All right, so we're moving right along. And as you can see, this module is going to focus on cultural competence, which I don't think I have to tell you, but it is huge in healthcare and in nursing, very, very important. In Southern California, particularly, we're in such a multi-ethnic community that no matter what hospital you go to here in Orange County, LA, you are definitely going to be encountering people from cultures that are different from yours.
And you might be called. encounter people from cultures that you've never heard of before. And in order for us to be able to take care of our patients and people holistically, we really have to be able to integrate culturally congruent care within our nursing practice.
Your book does a really nice job on this content. So I think there's lots of tips and tricks in there. So hopefully by the end of this, what I'm hoping you get from this, aside from learning a bunch of new terms and models and those types of things. is just to really have a curiosity about people who are different than you. You're going to be working with patients who are so very different from you and people that you may never run across in any other aspect of your life, but as a nurse, you are going to run across those people.
And just having a curiosity about people's differences, about what's unique within their cultures, it... gives you something unique in your life too, because you're going to learn a lot from these people, but it also is going to enhance your relationships with them. If you're able to demonstrate that you understand what makes them different and unique, and that you are willing to help them to, to carry out their cultural practices without judgment from you.
I set up a few objectives for you. They all came straight from the book, except for the first one, which talks about the impact of bias and whether that's unconscious or implicit, your book in this edition, sorry, I'm tripping over my words, does actually talk about implicit bias, which in previous editions, they didn't even touch that, which I think is an injustice. So they do a good job covering it.
They just didn't set up an objective for it. And since I think it is something that is so important and it's so at the forefront of why we need to have some cultural competence, I just set up an objective around that. The others come from the book.
And for this... module, I'm going to pretty much follow the outline in the book. So if you want to just have your book open and be able to highlight a little bit, then absolutely, I think that will help you to kind of get through the content for this module.
The first thing that we're going to do is look at the definition for culture. And the definition that I have here for you was from Geiger and Haddad in 2021, but it really hasn't changed that much from definitions that we've had. previously surrounding culture. So we've always talked about how culture is learned.
So it's what you learn within your cultural group. And it's those shared beliefs, values, norms, and traditions that are unique to your cultural group. And they in turn then guide your thinking decisions and actions.
And so generally, the cultural beliefs that a group has are different from the beliefs outside of the group, which they're the beliefs that unite that cultural group. but they can also be the thing that separate that cultural group from other groups, right? So it's something that can divide and something that can unite.
And the more you learn, the more you realize that even though we all have different beliefs, we're really not that different. So that's kind of one of the advantages that we get learning about culture. The other thing I would say is that culture is kind of the context that people use for interpreting their human experiences.
So when we talk about health and illness. decision-making, birth, death, all of those things, there's usually a cultural lens that people view that from of what is acceptable and what is not acceptable. The other thing with culture is that it's both visible and invisible.
So there's some visible things that you will see about somebody that will indicate what culture they are subscribing to, but there's many, many more things that are invisible that you really have to ask and have a curiosity about because otherwise. you won't pick up on those. The next slide that I have for you guys is a lot of different terms.
some of which are fairly self-explanatory, and others might take a little bit more digging in to get to. So we just went over the definition of culture, so I'm not going to do that again. Subcultures, I think, is fairly self-explanatory, but they are groups with distinct characteristics that might be a little bit different from the dominant culture. So a culture can have, again, several little subcultures within it, and that's...
That's as much as I can tell you on that term there. Then when we get to the next three, enculturation, acculturation, and assimilation, those are all fairly similar. So I'm going to do my best to describe the differences. It's also obviously in your book.
But I want you guys to understand the difference between these, even though it's kind of a nuance. So when we talk about enculturation, that is someone's socialization into their primary culture as a child. So whatever culture you are being raised in, you are encultured into that from the day that you are born. And then that's how that becomes your culture.
When we talk about acculturation, that is the process of adapting to a new culture. So if you were taken from your culture and dropped off into a different culture, then acculturation is what's going to happen there where you start to assimilate, which is the next one. into this new culture. So assimilation is really just the process of acculturation.
So as you are assimilating, meaning picking up some of the beliefs, some of the values from this new culture, then you're going to start to acculturate to the new culture. I get that that all sounds super confusing. Read the book.
