Title: Culturally Responsive Nursing Care at LAC USC
1Culturally Responsive Nursing Careat LACUSC
- Geri-Ann Galanti, PhD
- www.ggalanti.com
Los Angeles County Department of Health Services
Office of Diversity Programs
2Ground Rules
- Ask questions
- Dont worry about political correctness
- Let us know if something offends you
- Assume any such statements are made out of
ignorance, not malice.
3Stereotype vs. Generalization
- Generalizations are statements about common
cultural patterns probability statements about a
group that have to be checked in the individual
case. - Stereotypes are assumptions that an unchecked
generalization is accurate in the individual
case.
4Primary Issues To Be Addressed
- Misunderstandings which are based on cultural
differences in the meaning of behavior, and which
can lead to lack of rapport or bad feelings - Noncompliance (non-adherence) issues which are
often based on different beliefs or values
5Communication Gestures
6Communication Gestures
7Communication Gestures
8Communication Gestures
9Lack of Eye Contact
- Anglo/African American
- Asian
- Middle Eastern
- Native American
10Personal Space
Anglo American
Middle Eastern American
Asian American
11Language
Dont be crazy!
Step on it!
12Language Confusion
- Same language, different meaning
Fanny (American)
13Language Confusion
- Same language, different meaning
Fanny (British)
14Language Confusion
- Different language, different meaning
Puto (Spanish)
15Language Confusion
- Different language, different meaning
Puto (Filipino)
16Saying "yes" when the answer is no
- Saving face
- Show respect
- Grammar
17Style of Interaction
18Using Interpreters
- Studies show that an average of 70 of the
interpreted exchanges by ad hoc interpreters
contain clinically important errors. - Family members, especially, are prone to edit
both the clinicians and patients utterances. - Children are frightened or intimidated if asked
to interpret. There are ethical problems
involved. - Confidentiality concerns must also be considered.
19Issues of Language Access in Health Care
- DHHS guidance for language access under the Title
6, Civil Rights Act of 1964 - MediCal contract regulations
- Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) includes standards for
cultural competence training and language
services.
20JCAHO Ruling
- JCAHO views the provision of linguistically
appropriate care as an important quality and
safety issue. - JCAHO requires the inclusion of language and
communication needs in the medical record. - Interpretation and translation must be provided
for patients who need it.
21DHHS says
- Assess patients language needs.
- Try not to use family or friends or whoever you
can grab. - Dont use minors to interpret.
- Try to use trained medical interpreters whenever
possible. - Use telephonic interpreters for rare languages.
22What Can You Do?
- Honestly assess your own bilingual skills
- Understand the pitfalls in using untrained
interpreters - Use interpreters effectively
- Use telephonic interpreters skillfully
23Are your bilingual skills really adequate? Can
you
- formulate questions easily?
- ask a question in more than one way?
- understand nuance and connotation in the
patients response to questions? - understand regional variations?
- know terms for anatomy and healthcare concepts?
- convert biomedical terms into lay terms in the
target language?
24The Effective Use of Face-to Face Interpreters
- Brief the interpreter first, if possible.
- Introduce the interpreter to the patient.
- Position the interpreter behind the patient or
behind you. - Speak and look directly at the patient.
- Use first person and expect the interpreter to do
the same. - Avoid interrupting the interpretation.
25Using Telephonic Interpreters
- Use a speaker phone do not pass a handset back
and forth. - Remember that the interpreter is blind to visual
cues. - Let the interpreter know who you are, who else is
in the room, and what sort of patient encounter
it is. - Let the interpreter introduce her/himself.
26What You Need to Know to Connect
- The language needed
- Dial 0 for hospital operator
- Tell operator to connect you with the Language
Line. - Remember that the telephonic interpreter is bound
by confidentiality regulations, just as any other
health care personnel.
27Values
- The things we hold as important
- They are generally related to the circumstances
that lead to success within the physical and
social environment
28Dominant American Values and the Health Care
System
- Money
- Privacy
- Independence
- Individualism
29When Family is the Primary Value
- Too many visitors
- Conflict with HIPPA regulations
- Deferring decision-making
- Lack of self-care
30The 4 Cs of Culture
- What do you call the problem?
- What do you think caused the problem?
- What have you done to cope with the problem?
-
- What concerns you most about the problem and
about the treatment?
31Video
- Patient Diversity
- Beyond the Vital Signs
32Cupping
During
2 Days Later
33Protection Against Evil Eye
Mexico
Mediterranean
Middle East
34Expression of Pain
Labor Pains
- Some cultures encourage stoicism
- Northern European
- Anglo American
- Asian
- Native American
-
- Some cultures
- allow expressiveness
- Middle Eastern
- Hispanic
- Mediterranean
35Providing Culturally Responsive Care
- Learn about the beliefs and practices of the
patient populations you serve - Develop a tolerant accepting attitude about views
different from your own - Keep in mind that there is always individual
variation within a group - Dont make assumptions ask