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Medical and pregnancy-related conditions that may prevent safe fasting should be assessed and information provided on maintaining adequate nutrition and hydration during this time. Leave A Comment Cancel reply Comment. Sallie Jimenez is content manager for healthcare for Nurse. The federal government has recognized the unique health needs of First Nations and Inuit communities in Canada. We take our role in ensuring your information is private and secure very seriously.
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The authors' intent is to raise readers' awareness of how to maintain an ethical and culturally sensitive approach to practice in developing nations.
- Many nurses might regard a patient who refuses to take a certain medication, constantly has a roomful of visitors or demands that a family member feed him as noncompliant.
- Providing culturally sensitive care is an important component of patient centered-care.
Content courtesy of Chamberlain College of Nursing. As the U. The U. According to the same report, nearly one in five people in the U. The continuum of cultural competency starts with exposing yourself to different cultures, said Sheri Sawchuk, MSN, RN, an assistant professor at Chamberlain. Over the course of two weeks, students care for patients, make home visits, experience the culture first-hand and gain a new perspective on their own beliefs and culture.
Research can provide a foundation for cultural understanding and can happen through books, movies, readings, trainings or talking with people. What are your beliefs? I seek to understand, and then when I have a patient from the same culture in the future, I am able to provide better care for them.
For instance, the beliefs and cultures of Puerto Ricans, Cubans and Mexicans vary considerably, although they are all a part of the larger Hispanic community. On a recent trip to Haiti, Chamberlain students spent a five-hour shift in the local hospital working alongside Haitian nurses to get a fuller picture of the sociocultural aspects of health. When determining if a patient understands English, be sure not to jump to any conclusions, Vital said.
Always, always ask the patient and include them before making assumptions. A simple way to ensure a patient has comprehended is to ask them to repeat back to you, Vital said. And always keep in mind that certain terminology may not be easily translated or understood — particularly figures of speech. When working with a translator, it can be tempting to look at and speak directly with the interpreter, Sawchuk said.
And regardless of culture, other ways of connecting with a patient all still apply — including listening, asking questions, seeking to understand and following through. This introductory and fun webinar will help you learn to greet patients, translate activities of daily living or help a Spanish speaker navigate through an appointment or hospital stay in Spanish.
No prior knowledge of Spanish is required. Learn key phrases to help you speak Spanish immediately. With proper education, development and use of effective protocols, and close monitoring, interprofessional care teams can have a substantial impact on improving patient outcomes and reducing healthcare costs. Tools and approaches are available to help prevent or halt the progression of sepsis in at-risk patients.
This webinar discusses sepsis pathophysiology, patient presentation and healthcare team management approaches to help combat sepsis. All great suggestions to enhance cultural competence. However, cultural understanding is gained through apllying these suggestions in the lived experience. A huge barrier exists in the workplace today, and that is the computer. They are very comfortable with computers and prefer spending their time with the technology rather than building a face-to-face relationship with the patient and family.
The experienced nurse who have the years of lived experiences and expert knowledge are now challenged with getting the documentation finished at the expense of nursing the way we should be. Doctors are exploring the use of medical scribes and dragon voice-activated documentation technology. Those are just my thoughts…lets bring back some of what used to work to provide good nursing care. I agree that cultural understanding is gained by applying the 5 strategies in the lived experience.
However, I disagree with using computers and new nurses as scapegoats for the cultural insensitivity that has existed in healthcare for decades. Generalizing nursing students and new nurses as preferring to spend time with their technology than building relationships with the patient and family is false and reflects a dysfunctional attitude toward students and new nurses who are an important aspect of progress in the nursing profession.
Instead, the biggest barrier to achieving cultural competency in the nursing profession is that there are still nurse educators, nurse managers, staff nurses, and students who tolerate or actively support discriminatory behavior.
There needs to be zero tolerance towards institutionalized prejudice and discrimination in every nursing school and healthcare facility starting from top management down to every staff nurse and student. It only takes a handful of faculty, managers, staff nurses, or students to undermine a positive and culturally sensitive environment. Everyone needs to be held accountable. Dear Edith Ovellet: Your letter is a full expression of what I have been feeling for the past ten years in the nursing profession.
