Cultural Sensitivity The Rev. George F. Handzo, BCC Director of Health Services Research & Quality...

Cultural Sensitivity

The Rev. George F. Handzo, BCC

Director of Health Services Research & Quality

HealthCare Chaplaincy Network

New York, NY

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The End Game

A health care institution where patients, family members and staff can live out their spiritual and religious beliefs, values, and practices within the bounds of mutual respect and safe health care practice.

© HealthCare Chaplaincy#

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A New Mindset

Not about avoiding anything that might possibly offend someone.

Not about minimizing risk It’s about “why not” rather than “why” It’s about customer service and patient-centered care It is about employee satisfaction and retention


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Cultural Competence/Sensitivity

Being culturally sensitive or competent does NOT mean knowing everything about every culture...

It is instead respect for differences, eagerness to learn, and a willingness to accept that there are many ways of viewing the world.


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Ethnicity

A group of people whose members identify with each other, through a common heritage, consisting of a common language, a common culture (often including a shared religion) and a tradition of common ancestry.


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Culture

The learned or shared knowledge, beliefs, traditions, customs, rules, arts, history, folklore and institutions of a group of people used to interpret experiences and to generate social behavior.


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Spirituality

Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.


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What Are You Own Predispositions?


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Attitudes

What causes illness?

What does it mean to be a “good patient”?

How to treat illness and injury?

Who do you go to?


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Attitudes- Right and Wrong

Is it whatever works for the patient/service member?

What is “wrong”?


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Aspects of Culture


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Aspect of Cultural Sensitivity

Attitudes

Knowledge and Comprehension

Skills

Desired Outcome- Internal-External

Deardorff, D.K. (2004) Identification and Assessment of Intercultural Competence as a Student Outcome of Internationalization.; Journal of Studies in International Education. 10: 241-266,


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Aspects of Cultural Sensitivity

Individual

Organizational


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Aspects of Cultural Competence

Facilitate- food, worship, prayer space & time

Provide- worship

Care- culturally sensitive care

Advise- policy making, accommodation


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Health Care Culture


Beliefs a) Standardize definitions of health and illnessb) The omnipotence of technology

Practices a) Maintenance of health and prevention of disease via mechanisms such as the avoidance of stress and the use of immunizations

b) Annual physical examinations and diagnostic procedures such as Pap smears

Habits a) Chartingb) Constant use of medical jargonc) Use of a systematic approach and problem solving methodology

Likes a) Promptnessb) Neatness and organizationc) Compliance

Dislikes a) Tardinessb) Disorderliness and disorganization

Customs a) Professional deference and adherence to the “pecking order” found in

autocratic and bureaucratic systemsb) Hand washingc) Employment of certain procedures attending birth and death

Rituals a) Physical examinationb) Surgical procedurec) Limiting visitors and visiting hours

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Aspects of Culture

Sense of self and space Informal, handshake Formal, bows, handshakes

Communication and language Explicit, direct. Emphasis on content – meaning found in

words Implicit, indirect. Emphasis on context --- meaning found

around words


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Aspects of Culture

Dress and appearance “Dress for success” ideal. Wide range in accepted dress Dress seen as a sign of position, wealth, prestige. Religious rules Jewelry & hair

Food and eating habits Eating as a necessity – fast food Dining as a social experience. Religious rules


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Aspects of Culture

Time and time consciousness Linear and exact time consciousness. Value on

promptness. Time = money Elastic and relative time consciousness. Time spent on

enjoyment of relationships

Relationships, family, friends Focus on nuclear family. Responsibility for self. Value

on youth, age seen as handicap Focus on extended family. Loyalty and responsibility to

family. Age given status and respect


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Aspects of Culture

Values and norms Individual orientation. Independence preference for

direct confrontation of conflict Group orientation. Conformity. Preference for harmony.

Beliefs and attitudes Egalitarian. Challenging of authority. Individuals control

their destiny. Gender equality. Hierarchical. Respect for authority and social order.

