Unit 3NURS 7920

Dealing with Cultural Diversity in Primary

Care

By:  Javacia Owens, Nicole Percival & Abby Smith

Objectives Define cultural diversity/competence Identify facilitators and barriers of cultural

diversity Identify facilitators to minimize barriers in

healthcare Describe cultural factors that impact health Identify Joint Commissions standards

regarding cultural diversity Identify strategies to maintain positive

outcomes Identify follow-up strategies for positive

outcomes

Cultural Diversity Definition:

Being knowledgeable, sensitive, and appreciative of religious beliefs, language, gender, sexual orientation, age, customs, physical and mental disabilities, political orientation, and socio-economic status of individuals in different cultures around the world

Cultural Diversity in NP Practice A “cultural competent” health care system is one

that acknowledges and incorporates at all levels the importance of culture, assessment of cross-cultural relations, vigilance towards cultural differences and adaptations of services to meet culturally unique needs

A culturally competent system is also built on an awareness of the integration and interaction of health beliefs and behaviors, disease prevalence and incidence and treatment outcomes for different patient populations

Healthcare professionals are becoming increasingly aware of the need to provide health care services that are respectful and responsive to cultural needs to meet the diversity of the nation

Cultural Diversity in NP Practice Cultural diversity plays a huge part in

the practice of Nurse Practitioners (NP’s). NP’s use a holistic approach with culturally diverse patients and develop a trusting relationship that allows cultural boundaries to be overcome. NP’s are able to adjust healthcare practices to meet the cultural needs of the patient.

Facilitators of Cultural Diversity Healthy People 2020 Translators/Bilingual Staff Members ”I Speak” cards/Point-to-cards Healthcare Providers and Staff Pharmacist Social Workers U.S. Department of Health and Human

Services Office of Minority Health Healthcare Reform

Barriers of Cultural Diversity Lack of knowledge and awareness of local

services Language Religious beliefs Patient compliance Access to transportation Insurance Financial resources Health literacy Prior experience with healthcare system

Cultural Diversity Facilitators The movement towards cultural competence in

health care has gained national attention and is now recognized by health policy makers and providers as a strategy to eliminate racial/ethnic disparities

The US Department of Health and Human Services Office of Minority Health was created to improve health and healthcare outcomes for racial and ethnic minority

Heath Care Reform offers the potential to improve the health status in minority and vulnerable communities, and to reduce/eliminate health disparities

Using Facilitators to Minimize Barriers Healthy People 2020. Cultural and

linguistic competence must be instilled in all sectors of healthcare training to attain the goal of achieving health equality and access to all groups

A clinic or hospital CANNOT deny services because someone does not speak English. A patient has the right to have the hospital or clinic provide them with an interpreter at no cost

Joint Commission The Joint Commission. Developed new

standards that emphasize cultural competency, communication and language. The new standards address the collection of race, ethnicity, religion, spirituality, personal values and language data

Joint Commission requires the provision of language services and address qualifications for language interpreters and translators to address patient’s needs

Using Facilitators to Minimize Barriers The “I Speak” language card is a valuable

tool to allow patients to advocate for their rights.  It serves as a communication bridge and an informational piece for healthcare professionals and office staff in efforts of diminishing language gaps and increasing access to care.

Joint Commission requires that hospitals determine language needs at first point of contact with the patient.

Using Facilitators to Minimize Barriers A trained interpreter should be available

for patients that do not speak or understand English (do not use family/friends)

Provide written materials in English and the patients primary language, so information is available to the patient and their support system

Hiring of bilingual NPs and staff

Using Facilitators to Minimize Barriers Pharmacist. Provide medication labels and

instructions in the patient's primary language. Use a telephone interpreter when possible

Social Workers. Can provide services when providers or patients have concerns

Nursing schools. Curriculum must promote cross-cultural education to effectively prepare nursing students to serve diverse patients and communities

Healthcare systems. Should provide on going cultural competency training for staff

Strategies for Positive Outcomes In order to develop positive outcomes,

you must understand what is a facilitator in dealing with cultural diversity.

As well as understanding the facilitators, you must realize that barriers will prevent positive outcomes from occurring in the clinical setting.

Strategies for Positive Outcomes Effective Communication

Using appropriate resources such as translators and/or “I speak” cards. I speak cards help determine the patient’s language so that the provider knows what kind of translator is needed from the start. It is also important to realize who you are talking to and that they may not have any education or medical knowledge.

Make sure to speak in terms that not only the patient can understand, but the translator as well. Try to avoid using hard to understand medical terms.

Strategies for Positive Outcomes Cultural Competence

If a provider is not competent in various cultures and religious beliefs, it will be difficult to effectively treat the patient. Many patients have beliefs that do not allow them to take certain medications, or eat certain foods; therefore, the NP should avoid prescribing those things. It is important to meet the cultural needs of the patient.

The NP should also be knowledgeable that the prevalence of certain medical conditions may be more prevalent in some cultures.

The NP must reflect on their own beliefs and realize their own cultural influences, prejudices, and personal biases and be sure to not pass that off onto the care they provide.

Strategies for Positive Outcomes Develop trusting relationships

In healthcare, if the patient does not trust the provider, there will likely be a gap in the care and compliance of the patient.

For patients of different cultural backgrounds, socioeconomic statuses, and different languages, it is often difficult for the patient to entirely trust the advice of someone who is not entirely “like them.” Be sure to let the patient know you want to help them, and you understand their background. If you do not know exactly their possible limitations in medications, etc., be sure to ask. They will then know you are trying to understand and will be more likely to trust you.

Follow up Measures to Evaluate Strategies At the of the interaction, review the material

with the patient to ensure nothing has been missed if misunderstood. Ask if the patient of family members has any questions

Conduct periodically cultural competence proficiency assessments of the healthcare facility

Annual cultural and sensitivity training for healthcare providers

Cultural Diversity in Primary Care When health care providers fail to

understand socio-cultural differences between themselves and their patients, the communication and trust between them may suffer. This in turn may lead to patient dissatisfaction, poor adherence to medications and health promotion strategies, and poorer health outcome.

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