Transcultural Nursing – Cultural Competence in the Health

As the dynamics of our world are continually changing and becoming more multicultural, healthcare providers are facing a challenge in providing cultural competent care to this multicultural population. Dr. Madeleine M. Leininger was the first to use the term “transcultural nursing” (TCN) in describing the blending of anthropology and nursing into a specialization in nursing. Anthropology is the scientific study of humans, past and present. Building on the physical, biological, social sciences and humanities, anthropologists use this knowledge to find solutions to human problems. Using the combined studies of nursing and anthropology, Dr. Leininger established TCN as a theory and evidence-based formal area of study and practice within nursing that focuses on people’s culturally based beliefs, attitudes, values, behaviors, and practices related to health, illness, healing and human caring (Leininger, 1991, 1995).

Learning objectives for the module:
Upon completion of the module, students will be able to:

Define transcultural nursing.
Discuss the contributions of transcultural theories to the advancement of transcultural study and practice.
Explore the national standards for culturally and linguistically appropriate services in healthcare.
Compare individual advanced practice cultural competence and organizational cultural competence.
Readings:
Andrews & Boyle, J. Chapters 1,2
Websites:
The Model of Cultural Competence Through an Evolutionary Concept Analysis: http://tcn.sagepub.com/content/15/2/93.full.pdf+html
Communication Between Cultures: http://www.youtube.com/watch?v=AlMf_RGlaQU
Topic 1: Theories of Transcultural Nursing
For over 50 years nurses have recognized the necessity to provide culturally specific care to a population that is increasingly becoming more racially and culturally diverse. Based on the knowledge that various races and cultures have different needs and requirements the need to develop culturally competent nursing care continues. In order to provide nurses with the foundations to be knowledgeable about the various cultures being seen in their practices transcultural models have been developed. Perhaps the most notable theorist, Dr.Madeline Leininger has provided the basic foundation for cultural competency in nursing practice. Other models by Purnell, and Giger and Davidhizer are also commonly used nursing cultural models.

Using any of these models allows nurses at all levels to gain knowledge and provide culturally competent care. Having a greater nursing knowledge of the culturally diverse needs of our patients is vital in improving the quality of healthcare.

Topic 2: Culturally Competent Nursing Care
In order for the nurse to begin the process of becoming a culturally competent provider, one must start with cultural self-assessment. Evaluation of their own unconscious biases, cultural stereotypes, prejudices, and tendencies to discriminate against those different than themselves will give them valuable insight. With increased study and education, these unconscious tendencies can be resolved. To aid in the educational process, the American Academy of Nursing (AAN) Expert Panel on Global Nursing and Health and Transcultural Nursing Society have developed guidelines for the practice of culturally competent nursing care. These include knowledge of cultures, education and training in culturally competent care, clinical reelection. Cross-cultural communication, culturally competent practice, cultural competence in health care systems and organizations, patient advocacy and empowerment, multicultural workforce, cross-cultural leadership, evidence-based practice and research. As universally accepted guidelines nurses worldwide have a framework for providing culturally competent care.

A five step problem solving process is provide to assist nurses in delivering culturally competent care. This five step process consists of

a constructively critical self-assessment
mutual goal setting with the client and other members of the health care team
development of a plan of care
implementation of the care plan
evaluation of the plan.
Discuss It

Module 2
Discussion The culture of the deaf and hearing impaired is often overlooked because it is characterized as a nonethnic culture. What cultural characteristics do deaf people have in common with other cultural groups? If your client is both deaf and identifies with another cultural group as well, how does this affect your ability to provide quality cultural care?
Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text) for both posts. Refer to the Grading Rubric for Online Discussion in the Course Resource section.

Module 2: Discussion

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APA formatting is required in discussion posts with the following two exceptions (due to limitations with the text editor in LIVE): double line space and indent 1/2 inch from the left margin. Discussion posts will NOT be evaluated on those two formatting requirements. All other APA formatting guidelines should be followed. For example, in-text citations must be formatted with the appropriate information and in the correct sequence (Author, year), reference list entries must include all appropriate information following guidelines for capitalization, italics, and be in the correct sequence. Refer to the APA Publication Manual 7th ed. for each source type’s specific requirements. Please let your instructor know if you have any questions.

Module 2: Discussion

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The culture of the deaf and hard of hearing is often overlooked because it is characterized as a nonethnic culture. What cultural characteristics do deaf people have in common with other cultural groups? If your client is both deaf and identifies with another cultural group as well, how does this affect your ability to provide quality cultural care?

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text) for both posts. Refer to the Grading Rubric for Online Discussion in the Course Resource section.

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Understanding the nuances of the patients culture as well as understanding the communication techniques for the Deaf culture is vital for providing competent care and a responsibility of the health care provider. Collaboration within our healthcare community may be key! Well done!

