Cultural Competence: Background and Benefits

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Cultural Competence: Background and Benefits
HealthStream Regulatory Script
Cultural Competence: Background and Benefits
Version: May 2007
Lesson 1: Introduction
Lesson 2: Cultural Competence
Lesson 3: Clinical and Legal Significance of Cultural Competence
Lesson 4: Theory of Cultural Competence
Lesson 5: Practice of Cultural Competence
Lesson 1: Introduction
1001
Introduction
Welcome to the introductory lesson on the background and
benefits of cultural competence.
IMAGE: 1001.JPG
This lesson provides the course rationale, goals, and outline.
As your partner, HealthStream strives to provide its customers with excellence in
regulatory learning solutions. As new guidelines are continually issued by regulatory
agencies, we work to update courses, as needed, in a timely manner. Since
responsibility for complying with new guidelines remains with your organization,
HealthStream encourages you to routinely check all relevant regulatory agencies
directly for the latest updates for clinical/organizational guidelines.
If you have concerns about any aspect of the safety or quality of patient care in your
organization, be aware that you may report these concerns directly to The Joint
Commission.
Point 1 of 4
2
1002
Course Rationale
The United States is culturally diverse:
• More than 28 million Americans were born outside of the
United States.
• Forty-seven million Americans do not speak English at
home.
• Over 300 different languages are spoken in the United
States.
IMAGE 1002.JPG
Healthcare providers will see patients from many backgrounds.
Learning about how to give culturally competent care will allow you
to:
• Optimize your care for all patients
• Maintain compliance with laws and recommendations
This is the first course in a two-part series on cultural competence.
Point 2 of 4
1003
Course Goals
After completing this course, you should be able to:
• Describe the clinical outcomes associated with cultural
competence
• Detail the outcomes associated with lack of cultural
competence
• Identify laws and recommendations about cultural
competence
• Recognize key terms related to cultural competence
• Recall “typical” characteristics of selected cultural groups
NO IMAGE
Point 3 of 4
1004
Course Outline
This introductory lesson gave the course rationale and goals.
FLASH ANIMATION: 1004.SWF/FLA
Lesson 2 will introduce culturally competent care.
Lesson 3 will discuss the clinical and legal aspects of cultural
competence.
Lesson 4 will cover the theory of cultural competence.
Lesson 5 will discuss the practice of cultural competence.
Point 4 of 4
Lesson 2: Cultural Competence
2001
Introduction
Welcome to the lesson introducing cultural competence.
FLASH ANIMATION: 2001.SWF/FLA
After completing this lesson, you should be able to:
• Define cultural competence
• Describe how providers can be culturally competent
Point 1 of 6
2002
Cultural Competence
In the healthcare setting, cultural competence refers to the
ability to provide optimal medical care to members of various
cultural groups.
IMAGE: 2002.JPG
This ability rests on a set of:
• Attitudes
• Skills
• Policies
• Practices
This set of qualities makes it easier for providers to:
• Understand their patients
• Communicate with their patients
The end result is optimal care for all patients.
Point 2 of 6
2003
The Culturally Competent Provider
Providers must be able to provide healthcare to:
• Patients who do not speak English
• Patients from different cultures
IMAGE: 2003.GIF
Providers must understand the patient’s:
• Values
• Beliefs
• Attitudes
• Practices
• Communication patterns
Point 3 of 6
2004
Using Cultural Understanding
Providers use their understanding of the patient’s culture to:
• Improve medical care
• Correct disparities [ glossary] in health status
IMAGE: 2004.GIF
Failure to provide culturally competent care leads to:
• Less-than-optimal care for many patients
• Elevated rates of disease and mortality among certain
populations
Point 4 of 6
2005
Review
Cultural competence refers to the ability to provide medical care to
different cultural groups. Providing culturally competent care leads
to health disparities.
a. True
b. False
MULTIPLE CHOICE INTERACTION
Correct answer: B
Feedback for A: Incorrect. Culturally competent care leads
to optimal health care for all patients.
Feedback for B: Correct. Culturally competent care leads to
optimal health care for all patients.
Point 5 of 6
2006
Summary
You have completed the lesson on culturally competent care.
NO IMAGE
Remember:
• Cultural competence refers to the ability to provide medical
care to different cultural groups.
• Providers need a set of attitudes, skills, policies, and
practices to more effectively communicate with their
patients.
• Providers need to understand the patient’s values, beliefs,
attitudes, behaviors, and practices.
• Providing culturally competent care leads to better patient
care.
Point 6 of 6
Lesson 3: Clinical and Legal Significance
3001
Introduction & Objectives
Welcome to the lesson on the clinical and legal significance of
culturally competent care.
FLASH ANIMATION: 3001.SWF/FLA
After completing this lesson, you should be able to:
• Recall adverse patient outcomes that can result if culturally
competent care is not provided
• Recall benefits of improving your cultural competence
• Describe laws and recommendations about culturally
competent healthcare delivery
Point 1 of 17
3002
Cultural Competence and the Practice of Medicine Today
Cultural competence is a necessity.
IMAGE: 3002.JPG
Unfortunately, many providers guide their delivery of care by:
• Stereotypes
• Biases
As a result, racial and ethnic minorities tend to receive lower
quality care than similar non-minorities. This can have health
consequences.
Point 2 of 17
3003
Cultural Competence and Quality of Care (1)
In what ways do minorities receive lower quality care?
CLICK TO REVEAL
Lack of cultural competence can lead to:
Lack of medical care
Cultural minorities may choose not to seek medical care.
They may fear being misunderstood or treated
disrespectfully.
•
•
•
•
Lack of medical care
Misdiagnosis
Inappropriate testing
Suboptimal disease screening
Click on each to learn more.
