Ramont and Niedringhaus, Comprehensive Nursing Care

a. Defined as knowing about the similarities and differences among cultures. Goal was to end prejudice and discrimination b. Awareness often focused on differences without providing tools to meet client needs 2. Cultural sensitivity is defined as being aware of the needs and feelings of your own culture and of other cultures. 3. Cultural competence arose in the 1990s, which is a set of practice skills, knowledge, and attitudes that encompasses the following elements a. Awareness and acceptance of differences b. Awareness of ones own cultural values c. Understanding of the dynamics of differences d. Development of cultural knowledge e. Ability to adapt practice skills to fit the cultural context of the client 4. Development of transcultural nursing a. Study of transcultural nursing began in the 1950s by Dr. Madeleine Leninger. i. Noted differences in culture among clients and nurses ii. Realized health and illness are influenced by culture iii. Encouraged a broader awareness of cultural issues and led to study of culture within nursing curriculum b. Nurses need to be prepared to meet holistic needs of clients, including culture c. Ethnocentrisminterpreting beliefs and behaviors of others in terms of ones own cultural values i. Assumes ones own culture is superior ii. Difficult to avoid these tendencies d. Nurses must avoid stereotypes (oversimplified conceptions, opinions, or beliefs about some aspect of a group of people) e. Individuals vary greatly within any ethnic group f. Nurses care for each client as a unique person regardless of ethnicity or category Learning Outcome 2 Define terminology of transcultural nursing. Concepts for Lecture Discussed throughout chaptersee Key Terms above. Learning Outcome 3 Describe the 12 domains of culture. Concepts for Lecture 1. Nursing theories are based on four concepts a. Nursing b. Person/client c. Health d. Environment 2. Leningers theory a. Only theory focused on transcultural nursing with a cultural care focus b. Sunrise model represented in Figure 3-1 (p. 29) c. Can be used with individuals, families, groups, communities, and institutions d. Becomes more important in our global society e. Nurses must view client without prejudice (prejudgment or bias based on characteristics such as race, age, or gender) 3. Dorothea Orems theory of self-care deficits must be considered in light of the clients culture 4. Larry Purnell and B. J. Paulanka developed a model for cultural competence that describes 12 domains of culture a. Assessment tool identifies ethnocultural attributes of an individual, family, or group b. Box 3-3 provides information about domains, which include i. Overview, inhabited localities, and topography ii. Communication iii. Family roles and organization iv. Workforce issues v. Biocultural ecology vi. High-risk behavior vii. Nutrition viii. Pregnancy and childbearing practices ix. Death rituals x. Spirituality xi. Healthcare practices xii. Healthcare practitioners 5. Segregation and discrimination a. Segregation is the physical separation of housing and services based on race b. Discrimination is unfair and unequal treatment or access to services based on race, culture, or other bias c. Inequalities based on lack of access to equal health care d. The nurse must guard against unequal treatment related to gender, sexual orientation, or legal status Learning Outcome 4 Identify the effect of healthcare disparities among members of various cultural groups. Concepts for Lecture 1. Institute of Medicines Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care defined disparities in health care as racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of interventions. 2. Discrimination refers to differences in care that result from bias, prejudice, stereotyping, and uncertainty in clinical communication and decision making. 3. Studies demonstrate lower quality of health services and less likely to receive even routine medical procedures. 4. Racial and ethnic disparities found in a range of health service categories. Sources of disparities include client-level, provider-level, and system-level factors 5. Education may be one of the most important tools to eliminate healthcare disparities Learning Outcome 5 Discuss the role of communication in the delivery of culturally proficient care to hospitalized clients and their families. Concepts for Lecture 1. Intercultural communicationwhen members of two or more cultures exchange messages influenced by different cultural perceptions. 2. Verbal communication. a. What language is used to communicate b. Dialect differences increase difficulty of obtaining accurate information. 3. Nonverbal communication. a. More may be learned from what is not said than from what is said. Cultural variations have big influence on interpretation of nonverbal communication. Nurses can learn ways to identify a particular clients normal behavior b. Cultures differ on what touch they permit and accept. Nurses should ask permission to touch the client, and explain procedures fully before touching client. Personal space must be respected with clients and coworkers. Facial expressions and hand gestures have different meanings within cultures. 4. Transcultural communication and client concerns a. Preventing errors and noncompliancegive clear and specific instructions and evaluate understanding. b. Ensuring informed consent. Avoid using family members for translation as they may lack language skills, may be too emotionally involved, may break HIPAA privacy rules. Many facilities have qualified employees to provide translation c. Reducing client stress and anxiety by providing adequate understanding and communication d. Providing customer satisfaction through good communication Learning Outcome 6 List the components of a cultural assessment. Concepts for Lecture 1. Basic elements of the cultural assessment. a. The cultural identity of the client. b. The cultural factors related to the clients psychosocial environment. c. The cultural elements of the relationship between healthcare provider and client. d. The cultural explanation of the clients illness. 2. Nurse must consider the different cultural domains. Learning Outcome 7 Discuss the subculture of health care, including cultural diversity among nurses. Concepts for Lecture 1. Healthcare profession is a kind of subculture that nurses belong to. Nursing education and training affect their values. Insight into own changes in thinking will improve interactions with clients using empathy and acceptance. a. Healthcare facilities can provide training and policies to encourage culturally proficient care. b. Facilities must regularly assess staff attitudes and take steps to correct those that hamper delivery of culturally proficient care. c. Cultural empathy is the ability to experience as the client experiences rather than how they experience themselves. Express genuine interest in struggles, challenges, and conflicts surrounding clients health-related problems. Nurse has responsibility to help client explore feelings, thoughts, and behaviors. Validate the clients feelings and demonstrate genuine concern. d. Cultural diversity among nurses i. Nursing population now closely resembles population as whole. Nurses must learn how to work with others from