Valuing Cultural Competence in the Delivery of Health Care Services University of South Florida College of Nursing Tampa, Florida October 14, 2009 Time: 9:00am-1:00pm PRESENTERS PATRICK C. COGGINS PH.D., JD., LLD (HON.) DAVID C. SOLAR, M.Ed. P.C. COGGINS & ASSOCIATES, LLC MULTICULTURAL EDUCATION INSTITUTE, STETSON UNIVERSITY
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Valuing Cultural Competence in the Delivery of Health Care Services University of South Florida College of Nursing Tampa, Florida October 14, 2009 Time:
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Valuing Cultural Competence in the Delivery of Health Care
Services
Valuing Cultural Competence in the Delivery of Health Care
ServicesUniversity of South Florida
College of NursingTampa, Florida
October 14, 2009Time: 9:00am-1:00pm
PRESENTERSPATRICK C. COGGINS PH.D., JD., LLD (HON.)
DAVID C. SOLAR, M.Ed.
P.C. COGGINS & ASSOCIATES, LLCMULTICULTURAL EDUCATION INSTITUTE, STETSON UNIVERSITY
Managing Cultural Competence in the Delivery of Health Care
WORKSHOP PURPOSE
To provide participants from the College of Nursing with experiential and practical applications that will enable nursing and other health care professionals to bridge existing gaps in cross-cultural interactions with ethnically and racially diverse patients and consumers in the USF and Greater Tampa Bay communities.
QUESTIONS TO BE ANSWERED
What is Cultural Competence?
Why is Cultural Competence necessary in the delivery of health care?
What are the benefits to be derived from using the case study method in learning about Cultural Competence?
What Cross Cultural values should drive nursing practices?
Which issues and strategies are research based?
What are the benefits to be derived from the use of a Cultural Assessment regimen by nurses and health care professionals?
Understand the concept of Cultural Competence, specifically, the new CDC definitions which include the following Four Elements: 1) Cultural Diversity Awareness, 2) Culturally Competent Behaviors, 3) Cultural Sensitivity, and 4) Cultural Assessment (Coggins, CDC).
Apply experiential strategies that will increase the participants’ understanding of the practical application of:
Culture through semantic mapping (Leahy).
Commonalities vs. Differences through the Venn Diagram (De Anda).
Engage in experimental activities that apply innovative Cultural Assessment methods that are grounded in Culturally Competent Behaviors and Perspectives.
Review the seven (7) levels of Cultural Competence and their relevance to the delivery of Health Care.
Understand cross-cultural issues with respect to: a) Cultural generalizations about ethnic groups, b) Being adept to changing generalizations about ethnic groups, and c) Practical strategies to enjoy responsive interactions with cross-cultural and cross ethnic patients/clients.
Focus on the barriers to Culturally Competent Services.
Build an authentic Cross-Cultural Communication system that supports Cultural Competence in the workplace.
Understand the application of validated strategies through the use of relevant case studies that are appropriate for health care settings.
Other topics agreed on.
Managing Cultural Competence in the Delivery of Health Care
THE BASICS THE CONTINUUM OF WORKING ACROSS CULTURES
Cultural Destructiveness
Cultural Incapacity
Cultural Blindness
Cultural Pre-Competence
Culture Competence
Cultural Proficiency
Cultural Empowerment
Cultural Competence and Its Implications for Nursing Education
Cultural Competence Definitions Cultural Destructiveness:
Forced assimilation Subjugation Rights Privileges
For dominant groups only the AttitudesPoliciesPractices Create uneasiness, disconnect and are destructive to
the cultural group.
Cultural Incapacity: inability of systems to respond to the needs, interests, and preferences of culturally and linguistically
diverse groups.
Institutional or systemic bias; practices of discrimination in hiring and promotion; disproportionate allocation of
resources that may benefit one cultural group over another;
Subtle messages that some cultural groups are neither valued nor welcomed;
Lower expectations for some cultural, ethnic, or
racial groups.
Cultural Competence and its Implications for Nursing Education
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Cultural Blindness: Differences ignored, “treat everyone the same” Only meet needs of dominant groups. Focus on assimilation ignores cultural strengths Blaming the victim Little value placed on training and resources that
enhance cultural and linguistic competence. Workforce lack diversity are recognition of culture’s
perception and response to disease and illness.
Cultural Competence and its Implications for Nursing Education
Cultural Pre-Competence: Refers to the willingness to explore cultural issues
Assess needs of organization and individuals for effective cultural and linguistic resources
Hiring practices that support diverse workforce
Token representation on going boards, administrative positions
No clear plan to achieve individual and organizational cultural competence.
Cultural Competence and its Implications for Nursing Education
Cultural Competence: Refers to the organization recognizing individual and cultural differences
seek advice from diverse groups, hire culturally unbiased staff:Creates a mission statement for focus on
cultural and linguistic competence in all parts of organization.
Adapts evidence based promising practices that are culturally and linguistically competent.
Supports a common definition of cultural and linguistic competence.
Cultural Competence and its Implications for Nursing Education
Cultural Proficiency: Implement changes to improve services based upon cultural needs, do research and teach staff new approaches to being culturally and linguistically competent.Cultural Competence is integrated and held as a
core value in the organization.Develop and publish core values that support
cultural and linguistic competence.Develop and publish all health promotion
materials and communications that are sensitive and adapted to the cultural and linguistic needs of the population served.
Cultural Competence and its Implications for Nursing Education
The ultimate level is Cultural Empowerment Cultural Empowerment is reflected in a
philosophy that the student/staff is a co-equal partner in the educational and learning process.
The organization’s Cultural Proficiency is actualized in intake, assessment, treatment planning, treatment process and treatment completion and follow up:
The student/individual is consulted at every phase of the learning interaction/process.
