Professionalism and Culture in Healthcare

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Questions and Answers

What does cultural awareness primarily entail?

Recognizing differences in attitudes and values between oneself and others. (correct)

Evaluating medical practices based on cultural conventions.

Understanding only the cultural practices of one's own background.

Being knowledgeable about scientific techniques in healthcare.

Which recommendation emphasizes healthcare leadership according to the recommendations listed?

Compassionate, caring, committed nursing

Openness, transparency and candour

Accurate, useful and relevant information

Strong patient-centred healthcare leadership (correct)

What is the primary intention behind the Hippocratic Oath?

To promote scientific research in medicine.

To advocate for affordable healthcare access.

To establish a legal framework for medical practice.

To ensure the well-being and safety of patients. (correct)

How many times does the term 'benefit of hindsight' appear in the transcript of oral hearings?

378 times (D) Signup and view all the answers

Which of the following is NOT mentioned as a recommendation in the report?

Financial investments in healthcare (A) Signup and view all the answers

What is a key value promoted by the recommendations of the inquiry report?

Openness, transparency and candour (B) Signup and view all the answers

Which factor is NOT considered a social determinant of health?

Genetic predisposition (D) Signup and view all the answers

In the context of the inquiries, what does the frequent mention of 'hindsight' suggest?

An acknowledgment of better decision-making retrospectively. (C) Signup and view all the answers

The Hippocratic Oath includes a commitment to what action concerning patient treatment?

Ensuring no harm or injustice is done to patients. (A) Signup and view all the answers

How does interpersonal racism primarily affect health outcomes?

By reducing access to social resources (C) Signup and view all the answers

What aspect of health can result from structural conflict as a social determinant?

Deterioration of physical and mental health (C) Signup and view all the answers

Which of the following is a potential outcome of food insecurity?

Psychological distress (A) Signup and view all the answers

What is a consequence of systemic racism for Indigenous populations?

Reduced access to housing (A) Signup and view all the answers

Which social determinant significantly influences early childhood development?

Housing environment (B) Signup and view all the answers

Which statement best describes the impact of unemployment on health?

It increases psychological distress and risk behaviors. (D) Signup and view all the answers

How can racism affect healthcare access?

Through reduced trust in healthcare providers (C) Signup and view all the answers

What is the primary focus of cultural safety in healthcare?

To provide effective nursing practice as determined by individuals from another culture (C) Signup and view all the answers

Which of the following diseases was NOT listed among the leading causes of illness and death in Indigenous Australians?

Respiratory diseases (D) Signup and view all the answers

What impact does the Australian Burden of Disease Study suggest about health in Indigenous Australians compared to non-Indigenous Australians?

Indigenous Australians experience a higher burden of disease and ill-health (B) Signup and view all the answers

Which statement best describes unsafe cultural practices in healthcare?

They are actions that disempower individuals' cultural identities (C) Signup and view all the answers

What was the original context for the development of the concept of cultural safety?

To address the effects of colonialism on Maori health in New Zealand (B) Signup and view all the answers

What is a key element of the Decision Support Service?

It creates a legal framework for decision-making when a person lacks capacity. (C) Signup and view all the answers

Which of the following best describes a Decision-Making Assistant Agreement?

A person makes their own decisions with support from an assistant. (A) Signup and view all the answers

How does the legislation approach the assessment of capacity?

It adopts a flexible functional approach to assess capacity. (D) Signup and view all the answers

What role do Enduring Powers of Attorney play under the Act?

They allow individuals to plan for future decision-making when they may lose capacity. (D) Signup and view all the answers

Which arrangement allows a person to make decisions jointly?

Co-decision-making agreement (A) Signup and view all the answers

What is an Advance Healthcare Directive?

A way to document healthcare wishes in advance when a person may lose capacity. (A) Signup and view all the answers

Which option does NOT support decision-making for individuals lacking capacity?

Unilateral decisions by healthcare providers (B) Signup and view all the answers

What is the primary focus of the Assisted Decision-Making (Capacity) Act?

To support individuals in maximizing their decision-making powers. (D) Signup and view all the answers

What is the primary purpose of an Advance Healthcare Directive (AHD)?

To set forth treatment wishes for when a person is unable to decide. (A) Signup and view all the answers

What can a person do if they regain capacity after having previously established an AHD?

They can revoke their own AHD. (D) Signup and view all the answers

Which statement best describes the legal nature of an AHD treatment request?

It serves as a recommendation but is not legally binding. (C) Signup and view all the answers

What is a significant disparity highlighted in global health equity?

