Transcultural Care

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Transcultural Care
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Culture

• The shared values, traditions, norms, customs,
  arts, history, folklore, and institutions of a
  group of people that are unified by race,
  ethnicity, language, nationality, or religion.
• Source Office of Minority and Womens Health,
  HRSA, NIH

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Characteristics of Culture

• Learned roles, behaviors, values, attitudes
• Human nature, time, relationships, traditions
• Health beliefs, religion or spirituality
• Communication, decision-making, food/diet,
  grief/dying, family roles, sick roles.

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Characteristics of Culture

• Stabilizing forces and change agents
• Social Structure
• Family, politics, education, economics, art,
  history, physical environment, health care
  facilities, ethnicity

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Criteria for Defining Culture

• Common language/communication system
• Similarities in dietary preferences
• Common patterns of dress
• Predictable relationships and socialization
  patterns
• Shared values and beliefs

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Personal Culture

• Personality, unique structure
• Internal factors such as gender, age, sexual
  orientation
• External factors such as society, personal
  experiences
• Where one grows up or now lives
• With or without children, with or without
  religious affiliation
• Organizational/work influences
• Position within work place and its location

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Cultural Diversity

• Difference in Race, ethnicity, language,
  nationality, or religion among various groups
  within a community is said to be culturally
  diverse if its residents include members of
  different groups.
• Source Office of Minority and Womens Health.
  HRSA, NIH

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Diversity

• Differences can be found in communities that are
  bounded by similarities in ethnicity, language,
  religion, geography, history or politics.
• Every interaction is cross-cultural!

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Ethnicity

• Identity one has based on ancestry and national,
  religious, tribal, linguistic or cultural
  origins.
• Sense of belonging to a reference group within a
  society

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Race

• Use of the term is debated
• Biological term used to categorize people based
  on physical characteristics
• Disregards genetic variations
• Often used in discriminatory manner

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Acculturation

• Giving up traits of one culture and adopting
  those of another
• Bicultural function equally well in two
  cultures
• Traditional retains traits from culture of
  origin
• Marginal no traits from either culture or
  origin or new one in which he/she lives
• Acculturated gives up traits of original
  culture and adopts those of new culture

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Assimilation

• Social, political, and economic integration of a
  cultural group into a mainstream society
• Usually requires a degree of acculturation
• Many cultural groups may resist or reject
  acculturation
• Communities develop in which people are insulated
  from main stream
• Lack of political voice may disadvantage group

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Ethnocentrism

• Viewpoint that ones own way of believing or
  behaving is correct and preferred
• Ethnosensitivity
• Process of becoming more sensitive and respectful
  of cross cultural differences

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Cultural Competence

• A set of academic and interpersonal skills that
  allow individuals to increase their understanding
  and appreciation of cultural differences and
  similarities within, among, and between groups.
  This requires a willingness and ability to draw
  on community-based values, traditions, and
  customs and to work with knowledgeable persons of
  and from the community in developing targeted
  interventions, communications and other support.
• Source Office of Minority and Womens Health,
  HRSA, NIH

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5 Elements of Cultural Competence

• Awareness and acceptance of differences
• Self-awareness or individual or organizational
  culture
• Understanding the dynamics of difference
• Integration of cultural knowledge within
  individuals and systems
• Adaptation to diversity

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Steps to Cultural Competence

• Awareness
• Becoming aware of other cultural viewpoints and
  taking into account the diversity in values,
  beliefs, practices, lifestyles and problem
  solving strategies
• Examination of ones own culture, learned biases
  and prejudices

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• Knowledge
• Learning about historical, social, political
  and/or religious influences that affect anothers
  worldview
• Distinguishing between an individuals traits and
  those common to a community or people with
  similar origins
• Give and take of ideas and knowledge for
  effective interpersonal relationships

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• Skills
• Integrating awareness and knowledge into western
  bio-medical system during a cross-cultural
  encounter to achieve culture-specific,
  individualized interventions
• Collecting relevant cultural data in both a
  history and physical assessment
• Ability to generate conversation not
  confrontation
• Partnerships instead of misunderstandings

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• Cultural Encounters
• Cross-cultural interactions that allow new
  learning or refinement of knowledge and beliefs
• Prevent stereotyping as the experience of
  interaction reveals intra-cultural group variation

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Medical Interpreters

• People who orally translates a message spoken in
  one language into another language
• People who are fluent in both languages
• People who are not relatives of the patient
• People who have received professional training

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Use of Interpreters

• Secure an interpreter for people who
• Are non-English speaking
• Are limited English proficient
• Have limited understanding of health care issues
  in the English language

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Professional Interpreters VS Untrained
Interpreters

• Professional interpreters have been screened to
  assure fluency in both languages
• Untrained interpreters may
• Omit important information
• Add ideas
• Answer for the patient
• Give advice even if they dont understand

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Family and Friends Used as Interpreters

• May commit all of the errors as other untrained
  interpreters
• May cause the patient to not feel comfortable
  sharing information
• May react to a situation or information rather
  than serve as an interpreter
• May make decisions for the patient
• There may be a breach of confidentiality

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Acceptable Interpreters

• Bilingual staff that is trained and demonstrates
  competence
• Contract interpreters
• Community volunteers who are competent
  interpreters
• Telephone interpreter services

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Working Effectively Through an Interpreter

• Conduct pre-session to introduce yourself and
  goals for the encounter
• Speak directly to the patient
• Speak slowly in short segments with pauses
• Ask that everything you and the patient and
  family says is interpreted
• Be aware there may not be linguistic equivalence
  for some terms

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Things to Avoid

• Highly idiomatic speech
• Complicated sentence structure
• Sentence fragments
• Changing an idea in mid-sentence
• Asking more than one question at a time

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Tips

• Have the interpreter ask questions and alert you
  to cultural misunderstandings
• Respect an interpreters opinion that a question
  may be culturally inappropriate
• Avoid patronizing or demeaning the patient
• Be patient as this may take more time

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Roles of the Interpreter

• Conduit of Information
• Clarifier Facilitates understanding when no
  linguistic equivalence exists
• Culture Broker Provides a cultural framework
  for understanding when cultural differences are
  leading to a misunderstanding
• Advocate Actions to eliminate systematic
  barriers to quality care