Post on 24-Feb-2016
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Multicultural Opportunities for Success in
Hospital Services
FirstName LastNameTitleOrganization
Questions to Run on:
• Can cultural identity influence your work in Hospital
Services?
• How comfortable are you with your knowledge of
cultures and religions and how does that impact your
interactions and instructions in the hospitals?
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Cultural Assumption
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New Perspective
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Objectives
By the end of this presentation the learner
will be able to:
1. Recognize the need for Hospital Services staff to
develop multicultural skills.
2. Be more culturally aware and skilled in working
with others of different cultures.
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Overview
• Laying Foundations
─ Operational definitions of culture, race and ethnicity
• Implications for Hospital Services
─ working with multicultural health care professionals
─ health care professionals’ multicultural needs
• Basic Principles
─ Practical tips in working with different cultures
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Laying Foundations
Operational Definitions of
Culture, Ethnicity, and Race and
the Differences Between These Terms
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Laying Foundations
• Culture is requires a broad definition and should
include:
─ Ethnographic variables
─ Demographic variables
─ Status variables
─ Affiliation variables
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Laying Foundations – Defining Culture
“Culture is defined as a specific
set of social, shared,
educational, religious, and
professional behaviors,
practices and values that
individuals learn and ascribe to
while participating in or outside
of groups with whom they
typically interact.” (Bomar, 2004)
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Laying Foundations – Defining Ethnicity
“Ethnicity is a key facet of culture and refers to a
common ancestry, a sense of ‘peoplehood’ and group
identity. From a common ancestry and a shared social
and cultural history and national origin have evolved
shared values and customs.”
(Friedman et al., 2003)
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Laying Foundations – Defining Race
“an ancient, nonscientific, political classification of
human beings and is based on physiological
characteristics, such as skin color, eye shape, and
texture of hair.” (Bomar, 2004)
• It is a narrower term then ethnicity and denotes a
human biological definition
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Laying Foundations
Important Clarifications:
─ Race and ethnicity should NOT be confused
─ People of one race can vary in terms of their ethnicity and
culture
─ Race is NOT considered a correct or useful means of
classifying people
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Laying Foundations
Important Clarifications:
─ There are no distinct, pure
races today
─ Religion is very much
entwined with ethnicity,
shaper of health values,
beliefs, and practices
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Thought Question
Knowing that people of one race can vary in terms
of their ethnicity and culture, can we truly make
assumptions about someone based on their
biological looks or even based on the little we may
know of their
“culture” or “ethnicity”?Spring2011
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Who / What Do You See?
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Implications for Hospital Services
Working with Multicultural
Health Care Professionals
&
Health Care Professionals’
Multicultural Needs
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Implications for Hospital Services
Working with Multicultural Health Care Professionals
• Communication and education – medical approach
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Implications for Hospital Services
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HCP Mind
Life Experienc
e
Education
DonationEducation
Implications for Hospital Services
Working with Multicultural Health Care Professionals
• Communication and education
– medical approach
• Communication and education
– multicultural approach
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Implications for Hospital Services
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HCP Mind
Culture
Religion
Life Experienc
e
EducationDonation
Education
Implications for Hospital Services
Working with Multicultural Health Care Professionals
• Communication and education
– medical approach
• Communication and education
– multicultural approach
• Education in groups
• Education one-oneSpring2011 OPO-MCT_HAguiar 21
Implications for Hospital Services
• Applying a multicultural framework to group
presentations
• Hofstede’s Five-Dimensional Model
• Created to improve and provide cross-cultural
communication for IBM
• Investigation that led to this framework was
conducted across 50-countries
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Implications for Hospital Services
• Hofstede’s Five-Dimensional Framework
• Power Distance Index (PDI)
• Individualism (IDV)
• Masculinity (MAS)
• Uncertainty Avoidance Index (UAI)
