Cultural and Health Ethnic disparities and culturally competent Care

Culture: The behaviors, customs, arts, and beliefs of a particular group of people
Acculturation : a concept related to culture that is typically used to explain ethnic disparities in health
outcomes.
 Acculturation as a predictive or explanatory variable is based on the assumption that
culturally based knowledge, attitudes, and beliefs cause people to behave in certain
ways and make specific health choices.
Health disparity : defined as an increased burden of an adverse health outcome or health determinant
within a specific subset of the population.
 Health disparities are gaps in the quality of health and health care that mirror
differences in socioeconomic status, racial and ethnic background, and education level

Explaining the large disparities in health Philippines

Key factors include:
1. persistently large social inequity and chronic poverty
2. severe underinvestment of the government in health facilities, services, and manpower since
the 1970s despite the ballooning population
3. Political instability due to insurgency problem which has further reduced access to care among
households in areas of civil unrest
4. character of jobless growth of Philippine development
5. archipelagic nature of the country

 impinges adversely on the delivery of health resources and households` access to

health care;
 6. frequent disasters in the country and environmental risks, heightened by climate change, which
further contribute to health inequity.
 Cultural, ethnic, and religious diversities are important considerations for all health care
professionals
 Nurses in the perioperative area should be aware of medications that may be prohibited by
certain groups (e.g., Muslims and those of the Jewish faith may not wish to use porcine-based
products [heparin (porcine or bovine)]; Buddhists may choose not to use bovine products).
 In certain cultures, the head is a sacred area, and staff should allow patients to apply their
own surgical cap in this case.
 For example, race, socioeconomics, health literacy, and other factors can influence:
a. How patients perceive symptoms and health conditions
b. When and how patients seek care
c. Patients’ expectations of care
d. Patients’ preferences regarding procedures or treatments
e. Patients’ willingness to follow doctor recommendations or treatment plans
f. Who patients believe should participate in making healthcare decisions

Cultural Competence
 Social determinants of health, such as working and living conditions and quality healthcare
access, aren’t the same for everyone. Health inequities pose a serious challenge to the
healthcare community, but healthcare providers have a powerful tool at their disposal: cultural
competence.

What Is Cultural Competence in Health Care?

1. Cultural competence in health care addresses the disparities that people of racially and
culturally diverse backgrounds often experience. It can ensure all patients get the care they
need to live healthier lives.
2. Cultural competence in health care means delivering effective, quality care to patients who
have diverse beliefs, attitudes, values, and behaviors. This practice requires systems that can
personalize health care according to cultural and linguistic differences. It also requires
understanding the potential impact that cultural differences can have on healthcare delivery.

•Cultural competence has gained attention from health care policymakers, providers, insurers, and
educators as a strategy to improve quality and eliminate racial/ethnic disparities in health care.
•The goal of cultural competence is to create a health care system and workforce that are capable of
delivering the highest-quality care to every patient regardless of race, ethnicity, culture, or language
proficiency.
•Bringing this to fruition requires action by various health care sectors, each with different motivations,
approaches, and leverage points for advancing this field.
While cultural competence in health care initially referred to meeting the needs of people from
distinctive ethnic and racial groups, it now also refers to meeting the needs of people with disabilities,
those from diverse socioeconomic backgrounds, and members of the LGBTQ community.

Goals of Cultural Competence in Health Care

 Cultural competence aims to break down barriers that get in the way of patients’ receiving the
care they need.
  It also strives to ensure improved understanding between patients and their providers.
 Cultural competence offers a pathway and a framework to reach the goal of better health for all
patients.

Combining Cultural Competence with Cultural Humility

 Healthcare providers strive to develop a multicultural orientation to deliver culturally sensitive
care and improve communication. However, even when healthcare professionals have a
meaningful understanding of a culture, they still can’t predict the behaviors and attitudes of
their patients simply based on their cultural backgrounds. That’s because people are unique,
and their behavior and beliefs might not always reflect those of their cultures.

 Cultural humility involves an ongoing process of self-evaluation. Through exploration of and

reflecting on their own beliefs and behaviors, healthcare professionals can improve their
awareness of implicit biases and foster an approach to patients characterized by openness and
curiosity about each new patient.

