Cultural Competence

1. Cultural Competence

2. Spirituality & Health • As far back as 1973 International Council of Nurses declared that culturally congruent health care “is a basic human right, not a privilege” (ICN, Code for Nurses) • Koenig, Mcullough, and Larson (2001) reviewed more than 1200 studies on religion and health, 2/3 of which showed a significant statistical relationship between religious activity, better physical health, and lower use of medical services • Long established practice in the training of nurses to include courses in “cultural awareness” to help nurses deal with the patient’s of different cultures in the clinical setting

3. “Culturally Congruent Care” & Cultural Competence • Culturally Congruent Care: Refers to health care that is customized to fit with the client’s cultural values, beliefs & traditions • Providing water and equipment for ritual and cultural practices • Greater allowance for different customs of dress in medical facilities • Protocols for intercommunication between caregivers, patients and family members • Protocols for treatment of bodies

4. Culturally-Sensitive Care • “The findings identified the learning needs of nurses in areas including cultural assessment and communication, knowledge about culture and health, and the development of an attitude that conveys respect, acceptance and understanding.”—Multicultural Health Education for Nurses: A community Perspective. RNANS 1995

5. Cultural Competence • Cultural Competence: is a learning process that aims to achieve culturally congruent care and higher levels of cultural sensitivity • Professional standards, societal needs, ethical considerations and legal issues all declare the need to prioritize cultural competence in the training of nurses

6. Sikhism: Unfortunate Incident in BC Hospital • http://www.cbc.ca/canada/british-columbia/story/2010/03/24/bc-sikh-beard-cut-fraser-health.html?ref=rss • How could this happen in a province with a large population of Sikhs (135,310)? Not a new population, Sikhs have been in B.C. for over 100 years, and their % of the B.C. population has been about the same!

7. Canada and British Columbia: Religion

8. Canada and British Columbia: Religion

9. Sikhism • Religion founded in Northern India by Guru Nanak (1469-1539), followed by 10 other Gurus. • Sikh places of worship are called Gurdwaras • Easily recognized (men wear prominent colorful turbans) • Other symbols include: • Uncut hair, special combs, steel bracelets, ritual knives (Kirpan), and underwear (kaccha)

10. Other examples of points of conflict • Some cultures shield patient from information by putting decisions in hands of a second order relative (eg. Uncle) • Some cultures prefer water cleansing rather than toilet paper (or in addition) • Sikhs usually have 3 names. • “There is a first name Mahinda for a male or Amrit for a female. Then comes a title, Singh for all men and Kaur for all women. A family name such as Gill or Bhuller then follows. Thus a man’s name may be Mahinda Gill Singh. To keep medical records from confusion, it is wiser to register patients under the family name as Gill, M.S. or Bhuller, A.K. A husband is usually known as Mr. Singh and his wife as Mrs. Kaur—never Mrs. Singh” (Kirkwood, 76) • Issue of Muslim women and headdress in Canada and France

11. 5 Challenges to Achieving Cultural Competence • Religion can strongly influence a person’s cultural practice • [but] Cultures can also influence the practice of religion • Cultures intermingle • Individuals vary in their adherence to religious and cultural beliefs and practices • In each religion there are groups with different emphases or differing “traditions”, “sects” or “denominations” (as found within the Christian religion) • It is not possible for a health care worker to know all these divisions (so always inquire)

12. Two Stereotypes • http://www.youtube.com/watch?v=fUspLVStPbk • http://www.youtube.com/watch?v=ifgHHhw_6g8

13. What’s Wrong With Stereotypes? • Obviously they can misrepresent the individuals and groups to which they are applied although they can contain much that is true in their representations • The deeper problem is that they ignore the deeper meaning of the beliefs and values that lay behind various outward characteristics of groups • Lack of understanding of such detail makes the actions of others appear incomprehensible, bizarre, arbitrary close-minded, stubborn, or ridiculous

14. Achieving Cultural Competence • Cultural competence is not simply a question of having or adopting a certain attitude (openness tolerance, etc.) • It is not intention that determines cultural competence, it is ones actual knowledge of the underlying detail of other people’s outlooks and traditions, so that their practices are not simply accommodated, but also, at least to some degree, understood • Such understanding requires effort to learn about the traditions of others, not just relevant facts about their practices

15. The meaning of the Sikh Turban • Our textbook: “The removal of Kaccha (undershorts) from either male or female may cause great embarrassment, as will the removal of the turban.” • Much training in nursing has emphasized in the past simply listing such “rules of thumb” • Kesh, uncut hair is symbolic of a Sikh’s devotion to a creator God and the natural body they have been given by that God • BhaiTaru Singh (c. 1720 – 1745) was a Sikh martyr who was scalped at the behest of a non-tolerant ruler—the turban is a symbol of their ideals of tolerance and respect of other religions, which is a cornerstone of the Sikh faith