Cultural Cultural Competency Competency

in the Practice in the Practice of the Nursing of the Nursing

ProfessionProfession

Group 1 - IntroductionGroup 1 - Introduction Crispo AlvarCrispo Alvar Eva CoxEva Cox Norman IlaganNorman Ilagan Marie JimenezMarie Jimenez Zoya PoltilovZoya Poltilov Ifeyinwa UtohIfeyinwa Utoh Tsering Tsering

YanchenYanchen

Culture:Culture: Impact on health Impact on health

beliefs of clients and beliefs of clients and nursing practicenursing practice

Tsering YanchenTsering Yanchen

CULTURECULTURE Accumulated learning for generational Accumulated learning for generational

groups of individuals within structured or groups of individuals within structured or non-structured societies.non-structured societies.

Heritage learned through formal and Heritage learned through formal and informal experiences through the life informal experiences through the life cycle. cycle.

Combined heritage of language and Combined heritage of language and communication style, health beliefs and communication style, health beliefs and health practices, customs and rituals, health practices, customs and rituals, and religious beliefs and practices. and religious beliefs and practices.

Contributions to Contributions to HealthcareHealthcare

Experience in different culture groups Experience in different culture groups may lead the nurse to understand the may lead the nurse to understand the complexity of culture, such as their complexity of culture, such as their beliefs and practices in times of beliefs and practices in times of illness. illness.

Skills related to cultural diversity can Skills related to cultural diversity can strengthen and broaden health care strengthen and broaden health care delivery, e.g. Personal Space.delivery, e.g. Personal Space.

Personal cultural heritage of the nurse Personal cultural heritage of the nurse can maximize the care of the client, can maximize the care of the client, e.g. volunteer services to public.e.g. volunteer services to public.

Barriers to culturally Barriers to culturally competent carecompetent care

PrejudicePrejudice EthnocentrismEthnocentrism StereotypingStereotyping

Nurses must:Nurses must:

Develop Cultural SensitivityDevelop Cultural Sensitivity

Be exposed to different Be exposed to different people of different ethnic people of different ethnic backgroundsbackgrounds

Ethnicity:Ethnicity: Impact on health Impact on health

beliefs of clients and beliefs of clients and nursing practicenursing practice

Ifeyinwa UtohIfeyinwa Utoh

What is Ethnicity?What is Ethnicity? Ethnicity and culture are sometimes Ethnicity and culture are sometimes used interchangeably but in the main used interchangeably but in the main perspective, they are different. perspective, they are different. Ethnicity is a social construction that Ethnicity is a social construction that indicates identification with a particular indicates identification with a particular group which is often descended from group which is often descended from common ancestors. Its members share common ancestors. Its members share common cultural traits.common cultural traits. For example : They share the same For example : They share the same language, religion and dress and they language, religion and dress and they are an identifiable minority within the are an identifiable minority within the larger nation.larger nation.

EthnicityEthnicity::Impact on HealthcareImpact on Healthcare

Nursing practice has expanded Nursing practice has expanded even more and thereby even more and thereby embracing all varieties of people embracing all varieties of people in order to give care.in order to give care.

Nurses need to understand the Nurses need to understand the impact of ethnicity as it relates impact of ethnicity as it relates to an individual.to an individual.

EthnicityEthnicity::Impact on HealthcareImpact on Healthcare

The diversity of ethnicity has made The diversity of ethnicity has made it possible that even when patients it possible that even when patients are told to fill out the admission are told to fill out the admission forms, there is a portion where forms, there is a portion where one’s ethnic group is required. one’s ethnic group is required. Most times it is necessary to fill it Most times it is necessary to fill it out, in order to know how to better out, in order to know how to better treat the patient.treat the patient.

