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Cultural relevance in nursing

education

Audrey Snyder, PhD, RN, FAAN, ACNP-BC

University of Northern Colorado

July 13, 2017

1) Approval Statement

This continuing education activity was approved by the Western Multi-State Division, an accredited

approver by the American Nurses Credentialing Center’s Commission on Accreditation.

Arizona, Colorado, Idaho, and Utah Nurses Associations are members of the Western Multi-State

Division. Approval # 72-17

2) Criteria for Successful Completion

To receive contact hours, participants must check-in to the session using the barcode scanner, attend

the entire session and then complete both the session evaluation and full conference evaluation by

July 31, 2017.

3) Conflicts of Interest

This educational activity does not include any content that relates to the products and/or services of a

commercial interest that would create a conflict of interest.

4) Commercial Support

There is no commercial support being received for this session.

Session Disclosure

Behavioral outcomes

The purpose of this presentation is to enable the learner to:

1. Discuss concepts of cultural relevance vs. competence in health professions.

2. State the process of developing cultural relevance in nursing education.

3. Articulate two methods for incorporating cultural experiences for understanding of cultural relevance into the nursing curricula.

Personal definition of culture

Take time to write on a piece of paper what you define as your

culture

1

http://www.dismalworld.com/im/world_tour/japanese-culture-and-westernization-1.jpg

2

http://img252.imageshack.us/img252/8940/cellphoneholderinearty1.png

3

http://3.bp.blogspot.com/_T0gYy2QpElk/SSs0sy-W_oI/AAAAAAAAADY/3DCmOpjoBOk/s400/neck+rings1.jpg

4

http://www.washington.emb.mfa.gov.tr/images/culture2.jpg

5

http://www.burma-all.com/new%20burma-all.com/buddhist%20monks%20school.jpg

6

http://www.africanconservancy.org/im...surmadisk1.gif

7

http://thefinanser.co.uk/fsclub/2009/07/shamish-about-the-amish.html

8

http://declubz.com/blog/2008/07/14/weird-tatoos/

9

http://www.life.com/image/82072744

10

http://blog.piercingmap.com/wp-content/uploads/2007/04/1.jpg

11

http://thebovine.wordpress.com/2009/02/14/small-farmers-saying-nay-to-nais/

12

http://africanamericanfamilyconference.com/

Culture

Refers to total way of life that is learnt and shared by any

society

Culture

Totality of experience, including aesthetics and artifacts, that

hold relevance for the individual enabling them to feel a sense

of connectedness to their social network and preferred peer

group and associated affiliations. (Adelman & Legg, 2009,

p.102)

Cultural Competence in Delivery of

Healthcare Services

Cultural competence is a process, not an event, new thoughts cultural relevance. How can anyone be truly culturally competent?

Five constructs:

cultural awareness

cultural knowledge

cultural skills

cultural encounters

cultural desires

Cultural relevance

More variations within ethnic groups than across

Direct correlation between competence of HCP and their

ability to provide culturally responsive care

Understanding is essential to provide care to diverse

clients

Cultural Diversity

Definition of Culture:

Integrated pattern of human

behavior including thoughts,

communication, actions,

customs, beliefs, values and

institutions of a racial, ethnic,

religious or social group.

Definition of Diversity:

Different, variety,

multiformity.

Generalization vs. Stereotype

Stereotype- end point

Within the same culture, people judge and stereotype

Generalization- beginning point

Some traits are consistent across cultures within designated groups

Helps to begin to understand other cultures

Prejudice and Discrimination

Slavery history

Unfortunately minorities may be judged by the color of their

skin

KKK rally in Charlottesville, Virginia

http://www.newsplex.com/content/news/Charlottesville-police-arrest-more-than-20-at-KKK-rally-433354813.html

Values

Individuals hold certain values

Each culture promotes different values

American Money Freedom Independence Autonomy Privacy Health and fitness Physical appearance Sports

How did you define your

culture?