The individual sees the integration of his/her culture and linguistic needs and attributes in learning, advising and social processes.
The individual is empowered to initiate and integrate cultural concerns in learning, classroom, advisory and social processes.
The individual respects and actively supports the infusion of his/her culture and linguistic dimensions in the learning, advising and social processes.
The interaction is characterized but mutual respect , mutual praise, acceptance of differences, recognition of similarities and mutual striving to achieve one’s best potentials through empowerment.
Organizations mission, policies and procedures reflect cultural empowerment
CULTURAL COMPETENCE IN HEALTH CARE SETTINGS – CULTURAL EMPOWERMENT
Advocate on behalf of the diverse populations served by the University organization.
Maintain partnerships with diverse groups in education, health, and community based and racially diverse organization.
Integrates as part of client assessment an assessment of the cultural background and dynamics of the client (Coggins & Bell, 2007 Model)
Progress in maintaining cultural and linguistic competence is discussed at each policy advisory and teaching decision making process.
Cultural Competence and its Implications for Nursing Education
“Culture represents the histories, attitudes, behaviors, languages, values, beliefs and uniqueness, which distinguishes each racial or sub-cultural group in a society. Each of us has a historical heritage and a contemporary heritage that comprises our present culture.” (Coggins, 2004)Definition of CulturePlease define in your own words the term of culture and indicate what values are expressed in the definition._______________________________________________________________________________________________________________________________________________________________________________________
Exercise 7: Developing an Assessment Instrument for
Cultural CompetenceTask 1: Working in your groups of 6 and using the information you have learned thus far, please develop five questions that you would ask to get deeper into the culture of the patient/student.
Task 2: List Questions that you would include in assessment of the patient.
1.
2.
3.
4.
5.
Activity 1: Be prepared to post your questions on the newsprint.
2: Select a member of your group to share the information with the entire group.
Definitions1. Cultural Diversity Awareness – Acquisition of
knowledge of the history and cultural characteristics of diverse groups (your patient/client/student).
2. Cultural Competent Behaviors – Habit of exhibiting appropriate behaviors with diverse individuals/groups. Always relevant and positive actions – Just Do It – Beyond Saying it.
3. Cultural Sensitivity – Be flexible, kind, non-harsh, non discriminatory- driven by genuine respect for the patient/client/student. (Feeling a sense of being cared for)
4. Cultural Assessment – To assess cultural needs of the client/student by asking appropriate questions, using data to enhance the treatment and services of patients/clients.
1. Please answer the questions as briefly and concisely as possible by jotting down areas, concepts, or topics. “I would consider myself as a ‘Culturally Competent’ person because I…” __________________________________________________________________________________________________________________________________________________________________________________________________________________
2. Supervisor/individuals/nurses and University staff could increase their “Cultural Competence” by developing or enhancing the following skills:__________________________________________________________________________________________________________________________________________________________________________________________________________________
3. The College of Nursing in the University I work for can ensure Cultural Competence between supervisors and workers, and with patients/clients/students by:__________________________________________________________________________________________________________________________________________________________________________________________________________________
Jane, who is a very smart and friendly 20-year-old woman was experiencing severe depression, pains in her chest, and anxiety. She was told by her supervisor to, “stop acting up and take time off to straighten out her behavior... no more outbursts will be tolerated!” So her mother encouraged her to go to the hospital for help. Upon arriving at the hospital, Jane was asked by the nurse, “in case of an emergency, who should we contact?” Jane said, “my mother who is standing right here next to me.” The nurse said, “are you sure this is your mother? She is black and darker than you.”
Upon hearing the nurse’s comment, the mother was annoyed and demanded to see the supervisor or the doctor. The doctor came out and inquired about what was going on. The doctor shouted, “can’t you people conduct yourself properly?” Jane blurted, “we are fine, the problem is with this clerk who refuses to take down the information I provided about my mother!” Sensing a problem, the doctor said, “take the woman’s information down, okay?” The nurse did, and Jane’s mother strolled off to the waiting room.
You are a caregiver. A middle-aged Korean woman with chronic back problems is admitted into your hospital. She speaks little English. Her husband speaks English and translates for her. When the husband is present, the patient denies pain. when the husband leaves the room, the patient admits to having pain.
You believe that the husband has little faith in the U.S. medical community. The husband says that he believes that pain medications interfere with the patient’s body’s “natural healing process” and he places the pain medication out of the patient’s reach. Instead, he provided his wife with herbal teas to help her “heal.”
You want to help the patient be more comfortable, but can’t get her to acknowledge the pain in her husband’s presence. You feel that the husband has no clinical experience to dictate how his wife should handle her pain. 29
1. What are the issues from the patient’s perspective? From the husband’s perspective?
2. What are the possible “cultural” issues in this case?
3. Brainstorm how you could handle this situation more effectively.
4. How does the use of the husband as an interpreter impact the situation?
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A 19-year-old Hmong Male
A 19-year-old, English-speaking, Hmong college student, born and raised in the United States to Hmong immigrant parents, developed progressive liver failure requiring a liver transplant. He agreed to be placed on the transplant waiting list, but his family members, when presented with this information, rejected his decision, saying, “If you have this transplant, you will no longer be our son!”
______________________________________________________________________________________________________________________________________________________________________Facilitator’s Note: The College of Nursing is encouraged to Build Cultural Competence among staff by using the “Case Method” to discuss and explore common solution to creating a culturally competent school and clinic.
Exercise 11: Examination of the Racial/Ethnic Gap Between Minority
and Majority Groups
Note: Culture is everything; we need to understand that humans have commonalities as well as differences. Avoid focusing on only differences. Also recognize the commonalities we share as humans.