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Cultural Diversity & Inclusion
Editor's Notes
- Essential in closing the disparities gap in healthcare. Services that are respectful and responsive to health beliefs, practices, cultural and linguistic needs to diverse patients can help bring about positive outcomes.
- Becoming “culturally competent” and “inclusive” is an ongoing process. We’ll focus on specific steps you can take to become more culturally competent and inclusive. Respect differences and have a willingness to learn.
- This is one definition that’s out there. All about respect and dignity. What’s in it for the nurse? Increased feeling of personal satisfaction. Not only about doing it “because it’s the right thing to do”. As we’ll see, there are many facets to this issue. Also increases likelihood that patients will follow plan of care, creating positive outcomes for patient/family.
- Aspects of culture/diversity ***Village of 100 here – 3 minutes
- Culture influences many aspects of care (see above) ie- in some fatalistic cultures, it’s believed that illness is due to God punishing them. In situations like this, it is going to be necessary to address this issue (perhaps you could include pastoral care while also speaking with pt/family about need to provide medical treatment). Who should provide treatment – many religions/cultures do not approve of treatment by an opposite sex clinician (RN or MD). Food and eating habits may be affected by culture (ie – Muslims and pork, Ramadan in Islam). Communication – have to keep items such as eye contact, gestures, personal space in mind.
- Information from Pew Research showing the changes in the US population (see values above). The last column has different, lighter colors since these figures are “projected”. Andres Tabias calls this an “upside down” world (ie-things are being flipped “upside down” from what they once were in terms of rapid change in the US such as in 2010 we have an African American President – 30 years ago this would have been hard to believe).
- AHRQ states that biases, stereotyping and prejudices contribute to disparities in healthcare. Personal factors also play into this (such as patient adhering to diet, etc), but it’s a fact that biases, stereotypes, etc play a huge role in health disparities. In one Harvard study, 23% of African Americans reported having gotten poor quality care b/c of race vs. 1% of whites. In order to reverse the trend of disparities in healthcare increasing or staying the same, we have to be the generation of nurses to put an end to this.
- Have you heard that multitasking really isn’t multitasking? What studies show is that when someone is multitasking, they are mostly focusing on one main project. The other things that they are doing are being done without really thinking because they’ve done them so many times before, all the while using a “map” of “script” of how we did those activities in the past. What we’ve seen (through looking at the concept of branding) is that we use what are called “cognitive scripts” in our day to day interactions with others. A cognitive script is (see definition above) and can influence how we feel and behave towards others. Cognitive scripts are formed through habits and often “mindlessly” (more on this in a bit). The scripts work until the variables change, then we need a paradigm shift (or a change in viewpoint). Once we change our paradigms, we realize how others see things differently from our own apparently equally clear and objective point of view. With this in mind, what we need to do is to become more “mindful” in our thinking.
- Stereotyping involves positive and negative beliefs (usually negative) that we apply to entire category of people (ie- all Chinese are……..all Buddhists believe…….etc). However, stereotyping is usually wrong. We have to remember that everyone has multiple identities and that just b/c someone belongs to one “category” does not mean that that defines who they are as an entire person. Interesting that we are more likely to stereotype when we are stressed and tired – something that nurses are familiar with, right? Ethnocentrism is the tendency to believe that one's ethnic or cultural group is centrally important, and that all other groups are measured in relation to one's own.
- As mentioned before, becoming culturally competent is an ongoing process. The American Academy of Pediatrics identified 3 stages to becoming culturally competent. Develop awareness includes recognizing the value of diversity, doing an honest assessment of one’s own biases and stereotypes (something we will do in just a moment). Acquiring knowledge-you can never learn everything about another culture. However, acquiring knowledge about other groups is the foundation of cultural competence. Develop and maintaining cross cultural skills – becoming culturally competent includes informal interaction and networking (including experience).
- What we are seeing today is a move to inclusion. We are all aware that diversity exists. We all know that we live and work in a world that is diverse. We got it! Inclusion is about bringing everyone to the table. It’s about respect and dignity. It’s about coming to an agreement that with our differences (diversity), what can we create…….together? (Inclusion). Inclusion is about bringing outsiders in.
- So how do we go about practicing inclusion? Here are some tips. Ask the participants if they have any others that have helped them in the past or anything that they can thing of to add and they will try in the future. It’s important to keep in mind that when dealing with those of another culture, start with being formal. Use Mr., Mrs, etc. In most cultures, the relationship between healthcare practicioner and patient is much more formal than in the US. If the patient prefers for the relationship to be less formal, they will let you know. Regarding treating others the way they want to be treated, here’s a story of “inclusion” and accomodation to someones culture (here we tell the story of the Vietnamese patient in labor with ice chips given to her. She ended up dehydrated since in her culture, birth is seen as losing heat. Why would she want ice chips or cold water? Something as simple as the temperature of the water can make a huge difference in quality of care that our population receives). “ I know a little about your culture, but please tell me anything that can help me in providing you with excellent care” (or if you don’t know anything about their culture, leave out the first part of that sentence).
- The above statistics are for CMC. We have forms in many languages (consents, pt ed documents, etc), interpreters that can help. Interpreters can also help us in understanding the pts cultural needs. Charlotte Mecklenburg Schools states that their student population includes those from 152 countries, speaking 97 languages (CMS, 2006). Most likely, these students are/will be coming to us, so we need to accommodate their needs.
- Self explanatory. Will show Mosby’s Cultural Guide.
- The CHS tree of life even stands for inclusion. The tree of life is recognized by many religions (Buddhism, Hinduism, Christianity, Mormonism). The meaning is “everyone is connected”. CHS chapels are now designed for mulitple faiths. -Joe Piemont, CHS President Diversity Seminar, 2010
- Question from Partnership for Clear Health Communication at the National Patient Safety Foundation. See next slide for answer (Participants will be asked to answer this out loud).
- Question from Partnership for Clear Health Communication at the National Patient Safety Foundation. See next slide for answer (Participants will be asked to answer this out loud).
- With first note above: there has been an initiative to lower the reading level of healthcare publications, forms, etc. WebMD, ehealth.com have all lowered the reading level that their publications are written in online – this is important when you think of the #’s of people getting their health information from the web on sources like ehealth, etc. Carenotes (which we all have access to) is written on a 3 rd to 4 th grade level. If it seems elementary, it’s on purpose. Those with low literacy levels are more likely to skip medical testing, end up in the ER more often and have a harder time managing chronic diseases like HTN and DM. As we look at healthcare reform and the costs of low health literacy, it’s obvious that we need to play our part in this problem. ***Ask me 3 poster shown here*** ****Video from Sharepoint at this point??????
- So what can we do? (See tips above). Plus, remember someone can be illiterate in their own language (I’ll tell the story of my cancer pt who was illiterate, yet was given written information on an upcoming procedure he was going to have). Realize that medical terms are a “language”. Speak to people in plain language. Most people don’t know what it means if you say to them “You’re NPO”. In plain language tell them what that means.