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Introduction To Nursing (RNSG 1309)
Laredo College
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CHAPTER 6
Health and Wellness
•Health is a multidimensional concept that must be viewed in a broad er sense than good health,
wellness, or the absence of disease. Models of health offer a pers pective from which to understand the relationships between health, wellness, and illness.
•Nurses who understand how patients react to illness can minimiz e the effects of illness and help
patients and their families maintain or return to their highest level of functioning.
OBJECTIVES
Describe variables influencing health beliefs and practice
Describe health promotion, wellness, and disease prevention activities
Discuss the 3 levels of preventive care
Discuss risk factor modification and changing health behaviors
Describe variables influencing illness behavior
Describe the effect of illness on patients and families
Discuss a nurse’s role in health and illness
HEALTHY PEOPLE DOCUMENTS
➔ Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention, 1979 ➔ Healthy People 2000: National Health Promotion and Disease Prevention Objectives ➔ Healthy People 2010 ➔ Healthy People 2020 ◆ The U. government set national health care goals back in 1979 , with the publication of Healthy People: The Surgeon General’s Report on Health Promotion and Disease . The report outlined priority objectives for preventive services, he alth protection, and health promotion that addressed improvements in health status, risk reduct ion, public and professional awareness of prevention, health services and protecti ve measures, surveillance, and evaluation. ◆ Since then, three more documents have been developed to ident ify and address health care needs. ◆ Healthy People 2010 served as a road map for improving the health of all people in the United States. This edition emphasized the link between indi vidual and community health and the premise that the health of communities determines the o verall health status of the nation. ◆ Healthy People 2020 goals are on the next slide. ➔ Healthy People 2020 Goals ◆ Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death ◆ Achieve health equity, eliminate disparities, and improve the health of all groups ◆ Create social and physical environments that promote good health for all ◆ Promote quality of life, healthy development, and healthy behaviors across all life stages
DEFINITION OF HEALTH
➔ A state of complete physical, mental, and social well-being, n ot merely the absence of disease or infirmity (WHO, 1947) ➔ A state of being that people define in relation to their own values, personality, and lifestyle ◆ Individual views of health vary among age groups, genders, races, and cultures. ◆ To help patients identify and reach health goals, nurses discove r and use information about their concepts of health. ◆ Nurses need to consider the total person and the environment in which the person lives to individualize nursing care and enhance meaningfulness of the patient’s future health status.
MODELS OF HEALTH AND ILLNESS
➔ A model is a theoretical way of understanding a concept or idea ➔ Health beliefs ➔ Health behaviors ◆ Positive ◆ Negative ◆ Models represent different ways of approaching complex issues. Be cause health and illness are complex concepts, models are used to understand th e relationships between these concepts and the patient’s attitudes toward health and health behaviors. ◆ Health beliefs are a person’s ideas, convictions, and attitude s about health and illness. They may be based on factual information or misinformation, co mmon sense or myths, or reality or false expectations. Because health beliefs usual ly influence health behavior, they can positively or negatively affect a patient’s level of health. ◆ Positive health behaviors are activities related to maintaini ng, attaining, or regaining good health and preventing illness. ◆ Negative health behaviors include practices actually or potentially harmful to health.
➔ Rosenstoch’s (1974) and Becker and Maiman’s (1975) health belief model addresses the relationship between a person’s beliefs and behaviors. The health belief model helps you
➔ The hierarchy of needs model provides a basis for nurses to care for patients of all ages in all health settings. However, when applying the model, the focus of care is on a patient’s needs rather than on strict adherence to the hierarchy. To provide the most effective care, you need to understand the relationships of different needs and the factors that determine the priorities for each patient. ➔ Health care has begun to take a more holistic view of health by considering emotional and spiritual well-being and other dimensions of an individual to be important aspects of physical wellness. ➔ In this model, nurses using the nursing process consider patients to be the ultimate experts concerning their own health and respect patients’ subjective experience as relevant in maintaining health or assisting in healing. In the holistic health model, patients are involved in their healing process, thereby assuming some responsibility for health maintenance. ➔ Nurses use holistic therapies either alone or in conjunction with conventional medicine. ➔ Basic human needs are elements that are necessary for human survival and health. Eg-food water safety and love) ➔ All persons have unique needs, all have basic needs. Some needs must be met before other needs. ➔ Apply to each patient individually.
