Cultural awareness TMT 2013

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Cultural awareness TMT 2013

  1. 1. Cultural Awareness Training Achieving Cultural Competency Dr. Hung The Nguyen hunguyen250369@gmail.com TMT, Cairns 07/02/2013Monday, 4 February 2013 1
  2. 2. A word on stereotyping Stereotyping Generalising unconscious conscious judgemental descriptive fixed perspective flexible, adaptableMonday, 4 February 2013 2
  3. 3. What we expect from each other !join in the discussion !be willing to receive and give feedback !participate, engage and volunteer !respect each others views !maintain confidentiality - what is said here, stays hereMonday, 4 February 2013 3
  4. 4. Outline "a warm up "culture and its dimensions "identification and patient diversity "communication and connecting "last comments and questionsMonday, 4 February 2013 4
  5. 5. Warm-upMonday, 4 February 2013 5
  6. 6. An approach to cultural competence Awareness + Reflection (know yourself, know them) Sensitivity +Safety (trust yourself, trust them) Competence + Structural change (working together, organisation change)Monday, 4 February 2013 6
  7. 7. Being culturally aware • culture is a blueprint for action - Laksiri Jayasuriya • a cultural group can be understood through the group’s rituals, customs, heroes and values • cultural blindness occurs when we don’t accept or perceive people’s behaviours are guided by their cultureMonday, 4 February 2013 7
  8. 8. Being culturally sensitive • culture is complex but not chaotic. • we perceive the values of out culture in moral terms and therefore we tend to view other peoples values as morally inferior • Cultural dimensions through the cultural lensMonday, 4 February 2013 8
  9. 9. “With the education they get, this is all we can expect.” “They are just not used to working hard – look at their history.” “They really don’t seem to care about their health. Life is not valued as much in their country.” “As soon as you take your eyes off them, they stop working. They haven’t been taught responsibility.” ! Explanation 1. People from some other nations/ cultures are stupid, lazy, amoral, and/or obstructionist.Monday, 4 February 2013 9
  10. 10. " Explanation 2. People from some other nations/ cultures differ in cognition in ways that result in different perceptions, judgments, decision making and behaviours.Monday, 4 February 2013 10
  11. 11. acceptable behavioursPhysical ecology National emotional expression Social ecology Culture communication tendencies and preferences Culture confers a survival advantage. If it does not that cultural component would be extinct.Monday, 4 February 2013 11
  12. 12. People can only see their culture when they encounter a mismatch b/w their lifelong patterns of thinking and that of other people. Klein, 2004Monday, 4 February 2013 12
  13. 13. People cannot adjust mismatches by altering their underlying cognitive processes i.e. how they think about the world. Klein, 2004Monday, 4 February 2013 13
  14. 14. The lens filters and organizes incoming information, makes sense of the information, structures planning and adaptation activities, and guides interactions and communication. Klein, 2004Monday, 4 February 2013 14
  15. 15. Applying the Cultural Lens • know about the cognitive differences ie cultural dimensions • know how and why cultural dimensions sustain a culture trait • observations and perspective taking • cultural immersion and experiential learningMonday, 4 February 2013 15
  16. 16. Cultural dimensions high vs low power distance hypothetical vs concrete reasoning mastery vs fatalism short vs long term time orientation high vs low tolerance for uncertainty root cause vs systems approach masculinity vs femininity individualist vs collectivistMonday, 4 February 2013 16
  17. 17. Individualism Individualism CollectivismMonday, 4 February 2013 17
  18. 18. Power Distance Low PD High PDMonday, 4 February 2013 18
  19. 19. The Weekend Australian Magazine (11/12/07) Richard Guiliatt ʻBeautiful mindsʼ (Terry Tao) ʻI skipped year 5ʼ Nigel notes, ʻbut I donʼt try to make a big deal out of it and I donʼt let that define me. Maybe thatʼs an Australian thing, where you admire someone for being a good bloke rather than something theyʼve achieved. If weʼd grown up in the US it might have been different. In Australia you can be tremendously good at something but if youʼre a whacker, people still arenʼt going to like you.ʼMonday, 4 February 2013 19
