Cultural Comptetence BC lab educators Conference Keynote Adddress
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Cultural competence and humility is required to design culturally safe and sensitive learning in simulation. This presentation features lessons learned while living and working at the University of Calgary, Qatar.
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Cultural Comptetence BC lab educators Conference Keynote Adddress
- 1. Cultural Competence in Nursing Education Journey to Qatar BC Lab Educators Conference, May 2012 Colette Foisy-Doll RN BScN MacEwan University May 14, 2012 foisydollc@macewan.ca
- 2. Presentation Objectives Explore: Culture Cultural Competence Cultural Sensitivity Cultural Awareness Cultural Safety Cultural Humility Explore Elements of Qatari Culture Sharing Lessons Learned 3/22/20152
- 3. Defining Culture... 3/22/20153 University of Calgary Qatar
- 4. “Most simply, the learned and shared behaviours of a community of interacting human beings” (Useem, J., & Useem, R., 1963, p. 169) “A process that happens between individuals and groups within organizations and society, and that confers meaning and significance” (Varcoe & Rodney, 2009 as cited in CNA, 2010) 3/22/20154
- 5. Iceberg Model of Culture 3/22/20155 Visible Culture Conscious Awareness Invisible Culture Out of Awareness Dress… Heroes… Traditions… Artefacts… Customs… Symbols… Behaviours… Race… Gender… Age… Assumptions… Beliefs… Values…Perceptions… World Views… Attitudes… Body Language… Patterns of superior/subordinate… Patterns of handling emotions… Problem solving approaches… (Communicaid Blog, 2009)
- 6. Ethnic Culture Business/Corporate Pop Fashion Healthcare Societal Organizational Professional Types of Culture, Sub Cultures National 3/22/20156
- 7. “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 profound respect for cultural differences and are eager to learn and willing to accept, that there are many ways of viewing the world.” ( Udo, 2008) 3/22/20157 University of Calgary Qatar
- 8. 3/22/20158
- 9. Concepts, Constructs, and Theories Cultural Competence Dr. Madeleine Leininger • Anthropologist/Nurse (50s-60s) Transcultural Nursing (1970) Theory of Culture Care Diversity and Universality • Qualitative Ethnoresearch Method – Culturally Congruent Care Leininger, 1991 3/22/20159
- 10. Dr. Leininger’s 2050 Vision… “Culturally congruent care needs to further established as a core competency…Currently these care constructs need to be taught and creatively used to provide culturally congruent care for beneficial health and well-being outcomes” (Leininger,1994). 3/22/201510
- 11. CNA: Position on Cultural Competence in Nursing “Aplication of knowledge, skills, attitudes, or personal attributes required by nurses to maximize respectful relationships with diverse populations of clients or co-workers. Underlying values: inclusivity, respect, valuing differences, equity, and commitment” (CNA, 2010) 3/22/2015
- 12. Other Nursing Theories… Dr. Jean Watson Model of Human Care “nurse enters into a deeper subjective human dimension related to self-knowledge, self-control, self-caring, and even self-healing potential” (Watson, 2007, p. 12) 3/22/2015
- 13. Cultural Sensitivity Process that, “Alerts a person to the legitimacy of difference and begins a process of self- exploration as powerful bearers of their own life experience and realities and the impact that has on others” (NZNC, 2005, p. 4) . 3/22/201513
- 14. Cultural Awareness “ A beginning step towards understanding [of self] and learning that there is a difference in emotional, social, economic and political contexts in which people exist” (NZNC, 2005) 3/22/201514
- 15. Cultural Safety: Definition “Effective nursing practice of a person or a family from another culture as determined by that person or family” (NZNC, 2005, p. 4) 3/22/201515
- 16. Cultural Safety Ramsden’s Cultural Safety Model (1992) • Subsumes cultural awareness, sensitivity and competence • Both professional process and outcome • Grounded in self-awareness of own power, prejudice, attitude • Client-driven, individual or family defines safety • Gives power back to the client • Removal of barriers and inequities (Social Justice) 3/22/201516
- 17. Cultural Humility: Definition 3/22/201517 • “It is a process that requires humility [each has something of great value to learn from the other] as individuals continually engage in self- reflection and self-critique as lifelong learners and reflective practitioners… to redress power imbalances to develop mutually beneficial non- paternalistic partnerships in care” (Tervalon & Garcia, 1998, p. 117)
- 18. Economic Status Religion Education Gender Generational Norms Regions Race/ Ethnicity Elements of a Cultural Profile 18 Values: shared ideas of what is good, right, true and desirable in the society.
