Indigenous Health Communication Cultural Sensitivity
Jan 01, 2016
Indigenous HealthIndigenous Health
CommunicationCultural Sensitivity
CommunicationCultural Sensitivity
Cross Cultural interactionCross Cultural interaction Obstacles to positive interaction
Culture shock: health workers Culture Shock: stressors Cultural Shock: indigenous clients
Cultural safety
Obstacles to positive interaction
Culture shock: health workers Culture Shock: stressors Cultural Shock: indigenous clients
Cultural safety
Positive Cross-cultural Interaction when…Positive Cross-cultural Interaction when… Equal status contact between members of various ethnic groups
Contact is between members of majority and higher status members of minority group
When “authority” and/or social climate in favour of an promote the intergroup contact
When contact of intimate rather than casual nature
When intergroup contact is pleasant or rewarding When members of both groups interact in functionally important activities… that are greater in importance than individual goals of each group
Hewstone and Brown: Contact and conflict in intergroup encounters, Basil Blackwell, Oxford 1986
Equal status contact between members of various ethnic groups
Contact is between members of majority and higher status members of minority group
When “authority” and/or social climate in favour of an promote the intergroup contact
When contact of intimate rather than casual nature
When intergroup contact is pleasant or rewarding When members of both groups interact in functionally important activities… that are greater in importance than individual goals of each group
Hewstone and Brown: Contact and conflict in intergroup encounters, Basil Blackwell, Oxford 1986
Obstacles to Positive InteractionObstacles to Positive Interaction
Structural Highly institutionalised health system
isolated from issues related to personal, family and community care
History of colonialism, scientific and institutional racism, legacy of negative legislation, minority anxiety, dependency, mutual stereotypes
Professional structures and demands which overshadow client and caregiver personal needs
Biomedical “curative” rather than holistic health models
Structural Highly institutionalised health system
isolated from issues related to personal, family and community care
History of colonialism, scientific and institutional racism, legacy of negative legislation, minority anxiety, dependency, mutual stereotypes
Professional structures and demands which overshadow client and caregiver personal needs
Biomedical “curative” rather than holistic health models
Obstacles to Positive InteractionObstacles to Positive Interaction
Individual/Personal 1 Our perceptions and attitudes to professional role - not just about quality service (Race, creed, religion ARE important)
Our perceptions of power Our perception of and attitude towards change
Individual/Personal 1 Our perceptions and attitudes to professional role - not just about quality service (Race, creed, religion ARE important)
Our perceptions of power Our perception of and attitude towards change
Obstacles to Positive InteractionObstacles to Positive Interaction
Individual/Personal 2 Our perceptions and attitudes to professional role - not just about quality service (Race, creed, religion ARE important)
Our perceptions of power Our perception of and attitude towards change
Individual/Personal 2 Our perceptions and attitudes to professional role - not just about quality service (Race, creed, religion ARE important)
Our perceptions of power Our perception of and attitude towards change
Culture Shock: Health WorkersCulture Shock: Health Workers “When well established habits no longer
have expected consequences…”(Bochner, S.: Cultures in Contact: Studies in Cross-Cultural Interaction, Pergamon, Sydney 1982
Three phases most people move through, and if they adapt well enough further stages follow.
“When well established habits no longer
have expected consequences…”(Bochner, S.: Cultures in Contact: Studies in Cross-Cultural Interaction, Pergamon, Sydney 1982
Three phases most people move through, and if they adapt well enough further stages follow.