They might say it better than I said it. And we can talk about it in class as well. But I really do want you guys to know the difference between enculturation, acculturation, and then that assimilation is basically just the process of acculturation. When it says multicultural, I think that's another one that's fairly self-explanatory, that individuals identify with more than one culture.
So this probably applies to most of you that, you know, you can say I am part of this culture and part of that culture. The more that time goes on, I think it's very hard to find somebody who really is just one dimensional. I have one culture and that's it because we are all intermingling and collaborating so much that I think it's more common to be multicultural than not.
Then you see that I switched colors a little bit here. And again, you probably have noticed I'm a pretty color coded person, but this helps me kind of, you know, remember things in my head as well. So I coded. unconscious bias and implicit bias, both in kind of that reddish color, because we don't really want either of those. They are not necessarily good things.
So when we talk about unconscious bias, we're talking about a bias that you are unaware of. So it's happening outside of your control. It's influenced by your background, your cultural environment, your personal experiences. what happens with those is that it can lead to quick judgments, assessments of people, stereotyping, which obviously is not good.
It's unconscious in that you're not consciously doing this, but based on where you grew up and the people you were surrounded with, these are the things that you were told were true. And so these are the beliefs that you have. Implicit bias is different. Implicit bias is a bias that you are aware of.
So we're responsible for implicit. bias. And we have to recognize and acknowledge our actions as they impact our behaviors, decisions, and patient care. So I don't think that you can meet a lot of people who say they have absolutely no bias.
I think most people have some slight bias, and hopefully we are all doing our very best to work on these implicit biases that we have and to learn more about people that we may have a little bit of apprehension about. to really understand what makes them unique, how can we work with that type of a person, and so that we don't approach them with bias. There's nothing good that happens in relationships, in healthcare, if you're approaching a patient with bias, whether it's something that you're aware of or something that you're not aware of. Obviously, you can't work on it if you're not aware of it.
So the first step is becoming aware of it. So moving it from an unconscious bias to an implicit bias is step one. But then we really need to work on eliminating that bias because our goal is, again, the green is culturally congruent care and transcultural care. So we really want to make sure that that is our end goal.
All right. So hopefully those terms make sense to you. Look up in your book and then also bring them to class.
Like I say, every time, put notes in your phone, write something on a piece of paper, whatever that is, so that you can ask your questions when we end up meeting. All right. So another thing that we have to look at is worldview. What is somebody's worldview?
So a worldview is how you see the world. And I think it goes, one of the things that always comes into my head is, is the thing that maybe your parents said it to you too, but I know my parents said to me, I'll be careful who you surround yourself with. You become the people you associate with. And I never really understood what they meant by that, but what they're saying is that, you know, we all share. And so if the people that are around you believe one thing, you're likely to believe that too.
So when we look at worldview, there's two unique words up here that quite frankly, before I started teaching this class, I had never heard of emic or etic. So when I read the book for the first time, I was like, well, okay, here's some new words for me that I have to learn. But they're kind of cool.
And I've seen them in some other literature and stuff. So they certainly are used just not in everyday language. When we see the term emic, that means an insider perspective. The way that I remember that is I just reverse the E and the M and I make it me, and that's my insider perspective. And then etic is an outsider perspective.
So I think of that as ET. So what happens is conflict kind of arises when healthcare providers interpret the behaviors of patients through their own worldview lens. So through their emic view, they are trying to look at somebody else's actions that are related to their culture.
And then we don't really understand each other. So instead of trying to uncover the worldview that guides the behaviors of their patients, they're just understanding their own worldview. So we really need to try to understand somebody else's perspective. I mentioned stereotype on the last, when I was talking about the last slide as well. And that really just is an assumed belief regarding a particular group.
So again, if you don't understand somebody and you have bias against them, then you may develop stereotypes, which obviously doesn't let you treat the patient as an individual. And then the last thing that I have on this slide is just talking about how every patient encounter you have essentially is going to be cross-cultural and you have something you can learn from everyone. So just like I said in the intro, there's so much to learn from patients.
Learn to open up your worldview and look at things from a different perspective. It's really, really powerful to be able to do that. And then the graphic on this slide came directly out of the book and again, talks to that socialization that happens within cultures and how that helps to develop your worldview. So if you're kind of a visual learner, that one might help you a little bit to see how this all kind of relates to each other.