VARIABLES INFLUENCING HEALTH AND HEALTH BELIEFS AND PRACTICES
➔ Variables influence how a person thinks and acts ➔ Health beliefs can negatively or positively influence health behavior or health practices ◆ Understanding the effects of these variables allows you to plan and deliver individualized nursing care.
INTERNAL VARIABLES
➔ Developmental Stage (growth and development) ➔ Intellectual Background (knowledge or lack of) ➔ Perception of Functioning (physical function) ➔ Emotional Factors (stress, fear, depression) ➔ Spiritual Factors (example: religion) ◆ Internal variables include a person’s developmental stage, intellectual background, perception of functioning, and emotional and spiritual factors. ◆ The nurse considers the patient’s level of growth and development when using health beliefs and practices as a basis for planning care. A person’s thought and behavior patterns change throughout life. ◆ A person’s beliefs about health are shaped in part by the person’s knowledge, lack of knowledge, or incorrect information about body functions and illnesses, educational background, traditions, and past experiences. These variables influence how a patient thinks about health. In addition, cognitive abilities shape the way a person thinks, including the ability to understand factors involved in illness and apply knowledge of health and illness to personal health practices. Cognitive abilities also relate to a person’s developmental stage. ◆ When you assess a patient’s level of health, gather subjective data about the way the patient perceives physical functioning such as level of fatigue, shortness of breath, or pain. Then obtain objective data about actual functioning such as blood pressure, height measurements, and lung sound assessment. This information allows you to more successfully plan and implement individualized care. ◆ The manner in which a person handles stress throughout each phase of life influences the way he or she reacts to illness. A person who generally is very calm may have little emotional response during illness, whereas another individual may be unable to cope emotionally with the threat of illness and may overreact or deny the presence of symptoms and not take therapeutic action. ◆ Spirituality is reflected in how a person lives his or her life, including the values and beliefs exercised, the relationships established with family and friends, and the ability to find hope and meaning in life. Religious practices are one way that people exercise spirituality. Some religions restrict the use of certain forms of medical treatment.
EXTERNAL VARIABLES
➔ Family Practices (use of health care) ➔ Psychosocial and Socioeconomic Factors (neighbors, peers, co-workers) ➔ Cultural Background (values, beliefs, customs) ◆ External variables influencing a person’s health beliefs and practices include family practices, socioeconomic factors, and cultural background.
◆ Focuses on those who have health problems or illnesses and are at risk for developing complications or worsening conditions (Hypertension--heart attack or stroke) ➔ Tertiary Prevention ◆ Occurs when a defect or disability is permanent or irreversible (car accident—paralysis of lower extremities-learns to use wheelchair) ➔ Nursing care oriented to health promotion, wellness, and illness prevention is described in terms of health activities on primary, secondary, and tertiary levels. ➔ Primary prevention aimed at health promotion includes health education programs, immunizations, nutritional programs, and physical fitness activities. ➔ Secondary prevention is delivered in homes, hospitals, or skilled nursing facilities. ➔ Tertiary prevention aims to help patients achieve as high a level of functioning as possible. This level of care is called preventive care because it involves preventing further disability or reduced functioning.
RISK FACTORS
➔ Variables that increase the vulnerability of an individual or a group to an illness or accident ➔ Risk factors include: ◆ Genetic and physiological factors ◆ Age ◆ Environment ◆ Lifestyle ➔ A risk factor is any situation, habit, or other variable such as social, environmental, physiological, psychological, developmental, intellectual, or spiritual that increases the vulnerability of an individual or group to an illness or accident. ➔ Genetic and physiological factors, such as being overweight, affect physical functioning of the body. Heredity, or genetic predisposition to specific illness, is a major physical risk factor. ➔ Age affects a person’s susceptibility to certain illnesses. ➔ The physical environment in which a person works or lives can increase the likelihood that certain illnesses will occur. Environment includes things like cleanliness, heat, cold, overcrowding, and air quality. ➔ Lifestyle practices and behaviors have positive or negative effects on health.
