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101 Cards in this Set
- Front
- Back
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2 categories of cultural competence
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1. Organizational
2. individual |
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Individual cultural competence
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Cmplex integration of knowledge, attitudes, beliefs, skills, & encounters with people of diff cultures that enhances cross-cultural communication & interactions with others
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Cultural competence is a -------- in which a nurse continuously strives to ------- within the cultural context of a "person" of a diverse cultural background
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Process
Work effectively |
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5 areas of cultural competence
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1. Cultural desire
2. Cultural awareness 3. Cultural knowledge 4. Cultural skill 5. Cultural encounters |
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Linguistic competence
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Of providers greatly impacts clients' access & response to health care services
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Cultural and linguistic competence refers to an ------- by providers and organizations to --------- & --------- to cultural and linguistic needs brought by clients to the health care encounter.
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Understand
Effectively respond |
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US DHH, Office of Minority Health recommended ---- standards for ------------- in 2000.
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14
Culturally & linguistically appropriate health care organizations |
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1. Promote -----, -------, -------, and ------- necessary for staff to work respectfully & effectively in culturally diverse environment.
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Attitudes,
behaviors, knowledge, skills |
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2. Have comprehensive --------- to implement standards.
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Management strategy
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3. Use formal mechanisms of ----- and ----- involvement in the development & execution of service delivery.
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Community
consumer |
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4. Develop & implement strategy to -----, -----, and ----- qualified diverse & culturally competent staff who are trained to -------------------.
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Recruit
Retain Promote Address needs of racial & ethnic communities |
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5. Require & arrange for ongoing ---- & ----- for staff in culturally & linguistically competent delivery of service
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Training
Education |
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6. Provide ----------- to all clients with limited English proficiency
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Bilingual interpretation services
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7. Provide ---- & ------- notices in clients' primary language, of their right to receive --------------.
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Written
Oral Interpreter services |
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8. Make ------- available in all ----- predominant in the service area.
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signage
languages |
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9. Ensure -------- of bilingual staff & interpreters
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Proficiency
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10. Include clients' -------- & --------- in the health care organization 's information system
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Primary spoken language
Self-identified race/ethnicity |
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11. Collect & utilize what 4 types of data for racial/ethnic groups & become informed about ethnic/ cultural needs, resources & assets in the surrounding community
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1. Demographic
2. Cultural 3. Epidemiological 4. Clinical outcome |
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12. Measure organizational cultural & linguistic competence for ------, ---------, --------, and ------- using internal audits & performance improvement programs
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Access
Satisfaction Quality Outcome |
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Develop procedures to address ---- and ------- issues in health care delivery and complaints by patients & staff about -------, -------, or ----- treatment, or difficulty in ------- health care services, or ------
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Ethical
Legal Unfair, culturally insensitive, discriminatory Accessing Denial |
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-------- progress in implementing these standards on a/an -------- basis
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Document
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Culturally congruent care
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The provision of care that is meaningful and fits with cultural beliefs and lifeways. (Leininger)
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It's possible to master the ---- & --- associated with cultural assessment and learn about some of the ------ of care for clients representing the groups most frequently encountered
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Knowledge, skills
Cultural dimensions |
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We must conduct -------- before we can conduct -------.
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Cultural self-assessment
Cultural assessment of others |
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what's the foundation for culturally competent & culturally congruent care.
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Cultural assessment
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What skill is foundational to all nursing interactions?
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Communication
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Communication
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Organized, patterned system of behavior that regulates & makes possible all nurse-client interactions.
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Communication is the ---------- & the creation of --------.
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Exchange of messages
Meaning |
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Differences in -------, --------, & ---- can be barriers to communication.
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Language
Worldview Values |
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-----% of all difficulties in nurse/client interactions have resulted from miscommunication.
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90
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2 types verbal communication
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Oral
Written |
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5 types nonverbal communication
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1. Gestures
2. Body movement 3. Posture 4. Tone of voice 5. Facial expressions |
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Environmental context
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The context in which the communication occurs.
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3 things which influence environmental context
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1. Setting
2. Purposes of the communication 3. Perceptions held by nurse & client re time, space, distance, touch, modesty |
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5 things to avoid to promote effective communication
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1. Technical jargon
2. Slang 3. Colloquial expressions 4. Abbreviations 5. Excessive use of medical terminology |
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3 domains of communication (Lipson & Steiger, 1996)
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1. Affective
2. Cognitive 3. Behavioral |
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5 Affective strategies for cross-cultural communication
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1. Respect for cultural differences
2. Enjoymentnof learning through cultural exchange 3. Ability to observe behavior without judging 4. Awareness of one's own cultural values & biases 5. Belief in cultural relativity - that there are many acceptable cultural ways |
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4 Cognitive strategies for cross-cultural communication
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1. Knowledge about different cultures
2. Ability to recognize when there is a cultural explanation for an interpersonal problem 3. Understanding that meanings can differ for others 4. Understanding the sociopolitical system with respect to its treatment of minorities |
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5 behavioral strategies for cross-cultural communication
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1. Flexibility in verbal and nonverbal communication styles
2. Ability to speak slowly and clearly without excessive use of slang 3. Ability to encourage others to express themselves 4. Ability to communicate sincere interest, empathy & patience 5. ability to observe & intervene when misunderstanding occurs |
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5 factors to consider for cross-cultural communication
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1. Communication with family members and significant others
2. Space, distance, and intimacy 3. Nonverbal communication 4. Language 5. Sick role behaviors |
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Knowledge of a client's family & kinship structure helps you to ascertain the ------, ------, & ------- within the household.