Misdiagnosis
Patients can be misdiagnosed if they are not understood.
This is most likely in patients with limited English
proficiency (LEP). [glossary]
Inappropriate testing
Providers may not order needed tests if they do not
understand the patient’s symptoms. Alternatively, providers
may overcompensate by ordering too many tests.
Suboptimal disease screening
Some diseases are associated with certain minority
groups. The physician must be aware of this to offer
appropriate screening.
Point 3 of 17
3004
Cultural Competence and Quality of Care (2)
Other problems include:
•
•
•
Noncompliance
Reaction to drugs
Conflicting drugs
Click on each to learn more.
CLICK TO REVEAL
Noncompliance
Cultural minorities may not follow the advice of medical
providers. They may not trust or understand the provider’s
instructions fully. This can cause problems in the correct
usage of medications or other treatments.
Reaction to drugs
Racial and ethnic background may affect how a patient
responds to a drug. Most drug doses are based on studies
of Caucasian patients.
Conflicting drugs
Patients may be using traditional remedies. This may lead
to harmful drug interactions.
wjPoint 4 of 17
3005
Cultural Competence and Health Disparities
Cross-cultural health disparities may result when care in not
culturally competent.
IMAGE: 3005.JPG
For example:
• African-Americans are at increased risk for:
o Breast cancer mortality
o Infant mortality
o Flu mortality
o Colorectal-cancer mortality
o HIV/AIDS
• Native Americans are at increased risk for:
o Infant mortality
o Flu mortality
o Colorectal-cancer mortality
• Hispanics/Latinos are at increased risk for:
o HIV/AIDS
For more examples of cross-cultural health disparities, see:
http://erc.msh.org/mainpage.cfm?file=7.0.htm&module=provider&la
nguage=English&ggroup=&mgroup=
Point 5 of 17
3006
Potential Benefits of Cultural Competence: Clinical (1)
What are the potential benefits of cultural competence in the
healthcare setting?
IMAGE: 3006.JPG
Benefits include:
• More successful patient education
• Increased likelihood that minorities will seek healthcare
• Fewer diagnostic errors
• More appropriate diagnostic testing and screening
• Fewer harmful drug interactions
• Greater patient compliance
• Expanded choices and access to high-quality clinicians
• Equality of healthcare outcomes
Point 6 of 17
3007
Quality of Care, Health Disparities, and Clinical Outcomes: Summary
Effects of Culturally Competent and Non-Competent Care
on Cultural Minority Patient Health
Cultural Competence
Lack of Cultural Competence
Increased likelihood that minorities will seek healthcare
Lack of medical care
Fewer diagnostic errors
Misdiagnosis
More appropriate testing and screening
Inappropriate testing and suboptimal disease screening
Greater patient compliance
Noncompliance
Fewer harmful drug interactions
Drug reactions and interactions
Equalization of cross-cultural health disparities
Health disparities
Expanded choices and access to high-quality clinicians
Limited healthcare choices
More successful patient education
Limited/ineffective patient education
Point 7 of 17
3008
Potential Benefits of Cultural Competence: Legal and Regulatory
Cultural competence also improves compliance with relevant laws
and recommendations.
FLASH ANIMATION: 3008.SWF/FLA
These include:
• Title VI of the Civil Rights Act of 1964
• The Joint Commission
• U.S. Department of Health and Human Services (HHS)
Office of Minority Health (OMH) recommendations for
national standards on culturally and linguistically [glossary]
appropriate services (CLAS)
Let’s take a closer look at each.
Point 8 of 17
3009
Title VI
Title VI of the Civil Rights Act of 1964 requires any health- or
social- service organization that receives federal funding to provide
language assistance to any patient with limited English proficiency
(LEP).
IMAGE 3009.JPG
Language assistance assures that:
• The LEP patient is able to communicate relevant
information to the provider.
• The provider is able to understand the LEP patient.
• The LEP patient is able to understand all necessary
information. This includes a description of services and
benefits available.
• The LEP patient is able to receive eligible services.
Point 9 of 17
3010
The Joint Commission Position
The Joint Commission considers culturally competent care an
important healthcare safety and quality issue.
FLASH ANIMATION: 3010.SWF/FLA
Several standards address issues related to culturally competent
care. Those directly addressing cultural competence include:
• Standard RI.2.10
• Standard RI.2.100
Other standards provide organizational supports for culturally
competent care.
Let’s take a closer look at Standards RI.2.10 and RI.2.100.
Point 10 of 17
3011
The Joint Commission Position: Standard RI.2.10
The Joint Commission Standard RI.2.10 states that an
organization should respect a patient’s rights. This includes their
cultural:
• Values
• Beliefs
• Preferences
IMAGE: 3011.JPG
Patients also have a right to their personal dignity.
Point 11 of 17
3012
The Joint Commission Position: Standard RI.2.100
Standard RI.2.100 addresses a patient’s right to effective
communication.
IMAGE: 3012.JPG
Element 2 of this standard states that written information about a
patient’s rights must be appropriate to :
• The population served
• The language of the patient
Element 3 addresses provision of interpretation and translation
services, if needed.
Element 4 instructs hospitals to accommodate a patient’s right to
spiritual services.
Point 12 of 17
3013
The Joint Commission Position: Hospitals, Language, and Culture Study
In January 2004, The Joint Commission started a project on
cultural competence. Over a 30-month period, they collected data
from 60 different hospitals. The ability of these hospitals to address
patient language and culture issues was determined.
IMAGE: 3013.JPG
Study results will be published in early 2007.
When available, the results of this study will allow The Joint
Commission to set realistic standards for hospitals.
