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Cultural'Competency:'What'Does'it'Really'Mean?'

Nancy'A.'Moriber'PhD,'CRNA,'APRN'Program'Director,'Fairfield'University'&'Bridgeport'Hospital'Nurse'Anesthesia'

Program'

What'is'Cultural''Competency?'

Cultural'Competency:'The'Bottom'Line'

!  In'all'clinical'practice'areas'we'observe'diversity'every'day'

!  The'anesthesia'provider'is'treating'a'more'diverse'population'as'a'result'of'immigration,'demographic'changes'across'the'country'&'increased'patient'participation'in'insurance'programs'

!  Therefore,'interest'in'designing'culturally'&'linguistically'appropriate'services'leading'to'improved'health'care'outcomes,'efficiency'&'patient'satisfaction'has'become'paramount'

!  One’s'personal'cultural'background,'heritage'and'language'have'a'considerable'impact'on'how'patients'access'&'respond'to'health'care'services'&'how'providers'practice'within'the'system.'

!  Cultural'&'linguistic'competence'suggests'an'ability'of'health'care'providers'&'health'care'organizations'to'understand'and'respond'effectively'to'the'cultural'&'linguistic'needs'brought'to'the'health'care'experience.'

US'2010'Census'Data:'Changing'face'of'America'

2000# 2010#

Total#population# 281,421,906' 308,'745,538'

%'Total' %'Total'

Hispanic/Latino' 12.5' 16.3'

Not'Hispanic/Latino'' 87.5'(69.1'white)' 83.7'(63.7'white)'

Race#

White' 75.1' 72.4'

Black'or'African'American' 12.3' 12.6'

Asian' 3.6' 4.8'

Native'American/Pacific'Islander'

0.9/0.1' 0.9/0.2'

Other' 5.5' 6.2'

2'or'more'races' 2.4' 2.9'

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National'Standards'for'Culturally'&'Linguistically'Appropriate'Health'Care'Services'(CLAS)'

!  Developed'by'the'Office'of'Minority'Health'in'1997'&'published'in'2001'&'revised'in'2013'

!  Consist'of'15'standards'that'must'be'met'by'most'health'care'organizations'in'order'to'maintain'accreditation'(Joint'Commission,'Professional'Organizations)'

!  http://www.hdassoc.org/wpccontent/uploads/2013/03/CLAS_handoutcpdf_aprilc24.pdf'

CLAS STANDARDS

Understanding'the'Impact'of'Heritage'on'Health'Care'Decisions'

!  Heritage'Consistency'!  The'degree'to'which'one’s'lifestyle'reflects'his'or'her'traditional'

culture'

!  Reflects'an'individual’s'cultural,'ethnic'and'religious'background'&'the'degree'to'which'they'identify'with'traditional'heritage'!  Exists'along'a'continuum'from!traditionalism!to'acculturation!

!  The'more'the'individual'identifies,'the'greater'the'chance'that'the'person’s'health'&'illness'beliefs'&'practices'may'vary'from'mainstream'society'

Religion'

'''''''Ethnicity'

'

Culture'

Socialization

HERITAGE CONSISTENCY

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What'is'Ethnicity?'

!  Office'of'Minority'Health'(OMH,'2001)'definition:'!  “A'group'of'people'that'share'a'common'and'distinctive'racial,'

national,'religious,'linguistic'or'cultural'heritage'including'similar'geographic'origin,'race,'language,'literature,'food'preferences,'etc.”'

!  Selected'cultural'&'sometimes'physical'characteristics'used'to'classify'people'into'groups'or'categories'considered'to'be'significantly'different'from'others''

What'is'Religion?'

!  Office'of'Minority'Health'(OMH,'2001)'definition:'!  “A'set'of'beliefs,'values,,'and'practices'based'on'the'teachings'of'a'

spiritual'leader”'

!  Ethnicity'&'religion'are'clearly'related,'&'religion'frequently'determines'one’s'ethnic'group'

!  Religion'provides'a'frame'of'reference'&'perspective'with'which'to'organize'information.''

!  Religious'teachings'in'relation'to'health'present'a'meaningful'philosophy'&'system'of'practices'within'a'social'system'!  Adherence'to'these'practices'is'often'necessary'for'spiritual'

harmony'&'health'

Impact'of'Religion'on'Health'practices'

!  Influences'!  Vaccination'utilization'!  Coping'Strategies'!  Childcare'practices'!  Dietary'restrictions'!  Beliefs'regarding'abortion'!  Blood'Transfusion'!  Use'of'caffeine,'alcohol'and'tobacco'

What'is'Culture?'