Religion:Religion: Impact on health Impact on health

beliefs of clients and beliefs of clients and nursing practicenursing practice

Norman IlaganNorman Ilagan

Importance of Importance of ReligionReligion

Influence attitudes, Influence attitudes, lifestyle, and lifestyle, and feelings about life, feelings about life, pain and deathpain and death

Help people live Help people live fuller lives and fuller lives and console or console or strengthen people strengthen people during suffering and during suffering and in preparation for in preparation for deathdeath

Types of ReligionsTypes of Religions According to According to

Rosdahl, “in Rosdahl, “in the United the United States, 35,000 States, 35,000 churches with churches with 1,500 different 1,500 different identified identified sects exist”sects exist”

Religion:Religion:Impact on Nursing PracticeImpact on Nursing Practice

Learn about major Learn about major religious differencesreligious differences

Respect their Respect their confidencesconfidences

Maintain a Maintain a nonjudgmental nonjudgmental attitudeattitude

Consider your Consider your personal values when personal values when seeking a nursing seeking a nursing positionposition

Socialization:Socialization: Impact on health Impact on health

beliefs of clients and beliefs of clients and nursing practicenursing practice

Marie JimenezMarie Jimenez

Socialization & Socialization & NursingNursing

Nursing is a profession Nursing is a profession where socialization is where socialization is a part of everyday a part of everyday nursing care nursing care

Professional Professional socialization and it’s socialization and it’s effect on nursingeffect on nursing

Socialization and its Socialization and its impact on the delivery impact on the delivery of nursing care for the of nursing care for the client client

Nursing ShortageNursing Shortage Current trend in nursingCurrent trend in nursing Causes of nursing shortageCauses of nursing shortage How quality patient care is affected How quality patient care is affected

in relation to time and safetyin relation to time and safety

Public Image of Public Image of NursingNursing

Unique professionUnique profession ““Lost” identity of Lost” identity of

nursingnursing Recent “movement Recent “movement

toward reestablishing toward reestablishing identifiable dress identifiable dress norms for norms for professional nurses” professional nurses” (Professional Nursing (Professional Nursing Concepts, 2007, p. Concepts, 2007, p. 49)49)

““How do you look?” How do you look?” handout/articlehandout/article

Problem Areas related Problem Areas related to Cultural to Cultural

Competency in Competency in Nursing PracticeNursing Practice

Eva CoxEva Cox

Problems in Problems in Communicating and Communicating and

Working Across CulturesWorking Across Cultures Language BarrierLanguage Barrier AgeAge AttentionAttention GenderGender Prejudice, stereotyping, and Prejudice, stereotyping, and

ethnocentrismethnocentrism

The Use of a The Use of a Professional Professional InterpreterInterpreter

Should know and understand Should know and understand medical terminologymedical terminology

Should know the formal slang, and Should know the formal slang, and conversational levels of the language conversational levels of the language that he/she is interpretingthat he/she is interpreting

Should be able to communicate Should be able to communicate without inferring judgment, bias, or without inferring judgment, bias, or personal opinionspersonal opinions

Therapeutic Therapeutic Communication Communication

TechniquesTechniques

Nonverbal TechniqueNonverbal Technique Use of SilenceUse of Silence ClarificationClarification ReflectionReflection

Solutions to Language Solutions to Language BarriersBarriers

Learn a second language, especially one Learn a second language, especially one that is spoken by a large ethnic that is spoken by a large ethnic population serviced by the healthcare population serviced by the healthcare agency. agency. Ex: Elmhurst Hospital - the nurse could Ex: Elmhurst Hospital - the nurse could learn Spanishlearn Spanish

Construct a loose-leaf folder or file cards Construct a loose-leaf folder or file cards with words in one or more languages with words in one or more languages spoken by clients in the communityspoken by clients in the community

Look at the client, not at the translator Look at the client, not at the translator when asking questions, and listening to when asking questions, and listening to the client’s responsethe client’s response

When English is a When English is a Second Language, the Second Language, the

nurse can…nurse can… Determine if the client can speak or Determine if the client can speak or

read Englishread English Speak slowly not loudly, using simple Speak slowly not loudly, using simple

words and short sentenceswords and short sentences Avoid using technical terms, slang or Avoid using technical terms, slang or

phrases with a double or colloquial phrases with a double or colloquial meaning like “do you have to use the meaning like “do you have to use the john?”john?”

Ask simple questions that can be Ask simple questions that can be answered by a “yes” or “no”answered by a “yes” or “no”

Legislations & Legislations & Resolutions Related Resolutions Related to Issues on Cultural to Issues on Cultural

CompetencyCompetency

Crispo AlvarCrispo Alvar

DefinitionDefinition

• Cultural competencyCultural competency - - a set a set of congruent behaviors, of congruent behaviors, attitudes, and policies that attitudes, and policies that comes together in a system, comes together in a system, agency, or among agency, or among professionals that enables professionals that enables effective work in cross-effective work in cross-cultural situations.cultural situations.