The next thing we're going to talk about, like I said, your book previously didn't cover this, which I think was a huge disservice. So we are going to spend a little bit of time talking about. health disparities.
But a health disparity is essentially just a health difference that is closely linked with the social determinants of health. And we'll talk about that a little bit on the next slide. So those are the social, economic, or environmental disadvantages that a patient might have. Healthy People 2030 has a focus of reducing health disparities and working towards health equity.
They are focusing on cultural competence, health literacy, patient and family-centered care, recognizing and valuing that each patient's unique needs improve the overall safety and quality of care and help to eliminate those health disparities. So Healthy People is not new. It's been around for several decades. During the past two decades, there has been an overarching goal focused on eliminating health disparities.
Um, but 2030 is when they've really, really kicked that in gear. So hopefully we'll make a little bit of progress because we have a lot of progress to make. Um, there's still definitely research out there showing that minority populations, those living in poverty, um, the less educated have much poorer health, health outcomes, access to health, um, dying at an earlier age. And at some point we've got to be able to do something about this. There's just, we cannot continue to be.
a world leader country and not take care of all our people. So that is something that we're looking at with this health disparity. And then I gave you guys some some info down here from the CDC as well, showing that, again, some of these racial and ethnic minorities have less access to care, lower quality care, increased incidence of disease, morbidity, mortality.
And then the one that always strikes me is decreased communication from providers. And the research study that I looked at, and I didn't cite it on here, I'm sorry, showed that actually. Even if the provider spoke the same language as the client or patient, there was still decreased communication, which absolutely just doesn't even make any sense to me.
But you can certainly see if there is a language barrier that there probably is going to be some impact to the communication there. All right. And then I'm not done yet. So our next slide here talks a little bit more, like I said, about those social determinants of health.
So. You know, the conditions which people are born, grow and live in age that affect their health functioning and quality of life. That's what we mean by social determinants of health. And then the other topic that your book, you know, went out and actually touched on this time, which they hadn't before, are marginalized groups. And that is huge.
Our marginalized groups have much poorer outcomes due to the complex interactions among health care environment. the communities they live in, the policies and practices of health care, government systems, all of that stuff. And so as you can see, I put a couple things up here. So we have our LGBTQ community, people of color, people with physical and mental challenges, people who are not college educated. These are all what we call marginalized groups.
So if you look at the graphic that's on this slide, you see what is sort of like our dominant group, all the yellow people who are hanging out together. And then you see there's some little stragglers that are just kind of outside of that norm. Those are our marginalized groups. And there's so much research that talks about when people from these marginalized groups seek healthcare, they feel judged. They are less likely to seek healthcare because they don't want to be judged.
They feel that people don't understand them. People don't understand their unique needs. And so it kind of puts them in this powerless or unimportant position. which certainly is very, very uncomfortable.
And if that's concerning healthcare, then that means that they are probably going to have poorer health outcomes and earlier mortality because they don't have access to the same thing that everybody else does. So that's what we're talking about when we talk about health disparity. And it's something that hopefully nursing is going to be at the forefront of here now to try and make a difference in this and to try and make it safer for these marginalized groups.
to have access to care and to not feel so particularly judged every time they interact with the healthcare system. The next thing we're going to look at is intersectionality. And this is not terribly complicated. It's kind of a research and policy model that they use to study the complexities of people's lives and experiences. And it just talks about the different forces, factors, power structures, all of that.
that shape and influence life and the fact that most people are at the intersection of two categories. When we talk about intersectionality, a lot of the times it is a category of privilege and a category of oppression as well. So again, most of the patients you meet are not going to be one dimensional.
So you may have a patient who is gay, who is also Korean. You might have somebody who is a veteran, who is also a woman. So just knowing that your patients, they're not just one dimensional and that intersectionality is definitely a reality with most of the patients that you take care of. The other thing that I will say as we talk about intersectionality, and I love this analogy of the iceberg because it really talks about, again, like I said, so much of somebody's worldview is hidden.
You see a little bit of their practices and behaviors, and that's certainly observable. But there's so much going on under the surface that you may not be aware of. And then being able to understand the different levels of oppression where you stand can help you develop kind of that cultural competence. The graph down on the bottom comes directly from your book as well.
