NR 601 Week 7 Exam with verified detailed answers ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Terms in this set (80) ||\\//|| ||\\//|| ||\\//|| ||\\//||
Original
What is culture? ||\\//|| ||\\//||
culture refers to an everchanging set of shared symbols, beliefs, and customs that shapes
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
individual and/or group behavior. ||\\//|| ||\\//|| ||\\//||
What is cultural competency? ||\\//|| ||\\//|| ||\\//||
a set of congruent behaviors, attitudes, and policies that come together in a system,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
organization, or among professionals that enables effective work in cross-cultural situations. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
One major critique of cultural competency is
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
low likelihood that sufficient cultural understanding can be obtained. Given that culture is an
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
everchanging process, categoric approaches to cultural competence training can potentially ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
result in unintended stereotyping and bias. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Wanda is a nurse practitioner in a community nursing home (NH) in Cleveland, Ohio, where
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
she has worked as the "house provider" for the past 3 years. She is 59 years old, Caucasian,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
and has worked in a variety of care settings and practices over the past 20 years. Christopher
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
is an LPN who works at the same facility. He is a 37-year-old Black man and is thinking
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
about going back to school to get his Bachelor of Science in Nursing. The clients they serve
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
at this NH are primarily low-income (Medicaid) and people of different races. The mandatory,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
, annual workshop on Cultural Competency Training was held last week. Wanda dutifully
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
attends the workshop and endorses the importance of learning about all types of people and
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
different backgrounds. She proudly displays her workshop certificate on the bulletin board
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
over her desk. Christopher is a little more restless about the content and feels it is a bit
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
oversimplified.
The following week, he does the admission intake for a new resident who is Afro-Caribbean
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(Haitian) and realizes that he is having a hard time understanding the woman and her family,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
both in language and "other ways." He is not sure why it makes him uncomfortable and he
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
is determined to spend more time with her and the family to ask more questions and
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
demonstrate his curiosity about her life in Haiti and how that impacts her views on day-to- ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
day living and approach to healthcare. This dialogue expands on a daily basis, as Christopher
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
does not allow his lack of familiarity with Haitian culture to be a barrier to a caring
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
relationship.
1. What are the differences between cultural competence and cultural humility?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
2. How did the reactions to the workshop differ between Wanda and Christopher?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
3. How should professional development "messages" be formatted to allow for greater
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
success when translated to the bedside? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Cultural humility in patient care ||\\//|| ||\\//|| ||\\//|| ||\\//||
Establishing a Therapeutic Relationship ||\\//|| ||\\//|| ||\\//||
Allows Providers to Comfortably Adhere to Person-Centered Care
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Ensures That Flexibility in Care Is Maintained ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Healthcare Provider Shortages (or Malalignment) ||\\//|| ||\\//|| ||\\//|| ||\\//||
Promote Diversity and Inclusion in Training and Hiring ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Person-centered care" involves considering a person's desires, family situations, social ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
circumstances, and values. To achieve this level of awareness, clinicians must seek and ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
maintain a level of cultural awareness and sensitivity. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
,The dominant US cultural definition of personhood in terms of independence and
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
achievement leads to excess disability and suffering among people with conditions like ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
dementia.
