Cultural Competent Health Care

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Cultural Competent Health Care
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Agenda

• Questions concerns
• Discussion on culture, race, ethnicity, value
• Needs for cultural competent care
• Negotiation for dates for individual
  presentations

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Shrink the Earths Population to 100

• 57 Asians
• 21 Europeans
• 14 North, Central and South Americans
• 8 Africans
• 70 would be non-white, 30 white
• 70 would be non-Christian, 30 Christian

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Population in the U.S.

• Year 2000
• Whites 69.4
• Black 12.7
• Hispanic 12.6
• Asian 3.8

• Year 2050
• Whites 50
• Black 14.6
• Hispanic 24.4
• Asian 8

US Census Bureau, 2004
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Registered Nurses in the U.S.(2000)

• 86.6 - non-Hispanic white

(US dept of Health Human Service, 2003)
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Population in San Jose (2000)

• Whites - 47.5
• Hispanic - 30.2
• Asian - 26.9
• Black - 3.5
• U.S. Census Bureau (2006)

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Globalization Q How to define
globalization? A Princes Dianas death Q How
come? A An English princess with an Egyptian
boy- friend crashes in a French tunnel, in a
German car with a Dutch engine, driven by a
Belgian who was pissed on Scottish whiskey,
followed closely by an Italian paparazzi, on
Japanese motorcycles, treated by an American
doctor, using Brazilian medicines. And this is
sent to you by a Israeli, using Bill
Gates Technology which he stole from the
Taiwanese.
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Minorities Receive Lower Quality Health Care Than
Whites

• Institute of Medicine, 100 studies reviewed over
  past 10 yrs.
• Full report www.nap.edu/books/030908265X/html
• Minorities less likely to receive sophisticated
  Txs for AIDS
• More likely to have leg amputations for diabetes
• Poorer relationships with MDs

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Other Cultural Domains

• Folk beliefs/religion - can be confused with
  religiosity
• Stereotyping labels - avoid generalizations
• Ethnopharmacology - genetic influence, effect,
  metabolism
• Herbal therapies - interactions with meds
• Folk healers treatment approaches, e.g..,
  hysteria, psychosis

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Cultural competence impact on clinical outcomes

• Patients fear of being misunderstood or
  disrespected
• Providers are not familiar with the prevalence of
  conditions among certain minority groups
• Providers may fail to take into account differing
  responses to medication
• Providers may lack knowledge about traditional
  remedies, leading to harmful drug interactions
• Patients may not adhere to medical advice because
  they do not understand or do not trust the
  provider
• Providers may order more or fewer diagnostic
  tests for patients of different cultural
  backgrounds

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ethnic disparities in health care

• African American women are more likely than
  European American women to die from breast
  cancer, despite having a lower incidence of the
  disease.
• Infant mortality rates are 2.5 times greater for
  African Americans and 1.5times greater for Native
  Americans than for European Americans.
• Influenza death rates are higher for African
  Americans and American Indian/Alaska
  Natives/Native Alaskans than they are for
  European Americans.
• Mortality for colorectal cancer is highest for
  African Americans, followed by Native Alaskans,
  and then Hawaiians.

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Needs for cultural competence

• American nurses experienced a lack of cultural
  confidence in caring for culturally diverse
  populations - Coffman, Shellman, Bernal (2004)
  and Hagman (2006)
• There were gaps in healthcare providers
  knowledge of other cultures and how to care for
  them in culturally sensitive ways - Jones, Cason,
  and Bond (2004)

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Other evidences

• Negative racial stereotypes - rate black patients
  as more likely to abuse drugs and alcohol, less
  likely to comply with medical advice, and less
  likely to participate in cardiac rehab than white
  patients - Van Ryn and Burke (2000)
• Less Dx test - physicians were less likely to
  recommend catheterization procedures for black
  female patients than white or black male patients
  if they experienced the same kind of symptoms.
  Schulman et al. (1999)

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cultural competence is a process

• American Nurses Association published its first
  guidelines on cultural diversity in nursing
  curricula in 1986 - understanding the concept of
  human diversity including cultural and racial
  variations
• The Board of Registered Nursing of California
  (2006) has required all nursing schools in
  California to include cultural diversity and
  competence into their curricula

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Language barriers and disparity

• Utilization of health care services
• Fewer doctor visit and less preventive services
• More diagnostic test to compensate communication
  problems
• Satisfaction
• Less satisfied unless with interpreter
• Adherence
• Miss the appointment or drop out
• Outcomes
• Patient education

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Health Disparities

• President Clinton (1998) set the goal reduce
  health disparities by the year 2010.
• Target areas (NIH, 2003)
• Infant mortality,
• Cancer screening and management,
• Cardiovascular disease,
• Diabetes,
• HIV/AIDS,
• Immunization

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Problems with Health Disparities- with cultural
factors

• Flaskerud, J. et al (2002) a review of 79
  articles in the past 5 decades
• Ignorance of certain groups (indigenous peoples)
• Inappropriate lump together ie. Hispanic members
  of disparate groups with their own cultural
  identity eg., Puerto Ricans, Mexicans, Cubans,
  Dominicans

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Adays 2010 Priorities Showcase Needs within
vulnerable population

• High-risk mothers infants-of-concern
• Chronically ill disabled
• Persons living with HIV/AIDS
• Mentally ill disabled
• Alcohol other substance abuses
• Suicide- or homicide-prone behavior
• Abusive families
• Homeless persons,
• Immigrants/refugees

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Impact of Cultural Competency

• More successful patient education
• Increases in pts health care seeking behavior
• More appropriate testing and screening
• Fewer diagnostic errors.
• Avoidance of drug complications
• Greater adherence to medical advice
• Expanded choices and access to high-quality
  clinicians.

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Culture - Bound Syndromes

• A person living within a certain reality
• Learned way to interpret the world based on
  enculturation
• Recurrent, locality- specific patterns of
  aberrant behavior and troubling experiences that
  may not be linked to a DSM-IV diagnosis

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Culture Bound Syndromes
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Culture Bound Syndromes Cont.
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Culture Bound Syndromes Cont.
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Culture Bound Syndromes Cont.
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Temporal Relations

• Time Orientation
• Past, present or future-oriented
• Punctuality

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Negotiation Process

• Listen to the clients perspective
• Teach from your knowledge in language
  appropriate for client family
• Compare similarities differences, disagree but
  do not devalue clients view
• Compromise
• if client treatment not harmful, promote
• If harmful, explain harm and suggest alternatives

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The Health Promotion Matrix
Gorin, S. Arnold, J. (1998). Health Promotion
Handbook. St Louis Mosby. P 92
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Before Next Class

• Take extra care of yourself and your family
• Prepare by reading for class get copies of
  articles
• Decide on group presentation medium for
  presentation bring IBM compatible disk one week
  before if you want to use Power Point for your
  presentation limit slides to 30
• Continue work on your group for presentation
• Have a great week

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The End