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.
This presentation introduces the concepts of cultural competency and health disparities and biases that may arise when treating patients of different backgrounds.
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.
This presentation introduces the concepts of cultural competency and health disparities and biases that may arise when treating patients of different backgrounds.
I had the opportunity to take a course on Human Relations. One of the many issues we discussed was Equal Opportunity and diversity in the workplace. This presentation sums up many of the concerns, issues, and laws on diversity in the workplace and equal opportunity.
Chapter 4Understanding Racism, Prejudice, and White Privilege4-WilheminaRossi174
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Chapter: 4
Understanding Racism, Prejudice, and White Privilege4-1Defining and Contextualizing Racism
4-1
Hoyt Jr. (2012) defines racism as âa particular form of prejudice defined by preconceived erroneous beliefs about race and members of racial groups.â It is supported simultaneously by individuals, the institutional practices of society, and dominant cultural values and norms. Racism is a universal phenomenon that exists across cultures and tends to emerge wherever ethnic diversity and perceived or real differences in group characteristics become part of a struggle for social power. In the case of the United States, African Americans, Latinos/as, Native Americans, and Asian Americansâgroups that we have been referring to as people of colorâhave been systematically subordinated by the white majority.
There are four important points to be made initially about racism:
¡ Prejudice and racism are not the same thing. Prejudice is a negative, inaccurate, rigid, and unfair way of thinking about members of another group. All human beings hold prejudices. This is true for people of color, as well as for majority group members. But there is a crucial difference between the prejudices held by whites and those held by people of color. whites have more power to enact their prejudices and therefore negatively impact the lives of people of color than vice versa. The term racism is used in relation to the racial attitudes and behavior of majority group members. Similar attitudes and behaviors on the part of people of color are referred to as prejudice and discrimination (a term commonly used to mean actions taken on the basis of oneâs prejudices). Another way of describing this relationship is that prejudice plus power equals racism.
¡ Racism is a broad and all-pervasive social phenomenon that is mutually reinforced at all levels of society.
¡ Institutional racism involves the manipulation of societal institutions to give preferences and advantages to whites and at the same time restrict the choices, rights, mobility, and access of people of color.
¡ Cultural racism is the belief that the cultural ways of one group are superior to those of another. Cultural racism can be found both in individuals and in institutions. In the former, it is often referred to as ethnocentrism. Jones (2000) mentioned that historical insults, societal norms, unearned privilege, and structural barriers are all aspects of institutional racism.
¡ People tend to deny, rationalize, and avoid discussing their feelings and beliefs about race and ethnicity. Often, these feelings remain unconscious and are brought to awareness only with great difficulty.
¡ When young children hear the stories of people of color, they tend to feel deeply and sincerely with the storyteller. âIâm really sorry that you had to go through thatâ is the most common reaction of a child. By the time one reaches adulthood, however, the empathy is often gone. Instead, reactions tend to involve minimizing, justifying ...
I had the opportunity to take a course on Human Relations. One of the many issues we discussed was Equal Opportunity and diversity in the workplace. This presentation sums up many of the concerns, issues, and laws on diversity in the workplace and equal opportunity.
Chapter 4Understanding Racism, Prejudice, and White Privilege4-WilheminaRossi174
Â
Chapter: 4
Understanding Racism, Prejudice, and White Privilege4-1Defining and Contextualizing Racism
4-1
Hoyt Jr. (2012) defines racism as âa particular form of prejudice defined by preconceived erroneous beliefs about race and members of racial groups.â It is supported simultaneously by individuals, the institutional practices of society, and dominant cultural values and norms. Racism is a universal phenomenon that exists across cultures and tends to emerge wherever ethnic diversity and perceived or real differences in group characteristics become part of a struggle for social power. In the case of the United States, African Americans, Latinos/as, Native Americans, and Asian Americansâgroups that we have been referring to as people of colorâhave been systematically subordinated by the white majority.
There are four important points to be made initially about racism:
¡ Prejudice and racism are not the same thing. Prejudice is a negative, inaccurate, rigid, and unfair way of thinking about members of another group. All human beings hold prejudices. This is true for people of color, as well as for majority group members. But there is a crucial difference between the prejudices held by whites and those held by people of color. whites have more power to enact their prejudices and therefore negatively impact the lives of people of color than vice versa. The term racism is used in relation to the racial attitudes and behavior of majority group members. Similar attitudes and behaviors on the part of people of color are referred to as prejudice and discrimination (a term commonly used to mean actions taken on the basis of oneâs prejudices). Another way of describing this relationship is that prejudice plus power equals racism.
