Cultural Competence: An Overview

Course #97430 - $15-


Self-Assessment Questions

    1 . A nurse acknowledges that she still has a lot to learn about different racial and ethnic minority groups. She is willing to learn from her patients and assume the role of learner. This nurse is demonstrating
    A) diversity.
    B) reflexivity.
    C) explicit bias.
    D) cultural humility.

    DEFINITIONS

    Cultural humility refers to an attitude of humbleness, acknowledging one's limitations in the cultural knowledge of groups. Practitioners who apply cultural humility readily concede that they are not experts in others' cultures and that there are aspects of culture and social experiences that they do not know. From this perspective, patients are considered teachers of the cultural norms, beliefs, and value systems of their group, while practitioners are the learners [5]. Cultural humility is a lifelong process involving reflexivity, self-evaluation, and self-critique [6].

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    2 . Which of the following is NOT a risk factor in triggering implicit biases for health professionals?
    A) Uncertainty
    B) Cognitive dissonance
    C) Time pressure to make a rapid decision
    D) Heavy workload and feeling behind schedule

    BIAS: IMPLICIT AND EXPLICIT

    Specific conditions or environmental risk factors have been associated with an increased risk for certain implicit biases, including [130,131]:

    • Stressful emotional states (e.g., anger, frustration)

    • Uncertainty

    • Low-effort cognitive processing

    • Time pressure

    • Lack of feedback

    • Feeling behind with work

    • Lack of guidance

    • Long hours

    • Overcrowding

    • High-crises environments

    • Mentally taxing tasks

    • Juggling competing tasks

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    3 . All of the following are categories of social determinants, EXCEPT:
    A) Race
    B) Economic stability
    C) Health care access and quality
    D) Social and community context

    SOCIAL DETERMINANTS OF HEALTH

    Social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. Healthy People 2030 groups social determinants of health into five categories [34]:

    • Economic stability

    • Education access and quality

    • Health care access and quality

    • Social and community context

    • Neighborhood and built environment

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    4 . Which of the following has been identified as a core value of Black culture?
    A) Spirituality
    B) Community
    C) Family/kinship
    D) All of the above

    BEST PRACTICES FOR CULTURALLY RESPONSIVE CARE

    Historical adversity and institutional racism contribute to health disparities in this group. For the Black population, patient assessment and treatment planning should be framed in a context that recognizes the totality of life experiences faced by patients. In many cases, particularly in the provision of mental health care, equality is sought in the provider-patient relationship, with less distance and more disclosing. Practitioners should assess whether their practices connect with core values of Black culture, such as family, kinship, community, and spirituality. Generalized or Eurocentric treatment approaches may not easily align with these components of the Black community [42]. Providers should also consider the impact of racial discrimination on health and mental health among Black patients. Reports indicate that expressions of emotion by Black patients tend to be negatively misunderstood or dismissed; this reflects implicit or explicit biases.

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    5 . Male gender identity is related to
    A) risk avoidance.
    B) emotional demonstration.
    C) denying pain and weakness.
    D) teamwork and help-seeking.

    BEST PRACTICES FOR CULTURALLY RESPONSIVE CARE

    An increasing amount of research is supporting a relationship between men's risk for disease and death and male gender identity, and the traditional male role has been shown to conflict with the fostering of healthy behaviors [62,63]. Male gender identity is related to a tendency to take risks, and the predilection for risky behavior begins in boyhood [63,64,65]. In addition, boys are taught that they should be self-reliant and independent and should control their emotions, and societal norms for both boys and men dictate that they maintain a strong image by denying pain and weakness [62,64,65].

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    6 . Cultural heterosexism is characterized by
    A) negative feelings toward oneself and self-hatred.
    B) a negative attitude or fear of non-straight sexuality or GSM individuals.
    C) considering sexual identity and determining that one does not want to think further about it.
    D) the stigmatization in thinking and actions found in cultural institutions, such as educational and legal systems.