There is an 18-year life expectancy gap between high- and low-income populations. (C) Signup and view all the answers

Which of the following statements is true regarding health outcomes in poorer populations?

They face systematic barriers leading to worse health outcomes. (C) Signup and view all the answers

What does the increase in relative gaps between wealthy and poor subgroups indicate?

Health inequities are worsening within countries. (A) Signup and view all the answers

How has the under-5 mortality rate varied between Africa and Europe?

It's more than eight times higher in Africa compared to Europe. (A) Signup and view all the answers

In the context of an AHD, who can a person appoint to ensure that their wishes are carried out?

A designated healthcare representative they trust. (D) Signup and view all the answers

What is a major barrier that Indigenous Australians face in accessing health services?

Cost of services (B) Signup and view all the answers

Which of the following factors is NOT considered a determinant of health and wellbeing for Indigenous Australians?

Access to technology (B) Signup and view all the answers

Which concept requires practitioners to reflect on their own cultural values and beliefs?

Cultural safety (C) Signup and view all the answers

What is primarily emphasized in creating culturally safe health care systems and environments?

Building constructs of cultural safety (D) Signup and view all the answers

What aspect is NOT a key determinant of health for Indigenous Australians?

Availability of urban amenities (D) Signup and view all the answers

Which term best encapsulates the ongoing process of understanding and appreciating cultural diversity in health care?

Cultural competence (A) Signup and view all the answers

Which of the following is an example of cultural safety in a health care context?

Incorporating Indigenous healing practices with respect (C) Signup and view all the answers

What role does cultural identity play in the health of Indigenous Australians?

It is essential for wellbeing. (B) Signup and view all the answers

Study Notes

Professionalism, Culture, and Cultural Awareness in Healthcare

Healthcare professionalism encompasses patient welfare, patient autonomy, and social justice. These principles guide healthcare decisions and practices.
Defining culture involves understanding variations in beliefs, values, and behaviours across different groups.
Organisational culture is the shared way healthcare organizations think, feel, and behave.
Cultural awareness is recognizing differences in attitudes and values between individuals and groups, particularly those from different countries or backgrounds.

Organizational Culture

Healthcare organizations are made up of various subcultures, which can either drive or hinder initiatives for quality improvement.
Research indicates a correlation between strong organizational cultures and good quality of care.
Cultural factors play a significant role in healthcare scandals, and a nuanced understanding of cultural dynamics is needed to prevent and address them.
Simple diagnoses and prescriptions regarding culture are insufficient for effectively addressing complex issues.

Three Levels of Organizational Culture

Visible aspects of organizational culture encompass service distribution, physical layouts of facilities, established care pathways, staff roles, and systems (e.g. dress codes and rituals).
Shared understandings include beliefs and values underpinning visible practices, including views on patient needs and dignity.
Deeper shared assumptions include the unspoken and unexamined underpinnings of daily practice, for example how hierarchy is valued.

400-1200 Excess Deaths

The Mid Staffordshire NHS Foundation Hospital experienced 400 to 1200 excess deaths.
Poor care and high mortality were documented from 2005 to 2009 in the report by Dr Robert Francis.
There were various examples of poor care and compassion in the hospital.

A Negative Culture

Cutbacks in staffing and services contributed to financial surpluses for the hospital.
Poor leadership, pressure on staff, and a culture of fear and tolerance contributed to deficiencies in care in the hospital

Cultural Awareness

Cultural awareness involves an individual's understanding of differences between themselves and people from other countries or backgrounds, especially differing attitudes and values.

The Wong-Baker FACES Pain Rating Scale

It uses faces to help patients rate their pain.
The scale ranges from "no pain" to "worst possible pain".
It is available in various languages.

Different Cultural Views on Death

Some cultures, particularly Buddhist Southeast Asian cultures, value the natural cycle of life, karma, reincarnation, and view death as part of life.
Aggressive treatment might be perceived as interfering with the natural process of death.
Patients and families may view advance directives positively in these cultures.

Assisted Decision-Making Capacity Act (2015)

This Act aims to maximize individual capacity for decision-making.
It supports individuals who face challenges by providing tiered support systems.
The act emphasizes the right to self-determination.

Capacity

The 2015 Capacity Act established a four-stage test for mental capacity, considering understanding relevant information, retaining said information, weighing up the information, and being able to communicate one's decision.

Advance Healthcare Directive (Act 2015)

Advance Healthcare Directives allow individuals to pre-plan for future healthcare decisions, expressing their wishes and preferences concerning treatment.
AHDS must be followed, where applicable, regardless of capacity.