For more information, visit The Joint Commission Website.
http://www.jointcommission.org/JointCommission/Templates/Gener
alInformation.aspx?NRMODE=Published&NRNODEGUID=%7B84
C5612C-2C48-4927-974B
40D464FAFCEB%7D&NRORIGINALURL=%2FHLC%2Fhlc_facts.
htm&NRCACHEHINT=Guest [please link]
Point 13 of 17
3014
CLAS Standards
The U.S. Department of Health and Human Services Office of
Minority Health has 14 recommendations for national standards on
culturally and linguistically appropriate services (CLAS).
FLASH ANIMATION: 3014.SWF/FLA
These recommendations address:
• Culturally representative staffing
• Staff education and training
• Language-assistance services and materials
• Organizational self-assessment
• Data collection
• Cross-cultural conflict and grievance processes
The goals are to:
• Correct healthcare disparities
• Improve medical services
For more details, see: http://www.omhrc.gov/clas/ds.htm
The CLAS standards for language assistance (Standards 4, 5, 6,
7) are required for hospitals receiving federal funding.
Point 14 of 17
3015
Review
FLASH INTERACTION: 2015.SWF/FLA
Drag and drop each of the terms in the word bank to its proper place in the
table.
Cultural competence is
characterized by:
Effective communication
Thorough understanding of
individual patients
Willingness to learn
Lack of cultural competence is
characterized by:
Use of stereotypes
Biased delivery of healthcare
Making assumptions about patients
Point 15 of 17
3016
Review
Which of the following requires or recommends that hospitals
provide language assistance to LEP clients:
a. CLAS standards
b. Title VI of the Civil Rights Act of 1964
c. The Joint Commission standards on cultural competence
d. All of the above
MULTIPLE CHOICE INTERACTION
Correct answer: D
Feedback for A: Not quite. All of these require or
recommend that hospitals provide assistance to clients that
have problems speaking English.
Feedback for B: Not quite. All of these require or
recommend that hospitals provide assistance to clients that
have problems speaking English.
Feedback for C: Not quite. All of these require or
recommend that hospitals provide assistance to clients that
have problems speaking English.
Feedback for D: Correct. All of these require or recommend
that hospitals provide assistance to clients that have
problems speaking English.
Point 16 of 17
3017
Summary
You have completed the lesson on the clinical and legal
significance of cultural competence.
NO IMAGE
Remember:
• Cultural competence is often lacking in the practice of
medicine today. This leads to adverse patient outcomes
and health inequality.
• Delivering medical services in a culturally competent way
has many benefits for patients.
• Title VI of the Civil Rights Act requires any health- or
social- service organization that receives federal funding to
provide effective language assistance to LEP
patients/clients.
• The Joint Commission requires accredited hospitals to
respect a patient’s rights and dignity.
• The OMH released national standards on culturally and
linguistically appropriate services (CLAS). CLAS 4-7 are
requirements.
Point 17 of 17
Lesson 4: Theory of Cultural Competence
4001
Introduction & Objectives
Welcome to the lesson on theory of cultural competence.
FLASH ANIMATION: 4001.SWF/FLA
After completing this lesson, you should be able to:
• Discuss how patients differ in their healthcare attitudes,
beliefs, behaviors, and practices
• Distinguish between ethnocentrism [glossary] and cultural
relativism [glossary].
Point 1 of 17
4002
Understanding Patients
How can healthcare providers understand their patients?
FLASH ANIMATION: 4002.SWF/FLA
Useful information includes the patient’s healthcare-related:
• Beliefs
• Attitudes
• Behaviors
• Practices
Many of these arise from the patient’s underlying:
• Values
• Worldview
• Time orientation
• Traditional social structure
Let’s take a closer look at each of these four underlying
characteristics.
Point 2 of 17
4003
Understanding Patients: Values
A value is anything important to an individual or a culture.
FLASH ANIMATION: 4003.SWF/FLA
For example, in the United States, we tend to value:
• Money
• Freedom
• Privacy
• Health/fitness
• Physical appearance
Values drive behavior. Understanding a patient’s values can help
you understand his or her behavior.
Understanding allows you to respond to a patient’s behavior in a
respectful, effective way.
Point 3 of 17
4004
Understanding Values: An Example
Mr. C is a 45-year-old patient under the care of Nurse Jones.
IMAGE: 4004.GIF
Mr. C’s family members wish to participate in his care.
Nurse Jones responds with irritation and annoyance. She does not
understand why the C family does not abide by visiting hours. They
do not understand the importance of self-care for the patient.
Mr. C explains that his family values family loyalty and duty. He
tells Nurse Jones that his wife and children would feel guilt and
dishonor if they did not assist him.
Nurse Jones now understands that the C family is not ignoring her
instructions. She can find ways to allow the family to help the
patient.
Point 4 of 17
4005
Understanding Patients: Worldview (1)
A person’s worldview consists of his or her basic
assumptions about the nature of reality.
FLASH ANIMATION: 4005.SWF/FLA
Most people believe their worldview without question. This can
lead to ethnocentrism.
Ethnocentrism is the belief that:
• One’s own way is right and natural
• Other ways are inferior, unnatural, uncivilized, etc.
The opposite of ethnocentrism is cultural relativism. Cultural
relativism:
• Looks at behavior and beliefs in their cultural context
• Accepts that other ways may be different, but equally valid
Point 5 of 17
4006
Understanding Patients: Worldview (2)
Western healthcare tends to be ethnocentric. It is assumed that:
• Western approaches to healing are best
• Other methods are not to be trusted or accepted
IMAGE: 4006.GIF
Cultural competence demands cultural relativism. Healthcare
providers must be willing to:
• Acknowledge the validity of other methods
• Incorporate traditional or folk medicine into treatment plans
as needed
Point 6 of 17
4007
Understanding Worldview: An Example
According to the worldview of Western medicine, infection is
caused by microorganisms.
