Health Disparities and Culturally Competent Care

Health Disparities and Culturally Competent Care 150 150 Tony Guo

Health Disparities and Culturally Competent Care

 

Determinants of Health

  • This are factors that influence the health of an individual or groups and help explain why some people experience poorer health than others

Health Status

  • Health of a person or a community
    • Individual- sum of their current health problem plus their coping resources like family and financial resources.
    • Community- Includes birth and death rates, life expectancy, access to care, and morbidity and mortality rates related to disease and injuries respectively

 

Health Disparities and Health Equity

  • Factors and conditions leading to health disparities
    • Ethnicity and race
      • Conditions are subjective
      • Clients are asked to identify their own ethnicity and race for the purpose of health data collection
      • Collection of health data based on self-reported ethnic and race categories is important for research, to inform policy, and to understand and eliminate disparities.
    • Place
      • Where a person is born, grows, lives, works, and ages
      • This affects the use of health services, health status, and health behaviors.
    • Income, education, or occupation
      • People of lower income, education, or occupational status experience worse health, and die at a younger age than those who are more affluent.
      • Patients who lack knowledge are at risk.
    • Health literacy
      • Degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
    • Gender & Age
      • Adult women use health care services more than men like women may not receive the same quality of care
      • Older adults are at risk for experiencing health disparities in the number of diagnostic tests performed and aggressiveness of treatments use
    • Sexual orientation
      • Main concern is LGBT
    • Health care provider attitudes
      • Stereotyping
      • Prejudice
      • Discrimination
      • Bias

 

Culture

  • Knowledge, values, beliefs, art, morals, law, customs, and habits
  • Culture is a way of life for a group of people
  • Family roles and relationships differ from one culture to another
  • Cultural characteristics of different ethnic groups:
    • European American
  • Equal rights of gender
  • Materialistic
  • Independence and freedom
  • Self-reliance valued
  • Individualistic and competitive
  • Youth and beauty valued

 

  • Native American
  • Doing the honorable thing
  • Folk healing
  • Respect for tribal elders and children
  • Spiritual guidance
  • Living in harmony with people and nature
  • Returning what is taken from nature

 

  • African American
  • Cultural foods
  • Importance of religion 
  • Family network
  • Folk healing
  • Interdependence within ethnic group
  • Music and physical activities valued

 

  • Hispanic/Latino
  • Cultural foods 
  • Folk healing
  • Extended family valued
  • Religion and spiritual highly valued
  • Interdependence and collectivism
  • Respect for elders and authority 
  • Involvement of family in social activities

 

  • Asian America
  • Cultural foods 
  • Harmonious relationships
  • Family loyalty
  • Respect for elders
  • Folk healing
  • Harmony and balance within body vital for preservation of life energy
  • Respect for one’s parents and ancestors

 

  • Pacific Islander American
  • Collective concerns and involvement
  • Natural order and balanced relationship
  • Kinship alliance among nuclear and extended family
  • Collective concerns and involvement
  • Knowledge is collective; belongs to groups, not individual

 

Acculturation

  • Lifelong process of incorporating cultural aspects of the contexts in which a person grows, lives, works, and ages

 

Cultural Competence

  • Ability to understand, appreciate,  and work with individuals from cultures other than your own
  • Four components
    • Cultural awareness
      • Involves self-awareness for the nurse, examining personal attitudes related to various aspects of culture, to identify possible bias
      • Identify your own cultural background, values, and beliefs, especially as related to health and health care.
    • Cultural knowledge
      • Process of learning key aspects of a group’s culture, especially as it relates to health and health care practices
      • Learn basic general information about predominant cultural groups in your geographic area.
      • Assess patients for presence or absence of cultural traits based on an understanding of generalizations about a cultural group.
      • Do not make assumptions based on cultural background because the degree of acculturation varies among individuals.
    • Cultural skill
      • Ability to collect relevant cultural data
      • Be alert for unexpected responses with patients, especially as related to cultural issues.
    • Cultural encounter
      • Direct cross-cultural interactions between people from culturally diverse backgrounds
      • Create opportunities to interact with predominant cultural groups.

 

Cultural Factors Affecting Health and Health Care

  1. Folk healers and traditions
    • Folk medicine and traditions (cultural home remedies or treatment practices) are forms of prevention and treatment that are culturally based and traditionally rely on oral transmission of healing techniques from one generation to the next
  2. Spirituality and religion
    • Relates to the soul or spirit more than to the body, and it may provide hope and strength or an individual during an illness.
    • Religion is based on beliefs about life, death, good, and evil
  3. Cross-cultural communication
    • Verbal
    • Nonverbal
      • gestures, body movements, posture, facial expressions, and personal dress in some cultures
    • Silence
      • It is important to understand the meaning of silence for different cultural groups
  4. Family Roles and Relationships
    • Family roles differ from one culture to another
    • It is important for the nurse to determine who should be involved in communication and decision making related to health care
    • Some cultural differences relate to expectations of family members in providing care. In some cultures, family members expect to provide care for the patient even in the hospital.
  5. Touch
    • Physical contact with patients conveys various meanings depending on the culture
  6. Food and nutrition
    • An important part of cultural practices is food, including both the foods that are eaten and rituals and practices associated with food. Muslims fast during the daytime during the Islamic month of Ramadan, and this may affect when and how medications are taken.
    • Patients may be asked to make major changes in their diets because of health problems, or alternatively food may be used to cope with life changes such as homesickness.
  7. Immigrants
    • Migration is driven by a number of conditions, such as overcrowding, natural disasters, geopolitical conflict, persecution, and economic forces. These reasons has led to a rich diversity of cultures exists in many communities and countries today

 

Reducing Health Disparities and Increasing Cultural Competency

  • Nurse’s self-assessment
    • The first step in reducing health disparities and providing culturally competent care is for a nurse to assess their own cultural background, values, and beliefs, especially those that are related to health and health care.
  • Patient assessment
    • Assess patients for their risk for reduced health care services because of limited access,  inadequate resources, age, or low health literacy
  • Nursing Implementation
    • Advocacy
    • Community advisory group
    • Standardized guidelines
      • Evidence- based care guidelines can reduce disparities in diagnosis and treatments.
    • Communication
      • Use AIDET
A Acknowledge Increase safety
I Introduce Increase trust
D Duration Decrease anxiety
E Explanation Increase compliance
T Thank you Increase loyalty

 

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