Barriers to

Culturally Competent Care

 Who Are Vulnerable Populations?
Given the circumstances, any person or group
can be considered a vulnerable population
Older adults, religious groups, homeless, any
disenfranchised groupanyone who is not
part of the dominant culture
Barriers for Vulnerable Populations
Language Appropriateness
Assimilation Adaptability
Acculturation Acceptability
Gender roles Availability
Language Attitudes
Awareness Approachability
Accessibility Additional services
Affordability
 Assimilation and Acculturation
Assimilation: Gradually adopting and
incorporating the characteristics of the
prevailing culture.
Acculturation: Modification of the culture of a
group or individual as a result of contact with
another individual or group.
 Language
Language of the patient; not just ESL patients.
Dialects: Spanish is not Spanish is not Spanish.
Language of the health-care provider
 Availability
Is the service available and at a time when
needed (e.g., no services exist after 6 p.m. for
someone who needs suturing of a minor
laceration)?
Clinic hours coincide with clients' work hours,
making it difficult to schedule appointments
for fear of work reprisals.
 Awareness
Is the client aware that needed services exist
in the community? The service may be
available, but if clients are not aware of it, the
service will not be used.
What about awareness from the healthcare
provider about the beliefs of the patients?
 Accessibility
Transportation services may not be available, or
rivers and mountains may make it difficult for people
to obtain needed healthcare services when no
healthcare provider is available in their immediate
region.
It can be difficult for a single parent with 4 children
to take 3 bus transfers to get one child immunized.
 Affordability and Appropriateness
The service is available, but the client does not
have financial resources.
Maternal child services are available, but what
might be needed are geriatric and psychiatric
services.
 Adaptability and Acceptability
Adaptability: A mother brings her child to the
clinic for an immunization. Can she get a
mammogram at the same time or must she
make another appointment?
Acceptability: Are services and client
education offered in a language preferred by
the client?
 Attitudes
Adverse subjective beliefs and attitudes from
caregivers means that the client will not
return for needed services until the condition
is more compromised.
Do health-care providers have negative
attitudes about patients home-based
traditional practices?
QSEN Knowledge, Skills and Attitudes!
 Approachability
Do clients feel welcomed?
Do health-care providers and receptionists
greet patients in the manner in which they
prefer?
This includes greeting patients with their
preferred names.
 Additional Services
Are child and adult care services available if a
parent must bring children or an aging parent
with them?
Alternative Practices and Practitioners
Do biomedical providers incorporate clients
alternative/complementary practices into
treatment plans?
 Culture Check
In the United States, language has been the number
one barrier in health-care services. To ameliorate this
barrier, the health-care provider should use
a. A family member who knows English well.
b. A health-care provider who knows the patients
culture.
c. Certified translators
d. Certified interpreters
 Correct Answer
Correct answer: D
Certified interpreters are the best ones to use. A
translator works with the written language.
Family should be used as interpreters as a last
resort. A health-care provider might not be
certified.
 Culture Check
A 64 year-old female Hmong patient with diabetes
mellitus wants to use her local shamans advice for
treatment. The nurse should suggest:
a. Follow the physician's advice, not the shamans.
b. Get the shaman and physician to collaborate.
c. Encourage her try the physicians advice first.
d. Explain the problems that might ensue if she uses
the shamans advice.
 Correct Answer
Correct answer: B
Getting the physician and shaman to collaborate
is the best option. Discouraging the patient
from seeking the shamans help and advice,
might lead her to not disclose the shamans
recommendations, if sought.