Unit 11 Cultural Competency and Social Issues in Nursing and Health Care PDF

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Unit 11: Cultural Competency and Social Issues in Nursing and Health Care Textbook------Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care

Key Terms: ● Acculturation: The process of becoming adapted to a new or different culture. ● Assimilation: The cultural absorption of a minority group into the main cultural body. ● Biculturalism: Combining two distinct cultures in a single region. ● Cultural humility: Incorporates a lifelong commitment to self-evaluation and selfcritique, to redressing the power imbalances in the patient-clinician dynamic, and to developing mutually beneficial and advocacy partnerships with communities on behalf of individuals and defined populations. ● Cultural sensitivity: Experienced when neutral language, both verbal and nonverbal, is used in a way that reflects sensitivity and appreciation for the diversity of another. ● Culture: Shared values, beliefs, and practices of a particular group of people that are transmitted from one generation to the next and are identified as patterns that guide thinking and action. ● Enculturation: Adaptation to the prevailing cultural patterns in society. ● Ethnicity: Affiliation resulting from a shared linguistic, racial, or cultural background. ● Ethnocentrism: Believing that one’s own ethnic group, culture, or nation is best. ● Marginalized population: A subgroup of the population that tends to be hidden, overlooked, or on the outer edge. ● Minority: An ethnic group smaller than the majority group. ● Prejudice: Preconceived, deeply held, usually negative, judgment formed about other groups. ● Stereotyping: Assigning certain beliefs and behaviors to groups without recognizing individuality. ● Transculturalism: Being grounded in one’s own culture, but having the skills to be able to work in a multicultural environment. ● Worldview: Perspective shared by a cultural group of general views of relationships within the universe. These broad views influence health and illness beliefs. Culture ● Shared values, beliefs, and practices of a particular group of people that are transmitted from one generation to the next and are identified as patterns that guide thinking and action. Who Makes Up Our Population? POPULATION TRENDS ● Increasing the number of immigrants ● Minority populations will become the majority population in 2042 ● Growth in the number and proportion of older adults is increasing at an unprecedented rare ● Longer lifespans and aging Baby Boomers ○ By 2030, older adults will account for roughly 20% of the U.S. population. Effects of People Living Longer

Unit 11: Cultural Competency and Social Issues in Nursing and Health Care Textbook------Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care

● Increased opportunity to develop chronic illness ● Social isolation and depression resulting from loss of family and friends ● Primary care providers faced with promoting maximum functional status and identifying risks to health and independence ● Health care providers must guard against issues of ageism, assuming that health issues and levels of cognition are the same for every senior adult. Federally Defined Minority Groups ● Asian American ● Black of African American ● Hispanic or Latino ● Native Hawaiian and other Pacific Islander ● American Indian and Alaska Native ● Grown faster than the population as a whole ● By 2025 minorities will account for more than 55% of the population Health Disparities ● Life expectancy is shorter for African American ○ Racial gap between blacks and whites of 5.6 years ○ Life expectancy ■ Whites: 78 ■ Blacks: 72.7 ● Causes of death for minority groups ○ Cancer ○ Heart disease and stroke ○ Chemical dependency ○ Diabetes ○ Homicides and accidents ○ Infant mortality (twice as high for blacks than whites) Marginalized Populations ● A subgroup of the population that tends to be hidden, overlooked, or on the outer edge ● Lesbian ● Gay ● Bisexual ● Transgender ● Older adults ● Veterans ● Recent immigrants from countries such as Russia, Rwanda, and Afghanistan (their lives and health care needs are often kept secret, and they are often voiceless) ● Less visible than the federally defined minorities ECONOMIC AND SOCIAL CHANGES ● Changing Economics and Downsizing

Unit 11: Cultural Competency and Social Issues in Nursing and Health Care Textbook------Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care

Joblessness Homelessness Poverty Anxiety, hopelessness, depression, and despair commonly affect the individuals in our society who find themselves suddenly without a job and sometimes even without a home as a result of economic downsizing. ■ These conditions are often associated with increased stress-related symptoms, substance abuse, violence, and crime. ○ Limited access to health care insurance and health care ■ High cost of insurance and lower wages make it difficult for minority groups to rise out of poverty and access health care ○ Dramatic changes in technology and specialization in the care field have made health care costs skyrocket. ■ Higher costs and lower wages for minority groups ○ More minorities lack health care and live in higher percentage poverty ○ ○ ○ ○