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Module 2 DiscussionSubscribe
Jerrica Goins posted Sep 8, 2021 9:18 PM
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Individuals who are involved in or affiliated with the Deaf culture do not view deaf or the use of signed language as a disability. Diversity within the Deaf community must be considered and awareness of factors such as racial background, hearing status, and communication mode fall under the broader identity of being deaf. Understanding Deaf culture and learning about ASL are essential to building rapport and strengthening the therapeutic alliance (Boness, 2016). However, not all Deaf persons identify within this community. When a client identifies with another cultural group it is imperative to have a basic understanding of the culture they identify with. View the patient as an individual and find out their cultural preferences. The approach to them receiving care and treatment may need to be altered, to provide culturally competent care. For instance, there may be a patient who is deaf and is a member of the LGBTQ community. The provider needs to understand the population’s history, unique health concerns, risks, and develop communication skills that avoid discrimination, and provide compassionate care. Health professionals should be aware that the LGBTQ population experiences higher rates of challenges due to discrimination, social pressures, sexual behaviors, and less healthcare access (Bass & Nagy, 2020).Bass, B., & Nagy, H. (2020). Cultural Competence in the Care of LGBTQ Patients. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563176/less1 UnreadUnread2 ViewsViews
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View profile card for Kadijatu Sesay
Last post September 12 at 9:30 PM by Kadijatu Sesay
Boness, C. L. (2016). Treatment of Deaf Clients: Ethical Considerations for Professionals in Psychology. Ethics & Behavior, 26(7), 562–585. https://doi.org/10.1080/10508422.2015.1084929
References
Module 2 DP – H. StetsonSubscribe
Heather Stetson posted Sep 6, 2021 6:26 PM
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Historically, those afflicted with deafness or hard of hearing have been labeled as persons suffering from a disability. However, labeling an individual with a disability indicates there is an issue with deafness or being hard of hearing that needs to be “fixed” (Mauldin & Fannon, 2021). Many people who are deaf or hard of hearing do not feel as if they are disabled, but rather as individuals with their own unique cultural identity (Higgins, 2016). Characteristics the deaf and hard of hearing people have with other cultures include a common communication style (language/dialect), identity, and a shared heritage (Andrews et al., 2020). According to Mauldin and Fannon (2021), “People who are deaf and use ASL to communicate belong to a linguistic minority group in the United States and have historically identified as capital-D Deaf; the convention has largely been to use lower case deaf to describe an audiological status and a capital-D to denote cultural membership in a signing community” (p.4). If the client is both deaf and also identifies with another cultural group this added layer simply means the practitioner will need to be that much more vigilant in providing culturally competent care. The five steps for providing culturally competent and congruent care include self-assessment, mutual goal setting, care planning, implementation of care plan, and evaluation of care (Andrews et al., 2020). less1 UnreadUnread2 ViewsViews
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View profile card for Idida Aleman Musial
Last post September 12 at 8:08 PM by Idida Aleman Musial
Mauldin, L., & Fannon, T. (2021). They told me my name: Developing a deaf identity. Symbolic Interaction, 44(2), 339-366. https://doi.org/10.1002/symb.482
Higgins, M., & Lieberman, A. M. (2016). Deaf students as a linguistic and cultural minority: Shifting perspectives and implications for teaching and learning. Journal of Education (Boston, Mass.), 196(1), 9-18. https://doi.org/10.1177/002205741619600103
Andrews, M., Boyle, J. & Collins, J. (2020). Transcultural concepts in nursing care (8th ed.). Wolters Kluwer.
Kadijatu SesaySubscribe
Kadijatu Sesay posted Sep 8, 2021 10:50 PM
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Deaf and hearing-impaired people face multi challenges that evolve around isolation, neglect, and deprivation of essential social services that affect their welfare and survival. They are often isolated in the community because they are presumed different from everyone else, (Mugeere et al., 2016). In every culture, one will find people who are deaf or hearing impaired. The cultural characteristic deaf people have in common with other cultural groups is that many deaf people are born to hearing parents. More so, deaf or hearing impaired can be found in any culture regardless of race, ethnicity, social-economic status, or education. Deaf people maintain intimate relationships using facial expressions, touch, sign language, eye contact which are like other cultural groups, (Mugeere et al., 2016). ReferencesMugeere, A., Atekyereza, P. R., Kirumira, E. K., & Hojer, S. (2016, May 26). Deaf identities in a multicultural setting: The Ugandan context. African journal of disability. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433488/. less1 UnreadUnread5 ViewsViews
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View profile card for Jerrica Goins
Last post September 12 at 8:05 PM by Jerrica Goins
Marschark, M., Zettler, I., & Dammeyer, J. (2017, July 1). Social dominance orientation, language orientation, and deaf identity. Journal of deaf studies and deaf education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881267/.
If my client is both deaf and identifies with another cultural group, this will affect my ability to provide quality care in the sense that it might be difficult to communicate or provide an interpreter in the new culture since different cultures have different variations in their mode of communication and identity expression, (Marschark et al., 2017).
Module 2: DiscussionSubscribed
Gisselle Mustiga posted Sep 6, 2021 12:29 AM
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The topic of whether deafness should be viewed as a culture or not is of debate. Deafness has always been seen as a physical impairment that is associated with cognitive and blindness disabilities. Recently, views of deafness as a culture have been raised, considering the condition as a trait and not disability. This is because deafness does not need to be corrected; it is not a pathology (Chovaz, 2016). The deaf and the hearing cultures have various common factors which influence communication with each other. One of them is that deaf people go to churches and attend school for the deaf, just like hearing people who also go to school and attend churches to attain education and religious purposes (Giger & Haddad, 2020). Moreover, both hearing and deaf people use the English language; the only difference is how they communicate it. ReferencesChovaz, C. J. (2016). The Differences in our similarities. The Journal of Deaf Studies and Deaf Education, 16(3). 416. https://doi.org/10.1093/deafed/enr002 less1 UnreadUnread5 ViewsViews
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View profile card for Emilia Rodriguez
Last post September 12 at 4:17 PM by Emilia Rodriguez
Giger, J. N., & Haddad, L. (2020). Transcultural nursing-e-book: Assessment and Intervention. Elsevier Health Sciences.