• Long-Term Orientation (LTO)
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Implications for Hospital Services
Power Distance Index (PDI)• Assesses extent less powerful members of
society accept unequally distributed power• Cultures with high PDI
• Exhibit high dependency needs, inequality accepted, hierarchy is needed, superiors are inaccessible, powerholders have privileges, change is normally by revolution
• Cultures with low PDI• Tendency to low dependency needs, inequality
minimized, hierarchies exist for convenience, superiors accessible, all have equal rights, change occurs by evolution
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PDI0
10
20
30
40
50
60
USWorld
Implications for Hospital Services
Individualism (IDV)• People look after themselves and their families
vs. those with a tradition of collectivism, emphasize life and well-being of the extended family
• Cultures with high IDV• People are focused on “I” and have private
opinions, feel guilty when there is a loss of self-respect, fulfill obligations to self
• Cultures with low IDV• People focused on “we”, prioritize relationships
over tasks, feel shame when creating loss of face for the collective, fulfill obligations to the group
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IDV0
10
20
30
40
50
60
70
80
90
100
USWorld
Implications for Hospital ServicesMasculinity (MAS)
• Degree to which values like assertiveness, success, competition and performance (male characteristics) prevail vs. values like quality of life, service, care for the weak and solidarity, maintaining relationships (female characteristics)
• Cultures with high MAS• Focus on equity, performance and competition
– managers are expected to be assertive and decisive
• Cultures with low MAS• Focus on equality, quality of work life and
solidarity – managers strive for consensus and use intuition
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MAS0
10
20
30
40
50
60
70
USWorld
Implications for Hospital Services
Uncertainty Avoidance Index (UAI)• Degree to which people in a country prefer
and are comfortable in structured over unstructured situations. Cultures avoiding uncertainty, minimize such possibilities by strict laws and rules, security and safety measure
• Cultures with high UAI• Are resistant to change, have many rules and
low tolerance of deviant ideas• Cultures with low UAI
• Prefer innovative ideas, there are few rules
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UAI0
10
20
30
40
50
60
70
USWorld
Implications for Hospital Services
Long-Term Orientation (LTO)• Differentiates between Western and Eastern
thinking and explores long-term vs. short-term orientation
• Cultures with high LTO• Mentality includes frugality, persistence,
relationships are ordered by status, a concern for a sense of shame
• Cultures with low LTO• Mentality includes protecting your ‘face’,
respecting tradition, personal stability and steadiness, and reciprocation of favors, greetings, and gifts
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LTO0
10
20
30
40
50
60
USWorld
Implications for Hospital Services
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Implications for Hospital Services
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Implications for Hospital Services
• Weakness of Hofstede’s framework
• Generalization vs. Stereotyping
• Applying Hofstede’s framework to group
presentation on donation versus one-on-one
education
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Implications for Hospital Services
• Applying a multicultural model in one-one education
• Arthur Kleinman’s Explanatory model
• Unbiased approach to an individual
• Gain the emic perspective versus our etic perspective
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Implications for Hospital Services
Anthropological terminology:
• Emic perspective –
insider’s perspective
• Etic perspective –
outsider’s perspective
• Both perspectives –
most effective vantage point
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Implications for Hospital Services
Explanatory Model – 8 Questions by Arthur Kleinman:
• What do you call your illness? What name does it have?
• What do you think has caused the illness?
• Why and when did it start?
• What do you think the illness does? How does it work?
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Implications for Hospital Services
Explanatory Model – 8 Questions (cont.)
• How severe is it? How long do you think you will have it?
• What kind of treatment do you think the patient should
receive? What are the most important results you hope
he/she receives from this treatment?
• What are the chief problems the illness has caused?
• What do you fear most about the illness?
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Implications for Hospital Services
Simple triggers - the 4 Cs:
1. Call
2. Cause
3. Cope
4. Concerns
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Implications for Hospital Services
• Applying Kleinman’s questions to healthcare
professionals:• Have you had any experience, personal or professional with
this type of an injury/illness?
• In your opinion, how should this injury/illness be treated?
• What do you think is the likely outcome for the patient?
• At what point do you believe death occurs? What about in
brain death?