Poverty ● Most families with racially or ethnically diverse backgrounds have a lower socioeconomic status than does the population at large. ● Blacks, Hispanics, and American Indians have much higher rates of poverty than nonHispanic whites and Asians. ● The poor suffer more than the population as a whole for nearly every measure of health. ● Approximately 30.7% of Hispanic persons have the highest uninsured rates of any racial or ethnic group within the United States. ● For blacks, the percentage of uninsured in 2010 was 20.8%. ● Minority members of society often live in poverty. ○ Social inequality ○ Residential segregation ○ Substandard housing ○ Unemployment ○ Poor physical and mental health ○ Poor self-image ● The United States has a history of providing the highest quality health care to those with the highest socioeconomic status. ● Social, economic, and health problems have led to heated debates about the philosophy, scope and costs, and sources of funding for health care and insurance programs. VIOLENCE ● Changing economic and social conditions have contributed to the increasing level of violence in our society. ● Businesses, churches, and schools have become sites for random acts of violence ● Unemployment is associated with violence ○ It is an expectation in our society that people should be productive and gainfully employed.

Unit 11: Cultural Competency and Social Issues in Nursing and Health Care Textbook------Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care

● Homicide is the second leading cause of death among Americans 15-24 years of age ○ Leading cause of death in Black males 15-34 years of age ● Although the increasing incidence of violence affects all segments of society, women, children, older adults, and culturally vulnerable groups are especially at risk. ● Unemployment rates are consistently high among young minority men. ○ Highest rate of violence ■ Homicide is a major problem for young black males. ■ The differing rates of violence among races are more likely a result of poverty than race. ● Intimate Partner Violence (IPV) ○ Formerly known as domestic violence ○ Greatest cause of injury in women 15-24 years of age, across all ethnic, racial, socioeconomic, and educational groups ○ Includes ■ Battering ■ Physical injury ■ Psychological abuse ■ Sexual assault ● Societal changes have increased the tension between the empowered culturally dominant groups and the less visible vulnerable groups. ○ Has major implications for health care delivery and the education of nurses and other health care professionals ATTITUDES TOWARD CULTURALLY DIVERSE GROUPS

● Hate: Extreme negative manifestation of prejudice; has many violent and nonviolent forms. ● Contempt: Somewhat less intense, but is problematic because it is so widespread and undermines many aspects of society. ● Tolerance: Reflects a more neutral attitude that accepts differences without attempting to convert them; the minimal-level attitude essential in democratic societies. ● Respect: Manifested in behaviors that integrate differences into positive interactions and relationships; a demonstration of the inherent worth of the individual, regardless of differences. ● Celebration (Affirmation): Positive merits of cultural differences the value added to life experiences by multiple perspectives, traditions, rituals, foods, and art forms. ● Prejudice: Preconceived, deeply held, usually negative, judgment formed about other

Unit 11: Cultural Competency and Social Issues in Nursing and Health Care Textbook------Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care

groups. ● The combination of ignorance of other cultures and arrogance of one’s own culture fosters disrespect and hate. ● The deliberate attempt to discover and apply the positive benefits of cultural variation promotes respect and a celebration of the value of diversity, whereas perpetuating prejudice fosters narrow-mindedness and contempt. Critical Thinking Question Barriers to mainstream health care include lack of transportation and disrespectful treatment for a group of economically deprived, underserved Russian immigrants living in a remote area accessible only by water transportation. A mobile clinic provides blood pressure screening, minor first aid, and blood glucose checks. This group of individuals is best described as: A. marginalized B. stereotyped C. enculturated D. assimilated Rationale: A is correct because groups of marginalized individuals have limited access to health care or services that are considered essential by society. This group may be bitter or may lack the capacity to help themselves. In some countries, the caste system supports marginalization. B is incorrect because stereotyping refers to preconceived ideas or the assignment of certain beliefs and behaviors to ethnic or religious groups without recognition of individuality. C is incorrect because enculturated describes the adaptation of an individual, often from a minority group, to the prevailing cultural patterns in society. D is incorrect because assimilation is the cultural absorption of a minority group into the main cultural body. Level of Difficulty: Application CULTURAL COMPETENCE Standards of Practice for Culturally Competent Nursing Care (Table 10-1) 1. Social Justice 2. Critical reflection 3. Knowledge of cultures 4. Culturally competent practice 5. Cultural competence in health care systems and organizations 6. Patient advocacy and empowerment 7. Multicultural workforce 8. Education and training in culturally competent care 9. Cross-cultural communication 10. Cross-cultural leadership 11. Policy development 12. Evidence-based practice and research ● Recipient of the nursing care: an individual, a family, a community, or a population ● Can serve as a guide and resource by emphasizing cultural competence as a priority ● Lenburg and Colleagues’ Suggestions:

Unit 11: Cultural Competency and Social Issues in Nursing and Health Care Textbook------Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care

○ Be sensitive to and show respect for the differences in beliefs and values of others. ○ Take responsibility to inquire, learn about, and integrate beliefs and values of others in professional encounters. ○ Take responsibility to try to change negative and prejudicial behaviors in themselves and others. Reasons for Cultural Competence ● Nurse’s culture often differs from client’s ● Culturally incompetent care is more costly ● Culturally incompetent care is ineffective ● Meet specific objectives for persons in different cultures as outlined by Healthy People 2020 ● Disparities in health and health care ● Nursing is committed to social justice ● Global infectious disease epidemics ● May take a lifetime to attain; however, we can all aspire to achieve cultural humility, which incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-clinician dynamic, and to developing mutually beneficial and advocacy partnerships with communities on behalf of individuals and defined populations. ○ If we acquire cultural humility we should also demonstrate cultural sensitivity that shows appreciation of the diversity of others. CULTURAL COMPETENCE IN NURSING EDUCATION ● Mandatory for accreditation by AACN ● RWJF new careers in nursing scholarship program ● Minority Nurse Faculty Scholars Program ● Doctoral Advancement in Nursing (DAN) project ● Nursing Workforce Diversity Grants ○ Disparities in health and health care ○ Nursing is committed to social justice ○ Global infectious disease epidemics ● Mandatory for accreditation ● RWJF new careers in nursing scholarship program ● Minority Nurse Faculty Scholars Program ● Doctoral Advancement in Nursing (DAN) project ● Nursing Workforce Diversity Grants ● AACN The Essentials of Baccalaureate Education for Professional Nursing Practice Cultural Competencies: mandates the inclusion of culturally diverse nursing care concepts in the curriculum with attention to cultural, spiritual,ethnic, gender, and sexual orientation diversity ○ Apply knowledge of social and cultural factors that affect nursing and health care

Unit 11: Cultural Competency and Social Issues in Nursing and Health Care Textbook------Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care

across multiple contexts ○ Use relevant data sources and best evidence in providing culturally competent care ○ Promote achievement of safe and quality outcomes of care for diverse populations ○ Advocate for social justice ○ Participate in continuous cultural competence development ● The AACN, in collaboration with leading foundations and stakeholders, has taken the following steps to enhance diversity in nursing education: ○ (April 2008) Joined with the RWJF to launch the RWJF New Careers in Nursing Scholarship Program ■ Designed to alleviate the nation’s nursing shortage by dramatically expanding the pipeline of students from minority backgrounds in accelerated nursing programs ■ Scholarships are awarded to entry-level nursing students with preference given to students from groups underrepresented in nursing or from a disadvantaged background. ○ (2007) The AACN and the Johnson & Johnson Campaign for Nursing’s Future launched the Minority Nurse Faculty Scholars Program. ■ Features mentorship and leadership development components to ensure successful completion of graduate studies and preparation for a faculty role ○ (2013) AACN and the RWJF initiated the Doctoral Advancement in Nursing (DAN) Project ■ To enhance the number of minority nurses completing PhD and DNP degrees ■ Developed a white paper featuring student recruitment and retention strategies that can be used by schools of nursing; comprehensive approaches to leadership and scholarship development for students; suggestions for model doctoral curriculum; and more ○ (April 2008) Joined with the RWJF to launch funding for Nursing Workforce Development Programs, including funding for Nursing Workforce Diversity Grants ■ Provides funding for projects to increase nursing education opportunities for individuals from disadvantaged backgrounds, including racial and ethnic minorities underrepresented among registered nurses CULTURAL BELIEF SYSTEMS ● There is a tendency for people to be “culture bound” (i.e., to assume that their own values are superior, sensible, or right to that of others). ● Cross-cultural health promotion requires the nurse to work with clients without making judgment as to the superiority of one set of values over another. ● Each culture has a value system that dictates behavior directly or indirectly by setting norms and teaching that those norms are right. ● Health beliefs and practices tend to reflect a culture’s value system.