Dementia and personhood ||\\//|| ||\\//||
When personhood is defined as the ability to relate to others appropriately, dementia is less
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
of a threat to the patient's personhood.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Interactions With Coworkers ||\\//|| ||\\//||
Promotes Collective Growth of Healthcare Team (Avoids Dominance of Certain Cultural ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Identities)
Nettie Mae is 78 years old and widowed. She is Black and raised her family on a farm in
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Virginia and now lives with her grandson and his wife and their three small children. Her
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
own children live nearby and join for meals on a weekly basis. The family knows that she is
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
forgetful, and they do not like to leave her at home. She started a small fire in the kitchen
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
last year, and her family no longer lets her cook. In a joking but firm way, they took her car
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
keys away and did not allow her to drive.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Over the next 3 years, she became increasingly dependent on family for self-care and was
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
less able to have a conversation. However, she remained a vital part of the family and was
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
assisted to church and all family outings. The stories of days gone by that she had told for
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
decades are now told on her behalf by family members. Her daughter reports a back strain
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
associated with providing the heavy care that is now required by Ms. Nettie Mae. You raise ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
the consideration of assisted living or nursing home. The family politely and repeatedly
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
declines the need for any such assistance. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
1. If you had a parent or grandparent who needed assistance at the level of Ms. Nettie Mae,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
what criteria would you use to determine whether you could maintain her in your home? To
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
what extent do you believe that these criteria differ across different cultures?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
, 2. How does the definition of "personhood" impact how the family responds to her change
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
in care needs and family integration?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Many cultures rely on a family-centered approach (collectivism) as a principle for major
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
decision making, which opposes the autonomic/individual approaches of Western medicine. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
In collective decision making, family members often receive information about the diagnosis
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
and prognosis of the patient, and make treatment choices without consulting the patient. To
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
manage these situations, the clinician should consult with the patient regarding how he or ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
she would like to make treatment decisions and determine the extent to which the
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
patient/family members would like to be involved in the treatment decision. This requires a ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
skillful and artful approach. ||\\//|| ||\\//|| ||\\//||
Further, cultures that have experienced historical disenfranchisement or discrimination from
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
the healthcare system may be reluctant to trust clinicians.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
This distrust may be enhanced if the clinician is of a different race and/or ethnic background.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
To address this potential concern, the clinician can encourage the patient or family member
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
to inform them if they have quality-of-care concerns and reinforce to the patient/family that
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
decision-making processes will be a collective effort. Developing rapport with patients and ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
their family members to let them know that you are interested in their cultural heritage will
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
help facilitate more open communication when discussing end-of-life treatments.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Rosario is a 79-year-old Mexican-American woman with multiple medical problems, including
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
severe ischemic cardiomyopathy, diabetic neuropathy, peripheral vascular disease, and
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
moderate Alzheimer-type dementia. She had a below-the-knee-amputation 4 years ago. Her ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
renal function is declining and has recently approached the level of considering dialysis. A
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
few days after Thanksgiving, she is hospitalized for an exacerbation of heart failure (likely
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
because of dietary indiscretion). She becomes delirious in the hospital, which is distressing to||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
the patient and family. The inpatient team arranges a family meeting to discuss treatment
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
preferences and is surprised that the family is still wanting to be "full code." ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Terms in this set (80) ||\\//|| ||\\//|| ||\\//|| ||\\//||
Original
What is culture? ||\\//|| ||\\//||
culture refers to an everchanging set of shared symbols, beliefs, and customs that shapes
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
individual and/or group behavior. ||\\//|| ||\\//|| ||\\//||
What is cultural competency? ||\\//|| ||\\//|| ||\\//||
a set of congruent behaviors, attitudes, and policies that come together in a system,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
organization, or among professionals that enables effective work in cross-cultural situations. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
One major critique of cultural competency is
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
low likelihood that sufficient cultural understanding can be obtained. Given that culture is an
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
everchanging process, categoric approaches to cultural competence training can potentially ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
result in unintended stereotyping and bias. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Wanda is a nurse practitioner in a community nursing home (NH) in Cleveland, Ohio, where
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
she has worked as the "house provider" for the past 3 years. She is 59 years old, Caucasian,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
and has worked in a variety of care settings and practices over the past 20 years. Christopher
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
is an LPN who works at the same facility. He is a 37-year-old Black man and is thinking
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
about going back to school to get his Bachelor of Science in Nursing. The clients they serve
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
at this NH are primarily low-income (Medicaid) and people of different races. The mandatory,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
, annual workshop on Cultural Competency Training was held last week. Wanda dutifully
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
attends the workshop and endorses the importance of learning about all types of people and
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
different backgrounds. She proudly displays her workshop certificate on the bulletin board
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
over her desk. Christopher is a little more restless about the content and feels it is a bit
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
oversimplified.
The following week, he does the admission intake for a new resident who is Afro-Caribbean
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(Haitian) and realizes that he is having a hard time understanding the woman and her family,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
both in language and "other ways." He is not sure why it makes him uncomfortable and he
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
is determined to spend more time with her and the family to ask more questions and
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
demonstrate his curiosity about her life in Haiti and how that impacts her views on day-to- ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
day living and approach to healthcare. This dialogue expands on a daily basis, as Christopher
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
does not allow his lack of familiarity with Haitian culture to be a barrier to a caring
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
relationship.
