Cultural Sensitivity in Healthcare Communication PDF

Cultural Sensitivity in Healthcare Communication Objectives Discuss the ways in which our society is becoming more multicultural and ethnically diverse Explain the documented disparity that ethnic and racial minorities perceive in the quality and availability of health care Define...

Cultural Sensitivity in Healthcare Communication Objectives Discuss the ways in which our society is becoming more multicultural and ethnically diverse Explain the documented disparity that ethnic and racial minorities perceive in the quality and availability of health care Define cultural competence and explain the need for it on the part of HCPs Describe two models on developing cultural competence Discuss nonverbal communication between cultures Discuss the need for and the use of interpreters Disparities in Treatment & Access to Health Care There is ethnic minorities These disparities, socioeconomic significant, receive lower or differences, factors as income documented quality, and exist level, access to evidence to poorer access to, independently of medical indicate that health care such insurance, racial and that and geographical healthcare access cardiovascular for which minority proximity to and treatment, disease, cancer, patients are likely healthcare frequently and HIV are just to experience facilities. Studies resulting in poorer three of the disparities in have shown patient outcomes. diseases Today, professionals throughout the healthcare industry—from hospital and insurance executives to physicians and nurses to higher education administrators are coming to recognize that cultural competence is absolutely necessary to effective communication with patients and other members of the healthcare team.  The American Medical Association (AMA) has defined cultural competence as “the Defining knowledge and interpersonal skills that allow providers to Cultural understand, appreciate, and work Compete with individuals from cultures other than their own. nce & Some It involves an awareness and acceptance of cultural differences; Ideas self-awareness; knowledge of the about it patient’s culture; and adaptation of skills.”  There is no agreed-upon best method or path for an HCP to learn cultural competence. A brief look at two models for acquiring these interpersonal skills and knowledge will help us understand more about the process. I. The Volcano Model—“The Process of Cultural Competence in the Delivery of Healthcare Services” This model, developed by Josepha Campinha-Bacote, defines cultural competence as “the process in which the HCP continually strives to achieve the ability and availability to effectively work within the cultural context of the client (family, individual, or community). It is a process of becoming culturally competent, not being culturally competent”. This process contains the following five steps: 1. Cultural Awareness. This is the process of looking closely and honestly at your own biases toward other cultures, as well as examining your own cultural background. Cultural awareness includes an awareness that racism and other forms of discrimination exist in healthcare delivery. 2. Cultural Knowledge. This is the process of seeking a thorough understanding of the attitudes and beliefs of other cultural and ethnic groups, as well as the health conditions and diseases that 3. Cultural Skill. This is the ability to accurately understand the cultural details surrounding the patient’s presenting problem and to physically assess the patient within the context of their culture. 4. Cultural Encounter. This is when the HCP actively seeks face-to face encounters with members of other cultures in order to better understand the HCP’s own beliefs about other cultures and to prevent stereotyping. 5. Cultural Desire: This is the all-important desire of the HCP to become more culturally knowledgeable and skillful. It is important to emphasize that this has to be something the HCP genuinely wants to do instead of merely a need to fulfill a job requirement. ‫يؤديها باقتناع و ليس كمتطلب عمل او وظيفة‬  II. The Cultural Competence Continuum This model, created by researchers at Georgetown University’s Child Development Center, describes a range of six points on a continuum, or scale, of cultural competence. These include the following: 1. Cultural Destructiveness. This point on the scale is characterized by attitudes, policies, structures, and practices by an individual or within a system or organization that are destructive to members of a cultural group. This can refer to openly hostile racist behavior on the part of a single person or to a destructive act committed by a group or institution against a different cultural group. 2. Cultural Incapacity. This point describes the inability of an individual or institution to respond effectively to the needs and interests of culturally and linguistically diverse groups. For example, a pharmacy manager in a predominantly white neighborhood who is so afraid of displeasing customers that he becomes reluctant to hire qualified 3. Cultural Blindness. This describes the stance taken by many people or institutions of viewing and treating all people from different cultures as if they were the same. A HCP who does not recognize that women from some groups, such as Muslims or Latinas, may feel deeply uncomfortable being touched by a stranger, particularly a male stranger, suffers from cultural blindness. 