The following resource was submitted with the purpose of distributing to AONE members as part of the AONE Diversity in Health Care Organizations Toolkit Submitted by: Children ’ s Hospital Medical Center Contact person: Lisa Aurilio, RN, MSN, NEA-BC Director, Maternal Fetal Neonatal Services Akron, OH

Culturally Competent Health Care Assessment The Initial Interview: Asking Culturally Competent Questions Lisa Aurilio, RN, MSN, NEA-BC

What Is Culture? Culture is what you: believe value consider normal behavior Culture is learned over time and experience You are not born with culture! Culture helps form your identity

Dimensions of Culture Age Ethnicity Gender physical abilities & qualities Race Sexual orientation Educational background Geographic location Berkley University of California: Office of Human Resources Military experience Parental status Religious beliefs Work experience Job classification Marital status Income Customs Personality & unique style

Dimensions of Culture: Visual Dress & Attire Foods Mannerisms Accent Body Language Physical Features Eye contact Touch

Dimensions of Culture: Non-visual Religious rituals Decision making processes or patterns Self expression of pain Health & illness beliefs

Why Address Culture? United States In America 1 in 4 Americans belong to a minority or is foreign-born. Women currently make up less than half the work force but are expected to fill 65 percent of the jobs created during this decade. 30% of the general population describe themselves as being from a racial or ethnic minority

Why Address Culture? OHIO In 2004, Columbus, Ohio processed 14,211 citizenship applications triple the amount in 2003 In 2005, 808 new Americans from 92 countries became new citizens in Columbus, Ohio

Akron Children’s Hospital: Inpatient Population by Race The diversity of the inpatient population of patients at Akron Children ’ s is growing From the Asian, Hispanic, American Indian and Middle Eastern patient population all grew. The White population declined

Akron Children’s Inpatient Population by Religious Subgroups Amish/Mennonite population is 6% Muslim and Jewish populations are 1% Free Church Christians are the largest population (43%)

Why do Healthcare Providers Need to be Culturally Sensitive? * Helps staff work effectively in a diverse environment * Helps prevent discrimination * Helps promote inclusiveness

Why do Healthcare Providers Need to be Culturally Sensitive? * Enhances the organization ’ s responsiveness to an increasing diverse world of customers * Improves community relations * Increases the organization ’ s ability to cope with change * Expands the organization ’ s creativity -Berkley

Why do Healthcare Providers Need to be Culturally Sensitive? * Contributes to patient ’ s positive experiences at Akron Children ’ s Hospital * Enhances the effectiveness of patient care

Culturally Competent Care Culturally competent care means that you understand the effects of the care or process on the individual and their culture Culturally competent care does not mean you always accept the patient or family ’ s beliefs

Caution: Stereotyping It is critical that health care providers recognize individual differences Persons of same ethnicity can have very different beliefs and practices Obtain particular circumstances of the patient or family information during the initial interview and assessment with the family. Do NOT participate in “ cultural stereotyping ”.

Health Assessment: Asking Culturally Competent Questions Effectively Elements of effective interviewing hold true Privacy & Confidentiality Appropriate setting Open & respectful Encourage two-way communications Active listening

Language: Word Choice Instead of: “ What language do you speak? ” Try: “ What language would you like your health care information delivered in? ” “ What languages do you and your family speak in the home and those that you understand and speak. ”

Diet: Word Choice Instead of: Does your child have a special diet? Try: What foods does your child like when he is sick? What foods will help your child feel better? Are there any times during the year when you change your diet in celebration of religious or ethnic holidays?

Health & Illness Beliefs: Word Choice Instead of: Have you tried any home remedies to help your child? Try: Tell me what you think caused your child ’ s illness. What meaning does this ill ness have for you and your family? Have you sought assistance from individuals in your community with this illness? Are there certain health care procedures and tests which your culture prohibits?

Decision Making: Word Choice Instead of: Who makes the decisions in your family? Try: In addition to yourself, is there someone that you would like us to include in discussions about your child ’ s medical condition? How are decisions made in your family? Are there certain family members that need to be directly involved in your child ’ s care?

Pain Expression: Word Choice Instead of: Is your child in pain? Try: How will I know if your child is having pain? Hoe does your child express pain?

Spiritual: Word Choice Instead of: What is your religion? Try: Is there any religious practice that your family would like to share that will help you in being comfortable here? Tell me about any beliefs or practices that you feel I should know in helping to care for your child?

Family & Social Structure: Word Choice Instead of: Who is in your family? Try: Describe your family and who will be involved in your child ’ s care. Who is the most important person to help you with your child ’ s care? Who does your child go to for comfort and security?

Final Thought “ Every family is a culture unto itself ”