Obj. 4 Notes TR.pdf

PN1130 Therapeutic Relationships Learning Objective 4: Discuss culture, diversity and sensory deficits and their influence on communication. Picture: https://peregrineglobal.com/diversity-and-inclusion/ 1 Objective 4: Discuss culture, diversity and sensory deficits and their influence on commun...

PN1130 Therapeutic Relationships Learning Objective 4: Discuss culture, diversity and sensory deficits and their influence on communication. Picture: https://peregrineglobal.com/diversity-and-inclusion/ 1 Objective 4: Discuss culture, diversity and sensory deficits and their influence on communication. • 4.1 Discuss cultural competence and its relevance in the provision of care for diverse populations. • 4.2 Examine the impact of cultural values, practices, and norms on communication and relationships. • 4.3 Explore factors which influence communication with Indigenous populations. • 4.4 Recognize and respect the diversity of the client, family, and health care team. • 4.5 Describe effective communication techniques / tools when interacting with clients experiencing sensory deficits and cognitive impairments. • 4.6 Discuss strategies which promote respectful, professional interpersonal e-communication and social media use. ****completed in objective 3 slides**** 2 Objective 3.8 - Discuss cultural competence and its relevance in the provision of care for diverse populations. Instead of saying cultural competence, the terminology has now changed to cultural safety as a main theme. Cultural competence is i.ncluded within this 3 What is Culture? • A complex social concept made up of shared patterns of learned behaviors, values, and beliefs, which shape attitudes and are transmitted over time • Distinguishes the members of one group from another. Discuss cultural competence and its relevance in the provision of care for diverse populations Objective 3.9 - Examine the impact of cultural values, practices, and norms on communication and relationships. -Group of people with shared commonalities Understanding culture and its influences in healthcare is essential. It is necessary to respond to the types of patients seen in the Canadian healthcare system. Nurses must provide culturally sensitive/competent care to build trust and rapport with all patients, to increase treatment understanding, and react to important health matters in cultural communities. -Culture is influenced by socioeconomic factors values and beliefs, race, gender, ethnicity, sexual orientation, life experiences, spirituality, education and personal choices. - People bring with them different cultural norms and traditions, different values and beliefs about health and about illness and its treatment, which will influence 4 their views about health care delivery in general and nursing care in particular. - It is important to acknowledge that the norms of social interaction vary greatly between cutlures (ex. Personal space, eye contact) and so does the ways that emotions are expressed. Other factors that are impacted by cultural influence are facial expression, eye movement, space orientation and time orientation. Note that culture includes groups such as gender based minority groups, not necessarily people from a different country Culture impacts TC and TR. In the changing world, it is necessary for HCP to acknowledge & respond to address the needs of diverse populations. Nurses must be respectful of cultural and other forms of diversity. 4 Culture Involves? Ethnicity Age Race Birthplace, History Language Education Religion and spiritual beliefs Socio-economic status Sexual orientation / Gender Life experiences Ethnicity= a group of people who share a common social identity based on ancestral, national, or cultural experiences. Race= a grouping of humans based on shared physical or social qualities 5 Multiple Contexts of Culture • Historical Context • Sociopolitical Context • Material/Economic Context • Physical Context • Linguistic Context History is always exerting an influence on individuals and communities. Ex. In Canada with Indigenous populations, which we will discuss a bit more later. Your history and the histories of those you care for are important as they influence how each individual views the world and how they are viewed. Sociopolitical- Social determinants of health, such as where a person is born, grows up, lives and works as well as their economic status, education, sexual orientation, and social inclusion, are influenced by social and political factors that can influence access to healthcare. Individuals from the dominant culture are often unaware they are engaging in "othering". Material/Economic context- Links have been made between health outcomes and the way wealt and power are distributed in economies. In Canada, Indigenous, sexual and racial minorities, and immigrans have significant health inequities. Physical Context- Key findings demonstrated significant inequalities in COVID-19, with higher death rates for those living in large cities, apartments, lower income neighbourhoods, and neigbourhoods with more people who are a visible minority, recently immigrated to Canada, and speak neither English no French. Linguistic Context- within out multicultural country there are people who do not speak English or French. Words and nonverbal messages can have different meaning and be misinterpreted. 