IMAGE: 4007.GIF
Ms. P believes that her bacterial pneumonia is the result of an
imbalance of “hot” and “cold” in her body.
Western medicine would insist that antibiotics can cure bacterial
pneumonia.
But, antibiotics are unlikely to help Ms. P:
• Ms. P may not take the antibiotics because she believes
that they will not help.
• Even if Ms. P takes antibiotics, she may not reach a true
state of healing. She will not believe she has corrected the
underlying problem of heat/cold imbalance.
In other words, a patient’s beliefs must always be considered.
Accommodating beliefs while treating the body will:
• Help ensure compliance
• Help ensure full healing
Point 7 of 17
4008
Understanding Patients: Time Orientation
Time orientation has two aspects:
• Emphasis on past, present, or future
• Attention to clock time
FLASH ANIMATION: 4008.SWF/FLA
Let’s take a closer look at each.
Point 8 of 17
4009
Time Orientation: Past, Present, or Future
Persons with a past-time orientation tend to:
• Be traditional
• Do things the way they have always been done
IMAGE: 4009.GIF
Persons with a present-time orientation tend to:
• Look to today
• Make few plans or provisions for the future
Persons with a future-time orientation tend to:
• Place trust and faith in technologic innovations
• Plan for the future
Point 9 of 17
4010
Past, Present, or Future Time: An Example
Western healthcare tends to be future-focused. Preventive
medicine is emphasized. Follow-up care is given. New techniques
and medications are adopted.
IMAGE: 4010.GIF
Patients with a more present focus may not comply with
preventative health measures. For example, it may be difficult for
them to remember to take medication each day.
Point 10 of 17
4011
Time Orientation: Clock Time
Some people pay careful attention to the passage of time,
according to the clock.
IMAGE: 4011.GIF
Others mark time by activities.
Western healthcare is clock-focused. For example, you are late for
your 10:15 appointment if you arrive at 11:00.
Patients who are not clock-focused would consider both 11:00 and
10:15 “mid-morning.” They would not worry about being late.
Point 11 of 17
4012
Understanding Patients: Social Structure
In terms of power, authority, and opportunity, a social structure
may be egalitarian or hierarchical [glossary}.
FLASH ANIMATION: 4012.SWF/FLA
In an egalitarian society, such as the United States, all people are
inherently equal.
In a hierarchical society, people are not equal. Social status is
based on characteristics such as age, sex, lineage, or occupation.
Point 12 of 17
4013
Understanding Social Structure: An Example
In Western healthcare, all competent adult patients have equal
authority and power to make healthcare decisions for themselves.
IMAGE: 4013.GIF
In a hierarchical structure:
• Husbands may make healthcare decisions for their wives
and children.
• A patient may expect the provider to make treatment
decisions for him or her.
Social structure is often related to religious belief.
Point 13 of 17
4014
Understanding Social Structure: Family Structure
A patient’s family structure may determine who makes healthcare
decisions. There are seven family structures:
• Traditional Nuclear Family
• Nuclear Dyad Family
• Extended Family
• Skip Generation Family
• Alternative Family
• Single Parent Family
• Reconstituted or Blended Family
A family structure may also be:
• Matriarchal
• Patriarchal
CLICK TO REVEAL
A traditional nuclear family is composed of a married
man and woman and their biological or adopted child or
children.
A nuclear dyad consists of a man and woman only.
An extended family is composed of two or more adults
from different generations. Children, aunts, uncles,
cousins, grandparents, etc. may be included.
In a skip generation family, children are raised by their
grandparents.
An alternative family is composed of a same-sex couple
and children.
A single parent family is composed of a single adult and
their children.
A reconstituted or blended family is composed of two
parents, their biological or adopted children, and their
children from previous marriages or relationships.
In a matriarchal family, the family head is a female.
In a patriarchal family, the family head is male.
Point 14 of 17
4015
Review
Which of the following best supports the development of cultural
competence?
a. Ethnocentrism
b. Cultural relativism
c. Future time orientation
d. Observed family behavior
MULTIPLE CHOICE INTERACTION
Correct answer: B
Feedback for A: Incorrect. Cultural competence demands
acceptance that other ways are equally valid. The correct
answer is B.
Feedback for B: Correct. Cultural competence demands
acceptance that other ways are equally valid.
Feedback for C: Incorrect. Cultural competence demands
acceptance that other ways are equally valid. The correct
answer is B.
Feedback for D: Incorrect. Cultural competence demands
acceptance that other ways are equally valid. The correct
answer is B.
Point 15 of 17
4016
Review
FLASH INTERACTION: 4015.SWF/FLA
Complete the following table with terms from the word bank.
A person with a…
Past-time orientation
Present-time orientation
Future-time orientation
Tends to:
Do things the way they have always
been done.
Look to today.
Trust technological innovations.
Point 16 of 17
4017
Summary
You have completed the lesson on theory of cultural competence.
NO IMAGE
Remember:
• A value is anything important to an individual or culture.
• A person’s worldview consists of his or her basic
assumptions about the nature of reality.
• Western medicine tends to be ethnocentric. Cultural
competence demands cultural relativism.
• Time orientation has two aspects: emphasis on past,
present, or future, and level of attention to clock time.
• A social structure may be egalitarian or hierarchical.
• Cultural values, worldview, time orientation, and social
structure can shape healthcare-related attitudes, beliefs,
behaviors, and practices.
• You need to understand a patient’s values, worldview, time
orientation, and social structure to provide quality patient
care.
