CDS 236- Cultural Competence in Health Care..pptx

CDS 236 Communication Disorders & Cultural Diversity D R. D A L A L A L A L I Cultural Competence in Health Care  What is Cultural Competence in Health Care? Individual values, beliefs and behaviours about health and well-being are shaped by various factors...

CDS 236 Communication Disorders & Cultural Diversity D R. D A L A L A L A L I Cultural Competence in Health Care  What is Cultural Competence in Health Care? Individual values, beliefs and behaviours about health and well-being are shaped by various factors such as: o Race o Ethnicity o Nationality o Language o Gender o Socioeconomic status o Physical and mental ability Cultural competence in health care is defined as the ability of providers and organizations to understand and integrate these factors into the delivery of the health care services.  Purpose of Cultural Competence in Health Care The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background or language.  The Importance of Cultural Competence in Healthcare Allows opportunities to establish good relationships between patients and their providers. Without cultural competence, providers would not be capable of understanding people with different cultures, which could result in misjudgements that would affect the quality of care.  How Can SLPs Develop Cultural Competency in their Personal Skills Treat all clients with respect for their culture and religion.  How Can SLPs Develop Cultural Competency in their Personal Skills Do not impose your beliefs and value systems on clients, their family members, or their friends.  How Can SLPs Develop Cultural Competency in their Personal Skills Be aware that the roles of family members may differ within or across culture or families.  How Can SLPs Develop Cultural Competency in their Personal Skills Recognize family members and other designees as decision makers for services and support. Respect non-traditional family structures (e.g., divorced parents, grandparents as caretakers). The Western culture holds that patients are entitled to be fully informed in their own medical care. This includes making decisions. In the Arab world, autonomy in decision-making is not the norm. In some families, it's common to look to an authority figure as the primary decision- maker within the group. These families may wish to exclude the patient from decisions in order to avoid stress. This can cause friction between health providers, patients, and their relatives.  How Can SLPs Develop Cultural Competency in their Personal Skills Understand that views of the aging process may influence the clients’/families’ decision to seek intervention.  How Can SLPs Develop Cultural Competency in their Personal Skills Older Patients of Arab and/or Muslim Origin Muslims may resist eating or taking medications during the daytime hours of Ramadan. Elderly persons of Arab origin may subscribe to traditional remedies and beliefs. TIP: Explore these issues gently with the elderly and incorporate an understanding of traditional remedies into an overall care plan. Some may expect medications to address symptoms, but once symptoms subside, they may discontinue taking them. Some believe that seeking treatment is not necessary because recovery from illness is in the hands of God. TIP: Provide an explanation to patients about why extended medication use is necessary.  How Can SLPs Develop Cultural Competency in their Personal Skills Older Patients of Chinese Origin Older patients tend to be polite and may smile and nod. Nodding does not necessarily indicate agreement or understanding. If the older patient is nodding their head, it may only be a sign of respect and not comprehension of the message. TIP: Agreement and disagreement is expressed differently across cultures both verbally and non-verbally. Always check for understanding by having the patient re-state or demonstrate understanding of your directions, information back to you.. Oldest male may take on decision making for older patients. Some older patients may use proverbs or symbolic language to discuss disease or death rather than the actual word.  How Can SLPs Develop Cultural Competency in their Personal Skills Older Patients of East Indian Origin Older patients expect respectful TIP: Always address the older patient formally by calling them Mr., Mrs until they invite you to call them by their first name Important decisions are made after consulting with family members and close family friends. TIP: Ask the older patient about his or her preferences regarding healthcare decisions to avoid later conflicts. Modesty is highly valued and may be seen where elderly women may be soft-spoken and not advocate for themselves. TIP: Establish a bond with older patients. Gaining their trust is clinically valuable, as older East Indian patients are more likely to seek help from those with whom they have rapport.  How Can SLPs Develop Cultural Competency in their Personal Skills Older Patients of Filipino Origin Respect for elders is very strong in Filipino families. TIP: To show respect to the older person address as Mr., Mrs., or include the word po in social greetings, e.g., “How are you, po?” The older patient may avoid prolonged eye contact with healthcare practitioners as a sign of respect for authority. If the older patient is nodding their head, it may only be a sign of respect to the speaker and not comprehension of the message. TIP: To emphasize respect for elders, avoid asking, “Do you understand?” and instead ask the patient to repeat the information. Families may expect to be involved and may expect to be provided with substantial information regarding treatment plans. Family may be extended and include uncles, aunts, godparents who have long-standing and close relationship to the patient. TIP: Ask the older patient about his or her preferences regarding healthcare decisions to avoid later conflicts.  