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Question 1 What must the nurse assess first when providing culturally competent health care to an Asian American patient? 1. The tradition of the Asian American culture and the health care practices r/t health and wellness 2. The nurse’s heritage-based cultural values, beliefs, attitudes, and practices 3. Any differences between the nurse’s culture and the Asian American culture 4. The attitudes of Asian American cultures to the health care system in the United States

Immigration and Health Care Concerns • Status of immigrants entering the health care system: • 14% of population were foreign born individuals. • Asian immigrants have outnumbered Hispanic immigrants • Ability to navigate the health system • 53% of foreign-born individuals, ages 9 and over report being proficient in the English language • Need for a cultural assessment • Communication is an essential component: • Need for an interpreter • Conveying information through materials that are based on health literacy principles

Risk Factors for Health Disparity • Certain racial or ethnic groups • Religion • Socioeconomic status • Gender • Age • Mental health • Disabilities • Geographic locations • Other forms of discrimination

National Standards for Culturally and Linguistically Appropriate Services in Health Care • First and landmark Standard * S o u r c e : N a ti o n a l S t a n d a r d s f o r C u l t u r a l l y a n d L i n g u i s ti c a l l y A p p r o p r i a t e S e r v i c e s i n H e a l t h C a r e , F i n a l R e p o r t , M a r c h 2 0 0 1 , W a s h i n g t o n , D C : O ffi c e o f M i n o r i t y H e a l t h , D H H S Health care organizations should ensure that patients receive from all staff members effective, understandable and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language*

Culture-Related Concepts (2 of 2) • Terminology • Race: Based on physical characteristics such as skin color, head form, stature • Ethnicity : Social group with shared traits • Ethnic identity : Self-identification with a particular ethnic group • Ethnocentric: Attitude that the values, beliefs, and standards of one’s own ethnic group is superior • Acculturation : Process of adopting culture and behavior of the majority culture • Assimilation : Taking on the characteristics of the dominant culture • Biculturalism and integration : Allow for reciprocal change and maintaining ethnic identity – now preferred terms • Acculturative stress : Based on input from environment, social/interpersonal and societal

• Spirituality : • Broader term that encompasses something larger than one’s own existence with a belief in transcendence • Spirituality helpful in times of crisis such as serious illness or impending death • Religion : • Organized system of beliefs as a shared experience that can assist in meeting one’s individual spiritual needs • May influence decisions regarding medical and surgical treatments • Two concepts that can be interrelated but do not have to exist simultaneously • Individuals define their feelings and beliefs. Religion and Spirituality

Spiritual Assessment • Important to perform a spiritual assessment as part of a holistic assessment • Changing religious landscape in the world • In the U. S., only 62% of adults report being Christian • Can help to improve coping mechanisms • Promote engagement and improve outcomes • Identification of referral needs • Discussion of medical care

Health-Related Beliefs & Practices • Definition of health: • Balance of the person within the physical ( physical, mental & spiritual ) & outside world ( natural, communal or metaphysical ) • Complex interrelated phenomenon • Understand the logic of the belief system through the individual’s culture

Beliefs About Causes of Diseases • Biomedical or scientific • Cause and effect that can provide physical and psychological illnesses —e.g., germ theory • Naturalistic or holistic • Belief in the forces of nature that there is balance in the universe — e.g., yin/yang theory • Yin/Yang • Yin negative forces • Yang positive forces

Beliefs About Causes of Diseases • Naturalistic or holistic-cont • Hot/cold theory • Based on the four humors (blood, phlegm, black bile, yellow bile) • Add or subtract cold, heat, dryness, or wetness to restore balance • Magicoreligious • Supernatural forces dominate resulting in good versus evil—e.g., voodoo or faith healing • Hmong culture: If soul scared then illness will result

Traditional Treatments and Folk Healers • Each culture has its own proclaimed healers • Healing is not complete unless body and mind are healed. • Use of alternative, complementary, or traditional therapies • Use of technologic resources have led to increased numbers of individuals who self-treat • Increased variety of complementary therapies combined with adoption of non-traditional health therapies are now recognized by the traditional healthcare system models • Acupuncture, acupressure, therapeutic touch, massage, therapeutic use of music, biofeedback, relaxation techniques, meditation, hypnosis, distraction, imagery, iridology, reflexology, and herbal remedies

Traditional Treatments and Folk Healers Hispanics: • Curandero (ra)- healer • Espiritualista- spiritualist • Yerbo (ba)- herbalist • Partera-lay midwife Blacks: Houngan-voodoo priest or priestess Spiritualist or “old lady Native American: • Shaman- medicine man or woman

Traditional Treatments and Folk Healers Asians: • Herbalists • Acupuncturists • Bonesetters Amish: Braucher

Developmental Competence • Awareness of beliefs across the life cycle can impact perception of health care delivery and treatments • Parenteral perceptions of illness • Cultural taboos • Values held by dominant culture influence perception of older adults • Independence, self-reliance, and productivity • Care-dependent versus caregivers • Culture shock

Becoming a Culturally Sensitive Practitioner • Cultural Awareness • Recognize your own culture before you can work with to understand a different culture. • Cultural Knowledge & Skills • Learn about other cultures & obtain needed skills through your clinical experience. • Cultural Humility • See values in other beliefs.

Completing a Cultural Assessment • Cultural Sensibility: • “proactive behavior by healthcare providers who examine cultural situations through thoughtful reasoning, responsiveness & discrete interactions”. • Do not apply stereotypes but listen and learn. • Recommended list of domains of interest that may be included: • Heritage, health practices and communication • Family roles and social orientation, nutrition and pregnancy, birth/childrearing • Spirituality/religion, death, and health providers

Spiritual Assessment • Use open-ended questions to start the conversation • “Do you have any religious or spiritual preferences that we can support”? • Screening Tool • FICA—Faith, importance/influence, community and address/action