¡ Racism is a broad and all-pervasive social phenomenon that is mutually reinforced at all levels of society.
¡ Institutional racism involves the manipulation of societal institutions to give preferences and advantages to whites and at the same time restrict the choices, rights, mobility, and access of people of color.
¡ Cultural racism is the belief that the cultural ways of one group are superior to those of another. Cultural racism can be found both in individuals and in institutions. In the former, it is often referred to as ethnocentrism. Jones (2000) mentioned that historical insults, societal norms, unearned privilege, and structural barriers are all aspects of institutional racism.
¡ People tend to deny, rationalize, and avoid discussing their feelings and beliefs about race and ethnicity. Often, these feelings remain unconscious and are brought to awareness only with great difficulty.
¡ When young children hear the stories of people of color, they tend to feel deeply and sincerely with the storyteller. âIâm really sorry that you had to go through thatâ is the most common reaction of a child. By the time one reaches adulthood, however, the empathy is often gone. Instead, reactions tend to involve minimizing, justifying ...
What is Culture? Whatâs In Your Cultural Baggage?
Culture may involve many thingsâitâs a broad concept that can be defined in a wide variety of ways. Each and every community has a culture of its own. Culture is not only dissimilar but also exceptional, and we are able to find a variety of traditions in societies throughout the world.
I would like to focus on aspects of values that are related to etiquette, communication, social interactions, and other elements necessary to fostering sensitivity, awareness and understanding in XXI Centuryâs, ever-expanding international community.
Ethics issues for administrators power point session #7.bb.fa.2017bruce.miller
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I understand how EVERYoneâs perspective is important in our treatment of each other.
I have an understanding how I/we can reconcile this with my own/our schoolâs perspective.
Sharpen existing tools or get a new toolbox? Contemporary cluster initiatives...Orkestra
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UIIN Conference, Madrid, 27-29 May 2024
James Wilson, Orkestra and Deusto Business School
Emily Wise, Lund University
Madeline Smith, The Glasgow School of Art
Have you ever wondered how search works while visiting an e-commerce site, internal website, or searching through other types of online resources? Look no further than this informative session on the ways that taxonomies help end-users navigate the internet! Hear from taxonomists and other information professionals who have first-hand experience creating and working with taxonomies that aid in navigation, search, and discovery across a range of disciplines.
0x01 - Newton's Third Law: Static vs. Dynamic AbusersOWASP Beja
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f you offer a service on the web, odds are that someone will abuse it. Be it an API, a SaaS, a PaaS, or even a static website, someone somewhere will try to figure out a way to use it to their own needs. In this talk we'll compare measures that are effective against static attackers and how to battle a dynamic attacker who adapts to your counter-measures.
About the Speaker
===============
Diogo Sousa, Engineering Manager @ Canonical
An opinionated individual with an interest in cryptography and its intersection with secure software development.
Acorn Recovery: Restore IT infra within minutesIP ServerOne
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Introducing Acorn Recovery as a Service, a simple, fast, and secure managed disaster recovery (DRaaS) by IP ServerOne. A DR solution that helps restore your IT infra within minutes.
This presentation by Morris Kleiner (University of Minnesota), was made during the discussion âCompetition and Regulation in Professions and Occupationsâ held at the Working Party No. 2 on Competition and Regulation on 10 June 2024. More papers and presentations on the topic can be found out at oe.cd/crps.
This presentation was uploaded with the authorâs consent.
Competition and Regulation in Professional Services â KLEINER â June 2024 OEC...
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Cultural Humility, Racial Equity, and the Protective Factors
1. Cultural Humility, Racial Equity, &
Protective Factors
a presentation at the
Childrenâs Trust of South Carolina
Prevention Conference 2017
âEmbracing Prevention, Empowering Communitiesâ
October 2, 2017
Columbia, SC
Charlyn Harper Browne, PhD
Senior Associate, Center for the Study of Social Policy
3. Parenting is. . .
ď§ The single largest variable implicated in poor
childhood outcomes
and
ď§ The single largest variable implicated in healthy
or improved childhood outcomes
ď Buffer against harm and adversity
ď Mediator of damage
ď Optimize childrenâs potential
ď Maximize opportunities for potential to
flourish
4. A Caveat about Parenting
Parenting is contextual.
