2. End of this presentation ;
- Why we talk about culture ?
- Culture-induced problem s ?
- What is the best solution ?
??

3. Culture is everything about people;
the way they live, the way they wiev things, the
way they communicate, The term culture implies
the integrated patterns of human thoughts,
communications, actions, customs, beliefs, values,
and institutions of a racial, ethnic, religious, or
social group. It shapes individuals experiences,
perceptions, and decisions and how they relate the
others. It influence the way that clients respond to
nursing care services and the way that nurses
deliver those services
Gray & THOMAS (2005)

5. MIGRATION
HEALTH TOURISM
Changing Demographics

6. We provide care to many patients
from many different cultures

7. We are also working together
with many people from different
cultures

8. family cultural traditions
professional responsibility for the
clinical environment
religion
communication difficulties
rules
CULTURAL CHALLANGES

10. Communication
language barriers
Misunderstanding
Unnecessary physical, emotional
and spiritual suffering

12. Translation or İnterpretation?
•Is translation enough?
Avoid medical or complex jargon
Check for understanding
Find bilingual, bicultural staff medical translation
Avoid use of family as translators, especially minors

14. Physicians who would recommend
terminal extubation;
physicians who would
recommend terminal
withdrawal of mechanical
ventilation;
physicians who would
recommend only
antibiotics;
physicians who would do
everything
1961 / 21 countries

15. Muslim attitude
•Good health equated
with absence of visible
disease.
•They attended doctors
for treatment of visible
disease rather than
seeking preventive health
care for diseases such as
hypertension, diabetes,
and hyperlipidemia
Delivering Culturally Sensitive Care: The Perceptions of Older Arabian Gulf Arabs
Concerning Religion, Health, and Disease QualHealth Res, July 2006; vol. 16, 6:

20. Relationships between health professionals
and patients may be strained because of
historical or contemporary distrust
between various groups

25. The biggest cultural differences exist mainly
in relation to
•territorial space,
•eye contact,
•touch frequency
•insult gestures

26. Changing /Different Patient Expectations

27. IS CULTURAL COMPETENCY REQUIRED
IN TODAY’S NURSING CARE?

31. Nursing school students
•Refuse to wash male
patients
•Believes women should
be convinced not to have
abortion
•Caring from Islamic
perspectives is not well
versed in Eurocentric
nursing literature
Teaching nursing
•The challenge of
teaching cultural
competence to a
culturally diverse
student body
•Empathetic spiritual
competence? How to do
it?

32. There is no doubt that culture plays a large role in
shaping each individual's health-related values,
beliefs, and behaviors

33. Understanding cultural diversity will lead
to greater acceptance of health care
practices by other providers
Leonard, 2001

34. Knowledge about various cultural groups is
essential for cultural competence
Knowledge about cultures and its impact on
interactions with health care is essential for
nurses, whether they are practicing in a clinical
setting, education, research, or administration.
Cultural diversity addresses racial and ethnic
differences; however, these concepts or features
of the human experience are not synonymous
ANA, 1991

35. Poorly handled cross-cultural issues often result in
negative clinical consequences, patient
noncompliance, delays obtaining informed consent,
ordering of unnecessary tests, and lower quality of
care

36. Does Cultural Competency Training of Health
Professionals Improve Patient Outcomes???
a systematic literature review and analysis
34studies
• There is excellent evidence that cultural
competence training improves the knowledge of
health professionals
•There is good evidence that cultural
competence training impacts patient satisfaction

37. What is the best solution ?

38. Becoming culturally competent is a developmental
process, and identify three common factors that can
lead to an increase in the level of practitioners'
cultural competence
Cross et al. 1989
•Personal attributes
•Knowledge
•Skills
Personality Factors
in order to be culturally competent:
1.Possess a strong personal identity;
2.Have knowledge of and facility with
the beliefs and values of other cultures;
3.Display sensitivity towards other
cultures
4.Communicateclearly in the language of
the given cultural group;
5.Awareness of social norms

39. Knowledge & Skills
1. Families and patient need clear, direct, and consistent
information to make right decision
2. Physician-related issues affect nurses’ ability to
provide quality intensive care
3. Critical care nurses need more knowledge, skill and
sense of cultural competencey to provide quality care
4. Having properly completed advance directives can
reduce confusion about the goals of care
Crump SK, et all., Critical care nurses perceptions of obstacles, supports, and knowledge
needed in provideing quality end oflife care, Diemnsiond of Critical Care Nursing, 29(6):297-
306

40. Standard 1. Social Justice
Standard 2. Critical Reflection
Standard 3. Knowledge of Cultures
Standard 4. Culturally Competent Practice
Standard 5. Cultural Competence in HealthCare Systems and Organizations
Standard 6. Patient Advocacy and Empowerment
Standard 7. Multicultural Workforce
Standard 8. Education and Training in Culturally Competent Care
Standard 9. Cross Cultural Communication
Standard 10. Cross Cultural Leadership
Standard 11. Policy Development
Standard 12. Evidence-Based Practice and Research

41. Cross-cultural training enables the
individual to learn both content
and skills that will facilitate
effective cross-cultural interaction
by reducing misunderstandings and
inappropriate behaviors
Patient-based approach to cross-cultural
care
1.assessing core cross-cultural issues;
2.exploring the meaning of the illness
to the patient
3.determining the social context in
which the patient lives;
4.engaging in negotiation with the
patient to encourage adherence.
Cultural Competency: Providing Quality Care to Diverse Populations The
Consultant Pharmacist 2006

42. Cultural competency in critical care
 Providing care to patients and their families that
is compatible with their values and the traditions
of their faiths.
 This requires awarenessof one's own values and
those of the healthcare system.
 The nurse must be aware of the cultural and
spiritual values of patients and families.
 Although knowledge of all cultures is impossible,
willingness to learn about, respect, and work
with persons from different backgrounds is
critical to providing culturally competent care .
Awareness: The Heart of Cultural Competence Leonard, Barbara J. RN, PhD, PNP*; Plotnikoff, Gregory A. MD, MTS†
Section Editor(s): Lindquist, Ruth RN, PhD; Kirksey, Kenn RN, PhD

43. Campinha-Bacote J, Munoz C. A guiding framework for delivering culturally competent
services in case management. Case Manager. March-April 2001;12:48-52.

45. TEŞEKKÜRLER