RISK-FACTOR MODIFICATION AND CHANGING HEALTH BEHAVIORS
➔ Precontemplation - no change for next 6 months ➔ Contemplation - wants change next 6 months ➔ Preparation - small changes next month ➔ Action - actively engaged for 6 months ➔ Maintenance stage - sustained after 6 months and throughout life ◆ Discuss health hazards with a patient following a comprehensive nursing assessment, then help the patient decide if he or she wants to maintain or improve his or her health status by taking risk-reduction actions. ◆ Understanding the process of changing behaviors will help you support difficult health behavior changes in patients. It is believed that change involves movement through a series of stages. ◆ These stages range from no intention to change (precontemplation), considering a change within the next 6 months (contemplation), making small changes (preparation), and actively engaging in strategies to change behavior (action) to maintaining a changed behavior (maintenance stage). ◆ As individuals attempt a change in behavior, relapse followed by recycling through the stages frequently occurs. When relapse occurs, a person will return to the contemplation or precontemplation stage before attempting the change again. Relapse is a learning process, and people can apply the lessons learned from relapse to their next attempt to change.
◆ Most behavior-change programs are designed for (and have a chance of success when) people are ready to take action regarding their health behavior problems. ◆ Changes are maintained over time only if they are integrated into an individual’s overall lifestyle. ◆ Maintaining healthy lifestyles can prevent hospitalizations and potentially lower the cost of health care. ➔ Patient Teaching: Lifestyle Changes ◆ Objective ◆ Patient will reduce health risks related to poor lifestyle habits through behavior change ➔ Teaching strategies ◆ Provide active listening, ask about perceived barriers, assist the patient in establishing goals, and reinforce the process of change ➔ Evaluation ◆ Have the patient track adherence, and provide positive reinforcement ➔ Stress the importance of setting a goal when teaching lifestyle changes. ➔ Use written resources that are at an appropriate reading level. ➔ Ensure that educational materials are culturally appropriate. ➔ Include family members to support the lifestyle change.
ILLNESS
➔ A state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired ➔ Acute Illness ◆ Short duration and severe ➔ Chronic Illness ◆ Persists longer than 6 months ➔ Acute and chronic illnesses are two general classifications of illness used in this chapter. Both acute and chronic illnesses have the potential to be life threatening. ➔ An acute illness is usually reversible, has a short duration, and is often severe. The symptoms appear abruptly, are intense, and often subside after a relatively short period. An acute illness may affect functioning in any dimension. ➔ A chronic illness persists, usually longer than 6 months, is irreversible, and affects functioning in one or more systems. Patients often fluctuate between maximal functioning and serious health relapses that may be life threatening. Many chronic illnesses are related to four modifiable health behaviors: physical inactivity, poor nutrition, use of tobacco, and excessive alcohol consumption. ➔ Patients with chronic diseases and their families continually adjust and adapt to their illnesses. How an individual perceives an illness influences the type of coping responses. In response to a chronic illness, an individual develops an illness career. The illness career is flexible and changes in response to changes in health, interactions with health professionals, psychological changes related to grief, and stress related to the illness.
ILLNESS BEHAVIOR
➔ Involves how people monitor their bodies and define and interpret their symptoms ➔ Variables influencing illness and illness behavior ◆ Internal variables: Perception of illness and nature of illness ◆ External variables: Visibility of symptoms, social group, cultural background, economics, and accessibility to health care ➔ People who are ill generally act in a way that medical sociologists call illness behavior. It involves how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the resources in the health care system. ➔ How people react to illness varies widely; illness behavior displayed in sickness is often used to manage life adversities. In other words, if people perceive themselves to be ill, illness behaviors become coping mechanisms.
