2. CNUR 102 Diversity
Objectives:
Students will gain awareness of Cultural Awareness, Cultural Safety and Cultural Competency in the
context of healthcare
Students will gain awareness of gender in the context of healthcare
Critical Learning Elements:
Cultural Awareness, Cultural Safety and Cultural Competency
Gender in Healthcare
3. Where am I and
Why am I here?
• I ask myself this every day, and I also ask those who I am working with from time to
time…
• I would like to acknowledge Treaty 4
5. First quiz of the afternoon
1. How do you put a giraffe into a refrigerator?
2. How do you put an elephant into a refrigerator?
3. The Lion King is hosting an animal conference. All the animals attend.... except one. Which animal
does not attend?
4. There is a river you must cross but it is used by crocodiles, and you do not have a boat. How do
you manage it?
6. Invisible Backpack
“All of us carry an invisible ‘backpack’ of our culture, experiences, beliefs,
values and morals. Whenever we encounter another person, our backpack
is present with us and influences how we interact with our patients and
their families”.
Scott Harrison
Invisible Knapsack Peggy McIntosh
8. Cultural Sensitivity
Is about respecting differences and often uses neutral language, and neutral communication
Is a set of skills that enables us to learn about and understand people who are different from
ourselves, thereby becoming better able to serve them within their own communities
10. What happens if a bird poops on
you?
Bird poop brings good luck! There is a belief that if
a bird poops on you, your car or your property, you
may receive good luck and riches. The more birds
involved, the richer you'll be! So next time a bird
poops on you, remember that it's a good thing.
11. Cultural Knowledge
Familiarization with selected cultural characteristics, history, values, belief
systems, and behaviours of the members of another ethic group
12. Cultural Knowledge
Familiarization with selected cultural characteristics, history, values, belief
systems, and behaviours of the members of another ethic group
13. Cultural Competence
• Is about understanding, knowledge skills and attitudes, working effectively in
cross cultural and intercultural situations, this is the application of knowledge,
creates the environment of cultural safety
14. Cultural Competence
• Cultural Competency is a starting point, Cultural Safety better, and then is
Cultural Humility very good
• Cultural competence focuses on service provider vs cultural safety and humility
focuses on clients
15. Cultural Competence in Health Care
1. Provide interpreter services
2. Recruit and retain diverse staff
3. Provide training to increase cultural awareness, knowledge, and skills
4. Coordinate with traditional healers
5. Use community health workers
6. Incorporate culture-specific attitudes and values into health promotion tools
7. Include family and community members in health care decision making
8. Locate clinics in geographic areas that are easily accessible for certain populations
9. Expand hours of operation
10. Provide linguistic competency that extends beyond the clinical encounter to the appointment desk, advice
lines, medical billing, and other written materials
16. Cultural Competence in Health Care
Awareness of the influences that sociocultural factors have on patients, clinicians, and the clinical and care
relationship.
Acceptance of our responsibility to understand the cultural aspects of health and illness in context
Willingness to make clinical and care settings more accessible to patients
Recognition of personal biases against and towards people of different cultures and backgrounds
Respect, tolerance, acceptance, and interest for cultural differences
Acceptance of the responsibility to combat racism, classism, ageism, sexism, homophobia, and other kinds of
biases and discrimination that occur in health care settings.
17. Cultural Humility
Focuses on self reflection and acknowledges power differences, and
privilege. This occurs when you start to learn from your patients.
“Cultural humility involves humbly acknowledging oneself as a
learner when it comes to understanding another's experience”
https://www.fnha.ca/Documents/FNHA-Creating-a-Climate-For-Change-Cultural-Humility-Resource-Booklet.pdf
18. Cultural Safety
• Stresses the importance of relationships and partnerships, power shifts to the
client, to decide what is safe and what is not
“There is nothing either good
or bad but thinking makes it so”
William Shakespeare
19. An environment that is safe for people; where there is no assault, challenge or denial
of their identity, of who they are and what they need. It is about shared respect,
shared meaning, shared knowledge and
experience, of learning, living and working together
with dignity and truly listening.
(Health Q. F., 2012)
Cultural Safety
20. Culture is a world view
North American culture sees health as an individual problem, but we live in dynamic,
intercultural communities.
Culture can be a barrier to caring for our clients.
We often focus too much on learning about disease models of “health”.
We need to focus on wellness and resilience models of
health
Health is multifaceted with issues related to mental, spiritual, emotional, and physical
health.
21. What is Diversity
What makes us Diverse is differences in: backgrounds, racial, ethnic, socioeconomic, geographic, language, age,
gender, genetics, academic/professional and personal backgrounds. Our experiences also make us diverse, and
that refers to our: opinions, backgrounds (degrees and social experience), religious beliefs, philosophies, skills,
political beliefs, sexual orientations, heritage, and life experience.
22. How are we the same?
What things do you have in common with ………?