Importance of Cultural Competence in Health Care

1. Increased patient safety
 Studies have shown that the absence of culturally competent care can lead to
preventable mistakes and adverse events.
 For example, a recent study in Hospital Pediatrics that examined patient safety in
hospitals across the U.S. suggests that patients lacking English language proficiency
experience more adverse safety events during hospitalization than fluent English
language speakers. The events they experience tend to be more severe as well

2. Reduced inefficiencies
3. building teams with healthcare professionals who reflect the diversity of the patient populations
served can also improve cross-cultural communication. Diverse teams have a wider cultural
knowledge base that they can share with one another.
4. Reduced care disparities
 Delivery of equitable Care
 When healthcare providers fail to recognize the differences between them and their
patients, they may inadvertently deliver lower-quality care. Cultivating skills that
improve cross-cultural communication can play an important role in delivering equitable
care.
5. Decreased costs
6. Improved Patient Outcomes
 Healthcare environments that show an awareness of and respect for differences create
more satisfying experiences for patients. When providers adjust treatments to meet
patient needs and preferences, patients notice, and their overall experience improves.

7. improves communication, which keeps patients safer.

 Clear communication allows healthcare providers to collect accurate medical
information. It also encourages active dialogues in which patients and providers can ask
questions, correct misunderstandings, and build trust.
  For example, after a medical center introduced a bilingual Russian internist to help
resolve language barriers, Russian-speaking patients with diabetes experienced
significant reductions in their blood pressure and cholesterol.

Example of Culturally Competent Responses

1. Adapting to a New Patient Population
A local hospital experiences an influx of ultra-orthodox Jewish patients as a newly established Hasidic
community nearby grows. The hospital staff has little knowledge of the customs or traditions of this
growing segment of the facility’s patient population. However, the staff has already encountered:
Situations of patients refusing to eat. Complaints that visitors who couldn’t use elevators on Jewish
holidays lacked access to stairwells Confusing exchanges when members of the orthodox community
refused to shake hands with healthcare providers of the opposite sex
Culturally Competent Responses
The hospital invites representatives from the Hasidic community to meet with administrators and staff
members to openly discuss traditions and customs potentially relevant to their health care. The hospital
also asks the community representatives to explain their community’s specific needs. In this way, the
hospital gets ideas and suggestions about established solutions the community already has for dealing
with customs, such as not using electricity on Shabbat. The hospital also learns of other customs, such as
no physical contact between members of different genders. Based on the conversations, the hospital
proposes policies and procedures that can better serve the needs of the Hasidic patient population. It
then discusses those policies and procedures with the community representatives to ensure the
proposals are appropriate.

2. Respecting a Patient’s Choices

A severely ill 80-year-old patient learns that one of their heart valves has stopped working. To survive,
they need surgery to replace the valve. The patient has a history of excessive bleeding. This will require
doctors to perform blood transfusions during the surgery. The patient is a devout Jehovah’s Witness.
According to their religious beliefs and interpretations, the Bible does not allow any type of blood
transfusion, so the patient refuses the surgery.
Culturally Competent Responses
The patient’s medical team engages the patient, their family, and trusted members within the patient’s
religious community in discussions about the nature of the surgery and the risk that the patient might
not survive without it. After the patient gets all the information and seems to understand all the risks,
the medical team respects their choice to forgo the operation.

How to Improve Cultural Competence in Health Care

To meet the needs of all patients, organizations must learn how to improve cultural competence in
health care.
1. begin by implementing strategies that develop and improve cultural competence among
healthcare teams.
2. Promote Awareness and Education to Improve Cultural Competence in Health Care
 Promoting awareness and education plays a key role in improving cultural competence in health
care. To develop cultural competence, healthcare professionals need to identify their beliefs and
build an awareness of their culture. This gives them a basis to improve their cross-cultural
awareness.

