Cultural Competency in the Clinical Setting


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Cultural Competency in the Clinical Setting
by Robert F. Jex, RN, MHA, FACHE

Wednesday, January 20, 2009
12:00 p.m. - 1:00 p.m. (Mountain)

Robert Jex, RN, MHA, FACHE is a Trauma System Clinical Consultant within the Emergency Medical Services and Preparedness at the Utah Department of Health. He has been a practicing RN for 33 years with experience in ER, OR, Med/Surg/ICU, Nursery, Labor and Delivery, and home health care. He has a BS in Zoology, an MS in Reproductive Physiology and a Master of Health Administration. Mr. Jex is a licensed long term care administrator, a Fellow in the American College of Health Care Executives, and a certified trainer in Cultural Competency.

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  • Exploring the INdividual
  • Exploring Stereotype—Exercise 1
  • Exercise 2: Earliest Recall of Differences
  • Cultural Competency in the Clinical Setting

    1. 1. Diversity and Culture Robert F. Jex, RN, MHA, FACHE
    2. 2. Goals and Objectives <ul><li>Establish a clear and shared understanding of the concepts of diversity and culture </li></ul><ul><li>Define the concept of cultural competency and its relevance to health care </li></ul><ul><li>Be able to perform a self-assessment of individual cultural competency </li></ul><ul><li>Develop an awareness of the impact of culture on human dynamics </li></ul>
    3. 3. Cultural Competency <ul><li>“ A process of learning that leads to an ability to effectively respond to the challenges and opportunities posed by the presence of social cultural diversity in a defined social system .” </li></ul>
    4. 4. Cultural Competency <ul><li>“ To be culturally competent doesn’t mean you are an authority in the values and beliefs of every culture. What it means is that you hold a deep respect for cultural differences and are eager to learn, and willing to accept that there are many ways of viewing the world.” </li></ul><ul><li>Okokon O. Udo </li></ul>
    5. 5. <ul><li>To respond to current and projected demographic changes in the United States </li></ul><ul><li>To eliminate long-standing disparities in the health status of people of diverse racial, ethnic and cultural backgrounds </li></ul><ul><li>To improve the quality of services. </li></ul><ul><li>To enhance the workplace environment </li></ul><ul><li>To meet regulatory and accrediting mandates </li></ul><ul><li>To decrease the likelihood of liability/malpractice claims. </li></ul>Why Cultural Competency?
    6. 6. Diversity encompasses issues related to…. <ul><li>race </li></ul><ul><li>color </li></ul><ul><li>class </li></ul><ul><li>age </li></ul><ul><li>experience </li></ul><ul><li>ability </li></ul><ul><li>gender </li></ul><ul><li>ethnicity </li></ul><ul><li>language </li></ul><ul><li>religion </li></ul><ul><li>politics </li></ul><ul><li>sexual orientation </li></ul><ul><li>sexual identity </li></ul><ul><li>socio-economic status </li></ul><ul><li>resident status </li></ul>
    7. 7. Understanding Culture <ul><li>Individual culture : </li></ul><ul><li>Is multifaceted and encompasses - </li></ul><ul><li>personality, unique style </li></ul><ul><li>internal factors - gender, race, age, sexual orientation </li></ul><ul><li>external influences - society, experiences </li></ul><ul><li>where individuals grow up or live now, religious affiliation </li></ul><ul><li>organizational influences - seniority, level within organization, work location </li></ul>
    8. 8. <ul><li>Community culture : </li></ul><ul><li>Exists within a network of relationships-between language and tradition, tradition and history, history and economics </li></ul><ul><li>Organizational systems : </li></ul><ul><li>Operate as complex “cultures” with specified “languages” traditions, codes of conduct </li></ul>
    9. 9. Group Exercise <ul><li>Exploring the Individual: </li></ul><ul><li>Given Names and one Story </li></ul><ul><li>Ethnicities, Languages, Religions and Spiritual Beliefs </li></ul><ul><li>Current Roles in Life </li></ul>
    10. 10. Another way to view the world <ul><li>If we could shrink the world into a village of 100 people: </li></ul><ul><li>52 would be female: 48 would be male </li></ul><ul><li>33 would be children </li></ul><ul><li>6 would be over 65 </li></ul><ul><li>58 would be Asian </li></ul><ul><li>79 would be people of color </li></ul><ul><li>30 would be Christian </li></ul><ul><li>6 would own half the village’s wealth—all 6 would be American </li></ul>
    11. 11. Another way to view the world (cont’d) <ul><li>9 would speak English </li></ul><ul><li>50 would suffer from malnutrition </li></ul><ul><li>80 would live in substandard housing </li></ul><ul><li>66 would not have access to clean, safe drinking water </li></ul><ul><li>1 would have a college education </li></ul>
    12. 12. Changing Demographics <ul><li>18% of US residents over age 5 speak a language other than English in the home </li></ul><ul><li>Persons with physical and mental impairments are the largest single minority (45 million) </li></ul><ul><li>21-23% of the US population is “functionally illiterate”= “low literacy. (Most are English speaking native born) </li></ul><ul><li>35 million Hispanics. 34.5 million Blacks. 10.5 million Asian Americans. 4 million Native Americans. The U.S. has moved beyond Black and White to become a complex mosaic of races and ethnicities. </li></ul>