23. Sex and Gender: there is a difference
'Sex' and 'gender' are
often used interchangeably,
despite having different
meanings:
24. Sex
Sex refers to a set of biological attributes in humans and animals. It is
primarily associated with physical and physiological features including
chromosomes, gene expression, hormone levels and function, and
reproductive/sexual anatomy. Sex is usually categorized as female or
male but there is variation in the biological attributes that comprise sex
and how those attributes are expressed.
http://www.cihr-irsc.gc.ca/e/48642.html
25. Gender
Gender refers to the socially constructed roles, behaviours, expressions
and identities of girls, women, boys, men, and gender diverse people. It
influences how people perceive themselves and each other, how they act
and interact, and the distribution of power and resources in society.
Gender is usually conceptualized as a binary (girl/woman and boy/man)
yet there is considerable diversity in how individuals and groups
understand, experience, and express it.
http://www.cihr-irsc.gc.ca/e/48642.html
26.
27.
28. Definition of Family
Any combination of two or more persons who are bound together over
time by ties of mutual consent, birth and/or adoption or placement and
who, together, assume responsibilities for variant combinations of some of
the following:
29. _______ Story Hour on Pediatric Ward
_______ Volunteer cuddler on Pediatric Ward
30. Diversity, accommodation, and special treatment?
Racial and ethnic minorities are disproportionately
burdened by chronic illness
The population at risk for chronic conditions will become
more diverse
Access to health care differs by race and ethnicity
Language and communication barriers are problematic
Lack of cultural competence may lead to patient
dissatisfaction
32. What is my Role as a Nurse, a Student?
I need to understand myself, my place, my invisible knapsack or
worldview, my assumptions and understanding of myself and of
others and relationships and power dynamics.
What is the goal of caring for one another? as a Nurse it is
sometimes about learning more about myself as opposed to the
helping, fixing, healing, or whatever of the other.
We all need to be a bit more self-reflexive
33. The Nightmare Before Christmas
“If you’re going to learn about other people’s cultures and traditions,
approach it from a place of respect. Go to the people who live that life and
treat them as the experts. Listen to others if they say you’re stepping over
your bounds. Show humility. Ask questions in a respectful way.
Don’t try to “improve” cultural elements just because that’s easier than
understanding it fully. Above all, practice empathy. And that’s a pretty good
lesson for us at any age.”
Katie Schenkel
34. He said, She said, They Said
Different genders and cultures communicate differently
Indirect communication
Direct communication
Asynchronous communication – text, email, voicemail
We punish people for not being able to communicate properly as opposed
to helping them learn new skills..
35. Civility and Respect
Civility and Respect means showing appreciation, care, and consideration
for everyone, whether they’re patients, teachers, coworkers, supervisors,
customers, or clients. Creating a psychologically safe and healthy
(work)place is up to all of us.
http://www.mentalhealthcommission.ca/...
42. Greg…. You work with “those” people?!
HIV +
LGBTQ2S+
People who use injection drugs – addicts
Indigenous People
And who do you work with?
__________________________________________________?
43. "Have" to or "Get" to
I don’t “have” to. I “get” to
The key point is that both versions of reality are true. I have to do certain things, and I also get to do
them.
44. “I’m not confined to my wheelchair—
I am liberated by it. If it wasn’t for my
wheelchair, I would be bed-bound and never
able to leave my house.”
I once heard a story about a man who uses a
wheelchair. When asked if it was difficult being
confined.
45.
46. Lateral Kindness
Please be kind to each other
Respectful and responsible relationships, there are no apps for that.
Be Grateful
Be Great!
47. To – For – With Diversity
Actively include/recruit the underrepresented – gender, sexuality, those
with low opportunity hard to reach, often this population is not
represented
49. Contact information
Greg Riehl RN BScN MA
Indigenous Nursing Student Advisor
Saskatchewan Polytechnic Indigenous Nursing
Saskatchewan Polytechnic
Regina Campus
Email: greg.riehl@saskpolytech.ca
Editor's Notes
Treaty 4 is a treaty established between Queen Victoria and the Cree and Saulteaux First Nation band governments
1) Prisoner: this participant is there because they have been “told” to attend. They don’t want to be there and don’t see why they need to be there. They don’t want to contribute and they will lower the energy levels in the room.
2) Vacationer: the person who’s attending because it’s an excuse for a “day off ” from their normal job. They will get involved, but are not really interested in learning anything – more about having fun and avoiding the work they left behind on their desk.
3) Keener: this participant is there to genuinely learn as much as they can from the session. This type of learner is attentive during the session, gets actively involved in group work and brings high levels of energy into the room.
4) Expert: you clearly know more than I do,
http://www.clomedia.com/2008/06/17/engaging-the-prisoner-the-vacationer-the-expert-and-the-explorer/
A thumbs-up or thumbs-down is a common hand gesture achieved by a closed fist held with the thumb extended upward or downward in approval or disapproval, respectively.
