Shared Flashcard Set


Culturally Competent Provider
Psychological Elements of Community Wellness
Health Care

Additional Health Care Flashcards




“It is much more important to know what sort of a patient has a disease, than what sort of disease a patient has.” --- Who said this?
William Osler
Year 2000: what is the ratio of Americans that are a part of an ethnically diverse cultural group?
Year 2000: 1:3 Americans was part of an ethnically diverse cultural group
vague, unscientific term referring to a gr of individuals that display genetically transmitted physical characteristics is ...
A social gr that shares a common ancestry, Hx, or culture such as: geographic origin, Language, Values, Religion, Music, Diet, Gender roles
An adverse judgment or opinion formed beforehand or w/o knowledge or examination of the facts
Prejudice In Health Care
Values: The things we hold important
Conflict in Values
"the shared values, traditions, norms, customs, arts, history, folklore, and institutions of a group of people” is ...
“a set of cultural behaviors and attitudes integrated into the practice methods of a system, agency, or its professionals, that enables them to work effectively in cross cultural situations”
cultural competence
one of the main points of the Providers Guide to Quality and Culture
“When professionals are culturally competent, they establish positive helping relationships, engage the client, and improve the quality of service they provide.”
A person, group, event, or issue considered to typify or conform to an unvarying pattern or manner lacking any individuality. (An ending point) --- Categorize people with little effort to learn more
A general principle, statement or idea. (A beginning point)
5 Levels of Cultural Competency
Level 1 : No insight about the influence of culture on medical care.
Level 2: Minimal emphasis on culture in medical setting
Level 3: Acceptance of the role of cultural beliefs, values, and behaviors on health disease, and treatment
Level 4: Incorporation of cultural awareness into daily medical practice
Level 5: Integration of attention to culture into all areas of professional life
Perspective In Cultural Competency include:
1) Traditional Medical Encounter
2) Cross-Cultural Efficacy
3) Cultural Humility
define Traditional Medical Encounter
Intersection of three cultures: patient, provider and the health system
define cross-cultural efficacy
Neither the patient nor the caregiver's culture is preferred
define Cultural Humility
Goal is to shift the power differential & develop a more balanced relationship bw pt & provider
"LEARN" model to becoming culturally competent
L-Listen with sympathy and understanding to the patient’s perception of the problem
***E-Explain your perceptions of the problem and your strategy for treatment.***A-Acknowledge and discuss differences and similarities between these perceptions.***R-Recommend treatment while remembering the patient’s cultural parameters***N-Negotiate treatment agreement
ETHNIC model
E: Explanation
T: Treatment
H: Healers
N: Negotiate
I: Intervention
C: Collaboration
Kleinman’s Eight Questions
(1) What do you think caused your problem?
(2) Why do you think it started when it did?
(3) What do you think your sickness does to you?
(4) How severe is your sickness? Do you think it will last a long time, or will it be better soon in your opinion?
(5) What are the chief problems your sickness has caused for you?
(6) What do you fear most about your sickness?
(7) What kind of treatment do you think you should receive?
(8) What are the most important results you hope to get from treatment?
***B-Health beliefs (What caused your illness/problem?)***
E-Explanation (Why did it happen at this time?)***
L-Learn (Help me to understand your belief/opinion.)***
I-Impact (How is this illness/problem impacting your life?)***
E-Empathy (This must be very difficult for you.)***
F-Feelings (How are you feeling about it?)***
describe Provider and Staff Relations ---Cultural Awareness begins with these!
• Health care professionals are a culturally diverse group
• Respect each other.s differences
• Common Goal – Provide optimal health care for all patients
list 7 Domains of Cultural Competence
1: Values and Attitudes
2: Communication Styles
3: Community/Consumer Participation
4: The physical environment, materials, and resources available to the health care setting
5: Policies and procedures
6: Population based clinical practice
7: Training and professional development
list Legal Mandates
• Civil Rights Act of 1964 --- Title VI ---
o Ensure that no person is subjected to discrimination on the basis of race, color, or national origin under any program or activity that receives federal funding.
• U.S. Department of Health and Human Services Office of Minority Health developed recommendations for national standards for CLAS in health care
o 14 Standards that “ensure that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner.”
Professional Mandates - Physician Assistant Professional Oath --- I pledge to perform the following duties with honesty and dedication: (I will's...)
Physician Assistant Professional Oath --- I pledge to perform the following duties with honesty and dedication:
I will hold as my primary responsibility the health, safety, welfare and dignity of all human beings.
I will uphold the tenets of patient autonomy, beneficence, nonmaleficence and justice.
I will recognize and promote the value of diversity.
I will treat equally all persons who seek my care.
I will hold in confidence the information shared in the course of practicing medicine.
I will assess my personal capabilities and limitations, striving always to improve my medical practice.
I will actively seek to expand my knowledge and skills, keeping abreast of advances in medicine.
I will work with other members of the health care team to provide compassionate and effective care of patients.
I will use my knowledge and experience to contribute to an improved community.
I will respect my professional relationship with the physician.
I will share and expand knowledge within the profession.
These duties are pledged with sincerity and upon my honor
Oath for PA Students
I pledge to perform the following duties with honesty, integrity, and dedication,
remembering always that my 1’ responsibility is to the health, safety, welfare, and dignity of all human beings:
I recognize and promote the value of diversity and I will treat equally all persons who seek my care.
I will uphold the tenets of patient autonomy, beneficence, nonmaleficence, justice, and the principle of informed consent.
I will hold in confidence the information shared with me in the course of practicing medicine, except where I am authorized to impart such knowledge.
I will be diligent in understanding both my personal capabilities and my limitations, striving always to improve my practice of medicine.
I will actively seek to expand my intellectual knowledge and skills, keeping abreast of advances in medical art and science.
I will work with other members of the health care team to assure compassionate and effective care of patients.
I will uphold and enhance community values and use the knowledge and experience acquired as a PA to contribute to an improved community.
I will respect my professional relationship with the physician and act always with the guidance and supervision provided by that physician, except where to do so would cause harm.
I recognize my duty to perpetuate knowledge within the profession.
These duties are pledged with sincerity and on my honor.
Conducting the Cultural Status Exam

