Multicultural Opportunities for Success in Hospital Services

1. Multicultural Opportunities for Success in Hospital Services FirstName LastName Title Organization

2. Questions to Run on: • Can cultural identity influence your work in Hospital Services? • How comfortable are you with your knowledge of cultures and religions and how does that impact your interactions and instructions in the hospitals? OPO-MCT_HAguiar

3. Objectives By the end of this presentation the learner will be able to: • Recognize the need for Hospital Services staff to develop multicultural skills. 2. Be more culturally aware and skilled in working with others of different cultures. OPO-MCT_HAguiar

4. Overview • Laying Foundations • Operational definitions of culture, race and ethnicity • Implications for Hospital Services • working with multicultural health care professionals • health care professionals’ multicultural needs • Basic Principles • Practical tips in working with different cultures OPO-MCT_HAguiar

5. Laying Foundations Operational Definitions of Culture, Ethnicity, and Race and the Differences Between These Terms OPO-MCT_HAguiar

6. Laying Foundations • Culture is requires a broad definition and should include: • Ethnographic variables • Demographic variables • Status variables • Affiliation variables OPO-MCT_HAguiar

7. Laying Foundations – Defining Culture “Culture is defined as a specific set of social, shared, educational, religious, and professional behaviors, practices and values that individuals learn and ascribe to while participating in or outside of groups with whom they typically interact.” (Bomar, 2004) OPO-MCT_HAguiar

8. Laying Foundations – Defining Ethnicity “Ethnicity is a key facet of culture and refers to a common ancestry, a sense of ‘peoplehood’ and group identity. From a common ancestry and a shared social and cultural history and national origin have evolved shared values and customs.” (Friedman et al., 2003) OPO-MCT_HAguiar

9. Laying Foundations – Defining Race “an ancient, nonscientific, political classification of human beings and is based on physiological characteristics, such as skin color, eye shape, and texture of hair.”(Bomar, 2004) • It is a narrower term then ethnicity and denotes a human biological definition OPO-MCT_HAguiar

10. Laying Foundations Important Clarifications: • Race and ethnicity should NOT be confused • People of one race can vary in terms of their ethnicity and culture • Race is NOT considered a correct or useful means of classifying people OPO-MCT_HAguiar

11. Laying Foundations Important Clarifications: • There are no distinct, pure races today • Religion is very much entwined with ethnicity, shaper of health values, beliefs, and practices OPO-MCT_HAguiar

12. Thought Question Knowing that people of one race can vary in terms of their ethnicity and culture, can we truly make assumptions about someone based on their biological looks or even based on the little we may know of their “culture” or “ethnicity”? OPO-MCT_HAguiar

13. Implications for Hospital Services Working with Multicultural Health Care Professionals & Health Care Professionals’ Multicultural Needs OPO-MCT_HAguiar

14. Implications for Hospital Services Working with Multicultural Health Care Professionals • Communication and education – medical approach OPO-MCT_HAguiar

15. Implications for Hospital Services Donation Education OPO-MCT_HAguiar

16. Implications for Hospital Services Working with Multicultural Health Care Professionals • Communication and education – medical approach • Communication and education – multicultural approach OPO-MCT_HAguiar

17. Implications for Hospital Services Donation Education OPO-MCT_HAguiar

18. Implications for Hospital Services Working with Multicultural Health Care Professionals • Communication and education – medical approach • Communication and education – multicultural approach • Education in groups • Education one-one OPO-MCT_HAguiar

19. Implications for Hospital Services • Applying a multicultural framework to group presentations • Hofstede’s Five-Dimensional Model • Created to improve and provide cross-cultural communication for IBM • Investigation that led to this framework was conducted across 50-countries OPO-MCT_HAguiar

20. Implications for Hospital Services • Hofstede’s Five-Dimensional Framework • Power Distance Index (PDI) • Individualism (IDV) • Masculinity (MAS) • Uncertainty Avoidance Index (UAI) • Long-Term Orientation (LTO) OPO-MCT_HAguiar

