Culturally Responsive Nursing Care at LAC USC

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Culturally Responsive Nursing Careat LACUSC

• Geri-Ann Galanti, PhD
• www.ggalanti.com

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

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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.

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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

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Communication Gestures
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Communication Gestures
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Communication Gestures
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Communication Gestures
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Lack of Eye Contact

• Anglo/African American
• Asian
• Middle Eastern
• Native American

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Personal Space
Anglo American
Middle Eastern American
Asian American
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Language

• Idioms

Dont be crazy!
Step on it!
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Language Confusion

• Same language, different meaning

Fanny (American)
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Language Confusion

• Same language, different meaning

Fanny (British)
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Language Confusion

• Different language, different meaning

Puto (Spanish)
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Language Confusion

• Different language, different meaning

Puto (Filipino)
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Saying "yes" when the answer is no

• Saving face
• Show respect
• Grammar

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Style of Interaction

• Personalismo

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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.

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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.

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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.

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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.

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What Can You Do?

• Honestly assess your own bilingual skills
• Understand the pitfalls in using untrained
  interpreters
• Use interpreters effectively
• Use telephonic interpreters skillfully

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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?

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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.

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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.

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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.

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Values

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

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Dominant American Values and the Health Care
System

• Money
• Privacy
• Independence
• Individualism

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When Family is the Primary Value

• Too many visitors
• Conflict with HIPPA regulations
• Deferring decision-making
• Lack of self-care

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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?

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Video

• Patient Diversity
• Beyond the Vital Signs

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Cupping
During
2 Days Later
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Protection Against Evil Eye
Mexico
Mediterranean
Middle East
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Expression of Pain
Labor Pains

• Some cultures encourage stoicism
• Northern European
• Anglo American
• Asian
• Native American

• Some cultures
• allow expressiveness
• Middle Eastern
• Hispanic
• Mediterranean

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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