Andrews, M., Boyle, J., & Collins, J.W. (2020). Transcultural concepts in nursing care (8th ed.). Wolters Kluwer
If my client is deaf and identifies themselves with a particular cultural group, this will significantly influence how I will give quality and holistic care. This is because all cultural preferences of the patients must be respected while providing care. Providing quality care to clients that are deaf raises essential ethical consideration in relation to competency, assessment, confidentiality, evaluation, and diagnosis (Andrews et al., 2020). The nurse must therefore consider the relevant ethic codes that are required in providing treatment that is ethical. This is because the nurse is responsible for ensuring that the patient or client is comfortable and satisfied with healthcare services. Thus, all healthcare services providers must maintain a professional relationship with the client while also offering care in line with their culture and beliefs (Andrews et al., 2020).
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Julie Robichaud posted Sep 8, 2021 7:48 AM
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The deaf and hearing impaired are considered a nonethnic culture, but can be linked to another culture and become a double minority such as a Russian patient who is also deaf (Andrews et al., 2020). Deaf patients have many of the same characteristics as other cultural groups which include, decreased comprehension due to a language barrier, decreased psychosocial well-being due to difficulty with social and interpersonal skills, economic dependence due to perceived disability, and decreased quality of life due to unnecessary limitations sometimes placed by healthcare providers (Andrews et al., 2020). Caring for a patient that is deaf or hearing impaired and also identifies with another cultural group, may require more help or interventions. All cultures, ethnic and nonethnic, have different needs that have to be taken into consideration. Cultural respect combines a body of knowledge, beliefs, and behaviors that are specific to ethnic, nonethnic, racial, religious, geographic, and social groups (NIH, 2017). Cultural respect ensures reduction in health disparities and improves access to quality and safe healthcare that is respectful and responsive to culturally diverse patients (NIH, 2017). Andrews, M.M., Boyle, J.S. & Collins, J.W. (2020). Transcultural concepts in nursing care (8th ed.). Wolters KluwerNational Institutes of Health. (2017, February 15). Cultural respect. https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liason/clear-communication/cultural-respectless2 UnreadUnread3 ViewsViews
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View profile card for Laura Riccardi
Last post September 11 at 1:07 PM by Laura Riccardi
Ohta, G. (2015). National standards for culturally and linguistically appropriate services (CLAS) in health and health care. Hawaii Journal of Medicine and Public Health, 74(7), p.12.
Barksdale, C.L., Rodick, W.H., Hopson, R., Kenyon, J., Green, K. & Jacobs, C.G. (2016). Literature review of the National CLAS Standards: Policy and practical implications in reducing health disparities. Journal of Racial and Ethnic Health Disparities, 4(4). https://doi.org/10.1007/s40615-016-0267-3
The National CLAS Standards can be used to provide quality cultured care for patients with one diverse culture or those who belong to more than one cultural group. It is a great tool to improve cultural respect, competence, and healthcare service. The fifteen standards address governance, leadership, and workforce; communication and language assistance; and engagement, continuous improvement, and accountability (Ohta, 2015). There can be gaps in knowledge and communication between a provider and a patient who share the same race or ethnicity, which suggests that there is a need for a standard of care for appropriate cultural and linguistic competency training at least annually for all healthcare providers (Barksdale et al., 2016). This would improve culture competency, health services, and patient satisfaction.
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Emilia Rodriguez posted Sep 8, 2021 11:19 PM
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Deaf CultureNotably, deaf individuals typically identify with different cultures and cultural groups in addition to deaf culture. This is best exemplified by the case of deaf individuals with ethnic or racial minority backgrounds. Such intersections are consequential for the healthcare providers’ delivery of culturally competent care because of two principal reasons (Hill et al., 2020). Firstly, the overlap necessitates broadened comprehension of the sociocultural determinants of effective care delivery, given that such understanding must encompass both the sociocultural determinants of deafness and of the additional cultural dimensions and characteristics. For example, the provider must comprehend both the sociocultural aspects of deafness and of the Hispanic culture in the context of healthcare delivery when interacting with a deaf service user who also identifies with the Hispanic ethnic culture. Additionally, the overlap affects the ability to provide quality cultural care because it expands the domains of context-specific cultural competencies requisite for the effective case management.Englerth, K., Dennis, C., & Scott, S. (2020). Looking for the signs: OTs’ experiences with deaf culture. American Journal of Occupational Therapy, 74(4_Supplement_1), 7411510311p1-7411510311p1. https://doi.org/10.5014/ajot.2020.74S1-PO7321Leigh, I. W., Andrews, J. F., Harris, R. L., & Ávila, T. G. (2020). Deaf culture: Exploring deaf communities in the United States. Plural Publishing.less1 UnreadUnread1 ViewsViews
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View profile card for Jeffrey Mahoney
Last post September 11 at 12:53 PM by Jeffrey Mahoney
Hill, C., Deville, C., Alcorn, S., Kiess, A., Viswanathan, A., & Page, B. (2020). Assessing and providing culturally competent care in radiation oncology for deaf cancer patients. Advances in radiation oncology, 5(3), 333–344. https://doi.org/10.1016/j.adro.2020.02.007
References
Deaf culture refers the set of values, social beliefs, shared community institutions, literary traditions, art, and other cultural aspects that both influence deafness and also utilize sign language as the primary mode of communication. While deaf culture is characterized by unique and distinctive components it also has several cultural characteristics in common with other cultural groups including hearing culture and other ethnic and non-ethnic cultures (Englerth et al., 2020). Three areas of similarity, in this regard, include the feeling of community, behavioral norms, and social structure. Regarding social structure, deaf culture like all ethnic cultural groups is for instance characterized by the existence of a leadership structure that is felt to embody the unique characteristics of the entire group (Leigh et al., 2020). Self-recognition and recognition by others is also a central feature of the feeling of community within deaf culture as it is in other cultural groups (Hill et al., 2020). Behavioral norms governing different aspects of life such as decision-making and consensus-building also characterize deaf culture as they do all other cultural groups.
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Frances Hall posted Sep 8, 2021 8:26 AM
