PT 700 Cultural Competence Fall 2024 PDF

Cultural Competence in Physical Therapy PT 700 – Fall 2024 Cameron Brown, PT, DPT, PCS Session Objectives After completing this lesson, the learner will be able to:  Define cultural competence and cultural humility and understand the differences and similari...

Cultural Competence in Physical Therapy PT 700 – Fall 2024 Cameron Brown, PT, DPT, PCS Session Objectives After completing this lesson, the learner will be able to:  Define cultural competence and cultural humility and understand the differences and similarities between the two concepts  Describe the connection of cultural competence to the APTA vision statement and guiding principles  Distinguish the difference 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 basic principles of patient interaction with thoughtful and intentional consideration of cultural differences  Initial Thoughts  What do you think of when you hear the term “cultural competence”?  Consider the context of what this means for healthcare workers What is Culture?  “The way we do things around here”  You can only be truly competent in your own culture  Consists of a unique combination of factors  Influenced by more than just race or ethnicity and religion:  Gender Identity, Sexual Orientation  Socio-economic status  Geographic location  Disability status  Native language  Intersectionality  What is Cultural Competence?  Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.  Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.  Competence implies having the capacity 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. Newer frameworks are emphasizing the ongoing process of lifelong learning and importance of social justice in healthcare Critics caution the risk of stereotyping based on cultural assumptions CDC: https://npin.cdc.gov/pages/cultural-competence#what What is Cultural Competence?  Cultural competence is a developmental process that evolves over an extended period. Both individuals and organizations are at various levels of awareness, knowledge, and skills along the cultural competence continuum.  Cultural competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services; thereby producing better outcomes. CDC: https://npin.cdc.gov/pages/cultural-competence#what Principles of Cultural Competence Include Recognize Facilitate learning Define culture Value clients' complexity in between providers broadly cultural beliefs language and communities interpretation Involve the community in Institutionalize Collaborate with Professionalize staff defining and cultural other agencies hiring and training addressing service competence needs CDC: https://npin.cdc.gov/pages/cultural-competence#what Cultural Competence, Awareness, and Sensitivity What's the Difference?  Cultural competence emphasizes the idea of effectively operating in different cultural contexts and altering practices to reach different cultural groups.  Cultural knowledge, sensitivity, and awareness do not include this concept. Although they imply understanding of cultural similarities and differences, they do not include action or structural change. CDC: https://npin.cdc.gov/pages/cultural-competence#what  Cultural Humility  Cultural humility is a lifelong process of self-reflection and self-critique  The individual not only learns about another’s culture, but one starts with an examination of her/his own beliefs and cultural identities  Cannot be collapsed into a class or education offering; rather it’s viewed as an ongoing process  This process recognizes the dynamic nature of culture since cultural influences change over time and vary depending on location https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834043/pdf/nihms51094 9.pdf  Cultural Humility Addresses power imbalances between patient and provider → makes space for the patient to in a decision- making role Requires providers to acknowledge their own privileges and limitations of understanding Requires empathy and mindful/active listening https://journals.lww.com/jopte/Fulltext/2022/06000/Cultural_Competence_and_Cultural_Humility__A.6.aspx APTA Vision Statement for the PT Profession “Transforming society by optimizing movement to improve the human experience”  Guiding Principles  Consumer-centricity. Patient/client/consumer values and goals will be central to all efforts in which the physical therapy profession will engage. The physical therapy profession embraces cultural competence as a necessary skill to ensure best practice in providing physical therapist services by responding to individual and cultural considerations, needs, and values.  Access/Equity. The physical therapy profession will recognize health inequities and disparities and work to ameliorate them through innovative models of service delivery, advocacy, attention to the influence of the social determinants of health on the consumer, collaboration with community entities to expand the benefit provided by physical therapy, serving as a point of entry to the health care system, and direct outreach to consumers to educate and increase awareness.  Advocacy. The physical therapy profession will advocate for patients/clients/consumers both as individuals and as a population, in practice, education, and research settings to manage and promote change, adopt best practice standards and approaches, and ensure that systems are built to be consumer-centered. APTA Vision https://www.youtube.com/watch?v=7-0vPVcwuwQ Beliefs, Attitudes, and Behaviors  Beliefs are what people think is true  Attitudes are how people feel about something  Behaviors are what people do  Because culture impacts all 3 of these areas, health care professionals must be sensitive to clients’ beliefs, attitudes, and behaviors regarding their illness, injury, or disability as important components of evidence-based practice. Impact of Culture on Therapeutic Effectiveness  The ability to successfully communicate in culturally diverse settings is essential for all health care professionals  As part of the socialization in one’s own culture, one learns that certain complaints about distress are acceptable and elicit understanding, whereas other complaints are unacceptable  Understanding the cultural basis for the client’s symptoms becomes more critical to accurate evaluation of the presenting problem, leading to an accurate clinical diagnosis Davis, Carol/Musolino, Gina Maria. Patient Practitioner Interaction  Examples / Considerations EYE CONTACT SILENCE/SMALL EXPRESSION OF PERSONAL SPACE NON-VERBAL TALK DISTRESS OR COMMUNICATION DISCOMFORT WHAT ELSE? Bias  Your values, beliefs, and experiences shape your patient care by filtering the information you perceive and respond to and by directing your choices of action  Unchallenged assumptions can create negative realities for your patients  When feelings of criticism and negative judgment arise, work consciously to keep them from interfering with your commitment to compassionate, quality care  Initial beliefs CAN be modified through conscious thought and new experiences. Mobility In Context F.A. Davis 2018 Microaggressions and Micro-affirmations  The term microaggression has been used to describe causal, everyday actions or environmental conditions that communicate derogatory messages about a person or group of people.  