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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)
Congress of Black Women of Manitoba Inc.
President