!  No'single'definition'of'culture'

!  Classic'Definition:'“the'sum'total'of'socially'inherited'characteristics'of'a'human'group'that'comprises'everything'which'one'generation'can'tell,'convey,'or'hand'down'to'the'next”'!  The'noncphysically'inherited'traits'we'possess'

!  The'sum'of'beliefs,'practices,'habits,'likes,'dislikes,'norms,'customs,'rituals,'and'so'forth'learned'during'the'formative'years'of'socialization'

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Why'is'Culture'Important?'

!  All'facets'of'human'behavior'can'be'interpreted'through'the'lens'of'culture,'and'everything'can'be'related'to'&'from'this'context'!  Culture'is'the'medium'of'personhood'&'social'relationships'

!  Only'part'of'culture'is'conscious'

!  Culture'is'an'extension'of'one’s'biological'capabilities'!  Culture'is'a'devise'for'creating'and'limiting'human'choices'

!  Culture'can'be'in'2'places'at'once:'!  It'is'found'in'a'person’s'mind'&'exists'in'the'environment'in'which'

one'lives'

Cultural'Phenomena'Affecting'Health'

!  Time'Orientation:'Present,'Past'or'Future'

!  Personal'Space:'One’s'behaviors'and'attitudes'towards'the'space'around'one’s'self'!  Territoriality:'Behavior'and'attitudes'people'exhibit'about'an'area'they'have'

claimed'&'defend'

!  Methods'of'Communication:'Language,'verbal'and'nonverbal'behavior'

!  Social'Organizations'

!  Biological'Variations'

!  Environmental'Control:'The'ability'of'members'of'a'particular'cultural'group'to'plan'activities'that'control'nature'or'direct'environmental'factors'!  Western'versus'Eastern'Medical'Traditions'

'

Cultural'Competency'

!  What'is'Cultural'Competency?'!  �The'ability'of'the'individual'to'offer'better'care'within'differing'

value'systems'&'to'act'with'respect'&'understanding'without'imposition'of'our'own'attitudes'and'beliefs�'

!  It'is'an'ongoing'process'of'growth'and'development'of'knowledge'that'takes'a'considerable'amount'of'time'and'effort'!  Develops'along'a'continuum'from'Cultural'Awareness'to'

Cultural'Competence'

Papadapoulos, Tilki & Taylor Model for Development of Transcultural Competence (1998)

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Cultural'Proficiency'

!  Cultural'Proficiency;'Highest'level'!  Involves'employing'health'service'professionals'and'staff'that'

possess'the'cultural'expertise'to'provide'culturally'appropriate'care,'as'well'as'providing'training'for'those'within'the'organization'

Why'do'we'need'Cultural'Competence?'

!  The'perceptions'of'illness,'disease,'&'their'causes'vary'by'culture'

!  Diverse'belief'systems'exist'related'to'health,'healing'&'wellness'

!  Culture!influences!help3seeking!behaviors!&!attitudes!toward!health!care!providers!

!  Individual'preferences'affect'traditional'&'nontraditional'approaches'to'health'care'

!  Patients'must'overcome'personal'experiences'within'health'care'systems'

!  Health!care!providers!from!culturally!&!linguistically!diverse!groups!are!underrepresented!in!the!current!service!delivery!system!

Ways'of'Developing'Cultural'Competence'

!  Recognize'that'cultural'diversity'exists'

!  Recognize'your'own'biases;'Develop'Cultural'Humility'!  Address'your'own'Ethnocentricity!

!  Respect'people'as'unique'individuals'

!  Respect'the'unfamiliar'

!  Identify,'examine'&'discipline'your'own'attitudes,'biases'&'beliefs'

!  Recognize'differences'in'the'definition'of'health'&'illness'among'cultural'groups'

!  Be'willing'to'modify'health'care'delivery'in'keeping'with'patient�s'cultural'background'

!  Appreciate'that'cultural'values'are'ingrained'&'very'difficult'to'change'

Cultural'Perspectives:'Difference'between'Disease'&'Illness'

!  World'Health'Organization'(WHO)'defines!health!as'“a'state'of'complete'physical,'mental,'&'social'wellcbeing'and'not'merely'the'absence'of'disease”'!  For'the'individual'health'is'defined'differently'depending'upon'

one’s'culture'!  Impacts'has'one'interacts'with'the'health'care'delivery'system'&'

what'choices'regarding'care'will'be'made'!  �Disease�'is'a'pathophysiologic'process'

!  Cancer'!  �Illness�'is'defined'by'the'patient�s'belief'system'&'is'part'of'

enculturation'!  How'one'deals'with,'reacts'to,'and'lives'with'the'disease'

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So,'How'do'we'provide'culturally'competent'care?'