- 19. Educators and Educational Institutions… Major role to play: –Shaping knowledge base, attitudes, understanding of culture –Explore frames and how they impact nursing care 3/22/201519
- 20. Why Simulation? 3/22/201520 UCQ stock photo, 2012
- 22. QATAR Government: Royal Al Thani Family head of Constitutional Monarchy Population: approx. 1 million (2011 est.) 20% Nationals (Qatari) 80% other Official Religion: Muslim 77.5%, Christian 8.5% other 14% (2004 census) Economy: Gas and Oil accounts for 55 % GDP roughly 85% of export earnings, and 70% of government revenues Temperatures: 35 – 50 degrees Celsius from May - October 3/22/2015 22 http://www.qatarembassy.net University of Calgary Qatar
- 23. عليكم السالم His Highness Sheikh Hamad bin Khalifa Al-Thani Sheika Mosa http://www.qatarembassy.net
- 24. 3/22/201524 Capital City: Doha -96% of total population (2008) is urban People from more than 55 countries including... America , Australia, New Zealand, England, Holland, France, Egypt, Scotland, Canada, South African, most other European countries, Russia, Japan... Form the EXPATRIATE POPULATION http://www.qatarembassy.net
- 25. 3/22/201525 Qatarization Program … Building a Progressive Nation University of Calgary, Qatar
- 26. University of Calgary Qatar: Faculty and students engaged in a creative learning process with people from diverse cultures 3/22/201526 University of Calgary Qatar
- 27. Nursing in Qatar Image of Nursing Recognition as a Profession Public Awareness & Understanding of Nursing
- 28. Languages: - Arabic (official), English commonly used as a second language - 55% speak variety of languages -India alone has about 415 languages, Pakistan 72, Bangladesh 39, 171 in Philippines -Urdu (Pakistan), Indian dialects, Farsi (Persian), French www.ethnologue.com 3/22/201528
- 29. Trends influencing Cultural Diversity in our Learner Population • Globalization • Cultural Competence • Cross-Cultural Living 3/22/201529
- 31. ISLAM FIVE PILLARS OF FAITH Iman/Faith: Shahadah Salah /Prayer: 5 x daily Sawm /Fasting: Ramadan Zakat /Alms: Financial Obligation Hajj/ Pilgrimage: Mecca 3/22/201531 http://religioncompass.files.wordpress.com/2009/08/opened_quran.jpg
- 32. •Historically nomadic people •Bedouin tribal groups from Saudi Arabia •social class •Religion and State are one •Viewed as having more progressive and liberal application of Islam I.e. -women allowed to drive, study, work -alcohol is tolerated under strict conditions for non-Muslims www.qatar-info.com 3/22/201532
- 33. Family and Honour (Explorer Qatar, 2009) • Marriage is a family business matter • Men may have up to four wives • Large families • Multi-generational living • Children live with parents until marriage • Courtships are brief with a chaperone present 3/22/201533
- 34. Social Norms: • Courtesy, use of titles in introductions important • Politeness and greetings: women greet women, men greet men • Touch with greeting: same sex only • Direct eye contact is a sign of trust • Status and appearance are important • Exposing the body in public is undignified • Modesty is very important Explorer Qatar, 2009 Asalaam Alaykum 3/22/201534
- 35. Communication... HIGH CONTEXT 3/22/201535 Western Culture Low context Middle Eastern Culture Hofstede, 1984
- 36. Food... 3/22/201536 PHOTOS compliments of Al Tawash Restaurant, Doha (2009)
- 39. IN the name of God the most merciful, the most gracious: “And say to the believing women that they should lower their gaze and guard their modesty: and that they should not display their beauty and ornaments except what must ordinarily appear thereof: that they should draw their veils over their bosoms and not display their beauty except to their husbands” (Qur’an 24: 30-31) 3/22/201539
- 40. Qatari Female Dress for public and prayer Shayla Abaya Hijab Veil 3/22/201540
- 41. Burka : One piece of cloth, covering entire body, in some places the eyes must also be covered. Western Attire and look at home & Woman ONLY functions 3/22/201541
- 42. Qatari Male dress Thobe, Guthra with Tassels 3/22/201542 http://farm4.static.flickr.com/3216/3150545716_22b2da19d5.jpg
- 43. Views of Islam in Healthcare Sharia (Muslim law) Fatwa (Islamic consultation in social matters) -complex decisions are made alone -Specialized scholars or jurists 3/22/201543 (El Nashar, M., & Abdel Rahim, H (2009)
- 44. How are we doing at UC-Q? 11/4/200944 University of Calgary Qatar
- 45. Survey Cultural Accommodations Anecdotal feedback Sim Pilot Focus Group 11/4/200945 NEEDS ASSESSMENT
- 46. Dress in UCQ Labs • “Traditional pieces of clothing for the female are the Naqab, Batoula, Latham, the Qab, Abaya, Shayla and for the man the Thobe, the Guthra, the Aqall and the Gahfia. These are customs in clothing that we wear with great pride and they are important to us. • “it is very important for us to preserve our dignity and privacy and to not be exposed. Allah does not want us to be too exposed or to be not modest. We feel very uncomfortable if we are in this situation” • (Student Comments)
- 47. Culturally Sensitive UCQ Uniforms University of Calgary, Qatar
- 48. Imaging/Videotaping… “we would allow to be videotaped if it was only our group who saw the tape with our faculty member. After the tape should be destroyed” (UCQ Student)
- 49. Building cultural content into scenarios.... Example from Focus Group Scenario: End of Life (Ethical Dilemma) Players: • Nurse from India, UK • Physician from Egypt • Many Family at bedside • Mature Female Qatari women who does not speak English. She is gravely ill and likely not going to live past one or two months. She is not being told and all diagnostic interventions have been put on hold at the family’s request (husband’s decision to make) 3/22/201549
- 50. Faculty Comments
