Cultural Competence
Barbara Moulton
Ext. 2710
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Learning Objectives
Define culture.
Understand culture’s influences on health.
Understand the elements of cultural
competence.
Understand the importance of providing
equitable care.
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Cultural Competence
“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)
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The Need for Cultural Competence
A wide variety of individuals make up
our communities. Nobody should be
given less care, attention or
understanding because they are
different from you.
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The Need for Cultural Competence
This includes, not only patients and
their families, but the people that we
work with.
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Cultural Competence
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.
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The Need for Cultural Competence
“There is nowhere you can go and
only be with people who are like you.
Give it up.”
(Bernice Johnson Reagon)
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What is culture?
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.
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What is culture?
Our culture influences the way we perceive virtually
everything around us. This is often unconscious. Hence,
culture naturally influences health, through many channels:
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Behaviours and practices (which may have a positive or
negative effect.
Attitudes and reactions (towards health and illness)
Communication Patterns
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Examples
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•
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•
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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
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What is culture?
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Examples
“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.”
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Avoid Assumptions
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What is Cultural Competence?
A set of attitudes, behaviours and
skills that enable you to work
successfully in a cross-cultural
setting.
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What is Cultural Competence?
It goes beyond committing facts
about different cultures to
memory. It is an attitude to be
lived not just a skill to be learned.
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What is Cultural Competence?
It includes how we care for
patients and how we work with
each other.
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The Elements of Cultural Competence
1. Self Awareness
2. Communication
3. New Learning
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#1 Self Awareness
Develop insights into
your own personal
values and bias and how
they may influence your
interaction with patients,
family and other staff.
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Self Awareness
“By heightening awareness of our
own
cultural influences, we become more
compassionate caregivers.”
A.M.A. Journal of Ethics
Are you aware?
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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.
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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.
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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.
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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.
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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.
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Self Awareness
We all have areas of bias,
intolerance and/or lack of
knowledge. Be aware of your
responses!
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Self Awareness
Reflect and act on ways
to be inclusive in all
aspects of your practice.
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Reflect on previous examples
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.”
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#2 Communication
Develop communication skills that promote
culturally diverse settings.
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Communication
Ingredients in successful communication
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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.
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Communication
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?").
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#3 New Learning
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.
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Acquire Foundational Knowledge
•
Foundational knowledge of cultural issues can be found
on the HHCC intranet.
• Documents/Ethics & Equity at Headwaters
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Contact the Equity program (Ext. 2710)
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Explore the websites referenced at the end of this
learning package.
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Take advantage of learning opportunities.
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Acquire Specific Knowledge
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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.
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Be aware of disparities
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
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• Personal Health
Practices and Coping
Skills
• Biology and Genetic
Endowment
• Gender
• Culture
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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.
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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.
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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
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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
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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
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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/culturalcompetenceningmodules.html
University of Ottawa
http://www.med.uottawa.ca/sim/data/Culture_e.htm
Health Care Management and Practice 2002;14(5):378-86)
Mary Narayan
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Questions?
Please contact me: Barbara Moulton
Ex 2710
Please visit
www.headwatershealth.ca
for more information and a full list of services
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