Cultural Diversity in the US At least 106 ethnic groups

Over 500 American Indian groups

Minorities are the population majority in many of the large,

metropolitan areas

20% of US practicing physicians are trained abroad

Immigrant population with increasing health care needs

Greeley: Mexican, Somalian

Shared Layers of Cultural Diversity

or Social Identity

Gender

Age

Personality

Ethnicity

Physical Ability

Sexual Orientation

Race

Language (oral, ie. Navaho and Laotian vs. written)

Nationality

Religion

Education

Marital Status

Social Class

Income

Appearance

Personal Habits

Geographic Location

Mental health status

Political affiliation

Medical Care Goals

Provide optimal care for all patients

Cultural differences create conflicts and misunderstandings that

can result in inferior medical care

Goal to provide culturally relevant care to patients

Translate to Nursing education

Help students adapt to understand and embrace cultural

difference and provide culturally relevant care.

Standards for practice

chrome-extension://oemmndcbldboiebfnladdacbdfmadadm/http://www.tcns.org/files/Standards_of_Practice_for_Cult_Comp_Nsg_care-2011_Update_FINAL_printed_copy_2_.pdf

Standards

1. Social justice

2. Critical reflection

3. Knowledge of Cultures

4. Culturally Competent Practice

5. Cultural competence in HealthCare 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

Values and the American Health Care

Culture

Health Care System

Autonomy and independence

Efficiency

Self control

Patients

Family group decisions

Modesty

Emotional expression

World view

Basic assumptions about the nature of reality

Religion

Big Bang Theory

Image from http://www.crystalinks.com/bigbang.html

Emic and Etic

Derived from linguistics

Important in Anthropology

Emic- insiders perspective

Etic- perspectives of those of outsiders

Try to understand the person’s perspective about their

condition

Ethnocentricism and

Cultural Relativism

Ethnocentricism- view that one’s culture’s way of doing things

is right and the natural way

Cultural relativism- attitude that others ways of doing things

are different but equally valid.

Hierarchical vs.

Egalitarian Cultures

American culture

Egalitarian- equality

Hierarchical

Asian

Disease Etiology

Germ theory

Upset in body balance, yin and yang

Soul loss, soul theft, and spirit possession

Breach of taboo

Object intrusion

Treatment

Appropriate to the cause

Consider the placebo effect

Scientific hypothesis can be disproved, beliefs cannot

Theoretical perspective

Adaptation theory- people have developed traditions designed to achieve success in the broader environment in which they live (physical and social environments)

Circumstances sometimes change, obliterating the need for a custom. Ideology is enduring and soon becomes tradition.

Psychological value- sense of identify and belonging, special group

Concepts of Religion/Spirituality

Religion: The service as worship of God or the supernatural

Spiritual: Relating to or consisting of or affecting a spirit

Spirit: the activating or essential principle influencing a

person; a special attitude or frame of mind; presence

Religious Diversity in the US

63% of Americans affiliated with a church

Roman Catholicism--largest single religious

group

Protestant churches--94 million total, 220

denominations

3.8 million active Jews

5 million practicing Muslims

Concepts of Ethnicity

Nationality or ethnic background

Native language

Cultural considerations

Holiday observances

Food preference

Social affiliations.

Family relationships.

Health care beliefs.

Mainstream American Ethnicity

Individualism

Freedom

Competition

Materialism

Technology

Instant-time

Youth/Beauty

Equal Sex Rights

Leisure Time Valued

Reliance on Science

Less respect for elderly/authority

Generosity in times of crisis

Self esteem issues during illness

The next few slides share some generalizations about

cultural groups.

African American Health

Considerations

1/400 suffer from sickle cell disease

High incidence for other disease

Hypertension/Stroke/Coronary Artery Disease

Diabetes

High cholesterol

Cancer

Cirrhosis

Mexican American Health

Considerations

Same sex medical staff may be preferred

Folk-care healers, remedies

Hot-cold theory

High incidence of disease

Hypertension/Ischemic heart disease

Diabetes

Asian American Health

Considerations

Limit direct eye contact

May prefer same sex provider

Touching may be considered offensive

NEVER touch on head

Smile/nodding--sign of not understanding or polite disagreeing

May expect to receive medication

First name may be kept private, address by position, role

Native American Health

Considerations

No direct eye contact

Silence valued--do not rush, interrupt

Note taking may be offensive

High incidence of disease Type II diabetes

Gallstones

Ischemic heart disease

Lung disease

Alcoholism

Arthritis/Rheumatologic conditions

Arab American Health Considerations

Avoid male/female eye contact--may be misinterpreted as

sexual invitation

Avoid compliments on beauty

Right hand may be offered for diagnosis/treatment. Left hand

offensive.

