences the ways in
which we interpret and behave with mental illnesses

2
Transcultural Perspectives in Mental Health Nursing #2
Mental disorders are defined according to “cultural, social, and
familial norms and values” (DSM-V, 2013, p. 14).
Culture provides the framework that is used to interpret “the
experience and expression of the symptoms, signs, and
behaviors that are criteria for diagnosis” (p. 14).
Cultural norms shape what is considered normal versus
abnormal.
3
Defining Mental Health Within a Transcultural Nursing
Perspective #1
According to the World Health Organization (2013):
“Mental health is an integral and essential component of
health.”
“Health is a state of complete physical, mental, and social well -
being and not merely the absence of disease or infirmity.”
Determinants of mental health at any given point in time:
“social, psychological, and biological factors.”

4
Defining Mental Health Within a Transcultural Nursing
Perspective #2
Transcultural nurses should:
Understand patterns of values, beliefs, and practices for mental
health care
Avoid stereotypes and ethnocentrism
Be aware of “norms”
5
Question #1
Ethnocentrism can manifest as feelings of superiority or
discrimination with respect to one’s own group or culture over
another group or culture.
6
True
Rationale: Ethnocentrism presents as subconscious disregard for

cultural differences; it may also present as authoritative.
Example: believing that one’s own health care beliefs and
practices are superior to another culture’s.
7
Population Trends and Mental Health
Mental illnesses are identified as “common” in the United
States.
Approximately 44.7 million adults (~19%), aged 18 or older,
were currently, or within the past year, diagnosed with a mental,
behavioral, or emotional disorder.
Mental health care had difficulty moving to community-based
service centers. Many clients end up in emergency rooms.
8
Decision Making and Mental Health Care
Offering support and clear communication can be key to
favorable outcomes for all clients.
Shared decision-making (SDM) as a practice to advance mental
health care encourages providers and consumers to collaborate
on mental health care for the consumer.

9
Disparities in Mental Health Care
Reducing and eliminating disparities can be accomplished
through:
Professional organization initiatives
Caring
Reducing stigma
Identifying disparities
Recognizing cultural pain: feeling “insecure, embarrassed,
angry, confused, torn, apologetic, uncertain, or inadequate
because of conflicting expectations of and pressures from being
a minority”
10
Question #2
American biases and prejudges have made it difficult for
individuals of diverse cultures to have their beliefs and values
acknowledged.

11
True
Rationale: Historically, racism in America has led to difficulties
in acknowledging and/or discussing differences in cultural
values and lifeways for diverse cultural groups.
12
Mental Health Care for Immigrants
Regarding immigrants, health care providers should be sensitive
to:
Offensive terms, for example “illegal alien”
Culture shock
Degree of acculturation
Feelings of depression, guilt, shame, anxiety
These factors put individuals at risk for depression, anxiety,
posttraumatic stress disorder, substance abuse, and mental
health problems.
13
Cultural Criteria Changes in DSM-V

Culture-bound syndromes that have routinely been used by
mental health professionals have now been replaced with three
cultural concepts:
Cultural syndrome
Cultural idiom
Cultural explanation
14
Culture-Bound Syndromes
Culture-bound syndromes, also called folk illnesses, culture-
specific illnesses, or culture-specific syndromes, often are
localized to a particular cultural group.
Many of these patterns are indigenously considered to be
“illnesses,” or at least afflictions, and most have local names.
15
Cultural Values, Beliefs, and Practices
of Specific Cultural Groups
Health care providers want to help clients of all cultures
achieve their optimal level of human functioning.
An individual’s optimal level of human functioning can be
specifically tied to the meanings and expressions of care of
one’s culture.

The transcultural nurse is encouraged to understand the
diversity within cultural groups with respect to mental health
beliefs and practices.
A thorough history and cultural assessment can achieve this.
16
Culturally Competent Mental Health Care #1
Behavior can be misinterpreted and/or distorted if health care
providers are not knowledgeable about caring for clients from
diverse cultural groups.
Cultural competence is defined as a process in which nurses
strive to work successfully within the cultural context of
individuals, families, and communities.
Cultural competency can have a positive impact on the mental
health care that is provided to clients of diverse cultural groups.
17
Culturally Competent Mental Health Care #2
Developing cultural competence through:
Mutual trust
Moving beyond cultural sensitivity to competency-based
cultural care
Intrapersonal reflection: a personal inventory of one’s own
cultural values, beliefs, and practices to begin to identify,

understand, and remove personal cultural bias, ethnocentrism,
and prejudice
18
Important Factors to Consider in Transcultural Mental Health
Nursing #1
Three important factors:
Communication and language
Spirituality
Experiences of pain
19
Nursing #2
Communication
Verbal and nonverbal
Developing trust
Availability of a certified translator/interpreter
Empathy

Question #3
Researchers have shown that speaking the same language is the
most important element in communicating with patients from
diverse cultural backgrounds.
21
False
Rationale: Research has shown that speaking the same language,
while important, is not the most important element in
communicating with patients from diverse cultural backgrounds.
The attitude of the care provider is instrumental in helping the
client be open to treatment options. Communicating an
understanding of cultural diversity helps facilitate the client–
nurse relationship.
22
Nursing #4
Spirituality
Spirituality refers to a broad sense of the inner experience of

the self and a search for meaning; religion generally involves an
institution with a given set of rules and observances involving
devotion and ritual.
May enhance mental health and emotional stability.
23
Nursing #5
Pain
Pain has a component that includes emotional elements.
Pain and depression linked.
Psychosomatic pain, or pain with psychological components.
24
Question #4
There is increasing evidence to suggest that pain can be a
physical symptom of which mental health illness?
Paranoia
Alcoholism
Drug abuse
Depression

25
D. Depression
Rationale: There is increasing evidence to suggest that pain can
be a physical symptom of depression and that pain and
depression are common comorbidities.
26

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