NUSC 1P10 Lecture 3 Fall 2023 Brock University PDF

NUSC 1P10 | Fall 2023 Lecture 3 Class Objectives 1. Define culture and associated terms 2. Describe the importance of culture in interpersonal and therapeutic relationships 3. Discuss cultural safety and nurses' obligation provide culturally safe care 4. Describe principles of cultural safety inc...

NUSC 1P10 | Fall 2023 Lecture 3 Class Objectives 1. Define culture and associated terms 2. Describe the importance of culture in interpersonal and therapeutic relationships 3. Discuss cultural safety and nurses' obligation provide culturally safe care 4. Describe principles of cultural safety including with Indigenous peoples 5. Discuss strategies for communicating across language barriers 6. Discuss the role of the nurse as advocate and ally NUSC 1P10 | Fall 2023 Communication & Culture Culture What is culture? • Culture is the learned and shared beliefs, values and lifeways of a particular group • The acquired pair of glasses through which we see the word • Encompasses all other diversity dimensions Surface & Deep Culture • Surface/external culture • elements that we can plainly see • Deep/internal culture • larger • less apparent • influence surface elements Definitions associated with culture Culture – the language, values, beliefs, traditions, and customs people share and learn (Samovar, et al., 2012) Co-culture – membership in a subgroup that is part of an encompassing culture (Adler, 2020) Subculture – a smaller group of people living within the dominant culture with a distinct lifestyle and shared beliefs that set them apart from the mainstream (Drench et al., 2009) Ethnicity – the social identity and origins of a social group largely because of language, religion, and national origin (Leininger, 2002) Ethnocentrism – belief that one’s own culture is superior to all others, and should be the norm (Lewis, 2000) Culture is Relevant to all People • Avoid confusing culture with race, religion, ethnicity, or nationality • Avoids assumptions – “all Irish people …” • Highlights the relevance of culture to all people • Highlights the importance of understanding differences among groups • Leads to person-centred care • View culture as more than single-group membership Culture & Cultural Diversity in Canada Source: https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2017028-eng.htm Culture & Cultural Diversity in Canada https://www150.statcan.gc.ca/n1/daily-quotidien/221026/g-a005-eng.htm Culture is Contextual Context • The structures and processes that shape and are shaped by people’s lives • Not simply the backdrop of human activity • Shapes health and well-being Culture • Arises from multiple, dynamic contexts (not separate from life circumstances) • Is relevant to all people • Always changing Benefits of viewing culture as contextual • Avoids stereotyping • Celebrates difference • Avoids “lumping” people together based on ethic or religious background • Lessens judgement • Facilitates understanding The Transactional Communication Model • Environments affect communication • Culture is part of an individual communicator’s environment Source: Adler, R.B. et al. (2020). Interplay: The process of interpersonal communication. New York, NY: Oxford University Press. Page. 9. Intercultural Communication The process by which members of two or more cultures exchange messages in a manner that is influenced by their different cultural perceptions and symbol systems Intercultural Communication Interpersonal Significance HIGH LOW Parent and child discuss relationship Husband and wife from different cultural backgrounds Most nursing encounters English-speaking caller to English-speaking customer service rep. Intercultural Significance Traveler unintentionally violates local customs HIGH Intercultural Communication Concepts Collectivist vs. individualistic cultures - perceive interpersonal behaviours and social obligations differently Uncertainty avoidance - Some cultures are especially concerned with security – therefore avoid uncertainty High-context vs. low-context - whether information is implicit or explicitly conveyed depends on culture Why is intercultural communication important in healthcare? • The therapeutic nurse-client relationship is based on meaningful communication (CNO, 2018) • Nurses are morally and professionally bound to provide care that is safe – including cultural safety (SteinParbury, 2018) NUSC 1P10 | Fall 2023 Cultural Safety Cultural Safety – Concepts • Cultural sensitivity – tolerant and sensitive to difference • Problematizes difference • Leads to stereotyping or generalizing • Overlooks social inequities and structural determinants of health • Cultural Safety – beyond sensitivity and focuses on power imbalances, inequitable social relationships, and social justice • Views cultures as dynamic and constantly shifting • Culture is shaped by society (e.g., power, history, economics, policy) • Promotes actions that recognize, respect, and nurture unique cultural identity of people/families and safely meet their needs, expectations and rights Cultural Safety – Concepts Nursing care is unsafe if clients feel humiliated or alienated or are directly or indirectly dissuaded from accessing necessary care (Ramsden, 2002) Cultural Safety – Concepts • Cultural Competence – responding respectfully and effectively to people of all cultures, languages, classes, races, ethnicities, backgrounds, religions, spiritual traditions, immigration statuses, and other diversities • Does not require knowing everything about every culture à accept the idea that there are many ways to view the world • Cultural Humility – commitment to critical selfreflection to: • Identify and address biases, prejudices, attitudes, and behaviours • Includes openness, self-awareness, self-reflection and critiques Using the Ideas of Cultural Safety Examine the organization: • Do policies diminish, demean or disempower cultural identity or well-being OR recognize, respect and nurture? Examine your nursing practice: • What is the unique identity of this person or family and how can I practice to recognize, respect, and