- 51. Faculty Comments: • Male students have limited or no access to female patient care • Faculty find themselves teaching familiar content in very unfamiliar surroundings • I do not know the religious norms for students in this culture, much of what I have learned is second-hand anecdotal information 11/4/200951
- 52. 3/22/201552 Implications for the use of Simulation at UC-Qatar
- 53. Application of Findings: Program, Policy and Process Inclusiveness: Student consultation and membership on committees Gender Considerations: – Culturally proficient approaches to gender mixing for learning experiences – Use simulation for teaching female care for male students Body Exposure: – Student-driven progression re: exposure of body parts – Level use of simulation to facilitate touch and contact across learning experiences Photography and Videography: – Adopt a dual process (Filmed or Not Filmed) – Identify desire for no filming or immediate destruction of tape – Explore options for non-filmed scenarios/roles 11/4/200953
- 54. Challenges for all Educators -cultural proficiency in educators and learners, -cultural safety learning environments, -cultural competency in educational programs, policies and processes, and include -cultural content in curricula. 3/22/201554
- 55. Personal and Professional Growth… Heightened personal and professional cultural awareness, knowledge, and sensitivity Embracing Cultural Competence/Proficiency, Safety and Sensitivity Simulation is a powerful tool for teaching these concepts 3/22/201555
- 56. References for BC Lab Educators Keynote Address Presenter C. Foisy-Doll, May 2012 Association of American Medical Colleges. (1998, February). Contemporary Issues in Medical Education, 1(5). Center for Mental Health Services. (2000). Washington, D.C.: Superintendent of Documents, U.S. Government Printing Office [#20402]. Retrieved April 21, 2010 from http://mentalhealth.samhsa.gov/publications/allpubs/svp05-0151B/iceberg-OP.jpg Canadian Nurses Association (CNA). (2010). Position Statement: Promoting Cultural Competence in Nursing. Retrieved from www2.cna-aiic.ca/CNA/.../PS114_Cultural_Competence_2010_e.pdf Communicaid Blog. (2009). The Iceberg Model of Culture [picture]. Retrieved April 14, 2012 from http://blog.communicaid.com/cross-cultural-training/the-iceberg-model-of-culture/ Explorer Qatar: The complete residents guide. (2009). Dubai, UAE: Explorer Publishing & Distribution LLC. Goode, T., & Harrison, S. (2004). Cultural Care Continuum. Adapted from Cross, T., Bazron, B., Dennis, K., & Isaacs, M., (1989). Adapted by Towards a Culturally Competent System of Care, Volume 1. Washington, DC: CASSP Technical Assistance Center, Center for Child Health and Mental Health Policy, Georgetown University Child Development Center. Retrieved November 10, 2009 from http://gucchd.georgetown.edu/nccc/sidsdvd/continuum.pdf Hofstede, G. (1984). National cultures and corporate cultures. L.A. Samovar & R.E. Porter (Eds.), Communication Between Cultures. Belmont, CA: Wadsworth. Geography of Canada. (2009, September 29). Retrieved September 30, 2009, from http://en.wikipedia.org/wiki/Geography_of_Canada Qatar Embassy Washington D.C. (2010). Retrieved April 10, 2010 from http://www.qatarembassy.net Leininger, M. M. (1991). Culture care diversity and universality: a theory of nursing. New York: National League for Nursing. 3/22/201556
- 57. Leininger, M. M. (1994). Transcultural Nursing education: a worldwide imperative. Nursing and Health Care, (40), 40-51. Leininger, M. M., & McFarland, M. (2002). Transcultural Nursing: Concepts Theories, Research and Practice (3rd ed). New York: McGraw-Hill Medical. Leininger, M. M. (2007). Theoretical questions and concerns: Response from the Theory of Culture Care Diversity and Universality Perspective. Nursing Science Quarterly, 20(1), 9-12. Lewis, M. ed. (2009). Ethnologue: Languages of the world (16 ed). Dallas, Texas: SIL International. Retrieved April 12, 2010 from: http://www.ethnologue.com/ Nursing Council of New Zealand. (2005). Guidelines for Cultural Safety, the Treaty of Waitanga and Maori health in Nursing, Midwifery, Education and Practice. Whanau Kawa Whakaruruhau. Wellington, New Zealand: Nursing Council of New Zealand. Parson, T. (1949). Essays in Sociological Theory. Glencoe, IL. Roshan Cultural Heritage Institute (2001). Definition of culture. Retrieved April 22, 2010 from: http://www.roshan-institute.org/templates/System/details.asp?id=39783&PID=474552 Social Cultural Barriers to US Healthcare. (2001, May 5). Opening Doors: National Program Office. Retrieved April 21, 2010 from http://www.rwjf.org/reports/npreports/opendoorse.htm Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defi … Journal of Health Care for the Poor and Underserved, 9(2). Research Library, 117. Udo, O. (2008). Engaging Diverse Communities. Retrieved April 21, 2010 from: http://www.northlandfdn.org/News/EarlyWord/ewsummit08.html#s3 Useem, J., & Useem, R. (1963). Human Organizations, 22(3). Watson, J. (2007). Theoretical questions and concerns: Response from a caring science framework. Nursing Science Quarterly, 20(1), 13. 3/22/201557
Editor's Notes
- Provided me with many insights about how we make assumptions in implementation of educational programs but even moreso, on my development as a culturally competent professional. I will explore some of these, the reasons for them and some possible approaches in the use of Hi-fidelity Simulation
- I do not come to you as an expert in the area of culture, cultural competence, diversity, transcultural nursing …. Rather as someone who has lived a transformational immersion experience who has insights to share, I have my story to tell about what I lived and learned during my year in Qatar.