4. Cultural Pre-competence. This point on the continuum describes a level of awareness by people or institutions of their capacity for growth in responding effectively to culturally and linguistically diverse groups. This is true for many hospitals and healthcare organizations 6. Cultural Proficiency. This describes individuals or institutions that have a high regard for diverse culture and use this ethical stance as a foundation to guide their endeavors. From a desire to do so, such individuals actively pursue the development of their own cultural competence and seek to continually enhance their organization’s capacities in cultural and linguistic competence. They advocate with, and on behalf of,  Nonverbal Communication in Cross- Cultural Contexts Nonverbal communication is the primary means of expression for all cultures, and the meanings of different forms of nonverbal communication can vary greatly among different cultures. Even within a given culture, nonverbal communication can vary from individual to individual, depending upon age, education, gender, socioeconomic status, or geographic background. As an HCP who will work in an increasingly diverse workplace, you should be aware that many forms of nonverbal communication that seem absolutely clear to you Some examples of areas in which such misunderstanding may occur include the following: Facial Expression. Facial expressions play an important part of any interpersonal communication, but interpreting the exact meaning of facial expressions can be difficult when you are communicating across cultures. As noted in the previous lectures, there exist six facial expressions that are considered universal: happiness, sadness, Here follow just a couple examples to illustrate the point: The Smile—Everyone knows how to smile. However, not all the members of all cultures smile for the same reason, and not all cultures believe that smiling is appropriate in the same situations. Smiling is an expression of happiness in American culture. Germans also smile as an indication of happiness, but only smile when with people they know closely and really like. In many Asian cultures, the smile can mean  Crying or Expressions of Grief and Sadness— Crying and other expressions of grief and sadness are also specific to various cultures. White American men, for example, often suppress these expressions in public. Men of Chinese, Japanese, and Korean cultures also resist displaying these emotions through facial expressions,  Eye Contact—Eye contact is an important form of nonverbal communication, and like facial expression, it can mean different things in different cultures. In white American culture, direct eye contact is expected of someone who is listening to a speaker, whereas a speaker is expected to make frequent but flitting eye contact. Among African Americans, a listener will frequently avert their  Handshaking—This form of touch and its meaning can also vary greatly from culture to culture. American culture commonly uses the handshake as a form of greeting with friends and strangers. But other cultures have complex views of handshaking. In Arab culture, men will shake using their right hands–to use the left hand to greet someone is a harsh social insult. Tips for Improving Cross-Cultural Communication between the HCP and Patient 1. Do not treat the patient in the same manner you would want to be treated. 2. Begin by being more formal with patients who were born in another culture. 3. Do not worry if the patient fails to look you directly in the eye or ask questions about the treatment. 4. Do not assume anything about the patient’s ideas about how to maintain good health, what causes illness, or ways to prevent or cure illness. When a patient is ill, be sure to ask what they believe caused the illness. 5. Ask the patient how they prefer to make their treatment decisions. 6. Never assume that the patient is familiar with any particular type of medical test or procedure.  Communicating with Limited-Common language-Speaking Patients 1. Speak slowly, not loudly. 2. Face the patient and make appropriate use of gestures, pictures, and facial expressions, and closely observe the patient’s response. 3. Avoid idiomatic expressions‫ مصطلحات‬that may be difficult for the patient to understand. 4. Do not clutter your talk with unnecessary words or information. 5. Speak in simple, declarative sentences. 6. Remember to paraphrase and summarize often. 7. Check to see that the patient understands the concepts behind the words. 8. Avoid questions that can elicit a simple yes or no answer.  Summary of Strategies for Using a Medical Interpreter You will need the services of an interpreter for providing care to some patients whose speaks a different language, Below is a list of suggestions to follow when working with an interpreter: 1. Brief the interpreter: summarize for the interpreter the key information you want to convey 2. Look at the patient and address them directly. 3. Explain information and ask questions in more than one way. 4. Avoid long, complicated sentences: be concise and direct when speaking. 5. Break up what you have to say into short segments. 6. Allow the interpreter time to think. 7. Use appropriate facial expressions and gestures and take advantage of the interpreter’s speaking time to examine those of the patient. 8. Remember that the culture of the second language may cause the interpreter to modify what you or the patient has said. The End of the Lecture