1. Cultural Competence Barbara Moulton Ext. 2710 Exceptional Experience Every Time 1

2. Learning Objectives  Define culture.  Understand culture’s influences on health.  Understand the elements of cultural competence.  Understand the importance of providing equitable care. 2Exceptional Experience Every Time

3. Cultural Competence 3Exceptional Experience Every Time “ It is much more important to know what sort of a patient has a disease than what sort of a disease the patient has.” (Dr William Osler) “ It is much more important to know what sort of a patient has a disease than what sort of a disease the patient has.” (Dr William Osler)

4. The Need for Cultural Competence 4Exceptional Experience Every Time A wide variety of individuals make up our communities. Nobody should be given less care, attention or understanding because they are different from you.

5. The Need for Cultural Competence 5Exceptional Experience Every Time This includes, not only patients and their families, but the people that we work with.

6. Cultural Competence 6Exceptional Experience Every Time We work with people from different backgrounds. Promote a caring attitude towards other staff. Respect differences. Be: Patient when perspectives differ from yours. Open to their ideas and approaches. Flexible. Do not impose your perspective. Neither defensive nor offensive. Willing to apologize when offense does occur.

7. The Need for Cultural Competence 7Exceptional Experience Every Time “There is nowhere you can go and only be with people who are like you. Give it up.” ( Bernice Johnson Reagon) “There is nowhere you can go and only be with people who are like you. Give it up.” ( Bernice Johnson Reagon)

8. What is culture? 8Exceptional Experience Every Time Traditionally is thought to be behaviours and beliefs characteristic of a particular social, ethnic, religious or age group. However there are other differences reflected in our community. This includes gender, sexual orientation, physical challenges, socio economic factors, social environments etc. Culture impacts how we learn, interact, respond, communicate and relate with others.eanio life.

9. What is culture? 9Exceptional Experience Every Time Our culture influences the way we perceive virtually everything around us. This is often unconscious. Hence, culture naturally influences health, through many channels: Behaviours and practices (which may have a positive or negative effect. Attitudes and reactions (towards health and illness) Communication Patterns

10. Examples 10Exceptional Experience Every Time Different beliefs & values Different reactions Different communication habits Different notions of time Different values towards space with regards to personal contact Different decision making process Different assumptions

11. What is culture? 11Exceptional Experience Every Time

12. Examples 12Exceptional Experience Every Time “ My faith does not allow me to remove this item.” “I trust my family to make the right decisions. I don’t want to talk about it.” “English is my second language. I don’t understand your question.” “I do not want to take pain medication. I need to face death with clarity.”

13. Avoid Assumptions 13Exceptional Experience Every Time

14. What is Cultural Competence? 14Exceptional Experience Every Time A set of attitudes, behaviours and skills that enable you to work successfully in a cross-cultural setting.

15. What is Cultural Competence? 15Exceptional Experience Every Time It goes beyond committing facts about different cultures to memory. It is an attitude to be lived not just a skill to be learned.

16. What is Cultural Competence? 16Exceptional Experience Every Time It includes how we care for patients and how we work with each other.

17. The Elements of Cultural Competence 17Exceptional Experience Every Time 1.Self Awareness 2.Communication 3.New Learning 1.Self Awareness 2.Communication 3.New Learning

18. #1 Self Awareness Exceptional Experience Every Time18 Develop insights into your own personal values and bias and how they may influence your interaction with patients, family and other staff.

19. Self Awareness “ By heightening awareness of our own cultural influences, we become more compassionate caregivers.” A.M.A. Journal of Ethics Are you aware? 19Exceptional Experience Every Time

20. Self Awareness Ethnocentrism The sense that your beliefs, values and ways of life are superior to, and more desirable than the lifestyle of others Example Patient autonomy may appear the ideal to you, but your patient may wish to let her spouse decide on whether or not she has the operation. 20Exceptional Experience Every Time

21. Self Awareness Cultural Imposition Goes beyond believing your cultural is superior. Expresses itself in the imposition of the views and values of your own culture without consideration of the beliefs of others. Example The Muslim patient asks us not to interrupt his scheduled prayers. Since the caregiver believes in less formal, more spontaneous prayer, he pressures the patient to adapt to the hospital schedule. 21Exceptional Experience Every Time

22. Self Awareness Cultural Blindness The inability to see how specific situations may be seen by individuals of another culture. Those who exhibit it think that they are actually very culturally competent because they feel that colour, race, ethnicity, poverty, gender, etc. don’t matter at all or are inconsequential. Example “I’ll be back in a minute,” the nurse says to the patient, not understanding that in the patient’s culture this is heard as literal promise not a casual assurance of availability. 22Exceptional Experience Every Time

23. Self Awareness Cultural Shock Being stunned by what you see in another culture. Example A son is injured in a car accident and dies in ER. The family practices their faith, which teaches them to receive all things that happen as divinely appointed. They are calm and strong in that faith. The caregivers are shocked by what they feel is a cold and unfeeling response. 23Exceptional Experience Every Time

24. Self Awareness Cultural Conflict Conflict generated when the rules of your own culture are contradicted by the rules of another. Example In some cultures it is normal when a person is dying to invite extended family members to the bedside, sing songs and undertake rituals to help the person's soul on its journey; this can easily frustrate other dying patients who seek peace and quiet. 24Exceptional Experience Every Time

25. Self Awareness We all have areas of bias, intolerance and/or lack of knowledge. Be aware of your responses! 25Exceptional Experience Every Time

26. Self Awareness Reflect and act on ways to be inclusive in all aspects of your practice. 26Exceptional Experience Every Time

27. Reflect on previous examples 27Exceptional Experience Every Time How would you respond to the following? Can you think of examples from your experience of providing care? “My faith does not allow me to remove this item.” “I trust my family to make the right decisions. I don’t want to talk about it.” “English is my second language. I don’t understand your question.” “I do not want to take pain medication. I need to face death with clarity.”

