Transcultural Care

1. Transcultural Care

2. 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 Women’s Health, HRSA, NIH

3. 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.

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

5. 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

6. 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

7. 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 Women’s Health. HRSA, NIH

8. 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!

9. 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

10. 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

11. 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

12. 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

13. Ethnocentrism • Viewpoint that one’s own way of believing or behaving is correct and preferred • Ethnosensitivity • Process of becoming more sensitive and respectful of cross cultural differences

14. 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 Women’s Health, HRSA, NIH

15. 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

16. 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 one’s own culture, learned biases and prejudices

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

18. 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

19. 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

20. 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

21. 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

22. 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 don’t understand

23. 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

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

25. 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

26. 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

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

28. 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