multicultural opportunities for success in hospital services

Multicultural Opportunities for Success in

Hospital Services

FirstName LastNameTitleOrganization

Questions to Run on:

• Can cultural identity influence your work in Hospital

Services?

• How comfortable are you with your knowledge of

cultures and religions and how does that impact your

interactions and instructions in the hospitals?

Spring2011 OPO-MCT_HAguiar 2

OPO-MCT_HAguiar 3

Cultural Assumption

Spring2011

OPO-MCT_HAguiar 4

New Perspective

Spring2011

Objectives

By the end of this presentation the learner

will be able to:

1. Recognize the need for Hospital Services staff to

develop multicultural skills.

2. Be more culturally aware and skilled in working

with others of different cultures.


Overview

• Laying Foundations

─ Operational definitions of culture, race and ethnicity

• Implications for Hospital Services

─ working with multicultural health care professionals

─ health care professionals’ multicultural needs

• Basic Principles

─ Practical tips in working with different cultures


Laying Foundations

Operational Definitions of

Culture, Ethnicity, and Race and

the Differences Between These Terms


Laying Foundations

• Culture is requires a broad definition and should

include:

─ Ethnographic variables

─ Demographic variables

─ Status variables

─ Affiliation variables


Laying Foundations – Defining Culture

“Culture is defined as a specific

set of social, shared,

educational, religious, and

professional behaviors,

practices and values that

individuals learn and ascribe to

while participating in or outside

of groups with whom they

typically interact.” (Bomar, 2004)


Laying Foundations – Defining Ethnicity

“Ethnicity is a key facet of culture and refers to a

common ancestry, a sense of ‘peoplehood’ and group

identity. From a common ancestry and a shared social

and cultural history and national origin have evolved

shared values and customs.”

(Friedman et al., 2003)


Laying Foundations – Defining Race

“an ancient, nonscientific, political classification of

human beings and is based on physiological

characteristics, such as skin color, eye shape, and

texture of hair.” (Bomar, 2004)

• It is a narrower term then ethnicity and denotes a

human biological definition


Laying Foundations

Important Clarifications:

─ Race and ethnicity should NOT be confused

─ People of one race can vary in terms of their ethnicity and

culture

─ Race is NOT considered a correct or useful means of

classifying people


Laying Foundations

Important Clarifications:

─ There are no distinct, pure

races today

─ Religion is very much

entwined with ethnicity,

shaper of health values,

beliefs, and practices


OPO-MCT_HAguiar 14

Thought Question

Knowing that people of one race can vary in terms

of their ethnicity and culture, can we truly make

assumptions about someone based on their

biological looks or even based on the little we may

know of their

“culture” or “ethnicity”?Spring2011

OPO-MCT_HAguiar 15

Who / What Do You See?

Spring2011

Implications for Hospital Services

Working with Multicultural

Health Care Professionals

&

Health Care Professionals’

Multicultural Needs



Working with Multicultural Health Care Professionals

• Communication and education – medical approach




HCP Mind

Life Experienc

e

Education

DonationEducation



• Communication and education

– medical approach


– multicultural approach




HCP Mind

Culture

Religion

Life Experienc

e

EducationDonation

Education




– medical approach


– multicultural approach

• Education in groups

• Education one-oneSpring2011 OPO-MCT_HAguiar 21


• Applying a multicultural framework to group

presentations

• Hofstede’s Five-Dimensional Model

• Created to improve and provide cross-cultural

communication for IBM

• Investigation that led to this framework was

conducted across 50-countries



• Hofstede’s Five-Dimensional Framework

• Power Distance Index (PDI)

• Individualism (IDV)

• Masculinity (MAS)

• Uncertainty Avoidance Index (UAI)

• Long-Term Orientation (LTO)



Power Distance Index (PDI)• Assesses extent less powerful members of

society accept unequally distributed power• Cultures with high PDI

• Exhibit high dependency needs, inequality accepted, hierarchy is needed, superiors are inaccessible, powerholders have privileges, change is normally by revolution

• Cultures with low PDI• Tendency to low dependency needs, inequality

minimized, hierarchies exist for convenience, superiors accessible, all have equal rights, change occurs by evolution