- There are so many definitions of culture and not one universally accepted one! I like to define things in simple terms that are all inclusive… so this definition was one that served that purpose well. The definitions range from being quite single dimension in focus… such has defining culture by race and language… to other definitions that are multi-dimensional.. And all inclusive…
- http://www.google.ca/imgres?imgurl=http://blog.communicaid.com/wp-content/uploads/2009/06/picture1.jpg&imgrefurl=http://blog.communicaid.com/%3Fp%3D36&h=565&w=752&sz=32&tbnid=DQE2z1yk6_mNkM:&tbnh=106&tbnw=141&prev=/images%3Fq%3Diceberg%2Bmodel%2Bof%2Bculture&hl=en&usg=__Kp7fYGmyPUjZewPNySM-4lvjv1M=&ei=dZrMS8TkLYr-NbCB7fwE&sa=X&oi=image_result&resnum=5&ct=image&ved=0CBcQ9QEwBA Those behaviours which are Visible, observable Testable values Basic Assumptions (values, beliefs, and norms) Culture is often compared to an iceberg which has both visible (on the surface) and invisible (below the surface) parts. Elements of culture which we can plainly see, such as food or clothes, are represented by the upper portion of the iceberg. Those elements which are not as obvious such as why someone eats or dresses the way they do are represented by the much larger portion of the iceberg underwater.
- Not only do groups of people have identifiable culture…. It is layered with the overlaying of many other types of cultures….. All creating a tapestry, a mosaic that blends into, all becoming the larger definition of one’s culture! ACADEMIC INTERGRITY: They value “tribal approach” … help each other, westerners are individually competitive… there we see much more help and support of the other learner… more of a team approach… we had to communicate very clearly our expectations for group vs. individual assessment.
- theory of culture care diversity and universality was conceptualized in the late 1950s and developed for use by the early 1960s. It has been used by many nurses and several health professionals worldwide, and has generated a wealth of new nursing and healthcare knowledge. Culture care is a synthesized and integrated construct and not two separate concepts. The theory is a holistic, culturally based care theory that incorporates broad humanistic dimensions about people in their cultural life context. It is also unique in its incorporation of social structure factors, such as religion, politics, economics, cultural history, life span values, kinship, and philosophy of living; and geo-environmental factors, as potential influencers of culture care phenomena (Leininger, 1991, 1994; Leininger & McFarland, 2006). The term, culturally congruent care, was coined by the theorist in the early 1960s. The purpose of the theory is to discover culturally based emic and etic care phenomena that are congruent or meaningful to cultures, and which influence the lifeways of the people. The theory focuses on identifying the care values, beliefs, lifeways, and symbolic referents related to culture care phenomena that bear upon congruent care factors. The goal of the theory is to discover culturally based care that promotes and/or maintains the health and well-being of individuals, families, or groups (Leininger, 1970, 1991).
- Moving Towards Cultural Competence Continuum http://www.nccccurricula.info/assessment/B3.html Cultural destructiveness: MY way or the HIGHWAY! acknowledges only one way of being and purposefully denies or outlaws any other cultural approaches. Cultural incapacity supports the concept of separate but equal; marked by an inability to deal personally with multiple approaches but a willingness to accept their existence elsewhere. Cultural blindness fosters an assumption that people are all basically alike, so what works with members of one culture should work within all other cultures. Cultural pre-competence encourages learning and understanding of new ideas and solutions to improve performance or services. Cultural competence involves actively seeking advice and consultation and a commitment to incorporating new knowledge and experiences into a wider range of practice. Cultural proficiency involves holding cultural differences and diversity in the highest esteem, pro-activity regarding cultural differences, and promotion of improved cultural relations among diverse groups. Definitions source: Adapted by T. Goode (2004) from: Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Towards a Culturally Competent System of Care, Volume 1. Washington, DC: CASSP Technical Assistance Center, Center for Child Health and Mental Health Policy, Georgetown University Child Development Center. Available at: http://gucchd.georgetown.edu/nccc/sidsdvd/ continuum.pdf (accessed 11/05). Available at:http://www.nccccurricula.info/ documents/TheContinuumRevised.doc Accessed 7/28/06). Graph Source: Goode, T.D. and Harrison S. (2004). Cultural Competence Continuum. Policy Brief 3, 5, Washington, D.C.:National Center for Cultural Competence-Bureau of Primary Health Care Component, Georgetown University Child Development Center. http://www.nccccurricula.info/assessment/B3.html (accessed 11/05)
- Emic knowledge comes directly from cultural informants as they know and practice care with their values and beliefs in their unique cultural contexts. In contrast, etic care knowledge was derived from outsider views of non-local or non-indigenous care values and beliefs such as those of professional nurses. Accordingly, the quality of healthcare and well-being was predicted to be lodged in emic and etic culturally congruent care values and practices that were needed and essential to prevent cultural stresses, conflicts, and imposition of practices often evident in caring for diverse cultures. Providing congruent care could maximize wellness, prevent illnesses, alleviate cultural stresses, and help to sustain quality of cultural life. It is a qualitative research method that enables the researcher to enter the world of the participant and tease out the largely unknown and covert care beliefs, values, and lifeways. The method includes five enabler guides to facilitate discoveries of specific care phenomena.
