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Cultural Diversity
 

Cultural Diversity

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    Cultural Diversity Cultural Diversity Presentation Transcript

    • This material is the private property of Chesapeake Medical Cultural Diversity and HealthCultural Diversity and Health CareCare
    • This material is the private property of Chesapeake Medical Cultural DiversityCultural Diversity  We all have it!We all have it!  Obvious manifestations include:Obvious manifestations include:  religionreligion  ethnicity (race)ethnicity (race)  national origin (language)national origin (language)  gendergender
    • This material is the private property of Chesapeake Medical Cultural DiversityCultural Diversity Less obvious manifestations include:Less obvious manifestations include:  ageage  educationeducation  socioeconomic classsocioeconomic class  mobility (including handicaps)mobility (including handicaps)
    • This material is the private property of Chesapeake Medical What is Culture?What is Culture? Culture is the sum total of the way ofCulture is the sum total of the way of living; includes values, beliefs, standards,living; includes values, beliefs, standards, language, thinking patterns, behaviorallanguage, thinking patterns, behavioral norms, communications styles, etc.norms, communications styles, etc. Culture guides decisions andCulture guides decisions and actions of a group through time.actions of a group through time.
    • This material is the private property of Chesapeake Medical Expressions of Culture inExpressions of Culture in Health CareHealth Care Health Belief SystemsHealth Belief Systems  define and categorize health and illnessdefine and categorize health and illness  offer explanatory models for illnessoffer explanatory models for illness  are based upon theories of the relationshipare based upon theories of the relationship between cause and the nature of illnessbetween cause and the nature of illness and treatmentsand treatments  define the specific “scope” of practice fordefine the specific “scope” of practice for healershealers
    • This material is the private property of Chesapeake Medical The Culture of WesternThe Culture of Western MedicineMedicine Common Practices in Western MedicineCommon Practices in Western Medicine  Meliorism – make it betterMeliorism – make it better  Dominance over nature – take controlDominance over nature – take control  Activism – do somethingActivism – do something  Timeliness – sooner than laterTimeliness – sooner than later  Therapeutic aggressiveness –Therapeutic aggressiveness – stronger=betterstronger=better  Future orientation – plan, newer=betterFuture orientation – plan, newer=better  Standardization – treat similar the sameStandardization – treat similar the same
    • This material is the private property of Chesapeake Medical Comparing Our Beliefs to OthersComparing Our Beliefs to Others  ““Western”Western”  Make it betterMake it better  Control over natureControl over nature  Do somethingDo something  Intervene nowIntervene now  Strong measuresStrong measures  Plan ahead – recentPlan ahead – recent is bestis best  Standardize – treatStandardize – treat everyone the sameeveryone the same  ““Others”Others”  Accept with graceAccept with grace  Balance/HarmonyBalance/Harmony with naturewith nature  Wait and seeWait and see  Cautious deliberationCautious deliberation  Gentle approachGentle approach  Take life as it comesTake life as it comes – “time honored”– “time honored”  Individualize –Individualize – recognizerecognize differencesdifferences
    • This material is the private property of Chesapeake Medical Cultural CompetenceCultural Competence Cultural competence is defined as a setCultural competence is defined as a set of congruentof congruent behaviors, practices,behaviors, practices, attitudes and policiesattitudes and policies that come together in athat come together in a system or agency or among professionals,system or agency or among professionals, enabling effective work to beenabling effective work to be done in cross-cultural situations.done in cross-cultural situations.
    • This material is the private property of Chesapeake Medical The Cultural CompetenceThe Cultural Competence ContinuumContinuum Requires Self ReflectionRequires Self Reflection  Where am I now?Where am I now?  Where could I be?Where could I be?