These microaggressions can be unintentional and even unconscious, but their effect is to minimize the value of others.  Micro-affirmations substitute messages about deficit and exclusion with messages of excellence, openness, and opportunity.  Active Listening  Recognizing and validating experiences  Affirming emotional reactions Brown University https://www.brown.edu/sheridan/microaggressions-and-micro-affirmations-0 Avoiding Bias There are 3 questions that a health care professional should ask when working with clients to avoid potential biases:  1. How is this client like all human beings?  2. How is this client like some human beings?  3. How is this client like no other human being?  By asking these 3 questions, the health care professional can avoid stereotypes and generalizations and move toward the person’s unique problems, needs, and resources Davis, Carol/Musolino, Gina Maria. Patient Practitioner Interaction Bias against the provider  You will be working with patients of all different backgrounds  It is our job to provide quality care to all our patients, regardless of our differences  It is very likely that you will encounter a patient or caregiver who may demonstrate a bias against you  We can maintain a professional relationship, while also setting a clear and healthy boundary – without reacting impulsively with anger https://journalofethics.ama-assn.org/article/mayo-clinics-5-step-policy-responding-bias-incidents/2019-06 Bias against the provider  Example: Mayo Clinic SAFER Model: Step in when you observe behavior that does not align with Mayo Clinic values. Address (the inappropriate) behavior with the patient or visitor. Focus on Mayo Clinic values (such as respect and healing). Explain Mayo’s expectations and set boundaries with patients and visitors. Report the incident to your supervisor and document the event using the patient misconduct form. https://journalofethics.ama-assn.org/article/mayo-clinics-5-step-policy-responding-bias-incidents/2019-06  Hospital-based (inpatient acute) Skilled Nursing Facility / Residential Facility PT Practice Outpatient clinic Settings Home Health School-based / Early Intervention Vocational/Recreational settings Positive Patient Interactions  Keep an open mind. Remember that each patient has a unique set of beliefs and values, and they may not share yours.  Ask patients about their beliefs regarding their health condition.  Attend cultural competence training at your organization or through a continuing education program.  Be aware of your own culture and how that may affect how you communicate with your patients.  Reach out to cultural brokers to help you learn more about the differences and similarities between cultures.  Know what you don’t know! Agency for Healthcare Research and Quality. Taking Steps Toward Cultural Competence: A Fact Sheet Qualified Medical Interpreters  Provide qualified medical interpreters for patients whose English proficiency is limited  The use of unqualified interpreters—such as a family member, friend, or unqualified staff member—is not advisable. Never use a minor child to interpret.  Using unqualified interpreters is more likely to result in misunderstandings and medical errors  Tip: You can sometimes expose cultural misunderstandings by asking patients to say in their own words what you have taught them Agency for Healthcare Research and Quality. Taking Steps Toward Cultural Competence: A Fact Sheet Work to Build Trust  Show respect for your patients in culturally appropriate ways  Involve extended family members, when appropriate, in shared decision making and when planning care.  Encourage patients to ask you questions. Explain that asking questions is a good way to learn about health problems and options for treatment.  “What questions do you have for me today?”  “Is there anything else you would like to tell me? Taking Steps Toward Cultural Competence: A Fact Sheet Final Thoughts  Now what comes to mind when you hear the term “cultural competence”? In relationship to healthcare professionals? Resources  APTA DEI Bundle (only $25 for student members!) https://learningcenter.apta.org/student/MyLP.aspx?id=c7379b8c-3f90-4312- 80e5-4d630c6fb3a8&ProgramID=dcca7f06-4cd9-4530-b9d3- 4ef7d2717b5d&attempt=0  Introduction to LGBTQ+ Competency Handbook for Physical Therapy https://www.med.unc.edu/healthsciences/wp- content/uploads/sites/628/2022/03/LGBTQIA-Handbook-1.pdf  APTA Cultural Competence Resources: Individuals with Disabilities https://www.apta.org/article/2020/11/24/cultural-competence-disabilities  The Urgency of Intersectionality (TED Talk) https://www.youtube.com/watch?v=akOe5-UsQ2o  CPTA Challenge for Change Toolkit: https://www.ccapta.org/page/Toolkit_ChallengeforChange  APTA DEI Action Plan: https://www.apta.org/apta-and-you/diversity-equity-and- inclusion/dei-action-plan References:  Centers for Disease Control and Prevention website. Cultural Competence in Health and Human Services. https://npin.cdc.gov/pages/cultural- competence#what. Accessed: 10/11/21  Yeager KA, Bauer-Wu S. Cultural humility: essential foundation for clinical researchers. Appl Nurs Res. 2013;26(4):251-256. doi:10.1016/j.apnr.2013.06.008  Davis C, Musolino GM. Patient Practitioner Interaction. Sixth Edition. SLACK Incorporated. 2016  Cultural Competence and Cultural Humility: A Dialogue on Adopting a Multimodel Approach in Physical Therapist Education. Journal of Physical Therapy Education https://journals.lww.com/jopte/Fulltext/2022/06000/Cultural_Competence_and_ Cultural_Humility__A.6.aspx  Agency for Healthcare Research and Quality. The SHARE Approach. Taking Steps Toward Cultural Competence: A Fact Sheet. Accessed 10/11/21 https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curri culum-tools/shareddecisionmaking/tools/tool-7/share-tool7.pdf  Brown University Harriet W. Sheridan Center for Teaching and Learning. Microaggressions and micro-affirmations. Accessed 10/18/21 https://www.brown.edu/sheridan/microaggressions-and-micro-affirmations-0