Cultural Competence in Physical Therapy

Cultural Competence in Physical Therapy

• Cultural competence is a set of congruent behaviors, attitudes, and policies that come together to effectively work in cross-cultural situations.

• Culture is a combination of factors, including language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.

• Competence in cultural work implies the ability to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.

Session Objectives

• Define cultural competence and cultural humility, understanding their differences and similarities.

• Describe the connection between cultural competence and the APTA vision statement and guiding principles.

• Distinguish between beliefs, attitudes, and behavior.

• Understand the impact of culture on therapeutic effectiveness.

• Discuss the role of bias and its impact on patient care.

• Identify principles of thoughtful and intentional patient interaction regarding cultural differences.

Initial Thoughts

• The presentation invites reflection on the meaning of "cultural competence" in healthcare contexts.

What is Culture?

• Culture encompasses the "way we do things around here."

• Culture is significantly more complex than just race or ethnicity.

• Examples of influences include: gender identity, sexual orientation, socio-economic status, geographic location, disability status, native language, and intersections of these factors.

What is Cultural Competence?

• It's a developmental process evolving over time.

• Individuals and organizations are at different levels of awareness, knowledge, and skills within the cultural competence continuum.

• Cultural competence involves integrating and transforming knowledge about individuals' and groups' cultural backgrounds into practices, policies, attitudes, and standards to enhance the quality of service and promote better outcomes in diverse settings.

• Cultural competence requires ongoing learning and an understanding of social justice in healthcare.

Principles of Cultural Competence

• Define culture broadly.
• Value clients' cultural beliefs.
• Recognize the complexities of language interpretation.
• Facilitate learning between providers and communities..
• Involve the community in defining and addressing service needs.
• Collaborate with other agencies.
• Professionalize staff hiring and training.
• Institutionalize cultural competence.

Cultural Competence, Awareness, and Sensitivity

• Cultural competence emphasizes effective operation within varying cultural contexts while adjusting practices. This differs from cultural awareness, sensitivity, or knowledge, which do not include modifications aimed at structural change in the operation of the relevant culture.

Cultural Humility

• Cultural humility is a continual process of self-reflection and self-critique.

• It involves learning about a client’s culture, but first, includes learning about one's own cultural identities, beliefs, and assumptions.

• It is not a one-time event or class; rather it’s viewed as an ongoing dynamic process.

• Recognizes culture as constantly changing influences based on time and location.

Cultural Humility (cont'd)

• It addresses power imbalances between patient and provider to create space for patients to have a role in decision-making.

• It requires providers to acknowledge their own privileges and limitations of understanding.

• Empathy and focused, active listening are essential components.

APTA Vision Statement for the PT Profession

• "Transforming society by optimizing movement to improve the human experience."

APTA Guiding Principles

• Consumer-centricity: Patient/client values are central. Cultural competence is a critical skill to provide best practices, considering individual and cultural values.

• Access/equity: Recognizing health inequities and disparities. Using innovative service models, advocacy, and awareness of social determinants to improve access and equity.

• Advocacy: Advocating for patients and clients both individually and as a population. Working to promote best practice, manage change, and ensure systems are consumer-centered.

Beliefs, Attitudes, and Behaviors

• Beliefs: What people consider true.
• Attitudes: How people feel about something.
• Behaviors: What people do.
• Culture significantly impacts these aspects, requiring healthcare professionals to be sensitive to clients' beliefs, attitudes, and behaviors regarding their illness, injury, or disability for effective evidence-based practice.

Impact of Culture on Therapeutic Effectiveness

• Effective cross-cultural communication is fundamental for healthcare professionals.

• Understanding cultural contexts for complaints and distress helps in accurate clinical diagnosis.

• Recognizing cultural underpinnings of symptoms is crucial for accurate assessment and effective interventions.

• Knowledge about one's own culture and its influence on communication is also essential.

Examples/Considerations

• Eye contact, silence/small talk, expression of distress or discomfort, personal space, non-verbal communication.

Bias

• Values, beliefs, and experiences shape patient interactions by filtering information and guiding patient care choices.

• Unchallenged assumptions can create unfair realities for patients.

• Criticism and negative judgment should be consciously managed to maintain compassionate and quality care.

• Initial biases can be modified through conscious thought and experience.

Microaggressions and Micro-Affirmations

• Microaggressions are everyday actions that communicate derogatory messages about a person.

• Micro-affirmations counteract such messages with those that promote excellence and opportunity.

• Active listening and validating/affirming experiences are essential.

Avoiding Bias

• Ask the following 3 questions to avoid stereotypical thinking:
  • How is this client like all human beings?
  • How is this client like some human beings?
  • How is this client like no other human being?

Bias Against Providers

• Providers work with diverse patients.
• Unfavorable interactions from patients are likely.
• Maintaining professional boundary is essential while setting a healthy boundary without reacting impulsively.
• Examples include Mayo Clinics’ SAFER approach.

PT Practice Settings

• Hospital-based (inpatient acute)
• Skilled Nursing Facility/Residential Facility
• Outpatient clinic
• Home Health
• School-based/ Early Intervention
• Vocational/Recreational settings

Positive Patient Interactions

• Maintain an open mind.

• Understand patient beliefs and values.

• Ask patients about their health concerns and beliefs.

• Attend training on cultural competence.

• Be self-aware.

• Seek help from cultural experts when needed.

• Understanding of one's own culture helps in understanding others'.

Qualified Medical Interpreters

• Use qualified medical interpreters for non-English speaking patients.

• Avoid using non-qualified people like family members or unqualified staff.

• Use of unqualified interpreters may lead to misunderstandings.

• A tip is to ask patients to communicate ideas in their own words (without the interpreter).

Work to Build Trust

• Be culturally respectful.

• Engage family members when appropriate for decision-making.

• Encourage questions to promote treatment success.

• Use phrases like "What questions do you have for me today?" or "Is there anything else?".

Final Thoughts

• The presentation encourages reflective thinking about the meaning of "cultural competence" in healthcare.

Resources

• This section provides links to relevant websites and resources related to cultural competency and diversity, equity and inclusion (DE&I).

References

• This section cites sources and websites used for information.

This quiz explores cultural competence and humility, highlighting their significance in physical therapy. Participants will learn about the impact of cultural beliefs and biases on therapeutic effectiveness. Additionally, it discusses the connection between cultural competence and the APTA vision statement.