What you think you are saying: "Ayyyyy! I'm the fuckin' Fonz!"
What you are actually saying: "Ayyyyy! I'm going to jam my thumb in your anus!"
Give the "OK" Sign in Brazil
What you think you are saying: "Hi Brazil, I'm US President Richard Nixon, and I'm feeling terrific!"
What you are actually saying: "Hi Brazil, I'm US President Richard Nixon, and I'm feeling that you should all go fuck yourselves!"
(Note: The above examples are only valid if you are US President Richard Nixon)
“Understand the differences; act on the commonalities.” Andrew Masondo, African National Congress
“Understand the differences; act on the commonalities.” Andrew Masondo, African National Congress
“Understand the differences; act on the commonalities.” Andrew Masondo, African National Congress
https://hpi.georgetown.edu/cultural/#
Individual values, beliefs, and behaviors about health and well-being are shaped by various factors such as race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability, sexual orientation, and occupation. Cultural competence in health care is broadly defined as the ability of providers and organizations to understand and integrate these factors into the delivery and structure of the health care system. The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, English proficiency or literacy. Some common strategies for improving the patient-provider interaction and institutionalizing changes in the health care system include:(20)
“Understand the differences; act on the commonalities.” Andrew Masondo, African National Congress
https://hpi.georgetown.edu/cultural/#
Individual values, beliefs, and behaviors about health and well-being are shaped by various factors such as race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability, sexual orientation, and occupation. Cultural competence in health care is broadly defined as the ability of providers and organizations to understand and integrate these factors into the delivery and structure of the health care system. The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, English proficiency or literacy. Some common strategies for improving the patient-provider interaction and institutionalizing changes in the health care system include:(20)
white privilege http://dcgazette.com/2016/white-privilege/
Health Care
Culturally based beliefs significantly influence how patients seek out and respond to medical care. As international populations grow, Hospitals and physicians nurses all need to understand the different cultural sensitivities, languages and religions that can confound caregivers and affect the quality of care.
http://greenlining.org/blog/2015/a-case-study-in-white-privilege/
http://pub209healthcultureandsociety.wikispaces.com/%27A+Tree+Without+Roots%27+-+The+Importance+of+Cultural+Safety+in+the+Healthcare+System
Picture is from Yellowknife
culture no one has to talk about it, it doesn’t have to be written down, yet everybody knows it.
Aboriginal teachings encompass a totality of the human condition – physical, spiritual, mental and emotional – and the significance of balance is emphasized. All aspects of life are intricately interconnected. Relationships are fundamental to understanding the nature of events, and establishing standards of behavior. Separating things out from each other and studying them as singular entities without a wholistic viewpoint as an organizing point does not fall within the natural way of thinking in Aboriginal epistemology.
1. 10 things in common
Split everyone into pairs and hand each pair a piece of paper. Each pair is responsible for finding 10 things they have in common with one another. Remember to tell everyone easy cop-outs aren’t allowed, like “we both have hands”. Once they find 10 things they have in common, they share their discoveries with the group.
The point of this icebreaker is to help direct conversations and to find some similarities between you and your partner. You can repeat this a few times to have people chat with someone new.
https://www.achievesolutions.net/achievesolutions/en/Content.do?contentId=10241
The #1 Mistake in Modern Communication
no emotional communication ever No emotional communication via email, text or voicemail (AKA asynchronous media). Ever.
Unfortunately this is often how nursing is, we had to endure certain hardships as new nurses, and many feel the need to see one, do one, and teach one in the same manner, putting new graduate nurses through the same hardships they endured.
Confucius or One should not treat others in ways that one would not like to be treated
This is really what we are trying to do with all people. Basically treat other people how they want to be treated.
The Platinum Rule meets people where they are at, it is a balanced approach that gives power to the client. Just like all areas of the medicine wheel need to be balanced for (w)holistic health for the client, where the client is the person, family, group, or community. Indigenous teachings support addressing all areas of the person to achieve balance.
We all know the Golden Rule “do unto others…” but in health care, this does not work all the time for all people receiving or providing care. The Platinum Rule supports acceptance of all and avoids value and moral judgments to support care. Learn about the Platinum Rule and you.
http://culturalorganizing.org/the-problem-with-that-equity-vs-equality-graphic/
https://medium.com/@sandeepkumar_52041/equality-equity-and-justice-5f71ebe31245
https://www.winnipeg.ca/clerks/boards/citizenequity/pdfs/white_privilege.pdf
https://www.cbc.ca/news/canada/saskatchewan/anti-racism-education-blue-sky-phone-in-1.5042728
http://timeandplace.ubc.ca/user-guide/theme-ii/privilege-walk-version-1/ https://www.buzzfeed.com/nicolaharvey/what-is-privilege here is one with a video……. And some similar questions….
