Cultural Competence Barbara Moulton Ext. 2710 Exceptional Experience Every Time 1

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Cultural Competence

Barbara Moulton

Ext. 2710

Exceptional Experience Every Time

Learning Objectives

Define culture.Understand culture’s influences on health.Understand the elements of cultural

competence.Understand the importance of providing

equitable care.

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Cultural Competence


“It is much more important to know what sort of a patient has a disease than what sort of a disease the patient has.”

(Dr William Osler)

The Need for Cultural Competence


A wide variety of individuals make up our communities. Nobody should be

given less care, attention or understanding because they are

different from you.



This includes, not only patients and their families, but the people that we

work with.

Cultural Competence


We work with people from different backgrounds.

Promote a caring attitude towards other staff. Respect differences.

Be:• Patient when perspectives differ from yours.• Open to their ideas and approaches. • Flexible. Do not impose your perspective. • Neither defensive nor offensive.• Willing to apologize when offense does occur.



“There is nowhere you can go and only be with people who are like you. Give it

up.” (Bernice Johnson Reagon)

What is culture?


Traditionally is thought to be behaviours and beliefs characteristic of a particular social, ethnic, religious or age group. However there are other differences reflected in our community. This includes gender, sexual orientation, physical challenges, socio economic factors, social environments etc.

Culture impacts how we learn, interact, respond, communicate and relate with others.eanio life.

What is culture?


Our culture influences the way we perceive virtually everything around us. This is often unconscious. Hence, culture naturally influences health, through many channels:

• Behaviours and practices (which may have a positive or negative effect.

• Attitudes and reactions (towards health and illness)• Communication Patterns

Examples


• Different beliefs & values • Different reactions • Different communication habits• Different notions of time • Different values towards space with regards to personal

contact• Different decision making process • Different assumptions

What is culture?


Examples


“My faith does not allow me to remove this item.”

“I trust my family to make the right decisions. I don’t want to talk about it.”

“English is my second language. I don’t understand your question.”

“I do not want to take pain medication. I need to face death with clarity.”

Avoid Assumptions


What is Cultural Competence?


A set of attitudes, behaviours and skills that enable you to work

successfully in a cross-cultural setting.



It goes beyond committing facts about different cultures to memory. It is an attitude to be lived not just a

skill to be learned.



It includes how we care for patients and how we work with each other.

The Elements of Cultural Competence


1. Self Awareness2. Communication3. New Learning

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#1 Self Awareness


Develop insights into your own personal

values and bias and how they may influence your interaction with patients, family and other staff.

Self Awareness

“By heightening awareness of our own cultural influences, we become more

compassionate caregivers.” A.M.A. Journal of Ethics

Are you aware?


Self Awareness

Ethnocentrism

The sense that your beliefs, values and ways of life are superior to, and more desirable than the lifestyle of others

Example

Patient autonomy may appear the ideal to you, but your patient may wish to let her spouse decide on whether or not she has the operation.


Self Awareness

Cultural Imposition

Goes beyond believing your cultural is superior. Expresses itself in the imposition of the views and values of your own culture without consideration of the beliefs of others.

Example

The Muslim patient asks us not to interrupt his scheduled prayers. Since the caregiver believes in less formal, more spontaneous prayer, he pressures the patient to adapt to the hospital schedule.


Self Awareness

Cultural Blindness

The inability to see how specific situations may be seen by individuals of another culture. Those who exhibit it think that they are actually very culturally competent because they feel that colour, race, ethnicity, poverty, gender, etc. don’t matter at all or are inconsequential.

Example

“I’ll be back in a minute,” the nurse says to the patient, not understanding that in the patient’s culture this is heard as literal promise not a casual assurance of availability.


Self Awareness

Cultural Shock

Being stunned by what you see in another culture.

Example

A son is injured in a car accident and dies in ER. The family practices their faith, which teaches them to receive all things that happen as divinely appointed. They are calm and strong in that faith. The caregivers are shocked by what they feel is a cold and unfeeling response.


Self Awareness

Cultural Conflict

Conflict generated when the rules of your own culture are contradicted by the rules of another.

Example

In some cultures it is normal when a person is dying to invite extended family members to the bedside, sing songs and undertake rituals to help the person's soul on its journey; this can easily frustrate other dying patients who seek peace and quiet.


Self Awareness

We all have areas of bias, intolerance and/or lack of

knowledge. Be aware of your responses!


Self Awareness

Reflect and act on ways to be inclusive in all

aspects of your practice.


Reflect on previous examples


How would you respond to the following? Can you think of examples from your experience of providing care?