    13. 13. Changing Demographics (cont’d) <ul><li>Since 1970 and the end of immigration limits imposed in 1924, the Asian American population has grown from 1.5 million to nearly 12 million in 2000. </li></ul><ul><li>By 2030, 1 in 4 elderly persons will be from a racial or ethnic minority group </li></ul><ul><li>By 2030, it is projected that: </li></ul><ul><li>- the Hispanic population 65 and older will increase 328% </li></ul><ul><li>- Asian and Pacific Islander 65 and older population will increase 285% </li></ul>
    14. 14. Disparities <ul><li>Avoidable differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups. </li></ul>
    15. 15. Institute of Medicine 2002 Report on Disparities <ul><li>“ Racial and ethnic minorities tend to receive lower quality health care than whites do, even when insurance status, income, age, and severity of conditions are comparable.” </li></ul><ul><li> - Alan Nelson M.D. </li></ul><ul><li> Committee Chair </li></ul><ul><li> March 20, 2002 </li></ul>
    16. 16. Disparities in Health Care <ul><li>Infant mortality for blacks is twice the rate of whites </li></ul><ul><li>Cancer deaths among blacks and Latinos are high </li></ul><ul><li>Cervical cancer is 5 times more likely to strike Vietnamese women as white women </li></ul><ul><li>Native Americans have higher rates of diabetes and heart disease </li></ul><ul><li>Minorities are less likely to be immunized </li></ul><ul><li>Minorities are less likely to have regular check-ups </li></ul>
    17. 21. Aggravating issues <ul><li>21-23% of the US population is “functionally illiterate”= “low literacy. (Most are English speaking native born) </li></ul><ul><li>60% of Medicaid population has low literacy </li></ul><ul><ul><li>25% don’t know diagnosis or name of drug </li></ul></ul><ul><ul><li>50% don’t know purpose of drug </li></ul></ul><ul><ul><li>75% can’t describe their disease </li></ul></ul>
    18. 22. Impact of low literacy on health <ul><li>Those who lack basic literacy skills are much more likely than others to suffer from: </li></ul><ul><li>heart disease </li></ul><ul><li>diabetes </li></ul><ul><li>cancer </li></ul><ul><li>and to have health care expenses as much as six times higher than adults with average levels of literacy. </li></ul><ul><li>Source: U.S. Programs Division of Pro-Literacy Worldwide </li></ul><ul><li> March 2003 </li></ul>
    19. 23. Assumptions <ul><li>“ At least half of the exercise I get everyday comes from jumping to conclusions.” </li></ul><ul><li>Bruce Dexter </li></ul><ul><li>Journalist </li></ul>
    20. 24. Assumptions
    21. 25. Exercise <ul><li>Describe a time when assumptions were made about you that led to discrimination </li></ul>
    22. 26. Successful Organizations have the ability to: <ul><li>Value Diversity </li></ul><ul><li>Conduct on going self assessment </li></ul><ul><li>Manage the dynamics of difference </li></ul><ul><li>Acquire and institutionalize cultural knowledge </li></ul><ul><li>Adjust to diversity and the cultural contexts of the communities they serve </li></ul>
    23. 27. The Elements of Cultural Competence <ul><li>Awareness of one’s own culture </li></ul><ul><li>Understanding the dynamics of difference </li></ul><ul><li>Awareness and acceptance of difference </li></ul><ul><li>Development of cultural knowledge </li></ul><ul><li>Celebration of diversity </li></ul>
    24. 28. Reflections <ul><li>“ Each person is likely to have his personal system of values which he believes to be preferable to some others. Those values he prefers are likely to be heavily weighted in favor of those in his own cultural background, whether or not he realizes it.” </li></ul><ul><li>Condon and Yousef, 1975 </li></ul>
    25. 29. Personal Culture on Communication <ul><li>Incorrect assumptions about the other </li></ul><ul><li>Language and communication style issues </li></ul><ul><li>Bias against the unfamiliar </li></ul><ul><li>Personal values conflict </li></ul><ul><li>Expectations that others will conform to established norms (stereotypes) </li></ul><ul><li>Adapted from Selma Myers </li></ul>
    26. 30. Communication <ul><li>&quot; Doctors (and other health care providers) today devote far more time and thought to the words of a pathologist (words that are often not even heard, but read off a computer screen) than to the words of the man or woman for whose life they have taken responsibility.” </li></ul><ul><ul><ul><li>Source: Nuland, Doctors and Deities: Medicine, Multiculturalism and the Duty of Physicians. New Republic October, 13, 1997, 31-39 . </li></ul></ul></ul>
    27. 31. <ul><li>To offer culturally appropriate care requires being open to the expectations, perceptions, and realities of various individuals and communities. </li></ul>
    28. 32. Parting Thoughts <ul><li>Every relationship we have is successful because we are culturally competent with that individual. </li></ul><ul><li>All hate is self hate. </li></ul><ul><li>It is more important to know what sort of person this disease has than what sort of disease this person has. </li></ul><ul><li>William Osler </li></ul>
    29. 33. References <ul><li>National Center for Cultural Competence Georgetown University, Bureau of Primary Health Care </li></ul><ul><li>Alliance Community Services, Jorge J. Arce-Larreta </li></ul><ul><li>Cultural Competency in Health and Human Services, CCHCP </li></ul>