My wife had surgery, and during her recovery and hospital stay of four days , my wife and I had seen briefly -one student nurse, and 3 brief nurse visits, and because I am a nurse, my initials were the ones on the flow record on the door. I was the nurse, the therapist and the record recorder. The Hispanic Concentration is a joke. It is just a money making scheme for Chamberlain. Chamberlain is defrauding students by selling the idea that the Hispanic Concentration is a distinction that potential employers will recognize.
Chamberlain does not care about decreasing institutionalized prejudice and discrimination in healthcare, especially not through their Hispanic Concentration. You are here: Home - Archived - Blogs - Education - 5 ways nurses can improve cultural competency. Previous Next. View Larger Image. Be curious The continuum of cultural competency starts with exposing yourself to different cultures, said Sheri Sawchuk, MSN, RN, an assistant professor at Chamberlain.
About the Author: Sallie Jimenez. Sallie Jimenez is content manager for healthcare for Nurse. She develops and edits content for the Nurse. She also develops content for the Nurse. Related Posts. August 18th, 0 Comments. August 1st, 8 Comments. July 6th, 3 Comments.
June 20th, 0 Comments. June 16th, 1 Comment. June 9th, 0 Comments. Nursing Student December 18, at pm - Reply. Dear Edith Quellet and Delbert Owens: I agree that cultural understanding is gained by applying the 5 strategies in the lived experience. Delbert Owens May 11, at am - Reply.
Review of the Hispanic Concentration, managed by Dr. Leave A Comment Cancel reply Comment.
Delbert Owens May 11, at am - Reply. Patient Satisfaction 0. When communication barriers exist, you are responsible for using communication strategies and skills so the patient is an informed partner in the care provision. Diet Adherence Providing culturally sensitive care is an important component of patient centered-care. Tucker, Herman, Ferdinand et al. CNO has developed the following scenarios to provide guidance to nurses in providing culturally sensitive care.
Strategies for providing culturally sensitive care. Developing Cultural Competence in Nursing
Cultural sensitivity is foundational to all nurses. However, nurses from minority backgrounds represent 19 percent of the registered nursing RN workforce.
Men account for 9. Nurses and other healthcare providers must account for these differences through cultural respect to support positive health outcomes and provide accuracy in medical research. Campinha-Bacote and Munoz proposed a five-component model for developing cultural competence in The Case Manager. Nurses should explain healthcare jargon to patients whose native language is not English, according to Monster contributing writer Megan Malugani.
A breast cancer awareness program for U. Some assumed that Medicare and Medicaid were forms of cancer. Many people from other cultures seek herbal remedies from traditional healers — and they can be harmful or interact poorly with Western medicine. Nurses should ask patients about any alternative approaches to healing they are using. This requires sensitivity and effective verbal and non-verbal communication.
Nurses should never make assumptions or judgments about other individuals or their beliefs. Instead, nurses can ask questions about cultural practices in a professional and thoughtful manner. Rising educational standards are emphasized to increase the quality of care that patients receive.
Cultural knowledge involves seeking and obtaining an information base on different cultural and ethnic groups. The purpose of the present study is to test the PC-CSHC Model and, if necessary, offer further empirically-based recommendations for refining it. There is empirical support for the view that many health care providers lack adequate cultural sensitivity to effectively communicate with patients from minority groups.
There is some indication that perceived cultural sensitivity of health promoting interventions is associated with the effectiveness of these interventions. Despite the promise of the studies described above, one important limitation is their lack of a comprehensive theory that specifies the mechanisms linking culturally sensitive health care or patient-centered culturally sensitive health care to important health behaviors e.
The present study attempted to build on the current literature by empirically testing this comprehensive model of cultural interventions aimed at health care providers and health care environments. A basic premise of the PC-CSHC model is that training of medical patients and health care providers can promote patient-centered culturally sensitive health care.
It is understandable how patients who experience mistrust of their health care providers, racial bias in health care received, unsatisfactory patient-provider interactions e. Such stress as well as other health care circumstances e. Direct and indirect effects were expected to emerge in the test of this model.
Given our interest in culture- and race-specific applications of the model, we also tested whether the model fit equally well for African American patients and non-Hispanic White American patients. This study occurred as a part of a larger federal grant-funded research program on patient-centered culturally sensitive health care. The present study involved two community-based primary care clinics located in northern central Florida. Both clinics served populations of primarily low-income patients.