6 Cultural Factors that can Affect Health • Language • Communication Styles • Beliefs and Attitudes • Health Literacy • Cultural Assumptions All noted factors can affect health and health outcomes. Language When nurses & clients do not speak same language, communication can be challenging. Clients can feel confused, stressed, scared & this can lead to miscommunication. Use of paper, acting things out, computer aided translation Communication Styles In North American culture, a lack of eye contact considered rude, s/s of depression, however in Asian culture, a client may show respect by avoiding eye contact. Understanding the cues between cultures & how language has different meanings for different cultures is vital in the provision of care . Use of touch, varies between cultures Beliefs and Attitudes Religion, spirituality, rituals Diet restrictions Role of family A person’s culture can play an important role in how they think about HC issues. A client of Asian /African descent may prefer traditional herbal remedies & 7 alternatives. Denial of mental illness / stigma Some cultures do not talk about medical issues, some do Health Literacy Culture can affect health literacy. Individuals in some cultures unfamiliar with health conditions, RX options . Nurses must inform & educate individuals about a Dx & RX in a culturally sensitive manner. Cultural Assumptions Assumptions & lack of knowledge of other cultures can create challenges for both nurses & clients . Be open minded. Also remember that not all people of one cultural group have the same beliefs and that just because a person has the appearance of a “minority” group does not mean they were raised with the cultural traditions of that minority group 7 Language Barriers: What Can You Do? • Use a translator/interpreter if available • Explore translation technology • Use more common words • Use repetition • Check for understanding • Use visual methods of communication (pictures or hand gestures) 8 Translation services • Important that there is clear communication between the client and the health care team, therefore the use of a translation service is necessary • If possible, the translator should not be a family member • Hospitals often will have a Translation Service available for use via phone / Zoom calls • - See Table 7.2 p. 117 for further Guidelines Association of New Canadians Staff member who speaks the same language Emergencies – use family Caution on use of family – eg possible domestic abuse - Google translate is being used more often, although use with caution. - VERY IMPORTANT looking at the person and not the translater when speaking with the person 9 Appropriate cultural care is addressed in both the LPN Standards of Practice (2.12) and the LPN Code of Ethics (1.4) Standard 2.12 – Practice is an culturally competent manner Code 1.4 – Respect the rights of all individuals regardless of their diverse values, beliefs and cultures. Picture: http://nurseadvisormagazine.com/tn-exclusive/cultural-competency-andhonesty-in-a-professional-nurses-practice/ 10 Four Important Points About Culture 1.All people share a culture with others in society 2.Culture evolves over time and is adaptive 3.Creation of culture is ongoing and cumulative 4.Culture is transmitted from one generation to the next - Cannot assume that all people of the same “culture” share all the same beliefs and values - People are individuals yet influenced by culture - eg. hx of Gender based cultural changes 11 Cultural Sensitivity • Awareness of a person’s culture • Tolerance and sensitivity to difference • Knowledge and respect • Understanding the importance • Adapting care • Be careful of stereotyping • Remember that each client is an individual There are several definitions that are important to consider: cultural sensitivity Having cultural sensitivity is important in order to engage with clients who are in the minority in some way Understanding the importance – for the person (rituals, preferences, etc) Adapt care by taking into account cultural requests or needs eg food; visitors; how to address someone, eg Mr or Mrs instead of by first name Stereotyping – not everyone follows all tenets of their cultural religion, traditions, etc. Individualize care while taking into account cultural aspects 12 What is Cultural Safety? “An approach that considers historical and social contexts as well as structural and interpersonal power imbalances, social relationships, and social justice, all of which shape health and health care services” (Mallette & Yonge, 2022, p. 553) Brings in larger context to include broad hx of groups; discrimination because of it; adaptability and self-reflection of the hc provider Makes the hc provider part of it First coined in New Zealand, re colonialism on Maori people What does that mean: respectful engagement / address power imbalances inherent in the health care system. / free of racism and discrimination, where people feel safe when receiving health care. Cultural safety is an outcome based on respectful engagement that recognizes and strives to address power imbalances inherent in the health care system. It results in an environment free of racism and discrimination, where people feel safe when receiving health care. 13 Central Principles of Cultural Safety 1.Culture is dynamic 2.Focus on needs and perceptions of the person 3.Influence of social, economic and political factors 4.Care with individual and organizational discrimination 5.Critical reflexivity 6.Promote and recognize respect and understanding of clients 1. 2. 3. 4. Always changing throughout time eg LGBT community Perceptions differ based on hx Hx discrimation, way of living taken eg Indigenous community Discrimation should not be tolerated (how would you handle discrimination from clients, because it will happen) 5. Questioning of your own attitudes Reflexivity def’n – ability to understand and question your own contexts, attitudes, values, beliefs, assumptions, and experiences of advantage and disadvantage that have shaped how you understand the world. 6. Respect 14 Cultural Safety is Achieved Through? •Cultural competence •Cultural humility C competence – set of attitudes, skills, behaviours, and policies enabling individuals and organizations to establish effective interpersonal relationships that supersede cultural differences Its about respectful and effective response to people with differing backgrounds The ability to work within the cultural context of individuals, families, & communities from diverse cultural & ethnic background. It is a continuous process; as clients’ needs evolve, these changes will dictate how cultural diversity is addressed in healthcare. Nurses should reflect on their cultural beliefs & values to determine if/ how they impact the care they provide. Reflection can assist nurses in providing client -centred, culturally sensitive care. Cultural Competence What does cultural competence mean in practice? Requires HCP to understand cultural differences and respond accordingly. • What standards or resources exist to support nurses in becoming more culturally competent? C humility 15 Nurses must: be aware of their own values, attitudes and beliefs, as well as any biases. • Be comfortable with differences that