Cultural Sensitivity
The Rev. George F. Handzo, BCC
Director of Health Services Research & Quality
HealthCare Chaplaincy Network
New York, NY
The End Game
A health care institution where patients, family
members and staff can live out their spiritual and
religious beliefs, values, and practices within the
bounds of mutual respect and safe health care
practice.
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A New Mindset
 Not about avoiding anything that might possibly
offend someone.
 Not about minimizing risk
 It’s about “why not” rather than “why”
 It’s about customer service and patient-centered care
 It is about employee satisfaction and retention
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Cultural Competence/Sensitivity
Being culturally sensitive or competent does NOT
mean knowing everything about every culture...
It is instead respect for differences, eagerness to
learn, and a willingness to accept that there are many
ways of viewing the world.
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Ethnicity
A group of people whose members identify with each
other, through a common heritage, consisting of a
common language, a common culture (often including
a shared religion) and a tradition of common ancestry.
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Culture
The learned or shared knowledge, beliefs, traditions,
customs, rules, arts, history, folklore and institutions
of a group of people used to interpret experiences and
to generate social behavior.
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Spirituality
Spirituality is the aspect of humanity that refers to the
way individuals seek and express meaning and
purpose and the way they experience their
connectedness to the moment, to self, to others, to
nature, and to the significant or sacred.
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What Are You Own
Predispositions?
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Attitudes
 What causes illness?
 What does it mean to be a “good patient”?
 How to treat illness and injury?
 Who do you go to?
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Attitudes- Right and Wrong
 Is it whatever works for the patient/service member?
 What is “wrong”?
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Aspects of Culture
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Aspect of Cultural Sensitivity
 Attitudes
 Knowledge and Comprehension
 Skills
 Desired Outcome- Internal-External
Deardorff, D.K. (2004) Identification and Assessment of Intercultural Competence as a Student
Outcome of Internationalization.; Journal of Studies in International Education. 10: 241-266,
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Aspects of Cultural Sensitivity
 Individual
 Organizational
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Aspects of Cultural Competence
 Facilitate- food, worship, prayer space & time
 Provide- worship
 Care- culturally sensitive care
 Advise- policy making, accommodation
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Health Care Culture
Beliefs
a) Standardize definitions of health and illness
b) The omnipotence of technology
Practices
a) Maintenance of health and prevention of disease via mechanisms such as the
avoidance of stress and the use of immunizations
b) Annual physical examinations and diagnostic procedures such as Pap
smears
Habits
a) Charting
b) Constant use of medical jargon
c) Use of a systematic approach and problem solving methodology
Likes
a) Promptness
b) Neatness and organization
c) Compliance
Dislikes
a) Tardiness
b) Disorderliness and disorganization
Customs
a)
Rituals
a) Physical examination
b) Surgical procedure
c) Limiting visitors and visiting hours
Professional deference and adherence to the “pecking order” found in
autocratic and bureaucratic systems
b) Hand washing
c) Employment of certain procedures attending birth and death
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Aspects of Culture
Sense of self and space
 Informal, handshake
 Formal, bows, handshakes
Communication and language
 Explicit, direct. Emphasis on content – meaning found in
words
 Implicit, indirect. Emphasis on context --- meaning found
around words
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Aspects of Culture
Dress and appearance
 “Dress for success” ideal. Wide range in accepted dress
 Dress seen as a sign of position, wealth, prestige.
 Religious rules
 Jewelry & hair
Food and eating habits
 Eating as a necessity – fast food
 Dining as a social experience. Religious rules
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Aspects of Culture
Time and time consciousness
 Linear and exact time consciousness. Value on
promptness. Time = money
 Elastic and relative time consciousness. Time spent on
enjoyment of relationships
Relationships, family, friends
 Focus on nuclear family. Responsibility for self. Value on
youth, age seen as handicap
 Focus on extended family. Loyalty and responsibility to
family. Age given status and respect
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Aspects of Culture
Values and norms
 Individual orientation. Independence preference for
direct confrontation of conflict
 Group orientation. Conformity. Preference for harmony.
Beliefs and attitudes
 Egalitarian. Challenging of authority. Individuals control
their destiny. Gender equality.
 Hierarchical. Respect for authority and social order.
Individuals accept their destiny. Different roles for men
and women.
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Aspects of Culture
Mental processes and learning
 Linear, logical, sequential, problem-solving focus.
 Lateral, holistic, simultaneous. Accepting of life’s
difficulties.
Work habits and practices
 Emphasis on task. Reward based on individual
achievement. Work has intrinsic value.
