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TRANSCRIPT
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
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http://3.bp.blogspot.com/_T0gYy2QpElk/SSs0sy-W_oI/AAAAAAAAADY/3DCmOpjoBOk/s400/neck+rings1.jpg
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http://www.washington.emb.mfa.gov.tr/images/culture2.jpg
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http://www.burma-all.com/new%20burma-all.com/buddhist%20monks%20school.jpg
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http://www.africanconservancy.org/im...surmadisk1.gif
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http://thefinanser.co.uk/fsclub/2009/07/shamish-about-the-amish.html
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http://declubz.com/blog/2008/07/14/weird-tatoos/
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http://www.life.com/image/82072744
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http://blog.piercingmap.com/wp-content/uploads/2007/04/1.jpg
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http://thebovine.wordpress.com/2009/02/14/small-farmers-saying-nay-to-nais/
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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
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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