exist between themselves & clients in terms of race, gender, sexuality • be able to communicate with a wide variety of verbal and nonverbal culturally sensitive responses. C humility –To identify and address biases and prejudices Cultural humility involves humbly acknowledging oneself as a learner when it comes to understanding another’s experience. Self reflection is part of the process of cultural safety 15 Cultural Competence • A set of attitudes, skills, behaviours, and policies that enable individuals and organizations to establish effective interpersonal relationships despite cultural differences • Acknowledges culture as being fluid Discuss cultural competence and its relevance in the provision of care for diverse populations Fluid-ever changing, diversity in all -Important in cultural competence is nurses self reflecting about their own cultural values and beliefs and being aware of how this influences their nursing care. It is an ongoing process of critical reflection and action, which the nurse then uses to provide safe, congruent and effective care in partnership with your patient. -Its about respectful and effective response to people with differing backgrounds 16 Cultural Humility • Ongoing commitment to learn from the person and to critically self reflect • A commitment to identify biases, prejudices, attitudes and behaviours in addressing power imbalances within the relationship • A life-long process Nurse who demonstrate cultural humility have attributes of: -openness means having an open mind in exploring new ideas with the people you are caring for and not assuming knowledge of a person based on their culture -self-awareness is being aware of one’s own strengths, limitations, values and beliefs, behavious and how you appear to others - egoless meaning the nurse must be humble and view persons as equals - supportive interactions occur when there is sharing and the person you are working with feels supported, this can be shown by the nurse being actively engaged in a conversation -self-reflection- the nurse engages in self-questioning, critiquing actions being taken and discovery within themselves. 17 Why is Cultural Safety Important? • Promotes inclusivity, respect, valuing differences, equity, and commitment • Critical to reducing disparities • Respects diversity in the client population • Practical nurses have a duty to provide ethical care to their clients • Enhances nurses’ ability to meet client’s needs holistically. • Promote mutual respect and trust in the nurse-client relationship 18 How do you Apply Cultural Safety to Practice? By using the 3 Rs: • Revise • Respect • Rights of the person https://emilypost.com/about/definition-of-etiquetteconsideration-respect-and-honesty - These can assist you in promoting culturally safe practice… Revise – be self aware and recognize cultural difference Promote the rights of the person Remind you to challenge your own assumptions Do not assume Be non judgemental 19 How do you Apply Cultural Safety to Practice? And by avoiding the 3 Ds: • Demeaning • Devaluing • Disempowering https://phys.org/news/2019-02-demeaning-job-bullying-bosses-common.html Remind nurses to be aware of words that can be viewed as…. deaming, devaluing and disempowering Listen to your clients- it is important to listen to clients concerns when they are saying they feel unsafe and discriminated against Do not become defensive- instead actively listen to what the person is saying and feeling Be honest with them- when you feel uncomfortable and don’t know what to say, or feel you have said the wrong thing, be honest. 20 Cultural Terms • Acculturation • Assimilation • Cultural patterns • Cultural Diversity • Subculture • Cultural Relativism • Ethnocentrism Acculturation: A process where individuals from one culture interact with and adopt the practices and values of another culture, while still retaining their own distinct culture. When a group of individuals who have a different culture (immigrants) interact with a new culture. Results in changes in the original cultural patterns of one or both groups. Assimilation: The process by which individuals adopt a new culture, essentially replacing their original culture. These are "absorbed" into the old ways and now the dominant ways of a society. - the most extreme form of acculturation Cultural patterns: Socially transmitted beliefs, values, norms, and practices that lead to similar behaviours across similar situations. Cultural Diversity: Social variations between cultural groups; it's the quality of diverse or different cultures, as opposed to a single culture. Can also refer to having different cultures respect each others differences. Subculture: a smaller group of people living within the dominant culture with a distinct lifestyle, shared beliefs, and expectations that set them apart from the 21 mainstream. Ex. Mormons Ethnocentrism: Belief that one's own culture is superior to all others and should be the norm Cultural Relativisim: Concept that each culture is unique and should be judged only on the basis of it's own values and standards 21 Be careful of: • Discriminating between the “dominant” population and “others” • Stereotyping • Racism • Marginalization • Racializing • “Othering” • Power imbalances Discrimination- an action or decision that treats a person or group badly for reasons such as their race, age or disability Stereotype – eg she is of a certain culture therefore must not eat meat Racism – prejudice or discrimination directed against a person or people based on the basis of their membership in a racial or ethnic group you will see this with clients Marginalization- the treatment of a person , group, or concept as insignificant or minor Racializing- to categorize or divide a person or people according to their race. “othering” – client is other or different; “minority” group is other – all equal and deserving Power imbalances-nurses need to be aware of their power imbalances. Health care workers can be viewed as having power over the person in making decisions about their health care without looking at the complexity of who the person is. 22 Health Inequities Exist Indigenous community • Poor housing Sexual / Gender minorities • Food insecurity Racial minorities • Access to medical care Immigrants People with functional