Common Assumption: âPoor familiesâ have
poorer parenting skills because of the various
social conditions they experience (e.g., economic
inequities, community gang violence, limited
resources).
Emerging Evidence: âFamilies experiencing
povertyâ do not necessarily have weaker skills or
fewer of the qualities that aid child development
than do families living elsewhere.
5. âTraditionalâ Conception of Parenting
ď§ There is a single parenting norm/standard that
all parenting must be compared to.
ď§ Thus:
Differences = Deviances = Deficiencies
ď§ This minimizes or ignores important
differences in what cultures expect of and
understand about parenting and parent-
child relationships.
6. Parenting is a Cultural Act
ď§ Culture influences parentsâ:
ď Beliefs
ď Definitions (e.g., âgood parentingâ)
ď Values
ď Expectations of children
ď Behaviors
ď§ Culture influences parent-child relationships
ď§ Culture influences how parenting programs are
delivered and whether they are
accepted/effective
7. Iceberg Analogy of Culture
Surface Structure (external elements)
dress * food * music * drama visual
arts * celebrations * traditions * etc.
Deep Structure (internal elements)
ethos * norms * values * worldview
The ways people make sense of their
reality and lived experience
ď§ Ontology
ď§ Epistemology
ď§ Axiology
ď§ Cosmology
8. Culture Defined
ď§ âA set of values, beliefs, and ways of thinking
about the world that influences everyday
behaviorâ (Zepeda, Gonzalez-Mena, Rothstein-
Fisch, Trumbull, 2006, p. 2).
9. Research Findings:
Different racial and ethnic groups seem to
ď§ understand aspects of parenting differently
ď§ have different perceptions about when children
should reach milestones
ď§ view the importance of sources of information
differently (Kim & Hong, 2007; Lubell, Lofton, &
Singer, 2008; Melendez, 2005; Pinderhughes,
Dodge, Bates, Pettit, & Zelli, 2000; Spicer, 2010).
10. Typical Strategies for Being Culturally
Responsive
Building:
ď§ Cultural Sensitivity: The awareness of and
sensitivity to othersâ practices and cultures
ď§ Cultural Competence: Knowledge about
diverse cultures
11. Often Overlooked Strategy
Cultural Humility: A willingness to suspend what
you know, or what you think you know, about a
person/a group of people based on generalizations
about their culture
ď§ Shifts the focus of trying to understanding other
people to a focus on self-awareness
ď§ Acknowledges that oneâs own perspective may be full
of assumptions and prejudices
Tervalon, M. & Murray-Garcia, J. (1998). Cultural humility vs. cultural competence: A critical distinction in defining
physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117.
12. Principles of Cultural Humility
Tervalon, M. & Murray-Garcia, J. (1998). Cultural humility vs. cultural competence: A critical distinction in defining
physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117.
ď§ Lifelong learning and critical self-reflection
ď§ Recognizing and challenging power
imbalances for respectful partnerships
ď§ Institutional accountability
13. Cultural Humility: Principle 1
Lifelong Learning & Critical Self-Reflection
ď§ Investigating and acquiring an understanding of
key constructs
ď§ Understanding the complexities of individual
and collective culture
ď§ Examining oneâs own assumptions, prejudices,
and expectations about others; trying to figure
out how to suspend judgments
14. Key Construct:
Reframing âDifferencesâ
ď§ Reject the idea of a single human norm and the idea
Differences = Deviances = Deficiencies
âIt is not our differences that divide us. It is our
inability to recognize, accept, and celebrate those
differences.â Audre Lorde
16. Declaration. . .
ď§ This an open environment in which we not only
acknowledge the elephant in the room, we must
welcome it!
ď§ To have a dialogue in an authentic way, we must be
willing to venture into some challenging and
uncomfortable territory.
17. Race
White Privilege
âI believe in the power
and mystery in naming
things. . . In naming
what is right in front of
us because that is
often what is most
invisible.â
Eve Ensler,
The Vagina
Monologues
âWhen we name the
things that make us
uncomfortable or
afraid, then demons
are faced, silences
are broken, and
freedom is won.â
Eve Ensler,
The Vagina
Monologues
Inequities
Differential Treatment
Racism
Implicit Bias
18. Reasons This is a Difficult Discussion
ď§ Uncomfortable and highly emotional
ď§ Not understanding the types of racism
ď§ Failing to acknowledge the pervasive role of race
ď§ Preferring to address symptoms rather than the
roots of social problems
ď§ Preferring to address issues of gender and social
class rather than race
19. ď§ Several studies have shown: âWhites and
People of Color differ greatly in their
perceptions of race and racial inequality in
America todayâ (Byrd & Mirken, 2011, p. 4).