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Hearing loss is a major source of disability in adults, associated with serious communication and psychosocial problems and high health care costs, with economic implications at the societal and individual levels (Cunningham & Tucci, 2017). On a global level, hearing loss is the most prevalent disabling condition; however, lack of trained hearing health professionals and limited access to assistive technology restricts access to hearing health-care services (Ingram et al., 2016). The primary effect of adult hearing loss is impaired communication, which can adversely affect relationships with family and friends and create difficulties in the workplace. Untreated hearing loss in adults also has indirect health, psychosocial, and economic effects and leads to social isolation and a reduced quality of life (Cunningham & Tucci, 2017). I would think the inability to communicate weather it’s talking or speaking another language, and not having the ability to be understood correctly is something all cultural groups have in common. People with hearing loss described various negative emotions in response to hearing loss, including depression, sadness, desperation, frustration, shame, and embarrassment. These feelings were largely related to others’ reactions to their inability to hear (Ingram et al., 2016). ReferencesCunningham, L. L., & Tucci, D. L. (2017). Hearing loss in adults. New England Journal of Medicine, 377(25), 2465–2473. https://doi.org/10.1056/nejmra1616601less1 UnreadUnread5 ViewsViews
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View profile card for Francesca Provencher
Last post September 11 at 12:31 PM by Francesca Provencher
Ingram, M., Marrone, N., Sanchez, D., Sander, A., Navarro, C., de Zapien, J., Colina, S., & Harris, F. (2016). Addressing hearing health care disparities among older adults in a us-mexico border community. Frontiers in Public Health, 4. https://doi.org/10.3389/fpubh.2016.00169
Brooks, L. A., Manias, E., & Bloomer, M. J. (2019). Culturally sensitive communication in healthcare: A concept analysis. Collegian, 26(3), 383–391. https://doi.org/10.1016/j.colegn.2018.09.007
Three major uses of culturally sensitive communication were identified, including understanding one’s own culture, open and sensitive communication, and strategies to collaborate with the patient and family for optimal patient care (Brooks et al., 2019). Knowing that most of the stress of being deaf are the reactions people have toward them not being able to hear makes it so important for us as practitioners to be aware of this to provide compassionate care.
Module 2:DiscussionSubscribe
Idida Aleman Musial posted Sep 8, 2021 9:00 PM
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The Transcultural Interprofessional Practice (TIP) model by Andrews/Boyle is comprised five essential components in nursing care (Andrews & Boyle, 2019). Performing a self-assessment, collaborative goal setting with the family and the patient, developing, implementing and evaluating a plan of care are the five essential components of competent and culturally congruent nursing care. Implementing these aspects into clinical practice will improve the current nursing care culture. TIP promotes cultural congruent nursing care that is affordable, accessible, and based on evidence-based practice. more2 UnreadUnread3 ViewsViews
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View profile card for Donna Wrobel
Last post September 10 at 6:35 PM by Donna Wrobel
Young, J., Jerolimov, D., & Ofner, S. (2021). Promoting nursing students’ transcultural self‐efficacy to care for burmese refugees using a set of educational strategies. Nursing Forum (Hillsdale), 56(2), 460-466. https://doi.org/10.1111/nuf.12541
Wehbe-Alamah, H., McFarland, M., Andrews, M., & Lograsso, S. (2021;2019;). An ethnohistory of the transcultural nursing scholars and their contributions to the field. Journal of Transcultural Nursing, 32(1), 50-58. https://doi.org/10.1177/1043659619892671
Andrews, M. M., & Boyle, J. S. (2019). The Andrews/Boyle transcultural interprofessional practice (TIP) model. Journal of Transcultural Nursing, 30(4), 323-330. https://doi.org/10.1177/1043659619849475
Andrews, M., Boyle, J., & Collins, J.W. (2020). Transcultural concepts in nursing care (p.47, 8th ed.). Wolters Kluwer
Reference:
Providing care to individuals with special needs can be challenging for nurses, especially when one is not prepared. According to Andrews and Boyle, a deaf individual might self-identify with nonethnic cultures. Communication becomes a challenge when providing care to an individual that also comes from a subculture (Wehbe-Alamah, et al. 2021;2019). In order to be prepared for these types of challenges, preparation should start in nursing school. Nursing instructors and nurses can also promote culturally congruent care for deaf patients by teaching nursing students the importance of competent care for all individuals. Therefore, nursing students will benefit from knowledge on transcultural care for individuals of different backgrounds (Young, et al. 2020).
Impaired communication places clients with special needs at a higher risk for health disparities and inequities. The inability to communicate needs to the healthcare provider can become a barrier. This is a one common element that a deaf, or hard of hearing, individual has in common with members of other cultural groups.
Module 2 – Francesca ProvencherSubscribe
Francesca Provencher posted Sep 8, 2021 6:26 PM
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Taking care of a deaf patient has similarities to taking care of a patient from a different culture. It is important that when taking care of a patient that cannot hear their healthcare providers have appropriate resources to communicate with them. Clear communication can be one of the most crucial tools when it comes to diagnosing, treating, and educating a patient. The literature states, communication barriers between healthcare providers and patients contribute to health disparities which is particularly true concerning communication between providers and deaf patients. This is caused due to lack of understanding of cultural and linguistic differences, ineffectiveness of various means of communication and level of health literacy within that population (Hommes et al., 2018). Sirch, L., Salvador, L., & Palese, A. (2017). Communication difficulties experienced by deaf male patients during their in-hospital stay: findings from a qualitative descriptive study. Scandinavian Journal of Caring Sciences, 31(2), 368–377. https://doi-org.wilkes.idm.oclc.org/10.1111/scs.12356less2 UnreadUnread7 ViewsViews
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View profile card for James Neal
Last post September 10 at 6:19 PM by James Neal
Hommes, R. E., Borash, A. I., Hartwig, K., & Degracia, D. (2018). American Sign Language Interpreters Perceptions of Barriers to Healthcare Communication in Deaf and Hard of Hearing Patients. Journal of Community Health, 43(5), 956–961. https://doi-org.wilkes.idm.oclc.org/10.1007/s10900-018-0511-3
The research shows communicating strategies, include, sign language and oralism which have always been the two main methods of approach to language for deaf people (Sirch et al., 2017). Sign language is the normal form of communication for a deaf person and articulates the awareness and familiarities of their culture. According to the author “sign language is self-contained and has its own syntax, grammar, and semantics, which are different from spoken and written languages” (Sirch et al., 2017, p. 368). On our unit we utilize a variety of different tools to communicate with deaf patients, this includes interpreters that use American Sign Language (ASL) that come in person to the hospital along with an iPad that we can type ASL in and an interpreter comes on the screen. A deaf patient may also be proficient in lip reading so a provider would always have to make sure they were patient facing when providing information.
