Patient Centred Care in the Canadian Multicultural Mosaic: Issues and Challenges Ruth Lee, RN, PhD

Statistics Canada, % Canadians Foreign born, highest in 70 years Over 200 different ethnic origins 58% of new immigrants were from Asia, 20% Europe, 11% Caribbean, Central & South America, 8% Africa & 3% US Largest visible minority groups: Chinese, South Asian, Black, Filipino, Arab-West Asian

Statistics Canada, 2001 Between , 1.8 million immigrants came to Canada Canada had 4 times as many visible minorities in the 1990s as in the 1980s 9.4% can’t speak or understand English or French

Canadian Charter of Rights and Freedoms 15.(1) Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, color, region, sex, age or mental or physical disability. 27. This Charter should be interpreted in a manner consistent with the preservation and enhancement of the multicultural heritage of Canadians.

Multiculturalism Policy “A policy of multiculturalism within a bilingual framework commends itself to the government as the most suitable means of assuring the cultural freedom of Canadians. Such a policy should help to break down discriminatory attitudes and cultural jealousies. National unity, if it is to mean anything in the deeply personal sense, must be founded on confidence in one’s own individual identity; out of this can grow respect for that of others and a willingness to share ideas, attitudes and assumptions.” Pierre Elliott Trudeau, October 8, 1971

Definition of Culture The totality of learned and transmitted knowledge with its values, beliefs, rules of behavior, and life-style practices Forms the blue print for the development of one’s values, beliefs and practices Leininger, M. 1995

Cultural Competency is: Developing an awareness of one’s own existence, sensations, thoughts, and environment without letting it have an undue influence on those from other backgrounds Demonstrating knowledge and understanding of the client’s culture Accepting and respecting cultural differences Adapting care to be congruent with the client’s culture Purnell & Paulanka, 1998, p.2

Cultural Context High Context Culture - Group - Extended family - Hierarchy - Interdependence - Traditional Ways Low Context Culture –Individual –Nuclear family –Equality –Independence –Question beliefs Hall, E. (1976). Beyond Culture. New York: Doubleday

Culture of Western Health Care Each area of health care has its own emphasis which influences the health care worker’s beliefs and behaviour. Norms and values are derived from Western health culture –biomedical view of illness –low context culture –internal locus of control We must be aware of our own specific cultural values, beliefs and norms have on the care we provide to clients

Physiological Variation Acculturation Socioeconomic Status Health Beliefs and Practices Transcultural Patient & Family Social Support Communication Issues and Challenges

Health Beliefs & Practices Explanatory Model of Illness (Kleinman, 1980) –Symptoms –Cause of illness/injury and perceived stigma –Help-Seeking Behavior Impact on Treatment Plan Beneficial Neutral Harmful

Use of Alternative Medicine Acupuncture

Use of Alternative Medicine Herbs and Food Therapy

Use of Alternative Medicine Cupping

Use of Alternative Medicine Moxibustion

Physiological Variation Body build Tolerance to Medication Susceptibility to Certain Illnesses –Biological, metabolic, genetic Dietary Pattern –Cultural protocol –Cultural food beliefs

Socioeconomic Status Pre and Post Migration Education –Ability to speak, read and write English –Overseas credential recognized in Canada? Occupation –Canada VS homeland Bread Winner?

Support System Family Structure –Collectivism VS Individualism –Naming system View of Authority Decision Making Process Community Resources Combating Racism and Achieving Equity

Acculturation Country of Origin Reason for Migration Similarity with Western Medical Model Experience with Canadian Health Care System Interaction with the Larger Culture Religion Concept of Time and Space

Communication: Intercultural differences Non- Verbal –Space –Gesture –Facial expression –Eye contact Verbal –English as a 2nd language –Accent –Tone of voice –Speed –Working with interpreters

Implications Active Listening: defining client’s issues Self-reflection: examining personal biases Beware of generalization and stereotyping Validate Assessment:sharing interpretation Set realistic goals: discussing strategies Formulating workable care plan base on mutual respect Advocate for equitable care