Building on Cultural Competency in Home Care - Building on... · 2017-06-16 · Client and Family...

Building on Cultural Competency

in Home Care

Dementia Care 2014

Alzheimer Society Of Manitoba

March 10 & 11, 2014

Canad Inns – Polo Park

Winnipeg, Manitoba

Presenter: Antoinette Zloty MSW BSW

Disclaimer

This presentation is based solely upon the

presenter’s analyses and does not in any

way represent the views or policies of the

Department of Health of the Province of

Manitoba.

Purpose of Presentation

Highlight the importance of:

Client and family centered cultural care

Community engagement

A Cultural Safety Learning Plan Policy

Client and Family Centered Cultural

Care

Facilitates better care plans – avoids a cookie cutter approach, addresses barriers.

Addresses the complexity of a care situation by examining possible cultural resources which may be available to the individual.

Mobilizes community based, non-governmental cultural resources to help individuals remain in the community longer.

Community Engagement

Manitoba’s Multiculturalism legislation and policies

support community groups which foster cross-cultural

understanding.

Organizations engage people from different racial and

ethnic groups for their input.

Approaches to disease prevention, diagnosis and

treatment differ across cultures.

Approaches in health care can be tailored to cultural

needs.

Health Care System

• Communities

• Cultural and other orgs

• Families

• Friends

•Government and other orgs

•Management

•Administration

• Individual

• Client

• Patient Social, Cultural, Physical histories,

Varied Abilities

Human Resources-Policies,

Procedures and Practices

Linguistic, Ethnic, Racial,

Religious Supports

Linguistic, Ethnic, Racial ,

Religious Supports

Dimensions of Health Impacted by

Culture

Health Information

Prevention & Promotion

Disease Treatment

Learning

Learning is the acquisition of new knowledge and

ideas that change the way an individual perceives,

understands or acts. ( Treasury Board of Canada Secretariat-Policy

on Learning, Training, and Development)

Cultural Competence

Cultural competence is defined as a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations.

(Cross T., Bazron, B., Dennis, K., & Isaacs, M. (1989). “Towards a culturally competent system of care, volume I” . Washington, D.C.: Georgetown University Child Development Center, CASSP Technical Assistance Center )

Cultural Competency Cross et al

Cultural competency

Values diversity

Self

Assessment

Culturally adapted Service

delivery

Cultural

knowledge

Cultural Safety

Cultural safety is “a concept that not only considers

cultural sensitivity and awareness but also the power

imbalances that may exist within the health care

provider-patient interaction, institutional racism and the

effects of colonization as they pertain to health

care.”(CancerCare Manitoba, Navigating Cancer Services, 2007-2008 Progress

Report)

Cultural Safety

Regardless of how culturally sensitive, attuned or informed we think we are as service providers, the concept of cultural safety raises the following question for consideration:

How safe did the service recipient experience a service encounter in terms of being respected and assisted in having their cultural location, values, and preferences taken into account in the service encounter? Ball, J. (2007a). “Creating Cultural Safety in Speech-language and Audiology Services” Whistler, BC, October 25, 2007.

History and Example

Cultural safety was first introduced by Irihapeti Ramsden, a Maori nurse in Aotearoa (New Zealand), in 1990.

The following is an example of an aboriginal safety initiative to train all front line health care professionals in the area of Aboriginal cultural safety.

Aboriginal Safety Initiative

1. Learners will gain a better understanding of the historical,

political and cultural issues that impact the health of Aboriginal

peoples in Canada.

2. Learners will understand the connection between the historical

and current government practices and policies towards First Nations,

Inuit and Métis peoples and the related impacts on their social

determinants of health, access to health services and

intergenerational health outcomes.

Aboriginal Safety Initiative

3. Learners will understand Aboriginal concepts of health and

healing.

4. Learners will, through a process of self-reflection, identify,

acknowledge and analyze their own cultural values or

considered emotional responses to the many diverse histories,

cultures, world views, values, and contemporary events relating to

First Nations, Inuit and/or Métis people.

(Source:http:www.aht.ca/aboriginal-culture-safety)

Cultural Safety Learning Plan Policy

Development

1. Think about the principles of cultural safety and learning and the rational for such a policy.

2. Consider how language is used.

3. Devise a policy statement based on the principles of

cultural safety and learning.

4. Make cultural safety relevant to the overall goals, priorities and direction of the organization.

Development implementation and review processes are adapted from: “Writing an Inclusion

Policy” Healthy Child Manitoba http://www.gov.mb.ca/fs/childcare/pubs/writing_inclusion_policy_aug_2009_en.pdf

Policy Implementation

1. Ensure your other policies, procedures and practices

are congruent with your Cultural Safety Learning Plan

policy.

2. Have your policy approved by your board of directors

or executive committee.

3. Review and update the policy and other policies,

procedures and practices regularly.

Sample Policy on Cultural Safety

The following represents an effort by the

presenter to combine cultural safety and learning

plans to form a workable approach within home

care.

