amprevel's version from 2016-04-09 06:45

CLAS Standards

Question Answer
CLAS stands forCulturally and Linguistically Appropriate Services in Health Care (CLAS)
What are CLAS Standards14 National Recommended Standards that inform, guide, and facilitate implementation of CLAS.
Three themes of within CLAS:• Culturally Competent Care (1-3);
• Language Access Services(4-7);
• Organizational Supports for Cultural Competence (8-14).
Purpose of CLAS:should be understood by nurses and applied to their professional practice.
• Address the patchwork of definitions, guidelines, overlap, etc., on what constitutes cultural competence service delivery.
• Provide a road-map for providing culturally competent services.
• Serve as guiding principles for the delivery of quality health care to diverse populations.
Ways CLAS can Improve health:• Improve access to services
• Reduce medical errors
• Improve effectiveness of preventive services
• Improve patient satisfaction
• Improve patient adherence
• Reduce financial costs and risks

Commonly Held Health Belief Views

Question Answer
Magico-Religious Health BeliefsHealth & illness controlled by supernatural forces, result of “being bad” or opposing God’s will
Holistic Health Beliefshuman life is an aspect of nature, balance with nature. Symbols = medicine wheel, yin and yang.
Nurses must keep in mind/consider• treatment strategy consistent with the client’s beliefs may have a better chance of being successful
• whether any harm is resulting from the practice, and take caution to not judge different as wrong.
• important to obtain information about folk or family healing practices that may have been used before or while the client used conventional medical treatment.
Folk medicinebeliefs and practices relating to illness prevention and healing that derive from cultural traditions rather than from modern medicine’s scientific base. Often more comfortable and less frightening for the client.
Biomedical Health BeliefsIllness caused by germs, bacteria, or a breakdown of the ‘human machine,’ belief that pills, treatments, or surgery will cure
Components of Biomedical Health beliefs
• Meliorism
• Dominance over nature
• Activism
• Timeliness
• Therapeutic aggressiveness
• Future orientation
• Standardization
Activismdo something
Meliorismmake it better by human effort
Therapeutic aggressivenessstronger=better
Future orientationplan, newer=better
Standardizationtreat similar the same

Guidelines for using an interpreter :

• Learn and use a few phrases of greeting and introduction in the patient’s native language.
• Tell the patient that the interpreter will interpret everything that is said, so they must stop after every few sentences.
• When speaking or listening, watch the patient, not the interpreter.
• Reinforce verbal interaction with visual aids and materials written in the client’s language.
• Repeat important information more than once.
• Always give the reason or purpose for a treatment or prescription.
• Make sure the patient understands by having them explain it themselves.
• Ask the interpreter to interpret as closely to what was said.
• Avoid asking a member of the client’s family, especially a child or spouse, to act as interpreter.
• Be aware of gender and age differences; it is preferable to use an interpreter of the same gender as the client.
• Choose an interpreter who is politically or socially compatible with the client.
• Address the questions to the client, not to the interpreter.
  Speak slowly and distinctly. Do not use metaphors, for example, “Does it swell like a grapefruit?” or “Is the pain stabbing like a knife?”
• Observe the facial expressions and body language that the client assumes when listening and talking to the interpreter.
• Become aware of the individual expressions and colloquial words used in specific regions and acknowledge them when using interpreting services.


Verbal Communication with Clients Who Have Limited English Proficiency (LEP) :

• Avoid slang words, medical terminology, and abbreviations.
• Augment spoken conversation with congruent gestures or pictures to increase the client’s understanding.
• Speak slowly, in a respectful manner, and at a normal volume. Speaking loudly does not help the client understand and may be offensive.
• Frequently validate the client’s understanding of what is being communicated. Do not automatically interpret a client’s smiling and nodding to mean that the client understands; the client may only be trying to please the nurse and not understand what is being said.
• Use print resources that have been designed especially for clients with LEP.

Impact of culture on health beliefs, self-care practices, family patterns, communication, biological risk factors

-Health beliefs and practices, family patterns, communication style, space and time orientation, and nutritional patterns may influence the relationship between the nurse and the client who have different cultural backgrounds.
-When assessing a client, the nurse considers the client’s cultural values, beliefs, and practices related to health and health care.