limitations • Low income • Low education • Language issues There has been found to be significant health inequalities among people who are Indigenous, sexual and racial minorities, immigrants; people with functional limitations and people experiencing inequalities of socioeconomic status such as income, education level, and employment and occupation status. - where people live-access to health care, levels of pollution- can influence the development of respiratory and cardiovascular illness, cancer, mental health issues, increased occupational health hazards, intestinal disorders, viruses -where people work- farming, mining, office work vs. service industry -life style- sedentary vs. active - language can cause inequities when words or verbal messages can have different meaning and be misinterpreted. Nurses need to be change agents- increasing awareness of stereotyping and labelling based on culture. This change can come from your own assumptions and language being used, not using discriminatory language and being aware of how it can influence the care being provided. For example: instead of labelling someone as a frequent flyer the nurse can assess 23 and advocate for understanding why the person continues to return to the clinic. Exploring the person and families contexts, examining historical, sociopolitical, material/economic, physical and linguistic contexts the nurse can have a better understanding of the person’s unique culture and how their experiences influence their health care needs. 23 Relational Practice • Guided by conscious participation with clients using several relational skills including listening, questioning, empathy, mutuality, self-observation, reflection and sensitivity to emotional contexts • A way for the nurse to care for a person, encompassing their diverse cultural contexts • Builds on the strengths of the person Requires a commitment to caring and compassionate nursing practice with clinical competencies of a strong knowledge base, the ability to observe, be curious and authentic and explore and analyze information to guide clinical judgement, decision making and practice -without bias and being aware of the multiple contexts influencing who the person is and their health experience, the nurse responds to and with the person in a way that is meaningful to them. -Use of relational practice as the basis of communication -Both intrapersonal – what nurse and client are experiencing within And interpersonal – what is occurring between people Picture: https://www.bristolcarehomes.co.uk/residential-care-nursing-care/ 24 Reflexivity • A reflective practice • The ability to understand and question you own contexts, attitudes, values, beliefs, assumptions, and experiences of advantage and disadvantage that has influenced your view of the world in relative to others • Involves you looking at what you are doing and how you are doing it Where a person reflects on what they have learned and considers the implications of their learnings can impact the broader context 25 Self Reflection • Process to think about values, beliefs, attitudes and emotions you felt during a particular experience • Purpose is to understand the situation in different ways, to identify any lessons than were learned and to identify any positive changes that can be made in the future • Includes factors such as socio-economic, cultural and political • Goal – challenge assumptions, build new knowledge, care for others, learn new ways to work in a complex and changing health care environment -Reflective Practice is where a person reflects on what they have learned and how they can apply it or learn from it. Links to Reflexivity def’n – ability to understand and question your own contexts, attitudes, values, beliefs, assumptions, and experiences of advantage and disadvantage that have shaped how you understand the world. How your own personal hx influences your nursing practice Eg. deliberate decision when I started teaching clinicals at MUNFON Deliberate way I communicate with clients in PAU – total honest; eg you will not be admitted; you will not get that med. But how else can we help. Explain why. SSU – conversation about safety on unit re SI 26 htt ps://irshdc.ubc.ca/2020/06/16/celebrate-national-indigenous-peoples-day/ Indigenous Communities in Canada -Comprised of First Nations, Métis, Inuit, and urban Indigenous people in Canada 4.3 Explore factors which influence communication with Indigenous populations 27 Historical Perspectives on Communications and Indigenous Peoples • Colonization-The Indian Act • Residential Schools and the Sixties Scoop • Both verbal and non-verbal communication was impacted • Colonizing effects continue through, intergenerational effects, racism, and many other types of inequities • Self-determination and Decolonization -Within indigenous communities, communication is holistic, meaning it is not only verbal and nonverbal; it also encompasses behaviours, protocols, ceremony, governance, songs, and the passing on of traditional names and stories from generation to generation. -The Indian Act- extinguished Indigenous self- government and allowed the federal government to control mostly all aspects of Indigenous life. The intent of the Indian Act was to assimilate Indigenous peoples into a Eurocentric society through policies that eliminated social, economic, language, cultural, and political distinctness. This act led to residential schools, Indian hospitals, the Sixties scoop and Indigenous peoples being moved to reserves. -Oral communication was severed within indigenous communities through the impacts of colonial processes- In residential schools for example, Indigenous children were removed from their homes and forbidden to speak their language, practice traditional songs or have communication with their families. - Non-verbal communication was also impacted as Indigenous children could not practice traditional ceremonies and songs, wear traditional clothing or use traditional medicines. -The Sixties Scoop further impacted Indigenous peoples 28 - It is important to realize there are still impacts of these colonial processes and intergenerational trauma Self determination: occurs through reclaiming land, language, cultural traditions, oral history, songs, and healing, the nations as a result of