Post on 26-Dec-2015
CALD ResourcesCALD ResourcesCulturally and Linguistically Diverse
Supporting our workforce in responding to cultural diversity
for NGO, primary and secondary care health practitioners
CALD Cross Cultural Training CALD Cross Cultural Training Programme for Health ProfessionalsProgramme for Health ProfessionalsCALD 1 Culture and Cultural CompetencyCulture and Cultural Competency
CALD 2 Working with Migrant (Asian) Patients
CALD 3 Working with Refugee Patients
CALD 4 Working with Interpreters
CALD 5 Specialist Training: Working with Asian MH Clients
CALD 6 Specialist Training: Working with Refugee MH Clients
CALD 7 Working with Religious Diversity
CALD 8 Working with CALD Families – Disability Awarenesswww.caldresources.org.nz (CME/CNE/MOPS Accredited)
The HPCA ActThe HPCA Act• Responsible authorities also perform other functions. These
include: setting standards of clinical competence, cultural cultural competence competence and ethical conduct to be observed by health practitioners; (HPCA Act 2003 118i)
• Actively explores the client’s cultural preferencescultural preferences, health behaviours and attitudes regarding care and incorporates information into management plan. (Nursing Council, KPI - Nurse Practitioner)
• The Midwifery Council has integrated cultural competence cultural competence into its competencies for entry to the register of midwives. (Midwifery Council NZ)
History
Religion
Politics Rules Laws
Geographic locationSong/Dance FoodHealth beliefs
Appearance
Dress
Values Beliefs Ethics
EducationCommunication Language
Festivals
Traditions
Customs
What is Culture?
Physical contact
Expression of emotion
Beliefs
Norms
Relationships
Family structure
Rituals
Wordiness
Behaviour
Folk theories
How Culture Impacts Interaction
• Different health expectations, knowledge, experiences and communication styles
• Practitioners can misinterpret cross-cultural situations if they use their own beliefs and norms
• Inexperienced practitioners may prejudge CALD individuals which may lead practitioners to insult a person’s language, beliefs, habits or behaviours
Our Changing World of Practice • 233 ethnic groups in the Auckland region
• 1 in 5 people in Auckland from an Asian ethnic group
• A third of Asian migrants in NZ < 5 years
• Increasing in religious diversity: Sikh, Hindu, Muslim and Buddhist groups (SNZ, 2009)
• Growth in Middle Eastern, Latin American, African (MELAA) populations
• In 2006, all three MELAA ethnicities have approximately 80% of their populations born overseas
Super Diversity in Auckland (SNZ, 2006)
• Seven largest Asian ethnic groups:
• Chinese (147,570) Indian (104,583)
• Korean (30,792) Filipino (16,938)
• Japanese (11,910) Sri Lankan (8,310)
• Cambodian (6,918)
• Other groups include: Thai, Laotian, Vietnamese, Burmese, Bhutanese, Nepalese, Tibetan and Indonesian
• People born in India doubled 2001 - 2006.
• People born in Korea and Fiji increased significantly
Middle Eastern, Latin American, African (MELAA) (SNZ, 2006)
MELAA national total o National total: 35,250 people (1%)o Auckland region: 18,284 people (54% of total
MELAA nationally)
• ADHB: 6867 (36%)• WDHB: 6714 (36%)• CMDHB: 5313 (28%)
Our Changing Workforce
Challenges Across Cultures
What are the challenge/s you face when interacting with someone from a different culture?
•Choose one challenge and move into that group. Spend a few minutes discussing:
o A situation that involves this challengeo Your concerns with dealing with this challenge.
Challenges Across Cultures
How did your challenge appear in this video?What would you advise this Doctor to do differently?
Cultural Competency
“Cultural competence is a set of behaviours and attitudes and a culture within the operation of a system that respects and takes into account the person’s cultural background, cultural beliefs and their values, and incorporates it into the way healthcare is delivered to that individual”
Betancourt Green and Carillo (2002)
What is Cultural Competency?• Awareness – requires awareness of own
values and how these impact on beliefs and interactions
• Sensitivity – includes flexibility, non-judgement, enquiring attitude
• Knowledge – requires knowledge of own and other’s culture
• Skills – the ability to implement the above in practice, with empathy and compassion
Awareness: Dimensions of Culture
Individualism - Collectivism
Power distance
Uncertainty avoidance
Femininity - Masculinity
(Hofstede, 1980)
New Zealand Cultural Values
The Migrant Journey
Impact on Health
Migrant Health Beliefs
Accommodating Health Beliefs
• Accommodating is the willingness to consider the patient's health beliefs and practices and include them in the intervention.
Explanatory Models of Health
• Scientific• Supernatural
• Humoral• Religious
Treatment Examples
• Rest• Herbal treatments• Meditation• Acupuncture• Scraping – Guasha• Cupping
Humoral
Religious Influences in Practice• Dietary requirements• Dress & Physical touch • Gender Issues• Hygiene requirements• Prayer, ritual and
religious festivals• Traditional and
alternative remedies
• Acceptance of procedures, including bloods, drugs and organ transplant
• Reproductive Health
• Pregnancy and birth
• Informed consent
• End of life care
What would you need to know about each of the above?
Skills One (c)
Accommodating Health BeliefsIt is important to:
•Ask (tell me how...)
•Look for connections that help the patient work with you and their own system to ensure the best health outcomes for the patient
•Accommodating migrant beliefs ensures a better health outcome
Working with an Interpreter
You are in control. This course will help you understand how to gain and maintain control of a session when working with interpreters.
The interpreter does not have control because their role is to act as a conduit between the patient and the practitioner.
The patient does not have control because they are dependant on the interpreter to interpret correctly.
Who has control in the session?
Pre-brief• A brief introduction of your role and service.
• Provide brief objectives and outline the purpose of the session.
• Obtain cultural background information
• Confirm the use of the first person throughout the session.
• Establish the mode of interpreting - consecutive or simultaneous.
Structuring a Session
• Greet and direct the patient where to sit.
• Introduce yourself and explain roles.
• Introduce the interpreter and her/his role.
• Assure the patient of confidentiality.
• Inform the patient that everything will be interpreted.
• Familiarise the patient with the mode of interpreting.
Session Ground Rules
• Do not enter into direct conversation with the interpreter.
• Do not ask the interpreter for their opinion.
• Pause at regular intervals for the interpreter to assimilate and interpret.
• Allow interpreter to interpret after every 3-5 sentences.
• Allow enough time for the interpreter to convey information.
De-brief• Summarise the session outcome and identify any
issues meeting the session objectives.
• Clarify interpreting or cultural issues if:o you have concerns or are unsure about contradictory,
negative (non-verbal or verbal), unexpected responses, or lack of response, from the patient.
o you felt that at some point that the translation of information did not correspond with the responses from the patients.
o if you wish to clarify any cultural meanings of some of the words, concepts or responses.
CALD Courses and ResourcesPlease go to www.caldresources.org.nz to find out more about:
a) CALD courses that are available within your DHB for ongoing learning (CME/CNE/MOPS Accredited)
b) CALD resources that are available for ongoing support when working with CALD clients including:o Interpreting and Translation Service
o Culture-Specific Services
o Translated Resources
o Cross-Cultural Resources (to gain more knowledge of other cultures)