And it just kind of talks about our different types of biases. and how they affect us. So if we have a stereotype, that's going to lead to bias and prejudice. Bias and prejudice is going to lead to discrimination.
Discrimination is going to lead to oppression. So we want to start working on not having those biases, those stereotypes. And then looking at the other side of it, it is, you know, we can start with developing our own self-awareness, our own worldview. being able to look at the worldviews of others, develop appropriate interventions and techniques, and then understand the institutional forces that support or negate cultural competence.
So those are all steps on that ladder. And again, directly in your book, so you can take a peek at that. Then there's a lot of terms here as well. So cultural competence or cultural respect is just the meaningful use of care strategies based on knowledge of the cultural heritage, beliefs, attitudes, behaviors of those that we care for. And I'm actually going to go to the next slide to talk about this racial identity, ethnic identity, cultural identity.
And we've already talked about acculturation and assimilation. So we won't need to do that too much more. I do have an example for you. All right.
So here, when you talk about ethnicity, that's really more your cultural characteristics. So it's not necessarily it's more the group that you associate with. So, you know, are you Vietnamese? Are you Christian?
You know, these different cultural groups that you associate with. And then race is more of the biological characteristics that somebody has. refers more to their physical appearance, their skill, skin color, eye color, hair color, bone structure, that type of thing. Um, one of the things that your book does a nice job of talking about is your ethnic, um, identity and your racial identity. They are self-identifications.
So it, it's your patient who can tell you what their identification is. And so the example that I have for you. is that somebody could belong to an ethnicity, but not have the traditional race characteristics associated with that. I know that sounds kind of confusing. So the example I will give you is from one of my friends in Denmark.
He is, he's Danish. He looks like, like me, like most people, you know, do their fair skin, blue eyes, lighter hair. And he is married to a Black woman who is also Danish, grew up.
there, speaks the language. She, by all means, I would say is more Danish than I am. She cooks the food.
She, you know, has all the traditions, speaks the language better than I do, you know, subscribes to the different cultural traditions. But if you were to see us out to dinner somewhere, so the three of us are sitting there having dinner, somebody may assume that she's visiting, that she's not from around here, however that would be, when actually the person who's visiting and not from around here would be me, but I look like I fit in. So just knowing that just judging based on what somebody looks like is not really going on that iceberg of really understanding who your patient is below the surface.
So hopefully that kind of makes a little bit sense. And again, if you have questions, bring them into class and we'll, we'll talk it through. So one of the things that it's important for us to talk about, um, culture in is disease and illness, because obviously that is where we do a lot of our work as nurses is this is where we meet our patients. There's a very cool case study in your book as well that talks about how healthcare is perceived from a different perspective and how you may think as a nurse that you are doing what is best for your patient, but your patient isn't receptive to it because their culture is different and their beliefs are different. So if you consider how differently healthcare, illness, caring are viewed in Western cultures and non-Western cultures, they're very different, right?
In our biomedical orientation of the Western culture, we emphasize scientific investigation and some of our non-Western cultures emphasize a more holistic concept of health and illness. So there might be some areas where we clash on with that. So again, we want to make sure that we're as educated as possible about what our...
patient's perspectives are and what's important to them so that we can find some type of a compromise between what we are trying to accomplish with our health care and what is acceptable to them within their cultures. Then this slide here is really just more informational as far as what the predominant culture in the U.S. experiences. So, you know, most of the U.S. Culture is very comfortable with expressing positive and negative feelings, with direct eye contact, with communicating.
We tend to address people in a casual manner, you know, prefer the strong handshake. And so that may not be the person that you are encountering. You might have a patient who is not so comfortable with eye contact.
You might have a patient who does not feel like they are able to express their positive and negative feelings and might be very closed up. And so really just make sure that you are as curious as you can be. And I know I've said this a few times so that you can learn from your patients. Your ATI book has a lot of really good information regarding things like health, birth, death rituals, because they're different within each culture.
The only thing I will tell you when you start learning more about this culture does that and that culture does that is, you know, make sure that it's all individualized. So, yes, you might know that this culture generally does that. but you don't know about your patient.
So you can have that information in the background, but now you need to get to know your patient to know, do they also subscribe to that? Is that important to them? And with that being said, we want to make sure that we don't trample somebody's culture.