    • The Cultural Competence ContinuumThe Cultural Competence Continuum
    • This material is the private property of Chesapeake Medical Cultural CompetenceCultural Competence DefinitionsDefinitions  Cultural DestructivenessCultural Destructiveness:: forcedforced assimilation, subjugation, rights andassimilation, subjugation, rights and privileges for dominant groups onlyprivileges for dominant groups only  Cultural IncapacityCultural Incapacity:: racism, maintainracism, maintain stereotypes, unfair hiring practicesstereotypes, unfair hiring practices  Cultural BlindnessCultural Blindness:: differences ignored,differences ignored, “treat everyone the same”, only meet“treat everyone the same”, only meet needs of dominant groupsneeds of dominant groups
    • This material is the private property of Chesapeake Medical Cultural CompetenceCultural Competence DefinitionsDefinitions  Cultural Pre-competenceCultural Pre-competence:: explore culturalexplore cultural issues, are committed, assess needs ofissues, are committed, assess needs of organization and individualsorganization and individuals  Cultural CompetenceCultural Competence:: recognize individualrecognize individual and cultural differences, seek advice fromand cultural differences, seek advice from diverse groups, hire culturally unbiased staffdiverse groups, hire culturally unbiased staff  Cultural ProficiencyCultural Proficiency:: implement changes toimplement changes to improve services based upon cultural needs,improve services based upon cultural needs, do research and teachdo research and teach
    • This material is the private property of Chesapeake Medical Acquiring CulturalAcquiring Cultural CompetenceCompetence  Begins with awarenessBegins with awareness  Grows with knowledgeGrows with knowledge  Enhanced with specific skillsEnhanced with specific skills  Polished through cross-culturalPolished through cross-cultural encountersencounters
    • This material is the private property of Chesapeake Medical The Explanatory ModelThe Explanatory Model Arthur Kleinman, Ph.D.Arthur Kleinman, Ph.D. Use a culturally sensitive approach toUse a culturally sensitive approach to inquiring about a health problem.inquiring about a health problem. Ask your patient:Ask your patient:  What do you call your problem?What do you call your problem?  What do you think caused your problem?What do you think caused your problem?  Why do you think it started when it did?Why do you think it started when it did?  What does your sickness do to you? HowWhat does your sickness do to you? How does it work?does it work?  How severe is it? How long do you think youHow severe is it? How long do you think you will have it?will have it?
    • This material is the private property of Chesapeake Medical Ask Your PatientAsk Your Patient  What do you fear most about your illness?What do you fear most about your illness?  What are the chief problems your sickness has causedWhat are the chief problems your sickness has caused you?you?  Do you know anyone else with the same problem?Do you know anyone else with the same problem?  What have you done so far to treat your illness?What have you done so far to treat your illness?  What treatments do you think you should receive?What treatments do you think you should receive?  What important results do you hope to receive from theWhat important results do you hope to receive from the treatment?treatment?  Who else can help you?Who else can help you?
    • This material is the private property of Chesapeake Medical TheThe LEARNLEARN ModelModel Berlin and FowkesBerlin and Fowkes  LListenisten to the patient’s perception of theto the patient’s perception of the problem.problem.  EExplainxplain your perception of the problem.your perception of the problem.  AAcknowledgecknowledge and discussand discuss differences/similarities.differences/similarities.  RRecommendecommend treatment.treatment.  NNegotiateegotiate treatment.treatment.
    • This material is the private property of Chesapeake Medical InterpretersInterpreters Qualifications:Qualifications:  Bilingual, bicultural,Bilingual, bicultural,  Understands English medicalUnderstands English medical vocabularyvocabulary  Comfort in the medical setting,Comfort in the medical setting, understands significance of theunderstands significance of the health problemhealth problem  Preserves confidentialityPreserves confidentiality
    • This material is the private property of Chesapeake Medical Multiple Roles of InterpretersMultiple Roles of Interpreters Interpreters have multiple roles including:Interpreters have multiple roles including:  translator of languagetranslator of language  culture brokerculture broker  patient advocate: convey expectations,patient advocate: convey expectations, concernsconcerns
    • This material is the private property of Chesapeake Medical Working with InterpretersWorking with Interpreters Use language to identify the interpreterUse language to identify the interpreter as the go-between, not as the person toas the go-between, not as the person to be blamed, e.g., the interpreter mightbe blamed, e.g., the interpreter might say, “The doctor has ordered tests andsay, “The doctor has ordered tests and this is what he says.”this is what he says.”