21. Implications for Hospital Services Power Distance Index (PDI) • Assesses extent less powerful members of society accept unequally distributed power • Cultures with high PDI • Exhibit high dependency needs, inequality accepted, hierarchy is needed, superiors are inaccessible, powerholders have privileges, change is normally by revolution • Cultures with low PDI • Tendency to low dependency needs, inequality minimized, hierarchies exist for convenience, superiors accessible, all have equal rights, change occurs by evolution OPO-MCT_HAguiar

22. Implications for Hospital Services Individualism (IDV) • People look after themselves and their families vs. those with a tradition of collectivism, emphasize life and well-being of the extended family • Cultures with high IDV • People are focused on “I” and have private opinions, feel guilty when there is a loss of self-respect, fulfill obligations to self • Cultures with low IDV • People focused on “we”, prioritize relationships over tasks, feel shame when creating loss of face for the collective, fulfill obligations to the group OPO-MCT_HAguiar

23. Implications for Hospital Services Masculinity (MAS) • Degree to which values like assertiveness, success, competition and performance (male characteristics) prevail vs. values like quality of life, service, care for the weak and solidarity, maintaining relationships (female characteristics) • Cultures with high MAS • Focus on equity, performance and competition – managers are expected to be assertive and decisive • Cultures with low MAS • Focus on equality, quality of work life and solidarity – managers strive for consensus and use intuition OPO-MCT_HAguiar

24. Implications for Hospital Services Uncertainty Avoidance Index (UAI) • Degree to which people in a country prefer and are comfortable in structured over unstructured situations. Cultures avoiding uncertainty, minimize such possibilities by strict laws and rules, security and safety measure • Cultures with high UAI • Are resistant to change, have many rules and low tolerance of deviant ideas • Cultures with low UAI • Prefer innovative ideas, there are few rules OPO-MCT_HAguiar

25. Implications for Hospital Services Long-Term Orientation (LTO) • Differentiates between Western and Eastern thinking and explores long-term vs. short-term orientation • Cultures with high LTO • Mentality includes frugality, persistence, relationships are ordered by status, a concern for a sense of shame • Cultures with low LTO • Mentality includes protecting your ‘face’, respecting tradition, personal stability and steadiness, and reciprocation of favors, greetings, and gifts OPO-MCT_HAguiar

26. Implications for Hospital Services OPO-MCT_HAguiar

27. Implications for Hospital Services OPO-MCT_HAguiar

28. Implications for Hospital Services • Weakness of Hofstede’s framework • Generalization vs. Stereotyping • Applying Hofstede’s framework to group presentation on donation versus one-on-one education OPO-MCT_HAguiar

29. Implications for Hospital Services • Applying a multicultural model in one-one education • Arthur Kleinman’s Explanatory model • Unbiased approach to an individual • Gain the emic perspective versus our etic perspective OPO-MCT_HAguiar

30. Implications for Hospital Services Anthropological terminology: • Emic perspective – insider’s perspective • Etic perspective – outsider’s perspective • Both perspectives – most effective vantage point OPO-MCT_HAguiar

31. Implications for Hospital Services Explanatory Model – 8 Questions by Arthur Kleinman: • What do you call your illness? What name does it have? • What do you think has caused the illness? • Why and when did it start? • What do you think the illness does? How does it work? OPO-MCT_HAguiar

32. Implications for Hospital Services Explanatory Model – 8 Questions (cont.) • How severe is it? How long do you think you will have it? • What kind of treatment do you think the patient should receive? What are the most important results you hope he/she receives from this treatment? • What are the chief problems the illness has caused? • What do you fear most about the illness? OPO-MCT_HAguiar

33. Implications for Hospital Services Simple triggers - the 4Cs: • Call • Cause • Cope • Concerns OPO-MCT_HAguiar

34. Implications for Hospital Services • Applying Kleinman’s questions to healthcare professionals: • Have you had any experience, personal or professional with this type of an injury/illness? • In your opinion, how should this injury/illness be treated? • What do you think is the likely outcome for the patient? • At what point do you believe death occurs? What about in brain death? • What is valuable to you in death? OPO-MCT_HAguiar

