HEALTHCARE PROFESSIONALS ROLE

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2 INTRODUCTION There has been a dramatic increase in the population of the United States in recent decades, as well as changes within the population itself. As health care providers, we find ourselves providing services in an environment where patients and their families may be of different cultures, traditions, languages and spiritual backgrounds. The goal of St. Theresa Specialty Hospital is to provide the best possible care for all patients. In our multicultural society, the challenge is determining how we can provide services in ways that are appropriate and sensitive to these differences.

3 INTRODUCTION (cont) Why do we need to be culturally and spiritually sensitive? The Joint Commission holds hospitals accountable for addressing and maintaining patient rights. These rights include the accommodation of cultural, religious, spiritual, and personal values as well as to religious and other spiritual practices.

4 HEALTHCARE PROFESSIONALS ROLE Health care professionals are entrusted to care for patients as whole persons-body, mind, and spirit. The health care approach is interdisciplinary and encompassing. It is important for that approach to be culturally and spiritually sensitive. In addition, health care professionals need to be empowered with the capacity, skills, and knowledge to respond to the unique needs of each patient and their love ones.

5 Upon completion the individual will: 1. Define key terms 2. Describe the characteristics and components of culture. OBJECTIVES 3. Deliver culturally appropriate and specifically tailored care to patients with diverse values, beliefs, and behaviors. 4. Identify the general beliefs that account for the differences among religions. 5. Describe how one s own beliefs or lack thereof can influence patient s care. 6. Discuss the healthcare provider role in meeting the spiritual needs of patient and family. 7. Analyze personal values and cultural beliefs. 8. Perform a cultural assessment.

6 CULTURE IS The Learned Or Shared Knowledge, Beliefs, Traditions, Customs, Rules, Arts, History, Folklore & Institutions Of A Group Of People Used To Interpret Experiences And To Generate Social Behavior.

7 ETHNICITY AND RACE Ethnicity a cultural group s perception of itself, or a group identity. Race a group of people with biological similarities. Typically based on specific characteristics Skin pigmentation, body stature, facial features, hair texture Five major categories: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

8 CULTURAL DIVERSITY Also Include Ethnocentrism the assumption of cultural superiority and inability to accept another culture s ways. Oppression when the rules, values and ideals of one group are imposed on another group. Stereotyping belief that people in same ethnic, racial, or cultural group act the same way, share same beliefs, attitudes. Dominant culture the group whose values prevail within a given society.

9 CULTURAL DIVERSITY Also Include (cont) Acculturation the process of learning beliefs, norms, and behavioral expectations of a group. Cultural assimilation members of a minority group are absorbed by the dominant culture, taking on the characteristics of the dominant culture. Minority group constituting less than a numerical majority of the population.

10 CULTURAL COMPETENCY IS The ability of health care providers and organizations to understand and respond effectively to the cultural and language needs brought by the patient to the health care encounter. Cultural competence requires organizations and their personnel to: 1) value diversity 2) assess themselves 3) manage the dynamics of difference 4) acquire and institutionalize cultural knowledge 5) adapt to diversity and the cultural contexts of individuals and communities served.

11 CULTURE S CHARACTERISTICS Culture is not inherited or innate, rather, it is integrated throughout all the interrelated components, motivations, activities, world views, relationships, and individuality are affected by consistent patterns of behavior and form a cohesive whole. Culture is learned. Culture is shared. Culture is dynamic (constantly changing). Culture is tacit (unspoken). Everyone in the cultural group understands acceptable behavior.

12 ASSESSING YOUR OWN CULTURAL HERITAGE The culture in which we are raised greatly influences our attitudes, beliefs, values, and behaviors. Our families taught us how to believe and treat people who were different than we are.

13 INFLUENCES ON HEALTH CARE BELIEFS AND PRACTICES Cultural values define human responses to illness and will determine whether an individual seeks professional care when ill and complies with prescribed treatment. Clients tend to define wellness and illness in the context of their own culture. As Healthcare Providers we must be able to: Relate care and treatment to patient s cultural context Incorporate informal caregivers, healers, and other members of patient s support system as allies in treatment.