colonization. Decolonization – attempt to undo colonialism; power, dominance and control 28 Indigenous Traditions • Importance of Elders and Knowledge Keepers • Protocols (eg. acknowledging territory; gift giving; situating self authentically; sharing circles) • Ways of Knowing and Being – ceremonies; stories; importance of nature; language; holistic health and healing) Elder - person with deep spirituality that influences every aspect of their lives and teachings. Show by example. Not defined by age; they have earned the respect of their community through wisdom, harmony and balance of their actions in their teachings. Knowledge keeper - someone who has been taught by an Elder or a senior Knowledge Keeper; This person holds traditional knowledge and teachings, they have been taught how to care for these teachings and when it is and is not appropriate to share this knowledge with others. Protocol – culturally appropriate behaviours to acknowledge the traditional ways of knowing and being; respectful (eg equivalent to national anthem) Acknowledging territory – now commonly done Situating self authentically – introduce yourself in proper way - traditional language, family lineage Sharing circles – many forms and purposes; Ways of knowing – stories, history, land, water, shiy, spiritual beliefs, systems – shared and passed on Ways of being – rights and responsibilities 29 Six Indigenous Determinants of Health • Balance • Life control • Education • Material • Social resources • Environmental and cultural connections Balance- a reflection of the maintenance of holistic health, through mental, physical, emotional, and spiritual elements. Life control- reflects the ability of an individual to care for themselves through maintenance of a healthy life and management of illness or disease. Education- a vital determinant to one’s economic status and overall well-being Material- income from work Social resources- The breadth and depth of social ties to rely on others in times of need Environmental and cultural connections- peoples abilities to access environmental resources for the purposes of cultural practices and Indigenous ways of being 30 Members of the Indigenous Community Experience Significant Health Inequities • Lower life expectance • Increased numbers of suicides • More hospitalizations due to mental illness • More chronic illness • Increased numbers of alcohol abuse disorder • Food insecurity Men in Canada live 7 years longer than First Nations men; ( women the gap is 5 years). Indigenous people are 2x likely to report fair /poor health status than non-Aboriginal people with =incomes 31 Ways to Provide Culturally Safe Care to Members of the Indigenous Community • 4 Rs: Respect; Reciprocity; Responsibility; Relevance • Recognize protocols; clan structure; who to speak with • Be in touch with the community about protocols for meeting, ceremonies (contact the appropriate Elder or Knowledge Keeper) • Indigenous Navigators • Reflection and reflexivity https://prairiemountainhealth.ca/national-indigenous-peoples-dayjune-21-2023/ Respect – demonstrate you care about traditions, activities Reciprocity – mutual; learn from each other; safe place Responsibility – re reconciliation Relevance – educate self on hx, traditions Indigenous Navigator – from Eastern Health site; “Aboriginal patient navigators support Aboriginal patients and their families by helping them to navigate the complexities of the health-care system. The APN program offers support to First Nations, Inuit and Métis people who are referred to St. John’s for health-care treatment. With assistance from the APN, patients and their families have a better understanding of their diagnosis, health-care plans and treatment options.” Reflection - think about values, beliefs, attitudes and emotions you felt during a particular experience; to understand the situation in different ways, to identify any lessons learned and to identify any positive changes that can be made in the future Reflexivity - ability to understand and question your own contexts, attitudes, values, beliefs, assumptions, and experiences of advantage and disadvantage that have shaped how you understand the world. How your own personal hx influences your nursing practice 32 Cultural safety as defined by the Indigenous community.. • https://youtu.be/cLDkA2RIeCM 33 Culturally Competent Communication Knowledge of cultural preferences A willingness to try to understand and respond to a client’s culture Be open and willing to become educated on the cultural topic Evaluate if communication is positive Objective 3.11 - Recognize and respect the diversity of the client, family, and health care team. -need to be comfortable with differences that exist between themselves and patients -Need to be able to communicate with a wide variety of verbal and nonverbal culturally sensitive responses. Language and communication problems may lead to patient dissatisfaction, poor comprehension and adherence, and lower quality of care Ask client about preferences, evaluate to see if communication is effective Nurse terminology – eg saying prn or bid 34 Culturally Competent Communication  Be respectful and work towards therapeutic goals.  Be accepting, open and most importantly, respectful, nonjudgemental  Avoid imposing your values on others.  Nurses have their own terminology - may not make sense to others 35 Several specialty groups • Multicultural • Gender • 2SLGBTQ1A • Children • Older adult • Generational diversity Recognize and respect the diversity of the client, family, and health care team. 36 Multiculturalism • Hallmark of Canada - “Cultural Mosaic” • Multiple cultures coexist in society • Different cultures maintain aspects of their culture • Respect for cultural diversity 37 Statistics • 21.9% of Canadians (7.5 million people) were or are landed immigrants of permanent residents • Majority from Asia, Africa, and Europe • Settling in large cities however more people are settling in prairies and Atlantic provinces Statistics Canada, 2017 38 International students • In 2018, 721,205 international students at all levels studied in Canada – the largest number ever Has this been a benefit for Canada? • These students contributed an estimated $21.6 billion to Canada’s GDP, and supported almost 170,000 jobs Students, including