35. Implications for Hospital Services Working with Multicultural Health Care Professionals & Health Care Professionals’ Multicultural Needs OPO-MCT_HAguiar

36. Implications for Hospital Services • Health Care Professionals’ Multicultural Needs • The Joint Commission requirement • Data reported to The Joint Commission demonstrates most root cause of sentinel events is due to communication: • Many standards relate to importance of understanding, acknowledging and respecting the patient’s culture • U.S. Department of Health & Human Services – The Office of Minority Health standards • 14 CLAS standards set for health care organizations with the following themes: Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational Supports for Cultural Competence (Standards 8-14) OPO-MCT_HAguiar

37. Implications for Hospital Services Leininger says that nurses are realizing the critical need to become more culturally competent and knowledgeablein working with individuals of diverse cultures. (Leininger, 1994) OPO-MCT_HAguiar

38. Implications for Hospital Services The Joint Commission definition of cultural competence: • the ability of health care providers and organizations to understand and respond effectively to the cultural and language needs brought by the patient to the health care encounter OPO-MCT_HAguiar

39. Implications for Hospital Services The Joint Commission definition of cultural competence (cont.): • Cultural competence requires organizations and their personnel to: • value diversity; • assess themselves; • manage the dynamics of difference; • acquire and institutionalize cultural knowledge; and • adapt to diversity and the cultural contexts of individuals and communities served • culturally and linguistically appropriate OPO-MCT_HAguiar

40. Implications for Hospital Services “Cultural competence is a journey, not a destination.” (Galanti, 2008) OPO-MCT_HAguiar

41. Implications for Hospital Services Attitudes in Multicultural Donation: • Preconceived ideas about cultures • African American • Filipino • Hispanic • Asian • Religious background • Jewish • Jehovah Witness • Hindu • Bias vs.. reality OPO-MCT_HAguiar

42. Implications for Hospital Services Culture Assessed by Observation: • Dress • Appearance • Speech • Education OPO-MCT_HAguiar

43. Implications for Hospital Services Risk of Cultural Imposition “The nurse must examine his/her biases and prejudices toward other cultures as well as explore his/her own cultural background….Without becoming aware of the influence of one’s own cultural values, a risk exist for the nurse to engage in cultural imposition”. (Campinha-Bacote et al 1996) OPO-MCT_HAguiar

44. Implications for Hospital Services “Unspoken assumptions regarding meaning of health, illness, and death may affect communication regarding donation.” Dr. Hawryluck & Knickle (n.d.) OPO-MCT_HAguiar

45. Implications for Hospital Services • Culture & communication connected • Communication – driven by culture • Connection forgotten = risk for misunderstanding OPO-MCT_HAguiar

46. Implications for Hospital Services • Communication varies: • overt & direct vs. covert & indirect • Overt & direct challenged by covert & indirect • Covert & indirect find overt & direct aggressive • Use indirect communication to identify and uncover perceptions of disease causation and best treatment OPO-MCT_HAguiar

47. Implications for Hospital Services Effective communication is your responsibility 6 barriers to communication: Nonverbals Ethnocentrism Assuming similarities vs. differences • Anxiety • Stereotypes and prejudice • Language problems OPO-MCT_HAguiar

48. Implications for Hospital Services • Good intercultural communicators: • Personality strength • Communication skills • Psychological adjustment • Cultural awareness • Eight different skills: • Self-awareness, self-respect, interaction, empathy, adaptability, certainty, initiative, and acceptance OPO-MCT_HAguiar

49. Implications for Hospital Services Cultural considerations • Identify the Decision Maker • Give the family what they need and want • Do not project your own personal feelings • Assess their readiness – let the family guide the conversation OPO-MCT_HAguiar

50. Implications for Hospital Services • Understand your motives • Concerns for the family • Concerns for the recipient • Turning a negative situation around to be positive OPO-MCT_HAguiar