Culturally Responsive Nursing Care at LAC+USC

1. Culturally Responsive Nursing Careat LAC+USC Geri-Ann Galanti, PhD www.ggalanti.com Los Angeles County Department of Health Services Office of Diversity Programs

2. 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.

3. 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.

4. 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

5. Communication: Gestures

6. Communication: Gestures

7. Communication: Gestures

8. Communication: Gestures

9. Lack of Eye Contact • Anglo/African American • Asian • Middle Eastern • Native American

10. Personal Space Anglo American Middle Eastern American Asian American

11. Language • Idioms Step on it! Don’t be crazy!

12. Language Confusion • Same language, different meaning: Fanny (American)

13. Language Confusion • Same language, different meaning: Fanny (British)

14. Language Confusion Different language, different meaning: Puto (Spanish)

15. Language Confusion Different language, different meaning: Puto (Filipino)

16. Saying "yes" when the answer is no • Saving “face” • Show respect • Grammar

17. Style of Interaction • Personalismo

18. 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.

19. 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.

20. 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.

21. 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.

22. What Can You Do? • Honestly assess your own bilingual skills • Understand the pitfalls in using untrained interpreters • Use interpreters effectively • Use telephonic interpreters skillfully

23. 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?

24. 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.

25. 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.

26. 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.

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

28. Dominant American Values and the Health Care System • Money • Privacy • Independence • Individualism

29. When Family is the Primary Value • “Too many” visitors • Conflict with HIPPA regulations • Deferring decision-making • Lack of self-care

30. 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?

31. Video Patient Diversity: Beyond the Vital Signs

32. Cupping During 2 Days Later

33. Protection Against Evil Eye Mexico Mediterranean Middle East

34. Expression of Pain Labor Pains • Some cultures encourage stoicism • Northern European • Anglo American • Asian • Native American • Some cultures • allow expressiveness • Middle Eastern • Hispanic • Mediterranean

35. 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