Culture Shock: Health WorkersCulture Shock: Health Workers
The honeymoon phase Short lived Excitement, fascination Different Friends and colleagues act as buffer, little if any real contact with the culture
The honeymoon phase Short lived Excitement, fascination Different Friends and colleagues act as buffer, little if any real contact with the culture
Culture Shock: Health WorkersCulture Shock: Health Workers
The disenchantment phase “Stuck here” The quaint becomes aggravating Having to do things in a different way Anxiety and inadequacy Compensated for by seeking out fellow countrymen, excluding the indigenous population OR “going native”
If you last, then a chance to take on board different ways of understanding, doing things
The disenchantment phase “Stuck here” The quaint becomes aggravating Having to do things in a different way Anxiety and inadequacy Compensated for by seeking out fellow countrymen, excluding the indigenous population OR “going native”
If you last, then a chance to take on board different ways of understanding, doing things
Culture Shock: Health WorkersCulture Shock: Health Workers
Beginning Resolution Phase Seeking to learn, making friends, becoming participant and observer as much as possible
Characterised by the return of the sense of humour?Brink and Saunders: Transcultural Nursing: A book of Readings, Prentice Hall, Toronto 1976
Increased ability to predict the actions and reactions in situations
Ability to function in more culturally appropriate ways
Beginning Resolution Phase Seeking to learn, making friends, becoming participant and observer as much as possible
Characterised by the return of the sense of humour?Brink and Saunders: Transcultural Nursing: A book of Readings, Prentice Hall, Toronto 1976
Increased ability to predict the actions and reactions in situations
Ability to function in more culturally appropriate ways
Culture Shock: Health WorkersCulture Shock: Health Workers
…then the worker may achieve:Effective Function Phase…as comfortable in the new setting as the old. Disadvantage may include reverse culture shock when he goes home
Reverse Culture Shock PhaseMay need debriefing. Ideally the worker should become as comfortable in one culture as the other
…then the worker may achieve:Effective Function Phase…as comfortable in the new setting as the old. Disadvantage may include reverse culture shock when he goes home
Reverse Culture Shock PhaseMay need debriefing. Ideally the worker should become as comfortable in one culture as the other
Culture Shock: StressorsCulture Shock: Stressors
Communication verbal and nonverbal complexity of ideas rules and conventions acceptable behaviour and etiquette
(respect especially to children and the elderly)
Promises and what they mean (sometimes there is the need not to say no, while at the same time not to say yes!)
(I call that Eastern Standard Koori Time)
Communication verbal and nonverbal complexity of ideas rules and conventions acceptable behaviour and etiquette
(respect especially to children and the elderly)
Promises and what they mean (sometimes there is the need not to say no, while at the same time not to say yes!)
(I call that Eastern Standard Koori Time)
Culture Shock: StressorsCulture Shock: Stressors
Mechanical DifferencesThings are different in the bush. Power Gas Electricity Telephone Water Shops Movies
Mechanical DifferencesThings are different in the bush. Power Gas Electricity Telephone Water Shops Movies
Culture Shock: StressorsCulture Shock: Stressors
Isolation Cultural Isolation Social isolation Professional isolation
Isolation Cultural Isolation Social isolation Professional isolation
Culture Shock: StressorsCulture Shock: Stressors
Customs Death: in some cultures the deceased is not mentioned, some they are remembered, some are adamant about returning to their land to die, many attend the funerals “because it would be disrespectful not to”
Birth: born into the community and introduced to it as soon as possible
Disharmony: gossip and shaming help groups control those they think have acted unacceptably. It is an INTERNAL mechanism - stay out of it…
Customs Death: in some cultures the deceased is not mentioned, some they are remembered, some are adamant about returning to their land to die, many attend the funerals “because it would be disrespectful not to”
Birth: born into the community and introduced to it as soon as possible
Disharmony: gossip and shaming help groups control those they think have acted unacceptably. It is an INTERNAL mechanism - stay out of it…
Culture Shock: StressorsCulture Shock: Stressors
Attitudes and Beliefs Health Intervention - when reinforced by legislation is not good - compulsory vaccination, chest X-Rays, mantoux tests
Respect cherished beliefs. They change far slower in communities than in journals
Changing the message every few years is NOT good practice