nurture that identity and meet their needs and expectations? (Doane & Varcoe, 2021) Using the Ideas of Cultural Safety Examine yourself: • How do my own personal and cultural history, values, and beliefs influence my practice? • How do my own economic, political, social, and historical location shape my practice? (Doane & Varcoe, 2021) Culturally Safe Relational Practice with Indigenous People – 4 Rs Respect • Understanding and demonstrating regard for cultural knowledge, traditions, values, and activities • Learning about the intergenerational impacts of colonialism Reciprocity • Mutual benefit from interaction Responsibility • Active participation in reconciliation and Indigenous events and activities Relevance • Understanding and acknowledgement of traditional Indigenous territories • Traditional languages • Show interest Culturally Safe Relational Practice with Indigenous People • Importance of protocol • Land acknowledgement • Gift giving • Introductions • Situating self • Name, family lineage, cultural background NUSC 1P10 | Fall 2023 Language Language Diversity in Canada Over 7 million (or 21.1.%) of people in Canada speak an immigrant language at home Source: https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2017025-eng.htm Language as a key aspect of culture Limited understanding of English is associated with: - Less access to healthcare [↓Preventive care or screening ↑ Emergency services] - Lower quality of care & Patient safety concerns [delayed diagnosis, missed diagnosis, inappropriate referral …] - Violations of patient’s rights [informed consent] Bowen, S. (2001). Language barriers in access to health care. Ottawa: Health Canada. Research Highlight De Moissac & Bowen, 2019 Title: Impact of language barriers on quality of care and patient safety for official language minority Francophones in Canada Methods: • Survey 297 Francophones in NL,SK, AB, ON • Interviews with 20 survey participants and 5 interpreter health navigators Findings: • Most participants had experienced language barriers that contributed to poor quality of care or increased risk of adverse events • Problematic practices: • Family members or friends translating • Google translate • Travel to Quebec or France for services Guidelines for communicating with clients partially fluent in English • Assess nonverbal and verbal communication • Keep eyes at same level and assess whether client is comfortable with eye contact • Speak slowly and clearly (not loudly) • Use pictures when possible Guidelines for communicating with clients partially fluent in English • Avoid using technical terms or jargon • Ask for feedback – providing client with paper and pencil • Remember clients understand more than they can express • Remember stress interferes with the client’s ability to think in English Guidelines for improving intercultural communication - LEARN L – listen with sympathy and understanding to the client’s perception of the problem E – explain your perceptions of the problem A – acknowledge and discuss the differences and similarities R – recommend treatment N – negotiate agreement Riley, J.B. (2020). Communication in Nursing. 9th ed. St. Louis, MO: Elsevir Inclusive Language Respects and promotes all people as valued members of society. Inclusive language does: • Use person-centred language • Respect person or group preferences • Reflect diversity Inclusive language does not: • Stereotype • Use descriptors that portray individuals or groups as dependent, powerless, or less valued • Use sexist, racist, or other discriminatory terminology Inclusive Language When communicating with patients and families, consider: • Does my communication cast blame on the person I am accompanying in care? • Does it reinforce stereotypes? • Does my communication include unnecessary opinions or information? • Does my language express disapproval? • How would my patient feel if they read my documentation? CNO Competencies - Advocate Entry to Practice Competency 7 – Advocate Registered nurses are advocates who support clients to voice their needs to achieve optimal health outcomes. Registered nurses also support clients who cannot advocate for themselves. Advocacy – Merriam-Webster To advocate: • to support or argue for (a cause, policy, etc.) • to plead in favor of … Advocacy: • the act or process of supporting a cause or proposal Nurse-Advocates • Nurses are highly skilled in interpersonal communication, assessment and planning • Advocating for patients is a fundamental nursing skill • Advocacy skills can be extended broadly from patients to communities and populations • Nurses have a very high level of credibility with the public • Nurses bring a unique perspective and knowledge to health policy issues (RNAO, 2015) Allyship an active, consistent, and arduous practice of unlearning and reevaluating, in which a person in a position of privilege and power seeks to operate in solidarity with a marginalized group (theantioppressionnetwork.com) Allyship Responsibilities: To acknowledge our privilege and power and openly discuss them To listen more and speak less To take guidance and direction from the people we seek to work with To educate ourselves about the oppression experienced by the people we seek to work with To be honest and accountable with our mistakes To understand our needs as secondary To not expect awards or special recognition (theantioppressionnetwork.com) Everyday Allyship • how much space are we taking up in conversations? in rooms? in organizing? • how do we actively improve access to our meetings? our actions? • how are our identities taking up space? physically? verbally? • how much do we know about the people we seek to work with? what are our assumptions and from where did they originate? • who are we leaving behind? (theantioppressionnetwork.com) To be continued in Lab • Explore your personal and social identity • Practice situating yourself as a part of cultural safety • Practice asking cultural questions Reminders • Lab Midterm Evaluations next week • Bring completed selfevaluation to lab • Bring blank evaluation form for peer-evaluation NUSC 1P10 | Fall 2023