A total of patients participated in this study. One hundred and ten of these patients self-identified as African American 25 men and 85 women and self-identified as non-Hispanic White American 39 men and 81 women.
The sample for the African American and non-Hispanic White American patients in the present study ranged in age from years and years, with a mean age of 51 and 55, respectively. The inclusion criteria for patients in the study were: a being 18 years or older; b having obtained health care services at one of the two community-based primary health care clinics at least 3 times in the year prior to the study; c identifying as African American not of Hispanic origin; or White American not of Hispanic origin; d having high blood pressure, alone, or in combination with diagnosed diabetes, high cholesterol, or coronary artery disease for at least one year prior to the start of the study; e being able to communicate effectively with others verbally or in writing in his or her native language; and f giving witness-verified written consent to participate.
The following two methods were used to recruit patients for the larger study: a a health care clinic office staff mailing method, and b an advertisement recruitment method. In the first of these methods, patients who met the participant inclusion criteria were identified by the health care clinic representative at each of the two community-based primary health care clinics participating in this study. These professionals mailed an invitation packet to each of the patients at their clinic who met the participation criteria.
In the advertisement recruitment method, two recruitment strategies were implemented. The first strategy involved recruiting patients via a televised commercial on a local television station. The commercial invited potential patient participants at the two participating community-based primary care clinics to call the Principal Investigator PI to request an invitation packet for the research study.
This invitation packet contained the same materials earlier described in the health care center office staff mailing method. Data were collected for this study over a 1-year period. The instruments in the AB were counterbalanced with regard to order. To ensure patient confidentiality, questionnaires were pre-coded and names matching codes were kept in a separate locked file from the coded questionnaire data in compliance with IRB regulations.
The Assessment Battery AB consisted of the instruments described in this section. The T-CSHCI-AA is a item scale that measures the level of self-reported patient-centered cultural sensitivity in one's health care center environment including physical and policy aspects of the center and in the behaviors and attitudes of one's health care provider and front desk office staff Tucker, Mirsu-Paun, van den Berg et al.
Higher scores are associated with higher self-reported levels of patient-perceived cultural sensitivity, whereas lower scores are associated with lower self-reported levels of patient-perceived cultural sensitivity. In sum this development involved three related studies. In the first study, patients from one of four community-based primary care centers were recruited to form 20 ethnicity and gender concordant focus groups. Items that received a mean rating of 1 or 2 were eliminated from the scale.
The scale has adequate reliability: Cronbach's coefficients alpha have ranged from. Higher scores on the TPS indicate higher levels of trust in one's physician. The ICS is widely used and has been shown to have adequate internal consistency ranging from 0. The PSQ has been reported to have excellent internal consistency that exceeded. Higher scores indicate greater patient satisfaction with provider care received.
The Strain Questionnaire SQ is a item scale that measures overall health-related stress and the three subscales of this overall stress—behavioral stress, cognitive stress, and physical stress. A score for each subscale of the SQ is determined by summing the ratings of the items in that subscale. Lower scores are associated with lower levels of stress, whereas higher scores are associated with higher levels of stress.
The HPLP is comprised of six subscales self-actualization, health responsibility, exercise, nutrition, interpersonal support, and stress management. Higher scores on the HPLP indicate higher levels of engagement in a health promoting lifestyle.
The 4-item MMA scale is scored by summing its items. Higher scores represent a higher level of medication adherence. The MMA Scale has been found to have an internal consistency of 0. The Dietary Adherence Scale DAS , which was developed by Williams , is a item scale used to measure adherence to the specific common dietary recommendations of an anti-hypertensive medical regimen i. We conducted a two-group path analysis to test the model depicted in Figure 1.
This path analysis was used to evaluate the system of direct and indirect effects. Full structural equation modeling SEM could not be conducted due to the available sample size. Model comparison analyses were conducted using the AMOS We estimated a fully recursive path model across the two cultural groups African Americans and non-Hispanic White Americans using the proposed model by constraining all path coefficients parameters to be equal across both groups.