Point 17 of 17
Lesson 5: Practice of Cultural Competence
5001
Introduction & Objectives
Welcome to the lesson on the practice of cultural competence.
FLASH ANIMATION: 5001.SWF/FLA
After completing this lesson, you should be able to:
•
Distinguish between generalizations and stereotypes
•
Identify the appropriate use of generalizations
Recognize selected generalizations about specific culture
•
groups
Point 1 of 21
5002
Culture Groups
Let’s look at how cultural characteristics influence a patient’s
healthcare-related attitudes and behaviors.
FLASH ANIMATION: 5002.SWF/FLA
Important note:
The cultural characteristics given are generalizations. They
indicate common trends and patterns.
Generalizations should NEVER be used to stereotype. Do not
assume that the patient fits the generalizations assigned to his or
her culture group!
Point 2 of 21
5003
Culture Groups: African-American (1)
Religion is important in the lives of African-Americans. Patients
should be given time and privacy to pray. Clergy should be allowed
to participate in the patient’s care.
FLASH ANIMATION: 5003.SWF/FLA
The head-of-household is often a woman. Other relatives and
friends may be included in the patient’s extended family.
African-Americans tend to have a present-time orientation.
Providers should emphasize the importance of prevention.
Point 3 of 21
5004
Culture Groups: African-American (2)
African-Americans may refer to “high blood” or “low blood.” You
need to determine what symptom the patient is describing. You
also must be sure that you use words the patient understands. Be
sure you both have a common understanding of the words used to
describe medical conditions.
FLASH ANIMATION: 5004.SWF/FLA
The tradition of herbal remedies is strong in the African-American
culture. Ask patients if they are taking any herbal remedies. This
will avoid drug interactions.
Remember! These are generalizations. They should not be used to stereotype any
patient. These also are selected examples only. You can learn more about this
culture group at:
•
www.ggalanti.com/cultural_profiles/african_american.html
•
http://erc.msh.org/mainpage.cfm?file=5.1.0.htm&module=provider&langu
age=English, page 5 of 14
•
http://erc.msh.org/mainpage.cfm?file=5.2.0.htm&module=provider&langu
age=English, page 8 of 15
Point 4 of 21
5005
Culture Groups: Anglo-American (1)
Anglo-American patients expect to be informed of the details of
their condition. They value direct eye contact, privacy, and
emotional control. They may expect nurses to provide
psychosocial [glossary] care.
FLASH ANIMATION: 5005.SWF/FLA
Patients in this culture group generally make healthcare decisions
for themselves. Parents make decisions for their minor children.
They value self-care.
Poverty may lead to a present-time orientation. These patients
may not comply with preventive medical advice.
Middle- and upper-class Anglo-Americans tend to have a future
focus. They are likely to comply with preventative medical advice.
Point 5 of 21
5006
Culture Groups: Anglo-American (2)
Anglo-Americans often prefer biomedicine. [ glossary] They also
may use alternative approaches. Ask about herbal remedies and
other complementary medicine.
FLASH ANIMATION: 5006.SWF/FLA
Patients in this group expect an aggressive approach to treatment.
They assume that treatment will focus on killing germs. They may
demand antibiotics, even when unnecessary.
Remember! These are generalizations. Do not stereotype any individual patient.
These also are selected examples only. You can learn more about this culture
group at:
•
www.ggalanti.com/cultural_profiles/anglo.html
Point 6 of 21
5007
Culture Groups: Asian (1)
To show respect, Asian patients may avoid eye contact with the
provider. They also may agree with their provider.
FLASH ANIMATION: 5007.SWF/FLA
Agreement does not always indicate understanding. Agreement
may not indicate an intention to comply with the treatment plan.
Avoid yes or no questions. Ask for responses that demonstrate
understanding. Always stress the importance of compliance.
Men may make healthcare decisions for their wives. Family
members will expect to be involved in treatment decisions and
patient care. Allow family to care for the patient as much as
possible.
Point 7 of 21
5008
Culture Groups: Asian (2)
Asian patients may not express pain. Pain medication should be
offered when appropriate. This should be done even if the patient
does not request it.
FLASH ANIMATION: 5008.SWF/FLA
Family members may wish to protect a patient from hearing a poor
prognosis or terminal diagnosis. Ask the patient which family
member(s) should receive information about his or her condition.
Coining [glossary] and cupping [glossary] are traditional medical
practices in many Asian cultures. They should not be mistaken for
signs of abuse.
Remember! These are generalizations. Do not stereotype any patient. These also
are selected examples only. You can learn more about this culture group at:
•
www.ggalanti.com/cultural_profiles/asian.html
•
http://erc.msh.org/mainpage.cfm?file=5.1.0.htm&module=provider&langu
age=English, page 7 of 14
•
http://erc.msh.org/mainpage.cfm?file=5.2.0.htm&module=provider&langu
age=English, page 10 of 15
•
http://erc.msh.org/mainpage.cfm?file=5.3.0.htm&module=provider&langu
age=English, page 6 of 10
Point 8 of 21
5009
Culture Groups: East Indian
East Indians may consider direct eye contact rude or disrespectful.
Silence may indicate acceptance or approval.
FLASH ANIMATION: 5009.SWF/FLA
Family members are likely to take over the activities of daily living
for a patient. Unless patient self-care is medically necessary, allow
this expression.
The Sikh religion forbids cutting or shaving head or facial hair.
Consult with patients before surgical prep.