 Emphasis on relationships. Rewards based on seniority,
relationships. Work is a necessity of life.
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Aspects of Culture
 Communication of medical information
 Death & dying
 Keeping the Sabbath
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Use of Authority
 Traditional
 Negotiating
 Individualistic
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It’s All About Assessment
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Cultural/Religious Issues
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Beliefs
Values
Family structure
Modesty
Food
Dress
Daily Religious Observance
Ritual Items
End-of-life care
Mourning
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Assessment Issues
 Stereotypes
 Cultural Patterns
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Goal of Chaplaincy
Helping patients discover and use their spiritual and
religious resources in the service of their healing.
What is “healing”?
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Cultural Discussion
 PRESERVE beliefs and practices that have a
beneficial effect on health.
 ADAPT OR ADJUST those that are neutral or
indifferent.
 REPATTERN those that have a potentially harmful
effect on health.
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Accommodations
 How do you decide what warrants an
accommodation?
 Patient rights vs. family rights vs. employee rights
 Ethics consults
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Spiritual/Religious
Accommodations for Staff
 Dress
 Food
 Religious Observance- Daily
 Religious Observance- Holiday
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Tips
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Don’t treat others as YOU would want to be treated.
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Address all adult patients from other cultures by their surnames
unless specifically asked to use a first name.
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Mind your tone of voice.
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Every culture has its own rules for touching and distance.
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Don’t ask a limited English-speaking patient or family member: “Do
you understand?”
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Informed consent forms and regulations can be extremely upsetting
and frightening.
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Tips
 Different is different, it’s not right or wrong.
 I’m not afraid to ask, even when I feel uncomfortable.
 It’s not about me!
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Joint Commission
Publications
http://www.jcrinc.com
Advancing Effective Communication, Cultural
Competence, and Patient-and Family-Centered Care: A
Roadmap for Hospitals
The Roadmap for Hospitals provides recommendations
to help hospitals address unique patient needs, meet the
new Patient-Centered Communication standards, and
comply with existing Joint Commission requirements.
Example practices, information on laws and regulations,
and links to supplemental information, model policies,
and educational tools are also included. The PatientCentered Communication standards are presented in a
separate appendix that provides self-assessment
guidelines and example practices for each standard.
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Advancing Effective Communication, Cultural
Competence, and Patient-and Family-Centered Care: A
Roadmap for Hospitals
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Assessment:
Identify and address patient communication needs
during assessment
Identify patient cultural, religious, or spiritual beliefs
or practices that influence care
Identify patient dietary needs or restrictions that affect
care
Communicate information about unique patient needs
to the care team
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Advancing Effective Communication, Cultural
Competence, and Patient-and Family-Centered Care: A
Roadmap for Hospitals
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Treatment
Involve patients and families in the care process
Address patient communication needs during
treatment
Accommodate patient cultural, religious, or spiritual
beliefs and practices
Monitor changes in dietary needs or restrictions that
may impact the patient’s care
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Advancing Effective Communication, Cultural
Competence, and Patient-and Family-Centered Care: A
Roadmap for Hospitals
End-of-Life Care
 Involve the patient’s surrogate decision-maker and
family in end-of-life care
 Identify patient cultural, religious, or spiritual beliefs
and practices at the end of life
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Advancing Effective Communication, Cultural
Competence, and Patient-and Family-Centered Care: A
Roadmap for Hospitals
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Organization Readiness
Leadership
Demonstrate leadership commitment to effective
communication, cultural competence, and patient- and
family-centered care
Integrate unique patient needs into new or existing
hospital policies
Data Collection and Use
Conduct a baseline assessment of the hospital’s efforts
to meet unique patient needs
Use available population-level demographic data to help
determine the needs of the surrounding community
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What Do We Do Now?
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Read the Roadmap
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Talk to the champion for cultural initiatives/compliance
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Ensure that your assessment process addresses and communicates
cultural and spiritual beliefs and values
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What ethnic/cultural groups is your institution focused on?
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Remember this is about communication & patient safety
What can you uniquely contribute to the effort?
• Cultural expertise
• Ties to local communities
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Resources
Advancing Effective Communication, Cultural
Competence, and Patient-and Family-Centered Care: A
Roadmap for Hospitals
http://www.jointcommission.org/assets/1/6/ARoadma
pforHospitalsfinalversion727.pdf
A Dictionary of Patients’ Spiritual & Cultural Values
for Health Care Professionals
http://bit.ly/1kHeAbY
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The Rev. George Handzo, BCC
ghandzo@healthcarechaplaincy.org
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