- Dr. Jean Watson, Founder, created her international nonprofit Watson Caring Science Institute in 2007 with the mission to restore the profound nature of caring-healing in today’s healthcare systems and to retain its most precious resource, caring professional nurses and transdisciplinary care team members.
- There is an emergence of a more unified, yet ironically, culturally diverse, whole person-environment field perspective that invites each person, each culture, each nation state to assert its own belief system, values, and hopes for what is health, healing, wholeness, and quality of living/dying for self and others -model starts with self and moves from self to other and connects with an infinite universal field of cosmic love that unites the entire field of humanity and planet earth/universe itself (Watson, 2005). -embraces the wholeness of being/becoming with acknowledgement of notions such as consciousness, intentionality; non-physical, subjective life world; inner healing processes and patterns; and transcendence, spirit, and unity of connectedness with universal energy and life source. Such emerging concepts and experiences awaken us to where illness, trauma, injury, crisis, and even death, become an opportunity to return home to deep soul emergence, meaning-making, seeking right-relation with self-other, and life source itself. -Such a shift in worldview is consistent with not only the caring theory in my work, but the timeless heritage of nursing and human phenomena across time, as well as the most current and futuristic extant nursing theories in general.
- Studies support the notion that despite great efforts to increase the legitimacy of cultural differences, by and large, these have only marginally effective in changing the attitudes of nurses. (Goold,2001;Blackford, 2005; McMurray, 2009). -NURSES in Australia, having been taught cultural care theory over three decades, “are not prepared to care for Australia’s indigenous people…. Racism, prejudice and discriminatory practices are alive and well in nursing and the healthcare system in general. p. 94 NURSE Canadian Scholars exploring cultural safety Smye, Browne, Anderson, McCann, Gustafson, Varcoe, Stout and Downey 2002-to date.
- Power shift from HCP to being solely on the client. NURSE IS NOT here to impose or negotiate, but to learn, become informed and to empower others.
- Treaty of Waitangi of 1840: Charter for social and economic rights and self-governance for Maori people Reemergence to uphold the conventions in the treaty occurred as a result of disease and poor health status of the indigenous Maori people. Poverty, crime and destructive lifestyles and failures leading to the near societal collapse. Now a part of nursing education in NZ. When one group far outnumbers another or has the power to impose its own norms and values on another, a state of serious imbalance occurs which threatens the identity, security and ease of other cultural groups, thus creating a state of disease” (NANC, 1992,p. 1). The term cultural safety was coined by nursing students in NZ.
- Power shift from HCP to being solely on the client. NURSE IS NOT here to impose or negotiate, but to learn, become informed and to empower others.
- What are Cultural Values.....? A set of rules or a way of thinking about certain aspects of life and living that are adopted by the majority as being acceptable and normal practice. What we hold dear as being good and true for a community, family, world. Creating a PERSONAL Cultural Profile....could look like this…. Explore variables or factors that influence our values and value systems…. that stem from beliefs and practices that are derived from the culture you live in. When I arrived in Qatar… I engaged in this process daily.. Comparing and contrasting our two different cultures and looking for ways of understanding what I did not. What did I arrive with …. ? Vs. What greeted me? What are my areas of blindness, biases, ignorance, conflicts? Leininger tells us that Teaching Faculty must first become cognisant of their own beliefs and values and biases so that they do not greatly interfere with the student’s learning. We help the students to also be aware of their own cultural values… creating stimulating, rich and rewarding learning experiences. I dropped my teacher-centered, teacher-directed, approach (context based learning… but still mine) to teaching health assessment and looked at a new model that would better meet their need for morning timing… COFFEE TALK>>> Clashing of values… timeliness… “Doha time… reminiscent of many other cultures who have differing values of promptness” Insha Allah was introduced… “ Madame, please do not worry… she will be here Insha Allah” And so began what was the beginning of an extremely significant cultural exchange… 30 minutes' of informal sharing about whatever… we talked about everything from raising kids, to religious celebrations, Islam, traditions, nursing care, social norms and values, sex education, marriage, aging parents, women’s roles in families, society, dress, …. You name it, we talked about it! Developed trust, understanding, valuing and a very solid respect for each other. A value system is a set of consistent values and measures that are not true. A principle value is a foundation upon which other values and measures of integrity are based. Values are considered subjective, vary across people and cultures and are in many ways aligned with belief and belief systems. Types of values include ethical/moral values, doctrinal/ideological (religious, political) values, social values, and aesthetic values. It is debated whether some values are intrinsic. Example: Academic Integrity… we hold as a value in our western culture but how we define it was clearly different… is one approach right and the other wrong? Need to look more in depth at the cultural realities in Qatari students
- Experiential Feelings often do not surface until we have experienced them Allows for debriefing in context of these feelings
- I arrived in Qatar with my own cultural egocentrism… I believed that I was culturally very aware and competent but what I learned was that I exhibited signs of cultural blindness….
