Communicating with patients with different social economic & cultural backgrounds Mary Esson, Theresa Prus, Becky Robinson

Hidden rules Generational Poverty Middle Class Wealth The driving forces for decision making are survival, relationships, and entertainment. The driving forces for decision making are work and achievement. making are social, financial, and political connections People are possessions. It is worse to steal someone’s girlfriend than a thing. A relationship is valued over achievement. That is why you must defend your child no matter what he or she has done. Too much education is feared because the individual might leave. Things are possessions. If material security is threatened, often the relationship is broken. Legacies, one-of-a-kind objects, and pedigrees are possessions. The “world” is defined in local terms. The "world" is defined in national terms. The national news is watched; travel tends to be in the nation. international terms. Physical fighting is how conflict is resolved. If you only know casual register, you do not have the words to negotiate a resolution. Respect is accorded to those who can physically defend themselves. Fighting is done verbally. Physical fighting is viewed with distaste. Fighting is done through social inclusion or exclusion and through lawyers. Food is valued for its quantity Food is valued for its quality. Food is valued for its presentation.

POVERTY Poverty has 2 types: Type 1: Generational Type 2: Situational

Definition of poverty Lack of resources 7 types of resources: Financial Emotional Mental Physical Support systems Role models Knowledge of hidden rules

government Resources BadgerCare- Health WIC FoodShare ChildCare Low-Income Housing Energy Assistance

LANGUAGE AND STORY STRUCTURE Language of poverty (casual register) Business/School language (formal register) Mediation & relation to language Teacher responsibility vs. parent responsibilities Relation to health care workers (nurses)

What is culture? Culture is the full range of learned human behavior patterns “Cultural competence is a set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations. http://anthro.palomar.edu/culture/culture_1.htm Cultural competence can have a real impact on clinical outcomes. Ignoring culture can lead to negative health consequences in many ways. For example, patients may choose not to seek needed services for fear of being misunderstood or disrespected, and patients may not adhere to medical advice because they do not understand or do not trust the provider. Providers may not order appropriate tests or medical interventions due to cross-cultural misunderstandings.

Five Constructions of Cultural competence by Campinha Bacotteh cultural awareness cultural knowledge cultural skills cultural encounters cultural desire Cultural awareness involves the “recognition of one’s biases, prejudice and assumptions about individuals who are different from you”; Cultural knowledge is the “process of seeking and obtaining information” Cultural skills are the “ability to collect relevant data regarding clients.” A cultural encounter is the “process of engaging in cross cultural interactions with clients from cultural diverse background.” Cultural desire is the motivation of the health care provider to want rather than have to, engage in the process of becoming culturally aware, cultural knowledgeable, culturally skillful and familiar with cultural encounters”, as defined by Campinha in her article

A really conscientious health provider can eliminate his or her own prejudices or negative assumptions about certain types of patients. True or False?

Answer (False) Most of us harbor some assumptions about patients, based on race, ethnicity, culture, age, social and language skills, educational and economic status, gender, sexual orientation, disability/ability, and a host of other characteristics. These assumptions are often unconscious and so deeply rooted that even when an individual patient behaves contrary to the assumptions, the provider views this as the exception to the rule. A conscientious provider will not allow prejudices to interfere with making an accurate diagnosis and designing an appropriate treatment plan.

During a medical interview with a patient from a different cultural background, which is the LEAST useful technique? a. Asking questions about what the patient believes about her or his illness - what caused the illness, how severe it is, and what type of treatment is needed. b. Gently explaining which beliefs about the illness are not correct. c. Explain the “Western” or “American” beliefs about the patient’s illness. d. Discussing differences in beliefs without being judgmental. Answer: b. although the provider may be tempted to correct the patient’s different beliefs about illness, this may lead the patient to simply withholds his/her thoughts in the future and interferes with building a trusting relationship. It is more effective to be nonjudgmental about differences in beliefs. The provider should keep in mind two goals: 1) the patient should reveal her/his medical history and symptoms to help the provider make an accurate diagnosis, and 2) the patient should develop trust in the provider’s medical advice and be willing and able to adhere to that advice. To accomplish these goals, it is essential to treat the patient with respect, openly discussing differences in health beliefs without specifying “correctness” or “incorrectness.”

What Not to Do: Intercultural communication in the Nurse-Client Relationship http://www.youtube.com/watch?v=a2i5-eTPWGg

EVALUATING ONESELF • Do not allow biases to keep us from treating everyone with respect • Assess yourself for positive and negative assumptions of others • Learn to evaluate own level of cultural competency

AVOIDING STEREOTYPES • Avoid jumping to conclusions • Diversity exists in every group of humans • Avoid jumping to conclusions • When in doubt, ask!

CULTURAL COMPETENCE POINTERS • “Check your own pulse” as a health care provider • No “one” way to treat a racial/ethnic group • Care should always be evidenced based • Don’t use a “cookbook” approach • Challenge and confront prejudice and discrimination

QUESTIONS??