1. How would you describe the problem that has brought you to me?

a. Is there anyone else with you that I can talk to about your problem?

b. Has anyone else in your family/friend network helped you with this problem?

2. How long have you had this (these) problem(s)?

a. Does anyone else have this problem that you know?

If yes, desc them, how old they are, and their different presentations/symptoms

3. What do you think is wrong, out of balance, or causing your problem?

a. Who else do you know who has, or gets this kind of problem?

b. Who, or what kind of people don't get this problem?

4. Why has this problem happened to you, and why now?

a. Why has it happed to (the involved part)?

b. Why did you get sick and not someone else?

5. What do you think will help to clear up your problem?

a. If they suggest specific tests, procedures, or drugs,

ask them to further define what they are and how they will help.

6. Apart from me, who else do you think can help you get better?

a. Are there things that make you feel better, or give you relief, that doctors don't know about?



Applying Cultural Competency in the Clinical Encounter

  • Choose a model that works best for you
  • Ask questions if you don't know
  • Avoid issuing mandates to your patients – encourage collaboration
  • Involve the family if the patient prefers

Language         ---        According to the 2000 Census:

  • More than 300 languages are spoken in the US
  • 44 million people in the US speak a language other than English at home
  • In 5 states, more than 10% of residents have limited English proficiency (LEP)

Language Barriers   --- According to the 2000 census...


19.4% speak English „less than very well. (>23,000,000 people)

things to consider:

-          Idioms

-          First Names

Language and Its Impact on Health Care                     ---        Utilization

Telephone Recording




Language and Its Impact on Health Care  -- 

Satisfaction – increased when able to establish effective lines of communication


Increased when using professional interpreters who are unrelated

Fewer Delays in Seeking Care – by improving trust and understanding


Language and Its Impact on Health Care

Pt education....


what influences these?