So that's kind of the whole point of it, right? So finding out how your patient makes decisions, is it a patriarchal society? Is it a matriarchal society?
We're used to here in our westernized American society that everybody makes their own decision. That's not the case in all cultures. In some cultures, it is the oldest son who makes decisions. In another culture, you know, there's somebody else who's in, you have to see the shaman, you have to, whatever that is. So don't just assume that your patient is going to be like you.
And when you walk in there with a consent form for a procedure and they can't quite make that decision themselves, don't push that on them. Find out, okay, so what do you need? Do you need to consult with somebody? Do we need to call somebody?
Because again, we don't want to trample what their culture is. Let me see what else here. I think I kind of said all of that there.
And we talked about eye contact on the last slide. So I think we're good. We're going to move on and switch gears a little bit.
The next slide, again, is something new that was added in your recent edition of the book. And this is something fairly technical, these core measures. So I'm not going to go into too much detail on this.
Essentially, they are quality indicators that help the healthcare institutions to provide the same type of care to all patients with whatever disease problem it is, and not have it be so based on, you know, this group gets this and this group gets that. And so I think I probably made that sound a little bit more difficult than it is. But when hospitals are held accountable to meet the core quality measures, then all patients regardless of their culture, culture or socioeconomic status. are to be treated equally because the core measures apply to all. So the example that I have, which may or may not make any sense to you guys, if a patient comes in with heart failure, then there is a type of medication called a beta blocker that we give that patient.
And so if it's a core measure, that means that every patient that comes into every hospital and is diagnosed with heart failure needs to receive a beta blocker. That kind of levels the playing field a little bit. And obviously, if it's appropriate for that patient, and they're not allergic, and you know, all of that type of stuff.
But that way, it's not a decision based on can they pay for it? You know, do it's a decision based on heart failure equals best outcomes equals beta blocker. And this is put in place by the CMS. So it affects reimbursement, that type of thing for hospitals, which as we talked about, And previously, you know, anytime you put dollar signs behind it, people kind of start paying attention a little bit more.
So that's the point of these core measures. Then we'll jump back into talking about cultural respect and the culturally congruent care. And again, I know we've talked about this a bit already and, you know, I keep coming back to it.
But that is the whole point of this module is that, you know, effective nursing care is going to integrate the cultural values and beliefs of. the individuals you're caring for, the families, communities, with the perspectives of our multidisciplinary team of healthcare providers. So we have to find a way of collaborating. Like I said, don't trample their culture, but you also need to accomplish what you need to accomplish for the reason that they're in the hospital.
When you're able to provide culturally congruent care, then you're able to bridge that cultural gap and provide meaningful and supportive care to your patients. And that's really what we're hoping for. Again, I put the reminder of not assuming that all members of a cultural group will feel the same way about a given situation.
Instead, you're going to use your clinical judgment. You're going to combine your knowledge about a cultural group with that attitude of helpfulness and flexibility so that you can provide quality patient-centered care that is culturally congruent. One of the examples that I have, just super simple, but if you have a patient and you would...
you know, you're coming from your perspective and you're thinking, I want to comfort them. So I'm going to put a hand on their shoulder. And you notice that patient tends up and kind of pull away from you. That's a sign to you, right?
So is that, that there's something within their culture that it's not appropriate for you to touch them? Is it a personal thing? Who knows? So you need to have a little curiosity and you need to kind of, you know, don't ignore the fact that it happened. Don't keep doing it either, but maybe it is just a quick, oh my gosh, I'm so sorry.
I realize I just made you uncomfortable. I was just trying to provide some comfort. Is there a different way that I can comfort you in?
Can you tell me a little bit more about why it makes you uncomfortable when I put my hand on you? Maybe it's that your hands were cold, who knows, but kind of have that conversation, be open to learning from your patients. That's what's really, really important.
I'm going to go over some terms again in this next slide here. So when we talk about cultural awareness, again, this is kind of our self-examination, looking at those biases that we have, exploring our own cultural professional backgrounds, looking at do we carry any stereotypes with us. So it's a good starting point and it really helps you understand your own worldview and how you perceive and engage with patients.
