Olga Kanitsaki Presentation

8/9/2019 Olga Kanitsaki Presentation

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The influence of culture on aged careThe influence of culture on aged care

deliverydelivery

Professor Olga Kanitsaki AM

Head

Division of Nursing and Midwifery

School of Health Sciences

RMIT University


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AimsAims

Identify what culture is and how it operates in

public mainstream society

Give an example of how culture care operates in

ethno specific contextGive an example of how the ruling normality

speaks for, undermines or subjugates other cultures

care practices in a multicultural society like ours

Propose actions that can be taken to improve health

services to ethnic aged in mainstream acute,

community, residential and ethno specific care

services


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Stats Aged 65 and overStats Aged 65 and over

2.4 Million aged 65 and over 12.5%

784, 600 or 33% born overseas

479, 400 61% CALD/NESB or 19.9% of the total olderpopulation

305, 200 39% ESB

By 2011 CALD 22.5% this is an increase of 66% growthsince 1996 compared to the same period of 23% for theAustralian born population

Italy, Greece, Germany, Netherlands & Poland

ABS & AIHW 2002 &AIHW 2001


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CultureCulture

Individual &

collective

experience,

History &

tradition

Human

Construction

Rules &

practices,

Rewards,

Punishments

Shared

Core values,

Beliefs,

Expectations,Goals,

Patterns of

social behaviour

& interactions

Living within &

interacting

with environment

in time & place

meaning,

Symbols,Language


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Cultural InterpretationsCultural Interpretations

Communicating MeaningCommunicating MeaningMembers of the same culture share sets of

concepts, images, and ideas which enable them to

think and feel about the world, to be able tointerpret the world in roughly similar ways. (Giles

& Middleton 1999, P 59 ).

It is not language alone that produces meaning,

but also behaviours and practices.


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Culture isCulture is::

Internalised (embodied) by the individual

Forgotten as embodied history (cfstructure of grammar)

Just as grammar (unconsciously) regulates

our speech, so too culture regulates ouraction, i.e. through internalised individualdispositions.


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Australian Public Culture & Institutional Structure:

Base of Society

Indigenous People

English

Scottish

EnglishIrish Ethnic

EthnicEthnic

Ethnic

Margins

Society

Margins of Society

Margins of Society

Margi n

sofSociet y

Welsh

of


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Transcultural Values andTranscultural Values and MoralMoral SystemsSystems

(Lay and Professional)(Lay and Professional) Values

Individuality versus collectivity

Privacy, confidentiality, truth telling

Independence versus paternalism Dignity, privacy, quality of life etc..

Family structure and relations

Care practices

Decision making processes Gender roles

Consent and informed consent


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Mainstream/Dominant cultureMainstream/Dominant culture

Well internalized and embodied by majority

or mainstream of people

Perceived as natural (like the laws of

gravity) and hence objective, factual, true


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Mainstream/Dominant culture,Mainstream/Dominant culture,

ContContAnyone who fails to uphold the normal

life way risks being labelled odd,

different, inferior, other, difficult,not normal and even a threat to social

cohesion


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LEININGER, M. 1995 P 23

Levels of cultureLevels of culture


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Greek Culture careGreek Culture care

Family structure, roles, values expectations

Child centred

Reflects ideal moral universeGods family: good father, mother, children

Interdependent

Family care trusted, strangers & paid not trustedCare institutions not trusted, family would go with

member. HCP surveillance by family


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Issues to be taken intoIssues to be taken into

accountaccount Generational differences in expectations Communication between generations

Children working Elderly isolation Economic & linguistic dependence Authority and respect for elderly may be

diminished within family

Difference between groups and individual agedpeople


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Case exemplarsCase exemplars

Case #1: Elderly Greek woman having a

shower

Case #2: Elderly Greek woman who

experienced both mainstream and ethnospecificaged care


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Cultural relational spaces inCultural relational spaces in

the Homethe Home

Old Aged

PCPC

Aust Greek Born Div 1&

Anglo Celtic

Anglo Celtic Div 1 Managers

BoardCEO

G

CG

C

Greek Nursing Home Culture in Action


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Ethnospecific Home BenefitsEthnospecific Home Benefits

Greek residence, PCs, relatives: Together share history,experience, language

Able to have a two way verbal communication with

carers, share jokes, reminisce, play games, have

arguments etcGreek environment, space objects, artefacts, meaningful

symbols

Greek food


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Ethnospecific Home BenefitsEthnospecific Home Benefits, Cont, Cont

Greek activities and religious practices

Greek entertainment, music, Greek TV,

dancing, picnics and community visiting

Name days

National days


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Concepts in the official documents too hard for PCs to

understand, thus no use translating them

PCs expected to learn English Pressure to learn English

Classes compulsory, after hours & without pay

Anglo Saxon/Celtic not expected or requested to learn

Greek


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Greek cultural capital devaluingGreek cultural capital devaluing

Greek RNs Div. 1 employed as SENs PCs

No systematic recruitment & retention plans for

Australian Greek or GA BornReasons

Funding & Div 1 level 4 position required

Inexperienced, youngGreek women (ethnic, immigrants)

Felt demeaned and insulted


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Greek RNs Div. 1 employed as SENs PCs

Because the other registered nurses and the other SENsknew I was registered as a [Division 1] nurse they wouldgive me a little bit more to do. But their expectations of mewere higher, and that was fine by me. I wanted to meetthose expectations. So, yes, I think at that stage I didnt

really know whether I was Arthur or Martha because I wasan SEN (they were paying me as an SEN) and that waswhat my job description said I have to do. Yet there wasthat expectation from them [that I would function as aDivision 1 RN], and I also had that expectation of myself.


