Download - Cultural Diversity
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Cultural Diversity and Health Cultural Diversity and Health CareCare
This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited.
Cultural DiversityCultural Diversity
We all have it!We all have it! Obvious manifestations include:Obvious manifestations include:
religionreligion ethnicity (race)ethnicity (race) national origin (language)national origin (language) gendergender
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Cultural DiversityCultural Diversity
Less obvious manifestations include:Less obvious manifestations include: ageage educationeducation socioeconomic classsocioeconomic class mobility (including handicaps)mobility (including handicaps)
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What is Culture?What is Culture?
Culture is the sum total of the way of Culture is the sum total of the way of
living; includes values, beliefs, living; includes values, beliefs, standards, standards,
language, thinking patterns, language, thinking patterns, behavioral behavioral
norms, communications styles, etc. norms, communications styles, etc.
Culture guides decisions and Culture guides decisions and
actions of a group through time.actions of a group through time.
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Expressions of Culture in Expressions of Culture in Health CareHealth Care
Health Belief SystemsHealth Belief Systems define and categorize health and define and categorize health and
illnessillness offer explanatory models for illnessoffer explanatory models for illness are based upon theories of the are based upon theories of the
relationship between cause and the relationship between cause and the nature of illness and treatmentsnature of illness and treatments
define the specific “scope” of practice define the specific “scope” of practice for healersfor healers
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The Culture of Western The Culture of Western MedicineMedicine
Common Practices in Western MedicineCommon Practices in Western Medicine Meliorism – make it betterMeliorism – make it better Dominance over nature – take controlDominance over nature – take control Activism – do somethingActivism – do something Timeliness – sooner than laterTimeliness – sooner than later Therapeutic aggressiveness – Therapeutic aggressiveness –
stronger=betterstronger=better Future orientation – plan, newer=betterFuture orientation – plan, newer=better Standardization – treat similar the sameStandardization – treat similar the same
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Comparing Our Beliefs to Comparing Our Beliefs to OthersOthers
““Western”Western” Make it betterMake it better Control over natureControl over nature Do somethingDo something Intervene nowIntervene now Strong measuresStrong measures Plan ahead – recent Plan ahead – recent
is bestis best Standardize – treat Standardize – treat
everyone the sameeveryone the same
““Others”Others” Accept with graceAccept with grace Balance/Harmony Balance/Harmony
with naturewith nature Wait and seeWait and see Cautious deliberationCautious deliberation Gentle approachGentle approach Take life as it comes Take life as it comes
– “time honored”– “time honored” Individualize – Individualize –
recognize differencesrecognize differences
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Cultural CompetenceCultural Competence
Cultural competence is defined as a set Cultural competence is defined as a set
of congruent of congruent behaviors, practices, behaviors, practices,
attitudes and policiesattitudes and policies that come together that come together in a in a
system or agency or among professionals, system or agency or among professionals,
enabling effective work to be enabling effective work to be
done in cross-cultural situations.done in cross-cultural situations.
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The Cultural Competence The Cultural Competence ContinuumContinuum
Requires Self ReflectionRequires Self Reflection Where am I now?Where am I now? Where could I be?Where could I be?
The Cultural Competence The Cultural Competence ContinuumContinuum
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Cultural Competence Cultural Competence DefinitionsDefinitions
Cultural DestructivenessCultural Destructiveness:: forced forced assimilation, subjugation, rights and assimilation, subjugation, rights and privileges for dominant groups onlyprivileges for dominant groups only
Cultural IncapacityCultural Incapacity:: racism, maintain racism, maintain stereotypes, unfair hiring practicesstereotypes, unfair hiring practices
Cultural BlindnessCultural Blindness:: differences differences ignored, “treat everyone the same”, ignored, “treat everyone the same”, only meet needs of dominant groupsonly meet needs of dominant groups
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Cultural Competence Cultural Competence DefinitionsDefinitions
Cultural Pre-competenceCultural Pre-competence: : explore cultural explore cultural issues, are committed, assess needs of issues, are committed, assess needs of organization and individualsorganization and individuals
Cultural CompetenceCultural Competence:: recognize individual recognize individual and cultural differences, seek advice from and cultural differences, seek advice from diverse groups, hire culturally unbiased diverse groups, hire culturally unbiased staffstaff
Cultural ProficiencyCultural Proficiency:: implement changes implement changes to improve services based upon cultural to improve services based upon cultural needs, do research and teachneeds, do research and teach
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Acquiring Cultural Acquiring Cultural CompetenceCompetence
Begins with awarenessBegins with awareness Grows with knowledgeGrows with knowledge Enhanced with specific skillsEnhanced with specific skills Polished through cross-cultural Polished through cross-cultural
encountersencounters
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The Explanatory Model The Explanatory Model Arthur Kleinman, Ph.D.Arthur Kleinman, Ph.D.
Use a culturally sensitive approach toUse a culturally sensitive approach toinquiring about a health problem. inquiring about a health problem. Ask your patient:Ask your patient:
What do you call your problem?What do you call your problem? What do you think caused your problem?What do you think caused your problem? Why do you think it started when it did?Why do you think it started when it did? What does your sickness do to you? How What does your sickness do to you? How
does it work?does it work? How severe is it? How long do you think How severe is it? How long do you think
you will have it?you will have it?