And then when we talk about cultural knowledge, you know, this is an ongoing process. So it's not like at some point somebody puts a stamp on you and says you're knowledgeable. You are learning, right? So you're learning and becoming educated with every interaction that you have.
You're learning more and more about different people, different groups, different cultures. So that becomes really important because it really helps you to be able to provide, again, that really competent care. Some of the other terms that your book talks about. storytelling, and I think we probably already talked about this a little bit, but storytelling is huge, right? So being able to let your patient tell their story, what is unique about them?
What are their needs? What's, you know, who are they? Not just the appendectomy in room 32, but who are they?
That's really important for you to know. There is an evidence-based PICO section in your book, and I sorry, I did flip enough pages, and you're going to hear me going back and forth, that talks about it asks the question, does the use of storytelling compared with standard assessment approaches among adult and pediatric patients affect involvement in selecting healthcare interventions. So it kind of goes through and what it looks at and finds is that storytelling can really be should be patient-centered and can give patients substantial control over how and when they tell a story. It empowers patients to use their own voice. So definitely they found that storytelling was helpful.
And I realized I just threw EBP at you without telling what that is. That's evidence-based practice. So each chapter in your book has an evidence-based practice question, a PCOT question, which is how we ask those research questions. And then it gives you a little bit of data as far as what they have found that answers that question.
I found those sections really, really super interesting. There is never a test question that comes from those. It's just sort of an additional nice to know, I think.
But look for those as you go through your chapters, because those are really helpful, too. And then when your book start was talking about the worldview of providers and patients again, I think we covered this a little bit already. But it really is, you know, where are you coming from? Where is your patient coming from? Have you looked a little bit under that iceberg to get to know a little bit more about your patients?
That becomes really important if you are trying to develop your cultural awareness and your cultural knowledge. There's another tool for you that is fairly helpful. So this is a cultural competence model.
And I'm not going to pretend I know how to say these people's names. I believe it's Kempfina Bakot, but your guess is as good as mine on that. But they've done a ton of research on cultural aspects. And so one of the things that they will say, and I think I've said this already too, you know, cultural competence is a journey, not a destination, and it's a work in progress. But this model here has some different interrelated constructs.
And I think... These are really interesting. So it talks about cultural awareness. And again, that's your self awareness as well. Your, you know, whether or not you have biases, then your cultural knowledge, again, what are you adding to your knowledge base as you're interacting with these patients, and then cultural skill, which is, you know, how are you able to interact with these different cultures, and it affects everything that you do.
You know, even something as simple as your physical assessment, it will affect that. people's culture and their beliefs and what is right and what is not right is going to affect that. And then your cultural encounters, again, those are those face-to-face interactions. And then where they spend a little bit more time is this cultural desire.
And one of the terms that I pulled out that I thought they used that was really nice was the difference between wanting to learn about somebody's culture and having to. So very often in the hospital, we'll have different presentations. One of the favorite ones I went to was it was.
each month they would present about a different culture and they would have a healthcare provider from that culture come and talk about how what they practice as a westernized healthcare provider and what they live in their own cultures with their families at home, how those can be kind of different with relating to birth and death and all those different things that have that cultural lens. And I would hear some people say, oh, I have to go to that cultural thing. And for me, I was like excited whenever I you know, was able to not be working that day or fit it into my lunch break or whatever that was, because I thought it was super interesting to learn how different. different cultures view things different practice things differently so i think if you can kind of flip your mindset from a have to learn and i have to deal with cultures to a want to that helps a lot and then like i said in this cultural desire and this is not in the same place in the book where the rest of this campina book code is it's toward it's one of the last pages in the book they talk about this learn model which talks about some ways that you can set yourself up for success with this. So if you listen to the patient's perception of the problem, explain your perception of what's going on to them, acknowledge not only the differences between the two perspectives, but also the similarities, and then develop some recommendations, which again, have to involve the patient.
It can't just be you. I think we should do this. I think we should do that. So it's very collaborative. How can we bridge this?
And then negotiate a treatment plan that considers what is medically your perspective. and culturally their perspective important. So I think, and I will talk about this a little bit more in class as well, but I do want you to flip to that last page and look at that because there's a little more detail to it than what I covered with you.
And then now we're flipping to the cultural skill part of this. So when you talk about meeting your patients and collecting their patient history, Maybe you need to find out how they would like to be addressed. So, you know, if in doubt, address them formally.