How Can SLPs Develop Cultural Competency in their Personal Skills Older Patients of Korean Origin Avoid putting hand’s in pockets when standing. Older patients may alternate between western & traditional medicine but may not share this with Western healthcare providers. Do not disclose direct thoughts about illness in front of older Korean patients as they think this will contribute to a poor outcome. In end-of-life care, the eldest son will usually be expected to make decisions.  How Can SLPs Develop Cultural Competency in their Personal Skills Older Patients of Vietnamese Origin Respect of older patients is expected and is traditionally shown by: o Avoid direct eye contact especially with elders o A slight bow when greeting someone. o Using both hands when giving something. Interpersonal space is slightly more distant than arms length Raising one’s voice, pointing or openly expressing emotion may be considered disrespectful Illness is sometimes attributed to “catching bad wind” and is often treated by cupping Younger family members are usually responsible for health care decisions of the elderly Family members most often do not want the older patient to be told about a serious or terminal illness.  How Can SLPs Develop Cultural Competency in their Personal Skills You should understand that the use of a foreign accent or limited language skill is not a reflection of: Reduced intellectual capacity The ability to communicate clearly and effectively in a native language Reference: American Speech-Language-Hearing Association. (2010). Cultural Competence Checklist: Personal reflection.  How Can SLPs Develop Cultural Competency in their Personal Skills You should understand how culture can affect child-rearing practices such as: Discipline Dressing Toileting Feeding Self-help skills Expectations for the future Communication Reference: American Speech-Language-Hearing Association. (2010). Cultural Competence Checklist: Personal reflection.  How Can SLPs Develop Cultural Competency in their Personal Skills How does culture affect child-rearing discipline? Europe The biggest trend in European child discipline is the move to make spanking or slapping a child illegal. The Council of Europe proposed the ban in 2009 and it has since been approved by more than 23 countries. France was the most recent country to outlaw spanking, in 2016. Sweden, on the other hand, was a pioneer of such bans, passing a law to end spanking as early as 1979. Many parents prefer to emphasize a child’s autonomy by allowing them to make mistakes and learn from them.  How Can SLPs Develop Cultural Competency in their Personal Skills How does culture affect child-rearing discipline? Britain and the Naughty Step The British lean on positive parenting. They have been moving toward praise and encouragement, rather than yelling or hitting when disciplining. Some of this may be due, in part, to the rise of the “supernanny” style of parenting Supernanny uses interaction, praise, and timeouts on the "naughty step" to discipline children and encourage reflection on their behaviour.  How Can SLPs Develop Cultural Competency in their Personal Skills How does culture affect child-rearing discipline? The United States Discipline in the United States is as diverse as the parents who populate the country.  How Can SLPs Develop Cultural Competency in their Personal Skills How does culture affect child-rearing discipline? Asia The child is pushed towards excellence and is demanded to become a constructive member of the family. Spanking a child is accepted in the push for excellence, as well as verbal harshness to keep a child on track.  How Can SLPs Develop Cultural Competency in their Personal Skills How does culture affect feeding practices in children? Many factors shape caregivers’ beliefs and practices about feeding. It is important to remember that caregivers of different cultures follow different food-related beliefs. 1st step: recognize your own cultural beliefs on feeding to become culturally responsive. 2nd step: be aware of the cultural practices of the families you work with. Remember parents raise children based on beliefs & customs from their ethnic practices and childhood experiences.  How Can SLPs Develop Cultural Competency in their Personal Skills How does culture affect feeding practices in children? Feeding practices are viewed differently among cultures Traditional practices may be perceived favourably in one’s home culture. However, in another culture it may appear as pressuring the child. Therefore, it is critical to be sensitive to different cultural practices.  How Can SLPs Develop Cultural Competency in their Personal Skills How does culture affect feeding practices in children? Some caregivers may use harmful controlling practices that may hinder children's health. Examples of such controlling practices include: o Giving children food as reward o Pressuring children to eat or clean their plate Such practices may seem effective in the short term to get children to eat or try new foods These practices however tend to have negative long-term implications. This can result in disliking the food in the long term, becoming fussy, and developing weight issues In some cultures, an obese child is viewed as being simply chubby or cute. Also, in some cultures, being overweight or obese may be considered a sign of good health & wealth  How Can SLPs Develop Cultural Competency in their Personal Skills How does culture affect feeding practices in children? Culturally responsive feeding strategies include the following: 1. Increasing your knowledge