Purpose of a Policy on Cultural Safety

Improve the delivery of health care.

Address the causes of diseases early on for more

effective early intervention, including prevention.

Engage individuals and communities in the reduction

of disparities by eliminating barriers to their

involvement and creating opportunities for their

inclusion.

Policy Statement Example

Organization X is committed to encouraging all of

its employees , clients and families to learn

about cultural safety, in an environment that

values both informal and formal learning. Adapted from Manitoba Civil Service Learning Policy:

http://www.gov.mb.ca/csc/pdf/learnpol.pdf

Benefits of Cultural Safety

Learning Plans

1.All staff are active participants in developing

their own learning plans.

2.The client, family and community are engaged

in being part of the exchange of cultural

knowledge for better health outcomes.

Benefits

3.Staff become more aware of the cultural needs of

people under their care and vice versa.

4.Information is identified regarding culture, customs,

traditions, history, challenges, issues and strengths of

people who are recipients and providers of care.

Benefits

5.Personal and professional goal achievement.

6.Organizational goal achievement.

7. Actual behaviours and attitudes which can be barriers

to improved interactions are identified.

Cultural Safety Learning Plan

A cultural care map that helps the

employee recognize:

What they already know

Their attitudes and behaviours

The impact of their attitudes and

behaviours

What they need to know

Plan of how they will get there

Policy Evaluation Cycle

Stakeholders

consultation

Draft Policy

Seek

Approval

Implement Policy

Review outcomes

Revise if necessary

Case Example

Rebecca, a woman of 86, moved into the home of her daughter, Andrea, age 55. Andrea recently retired and lived alone previously.

For several years, Andrea prepared Caribbean dishes for her mother and made sure that her other activities of daily living were attended to. Rebecca’s past experiences with people of other races had been unsatisfactory. She grew to distrust people due to a history of racist remarks and behaviours. She made no friends within the Caribbean community due in part to insensitive comments about her weight by some individuals within that community.

Case Example

Within a month of her mother’s move to Andrea’s home, Andrea was hospitalized and diagnosed with a serious illness.

Rebecca had been previously diagnosed with dementia and diabetes. She refused to eat any other type of food than Caribbean. She likes to listen to Caribbean music, but refuses to attend Caribbean social events with her daughter. She is often uncooperative with personal care assistance and lacks trust.

Case Example

Andrea’s daughter, Liz, who lives in another province, requests a Caribbean heritage care worker to assist in food preparation and personal care. However, there are none available through the organization responsible for home care in the region.

What is the best approach? Should a person of the same background be recruited and assigned? Should this request be given priority? Why? How could a Cultural Safety Learning Plan be applied?

Conclusions

An individual may have a physical or cognitive

disability, a behavioural or emotional issue, and also

need cultural or other accommodations or supports

in order to fully benefit from any care program.

Home Care service providers should engage people

from diverse communities for their input, in order to

increase the likelihood of better health outcomes.

Questions

Is there support in your region to match staff with clients of similar cultural heritage? What other considerations might there be?

Do you think that you are recruiting enough people from a variety of cultures and/or training staff to provide culturally safe care?

Do you establish staff learning plans? Is cultural safety considered?

References

Brascoupé, Simon and Catherine Waters “Cultural Safety Exploring the Applicability of the Concept of Cultural Safety to Aboriginal Health and Community Wellness” http://www.naho.ca/jah/english/jah05_02/V5_I2_Cultural_01.pdf

Ball, J. (2007a). Creating Cultural Safety in Speech-language and Audiology Services. PowerPoint Presentation: Presented at the Annual Conference of the BC Association of Speech-Language Pathologists and Audiologists, Whistler, BC, October 25, 2007.

Cross, T., Bazron, B., Dennis, K., & Isaacs, M., (1989). Towards A Culturally Competent System of Care, Volume I. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center. http://www.nasponline.org/resources/culturalcompetence/definingcultcomp.aspx

References

http:www.aht.ca/aboriginal-culture-safety

http://www.cancercare.mb.ca/resource/File/CCMB_Progress_Report_

07-08.pdf

http://www.gov.mb.ca/csc/pdf/learnpol.pdf

http://www.gov.mb.ca/fs/childcare/pubs/writing_inclusion_policy_a

ug_2009_en.pdf

http://www.nccccurricula.info/culturalcompetence.html

http://www.manitoba

http://www.tbs-sct.gc.ca/pubs_pol/hrpubs/tb_856/pclpsc-pacfpc01-

eng.asp

Thank You to:

Alzheimer Society – Manitoba / www.alzheimer.ca/en‎

The Winnipeg Foundation / www.wpgfdn.org

Canadian Home Care Association / www.cdnhomecare.ca/

Congress of Black Women of Manitoba Inc. / www.cbwc-manitoba.com

Contact Information

Antoinette Zloty MSW BSW RSW

Consultant (Manitoba)

antoinettezloty@hotmail.com

Congress of Black Women of Manitoba Inc.

President