14 BELIEFS OF SELECT CULTURAL GROUPS Americans Hispanic Americans Asian Americans Native Americans

15 Traditional healers: nurse, physician. AMERICANS Non-traditional healers: elderly women healers, community mother or granny, root doctor, voodoo healer, spiritualist. Healing practices: exercise, medications, modified diets, amulets, religious healing rituals. Other Healing practices: herbs, roots, oils, poultices, rituals, talismans.

16 HISPANIC AMERICANS Traditional healers: curandero, espiritualista, yerbero, brujo, sobadora, santiguadora. Healing practices: hot and cold foods, herbal teas, prayers and religious medals, massage, azabache, three baths ritual.

17 Traditional healers: herbalist, physician. ASIAN AMERICANS Healing practices: hot and cold foods, herbs, soups, cupping, pinching, and rubbing, meditation, acupuncture, acupressure, tiger balm, energy to restore balance between yin and yang.

18 Traditional healers: shaman, medicine man/woman. NATIVE AMERICANS Healing practices: plants and herbs, medicine bundle or bag, sweet grass burned to purify the ill person, estafiate (dried leaves) tea, the Blessingway ceremony, sand paintings

19 CULTURAL AND RACIAL INFLUENCES ON CLIENT CARE Can be viewed through: Communication Orientation to space and time Social organization Biological variations

20 COMMUNICATION Not everyone shares the same language. This can lead to misunderstanding and frustration. Alternative methods include gestures and flash cards. Family members may be able to assist. Interpreters may be used and can be contacted via phone

21 ORIENTATION TO TIME AND SPACE The distance that a person prefers to maintain from another is determined by one s culture. Individual s orientation to time may affect: Promptness, attendance at appointments. Compliance with self-medication schedules. Reporting the onset of illness.

22 SOCIAL ORGANIZATION Refers to the ways that cultural groups determine rules of acceptable behavior and roles of individual members and includes: Family structure. Gender roles. Religion.

23 Distinguishes one racial or cultural group from another. BIOLOGICAL VARIATION Includes variations in hair texture, eye shape, skin color, thickness of lips, and body structure. Also includes enzymatic differences and susceptibility to disease.

24 CULTURAL AWARENESS In order to provide sensitive and effective care to persons from cultures that are different from our own, two things must occur: 1. An awareness of one s own cultural values and beliefs and a recognition of how they influence our attitudes and behaviors. 2. An understanding of the cultural beliefs and values of others and how they are influenced by them. Even if we cannot understand or accept particular cultural practices, it is important to show respect for them.

25 CULTURAL INSENSITIVITY Cultural insensitivity is usually not intentional. It is, rather, caused by not having the knowledge we need to understand another person s frame of reference. Sometimes our insensitivity is a result of our fear of the unknown or of something new, or we try to deny that there are differences by viewing everyone as the same. At other times, our insensitivity is simply due to time constraints: who is waiting. When we are culturally insensitive, misunderstandings can result between the patient and/or family s expectations and ours. Miscommunication can occur. It becomes difficult for us to provide the best and most appropriate care. Too often we interpret the behaviors of others as negative because we don t understand the underlying value system of their culture. It is a natural tendency for us to assume that our own values and customs are more sensible and right. It is necessary, then, for us to become aware of the cultural assumptions from which we develop our judgment. This is the first step to becoming more culturally sensitive

26 CULTURAL SENSITIVITY AND COMPETENCE Embodies attitude, knowledge and skills Permits individuals to respond with dignity and respect to all people Is a continuum that encompasses several stages We don t become culturally sensitive or competent overnight. It is a process that take time, attention, and self-awareness. Unless we can identify and then step outside our own framework, it can be difficult for use to understand another s point of view. Cultural competence can and should occur in both individuals and organizations. It is the state of being capable of functioning effectively in the midst of cultural differences. It is being sensitive not to impose our personal values on someone else because they are different. It is the ability to establish relationships with people in the midst of diversity. It is celebrating difference, the recognition of similarities, and a clear commitment to seeing differences as differences and not deficits.

