Transcultural Care
Culture
The shared values,
traditions, norms,
customs, arts, history,
folklore, and institutions
of a group of people that
are unified by race,
ethnicity, language,
nationality, or religion.
Source: Office of Minority and
Women’s Health, HRSA, NIH
Characteristics of Culture
Learned roles,
behaviors, values,
attitudes
Human nature, time,
relationships,
traditions
Health beliefs, religion
or spirituality
Communication,
decision-making,
food/diet, grief/dying,
family roles, sick roles.
Characteristics of Culture
Stabilizing forces and change agents
Social Structure
Family, politics, education, economics, art,
history, physical environment, health care
facilities, ethnicity
Criteria for Defining Culture
Common
language/communica
tion system
Similarities in dietary
preferences
Common patterns of
dress
Predictable
relationships and
socialization patterns
Shared values and
beliefs
Personal Culture
Personality, unique
structure
Internal factors such as
gender, age, sexual
orientation
External factors such as
society, personal experiences
Where one grows up or now
lives
With or without children,
with or without religious
affiliation
Organizational/work
influences
Position within work place
and its location
Cultural Diversity
Difference in Race, ethnicity, language,
nationality, or religion among various groups
within a community is said to be culturally
diverse if its residents include members of
different groups.
Diversity
Differences can be
found in communities
that are bounded by
similarities in
ethnicity, language,
religion, geography,
history or politics.
Every interaction is
cross-cultural!
Ethnicity
Identity one has
based on ancestry
and national,
religious, tribal,
linguistic or
cultural origins.
Sense of belonging
to a reference
group within a
society
Race
Use of the term is debated
Biological term used to categorize
people based on physical
characteristics
Disregards genetic variations
Often used in discriminatory
manner
Acculturation
Giving up traits of one culture and
adopting those of another
Bicultural – function equally well in two
cultures
Traditional – retains traits from culture of
origin
Marginal – no traits from either culture or
origin or new one in which he/she lives
Acculturated – gives up traits of original
culture and adopts those of new culture
Assimilation
Social, political, and economic
integration of a cultural group into a
mainstream society
Usually requires a degree of
acculturation
Many cultural groups may resist or reject
acculturation
Communities develop in which people are
insulated from main stream
Lack of political voice may disadvantage
group
Ethnocentrism
Viewpoint that one’s own way of
believing or behaving is correct and
preferred
Ethnosensitivity
Process of becoming more sensitive
and respectful of cross cultural
differences
Cultural Competence
A set of academic and interpersonal skills that
allow individuals to increase their
understanding and appreciation of cultural
differences and similarities within, among, and
between groups. This requires a willingness
and ability to draw on community-based values,
traditions, and customs and to work with
knowledgeable persons of and from the
community in developing targeted interventions,
communications and other support.
Source: Office of Minority and Women’s Health, HRSA, NIH
5 Elements of Cultural
Competence
Awareness and acceptance of differences
Self-awareness or individual or
organizational culture
Understanding the dynamics of
difference
Integration of cultural knowledge within
individuals and systems
Adaptation to diversity
Steps to Cultural Competence
Awareness
Becoming aware of other cultural
viewpoints and taking into account the
diversity in values, beliefs, practices,
lifestyles and problem solving
strategies
Examination of one’s own culture,
learned biases and prejudices
Knowledge
Learning about
historical, social, political
and/or religious
influences that affect
another’s worldview
Distinguishing between
an individual’s traits and
those common to a
community or people
with similar origins
Give and take of ideas
and knowledge for
effective interpersonal
relationships
Skills
Integrating awareness and knowledge into western bio-medical
system during a cross-cultural encounter to achieve “culturespecific, individualized interventions
Collecting relevant cultural data in both a history and physical
assessment
Ability to generate conversation not confrontation
Partnerships instead of misunderstandings
Cultural Encounters
Cross-cultural
interactions that allow
new learning or
refinement of
knowledge and beliefs
Prevent stereotyping
as the experience of
interaction reveals
intra-cultural group
variation
Medical Interpreters
People who orally
translates a message
spoken in one
language into another
language
People who are fluent
in both languages
People who are not
relatives of the
patient
People who have
received professional
training
Use of Interpreters
Secure an interpreter for people
who:
Are non-English speaking
Are limited English proficient
Have limited understanding of health
care issues in the English language
Professional Interpreters
VS
Untrained Interpreters
Professional interpreters have been
screened to assure fluency in both
languages
Untrained interpreters may:
Omit important information
Add ideas
Answer for the patient
Give advice even if they don’t understand
Family and Friends Used as
Interpreters
May commit all of the errors as other
untrained interpreters
May cause the patient to not feel
comfortable sharing information
May react to a situation or information
rather than serve as an interpreter
May make decisions for the patient
There may be a breach of confidentiality
Acceptable Interpreters
Bilingual staff that is
trained and
demonstrates
competence
Contract interpreters
Community
volunteers who are
competent
interpreters
Telephone interpreter
services
Working Effectively Through
an Interpreter
Conduct pre-session to introduce
yourself and goals for the encounter
Speak directly to the patient
Speak slowly in short segments with
pauses
Ask that everything you and the patient
and family says is interpreted
Be aware there may not be linguistic
equivalence for some terms
Things to Avoid
Highly idiomatic speech
Complicated sentence structure
Sentence fragments
Changing an idea in mid-sentence
Asking more than one question at a time
Tips
Have the interpreter ask questions and alert you
to cultural misunderstandings
Respect an interpreter’s opinion that a question
may be culturally inappropriate
Avoid patronizing or demeaning the patient
Be patient as this may take more time
Roles of the Interpreter
Conduit of Information
Clarifier: Facilitates understanding when
no linguistic equivalence exists
Culture Broker: Provides a cultural
framework for understanding when
cultural differences are leading to a
misunderstanding
Advocate: Actions to eliminate
systematic barriers to quality care