PROGRAM GUIDE FOR PROFESSIONALS AND HEALTH CARE ASSISTANTS National Educational Video, Inc.TM is an approved provider of continuing education. State Board provider numbers: Florida #FBN2896, Alabama #5-97.0, California #CEP8803, Kansas #LT0121-1138, Kentucky #7-0045, West Virginia #WV96-0025RN and reciprocal approvals from the State Boards in Alaska, Delaware, Louisiana, Maine, Michigan, Nebraska, New Hampshire, New Jersey, Ohio, Texas, Utah. This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation. 1
PROGRAM DESCRIPTION This program discusses culturally competent care and the ways in which to promote effective cross-cultural communication. Originally created for the health care assistant, can be very useful to the health care professional. Video running time: 50 minutes (3.0 contact hours). OBJECTIVES At the completion of this program, the participant will be able to: 1. Define culturally competent care. 2. Describe the culturally competent health care worker. 3. List the cultural considerations that can affect the healthcare worker and the client. 4. Explain at least two qualities of caring people. 5. Define empathy. 6. List the ways in which to promote effective cross-cultural communication. 7. Explain the term ethnocentric. 8. List three examples of non-verbal communication. 2
The Nursing Process The nursing process is a systematic method of problem solving. It is based on the scientific method. The nursing process is called "process" because it is ongoing. These are the steps of the nursing process: Assessment: This is the systematic, ongoing collection of information from multiple sources. Assessment is done when a nurse interviews a client and the client s significant others. A physical assessment of the client is also completed observing the following: laboratory data, daily client actions, assessing the client s ability to carry out daily activities, symptoms and the client s response to treatment. In long term care, resident assessment instruments are used to provide a comprehensive multidisciplinary assessment. Problem Identification or Nursing Diagnosis: Assessment data leads to identifying client strengths and client problems. These may be actual problems the client currently experiences, or potential problems that may occur with that client in the future. Problems are stated and related to a cause or influencing factor. Planning: The systematic steps that the nurse will enact, with others, to assist the client to meet the goals (or outcomes) that are set. For each problem, a measurable, specific goal is identified. The plan includes nursing actions, based on aspects of nursing theory, nursing science, other sciences, and research findings. The beliefs and values of the nursing profession as well as the values of the client are taken into account. Implementation: Carrying out the plan. Evaluation: This is the systematic process of examining each client goal-related outcome to determine if it were met and to revise the plan accordingly. Evaluation may also identify the resources that are needed for the client or the health care provider in their continuing plan of care. Professional Nursing Roles As the nurse carries out the nursing process, the nurse enacts a variety of professional roles. These are: clinician teacher client advocate leader These roles may overlap. In the clinician role, the nurse may provide direct "hands on" care, or may assess a client's needs and direct others to provide services to meet those needs. The nurse may conduct client and family teaching in a teaching role. The nurse may also teach other health professionals when a multidisciplinary team addresses the client's needs. The nurse is a client advocate when collaborating with the client, finding resources for the client, and acting on behalf of the client. The nurse is a leader when planning and assigning the care of a client to others, maintaining overall responsibility and accountability for that care, assisting other members of the health care team to set and meet goals or when providing resources to other health care providers. 3
GLOSSARY OF KEY TERMS Cultural Diversity Ethnocentric Empathy Patient s Bill of Rights Folk Remedies Sensitivity Culturally Competent Care Different beliefs, traditions and ways of behaving that we share with a group of people. The belief that your customs or values are superior to others. Understanding and being objective about a situation and not becoming emotionally involved. Clearly states what the client can expect from all health care workers. Potions, plants and herbs used to alleviate or cure an illness. Having the capacity to feel, transmit or react to a situation. Adapts care to the client s cultural needs and preferences. 4