about culturally responsive feeding practices  How Can SLPs Develop Cultural Competency in their Personal Skills How does culture affect feeding practices in children? Culturally responsive feeding strategies include the following: 2. Using culturally responsive language with children Instead of saying Try You cannot waste your food; children in different Why don’t you start with one scoop of food? parts of the world don’t have enough to eat. If you are hungry, you can have more later. Finish all the food on your plate. You can stop eating if you feel full. We can try these vegetables again another No dessert until you eat your vegetables. time. Next time would you like to try them raw instead of cooked? You need to eat; otherwise, you will look pale If you eat well you will become strong and and weak. healthu. Why are you eating so little? Take some more You can try it but you don’t have to eat it if food. If you don’t eat, I feel bad that you did not you don’t like it. Maybe you will like it next like it. time.  How Can SLPs Develop Cultural Competency in their Personal Skills How does culture affect feeding practices in children? Culturally responsive feeding strategies include the following: 3. Eating family style Caregivers should consider having family meals where adults & children sit and eat the same foods together. This practice can result in a pleasant mealtime and improve children’s acceptance of new foods. Shared mealtimes provide an excellent opportunity for adults to model healthy eating habits to children.  How Can SLPs Develop Cultural Competency in their Personal Skills How does culture affect feeding practices in children? Culturally responsive feeding strategies include the following: 4. Following the division of responsibility During mealtime, caregivers and children are encouraged to implement the division of responsibility. The caregivers’ responsibility: to decide what, when, and where the food is provided. The child’s responsibilities: to decide how much, what & whether to eat while recognizing their hunger & fullness. Following this division of responsibility helps to build trust between the caregivers and children.  How Can SLPs Develop Cultural Competency in their Personal Skills How does culture affect feeding practices in children? Culturally responsive feeding strategies include the following: 5. Engaging the family In all cultures, the whole family, including grandparents, influences children’s eating habits. Communicate healthy feeding practices not only to the mother, but also to the father & the rest of the family. Doing this will increase awareness of the recommended practices for feeding children.  How Can SLPs Develop Cultural Competency in their Personal Skills You should understand the impact of culture on life activities, such as: Education Family roles Gender roles Alternative medicine The value of Western medical treatment Perception of time Views of disabilities Reference: American Speech-Language-Hearing Association. (2010). Cultural Competence Checklist: Personal reflection.  How Can SLPs Develop Cultural Competency in their Personal Skills You should understand that the clients’ cultural norms may influence communication in many ways, including: Eye contact Interpersonal space Use of gestures Comfort with silence Turn-taking Topics of conversation Asking and responding to questions Greetings Interruptions Use of humour Decision-making roles Reference: American Speech-Language-Hearing Association. (2010). Cultural Competence Checklist: Personal reflection.  How Can SLPs Develop Cultural Competency in their Service Delivery Include the clients and their families as partners in determining outcomes for treatment. Recognize differences in pragmatic behaviours that vary across cultures. Learn about acceptable behaviours and customs that are prevalent in clients’ cultures. Consider clients’ beliefs in both traditional and alternative medicines when prescribing a treatment regimen. Understand that some individuals may have different reading levels in Arabic and/or their native language(s). Provide written information for clients to take home in their preferred languages. Seek assistance from trained interpreters, bilingual co-workers who can help interpret, as needed. Use assessment tools and materials that are not biased in favour of or against any one population. Consider all of the available research evidence. Consider the cultural and linguistic background of clients when you select treatment materials  How Can SLPs Develop Cultural Competency in their Service Delivery I consider clients’ and their families’ norms and preferences when planning: Appointments Holiday celebrations Meals, snacks Services in the home Homework/recommendations for caregivers Reference: American Speech-Language-Hearing Association. (2010). Cultural Competence Checklist: Service delivery.  How Can SLPs Develop Cultural Competency in their Service Delivery When communicating with clients whose native language is NOT Arabic, I use: Key words or signs in their language Visual aids Gestures/physical prompts Trained Interpreters/translators Reference: American Speech-Language-Hearing Association. (2010). Cultural Competence Checklist: Service delivery.  Strategies for Understanding other Cultures and Becoming Culturally Competent Read as much as possible about the family’s culture and language. Information may be gathered from the internet, books and individuals from that cultural group. Talk with individuals from a variety of cultural backgrounds. Participate in social interactions with people whose cultural and linguistic origins are different from yours. Learn some basic communication skills (e.g. vocabulary, simple phrases) in the client’s language.