But then, you know, find out just like you would with any other patient. How would you like to be addressed? Determine their preference for touch.
Investigate maybe if there is a preference for silence. Be aware of the patient's beliefs about eye contact during conversation. So these are all things that are going to facilitate you being able to get. assessments done on these patients and whether it's patient history, it's determining their health literacy, it's knowing about, you know, doing their physical assessment.
These are all things that you have to have some cultural skill in order to be able to do. You can't approach every single patient. The old adage of, you know, do unto others as you would have done unto you, that doesn't work in culture, right? So you can't approach every patient the way that you would want to be approached because that may not be their frame of reference, right? The next slide is going to go a little bit more into that health literacy portion of working with your patients.
And let me see. Here we go. So the class guidelines are just guidelines for making sure that we provide language assistance to our patients. And that means that we have to in their language, we have to let patients know that we have language.
services available for them, interpreters, however that is. So we want to make sure that in addition to that, we also have learning materials and signs in the dominant languages and the population that we serve. That doesn't mean that we need to have learning materials and signs in every single language because we would never get anywhere.
No one would ever know that the bathroom is to the right because we'd have to read 75 different signs to try and find the one that's in our language. That doesn't make any sense. But when you're in the hospital, you will see. that some of the signs will have English and then maybe one, two, three different languages that are from those dominant cultures.
And that's a joint commission requirement. And even a local like governmental requirement that the signs need to be done that way. Joint commission also talks about those interpretation services, which is the next slide that we also are responsible for providing for our patients, I will try to bring in for you there is a one page sheet that has written on it, and I can't remember specifically, but I'll bring it into class, something along the lines of this is my language, but written in many, many different languages. So it'll be written in English and Vietnamese and Danish and French and, you know, whatever languages so that when a patient reads that, they can then point to that sentence and you follow the sentence across.
And it says French and you're like, Oh, I need to get a French interpreter. So that's one way of being able to find out what somebody's language is, because they may not be able to tell you, right? That would make sense.
Then some of the other resources that we have are what I'm showing you on this slide here. So there is this giant blue phone with the two receivers on it. And hopefully some of you guys have had some healthcare experience where you've had to use this old timey phone here. I think we have some better resources now, but this phone is still around.
And if needed, it's a valuable resource. And what we do is we call the interpreter for whatever language it is that our patient has, we give them one receiver, we take the other receiver, and then the phone. the person on the phone acts as the interpreter.
So I talk into the phone exactly like I would talk to my patient. So I say, Mr. Jones, my name is Caroline. I'm here to do an assessment on you. The interpreter then takes that into whatever language the patient speaks.
And in their language says, Mr. Jones, my name is Caroline. I'm here to do an assessment on you. So they say exactly the words you talk directly to your patient, not, hey, interpreter, please tell the patient.
That's not how you do it. So you're talking directly to the patient and the interpreter is then giving those words to them. Um, that's sort of the same process if you're using some of these other tools. So on the bottom left is a picture of kind of that iPad interpreter that we have. Um, so that way the patients are able to, you're still looking directly at your patient speaking directly to your patient, but the voice is coming from whatever mobile device that you have.
And then same thing, the patient is speaking directly to you, but that translator translates it for you. There's also tons of. language translation apps that are available to you on your phone.
So if you were just doing some simple, like you want to know what do they want for breakfast, you can just type that in, translate it, and then even have it speak to your patient or have your patient read it if they have literacy. So we have lots of different tools. I really hope that you guys will have the opportunity to kind of challenge yourselves with this because it's kind of cool to see what we have access to.
All right, I'm going to skip along to our next one here. Sorry, I just had to move something there. So this slide here, I think we've kind of talked about this throughout, but really, you know, just kind of tips and tricks for, you know, what can you do? So one of the things that you can do is really just focus on trying to become culturally aware, culturally competent, being able to ensure health literacy for your patient, being able to ensure patient family-centered care. And this requires you to recognize that your patients are all unique.
