Care Providers Culture_Dr Ibrahim Aziz
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Transcript of Care Providers Culture_Dr Ibrahim Aziz
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Does the culture of care
providers affect outcomes inpatient care?
Dr. Ibrahim AzizMBBS(Dhk), M.Med., PGDip.Med (Palliative Care)
10th Malaysian Hospice Congress1st ~ 3rd June 2012
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Outline
What is culture?
Does the culture of care providers affectoutcomes in patient care?
In palliative care context
Case scenario How to improve outcome in patient care
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Introduction
Healthcare in a multicultural society
Ethnic groups
Cultural diversity
Malaysia as an example
But ethnicity is only one factor
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What is culture?Culture refers to patterns or standards of
behaviour that one acquires as member of aparticular group (Masi, 1988).
Our race, gender, religion, ethnicity and
socioeconomic status all contribute to shaping
our values and behaviours, as well as to how
we view the world.
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How they view the world
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Culture
Culture may not make our
hearts beat, but it shapesthe rhythm and texture of
our lives (Collen, 2011)
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Rhythm and texture
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Like a fish in the water
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Culture
Culture guides our thinking,
doing and being, andbecomes patterned
expressions of who we are(Basic Nursing, 2003)
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Swan lake ballerina dancer
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So does the culture of care providers
affect outcome in patient care?
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Gibson (2008)
Providers preconception =
barrier to competent care
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Brach and Fraser (2000).
Cultural competency = betteroutcome
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Smedley et al.(2003)
Cultural differences = deficiencies ofcare
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Dayasiri (2010)
Cross-cultural issues = hastendeterioration
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No effect physically
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How and why do the culture of providersaffect outcome in patient care?
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Perception and attitudes
Differ between cultures
About origin of disease Appropriateness of treatment
Health care providers
Robbins (2005)
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Disrespectful
Leads to mistreatment
Decreased patient compliance Lack of informed consent
Increase risk of liability for malpractice
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Behaviours and attitudes
Impact how illness is manifested
Including symptoms of the disease Whether or not patient will seek
treatment at all
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Judgement about beliefs and values
Be non-judgemental
Important for physicians
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Cultural differences
Influence what treatment options are
offered (Gibson, 2008) How services are organized and
financed
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Cultural competence
Can have real impact on clinical
outcomes
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Bias inherent
Naturally make assumptions about
others
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Guests of one of the Chinese resorts coated with black mud, 2May 2007. They say that mineral-rich mud has healing propertiesthat favorably affect the skin. (REUTERS / China Daily).
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Provider-patient relationships
Effective communication
Awareness of social and culturalconstructs
Respect for those differences
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Communication
Patients need
Understand diagnoses Given treatment options
Make cooperative decisions
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When language is a barrier
Translator needed
May have limitation Not only bilingual but also bicultural
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Physician as authority figure
May affect outcome in patient care
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Cleansing ritual child who conduct religious adherents Boss,July 15, 2007. Such women are called Komians, it is believedthat they possess supernatural healing powers. (REUTERS /Luc Gnago)
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Ethnic and cultural heritage
Influential
Shaping attitudes Beliefs
Behaviours
Health care (Taylors, 2011)
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Diverse values and belief systems
Have significant impact
On progression of disease Treatment outcome
Patient-physician relationship
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Cultural awareness
Foundation
Communication Acceptance
Success
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In palliative care context
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Patients view and perspective
Culture = glasses
View of life limiting illness
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When losing control
Culture = basic core beliefs
They hold on to (Thomas, 2001)
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Different cultures
Cultural sensitivity
Targets entire person Not just physical ailment
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Cultural diversity
Address this
Help maintain comfort & dignity Respect & value uniqueness
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Cross-cultural factors
Be receptive
Enhance provider-patient relationship Facilitate provision of care
Strengthen patients coping skills
Help adjust deteriorating clinical status
Gain family & social support
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Culturally appropriate care
Maintain QOL
Support individual Culture
Linguistic preference
Spiritual needs
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Cultural competence
Requires
Acquisition of specific knowledge Clinical skills
Attitudes
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Cultural competence (cont)
Facilitate
Cross-cultural negotiation in clinical setting Improved outcomes & decrease disparities
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Death & dying
Significant & sacred events
Respect & support Customs
Beliefs
Rituals
Practices
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Collusion
Asian family
Family member direct treatment(Chaturvedi, Loiselle & Chandra, 2009)
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Advancement in palliative care
Emotional & spiritual context
Easily untangled> If culture is considered (Todd et.al, 2006)
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Case scenario
Dr Tan, a palliative care physician, is
treating an elderly Malay woman whohas been diagnosed with an advancedliver cancer and general debility.
He found her generally uncooperative
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Case scenario (cont)
and her family told him that the patient
refuses to take the medicationsprescribed, refuse to get out of bed and
prefer rather to be left alone to die in
peace
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Case scenario (cont)
Dr Tan learns that she believes that her
illness is a punishment for her pastwrong doings.
As such, she is convinced that efforts tohelp her are pointless and that she is
destined to die for her sins.
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What would your reaction be if you were
in a similar situation?
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Case scenario (cont)
In discussion with the patient, Dr Tan
learns that she would like to be free ofpain and be able to go to the bathroomindependently, to wash and pray, so shecould ask forgiveness from God for her
past wrong doings.
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Case scenario (cont)
She agrees to participate in therapy to
pursue this goal. This represent a start for Dr Tan and his
patient to begin working together toestablish an open and trusting
relationship and further explore thegoals and options for therapy.
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Another example
Lets say youre doing an assessment of
a person who talks very quietly andkeeps their eyes on the ground.
What is your impression?
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How to improve outcome in patient care?
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No right answer
Each situation is unique
Be interested in your own culture Understand your own culture and value
system
Cultural awareness
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Perception of health and illness
How does the patient and the family view
illness?
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Role of family in decision making
Who makes the decision?
Patient? Family-on behalf?
In conjunction?
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Customs and rituals
How do these affect the delivery of
health care? Could the ritual be incorporated into
care?
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An understanding of specific culture andreligion
Practices around death, dying and
bereavement Identify and support
individual needs and preferences
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Medicine and palliative care in itself is aculture
Specific procedures and protocols
Standardized models Care providers must now rethink some
of these standardized models(Kavanaugh & Gardiner, 2003)
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Areas to observe
Staffing issues
Nutritional needs Traditional methods for healing
Spiritual needs and care
Beliefs regarding illness End-of-life care
Decision making
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Areas to observe (cont)
Past life experiences
Avoid stereotyping Care providers
Good communication
Language barriers Nonverbal communication
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Conclusion
Compromise and understanding are thekeys
Culturally sensitive care results in morepositive outcomes