Cultural Competency In Health Care “Transforming Barriers into Assets” Trainers Dijana Rizvanovic Dov Sellem
Jan 01, 2016
Cultural Competency In Health Care
“Transforming Barriers into Assets”
Trainers
Dijana RizvanovicDov Sellem
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Active Listening
Level 1Basic Acknowledgements
Level 2Silence
Level 3Questions
Level 4Paraphrasing
Level 5Reflective Listening
LMC Learning Design Center** Adapted from the work of Jerry Wisinski
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Why Cross Cultural Training
Raise the level of consciousness of cultural issues and how they impact health care
Share and discuss culture and cultural generalizations that relate to health care
Develop skills for cross-cultural communication and interaction with patients and families
Identify your own specific values that may impact how you view people from other cultures
Create individual action plans for continual self-improvement related to improving each individual’s response to the opportunities/learning that can result from serving culturally diverse populations
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Definitions of Culture
An agreed upon set of norms, values, and behaviors.
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“One’s own culture provides the lens through which we view
the world; the logic... by which we order it; the grammar... by which it makes
sense.”(Avruch and Black)
Definitions of Culture
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Culture Simulation
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The Cultural Iceberg…an illustration of the components and levels of culture
Note: Use this diagram to bring to mind areas of interaction in which careful problem-solving may be needed to facilitate clear understanding and open communication
Touching, space, eye contact, body contact, tone of voice, non-verbal communication (learned through modeling, usually in early childhood)
Unconscious Rules: (“completely below sea level”) Because emotional loading at this level is intense, violations are taken personally, affecting relations between people.
Unspoken Rules: (“partially below sea level”) Because emotional loading at this level is very high, violations result in negative feelings about the violator.
Courtesies; use of time, punctuality; conduct in restaurants, social occasions, shopping (learned by trial and error)
Food, music,language, architecture (learned cognitively)
Visible Culture:(“above sea level”) Because emotional loading at this level is relatively low, few misunderstandings are produced at this level
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What is Cultural Competence?
•A process “in which an individual or agency continuously strives to achieve the ability to effectively work within the cultural context of an individual, family, or community from a diverse cultural/ethnic background,” ~Josepha Campinha-Bacote
•Culturally congruent care takes into account the cultural background of the patient. It involves decisions and actions that are acceptable to the consumer and matches the consumer’s expectations. In order to meet the consumer’s expectations, the provider must take into account the consumer’s world views, systems of values and norms, and orientation to health and illness; it must be culture specific. ~Leininger, 1988
•“A culturally competent system of care acknowledges and incorporates – at all levels – the importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet culturally unique needs. ~T. Cross, 1988
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Stages of Cultural Competence Development: The Bennett Model
Stage 1- Denial
Stage 2- Defense
Stage 3- Minimization
Stage 4- Acceptance
Stage 5- Adaptation
Stage 6- Integration
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Stereotypes
How can we manage and overcome these stereotypes both in the moment and in the longer term?
How can you give patients more information, so that they can change their perceptions of you?
Learning to reflect on what other people
might think of you is an important way of
building self-awareness, and of eventually building
greater better relationships with
your patients
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Overcoming Stereotypes
• Understand the distinction between Cultural Patterns and Stereotypes
• Acknowledge the existence of our preconceptions
• Understand how preconceptions impact us
• Know our labels and who we relegate them to
• Slow down, check it out, get information
• Adjust your understanding of cultural patterns when you get new information
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Barriers to Intercultural Communication
Assumed Similarity
Nonverbal Communication
Verbal Language
Tendency to Judge
Preconceptions and Stereotypes
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Bridging Barriers to Cross Cultural
Communication
• Raise self-awareness
• Don’t act on your stereotypes
• Listen with respect
• Increase culture-specific awareness
• Treat each person uniquely
• Seek out information
• Tolerate ambiguity
• Establish trust and show concern and empathy
• Show sensitivity to face-saving needs
• Have a sense of humor and patience
• Notice non-verbal cues
• Listen for hidden meanings
• Avoid confusing language
• Try to see things from the other person’s perspective
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Personal Communication Styles Mode of interaction:Initiating……………………………….…..…….…verses………..…….…………………….……….ListeningThe degree to which one initiates discussion or listens and responds as a primary mode of interaction.
Reference Point:Individual…………………………………..….…..verses………....………………..……………………Group The degree of emphasis placed on personal involvement and achievements versus group involvement and
achievements in communications.
Authority Base:Facts……………………………………….………...verses………….…….….…………………….……IntuitionThe degree to which one relies on factual data versus intuitive judgments as the basis for reasoning and
persuading.
Degree of Self-Disclosure:Impersonal…………………………………….…....versus……………………………..………….……PersonalThe emphasis placed on tasks versus sharing personal data in building new relationships and communicating
with others.
Mode of Expression:Rational……………………………………...……...versus………………….………….……..………..EmotionalThe degree of reliance on rational descriptions and facts only versus emotional reactions and
embellishments.
Method of Support:Challenge…………………………….…………..…versus……………….…………….………….....AgreementThe degree of challenge versus praise and agreement used to support others’ ideas, views, and so on.
Method of disagreement:Confrontation…………………………………..…..versus………….…….………………………….ComplianceThe degree of confrontational versus compliant behavior exhibited in conflict situations.
Vocal Characteristics:Low………………………………………….…….…versus……………….……………………………..…….HighThe pitch, accent, and volume displayed in verbal communications.
Method of assertion:Direct………………………………………….……..versus………….….…….……………………………IndirectThe degree of reliance on direct statements describing one’s position or point of view versus indirect
references, use of questions, and so on.
Physical proximity:Distant………………………………………….…....versus…………….……….…………………………….CloseThe degree of physical versus closeness maintained and preferred in interactions with others.
Reliance on Protocol:High…………………………………….…………….versus….……………….………...………………………LowThe degree of emphasis placed on formality and tradition versus spontaneous behavior in communications
with others.
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Communicating With Limited English Proficient (LEP) Patients
Miscommunication and lack of complete understanding often occurs between people who speak the same language. When communication is attempted between two people who do not speak the same native language, frustration and miscommunication are even more likely.
The following are some strategies that may help ensure that the desired communication actually occurs:
•Speak more slowly than usual, but do not use unnatural language.
•Be conscious of the beginning and ending of sentences, speaking as distinctly as possible.
•Present ideas or facts in a logical order.
•Pause frequently to give the listener adequate time to process the language and content.
•Watch for body language which may aid the communication or indicate confusion.
•Check for understanding by active listening or paraphrasing what the speaker has said.
•Provide adequate space for the communication; do not rush the listening-and-speaking flow of conversation.
•When there is uncertainty regarding the communication, reframe the sentence, using alternate words or phrases.
• Avoid idioms, slang or jargon. Define acronyms and abbreviations.
•Demonstrate, use visuals, and reinforce with written material whenever possible.
•Assume communication can occur. Handle your fear.
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Action Plan
What can you personally do to help your organization be more culturally competent?
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Crisis
In Chinese the word crisis is represented by two characters. Each character combined with other characters have different meanings:
The upper symbol can mean danger, while the lower can mean opportunity.