High incidence of disease: CAD, diabetes

Pacific Islanders:

Hawaiian and Samoans

Extended family/Interdependence

Family priority over self

Spiritual bond between family and nature

Hierarchical system

Nonverbal communication as verbal communication

Amish

Different appearance, behavior from mainstream Americans

Not outwardly demonstrative

Respect for elders

May not admit to using folk therapies

Traditionally seek counsel from religious leaders, friends, family

regarding health care decisions

Education: home schooled or religious school

Additional Cultural Concerns

Cleanliness

Personal Space

Modesty

Gestures

Pain

Language

Relationships

Time Orientation

Pharmacogenetics

Death and Dying

Language Barriers

Lucky and Unlucky Numbers

13 U.S.

Unlucky situations

Walking under a ladder

Spilling salt

Breaking a mirror

Friday the 13th

What others can you think of?

Good luck

Rabbit’s foot

4 leaf clovers

Number 7

Rain on wedding days

What others can you think of?

Project Cure Transportation to

clinics on the river in Suriname

Burial site of tribal leader

Cultural barriers

Economic, political, practical and social barriers to

deliver culturally relevant care.

Education to address these barriers

Incorporation into curriculum

Stand alone culture in health courses

Lessons within courses

International programs

Providing students with opportunities for cultural

encounters in the local community

Challenges to high profile/high

risk discussions

Create the class rules during the first class

Cultural Exposure Techniques

News

Movies

Books, for example: The Spirit Catches You and You Fall

Down

Social media

Use Flipped classroom to allow for class discussions

Younger generation social media

examples: ZdoggMD

https://www.youtube.com/watch?v=aS3xaXsh6vo

Show video and have class discussion

“Portraits” by Steve McCurry

Have students select a picture, research the country and present to the class on the culture and healthcare considerations

An example of a Portraits Photo

"Kusovo, Yogoslavia, 1989"

Share your experiences with students: Ghiridi, India with Virginia Children’s Connection

The nurses washed our supplies including gloves and gauze for reuse.

Nursing Students Without Borders

Local Migrant Farming Camps

Red Cross (Cruz Roja) San Sebastian, El Salvador

Remote Area Medical Clinics,

Wise, Virginia

Check out ramusa.org for opportunities

RAM Nursing and Medical Students

Snyder, A.E., Terzioglu, F. & Keeling, A. (2010). Striving for the ‘New Normal”: The Aftermath of International Disasters. Chapter 13 In Wall, B. & Keeling, A. Nurses on the Front Line: When Disaster Strikes, 1978-2010. New York: Springer Publishing, p.253-264

Haiti, Internally Displaced Persons (IDP) Camp

after the earthquake and Water Source

Study Abroad Courses: St. Kitts

Disaster Preparedness Course

Poverty Simulation

Missouri Community Action Network

https://www.youtube.com/watch?v=E9T_MH45YXY&feat

ure=youtu.be

Refugee Health Fairs

http://www.greeleytribune.com/news/local/global-refugee-center-helps-refugees-navigate-health-care-in-america/

ProjectCURE- Warehouse

Students can volunteer to sort supplies

for international distribution.

https://projectcure.org/

Student Diversity

Health Coach at Turntable Healthhttps://www.usatoday.com/story/tech/2015/08/25/vegas-health-clinic-gambles-new-brand-primary-care/32305923/

School policies

Holidays

Dress

Piercings

Tattoos

Guidance to students

English as second language

Requires time to explain

Student accents

“speak slower”

Research

Education methodologies

Cultural relevance- instilling these in

our students

Five constructs:

cultural awareness

cultural knowledge

cultural skills

cultural encounters

cultural desires

Learn from our students

Sarah McLachlan World on Fire

https://www.youtube.com/watch?v=FDmPcSWE0WU

audrey.snyder@unco.edu