nursing students are from a multitude of places 39 International students throughout Canada 40 Recent Important References • Ukraine refugees (2022) • Syrian refugees (2011, more recent years) • Truth and Reconciliation Commission (TRC) • Residential schools – missing children May encounter clients of the above groups, or affected by the above (Indigenous population) Be aware and incorporate this knowledge – be culturally sensitive TRC – reconcialiation re residential schools and past injustice 41 Gender 42 What Does “Gender” Mean? • characteristics, including (norms, behaviours, roles) of women, men, girls and boys • socially construct • varies from society to society • can change over time (non-binary) • gender interacts with but is different from sex Male, female, non-binary, trans gender, gender fluid Sex - refers to the different biological and physiological characteristics of females, males and intersex persons, such as chromosomes, hormones and reproductive organs. 43 What Does “Gender” Mean? • Gender and sex are related to but different from gender identity • Gender identity refers to a person’s deeply felt, internal and individual experience of gender, which may or may not correspond to the person’s physiology or designated sex at birth. Traditionally, gender is the range of characteristics pertaining to, and differentiating between, masculinity and femininity. Depending on the context, the characteristics of gender may include biological sex (i.e., the state of being male, female, or an intersex variation), sex-based social structures (i.e., gender roles), or gender identity. It is a socially constructed concept that seeks to look at differences between individuals. Increasingly society is challenging these concepts as individual diversity within society has resulted in increasing numbers of persons who do not readily identify as either. This has created a need for nurses to re-evaluate how we interact with people to ensure everyone receives high quality patient care and has positive care outcomes. 44 Gender and Communication  Traditionally, males and females are socialized differently which can account for differences in behaviour  In Western culture woman are thought to value intimacy more than men  Men are thought to value power and social status more than woman.  Some female dominated professions are viewed as less valuable than male dominated professions. Gender has implications for health in terms of norms, roles and relaionships -can influence a persons health seeking behaviours -shapes peoples experiences of healthcare, including their interaction with health care providers -Males and females are socialized differently worldwide which can account for differences in behaviour.... For example, in american culture women are thought to value intimacy more than men and men are thought to value social status more than women. 45 2SLGBTQ+ Community • violence, stigma and discrimination (including in healthcare settings) • higher risk of trauma and mental health problems, including suicide • rigid gender norms negatively affect people with diverse gender identities • Persons are socialized/appropriated into gender roles based on cultural norms, spiritual conceptions, and expectations • Sex related gender identities/roles are not the true lived experience or self realization of everyone 46 Communication • Open dialogue • Use of proper pronouns • Use gender neutral language • Provide transgender / non-binary option • Visible signs of support (posters, brochures) • Non-judgmental • Open-minded and empathetic -No unnecessary probing – deal with the matter at hand When you have a question - ask, don’t assume. Example of unethical care – calling by name given, not name chosen. Referring to he or she instead of the preferred pronoun identified by the individual. **Compromising care based on gender identity is actionable as a human rights violation. It is the nurses responsibility to ensure the fair and ethical treatment of all people in their care. Self awareness, reflection, openness, acceptance, and positive regard are necessary for patient centered care and therapeutic relationships 47 Appropriate Terminology • Government of Canada. (2020). LGBTQ2 terminology – Glossary and common acronyms. https://women-gender-equality.canada.ca/en/free-to-beme/lgbtq2-glossary.html • https://women-gender-equality.canada.ca/en/free-to-be-me/2slgbtqi-plusglossary.html 48 Pediatric Clients Picture:https://dimensionsofdentalhygiene.com/article/behavioral-managementpediatric-patients/ 49 Communication with Pediatric Clients • Show interest in child • Be honest and consistent • Parental (care-giver) involvement is very important • Be aware of developmental stage • Provide care-givers with clear and concise information • Use age-appropriate language • Involve care-giver in patient care • Observe for non-verbal cues • Provide emotional support to family 50 Older Adults Picture:https://www.federalretirees.ca/en/news-views/news-listing/sept/october1national-seniors-day 51 Communication with Older Clients • How to address client (eg. Mr./Mrs/Miss; first name) • Short frequent conversations • Ask one question at a time • Good listening skills • Focus on what client considers important Better lighting; speak louder; hearing aids; 52 Communication with Older Clients • Story-telling • Reminiscence • Communicate a willingness to help • Be aware of any sensory or cognitive losses and provide accommodations for those 53 Generational Diversity Amongst Nurses • “Members of today’s nursing workforce now span four generations” (Mallette & Yonge, 2022, p. 102) • Different attitudes related to work and communication styles • Can lead to conflict Age cohort – born within a 20 year period – generation gap Types of communication – eg switching to computer charting and pyxis – lot of resistance amongst older staff My experience doing computer training – most older and took us forever, 1 younger!! Older – working longer, more experience Note: if ignored can become a source of conflict in the workplace 54 Communication Disorder • Impairment- the ability to send, receive, process, and comprehend concepts or verbal, nonverbal, and graphic symbol systems • Associated with hearing, vision, speech, language, or processing problems • Congenital or acquired • Range: mild to severe • Individualized Objective 3.12 - Describe effective communication techniques / tools when interacting with clients experiencing sensory deficits and cognitive impairments. Any impairment of a person’s ability to send /or receive information can compromise their health. Communication impairments: Numerous causes: Congenital,some develop gradually or quickly. Some possible causes include: •Brain Injury •Drug Misuse •Autism Spectrum Disorder •Neurological Disorder •Mental health Disorder •Developmental Disabilities •Stroke •Environmental exposure •Age-related 55 Types of Communication Deficits/ Impairments • Hearing loss • Vision loss • Language disorders (eg. aphasia – non-fluent, fluent, global) • Impaired cognitive processing • Mental disorders (mental illness; dementia) • Treatment related communication disorders (eg. sensory deprivation; excessive, constant stimulation Aphasia : results from damage to one of more of the language areas in the brain (eg stroke) nonfluent –Understand what is being said but cannot express thoughts or feelings into words Fluent - difficulties in receiving & processing written & oral messages; they can speak but it is nonsensical Global : has difficulty with both People with aphasia know what they want to say but can’t communicate it May be no cognitive impairment Cognitive – thinking abilities; may need more time Mental illness – eg schizophrenia – thinking process is affected and may repeat words or phrases; or have thought blocking – no speech or sparse; Thought content is affect – may have delusions and speak about things 56 that are not real (hearing devices; being followed by gang); hallucinations – hearing and seeing things not present Treatment related – ICU immobilized Some other possible causes: brain injury, drug abuse, cleft lip or palate, neruological disorder, vocal cord injury, etc. 56 Potential Impacts of Ineffective Communication Increased risk for adverse events Less satisfaction with healthcare Reporting feeling of being excluded from care and decision-making Loss of independence Reporting being treated as intellectually impaired  Client may feel angry, frustrated, anxious or uncertain. Clients with communication impairments face many barriers in healthcare Loss of autonomy in HC decision making, Increased risk for medical errors Less satisfied with HC than clients without communication disorders. Loss of independence, because of the need to rely on others to communicate for them. Baylor, C., Burns, M., McDonough, K., Mach, H., & Yorkston, K. (2019). Teaching medical students skills for effective communication with clients who have communication disorders. Am J Speech Lang Pathol., 28(1), 155–164. doi: 10.1044/2018_AJSLP-18-0130 Other social/emotional consequences: •Social isolation Safety issues •Mobility limitations Reduced quality of life •All can impact the development of the therapeutic relationship. -Provide support and strategies that maximizes the client’s ability to for optimal functioning and quality of life. 57 Strategies • Client centered • Convey respect and concern • Assess current deficits and abilities to communicate • Speak slowly • Talk about one thing at a time Nurses have a professional responsibility to communicate with all clients and implement any necessary adaptations to do so. 18.2 strategies to assist with Cognitive deficits 58 Strategies • Give extra time for the person to process what you are saying, do not interrupt • Avoid, prolonged, continuous conversations • Encourage efforts to communicate • Use visual cues In all interactions… Treat the client with respect. Make eye-contact. Address client by name . • Determine their deficits & abilities to communicate . • Ask what you can do to ensure that communication goes well. Be familiar and knowledgeable on different ways to communicate Use communication aids (pens/paper, pictures, writing, APPs). Do not underestimate the person’s abilities • Talk directly to the person, not someone accompanying them. • Speak naturally & clearly, using your normal tone, volume, and rate. Move to a quiet area with no distractions- close doors, turn off radios etc. Never limit the client to yes/no responses if they are able to communicate more than that. Inquire/Assess literacy . -Keep the patient as the focus of the interaction -Confirm your understanding 59 Types of Communication Disorders -Hearing Loss -Vision Loss -Dementia We’ll look more in depth in these 3 areas 60 Hearing Loss Picture: https://midlandhealthcare.org/dont-let-hearing-loss-limit-you/ 61 Video on Hearing loss https://www.youtube.com/watch?v= JY4uof7vvZk https://www.youtube.com/watch?v=JY4uof7vvZk https://youtu.be/HEMr6tY1UaI https://www.youtube.com/watch?v=pDA_EXFTpxo 62 Strategies for Clients with Hearing Loss Face the client directly, making eye contact Speak normally and distinctly without exaggeration Be aware of how client typically communicates (home, work) Use gestures and facial expressions to reinforce the verbal message Interacting with a client with a Hearing Impairment p.339 •Make sure the C looking at you prior to starting conversation. •The C should be able to see your mouth, No exaggerated mouth gestures. •Speak normally, do not yell/shout - Minimize distractions (reduce background noise) 63 Strategies for Clients with Hearing Loss Use written materials and assistive devices Use a translator/interpreter's services Ensure assistive hearing device(s) are working Confirm client understands • Explore other ways of communicating (writing, typing, pictures, tech) • Reduce background noise and minimize distractions Check C’s assistive device(s). (may forget to put it or turn on hearing aids. Confirm that the person understands what you are saying. Speech impairment can lead to client frustration, anger, shame, isolation/ withdrawn. Client can communicate better when relaxed, give them sufficient time to respond 64 Vision Loss https://www.medicalnewstoday.com/articles/vision-loss#types 65 Video on Vision Loss https://youtu.be/fh8x7ie96pQ 66 Strategies for clients with Vision Loss • Make your presence known entering/leaving room • Introduce yourself and address client by name • Address the client directly, rather than their support person/companion • Be aware of how client typically communicates (home, work) Interacting