Culturally Competent Care Delivery

Question Answer
Cultural Competence is the• ability of health organizations and practitioners to recognize the cultural beliefs, attitudes and health practices of diverse populations, and to apply that knowledge in every intervention; at the systems level or at the individual level.
• “the ongoing process in which the health care professional continuously strives to achieve the ability and availability to work effectively within the cultural context of the patient (individual, family, community).” (Bacote, 2011)
Barriers to culturally competent care delivery:
-lack of info on particulars of a groups behaviors, inability to understand social and cultural customs of a group
-inability to understand cocial and cultural customs of a group
-a lack of awareness of your feelings about the cultures of people from an identified group
5 constructs of culturally competent care deliverydesire, awareness, knowledge, skills, encounters
desire construct of culturally competent care deliverythe motivation to “want to” engage in the process of becoming culturally aware, culturally knowledgeable, culturally skillful, and seeking cultural encounters
awareness construct of culturally competent care deliveryAwareness of one’s own cultural attributes & bias. What is my sense of belonging or identity in terms of culture? What positive and negative experiences have I had with different groups?
knowledge construct of culturally competent care deliveryunderstanding of client’s heritage and health traditions in terms of how the client maintains, protects and restores health. Assess interview: (examples)
•Tell me about your use of teas, herbs, vitamins other natural products to improve your health.
•What tradition or folk remedies are used in your family?
skills construct of culturally competent care deliverythe ability to collect culturally relevant data regarding the client’s health in a culturally sensitive manner. See ‘communication’ below.
encounters construct of culturally competent care deliveryengaging in face-to-face cultural interactions with persons from diverse backgrounds, and learning to modify one’s existing beliefs and prevent possible stereotyping.
Ways to promote culturally competent communication• Respect personal space
• Learn the cultural rules about touching
• Establish rapport
• Ask questions
• Listen to the answers
• Appreciate and use silence
• Notice eye contact
• Pay attention to body movements
• Note client responses


Question Answer
Factors affecting communicationfamily patterns, variations in verbal and non verbal communication style, space and time orientation
family patterns of communication-different roles/power status for children, elders, gender-roles, nuclear vs extended family
-naming systems
verbal communication patternsdifference in use of vocabulary, grammatical structure, voice qualities, intonation, rhythm, speed, pronunciation, and silence
cultural values regarding initiation of communicationdirectness or indirectness of discourse, who can discuss what with whom
translatorconverts written material (such as client education pamphlets) from one language into another.
interpreteris able to transform the message expressed in a spoken or signed source language into its equivalent in a target language, so that the interpreted message has the potential of eliciting the same response in the listener as the original message.
cultural brokerinterpreter must engage both provider and client effectively and efficiently in accessing the nuances and hidden sociocultural assumptions embedded in each other’s language
The Joint Commission requirements for interpretersqualified and competent interpreters required for clients who require them; may be on-site, available by telephone, or through videoconferencing. Studies have shown that fewer errors occur when professional (trained) interpreters are used with LEP clients
Can bilingual nurses provide interpretation for another provider?Nursing schools and health care institutions may prohibit nurses or nursing students from interpreting for other health care providers unless they have received specialized training and are approved as language assistants or medical interpreters. Check policy.

Nursing Management

Question Answer
ASKED modelhelps nurses to develop cultural consciousness: Awareness, Skill, Knowledge, Encounters, Desire. Campinha-Bacote (2007); nurses reflect on questions which focus on how well prepared they are to acknowledge their own biases, their openness to embracing differences in people, and their willingness to learn appropriate means of communicating and caring for diverse populations.
LEARN:commonly used cultural assessment tool (Berlin & Fowkes, 1983): -Listen actively with empathy to the client’s perception of the problem.
-Explain what you think you heard/ask for clarification.
-Acknowledge the importance of what is said and what it means.
-Recommend inclusive strategies.
-Negotiate the plan of care by collaborating with the client and others.
The 4 C’s of Culturewere a cultural assessment tool developed by Slavin, Galanti, and Kuo:
-What do you call your problem?
-What do you think caused your problem?
-How do you cope with your condition
-What are your concerns regarding the condition and/or recommended treatment
Heritage Assessment Interview:determines whether clients are: heritage consistent- clients are identifying with their traditional cultural heritage, or heritage inconsistent: cts have acculturated into the dominant culture of the modern society
Implementation of culturally sensitive nursing careincludes (a) cultural preservation and maintenance and (b) cultural accommodation and negotiation.
-negotiation = collaborative.
-If the client’s views reveal that certain behaviors would not affect the client’s condition adversely, then they are incorporated into the care plan. If the client’s views can lead to harmful behavior or outcomes, then an attempt is made to educate the client on the scientific view.
-Nurses should determine precisely how a client is managing an illness, what practices could be harmful, and which practices can be safely combined.

-When a client chooses to follow only cultural practices and declines all prescribed medical or nursing interventions, the nurse and client must adjust the client goals.



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