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So here I was, experienced in terms ofknowledge as a registered nurse, and I hadthe appreciation of the language and theculture, and so they expected me to establish

a rapport with these residents and to doreally well in my interpersonal [relations] inaddition to my [professional] skills. I hadthem both, so the expectation was there. Andfrom a gender perspective [they saw me] as awoman, a Greek woman, who should [behavelike a Greek woman].


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The RNs saw me when I was on, Here's mylittle interpreter, and Here is my little second

hand person. I didn't mind that. I loved theopportunity to be doing some other skills thatreinforced what I was trained for.


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RNs & PCs used as interpreters for Australian

Management

Messengers & mediators to Greek staff and

communityLiving in-between two ambivalent cultural worlds.

Identity problems


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Constructed as ethnic and inferior

go and pick cherries or go and work down atBosch [a factory]

Other times she will speak to us like we are thelast rubbish of the rubbish. It is not right to haveus here at 7 in the evening and to have ameeting to last till 10 pm.

Expected domestic staff who chipped or brokeplates to pay for them.


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Other IssuesOther Issues

RelativesComplaint about the variety of food

Number of staff on night duty

Harassment on food, and harassment onwater.

I was treated like I was a migrant. An

illiterate migrant.


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Anglo Saxon Celtic interpretation of dignityand privacy, for example, elderly was scaredduring the night and requested to put an

intercom so that elderly can hear a voice. Themanager dismissed the request and stated thatthis would violate the Residential Standards

because of the noise and because of dignity

and privacy. The relative stated that the elderlyand those others sharing the room wereconcerned with safety not about dignity, noiseor privacy.


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[MII] She angrily instructed me to say to them, Take yoursweets and go away from the nursing home. Then she wentaway. I thought if I send them away, it will be the wrong thing

to do and we would not have accomplished anything. It is because they mistrust the nursing home because of the

restrictions imposed upon them by the nursing managementand because of the way they have imposed those restrictions.


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All of the above mitigated against trans-formative cross-cultural practices

Sustained mainstream culture superiority and

domination and,

Reinforces Greek cultural inferiority and

subordination


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Transcultural IssuesTranscultural Issues

Patient & family knowledge of health system

Professional roles, rules and practices

Cultural interpretations (whose prevail?)Communication and communication styles

Ethnocentrism

Stereotyping V GeneralisationsTranscultural ethical systems

Consent and informed consent


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Transcultural care delivery at aTranscultural care delivery at a

professional service levelprofessional service level

Culture care preservation/maintenance

Culture care accommodation/negotiation

Culture care repatterning/restructuring

Results in culturally congruent nursing care that ishealing and empowering

Can be applied face to face delivery in acute,community and home care, administrative, managerialand institutional level.


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Transcultural care service delivery atTranscultural care service delivery at

institutional levelinstitutional levelPolicies and guidelines: cross-cultural outcomes

that can be measured

Individual HCPs performance appraisals to takeinto account cross-cultural practices

Policies and guidelines that explicitly require the

inclusion of family/significant others in the

medical, nursing and other care planing and

delivery


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TN Care ContinuesTN Care ContinuesClient/patient information sharing with

family/significant others unless explicitly requestedfor information not to be given

Systematic use of interpreters

Establishing a multicultural work force, including

transcultural nursing experts and staff. Thisshould include increasing the number of

bilingual and bicultural nurses, doctors and otherhealth professional in aged care.

Conscious effort should be made not toassimilate such professionals but to help them towork effectively in this country


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StateState && National LevelNational Levelss

Legal system to recognise relationships and

interdependence beyond husband and wife and/or

children to include those others that are significant

to the aged

Legal system to ensure that effectivecommunication takes place and clients have

relevant knowledge to participate in the decisions

for their care and treatment


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Additional funding to be geared forrealethnic aged needs in community, acute andresidential care

Specific funding to ethno specific homes touse for translation of government policiesand documents

Specific funding for teaching the relevant

language to staff, English to the ethniccarers and the ethnic language to Englishspeaking staff


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Ethno specific ServicesEthno specific Services

Accreditation standards to measure:

Consumer and staff communication and

participation in decision making

All government policies, guidelines translated to

relevant language in the service

All employees who work in the service to speak

the relevant language(s)


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Professionals to be educationally prepared to be

able to transform government policies to servethe relevant ethnic group

Health professional to be cross culturally

educated to transform and manage care delivery

within ethnic context (particularly DONs )

Health professionals (RNs) in management to be

representative of the ethnic group

Provision of group health needs as defined bythem


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Level of appointment and quality of staff

Staffing levels & quality with relevant salary

Continuous education & Cross-cultural educationRelevant community involvement and support


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