CARING FOR YOURSELF
➔ Eat a nutritious diet ➔ Get adequate sleep ➔ Engage in exercise and relaxation activities ➔ Establish a good work family balance ➔ Engage in regular non-work activities ➔ Develop coping skills ➔ Allowing personal time for grieving ➔ Focus on spiritual health ➔ Find a mentor ◆ Nurses are particularly susceptible to the development of compassion fatigue and the subsequent problems of secondary traumatic stress and burnout. ◆ Compassion fatigue develops as a result of the relationships that nurses develop with their patients and families, whereas burnout stems from conflicts or nurse job dissatisfaction within the work setting. ◆ Compassion fatigue and burnout frequently affect a nurse’s health, often leading to a decline in health, changes in sleep and eating patterns, emotional exhaustion, irritability, restlessness, impaired ability to focus and engage with patients, feelings of hopelessness, inability to take pleasure from activities, and anxiety. ◆ It is important for nurses to engage in personal and professional strategies to help combat compassion fatigue and promote resiliency. ◆ Personal strategies focus on health-promoting behaviors and healthy lifestyle choices. In an effort to combat secondary traumatic stress and burnout, you need to eat a nutritious diet, get adequate sleep, engage in exercise and relaxation activities, establish a good work-family balance, and engage in regular nonwork activities. Other strategies include developing coping skills, allowing personal time for grieving the loss of patients, and focusing on one’s own spiritual health. It can also help to find a mentor or an experienced nurse who understands the stress of the job and can help you identify coping strategies. ◆ An increasing number of health care institutions and organizations are offering educational programs for the nursing staff that are designed to help decrease compassion fatigue and increase resiliency.
CHAPTER 9
CULTURAL AWARENESS
•In the United States many individuals face greater obstacles to go od health on the basis of racial or ethnic group; religion; socioeconomic status; gender; age ; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity ; geographic location; or other characteristics historically linked to discrimination or exclusion.
•Culture relates to all of these factors.
•Research findings reveal differences in rates of cancer, diabete s, infant mortality, organ transplantation, and many other health conditions because of cultural factors.
OBJECTIVES
Describe cultural influences on health and illness.
Describe steps toward developing cultural competence.
Describe the relationship between cultural competence and patient centered care.
Use cultural assessment to plan culturally competent care.
Differentiate culture competent care and culturally congruent care.
Describe nursing interventions that achieve culturally congruent care.
HEALTH DISPARITIES
➔ Health disparity ◆ A particular type of health difference that is closely linked w ith social, economic, and/or environmental disadvantage (USDHHS, 2015) ➔ Social Determinants of Health ◆ The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, nationa l, and local levels (WHO, 2013) ➔ Healthy People 2020 defines a health disparity as “a particular type of health differe nce that is closely linked with social, economic, and/or environmental disadvantage.” ➔ The word parity means “equality.” Health disparity is literally an inequality or a gap between the health status of a disadvantaged group such as people with low in comes and wealth and an advantaged group such as people with high incomes and wealth. ➔ Members of the disadvantaged group bear a burden of disease, i njury, and violence that is disproportionate to the size of the group. ➔ While Americans’ health overall has improved during the past few d ecades, the health of members of marginalized groups has actually declined. ➔ Many organizations have developed different models incorpo rating social determinants of health to explain the complexity of these interactions.
HEALTH DISPARITIES AND HEALTH CARE
➔ Health care disparities ◆ Differences among populations in the availability, accessi bility, and quality of health care services ➔ Addressing health care disparities ◆ Focus on cultural competency, health literacy, and patient- and family-centered care
we are all affected by the system of oppression. Understanding the dynamics of oppression that operate on various levels while simultaneously affecting you a nd your patients helps you engage in the process of becoming more culturally competent. ➔ The many categories that comprise culture are not isolated from ea ch other—they stand alone, interact, and are interdependent and mutually reinforcing. Alt hough both groups and individuals within cultural groups may share commonalties in their experiences of oppression, there are also differences in these experiences. Including oppression in our definition of culture helps us recognize the profound effect it has on the individual and group experiences of all of us. ➔ Understanding culture requires you to adopt an intersectional p erspective. This allows you to consider the multitude of different experiences of your patient s so that you can provide effective, evidence-based, culturally competent care.