Module 2 Discussion – Jahenein Nagel
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Jahenein Nagel posted Sep 6, 2021 6:58 PM
Discrimination and prejudice remain uncomfortably common in the world. These attitudes are most obviously encountered between majority and minority groups with regard to religion, gender, race, ethnicity, and disability (Marschark et al., 2017). Prejudice and discrimination often involve one (majority) group seeking social dominance over another (minority) group (Marschark et al., 2017) Clason (2019) asserts that practitioners must be aware of how factors such as racial background, hearing status, and communication mode fall under the broader identity of being Deaf. The following guidelines are important tips to remember when communicating with the Deaf: (a) acknowledge the fact that your first attempts to communicate will feel awkward and uncomfortable; (b) it is acceptable to use paper and pen; (c) take the time to communicate and connect; (d) understand that deaf people listen with their eyes so only speak when you have eye contact, even if they are using an interpreter; (e) use the beginning and ending of a conversation as an opportunity to make physical and visual contact with the deaf person, especially if they have been using an interpreter during your conversation and make eye contact; (f) Recognize that Deaf clients may benefit from a counseling approach that is visual, tactile, or expressive (Clason, 2019).Clason, D. (2019, December 24). The importance of deaf culture. Healthy Hearing. https://www.healthyhearing.com/report/52285-The-importance-of-deaf-culture less0 UnreadUnread
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View profile card for Gisselle Mustiga
Last post September 10 at 6:19 PM by Gisselle Mustiga
Marschark, M., Ettler, I., & Dammeyer, J. (2017, May 30). Social dominance orientation, language orientation, and deaf identity. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881267/#enx018C2
References
Some Deaf individuals view themselves not as disabled, but as a member of a linguistic-cultural minority identified, most centrally, by their use of sign language (Marschark et al., 2017). According to Marschark et al. (2017), Deaf cultural identity is not a function of hearing status alone, but includes internalization of values and beliefs with regard to affiliation with the deaf community, language modality, and social networks. Deaf culture is the set of social beliefs, behaviors, art, literary traditions, history, values, and shared institutions of communities that are influenced by deafness and which use sign languages as the main means of communication (Marschark et al., 2017). When used as a cultural label especially within the culture, the word deaf is often written with a capital D and referred to as “big D Deaf” in speech and sign (Clason, 2019). When used as a label for the audiological condition, it is written with a lower case d (Clason, 2019).
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Jeffrey Mahoney posted Sep 6, 2021 12:59 PM
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According to Andrews et al. (2020), healthcare providers often group the culture of the deaf in with the disabled. However, from an emic perspective, the deaf often see themselves as well, whole, and non-impaired – identifying with a linguistic minority versus a culture of disability (Andrews et al., 2020).With the knowledge that a patient may identify with the culture of the deaf and another cultural group, it may be helpful to assess which other cultural group to determine the level of acculturation that person has experienced. Those that identify with the culture of the deaf on average have a sixth grade reading level proficiency, further supporting the need for an interpreter for health education (Sirch et al., 2017; Hubbard et al., 2018). Similarly, the health literacy of the Deaf is 6.9 times more likely to be inadequate – suggestive of meager education rather than intelligence (Hubbard et al., 2018). What other ways have you discovered to provide culturally competent care to this group?ReferencesHubbard, L. J., D’Andrea, E., & Carman, L. A. (2018). Promoting best practice for perinatal care of deaf women. Nursing for Women’s Health, 22(2), 126-136. https://doi.org/10.1016/j.nwh.2018.02.002 less1 UnreadUnread2 ViewsViews
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View profile card for Karimah Moss
Last post September 10 at 12:40 PM by Karimah Moss
Sirch, L., Salvador, L., & Palese, A. (2017). Communication difficulties experienced by deaf male patients during their in‐hospital stay: Findings from a qualitative descriptive study. Scandinavian Journal of Caring Sciences, 31(2), 368-377. https://doi.org/10.1111/scs.12356
Andrews, M., Boyle, J., & Collins, J.W. (2020). Transcultural concepts in nursing care (8th ed.). Wolters Kluwer.
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From this emic viewpoint, the culture of the deaf relate more so to patients that speak a foreign language. As such, a culturally competent nurse must first learning the patient’s perspective on their status (Hubbard et al., 2018). The nurse should be asking the following question: Does the patient identify with Deaf culture, or did they simply develop deafness later in life? The nurse would also benefit from learning which form of sign language that person is fluent in such as American sign language or Italian Sign Language (Hubbard et al., 2018).
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Evelyn Anderson posted Sep 8, 2021 10:16 PM
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One cultural characteristic that the deaf have in common with cultural groups is the language they use. Language can be a defining aspect of an individual’s culture. According to Krasniqi (2019), language and culture are supportive to each other in many situations, and they reflect many different aspects of the culture. They complement each other through words, attitudes, gestures and behavior (Krasniqi, 2019). Deaf communities consider themselves a linguistic minority using sign language as their identified form of language (Higgins & Lieberman 2016). In addition to the language of sign they use, deaf people consider themselves part of a cultural group connected through experiences and cultural practices and traditions (Higgins & Lieberman, 2016). Cultural practices and traditions are also defining aspects of many cultures. Higgins, M., & Lieberman, A. M. (2016). Deaf Students as a Linguistic and Cultural Minority: Shifting Perspectives and Implications for Teaching and Learning. Journal of education (Boston, Mass.), 196(1), 9–18. https://doi.org/10.1177/002205741619600103 less1 UnreadUnread3 ViewsViews
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View profile card for Jahenein Nagel
Last post September 10 at 11:10 AM by Jahenein Nagel
Ladha, T., Zubairi, M., Hunter, A., Audcent, T., & Johnstone, J. (2018). Cross-cultural communication: Tools for working with families and children. Paediatrics & child health, 23(1), 66–69. https://doi.org/10.1093/pch/pxx126
