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Exam 4 Study Grid Culture/Diversity Types of culture orientation  Enculturation: Process by which a person learns norms, values, and behaviors of another culture o Example: A high school student from the United States spends a summer abroad with a family in Switzerland  Acculturation: Process of acquiring new attitudes, role, customs, or behaviors o Example: An immigrant from China develops a preference for Western foods and music  Assimilation: Process by which a person gives up his or her original identify and develops a new cultural identity by becoming absorbed into the dominant cultural group o Example: A Native American loses his Native identity after living in Chicago for 10 years  Biculturalism: Dual pattern of identification o Example: A woman of Christian faith married to a Muslim adopts some Muslim practices and also maintains some traditional Christian practices Process of cultural competence The process of cultural competence in delivering health care services is “a culturally conscious model of care in which a healthcare professional continually strives to achieve the ability and availability to effectively work within the cultural context of a client” (family, individual, or community) ( Transcultural C.A.R.E. Associates, 2015 ). It is a process of becoming culturally competent, not being culturally competent ( Transcultural C.A.R.E. Associates, 2015 ). The goal of delivering cultural care is to utilize research findings to provide culturally specific care that is safe and beneficial to the well-being of the diverse population Global impact on culture Historical and social realities shape an individual’s or group’s world view, which determines how people perceive others, how they interact and relate to reality, and how they process information. World view is a set of assumptions that begins to develop during childhood and guides how one sees, thinks about, experiences, and interprets the world . Our world view evolves during a lifetime process of interacting with family, peers, communities, organizations, media, and institutions (Fig. 9.1).  Enculturation: Process by which a person learns norms, values, and behaviors of another culture o Example: A high school student from the United States spends a summer abroad with a family in Switzerland  Acculturation: Process of acquiring new attitudes, role, customs, or behaviors o Example: An immigrant from China develops a preference for Western foods and music  Assimilation: Process by which a person gives up his or her original identify and develops a new cultural identity by becoming absorbed into the dominant cultural group o Example: A Native American loses his Native identity after living in Chicago for 10 years  Biculturalism: Dual pattern of identification o Example: A woman of Christian faith married to a Muslim adopts some Muslim practices and also maintains some traditional Christian practices Stereotypes, prejudice, bias, etc.

Steps of cultural competence Cultural awareness is the process of conducting a self-examination of one’s own biases toward other cultures. understanding oneself, acknowledging your biases Cultural knowledge is the process in which a health care professional seeks and obtains a sound educational base about culturally diverse groups. reading, visiting ethnic neighborhoods, sampling different foods, learning a language, attending community events, talking with someone from another culture Cultural skill is the ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patient’s presenting problem, as well as accurately conducting a culturally based physical assessment. paying close attention to nurse patient relationship. Communication, engagement, collaboration Cultural encounter is a process that encourages health care professionals to directly engage in face-to-face cultural interactions and other types of encounters with patients from culturally diverse backgrounds. Cultural desire is the motivation of a health care professional to “want to” (and not “have to”) engage in the process of becoming culturally aware, culturally knowledgeable, and culturally skillful in seeking cultural encounters. learning to become more attuned to cultural differences Culturally congruent care pg. 107 Culturally congruent care or transcultural care emphasizes the need to provide care based on an individual’s cultural beliefs, practices, and values ; therefore, effective communication is a critical skill in culturally competent care and helps you engage a patient and family in respectful, patient-centered dialogue  Treating the patient in way that is congruent or agreed upon for them and their family as well as the health care professional Goal of culturally competent care Understanding of others and their diverse cultures and still being able to treat them  The goal of cultural competence in health care settings is to reduce racial, economic, ethnic, and social disparities when meeting a community's health care needs. Health care disparities and social determinants pg.108 A persons social detriments play a role in the outcome of their health. A persons social status (where they’re born, work, live) will effect their health status Ex: a person who has always been isolated (living in mts. May then get health care and find out they have had uncontrolled diabetes, HTN, etc.) Health disparity