CULTURALLY CONGRUENT CARE
➔ Transcultural nursing ◆ A comparative study of cultures to understand their similarities and differences ➔ Culturally congruent care ◆ Care that fits a person’s life patterns, values, and system of meaning ➔ Leininger defines transcultural nursing as a comparative stud y of cultures to understand their similarities (culture that is universal) and the differences am ong them (culture that is specific to particular groups). The goal of transcultural nursing is to provid e culturally congruent care, or care that fits a person’s life patterns, values, and system of mean ing. Patterns and meaning are generated by people themselves rather than from predetermined criteria. ➔ Effective nursing care integrates the cultural values and belie fs of individuals, families, and communities with the perspectives of a multidisciplinary team of health care providers. ➔ When you provide culturally congruent care, you bridge cultura l gaps to provide meaningful and supportive care for all patients. ➔ Do not assume that all members of a cultural group will feel th e same way about a given situation. Instead, combine your knowledge about a cultural g roup with an attitude of helpfulness and flexibility to provide quality, patient-centered, culturally congruent care.
MEANING OF DISEASE AND ILLNESS
➔ Cultural affects how an individual defines the meaning of illness ➔ Illness ◆ The way that individuals and families react to disease ➔ Disease ◆ Malfunctioning biological or psychological processes ➔ Culture and life experiences shape a person’s world view about health, illness, and health care. ➔ To provide culturally congruent care, you need to understand the di fference between disease and illness. ➔ People tend to react differently to diseases on the basis of t heir unique cultural perspective. Most health care providers in the United States are primarily educat ed to treat disease, whereas most individuals seek health care because of their experience wit h illness. In addition, there is a lack of cultural diversity among health care providers. This often frus trates patients and providers, fostering a lack of trust, lack of adherence, and poor health outcomes. ➔ Providing safe, quality care to all patients means taking into c onsideration both disease and illness.
CULTURAL COMPETENCY
➔ Defined as the enabling of health care providers to deliver serv ices that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patient ➔ Culturally competent organizations ◆ Value diversity ◆ Conduct a cultural self-assessment ◆ Manage the dynamics of difference ◆ Institutionalize cultural knowledge ◆ Adapt to diversity ➔ Developing cultural competency allows systems, agencies, an d groups of professionals to function effectively to understand the needs of groups access ing health information and health care and thus help eliminate health care disparities and ultimately health disparities. ➔ A culturally competent organization integrates these princip les and capabilities into all aspects of the organization and systematically involves consumers, key stakeholders, and communities. ➔ In 2000 the Office of Minority Health (OMH) developed the Cultu rally and Linguistically Appropriate Standards (CLAS). In 2013, after 10 years of successful implementation, the OMH updated the standards to reflect the tremendous growth in the field and the increasing diversity of the nation. The enhanced national CLAS are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a b lueprint to help individuals and health care organizations implement culturally and linguistically appropriate services.
- Respecting a patient’s health beliefs and understanding the e ffect of the patient’s beliefs on health care
delivery
- Shifting a model of understanding a patient’s experience from a d isease happening in the patient’s
organ systems to that of an illness occurring in the context of culture
Ability to elicit a patient’s explanation of an illness and its causes
Ability to explain to a patient the health care provider’s pers pective on the illness and its perceived
causes
- Being able to negotiate a mutually agreeable, safe, and effective treatment plan
➔ In its early stages, the field of cultural competency primarily foc used on the cultural barriers between health-care providers educated in Western health care p ractices and immigrants arriving from non-Western parts of the world. ➔ The early pioneers in cross-cultural medicine outlined a set of uni versal skills that are still applicable for helping health care providers work effectivel y with patients from any culture. These skills include: ➔ 1. Respecting a patient’s health beliefs as valid and underst anding the effect of the patient’s beliefs on health care delivery ➔ 2. Shifting a model of understanding a patient’s experience from a d isease happening in his or her organ systems to that of an illness occurring in the contex t of culture (biopsychosocial context) ➔ 3. Ability to elicit a patient’s explanation of an illness and its causes (patient’s explanatory model) ➔ 4. Ability to explain to a patient in understandable terms the h ealth care provider’s perspective on the illness and its perceived causes ➔ 5. Being able to negotiate a mutually agreeable, safe, and effective treatment plan
•As a nurse you are responsible for assessing patients’ health issues within their world view.