What makes culturally What makes culturally competent competent

healthcare imperative in the US?healthcare imperative in the US?• The presence and interests of The presence and interests of

different cultural constituencies different cultural constituencies have made provision of culturally have made provision of culturally competent health care imperative.competent health care imperative.

• many minority cultural groups have many minority cultural groups have already experienced a already experienced a disproportionate burden of health disproportionate burden of health care disparities e.g. access to care disparities e.g. access to health care, and the quality of care.health care, and the quality of care.

What is the status of cultural What is the status of cultural competency in the US?competency in the US?

• Surgeon General Report of 2005, stated Surgeon General Report of 2005, stated that the U.S. healthcare profession is still that the U.S. healthcare profession is still considered so unprepared to provide considered so unprepared to provide culturally competent care to our highly culturally competent care to our highly diversified population.diversified population.

• Because LPN’s also provides direct health Because LPN’s also provides direct health care to culturally diverse client populations care to culturally diverse client populations in various settings, we as Student of in various settings, we as Student of Practical Nursing (SPN) owe to be educated Practical Nursing (SPN) owe to be educated and be provided with the initial knowledge and be provided with the initial knowledge about Cultural Competency. Hence this about Cultural Competency. Hence this research paper presentation.research paper presentation.

Legislations and Resolutions Legislations and Resolutions Related to Issues on Cultural Related to Issues on Cultural

CompetencyCompetency Policymakers Policymakers – uses this to draft – uses this to draft

consistent and comprehensive laws, consistent and comprehensive laws, regulations, and contract languageregulations, and contract language

Accreditation and credentialing Accreditation and credentialing agenciesagencies – uses this as guidelines in – uses this as guidelines in assessing and comparing providers assessing and comparing providers who offer culturally competent services who offer culturally competent services and assurance to maintain quality of and assurance to maintain quality of service for diverse populationsservice for diverse populations

OrganizationsOrganizations – These are used to – These are used to serve guidelines and make it a bases serve guidelines and make it a bases for performance assessment and for performance assessment and evaluation –evaluation –

The fourteen (14) established The fourteen (14) established standardsstandards

1.1. Standards 1-3 address culturally Standards 1-3 address culturally competent carecompetent care

Standard 1. Ensure that patients/consumers Standard 1. Ensure that patients/consumers receive from all staff member effective, receive from all staff member effective, understandable, and respectful care understandable, and respectful care provided in a manner compatible with their provided in a manner compatible with their cultural health beliefs and practices and cultural health beliefs and practices and preferred language.preferred language.

Standard 2. Implement strategies to recruit, Standard 2. Implement strategies to recruit, retain, and promote at all levels of the retain, and promote at all levels of the organization a diverse staff and leadership organization a diverse staff and leadership that are representative of the demographic that are representative of the demographic characteristics of the service area.characteristics of the service area.

Standard 3. Ensure that staff at all levels and Standard 3. Ensure that staff at all levels and across all disciplines receive ongoing across all disciplines receive ongoing education and training in culturally and education and training in culturally and linguistically appropriate service delivery.linguistically appropriate service delivery.

The fourteen (14) established The fourteen (14) established standardsstandards

2. 2. Standards 4-7 address language Standards 4-7 address language competency competency ––

• These standards provide that every health These standards provide that every health care organization offers and provides care organization offers and provides appropriate language assistance services; appropriate language assistance services; put in place appropriate oral and written put in place appropriate oral and written notices of patients right to receive language notices of patients right to receive language assistance; involve only qualified interpreters assistance; involve only qualified interpreters and encouragement of bilingual staffs; and and encouragement of bilingual staffs; and make available easily understood patient-make available easily understood patient-related materials or post signage in related materials or post signage in languages of the commonly encountered languages of the commonly encountered groups.groups.

