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What is Culture Competence?
- Mandatory skill set for all health care providers
- Health care professionals need to attatin appropriate skills in order to embrace diversity and practice completely with diverse group
What is Culture?
- A shared pattern of values and behaviours shared over time to guide the decision and actions of a group
- Culture can be: Visivle or Invisible
- Can include:
- Spirituality and Religous belief
- Socioeconomic status
- Sexual Orientation
- Group history
- Geographic Origin
- Childhood or life Experiences
What is Minority?
- The smaller number or part, esp. a number that is less than half the whole number.
- Mathematical perventage - meaning existing in proportionately smaller numbers
- Health context:
- - Referring to groups who have limited access to opporunity, power and resources including healthcare
- - Most often refers to race, ethnicity, religion, gender, or sexual orientation.
What is Xenophobe?
Intense or irrational dislike or fear of people from other countries.
What is Invisible Culture?
Not easily seen or less observable
What is Enculturation?
Socialization into one's primary culture as a child
What is Assimilation?
- Adopting and adapting to characteristics a new culture
What is Acculturation?
- Result when people give up thier ethnic identity in favor of the dominat culture
What is Multiculturalism?
- Many culture existing within society
What is Ethnocentrism?
Belief in the superiority of one's own ethnic group.
What is Ethnicity?
- Refers to groups who members share a social and cultural heritage
- Members feel a sense of common identity (Ex. common values, language, history, physical characteristics, geographical space)
What is Discrimination?
- The unjust or prejudicial treatment amongst different categories of people or things, esp. on the grounds of race, age, or sex.
What is Collectivism?
- Focus on family or the group
- Children grow within the family unit
- Emphasis placed on:
- –Group interests
- –Social obligation
- –Interdependence within the family
Purpose of Communication
- Gather information
- Build relationship
- Using hands, heads and other body parts to communicate
- 93% of all communication is non-verbal
- Non-verbal aspects can convey stronger messages than verbal
- Can include the following:
- -Facial expression
Communication and language
- In Canada, 4 populations face barriers to healthcare access including:
- -People who used sign language
- -People who speak one of Canada's official languages, but live in an area where the other language is prominent (Ex. French/English)
Working with people who have limited English Proficiency(LEP)
- The first step in effective communication is a commitment to mutual communication
- See handout for common use of expressions and how they may be understood.
Strategies of working with people who have limited English proficiency(LEP)
- Speak slowly, not loudly
- Face the person and use non-verbal communication
- Avoid difficult and uncommonwords
- Be aware of frequently misunderstood words(ex. anxiety,depression) and words that describe sensation(ex. pins and needles)
- Don't complicate communication with unnecessary words or information
- Organize what you say for easy access
- Repeat when you have not been understood
- Rephrase and summaries often
- Don't ask questions that can be answered with yes or no
- Greet the client in the clients own language to establish reapport
- Area around the person's body and the objects within that area
- Intimate Zone - 11/2 feet
- -Allows adults bodily contact for perception of breath and odour
- -Visual distortion
- Personal distance - 11/2 - 4 feet
- -"bubble" of space around the body, no visual distotion
- -voice may be moderate, body odour not apparent
- Social distance - 4-12 feet
- - Reserved for impersonal business transaction
- Public distance - 12 feet or more
- -Impersonal interaction, voices projectied, subtle facial expressions maybe lost
- A state of complete physical, mental and social well-being, and not merely the absense of disease or infirmity
- The balance of the person, both within ones being - physical,mental and spiritual.
- Subjective experience of loss of health
- Imbalance of one's being-physical, mental, and spiritual
- -Studies show that pain threshold or tolerance levels vary within individuals, not base on culture or ethnicity
Pain Management: Pain
- A universal experience
- However, there is a different in how it is -Perceived(become aware of), interpreted, Treated
Pain Management: Threshold
Level where described as painful
Traditional health Protection
- The protection of HEALTH rests in the ability to understand the cause of a given illness or set of symptoms
- The traditional beliefs regarding the causation of illness differ
Health Protection: Traditional practices
- The use of protective objects - worn, carried, or hung in the home
- The use of substances that are ingested in certain ways and amounts or eliminated, and substances worn or hung in the home
- The practices of substances of religion, such as the burning of candles, the rituals of redemption, and prayer
- Small beaded bracelet
- Glass eye
- Items that maybe carried in a person's pocket
- Rosary beads
- Thousand Year Eggs
- The islamic prayer
Health Traditions: Small beaded bracelet
- From Mexico
- Has a deer's eye with image of the virgin of Guadalupe and a red pom-pom
- Is placed on an infant to protect its health
Health Traditions: Glass eye
- From Turkey
- May be pinned on clothing, pinned on a crib or bed, or hung in the home to protect the health of the person or family
Health Traditions: Items that may be carried in person's poket
- From Mexico
- These items were conatined in a small pouch that could be carried by a coyote, a person leads people across the United States/Mexico border. It contain the coyote tooth, a chachayotel(large seed), red strings and a crystal
- All items believe to protect the person and bring good luck
Health Traditions: Rosary beads
- From Italy
- symbolized prayer and mediatation methods used in both the spiritual maintainance and restoration of health.
Health Traditions:Thousand year Eggs
- From China
- Represent traditional foods that maybe eaten daily to maintain physical health.
Health Traditions: Nature
Depicts the notion that the enjoyment of nature, the environment, maybe universal way to maintaining mental health
Health Traditions:The Islamic Prayer
- Frm East Jerusalem
- Shows the prayer may be a way of maintaing spiritual health
Health Traditions: The Red String
- From the Tomb of Rachel in Bethlehem
- Israel s a place where a Red string that may be worn to protect physical health maybe secured.