28. #2 Communication Exceptional Experience Every Time28 Develop communication skills that promote culturally diverse settings.

29. Communication Exceptional Experience Every Time29 Ingredients in successful communication Show respect with your whole person (eye contact, body posture, pitch and tone of your voice). Be slow to judge. Be aware of your approach to knowledge. Don’t interrupt. Ask questions. Pay attention to non-verbal communication which makes up 65-70 % of all communication.

30. Communication Exceptional Experience Every Time30 The BELIEF Mnemonic (University of Ottawa MedU) Beliefs about health ("What caused this problem?"); Explanation ("Why did it happen now?"); Learn ("Please help me to understand how you see your illness"); Impact ("How is it affecting your life?"); Empathy ("This must be hard for you") ; Feelings ("How are you feeling about it?").

31. #3 New Learning Exceptional Experience Every Time31 a) Acquire knowledge relevant to our patients and colleagues. Know where to find information on culture and health. Access, utilize, and partner with cultural resources. b) Be aware of how disparities exist for diverse populations.

32. Acquire Foundational Knowledge Exceptional Experience Every Time32 Foundational knowledge of cultural issues can be found on the HHCC intranet. Documents/Ethics & Equity at Headwaters Contact the Equity program (Ext. 2710) Explore the websites referenced at the end of this learning package. Take advantage of learning opportunities.

33. Acquire Specific Knowledge Exceptional Experience Every Time33 You will gain this through genuine interactions with patients, families and staff. Put aside assumptions. Ask questions. Everyone is unique. Remember that culture influences us but it does not define us.

34. Be aware of disparities Exceptional Experience Every Time34 The following can impact both health and access to health care. Poverty and income barriers. (#1 determinant of health) Social Support Networks Education and Literacy Employment/Working Conditions Social Environments Physical Environments Personal Health Practices and Coping Skills Biology and Genetic Endowment Gender Culture

35. Did this module surprise you? Did you have the assumption that a module on cultural competence would give you a checklist of information about various cultures? Cultural competence goes beyond committing facts about different cultures to memory. It is an attitude to be lived not just a skill to be learned. Like learning to play an instrument you will be continually challenged and stretched. Exceptional Experience Every Time35

36. Did this module surprise you? As you move forward…. Practice self reflection. Put aside assumptions. Be willing to learn and change. Remember that culturally competent care is really patient centered care, ensuring an exceptional experience every time for every patient of every culture. Exceptional Experience Every Time36

37. Promote a caring attitude Respect for the patient; Be patient and perceive the patient's perspective. Be open to their ideas and approaches. Be flexible and do not impose your perspective. Awareness of culture In every encounter there is an interaction of two cultures: the patient's and the caregiver. Be aware of different feelings about eye contact, about body space; what is appropriate to talk about. Be attuned to possible differences in gender roles, in how decisions are made; in orientation to time and to fate. Additional Resource - Health Care Management and Practice 2002;14(5):378-86) Mary Narayan Exceptional Experience Every Time37

38. Obtain background information Try to find out about the patient's culture. Consider social etiquette; nonverbal communication; beliefs and values; typical health issues and concerns of the culture. History taking Pay particular attention to nutrition, attitudes to medications, pain perceptions, and type of care preferred. Resource: Health Care Management and Practice2002;14(5):378-86) Mary Narayan Exceptional Experience Every Time38

39. Preserve, accommodate, restructure Aim to preserve cultural practices that support recovery; accommodate your management to practices that are neutral; if you feel that some of the patient's cultural practices are harmful (e.g. refuses to take the medication) try to restructure these. Try to explain your recommendations using the patient's perspective. Don't be defensive! Mistakes will occur. Apologize, express regret, and be willing to learn and, if necessary, refer to another clinician. Resource: Health Care Management and Practice2002;14(5):378-86) Mary Narayan Exceptional Experience Every Time39

40. References Embracing Cultural Diversity in Health Care: Best Practice Guidelines RNAO April 2007 Hospital for Sick Children Cultural Competence eLearning Module http://www.sickkids.ca/culturalcompetencening- modules.htmlhttp://www.sickkids.ca/culturalcompetencening- modules.html University of Ottawa http://www.med.uottawa.ca/sim/data/Culture_e.htm http://www.med.uottawa.ca/sim/data/Culture_e.htm Health Care Management and Practice 2002;14(5):378-86) Mary Narayan Exceptional Experience Every Time40

41. Questions? Please contact me: Barbara Moulton Ex 2710 Please visit www.headwatershealth.ca for more information and a full list of services Exceptional Experience Every Time41