1. What are the differences between cultural competence and cultural humility?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
2. How did the reactions to the workshop differ between Wanda and Christopher?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
3. How should professional development "messages" be formatted to allow for greater
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
success when translated to the bedside? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Cultural humility in patient care ||\\//|| ||\\//|| ||\\//|| ||\\//||
Establishing a Therapeutic Relationship ||\\//|| ||\\//|| ||\\//||
Allows Providers to Comfortably Adhere to Person-Centered Care
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Ensures That Flexibility in Care Is Maintained ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Healthcare Provider Shortages (or Malalignment) ||\\//|| ||\\//|| ||\\//|| ||\\//||
Promote Diversity and Inclusion in Training and Hiring ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Person-centered care" involves considering a person's desires, family situations, social ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
circumstances, and values. To achieve this level of awareness, clinicians must seek and ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
maintain a level of cultural awareness and sensitivity. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
,The dominant US cultural definition of personhood in terms of independence and
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achievement leads to excess disability and suffering among people with conditions like ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
dementia.
Dementia and personhood ||\\//|| ||\\//||
When personhood is defined as the ability to relate to others appropriately, dementia is less
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of a threat to the patient's personhood.
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Interactions With Coworkers ||\\//|| ||\\//||
Promotes Collective Growth of Healthcare Team (Avoids Dominance of Certain Cultural ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Identities)
Nettie Mae is 78 years old and widowed. She is Black and raised her family on a farm in
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Virginia and now lives with her grandson and his wife and their three small children. Her
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own children live nearby and join for meals on a weekly basis. The family knows that she is
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forgetful, and they do not like to leave her at home. She started a small fire in the kitchen
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last year, and her family no longer lets her cook. In a joking but firm way, they took her car
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keys away and did not allow her to drive.
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Over the next 3 years, she became increasingly dependent on family for self-care and was
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less able to have a conversation. However, she remained a vital part of the family and was
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assisted to church and all family outings. The stories of days gone by that she had told for
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decades are now told on her behalf by family members. Her daughter reports a back strain
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associated with providing the heavy care that is now required by Ms. Nettie Mae. You raise ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
the consideration of assisted living or nursing home. The family politely and repeatedly
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declines the need for any such assistance. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
1. If you had a parent or grandparent who needed assistance at the level of Ms. Nettie Mae,
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what criteria would you use to determine whether you could maintain her in your home? To
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what extent do you believe that these criteria differ across different cultures?
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, 2. How does the definition of "personhood" impact how the family responds to her change
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in care needs and family integration?
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Many cultures rely on a family-centered approach (collectivism) as a principle for major
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decision making, which opposes the autonomic/individual approaches of Western medicine. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
In collective decision making, family members often receive information about the diagnosis
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and prognosis of the patient, and make treatment choices without consulting the patient. To
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manage these situations, the clinician should consult with the patient regarding how he or ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
she would like to make treatment decisions and determine the extent to which the
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patient/family members would like to be involved in the treatment decision. This requires a ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
skillful and artful approach. ||\\//|| ||\\//|| ||\\//||
Further, cultures that have experienced historical disenfranchisement or discrimination from
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the healthcare system may be reluctant to trust clinicians.
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This distrust may be enhanced if the clinician is of a different race and/or ethnic background.
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To address this potential concern, the clinician can encourage the patient or family member
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to inform them if they have quality-of-care concerns and reinforce to the patient/family that
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decision-making processes will be a collective effort. Developing rapport with patients and ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
their family members to let them know that you are interested in their cultural heritage will
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help facilitate more open communication when discussing end-of-life treatments.
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Rosario is a 79-year-old Mexican-American woman with multiple medical problems, including
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severe ischemic cardiomyopathy, diabetic neuropathy, peripheral vascular disease, and
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moderate Alzheimer-type dementia. She had a below-the-knee-amputation 4 years ago. Her ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
renal function is declining and has recently approached the level of considering dialysis. A
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few days after Thanksgiving, she is hospitalized for an exacerbation of heart failure (likely
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because of dietary indiscretion). She becomes delirious in the hospital, which is distressing to||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
the patient and family. The inpatient team arranges a family meeting to discuss treatment
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preferences and is surprised that the family is still wanting to be "full code." ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