Cross-cultural awareness
  makes healthcare providers more open to unfamiliar attitudes, practices, or behaviors. It also
improves collaboration with patients and helps them respond with flexibility. Benefits of cross-
cultural awareness include:
1. Improved rapport
2. Tailored treatment plans
3. Improved patient attendance and compliance

How can healthcare organizations best promote the cross-cultural awareness and other skills needed
for culturally competent health care?
1. Cultural Competence Training
 Cultural competence training teaches healthcare providers intercultural communication skills
and helps trainees respond to cultural differences with greater agility.
 Additionally, cultural competence training can help organizations uncover organizational policies
or practices that act as barriers to different communities. Then, they can adjust them to ensure
they meet the needs of diverse patients.
2. Accessibility Leads to Improved Cultural Competence in Health Care
 Cultural competence in health care demands accessibility. Accessibility means ensuring that
language, culture, race, and other such factors don’t become barriers to patients’ receiving
quality care. How can healthcare organizations make health care more accessible?
3. Build Knowledge About the Local Community
 Healthcare organizations should learn about the populations they serve. Collecting and
analyzing demographic data and sending targeted surveys to specific communities builds
important knowledge about local communities, which puts them in a much better position to
meet patient needs and ensure accessibility.
 In this way, a hospital may learn it needs interpreters in Korean or Farsi, or it may discover a
large segment of the population requires Halal dietary options for hospital stays.
 Surveys and community engagement can uncover other key information that enables healthcare
organizations to become more accessible. For instance, community engagement may clarify the
need for staff members familiar with Nepalese culture or the need to bolster a diabetes
outreach program.
4. Recruit and Retain Diverse Team Members
 Recruiting and retaining team members who accurately reflect the populations they serve gives
healthcare organizations a clear advantage in their efforts to deliver culturally competent health
care.
 When patients encounter team members who look like them, speak their language, and share
their culture, they tend to feel more welcome. Healthcare providers who share cultural
similarities with their patients often have a greater capacity to communicate with them,
understand their perspectives, and anticipate their needs.
 Diverse team members can also share their insights with their colleagues, deepening everyone’s
capacity to deliver culturally competent care.

Barriers to Cultural Competence in Health Care

Promoting cultural competence can present challenges. Some of the barriers to cultural competence in
health care include:
1. Adequate Knowledge of an Organization’s Cultural Competence
To successfully address cultural competence, healthcare organizations need to first gauge their
current performance. This involves answering questions such as:
Where does the organization fall short in providing language accessibility?
 Where do care disparities exist within the system?
Without knowing where disparities exist, leadership can’t properly channel its energy
and resources.
 As an example, data might reveal an organization serves a larger number of patients from the
LGBTQ community than previously realized. This gives leadership the opportunity to make sure
it has enough healthcare providers with specialized knowledge in LGBTQ health care.

2. Putting Cultural Competence Into Action

To put cultural competence into action, healthcare organizations must create an institutional framework
that:
a. Demonstrates culturally competent practices
b. Cultivates cross-cultural awareness and communication
c. Maintains a diverse workforce
d. Cultural competence demands an ongoing commitment and multipronged approach. Healthcare
organizations must build an infrastructure that supports activities and protocols that ensure
culturally competent practices.
 Additionally, organizations must weather pushback from staff members who may perceive
cultural competence as limited to racial and ethnic diversity and already consider themselves
culturally competent. In such cases, healthcare organizations can implement educational
programs that broaden definitions of cultural competence.

3. Limited Resources to Support Cultural Competence

 Realizing cultural competence in health care takes resources. Organizations must invest time,
money, and leadership into developing the infrastructure required to make cultural competence
more than just a value.
 This means budgeting for, among other things:
a. Linguistically diverse materials
b. Interpreters
c. Cultural competence training
d. Diverse staff recruitment programs
 Though prioritizing cultural competence comes with a price tag, it ultimately offers an essential
return on investment.

Promote Cultural Competence in Health Care

 Healthcare administrators have an instrumental role to play in promoting cultural competence
in health care. Their expert knowledge in organizational behavior, financial management, and
information systems and analysis empowers them to build the infrastructures needed to
support culturally competent systems.

Cultural Competence in Nursing

 Nurses are at the forefront of this change.
 nurses can create an environment that helps bridge the healthcare gap for disadvantaged
patients, supporting the overall goal of health equity.

What is Cultural Competence in Nursing?