Individuals accept their destiny. Different roles for men and women.


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Aspects of Culture

Mental processes and learning Linear, logical, sequential, problem-solving focus. Lateral, holistic, simultaneous. Accepting of life’s

difficulties.

Work habits and practices Emphasis on task. Reward based on individual

achievement. Work has intrinsic value. Emphasis on relationships. Rewards based on seniority,

relationships. Work is a necessity of life.


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Aspects of Culture

Communication of medical information

Death & dying

Keeping the Sabbath


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Use of Authority

Traditional

Negotiating

Individualistic


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It’s All About Assessment

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Cultural/Religious Issues

Beliefs Values Family structure Modesty Food Dress Daily Religious Observance Ritual Items End-of-life care Mourning


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Assessment Issues

Stereotypes

Cultural Patterns


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Goal of Chaplaincy

Helping patients discover and use their spiritual and religious resources in the service of their healing.

What is “healing”?


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Cultural Discussion

PRESERVE beliefs and practices that have a beneficial effect on health.

ADAPT OR ADJUST those that are neutral or indifferent.

REPATTERN those that have a potentially harmful effect on health.


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Accommodations

How do you decide what warrants an accommodation?

Patient rights vs. family rights vs. employee rights

Ethics consults


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Spiritual/Religious Accommodations for Staff

Dress

Food

Religious Observance- Daily

Religious Observance- Holiday


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Tips

Don’t treat others as YOU would want to be treated.

Address all adult patients from other cultures by their surnames unless specifically asked to use a first name.

Mind your tone of voice.

Every culture has its own rules for touching and distance.

Don’t ask a limited English-speaking patient or family member: “Do you understand?”

Informed consent forms and regulations can be extremely upsetting and frightening.


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Tips

Different is different, it’s not right or wrong.

I’m not afraid to ask, even when I feel uncomfortable.

It’s not about me!


Joint Commission Publications

http://www.jcrinc.com

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Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals

The Roadmap for Hospitals provides recommendations to help hospitals address unique patient needs, meet the new Patient-Centered Communication standards, and comply with existing Joint Commission requirements.

Example practices, information on laws and regulations, and links to supplemental information, model policies, and educational tools are also included. The Patient-Centered Communication standards are presented in a separate appendix that provides self-assessment guidelines and example practices for each standard.


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Assessment: Identify and address patient communication needs

during assessment Identify patient cultural, religious, or spiritual beliefs

or practices that influence care Identify patient dietary needs or restrictions that affect

care Communicate information about unique patient needs

to the care team


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Treatment Involve patients and families in the care process Address patient communication needs during

treatment Accommodate patient cultural, religious, or spiritual

beliefs and practices Monitor changes in dietary needs or restrictions that

may impact the patient’s care


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End-of-Life Care Involve the patient’s surrogate decision-maker and

family in end-of-life care Identify patient cultural, religious, or spiritual beliefs

and practices at the end of life


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Organization Readiness

Leadership Demonstrate leadership commitment to effective

communication, cultural competence, and patient- and family-centered care

Integrate unique patient needs into new or existing hospital policies

• Data Collection and Use Conduct a baseline assessment of the hospital’s efforts

to meet unique patient needs Use available population-level demographic data to help

determine the needs of the surrounding community


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What Do We Do Now?

Read the Roadmap

Talk to the champion for cultural initiatives/compliance

Ensure that your assessment process addresses and communicates cultural and spiritual beliefs and values

What ethnic/cultural groups is your institution focused on?

Remember this is about communication & patient safety What can you uniquely contribute to the effort?

• Cultural expertise• Ties to local communities


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Resources


http://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf

A Dictionary of Patients’ Spiritual & Cultural Values

for Health Care Professionals

http://bit.ly/1kHeAbY


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The Rev. George Handzo, BCC

[email protected]


mailto:[email protected]

Cultural Sensitivity The Rev. George F. Handzo, BCC Director of Health Services Research & Quality...

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