“My faith does not allow me to remove this item.”

“I trust my family to make the right decisions. I don’t want to talk about it.”

“English is my second language. I don’t understand your question.”

“I do not want to take pain medication. I need to face death with clarity.”

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#2 Communication


Develop communication skills that promote culturally diverse settings.

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Communication


Ingredients in successful communication

• Show respect with your whole person (eye contact, body posture, pitch and tone of your voice).

• Be slow to judge .• Be aware of your approach to knowledge. • Don’t interrupt. • Ask questions.• Pay attention to non-verbal communication which

makes up 65-70 % of all communication.

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Communication


The BELIEF Mnemonic (University of Ottawa MedU)

Beliefs about health ("What caused this problem?"); Explanation ("Why did it happen now?"); Learn ("Please help me to understand how you see your illness"); Impact ("How is it affecting your life?"); Empathy ("This must be hard for you") ; Feelings ("How are you feeling about it?").

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#3 New Learning


a) Acquire knowledge relevant to our patients and colleagues.

• Know where to find information on culture and health.

• Access, utilize, and partner with cultural resources.

b) Be aware of how disparities exist for diverse populations.

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Acquire Foundational Knowledge


• Foundational knowledge of cultural issues can be found on the HHCC intranet.• Documents/Ethics & Equity at Headwaters

• Contact the Equity program (Ext. 2710)

• Explore the websites referenced at the end of this learning package.

• Take advantage of learning opportunities.

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Acquire Specific Knowledge


• You will gain this through genuine interactions with patients, families and staff.

• Put aside assumptions. Ask questions. Everyone is unique.

• Remember that culture influences us but it does not define us.

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Be aware of disparities


The following can impact both health and access to health care.

• Poverty and income barriers. (#1 determinant of health)

• Social Support Networks• Education and Literacy• Employment/Working

Conditions• Social Environments

• Physical Environments

• Personal Health Practices and Coping Skills

• Biology and Genetic Endowment

• Gender• Culture

Did this module surprise you?

• Did you have the assumption that a module on cultural competence would give you a checklist of information about various cultures?

• Cultural competence goes beyond committing facts about different cultures to memory. It is an attitude to be lived not just a skill to be learned. Like learning to play an instrument you will be continually challenged and stretched.

Exceptional Experience Every Time 35

Did this module surprise you?

As you move forward….

Practice self reflection.

Put aside assumptions.

Be willing to learn and change.

Remember that culturally competent care is really patient centered care, ensuring an exceptional experience every time for every patient of every culture.


Promote a caring attitude

Respect for the patient; Be patient and perceive the patient's perspective.

Be open to their ideas and approaches. Be flexible and do not impose

your perspective.

Awareness of culture

In every encounter there is an interaction of two cultures: the patient's

and the caregiver.

Be aware of different feelings about eye contact, about body space; what

is appropriate to talk about.

Be attuned to possible differences in gender roles, in how decisions are

made; in orientation to time and to fate.

Additional Resource - Health Care Management and Practice 2002;14(5):378-86) Mary Narayan


Obtain background information Try to find out about the patient's culture. Consider social etiquette; nonverbal communication; beliefs and values; typical health issues and concerns of the culture.

History takingPay particular attention to nutrition, attitudes to medications, pain perceptions, and type of care preferred.

Resource: Health Care Management and Practice2002;14(5):378-86) Mary Narayan


Preserve, accommodate, restructure Aim to preserve cultural practices that support recovery; accommodate your management to practices that are neutral; if you feel that some of the patient's cultural practices are harmful (e.g. refuses to take the medication) try to restructure these. Try to explain your recommendations using the patient's perspective.

Don't be defensive!Mistakes will occur. Apologize, express regret, and be willing to learn and, if necessary, refer to another clinician.

Resource: Health Care Management and Practice2002;14(5):378-86) Mary Narayan


References

Embracing Cultural Diversity in Health Care: Best Practice Guidelines RNAO April 2007

Hospital for Sick Children Cultural Competence eLearning Module http://www.sickkids.ca/culturalcompetencening-modules.html

University of Ottawa http://www.med.uottawa.ca/sim/data/Culture_e.htm

Health Care Management and Practice 2002;14(5):378-86) Mary NarayanExceptional Experience Every Time 40

http://www.sickkids.ca/culturalcompetencening-modules.html



http://www.med.uottawa.ca/sim/data/Culture_e.htm



Questions?

Please contact me: Barbara Moulton

Ex 2710

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www.headwatershealth.ca

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