Cultural competence in nursing encompasses a nurse’s capability to engage with patients who come
from a wide range of cultural backgrounds where healthcare may be a challenge due to economic
disparity, religious background, societal complications, and other potential barriers to care. This also
means working with patients of different sexualities or genders.

Different ways for nurses to display cultural competence:

1. Using language and terms patients understand,
2. creating a deeper connection with patients and helping them understand their care
3. Respecting patients’ cultural or religious values or beliefs, empowering them to feel in charge of
their care protocols while honoring their backgrounds
4. Recruiting healthcare professionals from underrepresented communities so patients can choose
to work with nurses or other medical professionals who better reflect their experiences
5. Identifying patients in underserved populations and communities in order to address gaps in
care and ensure patients are getting the health and wellness support they need to thrive
6. Promoting and coordinating cultural awareness measures to encourage other medical
professionals to provide exceptional care to all patients

What are Components of Culturally Competent Care?

1. Awareness
 Having awareness of oneself and one’s value system helps create a guidepost from which nurses
can approach patient care. By addressing personal biases and exploring where they may have a
shortsighted approach to patients from different cultural backgrounds, nurses can be proactive
about addressing these biases and dismantle them to be a more effective caregiver to their
patients. It can be difficult to admit a cultural blind spot, but doing so—and making a concerted
effort to change—can make the job even more rewarding.
2. Understanding
 By learning about and understanding the disparities and inequities in healthcare—and the world
at large—nurses can offer more compassionate care and offer more effective treatment plans by
addressing issues that may impact prescribed care. Similarly, understanding healthcare
inequities that impact the world can also create more cultural understanding of patients and the
challenges they face but may be uncomfortable discussing.
3. Sensitivity
 Nurses can also create more opportunities for comprehensive patient care by exploring the
cultural issues that impact the communities they serve. Being sensitive to a patient’s culture can
create a more equitable healthcare experience by empowering the patient to be an active
participant in their care and display the compassion and support needed to help the patient
through their prescribed treatments.
4. Skills
 Combining skills, sensitivity, and awareness gives nurses the skills needed to provide culturally
competent care—and makes that care second nature. By understanding more about the
cultures they serve and meeting patient’s needs on their terms, nurses can create a care
partnership with their patients that’s built on trust. This can include knowing when and how to
use nonverbal communication, understanding that different ethnicities may require different
types of clinical care, and more.

How Can a Nurse be Culturally Competent?

1. Listening and Communicating
 No matter how swamped a nurse may be or how urgent the need for medical care, having
strong listening and communicating skills are important for creating an environment of culturally
sensitive care. Patients both need and want to be heard, but they also need to understand their
 care instructions—and that their nurse understands their cultural or societal needs in relation to
their care.
2. Reevaluating Your Perspective
 Communities shift and change, and those dynamics can affect each culture within a community
in a different way. The more that nurses can evolve their perspectives on the communities and
cultures they serve, the more capable they are of handling health-related challenges with
compassion.
3. Knowing Yourself and Your Own Biases
 Even the best nurses can have blind spots, but the difference between a good nurse and a great
nurse is a willingness to address their biases and grow from that knowledge. Doing so makes a
nurse a more effective caregiver on every level.
4. Traveling and Working in Diverse Settings
 Nurses who get out of their comfort zones and expose themselves to a variety of different
communities and work settings can gain valuable exposure to different cultures. This doesn’t
necessarily mean traveling to distant continents (though doing so is a transformative
experience). Nurses can also explore working within or volunteering at different medical
facilities in disadvantaged communities, rural settings, and more.
5. Utilizing Your Resources
 Read whitepapers and studies on cultural differences in healthcare. Connect with other medical
professionals who have experience with cultural competence. Even staying up to date on
healthcare issues in the news can go a long way to helping nurses understand more about
disparities in healthcare and how they can amend their approach to support patients of all
kinds.

Benefits of Culturally Competent Care (Featured Online MSN Programs )

 Research shows significant benefits resulting from culturally competent nursing care. Social
benefits include fostering mutual respect, understanding, and trust; promoting inclusion and
patient and family responsibilities for their health; and increasing community participation and
involvement in health issues.
 Health benefits include improved data collection, preventative care, and cost savings, along with
reduced care disparities and missed medical visits. Healthcare businesses benefit from fewer
barriers and costs, increased efficiency, higher legal and regulatory compliance, and access to
different ideas, perspectives, and strategies in decision making.