PRE TEST Circle T if the statements are true. Circle F if the statements are false. T F 1. America is a melting pot where everyone must give up distinctive language, customs and habits to become American. T F 2. Cultural diversity means each culture maintains its own special identity and contributes to the whole. T F 3. Health care workers should be client advocates. T F 4. Health care workers personal prejudices and values should be considered as important as those of the clients. T F 5. Empathy and caring are the foundation for good client care. T F 6. Culturally competent care adapts care to the client s cultural needs. T F 7. It s not important for health care workers to be aware of their own belief system. T F 8. Health care workers should be client advocates. T F 9. Everyone is a member of a particular culture. T F 10. Non-verbal communication is not considered a form of culture. 5
DISCUSSION QUESTIONS 1. What is cultural diversity? 2. Does dealing with culturally diverse clients sometimes cause conflict? Why? 3. Discuss the attitudes necessary to deliver good client care no matter what the cultural background. 4. Give examples of how you learned to be more tolerant and accepting of other cultural values. 5. Whose beliefs and values come first? Yours, the institution s/agency s or the client s? 6
POST TEST Choose the response that most accurately answers the following questions: 1. America is: a. a melting pot where all people are expected to be the same b. a culturally diverse society where each culture maintains its own special flavor and contributes to the whole c. intolerant of cultural differences d. a country with no culture 2. Health care workers: a. never have to deal with cultural conflicts b. often have a better perspective on the client s needs than do other members of the health care team c. should ignore cultural differences d. don t believe in cultural differences 3. Health care workers: a. can improve communication between the client and other members of the health care team b. should place their own values and beliefs above those of the client c. should make no effort to understand or accept different cultural values d. should not try to improve communication between the client and other members of the health care team. 4. The single most important step in successfully dealing with the challenges of cultural diversity is: a. to strictly enforce institutional rules without consideration of the client s needs b. to develop respect for and acceptance of the client and the cultural values he or she represents c. try to Americanize your clients so they can fit into society better d. do nothing 5. Which of the following is the third step in eliminating barriers to effective cultural communication? a. appreciation b. celebration c. tolerance d. intolerance 7
POST TEST (Continued) 6. Caring for clients of all cultural backgrounds means: a. recognizing others as separate and unique persons with special needs we should try to accommodate b. setting aside our own beliefs, values and prejudices c. treating others as we would like to be treated ourselves d. all of the above 7. The Client s Bill of Rights: a. clearly spells out what the client can expect from all health care workers b. can be ignored if things get too busy c. doesn t apply to all clients d. applies only in certain situations 8. Institutions have a set of values which: a. reflect the values of the world outside b. are never in conflict with the client s values c. can never be adjusted to meet the needs of the client d. doesn t reflect the values of the world outside 9. The single most important attitude a health care worker must have in dealing with cultural diversity is: a. curiosity b. sympathy c. acceptance d. ethnocentrism 10. The best way to learn to accept people whose cultural beliefs are different from our own is to: a. put yourself in your client s shoes b. think your values and practices are better than your client s c. impose your beliefs on your client d. ignore the clients beliefs 11. Some clients have different ideas about treatment. In a situation where treatment is important, what should you do? a. explain the importance of the treatment and the effectiveness of the treatment b. let your frustration show c. ignore the issue d. smile and say nothing 8