Cultural'Assessment'

!  Perform'a'“Cultural!Assessment”!

!  Focus'on'the'individual'!  DO'Not'stereotype'because'of'ethnicity'or'religious'background'

!  Examine'the'individual’s:'!  Health'beliefs'&'Practices'!  Religious'Influences'&'Special'Rituals'!  Language'&'Communication'!  Parenting'Styles'&'Role'in'family'!  Sources'of'support'beyond'the'family'!  Dietary'Practices'

!  Negotiate'the'plan'of'care'taking'into'account'cultural'preferences'!  “Buycin”'is'Essential'

Addressing'Language'&'Communication'Issues'

!  Miscommunication'in'health'care'is'common.''Multiple'Causes:'!  NoncEnglish'Speaking'Patients'

!  Differences'in'meaning,'connotation'within'the'same'language'!  Utilization'of'Idioms'

!  Differences'in'Communication'style'!  Formal'versus'Informal'Language'

!  Directive'versus'Nondirective'approaches'

!  Does'the'patient’s'culture'allow'for'equal'partnership'in'decision'making?'

!  How'is'the'ability'to'question'medical'professionals'viewed?'

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Communication'Requirements'

!  While'the'majority'of'the'CLAS!standards!are'recommendations,'the'4'standards'focusing'on'language'services'are'MANDATES'by'the'federal'government'for'organizations'receiving'federal'funds:'!  Offer'Communication'&'Language'Assistance:'

INTERPRETATION#&#TRANSLATION#SERVICES#!  Inform'individuals'of'the'availability'of'language'assistance'!  Ensure'the'competency'of'individuals'providing'language'

assistance'!  Provide'easily'understandable'materials'&'signage'in'the'

languages'commonly'used'by'the'populations'in'the'service'area'

Utilization'Translators'

!  First'instinct'is'to'use'family'members'or'find'a'staff'member'who'speaks'the'language'

!  However,'not'appropriate'd/t'confidentiality''concerns'&'problems'with'interpretation'd/t'differences'in'dialect'

!  CLAS'standards'require'the'facility'to'have'trained'interpreters'for'the'predominant'languages'spoken'by'patients'and'a'language'line'to'accommodate'all'other'languages'to'ensure'the'patient'experiences'optimal'communication'!  Martti,'Language'Access'Network'

'World’s'Apart:'Mohammad'Kochi’s'Story'

!  Issues'Highlighted'!  Effects'of'immigration'&'acculturation'on'family'dynamics/

beliefs:'Heritage!Consistency!

!  Language'Barriers'&'Communication'

!  Religious'Beliefs,'spirituality'&'the'impact'on'Healthccare'decisions'!  Importance'of'Negotiation'

!  Family'DecisioncMaking'&'Withholding'of'Information'

!  The'Impact'of'the'“Culture'of'Medicine”'

References'

Galanti,'G.'(2008).'Caring'for'patients'from'different'cultures'(4th'Ed.).'Philadelphia:'University'of''Pennsylvania'Press.''

National'Standards'for'Culturally'and'Linguistically'Appropriate'Services'in'Health'Care.'(2001,''March'1).'Retrieved'March'10,'2015,'from'http://www.minorityhealth.hhs.gov/'

Papadopoulos,'I,'Tilki,'M.,'&'Taylor,'G.'(1998).'Transcultural'care:'A'guide'for'health'care''professionals.'Dinton,'Wilts:'Quay'Publications.'

Rose,'P.'R.'(2013).'Cultural'Competency'for'the'health'professional.'Burlington,'MA:'Jones'&''Bartlett.'

Spector,'R.'E.'(2013).'Cultural'diversity'in'health'and'illness'(8th'Ed.).Upper'Saddle'River,'NJ:''Pearson'Publications.'

The'National'CLAS'Standards.'(2013,'April'1).'Retrieved'March'10,'2015,'from'http://'www.hdassoc.org/wpccontent/uploads/2013/03/CLAS_handoutcpdf_aprilc24.pdf'

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QUESTIONS?