PDI0

10

20

30

40

50

60

USWorld


Individualism (IDV)• People look after themselves and their families

vs. those with a tradition of collectivism, emphasize life and well-being of the extended family

• Cultures with high IDV• People are focused on “I” and have private

opinions, feel guilty when there is a loss of self-respect, fulfill obligations to self

• Cultures with low IDV• People focused on “we”, prioritize relationships

over tasks, feel shame when creating loss of face for the collective, fulfill obligations to the group


IDV0

10

20

30

40

50

60

70

80

90

100

USWorld

Implications for Hospital ServicesMasculinity (MAS)

• Degree to which values like assertiveness, success, competition and performance (male characteristics) prevail vs. values like quality of life, service, care for the weak and solidarity, maintaining relationships (female characteristics)

• Cultures with high MAS• Focus on equity, performance and competition

– managers are expected to be assertive and decisive

• Cultures with low MAS• Focus on equality, quality of work life and

solidarity – managers strive for consensus and use intuition

Spring2011OPO-MCT_HAguiar

26

MAS0

10

20

30

40

50

60

70

USWorld


Uncertainty Avoidance Index (UAI)• Degree to which people in a country prefer

and are comfortable in structured over unstructured situations. Cultures avoiding uncertainty, minimize such possibilities by strict laws and rules, security and safety measure

• Cultures with high UAI• Are resistant to change, have many rules and

low tolerance of deviant ideas• Cultures with low UAI

• Prefer innovative ideas, there are few rules


UAI0

10

20

30

40

50

60

70

USWorld


Long-Term Orientation (LTO)• Differentiates between Western and Eastern

thinking and explores long-term vs. short-term orientation

• Cultures with high LTO• Mentality includes frugality, persistence,

relationships are ordered by status, a concern for a sense of shame

• Cultures with low LTO• Mentality includes protecting your ‘face’,

respecting tradition, personal stability and steadiness, and reciprocation of favors, greetings, and gifts


LTO0

10

20

30

40

50

60

USWorld


• Weakness of Hofstede’s framework

• Generalization vs. Stereotyping

• Applying Hofstede’s framework to group

presentation on donation versus one-on-one

education



• Applying a multicultural model in one-one education

• Arthur Kleinman’s Explanatory model

• Unbiased approach to an individual

• Gain the emic perspective versus our etic perspective



Anthropological terminology:

• Emic perspective –

insider’s perspective

• Etic perspective –

outsider’s perspective

• Both perspectives –

most effective vantage point



Explanatory Model – 8 Questions by Arthur Kleinman:

• What do you call your illness? What name does it have?

• What do you think has caused the illness?

• Why and when did it start?

• What do you think the illness does? How does it work?


OPO-MCT_HAguiar 35


Explanatory Model – 8 Questions (cont.)

• How severe is it? How long do you think you will have it?

• What kind of treatment do you think the patient should

receive? What are the most important results you hope

he/she receives from this treatment?

• What are the chief problems the illness has caused?

• What do you fear most about the illness?

Spring2011


Simple triggers - the 4 Cs:

1. Call

2. Cause

3. Cope

4. Concerns



• Applying Kleinman’s questions to healthcare

professionals:• Have you had any experience, personal or professional with

this type of an injury/illness?

• In your opinion, how should this injury/illness be treated?

• What do you think is the likely outcome for the patient?

• At what point do you believe death occurs? What about in

brain death?

• What is valuable to you in death? Spring2011 OPO-MCT_HAguiar 37


Working with Multicultural

Health Care Professionals

&

Health Care Professionals’

Multicultural Needs



• Health Care Professionals’ Multicultural Needs• The Joint Commission requirement

• Data reported to The Joint Commission demonstrates most root cause of sentinel events is due to communication:

• Many standards relate to importance of understanding, acknowledging and respecting the patient’s culture

• U.S. Department of Health & Human Services – The Office of Minority Health standards• 14 CLAS standards set for health care organizations with the

following themes: Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational Supports for Cultural Competence (Standards 8-14)


OPO-MCT_HAguiar 40


Leininger says that nurses

are realizing the critical

need to become more

culturally competent and

knowledgeable in working

with individuals

of diverse cultures. (Leininger, 1994)

