Chapter 2 Culturally Competent Nursing CareCopyri.docx

Chapter 2:
Culturally Competent Nursing Care
Copyright © 2016 Wolters Kluwer • All Rights Reserved
1
Cultural Competence #1
Multiple factors are converging to heighten societal awareness
of cultural similarities and differences among people:
Vulnerable populations
Immigration
Health tourism
Refugees
Requires interprofessional collaborative practice engaging:
Health care providers
Patients, families, caregivers, communities
Folk or traditional healers
Religious/spiritual leaders

Cultural competence can be divided into two major categories:
Individual cultural competence
Organizational cultural competence
4
Individual cultural competence refers to the care provided for
an individual client by one or more health providers.
Organizational cultural competence focuses on the collective
competencies of the members of an organization.
5
Question #1
Is the following statement true or false?
Individual cultural competence refers to care for a single client.

6
Answer to Question #1
True
Rationale: Individual cultural competence refers to the care
provided for an individual client by one or more health
providers.
7
Cultural Self-Assessment #1
Cultural self-assessment enables you to use personal life
experiences to gain insights into your health-related:
Attitudes
Values
Beliefs
Practices
A personal and professional journey

8
Cultural self-assessment can help nurses overcome
ethnocentric tendencies and cultural stereotypes, thus helping to
prevent prejudice and discrimination.
Assists nurses to recognize the ways in which their background
and lived experiences have shaped and informed the person he
or she has become today
9
Ethnocentrism
The human tendency to view one's own group as the center
of and superior to all other groups
Cultural stereotype
A preconceived, fixed perception or impression of
someone from a particular cultural group without
meeting the person

Prejudice
Inaccurate perceptions of others or preconceived judgments
about people based on ethnicity, race, national origin,
gender, sexual orientation, social class, size, disability,
religion, language, political opinion, or related personal
characteristics
Discrimination
The act or behavior of setting one individual or group apart
from another, thereby treating one person or group differently
from other people or groups
Question #2
What is the expected nursing outcome of an effective cultural
self-assessment?
The prevention of prejudice and discrimination in the care of
any ethnic group
The successful resolution of the culturally diverse client’s
health care issues
The establishment of institutional services that are culturally
sensitive
The development of a culturally competent individual nursing
personnel
12

A. The prevention of prejudice and discrimination in the care of
any ethnic group
Rationale: Through self-assessment, it is possible to gain
insights into the health-related values, attitudes, beliefs, and
practices that have been transmitted to you by your own family
and your own life experiences. These insights also enable you to
overcome ethnocentric tendencies and cultural stereotypes,
which are vehicles for perpetuating prejudice and discrimination
against members of certain groups.
13
Cultural Assessment of Client #1
Collection of data about the client’s health state:
Subjective – what is said
Objective – what is observed
May need to consider familial and kinship involvement
Cultural Assessment of Client #2
Emic
Appreciating the client’s point of view or insider’s
perspective

Etic
Appreciating the outsider’s point of view
Individual Cultural Competence #1
Cultural competence is a dynamic, ongoing, lifelong,
developmental process that requires self-reflection, intrinsic
motivation, and commitment by the nurse.
It is impossible to know everything about every culture; it is
possible to develop excellent assessment and skills.
Individual Cultural Competence #2
The five-step problem-solving process for delivering culturally
congruent and competent nursing care is central to transcultural
practice.
Assessment of nurse (self) and client
Mutual goal setting
Development and
Implementation of the plan of care
Evaluation of the plan with the client

17
Five-Step Problem-Solving Process
Organizational Cultural Competence
Culturally competent organizations have defined values and
principles as well as behaviors that enable them to work
effectively cross-culturally, and the capacity to:
Value diversity
Conduct self-assessments
Manage the dynamics of difference
Acquire and institutionalize cultural knowledge
Adapt to diversity and the cultural contexts of the communities
they serve
Health Disparities #1
Health disparities are population-specific differences in the
presence of disease, health outcomes, or access to care.
Affected populations include:
Racial and ethnic minorities
Residents of rural areas
Women, children, and the elderly
Persons with disabilities
Other special populations such as the deaf

Health Disparities #2
These populations may experience a lower quality of health
services, are less likely to receive routine medical procedures,
and have higher rates of morbidity and mortality.
Culturally competent nursing care may reduce health
disparities and inequities in these high-risk populations.
Culture of the Deaf
These individuals may experience social isolation, prejudices,
and difficulties across their lifetime.
Sign language dialects differ worldwide.
Assistive devices include signaling and assistive listening
devices, alerting devices, telecommunication devices for the
deaf (TDD), and telephone amplifiers.
Communication and Language Assistance
In the United States, about 20% of people speak a language
other than English at home.
Language assistance should be provided when necessary.
By 2050, more than half the population will come from racial
or ethnic minority backgrounds.

23
Question #3
Is the following statement true or false?
Culturally competent nursing care may reduce health
disparities and inequities.
True
Rationale: Agencies have found that culturally competent
nursing care may reduce health disparities and inequities in
these high-risk populations.
Short Answer/Fill in the blank (4 points each): Type the answer
in the space provided or in the blank provided.
1. _________ is the concept that the pay for all jobs requiring
comparable knowledge, skills, and abilities should be similar
even if actual duties and market rates differ significantly.

2. Pay for performance plans that offer a means to sharing
productivity gains with employees and are based on group/team
performance that does not become a part of employees’ base
salaries are ______.
3. Compensation that is adjusted to maintain the expatriate’s
standard of living in the home country while on assignment in
the host country is known as the ____ approach.
4. Employers promising employees pay increases if they vote
against the union is known as a(an) _____.
5. ______programs are designed to maintain or improve
employee health before problems arise.
6. Employees who have worked the required number of years
retain their pension rights and receive the amounts contributed
by both the employer and themselves. This is referred to as
____.

7. During a contract negotiation, the management of RMS,
Inc. and its employee union fail to reach an agreement on an
issue related to night shift pay scales. A neutral third party is
called in to actively work with both sides and help them reach a
settlement. This party suggests several ideas that could help in
solving the issue. The process used by third party in the given
scenario is referred to as ____.
8. The workers at a construction site are refusing to work saying
that the scaffolding on which they have been working is unsafe
and that their management has been avoiding their request for a
safe work environment. Is their refusal to work justified and
why?
9. We discussed a case, “Loafers at Lakeside”, in class. This
case was about using ___ -based pay. One of the negative
outcomes of this form of pay was free riders, which is defined
as ____.
10. The Act that extends dependent coverage up to age 26 is
known as ______ (write it out….).
Essay Questions (10 points each): Answer the two questions
below. You will be graded on the completeness of your
response (which is not synonymous to length).

1. Describe what a job evaluation is and the purpose of job
evaluation. Describe (don’t just list the steps) the process of
doing the point method of job evaluation. Your description
should include a definition of a compensable factor. Also
describe some potential problems with these systems.
2. We are currently in a world of uncertainty due to the impact
of the coronavirus on our lives at work and at home. The
design of work will change dramatically. Two influences can
and likely will impact workplace safety issues and working
conditions.
a) Describe OSHA’s role in impacting workplace safety (be sure
to include a description of the law).
b) What role do Unions play in improving working conditions?
For example, how does the legal realm (related to unionization)

impact employees’ abilities to have a safe workplace? Also,
how does the collective bargaining process impact workplace
safety?

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