- Qatar is an independent state in the Southern Arabian Gulf surrounded by Saudi Arabia, Bahrain, the United Arab Emirates and Iran and Iraq. Historical economical revenue Pearl Diving, markets on trade routes, camels, horses,
- Ruled by the al-Thani family since the mid-1800s, Qatar transformed itself from a poor British protectorate noted mainly for pearling into an independent state with significant oil and natural gas revenues. During the late 1980s and early 1990s, the Qatari economy was crippled by a continuous siphoning off of petroleum revenues by the Amir, who had ruled the country since 1972. His son, the current Amir HAMAD bin Khalifa al-Thani, overthrew him in a bloodless coup in 1995. In 2001, Qatar resolved its longstanding border disputes with both Bahrain and Saudi Arabia. As of 2007, oil and natural gas revenues had enabled Qatar to attain the second-highest per capita income in the world. His Highness Emir Sheikh Hamad bin Khalifa Al Thani since June 1995 Shieka Mosa (preferred wife) of four
- Capital City: Doha -96% of total population (2008) is urban People from more than 55 countries including... America , Australia, New Zealand, England, Holland, France, Egypt, Scotland, Canada, South African, most other European countries, Russia, Japan... Form the EXPATRIATE POPULATION: Expat is a person who is temporarily or permanently residing in a country and culture other than that of the person’s upbringing or legal residence. Latin roots.. Meaning ex patrius… out of the fatherland.
- The University of Calgary Qatar In 2007, the University of Calgary opened its first satellite campus, in Doha, Qatar. Generously funded by the State of Qatar, the campus offers nursing degrees to students in the Middle East. They have entered their third year of operations, UCQ currently offers two undergraduate programs: -a generic four-year Bachelor of Nursing (BN Regular Track) and -a Post-Diploma Bachelor of Nursing for qualified and experienced nurses. -Qatari National -sponsorships for Qatari Citizens Future plans include offering nurse education at the Masters and Doctorate levels. Programs of study at UCQ are identical in quality and standards to those offered in the Faculty of Nursing at the University of Calgary in Canada. Every program offered at UCQ is designed to foster nursing leadership in health and wellness in Qatar. The highest standards of instruction and technology will ensure that the UCQ campus meets, and where possible, exceeds expectations to support Qatar’s vision to educate and maintain a sustainable world-class nursing workforce. The defining characteristic of UCQ will be its focus on the development of high levels of clinical competence and nursing scholarship. As part of this commitment, they have asked that I develop a plan for integration of current technologies that support excellence in nursing education. I have completed 6 mos. And will be leaving in December 2009. All learners are studying as ESL students. In order to support student success, UCQ focuses on providing support for English language proficiency and academic skills needed by applicants and students. This is a specific goal in the development of the nursing clinicians and leaders desired by the State of Qatar. UCQ also works actively with existing and potential stakeholders in Qatar to create clinical learning experience for its students and to provide sponsorship and support for students in UCQ programs. Enrollment: In the 2008-09 academic year, 55 students enrolled in the BN Regular Track Program, of which the first two of four years were offered, and 41 students enrolled in the Post Diploma BN Program. In 2008-09, there were 18 academic staff and 30 administrative support staff. The goal is to build the enrolment of these programs towards a steady state of about 400 students. Funding is growing commensurately. Further information may be found at www.qatar.ucalgary.ca. The atmosphere at UCQ is positive, as faculty and staff work collaboratively to deliver the types of programs and graduates mandated by University of Calgary’s ten-year Comprehensive Agreement with the State of Qatar.
- Leininger< 1978. Transcultural Nursing: A formal area of study and practice which takes in to account the specific values, beliefs and ways of life of people of diverse or similar cultures with the goal of using their knowledge in creative ways to provide culturally congruent care. Melting pot… in order to thrive… we must be able to better understand each other… each of these people is an iceberg…. They can never come close together unless they manoeuvre that which is under the surface…attitude of inquiry, of finding ways to come closer to acceptance and understanding of each other. In essence, what we are talking about is becoming culturally competent.
- - Arabic (official), English commonly used as a second language: A - 55% speak variety of languages -India alone has about 415 languages, Pakistan 72, Bangladesh 39, 171 in Philippines -Urdu (Pakistan), Indian dialects, Farsi, French
- Globalization…. Boundaries where education is concerned are disappearing…. Online education has created a global accessible community and Colleges
- State and Religion are ONE I want to share what I learned in the first few months…. Story about class…. Government and Law is based on both Islamic and civil law codes; discretionary system of law controlled by the Amir, although civil codes are being implemented; Islamic law dominates family and personal matters; has not accepted compulsory ICJ jurisdiction