Attitudes and Beliefs Health Intervention - when reinforced by legislation is not good - compulsory vaccination, chest X-Rays, mantoux tests
Respect cherished beliefs. They change far slower in communities than in journals
Changing the message every few years is NOT good practice
Culture Shock: Indigenous ClientsCulture Shock: Indigenous Clients
It may seem strange but the issues that affect the health worker also affect the health care recipient
Changes deeply affect the indigenous patient transferred to the big city for surgery - loss of identity, loss of autonomy, alienation, loss of personal space, shame/embarrassment, powerlessness, fear, anxiety
Dealing with you in the community or outside it presents them with all the same issues raised so far. Communication Mechanical Differences Isolation Customs Attitudes and Beliefs
It may seem strange but the issues that affect the health worker also affect the health care recipient
Changes deeply affect the indigenous patient transferred to the big city for surgery - loss of identity, loss of autonomy, alienation, loss of personal space, shame/embarrassment, powerlessness, fear, anxiety
Dealing with you in the community or outside it presents them with all the same issues raised so far. Communication Mechanical Differences Isolation Customs Attitudes and Beliefs
Cultural SafetyCultural Safety
Health workers are aware of the importance of physical, ethical and legal safety in health care, but unaware of or insensitive to the importance of providing culturally safe environment to facilitate physical, ethical and legal safety of the clientsRamsden, Whakaruruhau: Cultural Safety in Nursing Education in Aotearoa. A report for the Maori Health and Nursing Ministry of Education, New Zealand, 1990
Health workers are aware of the importance of physical, ethical and legal safety in health care, but unaware of or insensitive to the importance of providing culturally safe environment to facilitate physical, ethical and legal safety of the clientsRamsden, Whakaruruhau: Cultural Safety in Nursing Education in Aotearoa. A report for the Maori Health and Nursing Ministry of Education, New Zealand, 1990
Cultural SafetyCultural Safety
Cultural safety, as defined in 1988 by the Hui Waimanawa, Christchurch, requires that:
The validity of [Maori] cultural values be recognised, especially as they relate to their perceptions of health, their tapu, and the holistic nature of their being…
Ramsden, Whakaruruhau: Cultural Safety in Nursing Education in Aotearoa. A report for the Maori Health and Nursing Ministry of Education, New Zealand, 1990
Cultural safety, as defined in 1988 by the Hui Waimanawa, Christchurch, requires that:
The validity of [Maori] cultural values be recognised, especially as they relate to their perceptions of health, their tapu, and the holistic nature of their being…
Ramsden, Whakaruruhau: Cultural Safety in Nursing Education in Aotearoa. A report for the Maori Health and Nursing Ministry of Education, New Zealand, 1990
Cultural SafetyCultural Safety
Cultural safety then is the need to be recognised within the health care system, and to be assured that the system reflects something of you - of your culture, language, customs, beliefs, attitudes and preferred ways of doing things
It must adopt a holistic approach, as must your communication
Communication is a two way process
Cultural safety then is the need to be recognised within the health care system, and to be assured that the system reflects something of you - of your culture, language, customs, beliefs, attitudes and preferred ways of doing things
It must adopt a holistic approach, as must your communication
Communication is a two way process
Cultural Safety - from the communityCultural Safety - from the community
Health is the well-being of the whole person - if you feel good in your spirit, that’s health - it’s not just a medical thing. If you’ve got a good spirit you’re happy in your heart People have a good spirit when you can have all of your family with you, to know your children are well, to have your child born on your land, to have a job, not to have to worry about where your next feed is coming from, to be where everything is familiar, to feel comfortable, to be free of worries about health problems, to have choice without fear of reprimand - an anxious mind drains a good spirit.
Health is the well-being of the whole person - if you feel good in your spirit, that’s health - it’s not just a medical thing. If you’ve got a good spirit you’re happy in your heart People have a good spirit when you can have all of your family with you, to know your children are well, to have your child born on your land, to have a job, not to have to worry about where your next feed is coming from, to be where everything is familiar, to feel comfortable, to be free of worries about health problems, to have choice without fear of reprimand - an anxious mind drains a good spirit.