Spring2011


The Joint Commission definition of cultural

competence:

• the ability of health care providers and organizations to

understand and respond effectively to the cultural and

language needs brought by the patient to the health care

encounter



The Joint Commission definition of cultural competence (cont.):• Cultural competence requires organizations and their

personnel to: 1. value diversity;2. assess themselves; 3. manage the dynamics of difference;4. acquire and institutionalize cultural knowledge; and5. adapt to diversity and the cultural contexts of individuals

and communities served• culturally and linguistically appropriate



“Cultural competence

is a journey,

not a destination.”(Galanti, 2008)



Attitudes in Multicultural Donation:• Preconceived ideas about cultures

• African American• Filipino• Hispanic• Asian

• Religious background• Jewish• Jehovah Witness• Hindu

• Bias vs.. reality



Culture Assessed by Observation:

• Dress

• Appearance

• Speech

• Education



Risk of Cultural Imposition

“The nurse must examine his/her biases and prejudices

toward other cultures as well as explore his/her own cultural

background….Without becoming aware of the influence of

one’s own cultural values, a risk exist for the nurse to engage

in cultural imposition”. (Campinha-Bacote et al 1996)



“Unspoken assumptions regarding meaning of health,

illness, and death may affect communication regarding

donation.”

Dr. Hawryluck & Knickle (n.d.)



• Culture & communication

connected

• Communication – driven

by culture

• Connection forgotten = risk

for misunderstanding



• Communication varies: • overt & direct vs. covert & indirect

• Overt & direct challenged by covert & indirect

• Covert & indirect find overt & direct aggressive

• Use indirect communication to identify and uncover

perceptions of disease causation and best treatment


• Effective communication is your responsibility

• Anxiety

• Stereotypes and prejudice

• Language problems

• 6 barriers to communication:

• Nonverbals

• Ethnocentrism

• Assuming similarities vs.

differences




• Good intercultural communicators:• Personality strength

• Communication skills

• Psychological adjustment

• Cultural awareness

• Eight different skills:• Self-awareness, self-respect, interaction, empathy,

adaptability, certainty, initiative, and acceptance



Cultural considerations

• Identify the Decision Maker

• Give the family what they need and want

• Do not project your own personal feelings

• Assess their readiness – let the family guide the

conversation


OPO-MCT_HAguiar 53


• Understand your motives

• Concerns for the family

• Concerns for the recipient

• Turning a negative

situation around to be

positiveSpring2011


Professional Empowerment• Hospital Services staff should help nurses to

understand how to: • Developed their own interpersonal skills• Utilize their strengths• Focus on the family

• Time • Taking care of their needs• Pick-up on cues from the family• Sensibility, sensitivity and adaptation



• Multicultural toolkit for HS staff• Abbreviated Kleinman cheat-sheet as a handout for hospital

staff as a reference tool

• Mini-inservice – one pager

• Multicultural PPT presentation

• Example of a Nursing Orientation presentation that applies

Hofstede’s framework


Basic Principles

Practical Tips in Working with

Different Cultures


Basic Principles

Reflections – know & understand yourself:

• What is your culture? Your beliefs?

• Have your culture and beliefs been influenced by your

family? Has it evolved?

• If you have changed your perspectives, what led you to

change your perspectives?


Reflect. Know yourself.

Basic Principles

Leverage real-time education opportunities

• Opportunity for in-the-moment education

• Raises questions and concerns

• Brings to light perceptions

• Moments for intimate conversations


Win them one-by-one.

Basic Principles

Cultural-Communication Tips

• Learn and use a few phrases of greeting and

introduction in the patient’s native language –

conveys:• Respect

• Demonstrates your willingness to learn about their culture


Beware of hand gestures, some examples:


Basic Principles

Basic Principles

• Do not assume you know the culture

• Seek to understand –

Don’t be afraid to ASK!

• Become a student of the person / the family

• Identify what provides value in death to that

individual


Remember - your culture is not superior.

Questions to Run on:

• Can cultural identity influence your work in Hospital

Services?

• How comfortable are you with your knowledge of

cultures and religions and how does that impact your

interactions and instructions in the hospitals?


Questions ?

Thank you for your attention!

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