1. Transcultural Guidelines for Health Care Givers
Reviewed 10/2014

2. Ethnicity
Definitions (Cornell University) - Describes your family “origins” e.g.
American Native or Alaskan Native
Origins in any of the original peoples of North & South America (including Central America), & who maintain tribal affiliation or community attachment
Describes who we are, our family heritage and where we come from.

3. Ethnicity Asian Black/African American
Far Eastern countries
Black/African American
African or Caribbean
Caucasian/White/Not of Hispanic origin
Europe, Middle East, North Africa, Australia, New Zealand
Mexican American
Mexican culture or origin regardless of race

4. Ethnicity Native Hawaiian or other Pacific Islander Puerto Rican
Hawaii, Guam, Samoa, Pacific Islands
Puerto Rican
Puerto Rican culture or origin, regardless of race
Other Hispanic
Cuban, South or Central American, Dominican Republic, or other Spanish culture or origin, regardless of race

5. El Paso’s Population Hispanic vs. Non-Hispanic 2010 Statistics
Approximately 84.13% Hispanic
Non-Hispanic %
What other things contribute to diversity?
If I’m Hispanic is a non-Hispanic another culture? Maybe…
Reviewed October, 2008
There is enormous diversity in populations of all cultures. Individuals also vary in many ways and diversity becomes much more complex

6. Many Things..
Including culture, religion, language, age, and gender have an effect on how we access and view health care services.
Language and religion are both part of what is sometimes called “culture”. Culture really is just a name for the set of rules , traditions or habits which inform how we live, and save us from having to think, from scratch, about every choice we might make! Religious rules or traditions may suggest what is seen as appropriate behavior in many aspects of life.
They all part of what is sometimes called culture. It keeps us from having to think from scratch about every.

7. Culture Some may think culture determines certain things:
Physical attributes
hair or skin color
Diet
Language
Our religious & spiritual beliefs
Culture is much more complex. It includes local (geographical0 traditions, which come from the history of a group (not just religious traditions. Individuals, however, are not cultural cardboard cutouts. Not all people identify with their culture ethnic cultural background. Individuals with in the same family may have different sets of beliefs.
Individuals are not cultural cardboard cutouts Don’t forget about superstition, death and dying, family role. Keep in mind that not all people identify with their culture ethnic cultural background. Individuals with in the same family may have different sets of beliefs.

8. Ethnocentrism
Despite the fact that we understand that everyone is different, we still tend to subconsciously believe that our culture & religion is the right one. We may view other cultures or religions as bizarre, strange, inferior or unenlightened. This is called ethnocentrism.
Providers must realize how their own perceptions, beliefs, and biases influence the clinician–patient relationship.

9. Ethnocentrism It can cause misunderstandings and harm patients by:
Incorrect diagnosis
Failure to provide adequate pain relief
Arrest of parents for child abuse due to misunderstood cultural childrearing beliefs and practices

10. Cultural Competency Understanding of own self
Knowledge of various cultural characteristics
Understanding of cultural characteristics
Application of cultural knowledge & understanding in the healthcare setting
Acknowledge cultural differences, understand your own culture , acquire cultural knowledge, and view behavior within a cultural context.

11. Avoid Stereotyping
We must not presume that all people of a certain cultures adhere to all aspects of their culture
The healthcare provider must identify which aspects are appropriate for each patient during the admission process
You do not have to agree with every aspect of another's culture just as the other person does not have to accept everything about yours. The simple fact is that effective and culturally sensitive health care can still occur regardless of our occupation, gender or ethnic background.

12. Do Not Assume Anything
Be truly open-minded & respectful toward other’s beliefs, values, & practices
You can help patients feel more comfortable
Many of us belong to more than one ethnic group, cultural group, age group, and social group
Interact positively with people who do not look, think, believe, act or live like you.

13. Lost in Translation Family members are not good translators
Issues of privacy and confidentiality
Interpreter errors could be a previously unrecognized root cause of medical errors (Healthcare Risk Management)
A qualified interpreter should be bilingual, bicultural, understands English medical vocabulary, have a
comfort level in the medical setting, understand the significance of the health problem, and preserve confidentiality

14. Language & Translation
Those whose English is limited often wish to speak their native language when possible
Feel that both their explanations & their understandings can be more accurate
It is more comfortable
There are always other approaches to obtaining the same information within the limits of ethnicticity.

15. Policy & Procedure
Facility approved Translation Services should be used
Find someone in your facility who knows the policy
It is important to be facility specific
Should be HIPAA & The Joint Commission Compliant
Seek structures, practices, and dedicated resources such as policies and procedures in place to support language translation capacity.

16. Face & Body Language
Facial expressions, body language & tone of voice play a much greater role in many cultures.
Children in many cultures are taught that a soft voice is polite, and a loud voice is rude. Some cultures consider talking with your hands undignified. In other cultures, a smile can be used to cover anger, embarrassment, or feelings of being upset.

17. Cultural Differences Some Cultures:
May perceive a response like “maybe” or “that would be difficult” as a polite no
Some cultures prefer indirect communication and talking around the issue
You need to be aware of your own cultural assumptions as well as its impact on people for whom this is unfamiliar.

18. Gestures Use with care – may have negative meanings in other cultures
Thumbs-up and the OK sign are obscene gestures in parts of South America & the Mediterranean
Pointing or beckoning with the index finger as “come here”, or snapping fingers are seen as rude in some cultures
As the global village continues to shrink and cultures collide, it is essential for all of us to become more sensitive, more aware, and more observant to the countless motions, gestures, and body language that surround us each day. And as many of us cross over cultural borders, it would be fitting for us to respect, learn, and understand more about the effective, yet powerful "silent language" of gestures.

19. Touch To touch or not to touch is only part of the question
Cultures also have different rules about who can be touched & where
Even casual touching people of the opposite gender can be offensive in some cultures
Where, how and how often people can touch each other while conversing are determined by each culture’s norms. In many cultures, some touching is acceptable between people of the same gender, but not between males and females, even husbands and wives, if they are in public.

20. (CLAS)
The National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. CLAS Standard 1-15
Where, how and how often people can touch each other while conversing are determined by each culture’s norms. In many cultures, some touching is acceptable between people of the same gender, but not between males and females, even husbands and wives, if they are in public.

21. Overview
Medical care is complex and confusing, and many people struggle with understanding medications, self care instructions and follow up plans because of cultural differences. Not having a cultural awareness of our patients and an understanding of their health literacy can create significant problems that go beyond the walls of the hospital and into our community.

22. Significance for Culturally Competent Health Care
Responding to demographic changes
Eliminating disparities in the health status of people of diverse racial, ethnic and cultural backgrounds
Improving the quality of services and outcomes

23. CLAS Standards 1-15
The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations

24. CLAS Standards 1-15 Principal Standard: (Standard 1)
Governance, Leadership and Workforce: (Standard 2-4)
Communication and Language Assistance: (Standard 5 – 8)
Engagement, Continuous Improvement, and Accountability: (Standards 9-15)

25. In Summary
Observe the kinds of cultures you see in your patient population
Adjust your care for patients of different cultures
Look for resources available for patients of different cultures
Provide translation for a patient that doesn’t speak English