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Values
Decision-making patterns Overall communication |
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Familism
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Emphasizes interdependence over independence, affiliation over confrontation, & cooperation over competition
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Clients are likely to perceive family involvement as a source of -----, --------, & ---------.
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Mutual support
Security Fulfillment |
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Family
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Basic social unit in which kids are raised & learn culturally based values, beliefs & practices about health & illness
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What's the essence of family?
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Living together as a unit
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When caring for a child, it's important to determine who's the ------------ & who's the ----------.
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Primary caregiver
Key decision maker |
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A child's primary caregiver may not be the biologic parent - name 2 likely groups. What type of relationships are these?
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1. Hispanic - sisters or aunts
2. African-American - grandmothers Collateral relationships |
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To provide culturally congruent care, you must be certain that you are communicating effectively with the -----------.
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Appropriate decision maker(s)
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In many ------- cultures, the eldest son assumes responsibility for his aging parents & make decisions for them.
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Asian
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If ----------are valued, decisions about the client may be interrelated with the impact of illness on the whole family or group
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Collateral relationships
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Te individual values orientation concerning relationships is predominant among the dominant cultural majority in what country?
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North America
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Interactions between nurse and client are influenced by the degree of ------ desired, which may range from ------ to -------.
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Intimacy
Formal interactions Close personal relationships |
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Asian cultures may expect health care providers to be ------.
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Authoritarian
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Appalachian clients often expect to have ---------- with their providers.
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Close personal relationships
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Latin American & Mediterranean clients often expect a high degree of ------ with their providers.
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Intimacy
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Simpatia (Hispanic)
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Need for smooth interpersonal relationships - characterized by courtesy, respect & absence of critical/confrontational behavior
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Nurse should ------- herself and tell client how --------------.
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Introduce
She prefers to be called |
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Nurse should also find out how client wishes to be -------- so nurse can address client in a ---------- manner.
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Addressed
Culturally appropriate |
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6 forms of nonverbal communication
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1. Silence
2. Eye contact 3. Touch 4. Space 5. Distance 6. Facial expression |
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Nonverbal communication patterns vary widely across --------- and between ---------.
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Cultures
Genders |
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Some individuals are ------ with silence.
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Uncomfortable
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Silence may show ----, -----, -----, or ------.
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Respect for others
Consideration Respect another's privacy Response to question deemed inappropriate |
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The use of --------- is among the most variable of nonverbal behaviors.
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Eye contact
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5 cultures that perceive direct eye contact as impolite or aggressive
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Asian
Native N. Americans Indochinese Arab Appalachian |
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Native N. Americans do what during conversations?
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Stare at the floor - shows they're concentrating on speaker's words
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Oculistics
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Eye-rolling
Used by some black Americans in response to questions perceived as inappropriate |
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In the nurse-client relationship, Hispanic clients expect you to make ----------, but may not ------, based on what 5 factors?
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Eye contact
Reciprocate 1. Age 2. Sex 3. Social position 4. Economic status 5. Position of authority |
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3 cultures where modesty of men & women is interrelated with eye contact
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1. Arab
2. Latino 3. African American |
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In many cultures, the only woman who smiles and establishes eye contact with a man in public is a -------.
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Prostitute
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In many ------ & ------- cultures, a male health care provider may be prohibited from touching or examining the female body.
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Arab
Hispanic |
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In some cultures, there are strict norms related to touching ---------.
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Children
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Many ------- believe that touching the head is a sign of ------.
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Asians
Disrespect |
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4 "close talker" cultures
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1. Hispanic
2. East Indian 3. Middle Eastern 4. Japanese |
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Backing away from a client may be perceived as ------ & --------.
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Aloof
Unfriendly |
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3 cultures requiring most personal space
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1. American
2. Canadian 3. British |
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Intimate distance in interpersonal interactions
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0-18 inches
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Range of personal distance
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1.5-4 ft
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Range of social distance
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4-12 ft
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Range of public distance
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>12 ft
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Proxemics
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How people in various cultures relate to their physical space
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What distance is needed to detect another person's odor, heat, & touch?
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Intimate
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What's the distance where communications between friends & acquaintances usually occurs?
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Personal
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Cultural code
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Set of rules/norms of behavior used by a cultural group to guide behavior & interpret situations
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Failure to adhere to cultural code is viewed as a serious ------.
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Transgression
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Violation of cultural code may ----.
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Jeopardize therapeutic relationship with clients and their families
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When in doubt about cultural norms, ------!
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Ask!
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In the US, ---------people age 5 and older speak a language other than English at home (US Census Bureau, 2000).
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45 million
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Top 3 languages spoken in US
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1. English
2. Spanish 3. Chinese |
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Largest increase has been in what language?
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Russian
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One of the greatest challenges in cross-cultural communication occurs when ---------------.
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You & your client speak different languages
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Ideally, the interpreter will be ------ --------.
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Medically trained
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Although the nurse is in charge of the flow of the interview, the interpreter should be viewed as a -------------.
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Key member of the health care team
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Why you should not ask a family member, friend, or other client to act as interpreter
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Violates confidentiality of client info
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Whenever possible, work with a -------- member of the health care team.
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Bilingual
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Expect an interview utilizing an interpreter to take more/less time than a one-on-one interview.
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More
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Y/N: Do you need an alternative plan in case no interpreter is available?
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Yes
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Linguistically isolated household
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All household members 14 and older have at least some difficulty speaking/understanding English
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What fraction of Latinos residing in the US live in linguistically isolated households?
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1/4
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National Council on Interpreting in Health Care (2996)
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Group that developed first set of National standards for medical interpreting professionals in the US
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Sick role behavior
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Cultures vary in acceptable behaviors for sick people
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Phrase questions in a neutral manner to avoid ----------------.
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Foreshadowing an expected response
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