Health Equity (or Inequity)

Poorer populations experience worse health outcomes than wealthier populations.
Differences exist in life expectancy between high and low-income countries.
Gap between poorer and richer subgroups for illnesses (e.g. cancer) is widening.

Social determinants of health are non-medical conditions that impact health and well-being.
These factors involve income, education, unemployment, working conditions, food security, housing, and environment, etc.

Racism and Health

Racism/racial discrimination is associated with poorer physical and mental health.
Indigenous cultures are negatively impacted by colonization, with social systems perpetuating disparities.
Racism can be interpersonal or systemic and impacts health through reduced access to resources.

Indigenous Health and Wellbeing

The Australian Burden of Disease Study shows Indigenous Australians experience significant premature mortality.
Leading causes of illness and death include mental health issues, injury, cardiovascular disease, cancer, and musculoskeletal issues.
Indigenous health problems are significantly greater than other populations.

Cultural Safety in Healthcare

Cultural safety, from the New Zealand definition, involves effective care practices determined by the patient or family, aiming to not diminish, demean or disempower cultural identities.
It emphasises client-centered culturally safe health care delivered by care providers who understand the values and practices of the client’s culture.

Cultural Differences

Collective decision-making is prevalent in many cultures.
Cultural values regarding autonomy and individual rights often clash with collective decision-making.
Treatment dilemmas arise when a health care provider prioritizes individual decision-making.

Cultural Awareness Model

Cultural awareness is described as a reflective process for practitioners to understand their own cultural background and how it impacts communication.
Cultural backgrounds include knowledge of values, beliefs, biases, and assumptions.
Cultural awareness is vital for understanding how cultural differences can affect communication and interactions.

Cross-cultural Communication

Cross-cultural/intercultural communication is the study of how verbal and nonverbal communication happens in diverse cultural settings.
Cultural norms, communication styles, language differences, and nonverbal communication methods can vary significantly impacting communication.
Misunderstandings can occur due to assumptions, differing language skills nonverbal communication interpretation, cultural stereotypes and high anxiety caused by unfamiliarity with the culture.

Cultural Competency

Cultural competency allows healthcare providers to deliver individualized care that takes into account cultural considerations.
It involves the process of cultural desire, awareness, knowledge, skill, collaboration and encounter.
Cultural competency enables culturally sensitive healthcare that avoids stereotyping.

Discrimination

Direct discrimination occurs when treating someone less favourably due to a protected characteristic.
Indirect discrimination occurs if a practice, criteria or policy, although seemingly neutral, negatively impacts a certain group, putting them at a disadvantage.
Discrimination stemming from disability often involves unfavourable treatment based on disability-related factors.

Cultural Safety

Cultural safety emphasizes the importance of healthcare providers acknowledging and respecting the cultural identities and needs of clients.
It requires health practitioners to reflect on their own cultural values and how they affect their behaviors. This process ensures clients are treated with respect and safety.
A method called ACCESS helps in assessing and improving cultural safety skills.

GMC Ethnic Bias

Doctors from marginalized ethnic groups face twice the referral ratio to the GMC for fitness-to-practice concerns compared to white doctors.
Exam pass rates show disparities between White and Black and minority ethnic (BME) UK graduates, with overseas graduates displaying even greater disparity.

GMC “Fair to refer” Report 2019

The report found that ethnic minority doctors and international medical graduates face higher referral rates.
There are issues with adequate induction, feedback, support, and opportunities for continuous learning.

NMC 'Ambitious for Change' Research

The research emphasized the significant variation in experience and outcomes across different ethnic groups in NMC procedures.
Black and ethnic minority nurses experience higher referral ratios for fit-to-practice proceedings.
Variations in outcomes across ethnicity are highlighted.

Irish Traveller Health Inequality

Traveller communities experience significant health inequalities, including lower life expectancy for women and men.
Infant mortality rates are significantly higher.
There are increased rates of deaths from respiratory, cardiovascular diseases, and suicides.

Learning Objectives

Learners will gain a comprehensive knowledge and understanding of culture and organizational culture in healthcare settings.
This includes diversity and discrimination, culturally safe and sensitive practice including methods (ABCD, RESPECT, ACCESS) impacts on healthcare outcomes, and impacts on topics like medical insurance, indemnity, and regulation.

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Description

Explore the crucial concepts of professionalism, culture, and cultural awareness within the healthcare sector. Understand how these factors affect patient welfare and the overall quality of care provided in healthcare organizations. Delve into the relationship between organizational culture and patient outcomes to recognize the impact of cultural dynamics in healthcare.