12. If you don t speak your client s language, how can you communicate? a. ask a family member to interpret b. learn non-verbal communication techniques c. as a gesture of good will, learn a few words in your client s native language d. all of the above 13. Non-verbal communication with a client that doesn t speak English: a. should never be used b. is more reliable than spoken language c. is difficult to learn d. is not reliable 14. When a client denies having pain, but body language indicates pain is present, you should: a. tell others on the health care team b. let the client suffer in silence c. tell the client s family d. do nothing 15. If a client doesn t make eye contact, you should: a. presume he or she isn t listening or can t understand b. consider that in some other cultures, direct eye contact is considered to be impolite and consult with your supervisor c. demand he or she look you in the eye before you proceed d. ignore the client 16. What should you do if a client s family asks to assist you in your duties? a. tell them to leave b. explain your actions and, if permissible, allow them to assist c. ignore the request and continue with your duties d. allow them to take over 9
ADDITIONAL DISCUSSION QUESTIONS 1. Discuss ways to cope with language differences. What non-verbal signs of a client s condition can you read? 2. Do family members ever present a problem? How do you deal with family members who don t observe institutional rules? 3. For some clients, spiritual healing is equal in importance to physical treatment. What should your attitude be toward folk medicine or traditional healing methods? 4. A family member offers you a cultural food delicacy you find unappetizing. What should your reaction be? 10
ANSWER SHEET PRE TEST 1. F 6. T 2. T 7. F 3. T 8. T 4. F 9. T 5. T 10. F PART 1 POST TEST 1. b 11. a 2. b 12. d 3. a 13. b 4. b 14. a 5. a 15. b 6. d 16. b 7. a 8. a 9. c 10. a 11
RESOURCE ADVISORS DEBORAH UNSWORTH, M.S. ARNP: Received her Bachelor of Science Degree from the University of South Florida and her Master of Science Degree from State University of New York. She has worked as a nurse since 1973 in the areas of med-surg, obstetrics and ER. She has been a nurse practitioner and women s health educator since 1990 and is currently the Director of Education at National Educational Video, Inc. BERNARDO GARCIA, MA, BS... is the Director of the Office of Multicultural Student Language for the State of Florida. From 1991 to 1993 he was Coordinator of LEP students and Foreign Language Program. Mr. Garcia worked as assistant director of the Collier County Vocational Technical Center from 1984-1991. Prior to his work at the center, from 1974 to 1984 Mr. Garcia worked as an assistant principal in middle schools. In 1963 to 1974 he worked as Spanish and Humanities teacher in New Jersey and Illinois. His educational background began in 1959-1961 at the University of Havana Law School. In 1968 he obtained a BA in American History from Lewis University. Post graduate work was obtained from Montclair State College, Florida International University and the University of South Florida. Mr. Garcia completed his doctoral course work at the University of Miami. NEVCO video educational programs are prepared using specific criteria designed by National Educational Video, Inc. All educational programs are coordinated and reviewed under the direction of the NEVCO Director of Education, who is a master s prepared nurse. 12
REFERENCES Lahiri, I. & Sedicum, A. (2000). Global diversity. Providian interculturally competent health care, Retrieved May 2, 2004 from http://www.diversityhotwire.com/learning/global_diversity.htm Matzo, M, et al (2002). Teaching cultural consideration at the end of life: End of Life Nursing Education Consortium program recommendations. Journal of Continuing Education Nurse, 33(6), 270-8. Narayan, M. (2003). Cultural assessment and care planning. Home Healthcare Nurse, 21(9), 611-620. Phillips, K. (2004). AHA touts culturally competent health care, Retrieved June 8, 2004 from http://www.nursezone.com Spector, R. (2000). Cultural Diversity in Health and Illness. Stamford, CT: Appleton & Lange. Spence, D. (2001). Hermeneutics: Transcultural nursing. Journal of Advanced Nursing, 35(4), 624-627. While NEVCO strives to remain current with federal and state regulatory requirements, the information contained in this video presentation is always subject to governmental amendment. Therefore, we suggest that you contact your state and federal authorities for any possible revisions to this material. 13
Participant Evaluation of Objectives Please evaluate the presentation by circling the number that best describes your rating. 4=Excellent 3=Good 2=Average 1=Poor Define culturally competent care. 4 3 2 1 Describe the culturally competent health care worker. 4 3 2 1 List the cultural considerations that can affect the health care worker and the client. 4 3 2 1 Explain at least two qualities of caring people. 4 3 2 1 Define empathy. 4 3 2 1 List the ways in which to promote effective cross-cultural communication. 4 3 2 1 Explain the term ethnocentric. 4 3 2 1 List three examples of non-verbal communication. 4 3 2 1 Do you feel you met your personal objectives? Time required to complete this program? minutes COMMENTS: Return this form to the facilitator who distributed the learning materials. Thank You! 14