We then re-examined the path model, allowing all coefficients to be freely estimated across groups. A nested model test was conducted to compare whether this equality constraint on regression estimates significantly degraded model fit; chi-square deviance between models was used to inform this evaluation. As a path analysis, other SEM fit statistics were not examined, since structural parameters are entirely fixed in a path analysis.
Schematic of the fully recursive model tested in this study. Regression estimates were first tested in a constrained model equal parameters for African Americans and Whites and then in an unconstrained model free variation in parameters across groups.
The invariance of the path models across groups was tested using full-information maximum likelihood FIML estimation. Missing data here tended to be the result of idiosyncratic testing sessions e. In the current study, only six participants 2. These participants were simply eliminated from the path analyses. Significance tests were conducted using bootstrapped estimates of standard errors for direct, indirect, and total effects.
Five thousand bootstrapped samples were selected. In addition to evaluating the significance of each effect, we also examined group differences in effect strength. Prior to the study's main analyses, an exploratory data analysis was conducted to inspect the data for univariate normality, multivariate normality, outliers, multicollinearity, and relative variances Kline, Data were not significantly skewed and assumptions of normality were met.
Intercorrelations among the scores on the investigated variables as well as means, standard deviations, and scale properties for these variables, separated by ethnicity, appear in Table 1. Inter-item reliabilities were generally acceptable for research purposes, although the diet adherence score for African Americans and medication adherence for non-Hispanic Whites raised some concerns about internal consistency and measurement error with those indicators.
In general, this unconstrained model supported the study's hypothesis, which held that patient health perception variables i. Values represent standardized effect estimates for total, direct, and indirect effects of each predictor; values in parentheses represent standard errors. Standard errors were empirically estimated with 5, bootstrapped samples. For White Americans, sense of control had a significant negative effect on perceived physical stress, whereas for African Americans, it had a significant positive effect on dietary adherence.
Physical stress had a negative effect on medication adherence but this was true for African Americans only. No direct effects or group differences in direct effect were observed when care satisfaction was examined as a predictor. This model was developed to explain and thus identify ways to improve adherence to provider treatment recommendations engagement in a health promoting lifestyle, dietary adherence, and medication adherence and health care outcomes among culturally diverse patients.
Testing of the PC-CSHC model was based on data derived from a participant sample of predominantly low-income adult African Americans and non-Hispanic White Americans who utilized one of two community-based primary care clinics. Testing of the PC-CSHC model involved using path analyses to examine the links between the following variables: a patient-perceived provider cultural sensitivity i.
Overall, the findings provide support for the provision of patient-centered culturally-sensitive health care and provide some empirical support for the PC-CSHC model - a literature-based model that offers an explanation of the health-related effects of such care.
Although the general tenets of the PC-CSHC model fit for both the African American patients and the non-Hispanic White American patients in the present study, there were some notable model differences. For African American but not White American patients, provider cultural sensitivity also had a direct effect on an important treatment regimen variable, dietary adherence. Trust in provider was linked to care satisfaction for both racial groups, but the size of that association for White American patients was significantly larger than observed with the African American patients.
Sense of interpersonal control was also an important predictor of health promoting lifestyle for both groups, with a stronger tie between those variables emerging for African American than White American patients. Sense of control also was significantly associated with dietary adherence for the African American but not White American patients. Indeed, interpersonal control emerged as a key component of the model, providing some empirical support for the increasing interest in empowering patients and communities to have the option of actively participating in their own health promotion and health care Agency for Healthcare Research and Quality, Tests of indirect effects revealed that, not surprisingly, for both racial groups satisfaction with care was likely an indirect function of the effect that provider cultural sensitivity had on trust in provider.
In essence, both racial groups were likely to have greater trust in providers they deemed to be culturally-sensitive. In turn, that trust translated into greater likelihood of being satisfied with the care received.
In addition, that indirect path from sensitivity through trust to care satisfaction was significantly stronger for the White American patients than it was for the African American patients. The model did not account for medication adherence in either group. Such an understanding was promoted in the present study by using race-specific assessments of provider cultural sensitivity and testing the PC-CSHC model with the participating patients by race and across race.
Though important, the findings in this study should be interpreted with caution given the limitations of this single study. These limitations include the cross-sectional nature of the data, the use of self-report data, and some lower-than-desired internal consistencies that may have attenuated parameter estimates. Another limitation was the focus on only two racial groups.