Patient Education   ---   Improves because culturally competent clinicians can target, tailor, and communicate health related messages more effectively


Greater Compliance

A culturally competent clinician takes the time to learn how to best communicate with the patient and therefore, is able to establish a treatment plan that is most consistent with patient's cultural beliefs and lifestyle. Thus, the patient can better understand how to follow the treatment plan and increases the likelihood of the pt adhering to the treatment plan.


Language and It.s Impact on Health Care     ---            Tx  Explain how the decisions are affected when there are barriers to understanding.



Fewer tests – because cannot convey history and symptoms

More tests – to compensate for not understanding


Language and Its Impact on Health Care         ---        Outcomes

  • Misdiagnosis – must understand patient’s history and symptoms
  • Drug Complications – drug allergies? herbal medications?
  • Expanded Choices – not restricted by language


important things to remember ...


-          Use of same-sex interpreters

-          Use of family members is not recommended

-          take into consideration Family hierarchical structure

-          Medical interpreters

-          ask for Permission to use an interpretor


How to Work With A Foreign Language Interpreter?


-          Speak in short units of speech, not long involved sentences or paragraphs. The provider and patients takes turns speaking. The longer either party talks, the greater the margin of error.

-          Be patient. An interpreted interview takes longer......

-          Expect that the interpreter may pause to ask you for an explanation or clarification of terms.

-          Avoid colloquialisms, abstractions, idioms, slang, similes or metaphors.

-          During the interaction, look at and speak directly to the patient, not to the interpreter. The interpreter should stand a little behind and to the side of the patient.

-          Avoid saying to the interpreter, “Ask him...” or “Tell her...”. Speak in first person, as will the interpreter.

-          The interpreter will relay all that is said in the presence of the patient and will not omit anything spoken on the sideor anything that is said to others in the room.

-          Listen to the patient and watch their nonverbal communication. Often you can learn a lot regarding the affective aspects of the patient’s response by observing facial expressions, voice intonations, and body movements.

-          Repeat important information more than once. Always give a reason or purpose for a treatment or Rx.

-          Check the patient’s understanding and accuracy of the interpretation by asking the patient to repeat instructions or whatever has been communicated in his or her own words, with the interpreter facilitating.

-          When possible, reinforce verbal interaction with materials written in the patient’s language and/or with visual aids.Do not use computer software to help translate as they are frequently not accurate.

-          Realize that the interpreter cannot reveal any information or opinions about the patients. Do not ask the interpreter to clarify any cultural norms.



Working with Hearing Impaired Patients


-          American Sign Language (ASL)-complex language w/ its own grammar & syntax, using facial expressions, body mov-ts and hand signs

-          Lip reading

-          Assistive listening devices

-          TTY (Text telephone, sometimes called TDD)

-          Do not rely only on written information

-          Know your resources for TTY and interpreter access

-          Speak directly to the patient not the interpreter

-          Confirm understanding


what do you know about

Complementary and Alternative Medicine?


-          About 1800 different therapies and systems of care

-          Defined as – The field of health care outside Western allopathic medicine that includes treatments and healthcare practices not taught in allopathic schools of medicine.

-          Consumer-patients cite a desire for a more holistic approach to treatment.

-          Increasing Use - Estimates CAM usage at 42% among US adults

-          Most Common Health Problems

Back problems

Chronic pain


Urinary tract problems

-          The problem is that they don't tell their health care provider.



Complementary and Alternative Medicine

Coin Rubbing


tell me more


Coin Rubbing

Rub body vigorously with coin

Coin may be heated or have oil applied

Draws out illness


Vacuum sealed cup applied to skin

Pain relief, improve circulation, open up chest/lungs, digestive problems, common cold


Complementary and Alternative Medicine

Acupuncture    and   Chelation Therapy

 tell me more


Acupuncture    - stimulates movement of energy in the body

Chelation Therapy -  used to rid the body of toxic metals and chemicals

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