Health Disparities and Culturally Competent Care

ZOYA MINASYANRN-MSN EDU

Determinants of Health

Health Disparities

• They refer to differences in measures of health status between different groups of people living in a community, a state, or entire nation.

• They occur when one group of people has a – higher incidence or mortality rate than another– when survival rates are less for one group than

another.

Health Disparities

Factors and Conditions Leading to Health Disparities– Race, ethnicity, and culture– Geographic location– Income, education, and occupation– Gender– Age – Health care provider attitude

Health Disparities

Impact of Health Disparities on HealthCancer-African Americans have higher rates than whites.Diabetes mellitus- more in minority groups with higher risk of complications.Obesity- affects African American , Mexican American and white women.

Nursing Interventions to eliminate Health Disparities

• Treat all pts equally.• Monitor for their response to therapy.• Be a pt advocate regardless of cultural

differences.• Be aware of one’s own biases.• Give the same standards of care to all pts.• Participate in research.

Culture

• Culture encompasses the knowledge, values, beliefs, art, morals, law, customs, and habits of the members of the society.

• Culture includes the systems of technology, education, social structures and political practices.

• Cultural patterns of behavior develop over time, shared by members of the same cultural group and transmitted to the next generation.

Culture

Culture

• Values are the set of rules by which individuals, families, groups and communities live.

• Acculturation- an individual or group learns how to take on many, but not all values, beliefs of another culture.

• Assimilation-and individual or group from one culture adopts certain features of other culture; it may be voluntary or forced on a group.

• Subcultures-smaller and may not hold all of the values of the dominant culture:

Religious subcultures- Catholics, Jews, MuslimsEthnic subcultures- African Americans, Hispanics and

Native Americans.

Culture

• Ethnicity-groups whose members share a common social and cultural heritage.

• Race- share a common ancestry and physical characteristics such as skin color, bone structure, or blood group.

• Stereotyping- viewing members of a specific culture, race or ethnic group as being alike and sharing the same values and beliefs.

• Ethnocentrism-belief of once own ways are superior to those of others from different culture, ethnic, or

racial background.• Trans-cultural nursing-study and analysis of cultures and

subcultures.

Cultural Competence• Cultural awareness-Identify one’s own cultural

background, values, biases.• Cultural Knowledge- learn, assess, read, view

documentations and do not make assumptions.• Cultural skills- become aware of cultural differences,

be alert for unexpected responses.• Cultural encounter-interact with different cultural

groups, attend cultural events, visit markets and restaurants , learn about their beliefs and practices.

Cultural Diversity in the Health Care Workplace

Cultural Diversity in the Health Care Workplace

Cultural Factors Affecting Health and Health Care

Personal SpaceIntimate distance 0-18 inches.Personal distance 18 inches to 4 feet.Social distance 4-12 feet or more.

Touch Nurse must ask permission before touching anyone.

NutritionFood and rituals associated with food. Immigrants may face with many unfamiliar foods.

Cultural Factors Affecting Health and Health Care

MedicationsNational Medical Association (NMA) and National Pharmaceutical Council (NPC) titled “Racial and Ethnic Differences in Response to Medicines: Towards Individualized Pharmaceutical Treatment.”Ex: Isosorbide dinitrate and Hydralazine-for African American pts.

Psychologic FactorsCulture-bound syndrome that is within a cultural groupEx: Susto- Latin America-soul loss, fright sickness which can cause loss of appetite, anxiety, social withdrawal.

Nursing Management:Reducing Health Disparities and Increasing

Cultural Competency

Nursing Implementation-Communication- Voice tone, gestures, spoken words, small talk, silence.-Choosing an interpreter-should be trained, able to translate, act as pts advocate, be culturally sensitive.

Activates and characteristics of the nurse

• Nurse as – Caregiver– Educator– Advocate– Leader– Manger– Researcher