Cultural Competency In Health Care “Transforming Barriers into Assets” Trainers Dijana Rizvanovic Dov Sellem

2 Active Listening Level 1 Basic Acknowledgements Level 2 Silence Level 3 Questions Level 4 Paraphrasing Level 5 Reflective Listening LMC Learning Design Center ** Adapted from the work of Jerry Wisinski

3 Why Cross Cultural Training Raise the level of consciousness of cultural issues and how they impact health care Share and discuss culture and cultural generalizations that relate to health care Develop skills for cross-cultural communication and interaction with patients and families Identify your own specific values that may impact how you view people from other cultures Create individual action plans for continual self- improvement related to improving each individual’s response to the opportunities/learning that can result from serving culturally diverse populations

4 Definitions of Culture An agreed upon set of norms, values, and behaviors.

5 “One’s own culture provides the lens through which we view the world; the logic... by which we order it; the grammar... by which it makes sense.” (Avruch and Black) Definitions of Culture

6 Culture Simulation

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8 The Cultural Iceberg …an illustration of the components and levels of culture Note: Use this diagram to bring to mind areas of interaction in which careful problem-solving may be needed to facilitate clear understanding and open communication Touching, space, eye contact, body contact, tone of voice, non-verbal communication (learned through modeling, usually in early childhood) Unconscious Rules: (“completely below sea level”) Because emotional loading at this level is intense, violations are taken personally, affecting relations between people. Unspoken Rules: (“partially below sea level”) Because emotional loading at this level is very high, violations result in negative feelings about the violator. Courtesies; use of time, punctuality; conduct in restaurants, social occasions, shopping (learned by trial and error) Food, music, language, architecture (learned cognitively) Visible Culture: (“above sea level”) Because emotional loading at this level is relatively low, few misunderstandings are produced at this level

9 What is Cultural Competence? A process “in which an individual or agency continuously strives to achieve the ability to effectively work within the cultural context of an individual, family, or community from a diverse cultural/ethnic background,” ~Josepha Campinha-Bacote Culturally congruent care takes into account the cultural background of the patient. It involves decisions and actions that are acceptable to the consumer and matches the consumer’s expectations. In order to meet the consumer’s expectations, the provider must take into account the consumer’s world views, systems of values and norms, and orientation to health and illness; it must be culture specific. ~Leininger, 1988 “A culturally competent system of care acknowledges and incorporates – at all levels – the importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet culturally unique needs. ~T. Cross, 1988

10 Stages of Cultural Competence Development: The Bennett Model Stage 1- Denial Stage 2- Defense Stage 3- Minimization Stage 4- Acceptance Stage 5- Adaptation Stage 6- Integration

11 Stereotypes How can we manage and overcome these stereotypes both in the moment and in the longer term? How can you give patients more information, so that they can change their perceptions of you? Learning to reflect on what other people might think of you is an important way of building self- awareness, and of eventually building greater better relationships with your patients

12 Overcoming Stereotypes Understand the distinction between Cultural Patterns and Stereotypes Acknowledge the existence of our preconceptions Understand how preconceptions impact us Know our labels and who we relegate them to Slow down, check it out, get information Adjust your understanding of cultural patterns when you get new information

13 Barriers to Intercultural Communication Assumed Similarity Nonverbal Communication Verbal Language Tendency to Judge Preconceptions and Stereotypes

14 Bridging Barriers to Cross Cultural Communication Raise self-awareness Don’t act on your stereotypes Listen with respect Increase culture-specific awareness Treat each person uniquely Seek out information Tolerate ambiguity Establish trust and show concern and empathy Show sensitivity to face-saving needs Have a sense of humor and patience Notice non-verbal cues Listen for hidden meanings Avoid confusing language Try to see things from the other person’s perspective

15 Personal Communication Styles Mode of interaction: Initiating……………………………….…..…….…verses………..…….…………………….……….Listening The degree to which one initiates discussion or listens and responds as a primary mode of interaction. Reference Point: Individual…………………………………..….…..verses………....………………..……………………Group The degree of emphasis placed on personal involvement and achievements versus group involvement and achievements in communications. Authority Base: Facts……………………………………….………...verses………….…….….…………………….……Intuition The degree to which one relies on factual data versus intuitive judgments as the basis for reasoning and persuading. Degree of Self-Disclosure: Impersonal…………………………………….…....versus……………………………..………….……Personal The emphasis placed on tasks versus sharing personal data in building new relationships and communicating with others. Mode of Expression: Rational……………………………………...……...versus………………….………….……..………..Emotional The degree of reliance on rational descriptions and facts only versus emotional reactions and embellishments. Method of Support: Challenge…………………………….…………..…versus……………….…………….………….....Agreement The degree of challenge versus praise and agreement used to support others’ ideas, views, and so on. Method of disagreement: Confrontation…………………………………..…..versus………….…….………………………….Compliance The degree of confrontational versus compliant behavior exhibited in conflict situations. Vocal Characteristics: Low………………………………………….…….…versus……………….……………………………..…….High The pitch, accent, and volume displayed in verbal communications. Method of assertion: Direct………………………………………….……..versus………….….…….……………………………Indirect The degree of reliance on direct statements describing one’s position or point of view versus indirect references, use of questions, and so on. Physical proximity: Distant………………………………………….…....versus…………….……….…………………………….Close The degree of physical versus closeness maintained and preferred in interactions with others. Reliance on Protocol: High…………………………………….…………….versus….……………….………...………………………Low The degree of emphasis placed on formality and tradition versus spontaneous behavior in communications with others.

16 Communicating With Limited English Proficient (LEP) Patients Miscommunication and lack of complete understanding often occurs between people who speak the same language. When communication is attempted between two people who do not speak the same native language, frustration and miscommunication are even more likely. The following are some strategies that may help ensure that the desired communication actually occurs: Speak more slowly than usual, but do not use unnatural language. Be conscious of the beginning and ending of sentences, speaking as distinctly as possible. Present ideas or facts in a logical order. Pause frequently to give the listener adequate time to process the language and content. Watch for body language which may aid the communication or indicate confusion. Check for understanding by active listening or paraphrasing what the speaker has said. Provide adequate space for the communication; do not rush the listening-and- speaking flow of conversation. When there is uncertainty regarding the communication, reframe the sentence, using alternate words or phrases. Avoid idioms, slang or jargon. Define acronyms and abbreviations. Demonstrate, use visuals, and reinforce with written material whenever possible. Assume communication can occur. Handle your fear.

17 Action Plan What can you personally do to help your organization be more culturally competent?

18 Crisis In Chinese the word crisis is represented by two characters. Each character combined with other characters have different meanings: The upper symbol can mean danger, while the lower can mean opportunity.