  20. 20. Uncertainty Avoidance Tolerance of ambiguity Need for certaintyMonday, 4 February 2013 20
  21. 21. Masculinity Feminine MasculineMonday, 4 February 2013 21
  22. 22. Time Orientation “Mankind differs from the animals only by a little, and most people throw that away.” “The superior man is modest in his speech but exceeds in his actions.” Short term Long TermMonday, 4 February 2013 22
  23. 23. • What about your national cultural dimensions?Monday, 4 February 2013 23
  24. 24. Applying the Cultural Lens • know about the cognitive differences ie cultural dimensions • know how and why cultural dimensions sustain a culture trait • observations and perspective taking • cultural immersion and experiential learningMonday, 4 February 2013 24
  25. 25. Being Culturally Safe Cultural safety is define by the patients not the health service. Nguyen, 2008Monday, 4 February 2013 25
  26. 26. Identification of Aboriginal and Torres Strait Islander Status • Why identify?Monday, 4 February 2013 26
  27. 27. What we know... • Most Aboriginal and Torres Strait Islander people seek medical advice from their mainstream GP - from 80% in urban setting to 6% in remote locations.Monday, 4 February 2013 27
  28. 28. What we know... Indigenous patient presenting to ACCHS (Townsville, Darwin) were: Indigenous patient presenting to private • younger, general practice were: • new to practice, • younger, • had complex problems, • seen in rural and remote areas, • more new problems, • problems managed per encounter • more problems managed per encounter, was similar, • types of problem managed were • problems managed were different to GP presentation, different • more consultation leading to admission to emergencyMonday, 4 February 2013 28
  29. 29. • RACGP Standards for general practices (4th edition) Criterion 1.1.7 Indicator E: ʻOur practice can demonstrate that we routinely record Aboriginal and Torres Strait Islander status in our active patient health recordsʼMonday, 4 February 2013 29
  30. 30. Who is Aboriginal or Torres Strait Islander? Bob Gallagher Simone Petersen Jack Thorpe Patricia Brown Thomasina CookMonday, 4 February 2013 30
  31. 31. Incentives? • For the patient and the GP... • For the GP and practice...Monday, 4 February 2013 31
  32. 32. ʻEfforts to close the life expectancy gap must be based on rock solid data, not estimates that can fluctuate.ʼ Tom Calma, Social Justice Commissioner ๏< 1/3 GPs routinely ask ๏ Low take-up of specific health services ๏ Poor quality Indigenous dataMonday, 4 February 2013 32
  33. 33. ʻIt is not credible to suggest that one of the wealthiest nations in the world cannot solve a health crisis affecting less than 3% of its citizensʼ Tom Calma, Social Justice Commissioner 85 Total Indigenous 80 Total Non- Indigenous 75 70 65 60 Males FemalesMonday, 4 February 2013 33
  34. 34. What is the question? ʻAre you of Aboriginal or Torres Strait Islander origin?ʼ Responses: No Yes, Aboriginal Yes, Torres Strait Islander 1. ASK 2. RECORD 3. RESPONDMonday, 4 February 2013 34
  35. 35. Being Culturally Competent Inala (Hayman, 2009) Majellan (Johanson and Hill, 2011) "Indigenous staff No indigenous person working there "Culturally appropriate waiting "Bulk billing room Lack of bulk billing Nothing to identify with "The clinic "Staff cultural awareness Staff perceived as unfriendly, uncaring Lack of indigenous awareness One session a week Staff talk down at you, “shame” Attended by AHW from ACCHS – recalls, cultural broker Treated poorly at reception Staff intolerance towards children’s behaviour "Transport Transport issues to clinic and ACCHS "Inform local indigenous Bus operated by ACCHS, petrol subsidized by DGP community "Consult Elders, Qld Dept. Health, "Promote inter-sectorial DGP collaborationMonday, 4 February 2013 35
  36. 36. Awareness + Reflection (know yourself, know them) Sensitivity +Safety (trust yourself, trust them) Competence + Structural change (working together, organisation change)Monday, 4 February 2013 36
  37. 37. Monday, 4 February 2013 37
  38. 38. Monday, 4 February 2013 38

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