Culturally Responsive Nursing Careat LAC+USC

Geri-Ann Galanti, PhD www.ggalanti.com

Los Angeles County Department of Health Services Office of Diversity Programs

Ground Rules

Ask questions Don’t worry about political correctness Let us know if something offends you Assume any such statements are made out

of ignorance, not malice.

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.

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

Communication: Gestures

Communication: Gestures

Communication: Gestures

Communication: Gestures

Lack of Eye Contact

Anglo/African American Asian Middle Eastern Native American

Personal Space

Asian American

Anglo American

Middle Eastern American

Language

Idioms

Don’t be crazy!Step on it!

Language Confusion

Same language, different meaning:

Fanny(American)

Language Confusion

Same language, different meaning:

Fanny(British)

Language Confusion

Puto(Spanish)

Different language, different meaning:

Language Confusion

Puto(Filipino)

Different language, different meaning:

Saying "yes" when the answer is no

Saving “face” Show respect Grammar

Style of Interaction

Personalismo

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 clinician’s and patient’s utterances.

Children are frightened or intimidated if asked to interpret. There are ethical problems involved.

Confidentiality concerns must also be considered.

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.

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.

DHHS says:

Assess patients’ language needs.

Try not to use family or friends or whoever you can grab.

Don’t use minors to interpret.

Try to use trained medical interpreters whenever possible.

Use telephonic interpreters for rare languages.

What Can You Do?

Honestly assess your own bilingual skills

Understand the pitfalls in using untrained interpreters

Use interpreters effectively

Use telephonic interpreters skillfully

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

patient’s response to questions? understand regional variations? know terms for anatomy and healthcare

concepts? convert biomedical terms into lay terms in

the target language?

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.

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.

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.

Values

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

Dominant American Values and the Health Care System

Money Privacy Independence Individualism

When Family is the Primary Value

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

The 4 C’s 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?

Video

Patient Diversity: Beyond the Vital Signs

Cupping

During 2 Days Later

Protection Against Evil Eye

Mexico Mediterranean

Middle East

Labor PainsExpression of Pain

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

Some cultures allow expressiveness• Middle Eastern• Hispanic• Mediterranean

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

Don’t make assumptions; ask