Tips for Nurses to Improve Cultural Competence

Cultural competence in nursing helps build trust more effectively, which leads to better patient
outcomes. This guide describes how to build cultural competence in your own work and your team's.
1. Change your practitioner/patient perspective
 Cultural competence in nursing means understanding differences in perspective. For example,
calling everyone by their first name immediately after meeting them is a friendly gesture in
many parts of the United States. However, it may seem disrespectful to somebody from a
culture where young people refer to elders as "Mr." or "Ms."
 Showing respect is a fundamental part of how to build cultural competence. "Work from a place
of humble partnership instead of from an imbalanced hierarchical notion of caregiver/care-
recipient," says nursing faculty member Caroline Ortiz.
2. Share Something About Your Own Culture That May be Similar to Your Patient's Culture
  Establishing common ground is another vital part of cultural competence in nursing. Sharing
from your own experiences is often part of cultural competency training. Norman points out
"This is just a great way to build rapport with your patient, and helps to break down
preconceived barriers."
 For example, if you are advising a patient about healthy eating, they might mention a favorite
dish from their background, a dish that is not very healthy. Rather than saying not to eat it or eat
less of it, share about a dish from your background that you might not want to give up, but that
you now serve as a side dish rather than an entree, or you substituted ingredients to make it
healthier.
3. Learn From Coworkers and Colleagues
 "Working in a place that has people with different cultures, beliefs, genders, race, and ethnicity
helps to foster an environment of belonging," Norman says. The more that an organization
recognizes and treats diversity as an asset, the easier it is to learn cultural competence.
 If people feel encouraged to bring their whole selves to work, staff can develop cultural
competence during all their interactions. Informal learning and employee-led initiatives can
augment formal cultural competency training. "Inquire about a cultural competency department
or task force," Dr. Gregory Knapik, DNP and assistant professor of nursing, recommends.
 Be sure that, as a supervisor, you respect the time and effort to learn or to teach. Avoid making
people feel as though they have to be spokespeople for an entire group. For example, ask for "a
Hindu perspective" from a Hindu staff member rather than "the Hindu perspective."
4. Learn a New Language
 Learning a new language can help to address many of the language gaps in healthcare. Language
barriers have a negative impact on healthcare outcomes and on the satisfaction of both patients
and providers.
 While only qualified medical interpreters should provide interpretation for patients with limited
English proficiency, learning medical vocabulary or common expressions creates a welcoming
atmosphere and increases trust.
 Knowing medical and healthcare vocabulary in another language also helps you understand
patients or family members who might speak conversational English fluently, but be less familiar
with healthcare terms.
 Being multilingual is an asset for any healthcare job, especially if you speak a language widely
spoken in the community, but less common among healthcare workers.
5. Complete Continuing Nursing Education Courses
 Many organizations offer cultural competency training for healthcare workers. These include the
following:
 The Office of Minority Health's free online cultural competency training, including the Culturally
Competent Nursing Care course, is designed for online learning. Once you have completed the
course, you can lead in-person facilitated sessions.
 Georgetown University's National Center for Cultural Competence provides online courses in
how to build cultural competence with specific audiences. The National LGTB Cancer Network
offers cultural competency training for oncology professionals.
6. Reach Out to Clergy to Understand Different Faiths in Your Community
 For example, imams (Muslim clergy) can provide guidance on how to work with patients who
wish to fast for Ramadan, but should not because of health considerations.
 Similarly, understanding the Amish belief that the heart is the "soul of the body" can help
healthcare workers communicate about heart health to Amish communities. Being able to speak
about a faith with knowledge and respect will strengthen communication with patients.
7. Seek Out Opportunities to Work With Local Community Leaders or Organizations
 Partnerships with local community leaders and organizations can help build your cultural
competence in nursing and establish relationships that lead to stronger relationships. For
example, your organization might invite leaders of community organizations to give a talk at
your workplace about a particular group and its perceptions and needs.

Cultural competence in nursing builds a virtuous cycle of improved reputation and trust, leading to
better health outcomes.