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Culturally Responsive Nursing Care at LAC USC

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(Filipino) Different language, different meaning: Saying 'yes' when the answer is no ... Interpretation and translation must be provided for patients who need ... – PowerPoint PPT presentation

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Title: Culturally Responsive Nursing Care at LAC USC


1
Culturally Responsive Nursing Careat LACUSC
  • Geri-Ann Galanti, PhD
  • www.ggalanti.com

Los Angeles County Department of Health Services
Office of Diversity Programs
2
Ground 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.

3
Stereotype 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.

4
Primary 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

5
Communication Gestures
6
Communication Gestures
7
Communication Gestures
8
Communication Gestures
9
Lack of Eye Contact
  • Anglo/African American
  • Asian
  • Middle Eastern
  • Native American

10
Personal Space
Anglo American
Middle Eastern American
Asian American
11
Language
  • Idioms

Dont be crazy!
Step on it!
12
Language Confusion
  • Same language, different meaning

Fanny (American)
13
Language Confusion
  • Same language, different meaning

Fanny (British)
14
Language Confusion
  • Different language, different meaning

Puto (Spanish)
15
Language Confusion
  • Different language, different meaning

Puto (Filipino)
16
Saying "yes" when the answer is no
  • Saving face
  • Show respect
  • Grammar

17
Style of Interaction
  • Personalismo

18
Using 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.

19
Issues 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.

20
JCAHO 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.

21
DHHS 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.

22
What Can You Do?
  • Honestly assess your own bilingual skills
  • Understand the pitfalls in using untrained
    interpreters
  • Use interpreters effectively
  • Use telephonic interpreters skillfully

23
Are 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?

24
The 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.

25
Using 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.

26
What 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.

27
Values
  • The things we hold as important
  • They are generally related to the circumstances
    that lead to success within the physical and
    social environment

28
Dominant American Values and the Health Care
System
  • Money
  • Privacy
  • Independence
  • Individualism

29
When Family is the Primary Value
  • Too many visitors
  • Conflict with HIPPA regulations
  • Deferring decision-making
  • Lack of self-care

30
The 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?

31
Video
  • Patient Diversity
  • Beyond the Vital Signs

32
Cupping
During
2 Days Later
33
Protection Against Evil Eye
Mexico
Mediterranean
Middle East
34
Expression of Pain
Labor Pains
  • Some cultures encourage stoicism
  • Northern European
  • Anglo American
  • Asian
  • Native American
  • Some cultures
  • allow expressiveness
  • Middle Eastern
  • Hispanic
  • Mediterranean

35
Providing 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
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