Byrd, D., & Mirken, B. (2011). Post-Racial? Americans and
Race in the Age of Obama. Berkeley, CA. Greenlining Institute.
Another Reason. . .
20. Examples of Differences in
Perceptions of Racial Injustice
âWhen you are a minority and refute the notion that you were
charitably allowed into a clubâthat you were being done a favor,
not that you earned itâyou will be punished, until it has been
determined that you have learned your lesson.â
Browne, R. (2017, September 12). Colin Kaepernick has a job. The Bleacher
Report. http://bleacherreport.com/articles/2732670-colin-kaepernick-anthem-
race-in-america
The Los Angeles City Council voted to eliminate Columbus Day from
the city calendar and replace it with âIndigenous Peoples Dayâ,
siding with activists who view the explorer as a symbol of genocide
for native peoples in North America and elsewhere.
http://www.latimes.com/local/lanow/la-me-ln-indigenous-peoples-day-
20170829-story.html
21. Key Construct: Implicit Bias
The unconscious emotions and stereotypes that
affect our understanding, actions, and decisions
ď§ Activated involuntarily and without an individualâs
awareness or intentional control
ď§ Develop across the lifespan through exposure to
direct and indirect messages, and through
media images and messages
http://kirwaninstitute.osu.edu/research/understanding-implicit-bias/
22. Key Construct: Racism
ď§ Racism is a SYSTEM: structures, policies, practices,
and norms
ď§ A worldview that overtly and covertly attributes
value and normality to White people and
whiteness, and devalues, stereotypes, and
labels âPeople of Color' as âother,â different,
less than, or render them invisible.
Aspen Institute Roundtable on Community Change
Jones, C. P. (2003). Confronting institutionalized racism in public health. Atlanta, GA: Emerging Investigations and Analytic
Methods Branch, Centers for Disease Control and Prevention.
23. Individual and Inter-Group Racism
ď§ Personal feelings, beliefs, and actions:
⌠Microaggressions
⌠Personal prejudices
⌠Use of racial slurs
⌠Inter-group tensions
⌠Lack of diversity and inclusion
⌠Lack of cultural humility
Aspen Institute Roundtable on Community Change
24. Structural Racism
ď§ Historical, social, political, institutional, and cultural
factors that contribute to, legitimize, and
facilitate the maintenance of racial inequities
ď§ Aspects of our history and culture that have
allowed the privileges associated with
âwhitenessâ and the disadvantages associated
with âcolorâ to endure and adapt over time
Aspen Institute Roundtable on Community Change
26. U.S. Department of Education Report
Hsieh, S. (2014, March 21). 14 disturbing stats about racial inequality in American public schools. The Nation. Retrieved from
www.thenation.com/blog/178958/14-disturbing-stats-about-racial-inequality-american-public-schools#
1. Black students accounted for 18% of the countryâs
pre-K enrollment, but made up 48% of pre-school
children with multiple out-of-school suspensions.
2. Black students represent 16% of Americaâs public
school students, but represent 27% of students
referred by schools to law enforcement, and 31% of
students arrested for an school offenses.
3. Black students tend to get less instructional time
because theyâre far more likely to receive out of
school suspensions or expulsions.
27. Dept. of Education Report, cont.
Hsieh, S. (2014, March 21). 14 disturbing stats about racial inequality in American public schools. The Nation. Retrieved from
www.thenation.com/blog/178958/14-disturbing-stats-about-racial-inequality-american-public-schools#
4. A quarter of the schools with the highest percentage
of Black and Latino students did not offer Algebra II;
a third of these schools did not offer chemistry.
5. Black, Latino, and Native American students
attended schools with higher concentrations of
first-year teachers (3-4%) than White students (1%).
6. Black students were more than three times as likely
to attend schools where fewer than 60% of teachers
met all state certification & licensure requirements.
28.
29. Key Construct: White Privilege
The implicit attribution of superiority.
Benitez, M., Davidson, J., & Flaxman, L. (2009). Small schools, big ideas: The essential guide to successful school transformation.
San Francisco, CA: Jossey-Bass.
30.