Krasniqi, K. (2019). The relationship between language and culture (case study Albanian language). Linguistics and Literature Studies 7(2): 71-74. https://www.hrpub.org/download/20190330/LLS5-19312921.pdf
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If a client is deaf and identifies with another cultural group as well, then consideration for both cultures is identified and addressed thoughtfully. This can be difficult for the practitioner as they will need to address both cultures in a considerate and thoughtful way to provide the best treatment possible for the individual. It may require using multiple modalities such as hearing-impaired services and interpreter services. One tool that may help communicate cross culturally is the LEARN model. The LEARN model helps create mutual understanding between the patient and provider to promote best patient care (Ladha et al. 2018). Each letter provides a framework to follow: Listen- Assess the patients understanding of their health condition, causes and their treatments; Explain- your own perception of their condition, causes and treatments; Acknowledge-use respect when discussing your point of view and their own; Recommend-create and offer a treatment plan to both the patient and family; Negotiate-seek a treatment plan agreement with the patient and family that incorporates cultural relevant treatment from the patients cultural point of view (Ladha et al. 2018).
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James Neal posted Sep 7, 2021 12:43 PM
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What cultural characteristics do deaf people have in common with other cultural groups?Culture is comprised of shared values, traditions and norms, a common language, and identity. In anthropology, culture is noted to be learned, shared, and exists as an integrated whole, or a connected framework that members understand and operate within (Haviland, 2001). The Deaf community exhibits each of these criteria, qualifying it as a culture. If your client is both deaf and identifies with another cultural group as well, how does this affect your ability to provide quality cultural care?ReferencesLane, H. (2005). Ethnicity, ethics, and the deaf-world. Journal of Deaf Studies and Deaf Education, 10(3), 291–310. https://doi.org/10.1093/deafed/eni030less1 UnreadUnread4 ViewsViews
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View profile card for Frances Hall
Last post September 9 at 1:40 PM by Frances Hall
Haviland, W. A. (2001). Cultural anthropology (10th ed.). Wadsworth Publishing.
One has to be both knowledgable and aware of both cultural backgrounds; affiliation with one group does not preclude identification with the other. This makes that person’s overall cultural identity more complex, but as covered in last week’s module, we should ideally be approaching each individual as unique without simply assuming each person embodies every aspect of their larger cultural identities.
In fact, Lane (2005) and others have argued that Deaf culture should indeed be characterized as an ethnic culture, making a case that its classification as a disability has caused harm to the community, and its reclassification as an ethnic culture would afford the deaf further legal protections and may erase the idea that those who are deaf or heard of hearing fail to meet an accepted physical ideal.
The Deaf culture and community is something that exists separately from those who are simply hard of hearing or deaf, an audiological condition that is federally recognized as a disability. The Deaf culture does not see being deaf as a disability, but rather as a difference in human experience and as a component of cultural identity.
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Laura Riccardi posted Sep 6, 2021 7:25 PM
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The deaf population can be defined as a subculture. A subculture refers to a group that has values and norms that are distinct from the majority within a wider society (Andrews et al., 2020). The deaf community is distinct due to their own way of communication through sign language and reading people’s mouth movements. They can have a normal fulling life in their own adaption to the world in general.Other examples of nonethnic cultures include the blind, sexual orientation, and age-specific. Characteristics of the deaf, blind, and transgender population learn to live and communicate within their own environments. Elements in these populations are feeling comfortable around others like themselves who understand them. Also, communication is more freely understood between the group. Other attributes can include specific healthcare providers in their communities who will not judge them and be able to understand their needs. Other characteristics can include loneliness and depression due to people not understanding them. Removing barriers to social participation and integration should be an objective to prevent social exclusion and loneliness which can include general attitudes, legislation, and social, cultural, or physical structures (Brunes et al., 2019). Andrews, M. M., Boyle, J. S., & Collins, J. W. (2020). Transcultural concepts in nursing care (8th ed.). Wolters Kluwer.Brunes, A., B. Hansen, M., & Heir, T. (2019). Loneliness among adults with visual impairment: Prevalence, associated factors, and relationship to life satisfaction. Health and Quality of Life Outcomes, 17(1). https://doi.org/10.1186/s12955-019-1096-yless1 UnreadUnread0 ViewsViews
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View profile card for Jennifer Johnson
Last post September 8 at 9:57 PM by Jennifer Johnson
Bodenmann, P., Singy, P., Kasztura, M., Graells, M., Cantero, O., Morisod, K., Malebranche, M., Smith, P., Beyeler, S., Sebaï, T., & Grazioli, V. S. (2021). Developing and evaluating a capacity-building intervention for healthcare providers to improve communication skills and awareness of hard of hearing and d/deaf populations: Protocol for a participative action research-based study. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.615474
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Examples of challenges with the deaf community include using complex medical terminology or drug prescription instructions, which are not understood by the patient, potentially leading to preventable adverse events (Bodenmann et al., 2021). Awareness from organizations is needed to be able to adapt to this population when seeking healthcare. If hospitals and facilities lack resources it can result in limited and negative consequences within this population.
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Jennifer Johnson posted Sep 6, 2021 9:57 PM
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A cultural characteristic that both deaf and hearing impaired people have in common with other racially and ethnically diverse groups is that they are both a minority group in this country, and around the world. According to the World Health Organization (WHO), about 432 million adults and 34 million children have disabling hearing loss (Andrews et al., 2020; WHO, 2021). However, according to Andrews et al. (2020), although deaf and hearing impaired people may be racially and/or ethnically a part of the majority, they may self-identify with nonethnic cultures. And still others may be considered a “double minority”; identifying both with a racial or ethnic minority and with the nonethnic culture of the deaf (Andrews et al., 2020; Nelson Schmitt & Leigh, 2015).It is interesting to note that until the APN knows how best to communicate with the patient, he/she must use their culturally competent non-verbal skills to create a supportive environment that will be the foundation of their therapeutic relationship. The experienced APN can do this simply with a kind gesture or a friendly and welcoming look in their eyes, rather than a rushed and exasperated expression on their face. And this is crucial, because research shows that non-verbal communication plays an important role in cultivating trust between racial/ethnically diverse patients and care providers; trust that is vital for positive health outcomes (Loire et al., 2017).