And by doing so, you're going to improve the overall safety and quality of care and tons of research behind that. And you're going to be taking steps towards eliminating those health disparities because you're now going to have patients who are not as hesitant to come into contact with the health care system because they don't feel so judged. And then we talked about storytelling already, but I would not resist an opportunity to put it up here again because it really... any patient and not just in cultural situations, but enabling your patient to tell a little bit of their story. And it doesn't mean you sit there with them for three hours and listen to their life story, but by giving them a little bit of a voice, it really is giving you a better understanding of their perspective and it really helps them to get the care that they need.
So it really is important. The other thing I want to make sure to talk about in your book does a nice job of this as well. And you'll do much more of this.
in skills lab as well. But teach back is really, really important, especially with patients who don't speak our language. So teach back in plain language, really, really important.
So you want to make sure that I'll address the plain language part first, that you are not using all your fancy new health assessment terms with your patients, whether they be English speaking or not. Most of those terms are not terms that the general public is aware of. Um, so even something as simple as, you know, I'm going to auscultate your lungs.
I don't know what the heck that means. They have no idea. Are you going to take their lungs? Are you going to poke their lungs?
They don't know what you're going to do. Um, so make sure that when you're talking to your instructor, you know, I'm going to go auscultate my patient's lungs, use your fancy new language. But when you go into your patient's room, say, may I listen to your lungs with my stethoscope so that they are understanding what you are saying. Um, the other part of. you know, teach back, you're really asking your patient, you're educating your patient about something, you're having a conversation about something, and then you're asking them to retell you to confirm that they understood.
It's not a test for them, but it really is just an opportunity for them to recall and to let you know that they heard what you said and they understood what you said. That becomes really, really important because that way you can kind of confirm that they understand what it is that you taught and go back and reteach or get an interpreter, whatever that is, you know, if they are not understanding that. We'll talk a little bit more in class about working with interpreters, but it's really, really important that when you're working with an interpreter that you speak directly to your patient, you face your patient, you speak to them just like you would if you were speaking in English. You don't speak to the interpreter, you don't pay attention to the interpreter, you're paying attention to the patient.
That becomes really, really important. And your book talks about that in this chapter, and I think in patient teaching and in communication. So it's covered in quite a few different areas. All right.
So the last thing I want to talk about is organizational culture. And your book doesn't really talk much about this. But I think it's important because you are entering into that healthcare environment.
And for some of you guys, this is new, and you don't have experience within healthcare so much. And what you'll find is that each organization will have a unique organizational culture that is based on its history, mission, goals, past and present leadership. And so it's really interesting to see that.
Again, each hospital will have its own nursing culture. And for me, I can feel the minute I walk into a facility, whether this is a culture that I'm comfortable with, it's a culture that I'm not comfortable with. And it's kind of just a different use of the word culture, right?
So I wish people had explained this to me before I became a nurse and started looking at places to work because I sort of took a job at the first place that offered me a job and I didn't really look at what the culture was like there. versus what the culture was like down the street. And I wish I had done that because I wasn't a real good fit for that place. So when we look at nursing culture, sometimes it's more of a feeling, a sensation. But it's interesting because it can be things like, so every hospital I've been in, aside from the one that I will give you in this example, being on time is a really like a cultural touch point.
Like it's a really big deal in nursing. If you're going to call in sick, you call in sick. you know, six hours before the start of your shift. If you're going to be late, you let somebody know. And recently I had a group of students at a hospital where it was the craziest thing.
People would call in sick 15 minutes before the start of the shift. They wouldn't show up till 30 minutes after the start of the shift and people weren't thrown by it. Like any hospital I've ever worked at, people would be just ticked off about this. And they were just like, oh yeah, no, that happens.
That's John. It's okay. And I knew right away, I was like, well, I cannot work in this hospital.
Like I can bring my students here, but I cannot work here because that just goes against everything that I know. One of the other things you'll see if you have the opportunity, I'm sure all of you will, to be in a magnet organization, you'll see that the cultural expectation there is that nurses are going to be involved in change. We're going to be utilizing evidence based practice.
You're going to be reaching for professional development. You're going to be doing some research. You're going to really look for quality outcomes.
So that's kind of interesting as well. So hopefully you guys will have the opportunity to go to a lot of different types of hospitals and feel different cultures and see what works for you and what maybe doesn't work for you. I think that's kind of interesting.
So just a different perspective on culture. Hopefully I did a good job sharing the content that was in your book. And hopefully you refer back to that.
for a little bit more details and then bring me your questions when we meet.