Cultural Competence

Cultural Sensitivity The Rev. George F. Handzo, BCC Director of Health Services Research & Quality HealthCare Chaplaincy Network New York, NY

The End Game

A health care institution where patients, family members and staff can live out their spiritual and religious beliefs, values, and practices within the bounds of mutual respect and safe health care practice.

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A New Mindset

 Not about avoiding anything that might possibly offend someone.  Not about minimizing risk  It’s about “why not” rather than “why”  It’s about customer service and patient-centered care  It is about employee satisfaction and retention

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Cultural Competence/Sensitivity

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.

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Ethnicity

A group of people whose members identify with each other, through a common heritage, consisting of a common language, a common culture (often including a shared religion) and a tradition of common ancestry.

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Culture

The learned or shared knowledge, beliefs, traditions, customs, rules, arts, history, folklore and institutions of a group of people used to interpret experiences and to generate social behavior.

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Spirituality

Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.

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What Are You Own Predispositions?

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Attitudes  What causes illness?  What does it mean to be a “good patient”?  How to treat illness and injury?  Who do you go to? #

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Attitudes- Right and Wrong

 Is it whatever works for the patient/service member?  What is “wrong”?

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Aspects of Culture

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Aspect of Cultural Sensitivity  Attitudes  Knowledge and Comprehension  Skills  Desired Outcome- Internal-External Deardorff, D.K. (2004) Identification and Assessment of Intercultural Competence as a Student Outcome of Internationalization.; Journal of Studies in International Education. 10: 241-266,

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Aspects of Cultural Sensitivity

 Individual  Organizational

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Aspects of Cultural Competence

 Facilitate- food, worship, prayer space & time  Provide- worship  Care- culturally sensitive care  Advise- policy making, accommodation

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Health Care Culture Beliefs

a) Standardize definitions of health and illness b) The omnipotence of technology

Practices

a) Maintenance of health and prevention of disease via mechanisms such as the avoidance of stress and the use of immunizations b) Annual physical examinations and diagnostic procedures such as Pap smears

Habits

a) Charting b) Constant use of medical jargon c) Use of a systematic approach and problem solving methodology

Likes

a) Promptness b) Neatness and organization c) Compliance

Dislikes

a) Tardiness b) Disorderliness and disorganization

Customs

a)

Professional deference and adherence to the “pecking order” found in

autocratic and bureaucratic systems b) Hand washing c) Employment of certain procedures attending birth and death Rituals

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a) Physical examination b) Surgical procedure

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Aspects of Culture Sense of self and space  Informal, handshake  Formal, bows, handshakes

Communication and language  Explicit, direct. Emphasis on content – meaning found in words  Implicit, indirect. Emphasis on context --- meaning found around words #

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Aspects of Culture Dress and appearance  “Dress for success” ideal. Wide range in accepted dress  Dress seen as a sign of position, wealth, prestige.  Religious rules  Jewelry & hair

Food and eating habits  Eating as a necessity – fast food  Dining as a social experience. Religious rules

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Aspects of Culture Time and time consciousness  Linear and exact time consciousness. Value on promptness.

Time = money  Elastic and relative time consciousness. Time spent on enjoyment of relationships

Relationships, family, friends  Focus on nuclear family. Responsibility for self. Value on youth, age seen as handicap  Focus on extended family. Loyalty and responsibility to family.

Age given status and respect

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Aspects of Culture Values and norms  Individual orientation. Independence preference for direct confrontation of conflict  Group orientation. Conformity. Preference for harmony.

Beliefs and attitudes  Egalitarian. Challenging of authority. Individuals control their destiny. Gender equality.  Hierarchical. Respect for authority and social order. Individuals accept their destiny. Different roles for men and women.

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Aspects of Culture Mental processes and learning  Linear, logical, sequential, problem-solving focus.  Lateral, holistic, simultaneous. Accepting of life’s difficulties .

Work habits and practices  Emphasis on task. Reward based on individual achievement.

Work has intrinsic value.  Emphasis on relationships. Rewards based on seniority, relationships. Work is a necessity of life.

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Aspects of Culture  Communication of medical information  Death & dying  Keeping the Sabbath

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Use of Authority  Traditional  Negotiating  Individualistic

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It’s All About Assessment

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Cultural/Religious Issues  Beliefs  Values  Family structure  Modesty  Food  Dress  Daily Religious Observance  Ritual Items  End-of-life care  Mourning © HealthCare Chaplaincy 24

Assessment Issues

 Stereotypes  Cultural Patterns

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Goal of Chaplaincy Helping patients discover and use their spiritual and religious resources in the service of their healing.

What is “healing”?

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Cultural Discussion  PRESERVE beliefs and practices that have a beneficial effect on health.  ADAPT OR ADJUST those that are neutral or indifferent.  REPATTERN those that have a potentially harmful effect on health.

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Accommodations  How do you decide what warrants an accommodation?  Patient rights vs. family rights vs. employee rights  Ethics consults

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Spiritual/Religious Accommodations for Staff  Dress  Food  Religious Observance- Daily  Religious Observance- Holiday

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Tips  Don’t treat others as YOU would want to be treated.  Address all adult patients from other cultures by their surnames unless specifically asked to use a first name.  Mind your tone of voice.  Every culture has its own rules for touching and distance.  Don’t ask a limited English-speaking patient or family member: “Do you understand?”  Informed consent forms and regulations can be extremely upsetting and frightening.

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Tips  Different is different, it’s not right or wrong.  I’m not afraid to ask, even when I feel uncomfortable.  It’s not about me!

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Joint Commission Publications http://www.jcrinc.com

Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals The Roadmap for Hospitals provides recommendations to help hospitals address unique patient needs, meet the new Patient-Centered Communication standards, and comply with existing Joint Commission requirements.

Example practices, information on laws and regulations, and links to supplemental information, model policies, and educational tools are also included. The Patient-Centered Communication standards are presented in a separate appendix that provides self-assessment guidelines and example practices for each standard.

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Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals

Assessment:  Identify and address patient communication needs during assessment  Identify patient cultural, religious, or spiritual beliefs or practices that influence care  Identify patient dietary needs or restrictions that affect care  Communicate information about unique patient needs to the care team #

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Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals

Treatment  Involve patients and families in the care process  Address patient communication needs during treatment  Accommodate patient cultural, religious, or spiritual beliefs and practices  Monitor changes in dietary needs or restrictions that may impact the patient’s care

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Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals

End-of-Life Care  Involve the patient’s surrogate decision-maker and family in end-of-life care  Identify patient cultural, religious, or spiritual beliefs and practices at the end of life

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Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals Organization Readiness Leadership  Demonstrate leadership commitment to effective communication, cultural competence, and patient- and family-centered care  Integrate unique patient needs into new or existing hospital policies

• Data Collection and Use  Conduct a baseline assessment of the hospital’s efforts to meet unique patient needs  Use available population-level demographic data to help determine the needs of the surrounding community

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What Do We Do Now?  Read the Roadmap  Talk to the champion for cultural initiatives/compliance  Ensure that your assessment process addresses and communicates cultural and spiritual beliefs and values  What ethnic/cultural groups is your institution focused on?  Remember this is about communication & patient safety  What can you uniquely contribute to the effort?

• Cultural expertise • Ties to local communities

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Resources Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals

http://www.jointcommission.org/assets/1/6/ARoadmapforHospit alsfinalversion727.pdf A Dictionary of Patients’ Spiritual & Cultural Values for Health Care Professionals http://bit.ly/1kHeAbY

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The Rev. George Handzo, BCC ghandzo@healthcarechaplaincy.org

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