Andrews, M., Boyle, J., & Collins, J.W. (2020). Transcultural Concepts in Nursing Care (8th ed.). Wolters Kluwer. Nelson Schmitt, S. S., & Leigh, I. W. (2015). Examining a sample of black deaf individuals on the deaf acculturation scale. Journal of Deaf Studies and Deaf Education, 20(3), 283-295. doi:10.1093/deafed/env017less1 UnreadUnread4 ViewsViews
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View profile card for Krista Romig
Last post September 8 at 8:26 PM by Krista Romig
World Health Organization. (2021, April 1). Deafness and Hearing Loss. Retrieved September 6, 2021 from https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing- loss
Lorié, Á., Reinero, D. A., Phillips, M., Zhang, L., & Riess, H. (2017). Culture and nonverbal expressions of empathy in clinical settings: A systematic review. Patient Education and Counseling, 100(3), 411-424. doi.org/10.1016/j.pec.2016.09.018
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The culturally competent advanced practice nurse (APN) knows how to be mindful of the needs not only of the hearing impaired patient, but of their racial and ethnic uniqueness as well. First and foremost, the APN must ascertain how the patient prefers to communicate. Do they use sign language, is an interpreter required, do they prefer written communication, or perhaps telecommunication devices for the deaf (TDD) (Andrews et al., 2020). Once the APN understands the best way to communicate with the patient, then the assessment, planning, and implementation of care can begin.
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Emily Meeks posted Sep 7, 2021 6:24 PM
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In the event an individual is a “double minority,” such as being deaf and also identifies with another cultural group, it is necessary to modify the care being provided to meet the needs of both cultures (Andrews et al., 2020, p. 47). Say the patient is deaf and speaks another language. A misconception is that sign language is universal, when in fact it is not, and greatly impacts the quality of care. In researching this topic, I found that there are up to 300 sign languages, and they can differ depending on geographic location and language of the community (Brooks, 2018). While it is impossible for an advanced practice nurse to know the beliefs of all cultural groups, it is necessary for one to withhold judgement or assumptions, and accommodate to the best of their abilities.Andrews, M., Boyle, J., & Collins, J. (2020). Transcultural concepts in nursing care. (8th ed.)Brooks, R. (2018). A guide to the different types of sign language around the world. K International. https://www.k-international.com/blog/different-types-of-sign-language-around-the-world/.https://www.nationaldeafcenter.org/sites/default/files/The%20Deaf%20Community-%20An%20Introduction.pdfless0 UnreadUnread
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National Deaf Center (2019). The deaf community: an introduction.
Philadelphia, PA: Wolters Kluwer.
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When discussing culture, one may immediately think of those from racially or ethnically diverse backgrounds. However, one must be able to identify that every group or subset of persons whom form a group of individuals, have a unique culture as well (Andrews et al., 2020). For example, the LGBTQ community, socioeconomic status, those with disabilities or are deaf, each encompass a nonethnic culture. The deaf culture is formed by way of language differences, shared-life experiences and struggles with adaptation (National Deaf Center, 2019). Characteristics the deaf culture have in common with other cultural groups could include language barriers, living in a community that doesn’t always accommodate diversity, biases, and social groups/ activities.
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Karimah Moss posted Sep 7, 2021 10:46 AM
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Module 2When healthcare professionals are not culturally competent and fail to recognize that a patient has cultural needs (deaf or ethnic culture), barriers are created leading to disparities. Like ethnic cultural groups, those that are part of the deaf cultural heritage are at risk for healthcare inequalities. Their access to information regarding health prevention, treatment, and care is significantly less than those who do not have hearing difficulties (Kuenburg et al., 2016). “Community perceptions of health such as diverse experiences and understanding of ill-health as well as language and communication barriers have been linked to challenging health care access in culturally and linguistically diverse populations” (Kuenburg et al., 2016, p. 1).ReferencesKuenburg, A., Fellinger, P., & Fellinger, J. (2016). Health care access among deaf people. Journal of Deaf Studies and Deaf Education, 21(1), 1–10. https://doi.org/10.1093/deafed/env042Therivel, J., & Punwani, K. (2016, October 28). Evidence-based care sheet: Clients who identify as deaf: Providing culturally competent care [PDF]. EBSCO Host. https://www.ebscohost.com/assets-sample-content/SWRC-Culturally-Competent-Care-Clients-Who-Identify-as-Deaf-Care-Sheet.pdf less0 UnreadUnread
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Pendergrass, K. M., Newman, S. D., Jones, E., & Jenkins, C. H. (2017). Deaf: A concept analysis from a cultural perspective using the Wilson method of concept analysis development. Clinical Nursing Research, 28(1), 79–93. https://doi.org/10.1177/1054773817719821
Abou-Abdallah, M., & Lamyman, A. (2021). Exploring communication difficulties with deaf patients. Clinical Medicine, 21(4), e380–e383. https://doi.org/10.7861/clinmed.2021-0111
Having a patient that is deaf and part of another cultural group, will impact how I provide culturally competent care. I would want to ensure that I utilize all available resources to effectively communicate and assess their deaf and ethnic cultural needs. On a few different occasions, I delivered care to a deaf patient. During each interaction, the patients declined the use of an interpreter and preferred to lip read. Now with COVID-19, this would be impossible, and I would need to utilize a clear face mask should I encounter this situation again. However, I would do my best to encourage the use of an interpreter to ensure that myself or the patient does not misunderstand anything important due to our communication or language differences (Abou-Abdallah & Lamyman, 2021). With the interpreter’s assistance, I will be able to assess the patient’s unique cultural needs and make certain that they are appropriately addressed and relayed to all other members of the team.