31. Internalized White Privilege
âIt is the role, responsibility, and moral imperative of
White, anti-racist transformational leaders who are
committed to achieving equity to:
ď§ take a critical look at their own privilege
ď§ recognize and discuss this privilege as it relates to the
tacit assumptions they and their colleagues may hold
ď§ develop the courage to use their privilege to challenge
racism in institutional settings.â
Benitez, M., Davidson, J., & Flaxman, L. (2009). Small schools, big ideas: The essential guide to successful school transformation.
San Francisco, CA: Jossey-Bass.
32. Cultural Humility: Principle 2
Recognizing and Challenging Power
Imbalances for Respectful Partnerships
ď§ Relinquishing the assumption of a hierarchy in a
relationship (e.g., one w/answers-one w/problems).
ď§ Recognizing that each person/group brings
something different into an interaction.
ď§ Both people/groups must collaborate and learn
from each other for the best outcomes.
33. Recognizing and Challenging Power
Imbalances for Respectful Relationships
âThe real tradition of this country is a testing of the limits
of people of color, to see how we can be pushed until we
either give up (and give in) or fight back (and die). The
remaining optionâto persistâis the one that has always
been inconvenient for White America. Colin Kaepernick
is inconvenient.â
Browne, R. (2017, September 12). Colin Kaepernick has a job.
The Bleacher Report. http://bleacherreport.com/articles/2732670-
colin-kaepernick-anthem-race-in-america
âIt is not about the flag or the anthem. . . . This is a
protest about whether or not the country has fulfilled its
promise of equal protection under the law to all of its
citizenry.â Wright, N. (2017, September 27). Fox News.
https://www.dailykos.com/stories/2017/9/26/1701881/-Incredibly-
powerful-host-asks-the-question-media-outlets-aren-t-asking-about-
the-NFL-protests
34. Cultural Humility: Principle 3
Institutional Accountability
ď§ Organizations should model principles 1 and 2
ď§ Develop partnerships with people and groups
who advocate for others
ď§ Cultural humility, by definition, is larger than
individualsâit must be addressed systemically
35. Diversity vs. Inclusion
ď§ Diversity: creating an organizational environment that
reflects differences with respect to race, ethnicity, age,
gender identity, sexual orientation, education,
socioeconomics, religion, etc.
ď§ Inclusion: proactive behaviors that make each person in
an organizationâespecially those who have been
historically marginalizedâfeel welcomed and a genuine
part of the organizational culture, including decision-
making.
Diversity is being invited to the party;
inclusion is being asked to dance.
36. Equality vs. Equity
Equality and equity are two strategies that can
be used to produce fairness.
ď§ Equality is treating everyone the same.
ď§ Equality can only work if everyone starts from
the same place and needs the same help.
ď§ Equity is providing the opportunity for everyone
to get what they need to be successful.
38. Risk and Protective Factors
Risk Factors
Conditions or attributes of individuals, families,
communities, and the larger society that increase
the probability of poor outcomes.
Protective Factors
Conditions or attributes of individuals, families,
communities, and the larger society that
simultaneously mitigate or prevent the impact of
risk factors and actively enhance well-being.
39. The SF Protective Factors
ď§ Parental Resilience: Managing both general life and
parenting stress, and functioning well when
faced with stressors, challenges, or adversity;
outcome is personal growth and positive change
ď§ Social Connections: Having healthy, sustained
relationships with people, institutions, the
community, and a force greater than oneself
ď§ Knowledge of Parenting and Child Development:
Understanding the unique aspects of child
development; implementing developmentally &
contextually appropriate parenting practices
40. The SF Protective Factors, cont.
ď§ Social and Emotional Competence of Children:
Providing an environment and experiences that
enable the child to form close and secure adult
and peer relationships, and to experience,
regulate, and express emotions
ď§ Concrete Support in Times of Need: Identifying,
seeking, accessing, advocating for, and receiving
needed adult, child, and family services; receiving
a quality of service designed to preserve parentsâ
dignity and promote healthy development
41. The Strengthening Families Approach
and Cultural Humility
ď§ Encourage parents to articulate how the
protective factors are understood and
manifest from their cultural and family
perspective
ď§ Encourage providers to conscientiously
engage in cultural humility
42. âThe fact that we are here and that I speak
these words is an attempt to break (the) silence
and bridge some of those differences between
us, for it is not differences which immobilize us,
but silence. And there are so many silences to
be broken.â Audre Lorde