African American and White American patients were studied for several reasons. Both of these groups have group-specific aspects of their culture, have evidenced unsatisfactory levels of treatment nonadherence, and have unacceptable levels of preventable diseases such as obesity, hypertension, and type 2 diabetes. A major limitation of this study, however, is the lack of evidence for the construct validity e.
To date, such validity research has not been published. This issue of shared variance among measures is not unique to our study; rather, it is endemic to the entire literature using subjective measures in psychology.
Ideally, this evidence is obtained via a Confirmatory Factor Analysis measurement model using tests of measurement invariance across groups. This needed measurement invariance testing and the needed earlier mentioned examination of the construct validity of the variables investigated in our path model did not occur because of an inadequate sample size. We as well as other researchers have not amassed large enough samples of hard-to-reach African Americans to conduct such measurement invariance and construct validity testing.
However, future research to test the Patient-Centered Culturally Sensitive Health Care Model must have as a priority the inclusion of large enough samples to do this testing. It is also important to note several major strengths of this study.
The findings of the present study in light of its limitations and strengths suggest that the PC-CSHC Model is potentially useful to health psychologists and thus warrants further model testing that addresses the limitations of the model testing reported in the present study. This future model testing should likely include testing a refined model that is responsive to the fact that although interpersonal control emerged as a strong predictor of health promoting behaviors, dietary adherence, and less physical stress, cultural sensitivity was not associated, either directly or indirectly, with interpersonal control.
Such a refined model could include other predictors of interpersonal control and could address the possible moderating, rather than mediating, role of interpersonal control to account for the relationship between cultural sensitivity and health behavior. Alternatively, effects of cultural sensitivity might be weakened for patients at relatively lower levels of interpersonal control. Physical stress was inversely linked to engagement in a health promoting lifestyle among the non-Hispanic White American patients and to medication adherence among the African American patients.
These findings suggest that health psychologists may promote positive health outcomes among patients with low household incomes such as those in the present study by developing stress management models for use in primary care community-based clinics that serve such patients.
Patient and community empowerment are consistent with the growing interest in community participatory intervention research among researchers Israel, ; Jason, and among the leadership at the National Institutes of Health. National Center for Biotechnology Information , U. Health Psychol. Author manuscript; available in PMC May 1. Carolyn M. Tucker , 1, 4 Michael Marsiske , 2 Kenneth G. Rice , 1 Jessica D. Jones , 1 and Keith C.
Herman 3. Kenneth G. Jessica D. Keith C. Author information Copyright and License information Disclaimer. Correspondence concerning this article should be addressed to Carolyn M. Tucker, Department of Psychology, P. Copyright notice. The publisher's final edited version of this article is available at Health Psychol.
See other articles in PMC that cite the published article. Conclusion The findings provide empirical support for the potential usefulness of the Patient-Centered Culturally Sensitive Health Care Model for explaining the linkage between the provision of patient-centered, culturally-sensitive health care, and the health behaviors and outcomes of patients who experience such care.
Keywords: patient-centered culturally sensitive health care, interpersonal control, health promoting lifestyle, patient satisfaction, treatment adherence. Patient-Centered Culturally Sensitive Health Care PC-CSHC Model Despite the promise of the studies described above, one important limitation is their lack of a comprehensive theory that specifies the mechanisms linking culturally sensitive health care or patient-centered culturally sensitive health care to important health behaviors e.
Method Participants This study occurred as a part of a larger federal grant-funded research program on patient-centered culturally sensitive health care. Procedure The following two methods were used to recruit patients for the larger study: a a health care clinic office staff mailing method, and b an advertisement recruitment method.
Overview of the Data Analyses We conducted a two-group path analysis to test the model depicted in Figure 1. Open in a separate window. Figure 1. Provider Cultural Sensitivity Trust in provider 0. Patient Interpersonal Control 0. Patient Satisfaction 0. Physical Stress 0. Health Promoting Lifestyle 0. Diet Adherence 0. Medication Adherence 0. Physical Stress
Practical strategies for providing culturally sensitive, ethical care in developing nations.
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End Note. Reference Manager.