Cultural Competence

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Cultural Competence
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Spirituality Health

• As far back as 1973 International Council of
  Nurses declared that culturally congruent health
  care is a basic human right, not a privilege
  (ICN, Code for Nurses)
• Koenig, Mcullough, and Larson (2001) reviewed
  more than 1200 studies on religion and health,
  2/3 of which showed a significant statistical
  relationship between religious activity, better
  physical health, and lower use of medical
  services
• Long established practice in the training of
  nurses to include courses in cultural awareness
  to help nurses deal with the patients of
  different cultures in the clinical setting

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Culturally Congruent Care Cultural Competence

• Culturally Congruent Care Refers to health care
  that is customized to fit with the clients
  cultural values, beliefs traditions
• Providing water and equipment for ritual and
  cultural practices
• Greater allowance for different customs of dress
  in medical facilities
• Protocols for intercommunication between
  caregivers, patients and family members
• Protocols for treatment of bodies

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Culturally-Sensitive Care

• The findings identified the learning needs of
  nurses in areas including cultural assessment and
  communication, knowledge about culture and
  health, and the development of an attitude that
  conveys respect, acceptance and
  understanding.Multicultural Health Education
  for Nurses A community Perspective. RNANS 1995

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Cultural Competence

• Cultural Competence is a learning process that
  aims to achieve culturally congruent care and
  higher levels of cultural sensitivity
• Professional standards, societal needs, ethical
  considerations and legal issues all declare the
  need to prioritize cultural competence in the
  training of nurses

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Sikhism Unfortunate Incident in BC Hospital

• http//www.cbc.ca/canada/british-columbia/story/20
  10/03/24/bc-sikh-beard-cut-fraser-health.html?ref
  rss
• How could this happen in a province with a large
  population of Sikhs (135,310)? Not a new
  population, Sikhs have been in B.C. for over 100
  years, and their of the B.C. population has
  been about the same!

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Canada and British Columbia Religion
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Canada and British Columbia Religion
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Sikhism

• Religion founded in Northern India by Guru Nanak
  (1469-1539), followed by 10 other Gurus.
• Sikh places of worship are called Gurdwaras
• Easily recognized (men wear prominent colorful
  turbans)
• Other symbols include
• Uncut hair, special combs, steel bracelets,
  ritual knives (Kirpan), and underwear (kaccha)

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Other examples of points of conflict

• Some cultures shield patient from information by
  putting decisions in hands of a second order
  relative (eg. Uncle)
• Some cultures prefer water cleansing rather than
  toilet paper (or in addition)
• Sikhs usually have 3 names.
• There is a first name Mahinda for a male or
  Amrit for a female. Then comes a title, Singh
  for all men and Kaur for all women. A family
  name such as Gill or Bhuller then follows. Thus a
  mans name may be Mahinda Gill Singh. To keep
  medical records from confusion, it is wiser to
  register patients under the family name as Gill,
  M.S. or Bhuller, A.K. A husband is usually known
  as Mr. Singh and his wife as Mrs. Kaurnever Mrs.
  Singh (Kirkwood, 76)
• Issue of Muslim women and headdress in Canada and
  France

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5 Challenges to Achieving Cultural Competence

• Religion can strongly influence a persons
  cultural practice
• but Cultures can also influence the practice of
  religion
• Cultures intermingle
• Individuals vary in their adherence to religious
  and cultural beliefs and practices
• In each religion there are groups with different
  emphases or differing traditions, sects or
  denominations (as found within the Christian
  religion)
• It is not possible for a health care worker to
  know all these divisions (so always inquire)

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Two Stereotypes

• http//www.youtube.com/watch?vfUspLVStPbk
• http//www.youtube.com/watch?vifgHHhw_6g8

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Whats Wrong With Stereotypes?

• Obviously they can misrepresent the individuals
  and groups to which they are applied although
  they can contain much that is true in their
  representations
• The deeper problem is that they ignore the deeper
  meaning of the beliefs and values that lay
  behind various outward characteristics of groups
• Lack of understanding of such detail makes the
  actions of others appear incomprehensible,
  bizarre, arbitrary close-minded, stubborn, or
  ridiculous

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Achieving Cultural Competence

• Cultural competence is not simply a question of
  having or adopting a certain attitude (openness
  tolerance, etc.)
• It is not intention that determines cultural
  competence, it is ones actual knowledge of the
  underlying detail of other peoples outlooks and
  traditions, so that their practices are not
  simply accommodated, but also, at least to some
  degree, understood
• Such understanding requires effort to learn about
  the traditions of others, not just relevant facts
  about their practices

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The meaning of the Sikh Turban

• Our textbook The removal of Kaccha
  (undershorts) from either male or female may
  cause great embarrassment, as will the removal of
  the turban.
• Much training in nursing has emphasized in the
  past simply listing such rules of thumb
• Kesh, uncut hair is symbolic of a Sikhs devotion
  to a creator God and the natural body they have
  been given by that God
• Bhai Taru Singh (c. 1720 1745) was a Sikh
  martyr who was scalped at the behest of a
  non-tolerant rulerthe turban is a symbol of
  their ideals of tolerance and respect of other
  religions, which is a cornerstone of the Sikh
  faith