    • This material is the private property of Chesapeake Medical Working with LanguageWorking with Language Translation ConsiderationsTranslation Considerations  Language: consider meaningful descriptionLanguage: consider meaningful description  Navajo: Explain Penicillin as “the strong white medicineNavajo: Explain Penicillin as “the strong white medicine shot you get for a cold”shot you get for a cold”  Minimize jargon, e.g., “machine to look at yourMinimize jargon, e.g., “machine to look at your heart” instead of “EKG”heart” instead of “EKG”  Nonverbal communication comprises 60% of allNonverbal communication comprises 60% of all communicationcommunication  Nodding may indicate politeness, notNodding may indicate politeness, not comprehensioncomprehension  Bilingual interviewing takes at least twice as longBilingual interviewing takes at least twice as long as monolingual interviews!as monolingual interviews!
    • This material is the private property of Chesapeake Medical Responsibilities of HealthResponsibilities of Health Care ProvidersCare Providers  Learn and use a few phrases of greeting andLearn and use a few phrases of greeting and introduction in the patient’s native language.introduction in the patient’s native language. This conveys respect and demonstrates yourThis conveys respect and demonstrates your willingness to learn about his/her culture.willingness to learn about his/her culture.  Tell the patient that the interpreter willTell the patient that the interpreter will translate everything that is said, so they musttranslate everything that is said, so they must stop after every few sentences.stop after every few sentences.
    • This material is the private property of Chesapeake Medical Responsibility of Health CareResponsibility of Health Care ProvidersProviders  When speaking or listening, watch theWhen speaking or listening, watch the patient, not the interpreter. Add yourpatient, not the interpreter. Add your gestures, etc. while the interpreter isgestures, etc. while the interpreter is translating your message.translating your message.  Reinforce verbal interaction with visual aidsReinforce verbal interaction with visual aids and materials written in the client’s language.and materials written in the client’s language.  Repeat important information more thanRepeat important information more than once.once.
    • This material is the private property of Chesapeake Medical Your ResponsibilitiesYour Responsibilities  Always give the reason or purpose for aAlways give the reason or purpose for a treatment or prescription.treatment or prescription.  Make sure the patient understands by havingMake sure the patient understands by having them explain it themselves.them explain it themselves.  Ask the interpreter to repeat exactly what wasAsk the interpreter to repeat exactly what was said.said.  Personal information may be closely guardedPersonal information may be closely guarded and difficult to obtain.and difficult to obtain.  Patient may request or may bring a specificPatient may request or may bring a specific interpreter to the clinic.interpreter to the clinic.
    • This material is the private property of Chesapeake Medical ConsiderationsConsiderations  In some cultures it may not be appropriate toIn some cultures it may not be appropriate to suggest making a will for dying patients orsuggest making a will for dying patients or patients with terminal illnesses; this is thepatients with terminal illnesses; this is the cultural equivalent of wishing death on acultural equivalent of wishing death on a patient.patient.  Avoid saying “you must”, instead teachAvoid saying “you must”, instead teach patients their options and let them decide,patients their options and let them decide, e.g., “some people in this situation would...”e.g., “some people in this situation would...”
    • This material is the private property of Chesapeake Medical Additional InformationAdditional Information  JCAHO requires education for all health careJCAHO requires education for all health care providers regarding cultural diversity.providers regarding cultural diversity.  Visit these sites for more information:Visit these sites for more information: www.ggalanti.com/articles.htmlwww.ggalanti.com/articles.html www.ggalanti.com/concepts.htmlwww.ggalanti.com/concepts.html www.ggalanti.com/cultural_profiles.htmlwww.ggalanti.com/cultural_profiles.html www.nursingworld.org/ojin/topic20/tpc20_2.htmwww.nursingworld.org/ojin/topic20/tpc20_2.htm www.diversityrx.org/www.diversityrx.org/ www.health.qld.gov.au/multicultural/cultdiv/default.aspwww.health.qld.gov.au/multicultural/cultdiv/default.asp
    • This material is the private property of Chesapeake Medical Cultural Diversity and HealthCultural Diversity and Health CareCare It is because we are different that each of us is special.It is because we are different that each of us is special.