PATIENT CENTERED CARE
➔ Landmark reports ◆ Crossing the Quality Chasm (IOM, 2001) ◆ Unequal Treatment (Smedley et al., 2003) ➔ Cultural Competence vs. Patient-Centered Care ◆ Each emphasizes different aspects of quality ◆ Patient-centeredness provides individualized care and resto res an emphasis on personal relationships ◆ Cultural competence aims to increase health equity and reduce di sparities by concentrating on people of color and other disadvantaged populations ➔ Two landmark reports from the Institute of Medicine (IOM)— Crossing the Quality Chasm (IOM, 2001) and Unequal Treatment (Smedley et al., 2003)—highlight the importance of patient-centered care and cultural competence. ➔ Crossing the Quality Chasm identifies patient-centered care as one of six “aims” for high-q uality health care. ➔ Unequal Treatment stresses the importance of developing cultural competence among h ealth care providers to eliminate racial/ethnic health care disparities. ➔ Campinha-Bacote views cultural competency as an expansion of patient-centered care. More specifically, cultural competence can be seen as a necessary set o f skills for nurses to attain in order to render effective patient-centered care. It is important f or nurses to see themselves as becoming culturally competent. Your ability to exercise cu ltural competence by applying the components of Campinha-Bacote’s model of cultural competency w ill allow you to deliver patient-centered care.
CULTURAL AWARENESS
➔ BIAS: a predisposition to see people or things in a certain light, either positive or negative ➔ Becoming more self-aware of your biases and attitudes about huma n behavior is the first step in providing patient-centered care ➔ Everyone holds biases about human behavior. A bias is a predispo sition to see people or things in a certain light, either positive or negative. ➔ You should spend time reflecting on what you learned, formally and in formally, throughout your life about health, illness (physical and mental), health care system, gender roles, sexual orientation, race, ability, age, family, and many other issues as a part of your commitment to becoming a culturally competent nurse. ➔ It is helpful to think about cultural competence as a lifelong pro cess of learning about others and also about yourself.
CULTURAL KNOWLEDGE WORLD VIEWS
➔ World view ◆ Emic ◆ Etic ➔ Avoid stereotyping ➔ Treat the individual
➔ See every patient encounter as cross-cultural
➔ World view refers to “the way people tend to look out upon the world or their universe to form a picture or value stance about life or the world around them.” ➔ When you assess a patient’s cultural background and needs, you take into account each patient’s world view, then you plan and provide nursing care in partnershi p with each patient to ensure that it is safe, effective, and culturally sensitive. ➔ In any intercultural encounter there is an insider perspecti ve (emic world view) and an outsider perspective (etic world view). ➔ Avoid stereotypes or unwarranted generalizations about any particu lar group that prevents an accurate assessment of an individual’s unique characteristi cs and world view. Instead approach each person individually, and ask questions to gain a better understanding of the person’s perspective and needs. ➔ Most health care providers educated in Western traditions are immersed in the culture of science and biomedicine through their course work and professional experience.
➔ Iceberg analogy ◆ Most aspects of a person’s world view are hidden ➔ Conduct a cultural assessment
➔ The Iceberg analogy is a tool that helps you to visualize the visible and invisible aspects of your world view and recognize that the same applies to your patients. Just as most of an iceberg lies beneath the surface of the water, most aspects of a person’s world view lie outside of his or her awareness and are invisible to those around the person. Conf lict arises when health care providers interpret the behaviors of patients through their own world view lens instead of trying to uncover the world view that guides this behavior. ➔ •Conduct a comprehensive cultural assessment to understand th e patient’s world view, including religious values, ethnohistory, and caring beliefs and practices. ➔ •Realize the need to develop your assessment skills and cultural in terventions that will allow you to successfully negotiate the various world views present in enc ounters with patients and families (and frequently other team members). Most important, remember t hat the core of this negotiation is compassionate care.