The fourteen (14) established The fourteen (14) established standardsstandards

3. 3. Standards 8-14 address organizational Standards 8-14 address organizational support for cultural competencesupport for cultural competence – –

• These standards require that health care These standards require that health care organization effect a written strategic plan organization effect a written strategic plan with the end in mind of providing clients with the end in mind of providing clients culturally and linguistically appropriate culturally and linguistically appropriate services; conduct ongoing organizational self-services; conduct ongoing organizational self-assessment about CLAS-related activities; assessment about CLAS-related activities; ensure that individual culturally relevant ensure that individual culturally relevant information are in place on health records; information are in place on health records; maintain cultural profile and develop maintain cultural profile and develop collaborative partnership with communities; collaborative partnership with communities; provision of culturally and linguistically provision of culturally and linguistically sensitive conflict and grievances resolution sensitive conflict and grievances resolution proceedings; and lastly, the encouragement to proceedings; and lastly, the encouragement to make readily available culturally relevant make readily available culturally relevant information to the public.information to the public.

Title VI of the 1964 Civil Rights Act Title VI of the 1964 Civil Rights Act ––

Implies that services provided with funding Implies that services provided with funding from the federal government must be delivered from the federal government must be delivered without regard to race, color, or national origin without regard to race, color, or national origin (HHS 2003). (HHS 2003).

To satisfy Title VI, a program, service or To satisfy Title VI, a program, service or agency must therefore provide "meaningful agency must therefore provide "meaningful access" at no cost to the LEP individual. – to access" at no cost to the LEP individual. – to include hospitals, managed care organizations, include hospitals, managed care organizations, state and local welfare agencies, physicians, state and local welfare agencies, physicians, and research programs— e.g. and research programs— e.g. including providers of services funded through including providers of services funded through Medicaid, Temporary Assistance for Needy Medicaid, Temporary Assistance for Needy Families (TANF), the State Children's Health Families (TANF), the State Children's Health Insurance Program (SCHIP), Head Start, and Insurance Program (SCHIP), Head Start, and other programs for families and youth.other programs for families and youth.

The Nurse’s Role in The Nurse’s Role in Developing Cultural Developing Cultural

CompetencyCompetency

Zoya PoltilovZoya Poltilov

Cultural CompetencyCultural Competency ““A set of academic and personal A set of academic and personal

skills that allow us to increase our skills that allow us to increase our understanding and appreciation of understanding and appreciation of cultural differences between cultural differences between groups“groups“

Becoming culturally competent is a Becoming culturally competent is a developmental process and we will developmental process and we will experience it throughout the whole experience it throughout the whole nursing experiencenursing experience

The Cultural The Cultural AssessmentAssessment

The cultural assessment is a tool The cultural assessment is a tool to help nurses understand where to help nurses understand where patients derive their ideas about patients derive their ideas about disease and illnessdisease and illness

Cultural Assessments help to Cultural Assessments help to determine beliefs, values and determine beliefs, values and practices that might have an practices that might have an effect on patient care and health effect on patient care and health behaviorsbehaviors

The Cultural The Cultural AssessmentAssessment Level of ethnic Level of ethnic

identity identity Language and Language and

communication communication process process

Migration experience Migration experience Self concept and self Self concept and self

esteem esteem Influence of Influence of

religion/spirituality on religion/spirituality on the belief system and the belief system and behavior patterns behavior patterns

Habits, customs, Habits, customs, beliefsbeliefs

Views and concerns Views and concerns about discrimination about discrimination and institutional and institutional racism racism

Educational level Educational level and employment and employment experiences experiences

Importance and Importance and impact associated impact associated with physical with physical characteristics characteristics

Current Current socioeconomic socioeconomic status.status.

Cultural health Cultural health beliefs and beliefs and practicespractices

The Nurse’s RoleThe Nurse’s Role It is impossible to know every cultural It is impossible to know every cultural

variation of the people for whom variation of the people for whom nurses provide care, but the best way nurses provide care, but the best way is to involve your patient and the is to involve your patient and the family in determining the plan of care family in determining the plan of care and to find an alternative that will be and to find an alternative that will be acceptable for that culture acceptable for that culture

All of these will help us in developing All of these will help us in developing cultural competency in the clinical areacultural competency in the clinical area

Summary & Summary & ConclusionConclusion

Crispo AlvarCrispo Alvar

Eva CoxEva Cox

Norman IlaganNorman Ilagan

Marie JimenezMarie Jimenez

Zoya PoltilovZoya Poltilov

Ifeyinwa UtohIfeyinwa Utoh

Tsering YanchenTsering Yanchen