27 WHY IS IT IMPORTANT TO MEET THE NEEDS OF DIVERSE PATIENTS? Communication is essential to quality care and patient safety. Direct communication can be inhibited by primary language barriers, hearing or vision impairment, literacy, culture, cognitive limitation, intubation, or disease. Individuals whose care is inhibited due to a communication barrier or a lack of sensitivity to a cultural belief may be at risk for poor outcome.

28 CULTURAL IDENTITY The definition of cultural identity, in its most basic form, is a sense of belonging. When a person identifies with their culture, they often embrace traditions that have been passed down for years. The cultural identity that relates to a person s heritage helps them to identify with others who have the same traditions and basic belief system. Cultures vary in their beliefs of the prevention, cause, and treatment of illness as well as in their understandings of the processes of life and death. These belief dictate practices used to maintain health and to prepare of and experience the processes of life from conception to death..

29 CULTURAL IDENTITY (cont) Includes a number of different things including, Symbolic Objects Spirituality & Religion Language Cooking & Dining Topics & Patterns of Conversation Family and Kinship Tone of Voice Concept of Time Non Verbal Clues

30 When encountering objects with which you are not familiar, politely ask about their significance, but don t press the issue if the patient or family does not appear willing to explain. SYMBOLIC OBJECTS

31 LANGUAGE Always use surnames unless you are given permission by the patient or family member to use their first name.

32 TOPICS AND PATTERNS OF CONVERSATION In many cultures, it is inappropriate to initiate a serious conversation immediately. Take a few moments to introduce yourself to the patient and family in order to build rapport and trust.

33 TONE OF VOICE Use a soft tone of voice, emphasize courtesy and respect, and refrain from harsh criticism or confrontation.

34 NON-VERBAL CLUES Such as Gestures, Facial Expressions, Body Language & Personal Space A handshake is customary among many Americans, however it is not always welcome among other cultures where it may be considered rude or intrusive, especially between opposite genders.

35 Individuals who are past-oriented value tradition and doing things the way they have always been done. They might be reluctant to try new procedures. Presentoriented people focus on the here and now and may be relatively unconcerned with future, dealing with it when it comes. They may show up late or not at all for appointments. Future-oriented people may become so caught up in the what-ifs of the future that focusing on the present moment may be difficult. CONCEPT OF TIME

36 FAMILY AND KINSHIP STRUCTURE How the family is constructed determines one s values, the decision-making patterns within the household, and who will be responsible for the patient and health care decisions.

37 COOKING AND DINING What time of day does the patient eat their meal? Do they have special needs for preparation, utensils, or diet. Some cultures place great value on the meal as an event when the entire family gathers together.

38 SPIRITUALITY AND RELIGION What one believes affects one s responses to health, illness, birth, dying, death and other life events. A person s source of meaning and purpose fosters a sense of wellbeing as well as solace and comfort during times of crisis.

39 HOW DO WE LEARN THE BASICS ABOUT CULTURE? Consider asking others to help you understand their culture and how it might be unique to the above aspects.

40 Being culturally sensitive or competent does NOT mean knowing everything about every culture It is instead respect for differences, eagerness to learn, and a willingness to accept that there are many ways of viewing the world.

41 To provide sensitive clinical care

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43 THANKS YOU FOR ALL YOU DO

44 REFERENCES Cultural Competence, Family Resource Coalition Report, Fall/Winter , Chicago, IL. Multicultural Health Care Solutions, Rationale for Cultural Competence in Primary Health Care, National Center for Cultural Competence. Developed by Elena Cohen and Tawara Goode, Winter Standards on Patient Rights and Responsibilities, Joint Commission for Accreditation of Healthcare Organizations, Oakbrook Terrace, IL, 2016