Remember! These are generalizations. Do not stereotype any patient. These also
are selected examples only. You can learn more about this culture group at:
•
www.ggalanti.com/cultural_profiles/eastindian.html
Point 9 of 21
5010
Culture Groups: Hispanic/Latino (1)
Hispanic/Latinos place high value on:
• Direct eye contact
• Friendly physical contact
• Friendly interpersonal interaction
FLASH ANIMATION: 5010.SWF/FLA
It is appropriate to maintain a friendly manner with Latino patients.
Ask patients about their families and interests before focusing on
health-related issues.
Children are highly valued and loved. Allow family members to
spend as much time as possible with pediatric patients.
The oldest adult male is the decision-maker. However, important
decisions involve the family.
Point 10 of 21
5011
Culture Groups: Hispanic/Latino (2)
FLASH ANIMATION: 5011.SWF/FLA
Hispanic/Latinos may refuse hospital foods that would upset their
hot/cold body balance. Offer alternatives.
Many traditional Mexican foods are high in salt and fat. Be certain
to discuss nutrition. This is very important for diabetics and
hypertensives [glossary].
Hispanic/Latino patients may use herbal remedies. Ask before
prescribing medication.
Remember! These are generalizations. Do not stereotype any patient. These also
are selected examples only. You can learn more about this culture group at:
•
www.ggalanti.com/cultural_profiles/hispanic.html
•
http://erc.msh.org/mainpage.cfm?file=5.1.0.htm&module=provider&langu
age=English, page 4 of 14
•
http://erc.msh.org/mainpage.cfm?file=5.2.0.htm&module=provider&langu
age=English, page 7 of 15
•
http://erc.msh.org/mainpage.cfm?file=5.3.0.htm&module=provider&langu
age=English, page 4 of 10
Point 11 of 21
5012
Culture Groups: Middle Eastern (1)
Your Middle Eastern patients may believe that communication is
two-way. You may need to share information about yourself first.
Then you can receive information from the patient.
FLASH ANIMATION: 5012.SWF/FLA
Sexual segregation is an important aspect of Middle Eastern
culture. Assign same-sex caregivers and interpreters.
Middle Eastern men may answer for their wives. Women may
allow their husbands to make healthcare decisions for the family.
Point 12 of 21
5013
Culture Groups: Middle Eastern (2)
Islam is important to the majority of Middle Eastern people. Allow
time and privacy to pray. Be aware that these patients believe that
personal health is in the hands of Allah. Middle Eastern patients
may avoid taking an active role in their own healthcare.
FLASH ANIMATION: 5013.SWF/FLA
Middle Easterners may expect all treatment plans to involve a
prescription for medication.
Remember! These are generalizations. Do not stereotype any patient. These also
are selected examples only. You can learn more about this culture group at:
•
www.ggalanti.com/cultural_profiles/middle_eastern.html
•
http://erc.msh.org/mainpage.cfm?file=5.1.0.htm&module=provider&langu
age=English, page 9 of 14
Point 13 of 21
5014
Culture Groups: Native American (1)
Patients in this group may communicate through anecdotes and
metaphors [glossary]. During a conversation, the patient may
pause for an extended length of time. This indicates careful
consideration of the question or issue. Do not press the patient for
an answer. Avoid direct eye contact. Do not speak loudly.
FLASH ANIMATION: 5014.SWF/FLA
Any illness concerns the entire family. Healthcare decisions may
be made by the male head of the family, the female head of the
family, or the patient.
Native Americans tend not to have a clock-focused time
orientation.
Point 14 of 21
5015
Culture Groups: Native American (2)
Native American patients may be stoic [glossary] about pain. Offer
pain medication when appropriate.
FLASH ANIMATION: 5015.SWF/FLA
If a patient wears a medicine bag, [glossary] do not treat the bag
casually. Do not remove it without asking the patient.
Traditional healing may be an important part of any treatment plan.
Accommodate traditional healers. Allow traditional rituals whenever
possible. Never touch or casually admire a ritual object.
Remember! These are generalizations. Do not stereotype any patient. These also
are selected examples only. You can learn more about this culture group at:
•
www.ggalanti.com/cultural_profiles/native.html
• http://erc.msh.org/mainpage.cfm?file=5.3.0.htm&module=provider&langu
age=English, page 5 of 10
•
http://erc.msh.org/mainpage.cfm?file=5.1.0.htm&module=provider&langu
age=English, page 6 of 14
•
http://erc.msh.org/mainpage.cfm?file=5.2.0.htm&module=provider&langu
age=English, page 9 of 15
Point 15 of 21
5016
Culture Groups: Russian/Eastern European (1)
When caring for patients in this cultural group, be firm and
respectful. Make direct eye contact.
FLASH ANIMATION: 5016.SWF/FLA
Russians tend to have a high threshold for pain. They also may be
stoic about pain. Offer pain medication when appropriate.
Food is appreciated. A good appetite is admired. Patients and
family members may offer small gifts of food or chocolate. Accept
these to avoid appearing rude.
Point 16 of 21
5017
Culture Groups: Russian/Eastern European (1)
Russian and/or Eastern European patients may not feel
comfortable with too many personal questions. They may be
suspicious of providers who take notes.
FLASH ANIMATION: 5017.SWF/FLA
Smoking, excessive use of alcohol, and lack of exercise may be
problematic.
Remember! These are generalizations. Do not stereotype any patient. These also
are selected examples only. You can learn more about this culture group at:
•
www.ggalanti.com/cultural_profiles/russian.html
• http://erc.msh.org/mainpage.cfm?file=5.3.0.htm&module=provider&langu
age=English, page 8 of 10
•
http://erc.msh.org/mainpage.cfm?file=5.1.0.htm&module=provider&langu
age=English, page 10 of 14
•
http://erc.msh.org/mainpage.cfm?file=5.2.0.htm&module=provider&langu
age=English, page 12 of 15
Point 17 of 21
5018
The Culture of Western Medicine
Let’s now take a brief look at the culture of Western medicine:
• Western healthcare tends to standardize definitions of
health and illness. Technology is believed to be allpowerful.