- Professing Faith/ IMAN "There is none worthy of worship except God and Muhammad is the messenger of God." This declaration of faith is called the Shahadah, a simple formula that all the faithful pronounce. The significance of this declaration is the belief that the only purpose of life is to serve and obey God, and this is achieved through the teachings and practices of the Last Prophet, Muhammad. Salah/Prayer: Salah is the name for the obligatory prayers that are performed five times a day, and are a direct link between the worshipper and God. There is no hierarchical authority in Islam and there are no priests. Prayers are led by a learned person who knows the Qur'an and is generally chosen by the congregation. Prayers are said at dawn, mid-day, late-afternoon, sunset and nightfall, and thus determine the rhythm of the entire day. These five prescribed prayers contain verses from the Qur'an, and are said in Arabic, the language of the Revelation. Personal supplications, however, can be offered in one's own language and at any time. Although it is preferable to worship together in a mosque, a Muslim may pray almost anywhere, such as in fields, offices, factories and universities. Oftentimes visitors to the Muslim world are struck by the centrality of prayers in daily life. The 'Five Pillars' of Islam are the foundation of Muslim life: Faith or belief in the Oneness of God and the finality of the prophethood of Muhammad; Establishment of the daily prayers; Concern for and almsgiving to the needy; Self-purification through fasting; and The pilgrimage to Makkah for those who are able. Iman or Faith "There is none worthy of worship except God and Muhammad is the messenger of God." This declaration of faith is called the Shahadah, a simple formula that all the faithful pronounce. The significance of this declaration is the belief that the only purpose of life is to serve and obey God, and this is achieved through the teachings and practices of the Last Prophet, Muhammad. Salah or Prayer Salah is the name for the obligatory prayers that are performed five times a day, and are a direct link between the worshipper and God. There is no hierarchical authority in Islam and there are no priests. Prayers are led by a learned person who knows the Qur'an and is generally chosen by the congregation. Prayers are said at dawn, mid-day, late-afternoon, sunset and nightfall, and thus determine the rhythm of the entire day. These five prescribed prayers contain verses from the Qur'an, and are said in Arabic, the language of the Revelation. Personal supplications, however, can be offered in one's own language and at any time. Although it is preferable to worship together in a mosque, a Muslim may pray almost anywhere, such as in fields, offices, factories and universities. Oftentimes visitors to the Muslim world are struck by the centrality of prayers in daily life. A translation of the Adan or Call to Prayer is: God is Great. God is Great. God is Great. God is Great. I testify that there is none worthy of worship except God. I testify that there is none worthy of worship except God. I testify that Muhammad is the messenger of God. I testify that Muhammad is the messenger of God. Come to prayer! Come to prayer! Come to success! Come to success! God is Great! God is Great! There is none worthy of worship except God. Zakah The financial obligation upon Muslims. An important principle of Islam is that everything belongs to God, and that wealth is therefore held by human beings in trust. The word zakah means both "purification" and "growth." Our possessions are purified by setting aside a proportion for those in need and for the society in general. Like the pruning of plants, this cutting back balances and encourages new growth. Each Muslim calculates his or her own zakah individually. This involves the annual payment of a fortieth of one's capital, excluding such items as primary residence, car and professional tools. Sawm/Fasting: Every year in the month of Ramada-n, all Muslims fast from dawn until sundown--abstaining from food, drink, and sexual relations with their spouses. Those who are sick, elderly, or on a journey, and women who are menstruating, pregnant or nursing, are permitted to break the fast and make up an equal number of days later in the year if they are healthy and able. Children begin to fast (and to observe prayers) from puberty, although many start earlier. Although fasting is beneficial to health, it is mainly a method of self-purification and self-restraint. By cutting oneself from worldly comforts, even for a short time, a fasting person focuses on his or her purpose in life by constantly being aware of the presence of God. God states in the Qur'an: "O you who believe! Fasting is prescribed for you as it was prescribed to those before you that you may learn self-restraint." (Qur'an 2:183) Hajj/ Pilgrimage: The pilgrimage to Makkah (the hajj) is an obligation only for those who are physically and financially able to do so. Nevertheless, over two million people go to Makkah each year from every corner of the globe providing a unique opportunity for those of different nations to meet one another. The annual hajj begins in the twelfth month of the Islamic year (which is lunar, not solar, so that hajj and Ramada-n fall sometimes in summer, sometimes in winter). Pilgrims wear special clothes: simple garments that strip away distinctions of class and culture, so that all stand equal before God. The rites of the hajj, which are of Abrahamic origin, include going around the Ka'bah seven times, and going seven times between the hills of Safa and Marwa as did Hagar (Hajir, Abraham's wife) during her search for water. The pilgrims later stand together on the wide plains of 'Arafat (a large expanse of desert outside Makkah) and join in prayer for God's forgiveness, in what is often thought as a preview of the Day of Judgment. The close of the hajj is marked by a festival, the 'Id al Adha, which is celebrated with prayers and the exchange of gifts in Muslim communities everywhere. This and the 'Id al Fitr, a festive day celebrating the end of Ramada-n, are the two holidays of the Islamic calendar.
- Women can not study engineering and technical studies
- Finding an extended care facility…. Only one exists….