A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage (ODPHP, 2016) Social determinants of health The conditions in which people are born, grow, live, work, and age (WHO, 2019) Marginalized groups Gay, lesbian, bisexual, or transgender; people of color; people who are physically and/or mentally challenged; and people who are not college educated Equity/inequity, attributes, roles (use box 24.8) Use other grid and look over ppts Care for patients with limited English Required to provide language access services for their patients. For hospitals unable to provide on-site interpreters, telephone interpretation services must be available (Marcus, 2014). Use of family members, friends, or bilingual staff members to interpret for patients is strongly discouraged Communication Ch. 24 P&P Levels of communication- pg.324 Pg. 333-337 Clarification questions- #22 ch.24 comms (box 24.1) To check if pt. actually understood you, restate, repeat, teach back Use open ended questions Ask who, what, where, when, why, how Look for non-verbal and verbal cues (non-verbal tell you more(better)) Touch, gestures, etc. Clarifying– To check whether understanding is accurate, or to better understand, the nurse restates an unclear or ambiguous message to clarify the sender’s meaning. “I’m not sure I understand what you mean by ‘sicker than usual’, what is different now?” Types of therapeutic communication- #22&23 ch.24 comms Therapeutic communication techniques POSITIVE/GOOD • Providing information- Providing relevant information • Clarifying Questions - Check for understanding, restate an unclear message Focusing- centering a conversation • Paraphrasing- restating what you heard ( I heard you say this) • Validation • Asking relevant questions • Summarizing- concise • Self-disclosure • Confrontation- don’t be confrontational- only after trust, must be done using therapeutic technique o You help the other person become more aware of inconsistencies in his or her feelings, attitudes, beliefs, and behaviors Active listening- attentive to what pt is saying verbally and nonverbally SURETY model^ - Sit at angle facing pt - Uncross legs and arms - Relax & comfortable w pt

- Eye contact conveying willingness to listen to what pt is saying - Touch- communicate empathy & understanding to pt - Your intuition- Trust as you grow in confidence to individualize, adapt & apply communication • Therapeutic communication techniques • Sharing observations • Sharing empathy • Sharing hope- do not give false hope • Sharing humor • Sharing feelings • Using touch • Using silence Nontherapeutic communication techniques NEGATIVE/BAD • Asking personal questions- Asking personal questions that are not relevant to a situation simply to satisfy your curiosity is inappropriate professional communication. • Giving personal opinions- takes decision making away • Changing the subject • Automatic responses -Stereotypes are generalized beliefs held about people • False reassurance • Sympathy- A nurse’s own emotional issues sometimes prevent effective problem solving and impair good judgment. Nontherapeutic communication techniques • Asking for explanations- don’t use Why question ( perceived as accusations) • Approval or disapproval • Defensive responses • Passive or aggressive responses • Arguing Adapting communication techniques for the patient with special needs • Use thought and sensitivity • Adapt to unique circumstances, developmental level, or cognitive and sensory deficits • Communication types/techniques- start#22 ch.24 comms Non-verbal vs. Verbal • Verbal communication o Vocabulary – Communication is unsuccessful if senders and receivers cannot translate one another’s words and phrases. o Denotative and connotative meaning – Some words have several meanings. LOOK AT OTHER GRID FOR FURTHER EXPLINATION

Look at Box 24.9 (comm. w/ pts. w/ special needs) Box 24.7 (can be select all ques.) o Pacing – Conversation is more successful at an appropriate speed or pace. o Intonation – Tone of voice dramatically affects the meaning of a message. o Clarity and brevity – Effective communication is simple, brief, and direct. o Timing and relevance – Timing is critical in communication. • Nonverbal o Personal appearance – Includes physical characteristics, facial expressions, and manner of dress and grooming. o Posture and gait – Can be forms of self-expression. o Facial expressions – The face is the most expressive part of the body. o Eye contact – People signal readiness to communicate through eye contact. o Gestures – Emphasize, punctuate, and clarify spoken word. o Sounds – Sounds such as sighs, moans, groans, or sobs also communicate feelings and thoughts. o Territoriality and personal space – Territoriality is the need to gain, maintain, and defend one’s right to space. • Metacommunication – A broad term that refers to all factors that influence communication. • Intrapersonal- self talk • Interpersonal- one on one • Small group • Public • electronic Transactional communication process- #9&10 ch.24 comms

• Components: o Referent – Motivates one person to communicate with another. o Sender and receiver – Sender is the person who encodes and delivers a message. The receiver is the person who receives and decodes the message. o Message – Is the content of the communication. o Channels – Use communication channels to send and receive messages through visual, auditory, and tactile senses. o Feedback – Is the message a sender receives from the receiver. o Interpersonal variables – Are factors within both the sender and receiver that influence communication. o Environment – Is the setting for sender-receiver interactions. Interaction types • Nurse-patient caring relationships o Caring relationships are the foundation of clinical nursing practice; they are created with skill and trust • Phases of the helping relationship o Pre-interaction phase o Orientation phase o Working phase o Termination phase • Motivational interviewing

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