• The practice of Western medicine stresses health
maintenance and disease prevention.
• Western healthcare providers are systematic and
methodical. They like promptness, organization, and
efficiency. They dislike tardiness, chaos, and inefficiency.
• Use of jargon is common in Western healthcare.
• Western healthcare providers recognize and adhere to a
hierarchical system. The provider’s status is based on
education, experience, and professional accomplishments.
• Western healthcare observes certain routines.
IMAGE: 5018.SWF/FLA
Point 18 of 21
5019
Review
Not all patients within a given cultural group fit the generalizations
applicable to that group.
a. True
b. False
TRUE / FALSE INTERACTION
Correct answer: A
Feedback for A: Correct. Generalizations indicate common
trends and patterns. But, each patient is unique.
Generalizations should NEVER be used to stereotype any
patient.
Feedback for B: Incorrect. Generalizations indicate
common trends and patterns. But, each patient is unique.
Generalizations should NEVER be used to stereotype any
patient.
Point 19 of 21
5020
Review
FLASH INTERACTION: 5020.SWF/FLA
Drag and drop appropriate terms from the word bank to complete the table.
The following characteristic of
Western healthcare…
Desire for efficiency
Value placed on promptness
Emphasis on preventive medicine
Belief in the value and efficacy of
modern technology and
biomedicine
…may conflict with the following
characteristic of certain patients:
Use of long pauses during
conversation, to indicate careful
consideration
Lack of attention to clock-time
Present-time orientation
Belief in the value and efficacy of
traditional/folk medicine
Point 20 of 21
5021
Summary
You have completed the lesson on practice of cultural
competence.
NO IMAGE
Remember:
• Generalizations indicate common trends and patterns
within a group. They should never be used to stereotype
an individual.
• Use generalizations as a starting point to:
o Help understand various culture groups
o Learn more about the unique values, beliefs, and
practices of each patient
Point 21 of 21
Course Glossary
#
Term
Definition
coining
using a coin(usually with heated oil) to vigorously rub the skin in a prescribed manner, causing a
mild dermabrasion, with the goal of releasing excess force or "wind" from the body, hence
restoring balance
placing small, heated glasses on the skin, forming a suction that leaves a red circular mark, with the
goal of drawing out a bad force
inequality or difference
limited English proficiency; used to describe people who do not speak English fluently
Joint Commission on the Accreditation of Healthcare Organizations
having to do with language
the belief that one’s way of doing things is the only right way
the belief that other ways may be different from one’s own, but equally valid in their
cultural context
a type of social organization that assumes the equality of all people, in which every
individual has an equal opportunity to obtain resources and the esteem of others in
leadership activities
a social structure in which there are ordered groupings of people
make worse
cupping
disparity
LEP
JCAHO
linguistic
ethnocentrism
cultural relativism
egalitarian
hierarchical
exacerbate
psychosocial
biomedicine
hypertensive
anecdote
metaphor
stoic
medicine bag
involving both psychological and social aspects
the branch of medical science that applies biological and physiological principles to clinical
practice
a patient with high blood pressure
short account of an incident
a figure of speech in which an expression is used to suggest a similarity between two
different things
seeming unaffected by pleasure or pain
a magical object used to control and direct supernatural forces; a charm
[Cultural Competence]
Pre-Assessment
1. If a provider does not understand a patient’s symptoms, they may order too many tests.
a. True
b. False
Correct: True
Rationale: This statement is true.
2. Culturally competent delivery of healthcare can contribute to all of the following EXCEPT:
a. Decreased diagnostic error
b. Decreased drug interactions
c. Decreased patient compliance with medical advice
d. All of these
Correct: Decreased patient compliance with medical advice
Rationale: Cultural competence in the healthcare setting increases patient compliance.
3. Your 10:15 patient arrives at 11:00. This patient is intentionally behaving in an inconsiderate and disrespectful manner.
a. True
b. False
Correct: False
Rationale: If the patient comes from a culture that is not clock-focused, he may consider both times mid-morning. He would not consider his
arrival late.
4. Which of the following is (are) true of the African-American culture group, as compared to European-Americans?
a. The African-American culture group has a higher infant mortality rate.
b. The African-American culture group has a higher rate of mortality due to flu.
c. The African-American culture group has a higher rate of mortality due to colorectal cancer.
d. All of these statements are true.
e. None of these statements is true.
Correct: All of these statements are true.
Rationale: African-Americans, as a group, have all of these health disparities, as compared to European-Americans.
5. Title VI of the Civil Rights Act mandates that federally funded health-service organizations must:
a. Make hiring and firing decisions without regard to race, color, or gender.
b. Provide emergency medical care to all patients, regardless of ability to pay.
c. Provide language assistance to any patient with limited English proficiency (LEP).
d. All of these are correct.
e. None of these is correct.
Correct answer: Provide language assistance to any patient with limited English proficiency (LEP).
Rationale: Title VI requires health- and social- services organizations to provide meaningful language assistance to LEP patients/clients.
6. The Western healthcare system, as a whole, is characterized by:
a. Ethnocentrism
b. Cultural relativism
c. A present-time orientation
d. An egalitarian organizational structure
Correct: Ethnocentrism
Rationale: The Western healthcare system tends to be ethnocentric (assuming that Western approaches to healing are best, and that other
methods are not to be trusted or sanctioned).