Unit 11: Cultural Competency and Social Issues in Nursing and Health Care Textbook------Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care

● Nurses must understand the patient’s value system to foster health promotion.

Box 10-1: Anglo-American and Other Cultural Values Anglo-American ● ● ● ● ● ● ● ● ● ● ● ● ●

Personal control over the environment Change Time dominates Human equality Individualism, privacy Self-help Competition Future orientation “Action-goal” work orientation Informality Directness, openness, honesty Practicality, efficiency Materialism

Other Cultural Values ● Fate ● ● ● ● ● ● ● ● ● ● ● ●

Tradition Human interaction dominates Hierarchy, rank, status Group welfare Birthright inheritance Cooperation Past orientation “Being” orientation Formality Indirectness, ritual, “face” Idealism, theory Spiritualism, detachment

CULTURAL PHENOMENA ● Vary among cultural groups and affect health care ● Environmental control ● Biologic variations ● Social organization ● Communication ● Space ● Time orientation Environmental Control ● The ability of members of a particular culture to control nature or environmental factors’ ● People who perceive that they have mastery over nature believe that they can overcome the natural forces of nature. ○ Would expect positive results from medication, surgery, and other treatment modalities ● People believe that whatever happens to them is apart of their destiny. ○ Blacks and Mexicans mostly subscribe this view. ○ May not be compliant with treatments ● People who hold the harmony with nature view, such as Asians and American Indians, believe that illness represents a disharmony with nature.

Unit 11: Cultural Competency and Social Issues in Nursing and Health Care Textbook------Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care

○ More likely to rely on naturalistic remedies, such as herbs or hot and cold treatments, to affect a cure ○ Traditional health and illness beliefs ○ The practice of folk medicine ○ The use of traditional and nontraditional healers ● Environmental control plays an important role in the way the clients respond to healthrelated experiences and use health resources. Biological Variations ● Body build and structure ● Genetic variations ● Skin Characteristics ● Susceptibility to disease ● Nutritional variations ● Ex: Babies who are born in Western culture weigh more than non-Western babies. ● Skin color ● Eye shape ● Hair texture ● Adipose tissue deposits ● Shape of earlobes ● Body configuration ○ Ex: Blacks have denser bones than whites, which may account for the low incidence of osteoporosis in the black population. ● The size of teeth varies among cultures, with whites having the smallest, followed by blacks, Asians, and American Indians. ○ Larger teeth can cause protruding jaws, a condition common in blacks, which does not represent an orthodontic problem. ● Laboratory Values ○ Serum cholesterol levels essentially are the same for blacks and whites at birth. During childhood, the levels are higher in blacks, but lower than whites in adulthood. ■ High morbidity and mortality from cardiovascular disease in blacks. ● The maternal mortality rate of blacks is three times that of whites. ● Occurrence of stomach cancer is twice as high among black men as white men. ● Occurrence of esophageal cancer is three times more common among blacks than the general population. ● Japanese Americans have a lower incidence of cardiovascular and renal disease than the general population, but a higher incidence of stress-related diseases, such as ulcers, colitis, psoriasis, and depression. ● American Indians have a higher incidence of streptococcal sore throat and gastroenteritis than the general population. ● American Indian women have the highest incidence of diabetes. ● Mexican Americans have higher rates of obesity and diabetes than the general population.

Unit 11: Cultural Competency and Social Issues in Nursing and Health Care Textbook------Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care