with a client with a Vision Impairment •Get the attention of the client; Address the client by name •Introduce yourself upon entry to room 67 Strategies for clients with Vision Loss • Ensure the room is well lit • Ensure appropriate aids or tech devices are available (Braille, cane, glasses, magnifier) • Inform the client of touch • Explain procedures and surroundings • Keep the room well lit; clients have varying degrees of vision loss • Indicate when a conversation is over & when you are leaving the room • Provide information on alternative ways - audio, large print, or braille, APPs • Glasses, ensure client has them & uses them Build rapport & provide full information and education. Safety is a concern for clients as environment is unfamiliar to them. Orient individuals to the new setting. Ask closed-ended question Use employer’s services .Make referrals -may be beneficial to place a sign over the bed which says visually impaired so other departments know how to approach the patient (need the clients permission for this). Box 17.1,p.341 68 Dementia Picture: https://alzheimer.ie/about-dementia/what-is-dementia-andalzheimers/types-of-dementia/ 69 Video on Dementia https://youtu.be/AJVjVgBTACI 70 Strategies for Clients with Dementia • Face the person • Explain what you are doing • Use short sentences, containing one topic • Pause between sentences • Speak clearly and slightly slowly Always explain what you are going to do (“I’m going to reposition you now”) •Use clear, everyday language; Avoid using unnecessary words, jargon, technical terms and long sentences. •Allow time for the person to understand or to speak, nod, signal “yes”. •Seek the assistance of a support person of available; this person may rephrase what you are saying or use other strategies to translate and communicate. 71 Strategies for Clients with Dementia • Use non-verbal cues • Point at items, people that you are speaking about • Use familiar objects • Use personal memento's so the client can relate and communicate 72 Working with Clients with Speech Impairments • Allow extra time for replying • Be patient, do not finish their sentence • Ask the patient to repeat a statement if necessary • If you do not understand something, say so! • Ask some closed-ended questions • Use technology as available • Use referrals as needed Referrals include to speech language pathology Speech impairments can limit a persons ability to communicate. These impairments can be lifelong or happen suddenly as in the case of a person having a stroke. Speech impairments can create feelings of frustration, anger, shame, and isolation. In some cases, can cause a person to become withdrawn. Do not treat people with speech impairments as mentally deficient or intoxicated. 73 Communicating with Patients with Altered Level of Consciousness (LOC) • Communicate with people as if they can understand • Orient the patient frequently • Explain noises, procedures and equipment • Always explain what you are going to do • Provide familiar objects • Encourage family to interact, as possible • Utilize technologies to enhance communication 74 How do we Overcome Barriers? • Recognize that barriers exist! • Establish and maintain trust • Demonstrate caring and empathy • Recognize and reduce anxiety • Use plain language • Use active listening techniques 75 Summary • The therapeutic nurse-client relationship is based on trust, respect, and professional integrity • Nurses are advocates for people in our care • The therapeutic relationship is essential in providing safe and competent, compassionate and ethical nursing care • There are multiple ways to communicate with clients • Multiple different skills can be learned in order to improve communication • Cultural safety is necessary in achieving trusting therapeutic relationships 76 References • Association of American Medical Colleges and the Khan Academy (nd.) Overview of culture. https://www.khanacademy.org/test-prep/mcat/society-and-culture/culture/v/overview-of-culture • Baylor, C., Burns, M., McDonough, K., Mach, H., & Yorkston, K. (2019). Teaching medical students skills for effective communication with clients who have communication disorders. Am J Speech Lang Pathol., 28(1), 155–164. doi: 10.1044/2018_AJSLP-18-0130 • Code of ethics for licensed practical nurses in Canada. (2013). • College of Licensed Practical Nurses of Alberta. (2018). Relational Practice. https://www.clpna.com/2018/01/study-clpna-relational-practice-self-studycourse/#:~:text=Relational%20practice%20is%20the%20current,%2C%20families%2C%20colle agues%20and%20others. • Culture Magazin. (2019). Canada’s New International Strategy for 2019-2024. https://culturemagazin.com/canadas-new-international-strategy-for-2019-2024/ 77 References • Gay & Lesbian Medical Association. (nd.).Guidelines for care of lesbian, gay, bisexual, and transgender patients. https://www.glma.org/index.cfm;jsessionid=EC47D492C1EF6F9AFD500B190424C55A.cfusion? fuseaction=document.viewDocument&documentid=16&documentFormatId=25&vDocLinkOrigin =1&CFID=41147670&CFTOKEN=fa3dcf0c9a5161e7-11AC6AB5-1C23-C8EB80F4BEC4ED436F9B • Government of Canada. (2020). LGBTQ2 terminology – Glossary and common acronyms. https://women-gender-equality.canada.ca/en/free-to-be-me/lgbtq2-glossary.html • Interior Health, BC. (2019). Aboriginal cultural safety: how to be an ally. https://www.youtube.com/watch?v=cLDkA2RIeCM • Kinsey Gorman, C. (2016). Is your communication style dictated by your gender? https://www.forbes.com/sites/carolkinseygoman/2016/03/31/is-your-communication-styledictated-by-your-gender 78 References • Mallette, C. & Yonge, O. (2022). Arnold & Boggs’s Interpersonal relationships: Professional communication skills for Canadian nurses. Elsevier. • Queen’s University. (2022). Elders, Knowledge Keepers, and Cultural Advisors. https://www.queensu.ca/indigenous/ways-knowing/elders-knowledge-keepers-and-culturaladvisors#:~:text=Knowledge%20Keeper%3A&text=This%20person%20holds%20tradition al%20knowledge,share%20this%20knowledge%20with%20others. • Standards of practice for licensed practical nurses in Canada (2020). • Statistics Canada. (2017). Immigration and ethnocultural diversity: Key results from the 2016 census. https://www150.statcan.gc.ca/n1/daily-quotidien/171025/dq171025beng.htm?indid=14428-1&indgeo=0 79