SKILLS AND INTERVENTIONS
➔ Cultural assessment ◆ Cultural assessment model ◆ Open-ended, focused, and contrasted questions ◆ Explanatory model ◆ Trust ➔ To provide patient-centered culturally competent care, you mus t know how to collect relevant cultural data about a patient’s presenting health problem(s) and how to then use it. ➔ The goal of a cultural assessment is to obtain accurate informati on from a patient that allows you to formulate a mutually acceptable and culturally relevant pla n of care for each health problem of a patient.
appropriate. The last step is to then n egotiate a mutually agreeable, culturally oriented, patient-centered plan. Remember that cultural assessment an d care planning requires a level of negotiation.
➔ Linguistic competence ➔ Health literacy ➔ Teach back
•
➔ Linguistic competence is the ability of an organization and its staff to communicate effectively and convey information in a manner that is easily understood by diverse audiences. These audiences include people of limited English proficiency, those who have low literacy skills or are not literate, individuals with disabili ties, and those who are deaf or hard of hearing. ➔ Most health care providers and virtually all health care organi zations nationwide are subject to federal civil rights laws. These laws outline requirements for the provision of language access services. ➔ Do not use a patient’s family members to interpret for you or oth er health care providers. Cultural dynamics, lack of interpreting skills, low health literacy, and bias could lead to inaccurate interpretation. ➔ Health literacy is the ability to obtain, process, and underst and health information needed to make informed health decisions. Studies show that health literacy h as direct effects on health outcomes, linking poor health outcomes to limited health li teracy. Commonly used measures of health literacy include literacy measures such as the Rapid Es timate of Adult Literacy in Medicine (REALM), which is a word recognition test, and the Test of Functi onal Health Literacy in Adults (TOFHLA), which measures reading skills and numeracy. ➔ Clear communication is essential for effective delivery of q uality and safe health care, but most patients experience significant challenges when communicat ing with their health care providers. The teach-back method is an intervention that helps you to confirm that you have explained what a patient needs to know in a manner that the patient understands. The teach-back technique is an ongoing process of asking patients for feedback through exp lanation or demonstration and presenting information in a new way until you feel confident that y ou communicated clearly and that your patient has a full understanding of the information p resented. When using the teach-back technique, do not ask a patient, “Do you understand ?” or “Do you have any questions?” Instead ask open-ended questions to verify the patient’s understanding. ➔ It is important to understand that teach back is not intended t o test a patient but rather to confirm the clarity of your communication.
CULTURAL
ENCOUNTERS
➔ The use of a caring, therapeutic, and culturally congruent relat ionship will lessen the likelihood of conflict when you engage in such encounters. ➔ A cultural encounter enables new forms of community and collec tive identity between you and your patients. ➔ Campinha-Bacote describes two goals of a cultural encounter to generate a wide variety of responses and to send and receive both verbal and nonverbal commu nication accurately and appropriately to continuously interact with patients from cultu rally diverse backgrounds in order to validate, refine, or modify existing values, beliefs, and pract ices and to develop cultural desire, awareness, skill, and knowledge. ➔ The challenge is being able to show compassion, especially if cross-cultural conflict develops.
CULTURAL DESIRE
•The motivation of a health-care professional to “want to”—not “ha ve to”—engage in the process of
becoming culturally competent •Health care organizations are increasingly integrating cultura l competence principles into everyday
organizational processes and practices
➔ It is easy to avoid cultural encounters with patients. Time, our personal discomfort in communicating with others who are “different,” and a focus on phy sical care priorities are just some of the factors that may limit encounters with patients. ➔ An ethically responsible professional nurse must embrace the importance of cultural competency and apply principles in daily patient encounters. ➔ Health care regulatory agencies, national think tanks, and gove rnment agencies expect health care organizations to incorporate cultural competence into pol icies and practices to ensure effective communication, patient safety and quality, and patient-centered care.
EXAM 3 Review - Questions
Course: Introduction To Nursing (RNSG 1309)
University: Laredo College
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