    BEST PRACTICES FOR CULTURALLY RESPONSIVE CARE

    The subtle and pervasive ways that discomfort with GSM individuals may be manifested have been examined and, in some instances, categorized as "cultural heterosexism," which is characterized by the stigmatization in thinking and actions found in our nation's cultural institutions, such as the educational and legal systems [80]. "Cultural heterosexism fosters individual antigay attitudes by providing a ready-made system of values and stereotypical beliefs that justify such prejudice as natural" [81]. Perhaps the paucity of information about the GSM community in basic professional education has been a reflection of cultural heterosexism. Writers, funding sources, and publishers have been exposed to the same cultural institutions for many years.

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    7 . Persons with disability experience higher rates of all of the following, EXCEPT:
    A) Obesity
    B) Smoking
    C) Cancer screening
    D) Breast and lung cancer mortality

    BEST PRACTICES FOR CULTURALLY RESPONSIVE CARE

    People with disabilities experience many health disparities. Some documented disparities include poorer self-rated health; higher rates of obesity, smoking, and inactivity; fewer cancer screenings (particularly mammography and Pap tests); fewer breast-conserving surgeries when breast cancer is diagnosed; and higher rates of death from breast or lung cancer [104].

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    8 . Which of the following is a typical characteristic of communication in high-context cultures?
    A) Use of more informal language
    B) Speaking more and often raising one's voice
    C) Assumption that meanings are described explicitly
    D) Reliance on interpreting eye contact, gestures, and tone of voice

    PROMOTING CULTURALLY SENSITIVE COMMUNICATION

    Communicators from high-context cultures generally display the following characteristics [106,107,110,111]:

    • Use of indirect modes of communication

    • Use of vague descriptions

    • Less talk and less eye contact

    • Interpersonal sensitivity

    • Use of feelings to facilitate behavior

    • Assumed recollection of shared experiences

    • Reliance on nonverbal cues such as gestures, tone of voice, posture, voice level, rhythm of speaking, emotions, and pace and timing of speech

    • Assimilation of the "whole" picture, including visual and auditory cues

    • Emotional speech

    • Use of silence

    • Use of more formal language, emphasizing hierarchy between parties

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    9 . Which of the following is an attribute of patient-centered practice?
    A) The practitioner focuses on observed signs and symptoms.
    B) The practitioner is concerned with identifying the disease pathology.
    C) The practitioner focuses on the subjective description of the illness.
    D) The practitioner is not influenced by how the client/patient defines the illness.

    CULTURALLY SENSITIVE ASSESSMENT GUIDELINES

    Practitioners may be categorized as either disease-centric or patient-centric [117]. Disease-centered practitioners are concerned with sign/symptom observation and, ultimately, diagnosis. On the other hand, patient-centered practitioners focus more on the patient's experience of the illness, subjective descriptions, and personal beliefs [117]. Patient-centered practice involves culturally sensitive assessment. It allows practitioners to move assessment and practice away from a pathology-oriented model and instead acknowledge the complex transactions of the individual's movement within, among, and between various systems [118].

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    10 . The basis of establishing a safe and welcoming environment for all patients is
    A) security.
    B) autonomy.
    C) beneficence.
    D) maintaining distance.

    WELCOMING AND SAFE ENVIRONMENT

    Improving access to care can be facilitated, in part, by providing a welcoming environment. The basis of establishing a safe and welcoming environment for all patients is security, which begins with inclusive practice and good clinician-patient rapport. Shared respect is critical to a patient's feeling of psychological well-being. Security can also be fostered by a positive and safe physical setting. For patients who are acutely ill, both the illness experience and treatment process can produce trauma. This is particularly true if involuntary detainment or hospitalization is necessary, but exposure to other individuals' narratives of experienced trauma or observing atypical behaviors from individuals presenting as violent, disorganized, or harmful to themselves can also be traumatic. As such, care environments should be controlled in a way to minimize traumatic stress responses. Providers should keep this in mind when structuring the environment (e.g., lighting, arrangement of space), creating processes (e.g., layout of appointments or care systems, forms), and providing staff guidance (e.g., nonverbal communication, intonation, communication patterns). During each encounter, the patient's perception of safety is impacted by caretakers and ancillary staff.

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