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Ask Your PatientAsk Your Patient
What do you fear most about your illness?What do you fear most about your illness? What are the chief problems your sickness has What are the chief problems your sickness has
caused you?caused you? Do you know anyone else with the same problem?Do you know anyone else with the same problem? What have you done so far to treat your illness?What have you done so far to treat your illness? What treatments do you think you should receive?What treatments do you think you should receive? What important results do you hope to receive from What important results do you hope to receive from
the treatment?the treatment? Who else can help you?Who else can help you?
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The The LEARNLEARN Model ModelBerlin and FowkesBerlin and Fowkes
LListenisten to the patient’s perception of to the patient’s perception of the problem.the problem.
EExplainxplain your perception of the your perception of the problem.problem.
AAcknowledge cknowledge and discuss and discuss differences/similarities.differences/similarities.
RRecommendecommend treatment. treatment. NNegotiateegotiate treatment. treatment.
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InterpretersInterpreters
Qualifications:Qualifications: Bilingual, bicultural, Bilingual, bicultural, Understands English Understands English
medical vocabularymedical vocabulary Comfort in the medical Comfort in the medical
setting, understands setting, understands significance of the health significance of the health problemproblem
Preserves confidentialityPreserves confidentiality
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Multiple Roles of Multiple Roles of InterpretersInterpreters
Interpreters have multiple roles Interpreters have multiple roles including:including: translator of languagetranslator of language culture brokerculture broker patient advocate: convey patient advocate: convey
expectations, concernsexpectations, concerns
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Working with InterpretersWorking with Interpreters
Use language to identify the interpreterUse language to identify the interpreter
as the go-between, not as the person to as the go-between, not as the person to
be blamed, e.g., the interpreter might be blamed, e.g., the interpreter might
say, “The doctor has ordered tests and say, “The doctor has ordered tests and
this is what he says.”this is what he says.”
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Working with LanguageWorking with LanguageTranslation ConsiderationsTranslation Considerations
Language: consider meaningful description Language: consider meaningful description Navajo: Explain Penicillin as “the strong white Navajo: Explain Penicillin as “the strong white
medicine shot you get for a cold”medicine shot you get for a cold” Minimize jargon, e.g., “machine to look at Minimize jargon, e.g., “machine to look at
your heart” instead of “EKG”your heart” instead of “EKG” Nonverbal communication comprises 60% of Nonverbal communication comprises 60% of
all communicationall communication Nodding may indicate politeness, not Nodding may indicate politeness, not
comprehensioncomprehension Bilingual interviewing takes at least twice as Bilingual interviewing takes at least twice as
long as monolingual interviews!long as monolingual interviews!
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Responsibilities of Health Responsibilities of Health Care ProvidersCare Providers
Learn and use a few phrases of greeting Learn and use a few phrases of greeting and introduction in the patient’s native and introduction in the patient’s native language. This conveys respect and language. This conveys respect and demonstrates your willingness to learn demonstrates your willingness to learn about his/her culture.about his/her culture.
Tell the patient that the interpreter will Tell the patient that the interpreter will translate everything that is said, so they translate everything that is said, so they must stop after every few sentences.must stop after every few sentences.
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Responsibility of Health Responsibility of Health Care ProvidersCare Providers
When speaking or listening, watch the When speaking or listening, watch the patient, not the interpreter. Add your patient, not the interpreter. Add your gestures, etc. while the interpreter is gestures, etc. while the interpreter is translating your message.translating your message.
Reinforce verbal interaction with visual Reinforce verbal interaction with visual aids and materials written in the client’s aids and materials written in the client’s language.language.
Repeat important information more Repeat important information more than once.than once.
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Your ResponsibilitiesYour Responsibilities
Always give the reason or purpose for a Always give the reason or purpose for a treatment or prescription.treatment or prescription.
Make sure the patient understands by Make sure the patient understands by having them explain it themselves.having them explain it themselves.
Ask the interpreter to repeat exactly Ask the interpreter to repeat exactly what was said.what was said.
Personal information may be closely Personal information may be closely guarded and difficult to obtain.guarded and difficult to obtain.
Patient may request or may bring a Patient may request or may bring a specific interpreter to the clinic.specific interpreter to the clinic.
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ConsiderationsConsiderations
In some cultures it may not be In some cultures it may not be appropriate to suggest making a will for appropriate to suggest making a will for dying patients or patients with terminal dying patients or patients with terminal illnesses; this is the cultural equivalent illnesses; this is the cultural equivalent of wishing death on a patient.of wishing death on a patient.
Avoid saying “you must”, instead teach Avoid saying “you must”, instead teach patients their options and let them patients their options and let them decide, e.g., “some people in this decide, e.g., “some people in this situation would...”situation would...”
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Additional InformationAdditional Information
JCAHO requires education for all health care JCAHO requires education for all health care providers regarding cultural diversity. providers regarding cultural diversity.
Visit these sites for more information:Visit these sites for more information:
www.ggalanti.com/articles.htmlwww.ggalanti.com/articles.htmlwww.ggalanti.com/concepts.htmlwww.ggalanti.com/concepts.htmlwww.ggalanti.com/cultural_profiles.htmlwww.ggalanti.com/cultural_profiles.htmlwww.nursingworld.org/ojin/topic20/tpc20_2.htmwww.nursingworld.org/ojin/topic20/tpc20_2.htmwww.diversityrx.org/www.diversityrx.org/www.health.qld.gov.au/multicultural/cultdiv/www.health.qld.gov.au/multicultural/cultdiv/default.aspdefault.asp
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Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different that each of us is It is because we are different that each of us is special.special.