- High-Context Communication Hall: "Most of the information is either in the physical context or initialized in the person." Knowledge is situational, relational Less is verbally explicit or written or formally expressed More internalized understandings of what is communicated (ex: "in-jokes") Often used in long term, well-established relationships Decisions and activities focus around personal face-to-face communication, often around a central, authoritative figure Strong awareness of who is accepted/belongs vs. "outsiders" Association Relationships depend on trust, build up slowly, and are stable. How things get done depends on relationships with people and attention to group process. One's identity is rooted in groups (family, culture, work). Interaction High use of nonverbal elements; voice tone, facial expression, gestures, and eye movement carry significant parts of conversation. Verbal message is indirect; one talks around the point and embellishes it. Communication is seen as an art form-a way of engaging someone. Disagreement is personalized. One is sensitive to conflict expressed in another's nonverbal communication. Conflict either must be solved before work can progress or must be avoided. Learning Multiple sources of information are used. Thinking is deductive, proceeds from general to specific. Learning occurs by first observing others as they model or demonstrate and then practicing. Groups are preferred for learning and problem solving. Accuracy is valued. How well something is learned is important. High context cultures are more common in the eastern nations than in western, and in countries with low racial diversity. Cultures where the group is valued over the individual promote group reliance. High context cultures have a strong sense of tradition and history, and change little over time, such as tribal and native societies. For instance, the French assume that the listener knows everything. Therefore, they may think that Americans think they are stupid because Americans will habitually explain everything to their counterparts. Former president Jimmy Carter understood the importance of high-context communication with his colleagues from Israel and Egypt during the peace talks at Camp David. When Prime Minister Begin was about to leave the unsatisfactory negotiations, Carter presented him with pictures of the three heads of state, with the names of each of Begin's grandchildren written on the photographs. The prime minister repeated the names of his grandchildren out loud as he looked at the pictures, reflecting on the importance of the peace negotiations to his grandchildren's futures. Carter recognized that a high-context reference to future generations would induce the prime minister to return to the negotiations. Low Context Communication Hall: "The mass of information is vested in the explicit code [message]." Rule oriented More knowledge is public, external, and accessible. Shorter duration of communications Knowledge is transferable Task-centered. Decisions and activities focus around what needs to be done and the division of responsibilities. Association Relationships begin and end quickly. Many people can be inside one's circle; circle's boundary is not clear. Things get done by following procedures and paying attention to the goal. One's identity is rooted in oneself and one's accomplishments. Social structure is decentralized; responsibility goes further down (is not concentrated at the top). Interaction Message is carried more by words than by nonverbal means. Verbal message is direct; one spells things out exactly. Communication is seen as a way of exchanging information, ideas, and opinions. Disagreement is depersonalized. One withdraws from conflict with another and gets on with the task. Focus is on rational solutions, not personal ones. Learning One source of information is used to develop knowledge. Thinking is inductive, proceeds from specific to general. Focus is on detail. Learning occurs by following explicit directions and explanations of others. An individual orientation is preferred for learning and problem solving. Speed is valued. How efficiently something is learned is important. An individual from a high context culture has to adapt, and/or be accommodated when shifting to a low context culture. High context cultures expect small close-knit groups, where professional and personal life is interrelated. Therefore, a high context individual is more likely to ask questions than attempt to work out a solution independently. Remember that in business, communication is everything, so make sure you know not only what to say, but also how to say it.
- Much of the traditional Qatari musical culture is derived from a legacy of Bedouin poetry, song and dance. Traditional dances such as the Ardah are regularly performed to the accompaniment of an array of percussion instruments, including drums of varying sizes, tambourines, and cymbals. Other instruments played in Qatar include the oud and the rebaba, both stringed instruments, and the Arab flute.
- NOT a RELIGIOUS OBLIGATION: National dress and a matter of pride in the practice of covering the body. Outside the home, most Arab women dress according to religious custom, which means that they must cover most of the body, from head to foot. The traditional black overgarment (abaya) is to the floor with long sleeves and a high neckline, and the hair is covered. Some Arab women are totally covered, including their face and hands, especially Saudis and those with strictly religious husbands. This is meant to protect women protection from unwanted attention Arab men wear the thobe, a loose, ankle-length robe made from fine white cotton (or heavier woollen material in winter). There are different styles of thobe, both in the cut of the cloth and in the fastenings at the neck and front. Perhaps the most distinctive are those worn by the Omanis, which sport a tassel. The thobe can be worn for all occasions, either social or business. An outer cloak, the bisht, is worn on formal occasions and can be very costly, with border embroidery in gold thread and the material itself of the finest quality. The traditional, distinctive head covering is the guthra, a white or red and white checkered cloth held in place by the agal, a black ‘rope’ which was originally a camel tether. There are different types of agal: for example, Qataris normally wear a more African-style headdress, with two long ‘tails’ reaching down the back. Arab men sometimes wear casual dress on very informal occasions or at the beach, but Saudi men are strongly encouraged to wear national dress at all times.
- -Medical providers are ethically and legally bound to seek out advice, it is also religiously forbidden to make these decisions independently -No decision that is complex can be made alone -Specialized scholars or jurists must be consulted http://www.scribd.com/doc/31611585/Qc-10-English-Qatar-Chronicle
- Cultural Accommodations and Perceptions related to Gender, Dress, Religious Practices were explored.
- Data was collected from a variety of sources as my curiosity was peeked. Anecdotal notes Student evaluations Survey Pilot student evaluative comments
- You actually remember the things you do in simulation We value faculty being present Honest feedback Negative comments were framed in a positive way... Patient safety We value faculty being present Honest feedback Negative comments were framed in a positive way... Patient safety
- Recommendations: Continue to develop an increased understanding of and sensitivity to gender issues with this population of learners Photography and Videography : Desire for no filming or immediate destruction of tape Explore options for non-filmed scenarios/roles Gender Considerations: Limit gender mixing as it increases anxiety for most learners however, use simulation to introduce this reality. Body Exposure: Limit exposure of body parts, do more with simulators first to help us build confidence and experience Use simulation more initially to decrease the discomfort of undressing and practicing on each other: levelling touch and contact across learning experiences
- -develop content that is culturally appropriate, rich and diverse for all learners regardless of geographical location -developing intercultural effectiveness to build more inclusive schools and learning communities where we learn from each other. -develop policies and processes that are culturally congruent with the cultural context of a given learner population