• What is valuable to you in death? Spring2011 OPO-MCT_HAguiar 37
Implications for Hospital Services
Working with Multicultural
Health Care Professionals
&
Health Care Professionals’
Multicultural Needs
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Implications for Hospital Services
• Health Care Professionals’ Multicultural Needs• The Joint Commission requirement
• Data reported to The Joint Commission demonstrates most root cause of sentinel events is due to communication:
• Many standards relate to importance of understanding, acknowledging and respecting the patient’s culture
• U.S. Department of Health & Human Services – The Office of Minority Health standards• 14 CLAS standards set for health care organizations with the
following themes: Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational Supports for Cultural Competence (Standards 8-14)
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Implications for Hospital Services
Leininger says that nurses
are realizing the critical
need to become more
culturally competent and
knowledgeable in working
with individuals
of diverse cultures. (Leininger, 1994)
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Implications for Hospital Services
The Joint Commission definition of cultural
competence:
• the ability of health care providers and organizations to
understand and respond effectively to the cultural and
language needs brought by the patient to the health care
encounter
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Implications for Hospital Services
The Joint Commission definition of cultural competence (cont.):• Cultural competence requires organizations and their
personnel to: 1. value diversity;2. assess themselves; 3. manage the dynamics of difference;4. acquire and institutionalize cultural knowledge; and5. adapt to diversity and the cultural contexts of individuals
and communities served• culturally and linguistically appropriate
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Implications for Hospital Services
“Cultural competence
is a journey,
not a destination.”(Galanti, 2008)
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Implications for Hospital Services
Attitudes in Multicultural Donation:• Preconceived ideas about cultures
• African American• Filipino• Hispanic• Asian
• Religious background• Jewish• Jehovah Witness• Hindu
• Bias vs.. reality
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Implications for Hospital Services
Culture Assessed by Observation:
• Dress
• Appearance
• Speech
• Education
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Implications for Hospital Services
Risk of Cultural Imposition
“The nurse must examine his/her biases and prejudices
toward other cultures as well as explore his/her own cultural
background….Without becoming aware of the influence of
one’s own cultural values, a risk exist for the nurse to engage
in cultural imposition”. (Campinha-Bacote et al 1996)
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Implications for Hospital Services
“Unspoken assumptions regarding meaning of health,
illness, and death may affect communication regarding
donation.”
Dr. Hawryluck & Knickle (n.d.)
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Implications for Hospital Services
• Culture & communication
connected
• Communication – driven
by culture
• Connection forgotten = risk
for misunderstanding
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Implications for Hospital Services
• Communication varies: • overt & direct vs. covert & indirect
• Overt & direct challenged by covert & indirect
• Covert & indirect find overt & direct aggressive
• Use indirect communication to identify and uncover
perceptions of disease causation and best treatment
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• Effective communication is your responsibility
• Anxiety
• Stereotypes and prejudice
• Language problems
• 6 barriers to communication:
• Nonverbals
• Ethnocentrism
• Assuming similarities vs.
differences
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Implications for Hospital Services
Implications for Hospital Services
• Good intercultural communicators:• Personality strength
• Communication skills
• Psychological adjustment
• Cultural awareness
• Eight different skills:• Self-awareness, self-respect, interaction, empathy,
adaptability, certainty, initiative, and acceptance
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Implications for Hospital Services
Cultural considerations
• Identify the Decision Maker
• Give the family what they need and want
• Do not project your own personal feelings
• Assess their readiness – let the family guide the
conversation
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Implications for Hospital Services
• Understand your motives
• Concerns for the family
• Concerns for the recipient
• Turning a negative
situation around to be
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Implications for Hospital Services
Professional Empowerment• Hospital Services staff should help nurses to
understand how to: • Developed their own interpersonal skills• Utilize their strengths• Focus on the family
• Time • Taking care of their needs• Pick-up on cues from the family• Sensibility, sensitivity and adaptation
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Implications for Hospital Services
• Multicultural toolkit for HS staff• Abbreviated Kleinman cheat-sheet as a handout for hospital
staff as a reference tool
• Mini-inservice – one pager
• Multicultural PPT presentation
• Example of a Nursing Orientation presentation that applies
Hofstede’s framework
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Basic Principles
Practical Tips in Working with
Different Cultures
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Basic Principles
Reflections – know & understand yourself:
• What is your culture? Your beliefs?
• Have your culture and beliefs been influenced by your
family? Has it evolved?
• If you have changed your perspectives, what led you to
change your perspectives?
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Reflect. Know yourself.
Basic Principles
Leverage real-time education opportunities
• Opportunity for in-the-moment education
• Raises questions and concerns
• Brings to light perceptions
• Moments for intimate conversations
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Win them one-by-one.
Basic Principles
Cultural-Communication Tips
• Learn and use a few phrases of greeting and
introduction in the patient’s native language –
conveys:• Respect
• Demonstrates your willingness to learn about their culture
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Beware of hand gestures, some examples:
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Basic Principles
Basic Principles
• Do not assume you know the culture
• Seek to understand –
Don’t be afraid to ASK!
• Become a student of the person / the family
• Identify what provides value in death to that
individual
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Remember - your culture is not superior.
Questions to Run on:
• Can cultural identity influence your work in Hospital
Services?
• How comfortable are you with your knowledge of
cultures and religions and how does that impact your
interactions and instructions in the hospitals?
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Questions ?
Thank you for your attention!