Individuals who utilize American Sign Language (ASL) as their primary method of communication, define the term “deaf” as a cultural heritage. The term “deaf” within the healthcare setting is usually defined as a pathological condition (Pendergrass et al., 2017). While the deaf and hearing-impaired community is a nonethnic culture, this community does have unique cultural characteristics as ethnic cultural groups do. It is equally important for healthcare professionals to demonstrate cultural competence when providing care to the deaf community as it is with ethnic cultural groups. Both groups have distinct health beliefs, attitudes towards healthcare and health professionals, cultural needs, values, and communication challenges (Therivel & Punwani, 2016). Ineffective communication can lead to lack of trust and medical errors which will negatively impact the patient’s health outcome (Abou-Abdallah & Lamyman, 2021).
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Donna Wrobel posted Sep 6, 2021 1:07 PM
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Although many people do not characterize the deaf community as a unique culture, deaf individuals do view themselves as members of a distinct society based on their use of sign language as their primary language. According to Giger and Davidhizer’s theory, culture is determined by shared beliefs and experiences in the areas of communication, time, space, social organization, environmental control and biologic variations (Giger & Davidhizar, 2002). Characteristics specific to the deaf community are based on shared life experiences that are different from hearing individuals in a world that is designed for verbal communication (The Deaf Community: An Introduction, n.d.). Deaf culture is based on the notion that disability is a social and environmental construct rather than a medical condition based on a loss of physical function. Members of the community are accepted based on whether an individual chooses to self-identify as deaf, rather than a medical diagnosis (Sligar, 2019).Many people identify as members of more than one specific culture. For example, a patient may identify as a member of the Latino culture and a member of the LGBTQ community. It is the responsibility of the APRN to become educated regarding the needs and beliefs of their patients, regardless of which culture the patient identifies with. If a patient indicates that they belong to more than one culture, it is necessary for the APRN to question the patient regarding how this may affect their beliefs and goals regarding their care. This is no different if the patient belongs to the deaf community as well as another culture as the needs of the patient must always be taken into consideration.Definition of culture. (2021). Merriam-Webster.com. Retrieved September 5, 2021, from https://www.merriam-webster.com/dictionary/cultureHuang, S. (2017). The relationship between language and culture: Evidence from the deaf bi-bi community. Perspectives of the ASHA Special Interest Groups, 2(14), 55–65. https://doi.org/10.1044/persp2.sig14.55The deaf community: an introduction. (n.d.). National Deaf Center on Postsecondary Outcomes. https://www.nationaldeafcenter.org/less0 UnreadUnread
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Sligar, S. R. (2019, November). Deaf and hearing: Conducting cross-cultural research in a postsecondary setting. JADARA Journal of American Deafness and Rehabilitation Association. https://nsuworks.nova.edu/jadara/vol40/iss1/3
Giger, J., & Davidhizar, R. (2002). The giger and davidhizar transcultural assessment model. Journal of Transcultural Nursing, 13(3), 185–188. https://doi.org/10.1177/10459602013003004
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In all cultures, the use of a common language helps to establish membership and identification as well as social support within the community and language and culture are usually tightly connected (Huang, 2017). The basis of deaf culture is the use of the common language of ASL (American Sign Language) but the community also maintains shared rules for behavior, traditions, beliefs and values much the same as other ethnic and racial cultures do. One such accepted behavior is to maintain eye contact while conversing, rather than looking away as hearing persons do (Sligar, 2019). These behaviors and beliefs are equivalent to the meaning of culture in the Merriam-Webster Dictionary in which the term is defined as the “customary beliefs, social forms, and material traits of a racial, religious, or social group as well as the shared attitudes, values, goals and practices that characterize an institution or organization” (Definition of Culture, 2021). Based on this definition, the deaf community makes up a distinct culture based on their shared beliefs and experiences that distinguish them from the hearing community.
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Krista Romig posted Sep 6, 2021 12:29 AM
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Deaf culture is often overlooked when considering culturally competent care as it is not a culture based on ethnicity. However, the deaf community has their own culture, which is based on deaf people being a cultural minority. Many people in the deaf community do not see their hearing loss as a disability, and rather embrace their differences just like many other cultural groups (Andrews et al., 2020).As healthcare providers, it is important to provide culturally competent care for to our patients. It has been found that deaf patients often have negative experiences within healthcare facilities, including limited ASL access and healthcare inequity. There are also many misconceptions about deaf patients (Greene & Scott, 2021). Since the deaf community often does not see themselves as disabled, it is important to determine what their goals are rather than push what we see as their goals onto them. As medical professionals, we tend to see anything out of the normal as something to fix, so it is typical to encourage hearing aids and cochlear implants on patients with hearing loss (Andrews et al., 2020). However, if the patient does not see their hearing loss as a disability and does not want it fixed, this can upset them.When providing care to patients of cultural minorities, the most important thing when providing quality cultural care is communication with the patient. It is important to ask questions to better understand the patients’ culture and goals of treatment. By being respectful and wanting to gain a better understanding of the patients’ culture, we can provide culturally competent care to all patients.Andrews, M., Boyle, J., & Collins, J. W. (2020). Transcultural concepts in nursing care (8th ed.). Wolters Kluwer.Hoffman, D. & Andrews, J. F. (2016). Why deaf culture matters in deaf education. Journal of Deaf Studies and Deaf Education, 21(4), 426-427. https://doi.org/10.1093/deafed/enw044
Greene, S. J. & Scott, J. A. (2021). Promoting cultural awareness, professionalism, and communication skills in medicine through anatomy: The Deaf culture session. Clinical Anatomy, 34(6), 899-909. https://doi-org.wilkes.idm.oclc.org/10.1002/ca.23752
References
Patients in the Deaf community can also belong to other cultural groups as well, such as being black or gay. It is important to not make assumptions about the patient based on their cultural groups, but instead to understand the challenges the patient has likely encountered.
Many people believe that the only difference deaf people experience is how they communicate. However, the Deaf community has much more in common than just American Sign Language. The deaf community recognizes the difficulties living in a hearing world and shares their experiences as deaf individuals (Hoffman & Andrews, 2016).

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