different cultures. Nurses may have been educated in a different country. This may lead to issues (a) Speaking a native language in front of other staff members (b) Criticizing an entire group when one member of that group is not performing to standards (c) Having a manager who is biased for or against a particular group when granting requests (d) Care should be taken to discuss issues and learn more about others backgrounds 2. Nursing care a. Nurses have responsibility to deliver culturally proficient care. b. Must first understand their own culture and biases c. Both the nurse and the client are influenced by their cultural identity, ethnic history, values, kinship, and family d. Illness and stress may cause these aspects of a persons life and cultural, religious, and spiritual beliefs to become more pronounced e. Philosophic points of view and moral and ethical perspectives also influence the nurseclient relationship  3. Assessing a. To meet holistic needs of clients, the nurse must complete a holistic assessment. This includes physical, psychosocial, emotional, and spiritual status as well as cultural status. Use of an interpreter may be necessary. b. Pain expression i. Personal experience ii. Perception of pain based on cultural learning, meaning of situation, and factors unique to each individual c. Culturally specific responses i. Cultural response to pain often either stoic or emotive ii. Pain has personal and cultural meaning iii. Cultural background affects pain perception iv. People within cultural groups may differ biologically from those in other groups v. Must consider clients concern for symptoms as much as the actual physical symptoms that are present. People often attribute meaning to their pain. Use of metaphors and rhetorical devices appear to be chosen by client as way of making sense of the pain experience. 4. Diagnosing, planning, and implementing a. Primary responsibility of nurse is to establish an open nurseclient relationship. b. Nurses must present themselves as supportive, effective, competent, and empathetic professionals. c. Nurses must respect the client as an individual, which reduces risk of stereotyping and prejudice. d. Collaboration with the RN or physician on cultural information can be an important function of the LPN/LVN. 5. Evaluating a. Discharge planning is a nursing responsibility. General Chapter Considerations 1. Have students study and learn key terms listed at beginning of chapter. 2. Have students complete end-of-chapter exercises either in their book or on the MyNursingKit website. 3. Use the Classroom Response Questions provided in PowerPoint to assess students prior to lecture. 2012 Education, Inc. 2012 Education, Inc. PowerPoint Slides 2022 Box 3.3 Events in the History of Cultural Care Suggestions for Classroom Activities Provide scenarios helping students to see that cultural sensitivity is awareness of differences, whereas cultural competence involves actions showing consideration for those differences. Then have students relate how the use of transcultural nursing would affect the outcomes of the scenario. Have students research the cultures represented in their community. Then assign each student one of these cultures to research and learn about with particular emphasis on healthcare views. Students can present their findings in class or write a paper on the topic. Suggestion for Clinical Activities Have students relate in postconference the culture of the client they cared for that day and how they altered their care to meet the cultural needs of that client. PowerPoint Slides 2327 Figure 3.1Leiningers Sunrise model, depicting the cultural care diversity and universality theory. Box 3.3 Twelve Domains of Culture Suggestions for Classroom Activities Have students relate their own cultures views of each of the domains of culture. Assign students a culture and have them research the cultures view of each of the 12 domains to present in class. Suggestion for Clinical Activities Have students write a paper on their clients culture and information about each of the 12 domains. PowerPoint Slides 2829 Suggestions for Classroom Activities Discuss the disparities of care that you, the instructor, have seen in your nursing practice and encourage students to problem solve how these disparities can be overcome. Ask students what role they can play in reducing disparities. Invite a guest lecturer from a free clinic in your area to speak with students about meeting the healthcare needs of people in the community and what disparities they have seen in their practice. Suggestion for Clinical Activities In postconference, ask students to relate the types of preventive care their client has received and explore any disparities the students have discovered. PowerPoint Slides 3033 Suggestions for Classroom Activities Have students relate their comfort and beliefs as related to communicationneed for personal space, comfort with touch, primary language spoken, etc. Invite someone from another country to speak with the students about cultural differences they encountered when they first moved to the United States or Canada and how they coped with these differences. Suggestion for Clinical Activities Have students relate how they changed their approach when speaking with their clients from different cultures. Was the change in approach successful What problems did they encounter How did they overcome these issues PowerPoint Slides 3436 Box 3.5 Elements and Questions for a Cultural Assessment Suggestions for Classroom Activities Break students into groups of two, ideally with different cultures represented within the pair. Have students practice performing a cultural assessment on one another. Discuss methods of approaching a cultural assessment and asking sensitive questions without offending the client. Suggestion for Clinical Activities Assign each student to perform a cultural assessment on their client with particular emphasis on each of the 12 domains of culture and write a paper describing their client and how care and communication would need to be altered to respect the clients cultural beliefs. PowerPoint Slides 3749 Box 3.6 Reviewing Your Attitudes Toward Cultural Diversity Box 3.7 Working with Interpreters Box 3.8 Discharge Planning Suggestion for Classroom Activities Ask students to relate what they have observed about the culture of nursing when interacting with nurses caring for them or their instructors. Why do they think nurses behave in this manner What factors may have led to the cultural variations they observe about nurses Suggestion for Clinical Activities Ask students to observe the interaction of nurses on the unit where they are performing their clinical. If possible, have students observe behavior on more than one unit. What commonalities did they find in the behavior of nurses on the unit How did behavior differ among units Why do they think this is MyNursingKit (www.mynursingkit.com) Websites NCLEX questions Case studies Animations and videos Student Workbook and Resource Guide Chapter 3 activities Separate purchase Classroom Response Question PowerPoints Testbank Suggestion for Classroom Activities Have students create a crossword puzzle using the terms related to transcultural nursing. (Note To be assigned to the upper-class students.) u/Ai@u3h0NLVz2O J