1. Culturally Responsive Nursing Care at LAC+USC Geri-Ann Galanti, PhD www.ggalanti.com Los Angeles County Department of Health Services Office of Diversity Programs

2. Ground Rules Ask questions Don’t worry about political correctness Let us know if something offends you Assume any such statements are made out of ignorance, not malice.

3. Stereotype vs. Generalization Generalizations are statements about common cultural patterns; probability statements about a group that have to be checked in the individual case. Stereotypes are assumptions that an unchecked generalization is accurate in the individual case.

4. Primary Issues To Be Addressed Misunderstandings which are based on cultural differences in the meaning of behavior, and which can lead to lack of rapport or bad feelings Noncompliance (non-adherence) issues which are often based on different beliefs or values

5. Communication: Gestures

9. Lack of Eye Contact Anglo/African American Asian Middle Eastern Native American

10. Personal Space Asian American Anglo American Middle Eastern American

11. Language Idioms Don’t be crazy!Step on it!

12. Language Confusion Same language, different meaning: Fanny (American)

13. Language Confusion Same language, different meaning: Fanny (British)

14. Language Confusion Puto (Spanish) Different language, different meaning:

15. Language Confusion Puto (Filipino) Different language, different meaning:

16. Saying "yes" when the answer is no Saving “face” Show respect Grammar

17. Style of Interaction Personalismo

18. Using Interpreters Studies show that an average of 70% of the interpreted exchanges by ad hoc interpreters contain clinically important errors. Family members, especially, are prone to edit both the clinician’s and patient’s utterances. Children are frightened or intimidated if asked to interpret. There are ethical problems involved. Confidentiality concerns must also be considered.

19. Issues of Language Access in Health Care DHHS guidance for language access under the Title 6, Civil Rights Act of 1964 MediCal contract regulations Joint Commission on Accreditation of Healthcare Organizations (JCAHO) includes standards for cultural competence training and language services.

20. JCAHO Ruling JCAHO views the provision of linguistically appropriate care as an important quality and safety issue. JCAHO requires the inclusion of language and communication needs in the medical record. Interpretation and translation must be provided for patients who need it.

21. DHHS says: Assess patients’ language needs. Try not to use family or friends or whoever you can grab. Don’t use minors to interpret. Try to use trained medical interpreters whenever possible. Use telephonic interpreters for rare languages.

22. What Can You Do? Honestly assess your own bilingual skills Understand the pitfalls in using untrained interpreters Use interpreters effectively Use telephonic interpreters skillfully

23. Are your bilingual skills really adequate? Can you: formulate questions easily? ask a question in more than one way? understand nuance and connotation in the patient’s response to questions? understand regional variations? know terms for anatomy and healthcare concepts? convert biomedical terms into lay terms in the target language?

24. The Effective Use of Face-to Face Interpreters Brief the interpreter first, if possible. Introduce the interpreter to the patient. Position the interpreter behind the patient or behind you. Speak and look directly at the patient. Use first person and expect the interpreter to do the same. Avoid interrupting the interpretation.

25. Using Telephonic Interpreters Use a speaker phone; do not pass a handset back and forth. Remember that the interpreter is blind to visual cues. Let the interpreter know who you are, who else is in the room, and what sort of patient encounter it is. Let the interpreter introduce her/himself.

26. What You Need to Know to Connect The language needed Dial 0 for hospital operator Tell operator to connect you with the Language Line. Remember that the telephonic interpreter is bound by confidentiality regulations, just as any other health care personnel.

27. Values The things we hold as important They are generally related to the circumstances that lead to success within the physical and social environment

28. Dominant American Values and the Health Care System Money Privacy Independence Individualism

29. When Family is the Primary Value “Too many” visitors Conflict with HIPPA regulations Deferring decision-making Lack of self-care

30. The 4 C’s of Culture What do you call the problem? What do you think caused the problem? What have you done to cope with the problem? What concerns you most about the problem and about the treatment?

31. Video Patient Diversity: Beyond the Vital Signs

32. Cupping During 2 Days Later

33. Protection Against Evil Eye Mexico Mediterranean Middle East

34. Labor Pains Expression of Pain Some cultures encourage stoicism Northern European Anglo American Asian Native American Some cultures allow expressiveness Middle Eastern Hispanic Mediterranean

35. Providing Culturally Responsive Care Learn about the beliefs and practices of the patient populations you serve Develop a tolerant accepting attitude about views different from your own Keep in mind that there is always individual variation within a group Don’t make assumptions; ask