7. You are explaining a treatment plan to an Asian patient. The patient expresses agreement with your instructions. You can assume that the
patient intends to comply with the treatment plan.
a. True
b. False
Correct: False
Rationale: Asian patients may agree with their provider, to show respect. Agreement does not necessarily indicate an intention to comply with the
treatment plan.
8. Patients in which healthcare group may expect their healthcare provider to be friendly and personable. They may expect to discuss their family
before their medical problems.
a. African-Americans
b. East Indian
c. Hispanic /Latino
d. Middle Eastern
Correct: Hispanic /Latino
Rationale: Latino’s place high value on friendly physical contact and friendly interpersonal interaction.
9. Mrs. L believes that bacterial infections result from an imbalance within the body. She does not believe that microorganisms cause bacterial
infections. Mrs. L has strep throat and you prescribe an antibiotic. Mrs. L agrees to take the medicine. Because the antibiotic will clear the
infection, Mrs. L will be completely healed.
a. True
b. False
Correct: False
Rationale: Mrs. L may not take the medicine even though she agrees to do so. Even if she does take the antibiotic, she may not reach a true state
of healing. This is because she believes the imbalance caused the problems and it has not been corrected. You need to consider Mrs. L’s beliefs
when treating her to ensure complete healing.
10. The Joint Commission does not have specific standards for culturally competent care of patients, but they expect patients to be treated in a
culturally competent way.
a. True
b. False
Correct: False
Rationale: The Joint Commission has two standards (RI.2.10 and RI.2.100) which specifically address culturally competent care. Several others
provide organization for culturally competent care.
11. The CLAS standards are meant to:
a. Correct current disparities in patient access to and receipt of medical care and services.
b. Improve medical services by making them better meet the needs of each individual patient.
c. Both of these are correct.
d. Neither of these is correct.
Correct Answer: Both of these are correct.
Rationale: Both of these are goals of the National standards on culturally and linguistically appropriate services (CLAS).
12. Which of the following is an example of cultural relativism?
a. A healthcare provider tells an African-American patient that voodoo is nonsense, and that he must take antibiotics if he wants to feel
better.
b. A healthcare provider acknowledges the importance of spiritual healing, and encourages a Native American patient to perform a
traditional healing ritual, in addition to using biomedicine.
c. Both of these are examples of cultural relativism.
d. Neither of these is an example of cultural relativism.
Correct Answer: A healthcare provider acknowledges the importance of spiritual healing, and encourages a Native American patient to perform a
traditional healing ritual, in addition to using biomedicine.
Rationale: Cultural relativism accepts that other ways may be different, but equally valid.
Final Exam
1. Ethnic/racial makeup cannot affect the metabolism of drugs.
a. True
b. False
Correct Answer: False
Rationale: Many drug dosages and other medical norms are based on studies of Caucasian patients --- but evidence suggests that racial/ethnic
makeup can affect how a patient metabolizes and responds to a drug.
2. Understanding a patient’s values can help you better understand his or her behavior.
a. True
b. False
Correct Answer: True
Rationale: Values drive behavior. Therefore, understanding a patient’s values can help you understand his or her behavior.
3. Always rely on generalizations about a patient’s cultural group to guide your culturally competent care.
a. True
b. False
Correct Answer: False
Rationale: Generalizations indicate common trends and patterns within a group. They should never be used to stereotype an individual.
4. Which of the following statements about worldview as a guide for proper cultural competence is true?
a. Ethnocentrism: our treatments are the most successful and advanced
b. Ethnocentrism: incorporation of traditional and folk medicine into Western medicine improves patient care for some cultural groups
c. Cultural relativism: our treatments are the most successful and advanced
d. Cultural relativism: incorporation of traditional and folk medicine into Western medicine improves patient care for some cultural groups
Correct Answer: Cultural relativism: incorporation of traditional and folk medicine into Western medicine improves patient care for some cultural
groups
Rationale: Western healthcare tends to be ethnocentric. But, cultural relativism is needed. Cultural relativism accepts that other ways may be
different, but are equally valid.
5. Culturally competent care contributes to:
a. Fewer diagnostic errors
b. Fewer drug interactions
c. Greater patient compliance
d. All of the above
e. None of these
Correct answer: All of the above
Rationale: All of the above result from culturally competent care.
6. Which of the following cultural groups would consider direct eye contact rude or disrespectful?
a. Asian
b. East Indian
c. Native American
d. All of these
e. None of these
Correct Answer: All of these cultural groups would consider direct eye contact rude or disrespectful.
7. Sexual segregation is an important part of ____ culture
a. Middle Eastern
b. Anglo-American
c. African-American
d. All of these
e. None of these
Correct answer: Middle Eastern
Rationale: Sexual segregation is important in Middle Eastern culture.
8. Patients from which cultural group are least likely to seek prompt medical treatment from a medical doctor when they are feeling ill?
a. Middle Eastern
b. Anglo-American
c. African-American
d. All of these
e. None of these
Correct answer: African-American
Rationale: African-Americans are more likely to delay seeking medical attention from a medical doctor.
9. ____ patients tend to be stoic about pain. Pain medication should be offered when appropriate, even if not requested.
a. Asian
b. Russian
c. Native American
d. All of these
e. None of these
Correct answer: All of these
Rationale: All of these cultures value stoicism.
10. The Joint Commission does not have specific standards for culturally competent care of patients.
a. True
b. False
Correct: False
Rationale: The Joint Commission has two standards (RI.2.10 and RI.2.100) which specifically address culturally competent care. Several others
provide organization for culturally competent care.
11. The CLAS standards are meant to:
a. Correct current disparities in patient access to and receipt of medical care and services.
b. Improve medical services by making them better meet the needs of each individual patient.
c. Both of these are correct.
d. Neither of these is correct.

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