Transcript Slide 1

Cultural Competency In Health
Care
“Transforming Barriers into
Assets”
Trainers
Dijana Rizvanovic
Dov Sellem
Active Listening
Level 1
Basic Acknowledgements
Level 2
Silence
Level 3
Questions
Level 4
Paraphrasing
Level 5
Reflective Listening
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LMC Learning Design Center
** Adapted from the work of Jerry Wisinski
Why Cross Cultural Training
Raise the level of consciousness of cultural issues
and how they impact health care
Share and discuss culture and cultural
generalizations that relate to health care
Develop skills for cross-cultural communication and
interaction with patients and families
Identify your own specific values that may impact
how you view people from other cultures
Create individual action plans for continual selfimprovement related to improving each
individual’s response to the opportunities/learning
that can result from serving culturally diverse
populations
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Definitions of Culture
An agreed upon set of
norms, values, and
behaviors.
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Definitions of Culture
“One’s own culture provides
the lens through which we view
the world;
the logic... by which we order it;
the grammar... by which it makes
sense.”
(Avruch and Black)
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Culture
Simulation
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The Cultural Iceberg
…an illustration of the components and levels of culture
Note: Use this diagram to bring to mind
areas of interaction in which careful
problem-solving may be needed to facilitate
clear understanding and open
communication
Visible Culture:
(“above sea level”) Because
emotional loading at this level
is relatively low, few
misunderstandings are
produced at this level
Unspoken Rules:
(“partially below sea
level”) Because emotional
loading at this level is very
high, violations result in
negative feelings about
the violator.
Unconscious Rules:
(“completely below sea
level”) Because emotional
loading at this level is
intense, violations are taken
personally, affecting relations
between people.
Food,
music,
language,
architecture
(learned cognitively)
Courtesies; use of time,
punctuality; conduct in
restaurants, social
occasions, shopping
(learned by trial and error)
Touching, space, eye contact,
body contact, tone of voice,
non-verbal communication
(learned through modeling,
usually in early childhood)
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What is Cultural Competence?
•A process “in which an individual or agency
continuously strives to achieve the ability to
effectively work within the cultural context of an
individual, family, or community from a diverse
cultural/ethnic background,” ~Josepha
Campinha-Bacote
•Culturally congruent care takes into account the
cultural background of the patient. It involves
decisions and actions that are acceptable to the
consumer and matches the consumer’s
expectations. In order to meet the consumer’s
expectations, the provider must take into account
the consumer’s world views, systems of values
and norms, and orientation to health and illness; it
must be culture specific. ~Leininger, 1988
•“A culturally competent system of care
acknowledges and incorporates – at all levels –
the importance of culture, the assessment of
cross-cultural relations, vigilance towards the
dynamics that result from cultural differences, the
expansion of cultural knowledge, and the
adaptation of services to meet culturally unique
needs. ~T. Cross, 1988
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Stages of Cultural Competence
Development: The Bennett Model
Stage 1- Denial
Stage 2- Defense
Stage 3- Minimization
Stage 4- Acceptance
Stage 5- Adaptation
Stage 6- Integration
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Stereotypes
How can we manage and
overcome these stereotypes
both in the moment and in
the longer term?
How can you give patients
more information, so that
they can change their
perceptions of you?
Learning to reflect on
what other people
might think of you is
an important way of
building selfawareness, and of
eventually building
greater better
relationships with
your patients
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Overcoming Stereotypes
• Understand the distinction between
Cultural Patterns and Stereotypes
• Acknowledge the existence of our
preconceptions
• Understand how preconceptions impact
us
• Know our labels and who we relegate
them to
• Slow down, check it out, get information
• Adjust your understanding of cultural
patterns when you get new information
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Barriers to Intercultural Communication
Assumed Similarity
Nonverbal Communication
Verbal Language
Tendency to Judge
Preconceptions and Stereotypes
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Bridging Barriers to Cross Cultural
Communication
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Raise self-awareness
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Don’t act on your stereotypes
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Listen with respect
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Increase culture-specific awareness
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Treat each person uniquely
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Seek out information
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Tolerate ambiguity
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Establish trust and show concern and empathy
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Show sensitivity to face-saving needs
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Have a sense of humor and patience
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Notice non-verbal cues
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Listen for hidden meanings
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Avoid confusing language
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Try to see things from the other person’s perspective
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Personal Communication Styles
Mode of interaction:
Initiating……………………………….…..…….…verses………..…….…………………….……….Listening
The degree to which one initiates discussion or listens and responds as a primary mode of interaction.
Reference Point:
Individual…………………………………..….…..verses………....………………..……………………Group
The degree of emphasis placed on personal involvement and achievements versus group involvement and
achievements in communications.
Authority Base:
Facts……………………………………….………...verses………….…….….…………………….……Intuition
The degree to which one relies on factual data versus intuitive judgments as the basis for reasoning and
persuading.
Degree of Self-Disclosure:
Impersonal…………………………………….…....versus……………………………..………….……Personal
The emphasis placed on tasks versus sharing personal data in building new relationships and communicating
with others.
Mode of Expression:
Rational……………………………………...……...versus………………….………….……..………..Emotional
The degree of reliance on rational descriptions and facts only versus emotional reactions and embellishments.
Method of Support:
Challenge…………………………….…………..…versus……………….…………….………….....Agreement
The degree of challenge versus praise and agreement used to support others’ ideas, views, and so on.
Method of disagreement:
Confrontation…………………………………..…..versus………….…….………………………….Compliance
The degree of confrontational versus compliant behavior exhibited in conflict situations.
Vocal Characteristics:
Low………………………………………….…….…versus……………….……………………………..…….High
The pitch, accent, and volume displayed in verbal communications.
Method of assertion:
Direct………………………………………….……..versus………….….…….……………………………Indirect
The degree of reliance on direct statements describing one’s position or point of view versus indirect
references, use of questions, and so on.
Physical proximity:
Distant………………………………………….…....versus…………….……….…………………………….Close
The degree of physical versus closeness maintained and preferred in interactions with others.
Reliance on Protocol:
High…………………………………….…………….versus….……………….………...………………………Low
The degree of emphasis placed on formality and tradition versus spontaneous behavior in communications
with others.
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Communicating With Limited
English Proficient (LEP) Patients
Miscommunication and lack of complete understanding often occurs
between people who speak the same language. When communication is
attempted between two people who do not speak the same native
language, frustration and miscommunication are even more likely.
The following are some strategies that may help ensure that the desired
communication actually occurs:
•Speak more slowly than usual, but do not use unnatural language.
•Be conscious of the beginning and ending of sentences, speaking as distinctly
as possible.
•Present ideas or facts in a logical order.
•Pause frequently to give the listener adequate time to process the language
and content.
•Watch for body language which may aid the communication or indicate
confusion.
•Check for understanding by active listening or paraphrasing what the speaker
has said.
•Provide adequate space for the communication; do not rush the listening-andspeaking flow of conversation.
•When there is uncertainty regarding the communication, reframe the
sentence, using alternate words or phrases.
• Avoid idioms, slang or jargon. Define acronyms and abbreviations.
•Demonstrate, use visuals, and reinforce with written material whenever
possible.
•Assume communication can occur. Handle your fear.
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Action Plan
What can you personally do to help
your organization be more culturally
competent?
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Crisis
In Chinese the word crisis is represented by two
characters. Each character combined with other
characters have different meanings:
The upper symbol can mean danger, while the
lower can mean opportunity.
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