Health Traditions: Eye
- From Cuba
- Represent the plethora of eye-related object that maybe worn or hung in the home to protect the mental health of people
Health Traditions: The Thunderbird
- From the Hopi Nation
- Maybe worn for spiritual protection, nte the "eye"
The Evil Eye
- From Southern Europe, Middle East, North Africa
- Illness often related to the "Evil Eye"
- A belief or a superstition where harm can be projected by gazing or glaring at another person or thier property
- Maybe seen as religion
The Evil Eye
- The power emenates(spread out) from the eye(or mouth) and strickes the victim
- The injury, illness or other misforutne is sudden
- The person who cast the "Evil eye " may not be aware of having this power
- The afflicted person may or may not know the source of eveil eye
- The injury cause by the Evil eye maybe prevented or cured with rituals or symbols
- This belief helps to explain sickness and misfortune
Proficiency in 2 language
In Canada refers to English/French
Generally refers to written communication because translators deals with words
Involves the spoken work and refers to the process of verbal interaction between people who speak two different language
Kinds of Interpreters
- Trained interpreters
- Multilingual healthcare provider
- Bilingual staff
- Family member
- Involves three parties, i.e., the two clients and the interpreter
- With Triadic Interpretation, Attention should be given to;Emphasis on meaning and understanding
- Physical positioning
- Unobtrusive posturing and eye contact by the interpreter
- Strategies to maximize provider clt interaction
- Use of first person voice
- Control of health care provider
- **Confidentiality must be stressed
General Guidlines when Working with Cultural Interpreters
- Allow extra time for the session
- Use trained bilingual/bicultural interpreters
- Never use children as interpreters
- Consider the gender, ethnicity, language/ dialect ect.
- Beware of common issues:-Words that can't be translate
- -jargon or teminology
- -being rushed
- -Interpreter answer for the client
- -conflict between the interpreter and clt(stop session)
- Verify to avoid misunderstandings, mistakes and distortions
- The traditional belief and practice concering the activities, such as the use of folk remedies and traditional healer that must be used to restore HEALTH.
- Restore Health as following:Physical
Restore Health: Physical
Countless traditional remedies such as herbal teas, liniments, special foods and food combinations, massage and other activities
Restore Health: Mental
The use of various technique such as exorcism, calling on traditional healers, using teas or massage, and seek family and community support
Restore Health: Spiritual
Religious healing rituals, th use of symbols and prayers, meditation, special prayers and exorcism
Health Care Choices
- Allophatic - Modern care or Conventional care
- Homeopathic - Traditona or Folk
- Importance of:
- Importance of:
Health care that is practiced by M.D.s and allied health professionals such as registered nurses, Physical thereapist, and psuchologist.
- By Dr. Still in Kirksville
- The art of curing withour excessive use of sugery drugs
- Attempts to discover and correct all mechanical disorder in the human machine and to direct the recuperative power of nature that is within the body to cure the disease
- Osteopaths are fully qualified physicians - practice in all areas of medicne and surgery
What is Acupuncture?
- Originated in China
- Acupuncture involves the insertion of very thin needles through the patient's skin at specific points on the body - the needles are inserted to various depths.
- Regulated in most provinces except Nova Scotia
Accupunction Benefits and Condition in can help:
- Benefits and Condition it can help:
- Neck or Cervical Pain
- Shoulder Pain
- Lower Back Pain
- Hip Pain
- Anxiety & Depression
- Headaches & Migraines
- Chronic Fatigue Syndrome
- Sinus Problems
- Arthritis & Arthritic Pain
- Jaw and Face Pain
- Irritable Bowel Syndrome
- Sports Injuries
- Bladder Infection
- Menstrual & PMS Problems
- Smoking & Addiction
- Obesity & WeightControl
AccupunctureRisks and disadvantages:
- Risks and disadvantages:
- A small amount of bleeding may appear at the needle site and is more likely to occur in those patients taking aspirin. Bleeding will usually stop within minutes after removing the needle.
- A small bruise
- Fatigue has been observed to occur follow acupuncture treatments
- Pain while needle is in place
Biologically Based Therapies: Traditional or Ethno-Cultural(ethnic group that has a distinct culture) HEALTH Care
- Four thousand-year-old method of healing originatinf in India
- Most acient existing medical system
- Uses diet, natural theaoies and herbs
- Form of Chinise traditoinal medicine
- Combines movemet, meditation and regulation of breathing
- Enchance immne system
- Improves circulation
- A religion that is combination of Christianity and African Yoruba religious belief
- Uses diet, natural therapies and herbs
- Voodo Dools - belief to have originated in the fon people of present day Benin
- Voodo religion was created in slave quarters in Haiti and Louisiana when the faiths of various prople began to intermingled
The End of life Care
- Advance directives
- Organ donation
- Rituals surounding funerals and mourning
End of Life: ABC approach
- Bearing Witness
- Using this approach can promote knowledge and skills necessary to provide culture competent end-of-life care
- Communicaiton is important
End of Life in 4 F's
Death Rites for Select Groups
- Bangladesh –Muslim rites: body remains at home – cared for, washed, wrapped in white cloth
- China –Initial burial in coffin; after 7 years, body exhumed and cremated,urn reburied in a tomb.
- Egypt –Muslim rites
Death Related Objects
- Masks—used to hide from “Angel of Death” or placed on face of deceased
- –African mask
- –American Indian mask
- Jade stone- from China, is placed in orifices(An opening, as of a pipe or tube) of the body to block the entrance of the evil spirits after death.
- Ghost money-from China, is burned to send payments to a deceased person and to ensure hisor her well-being in the afterlife.
What is Deaf Culture?
- Status within the culture does not depend on the level of hearing loss, but theattitude towards it.
- Conflict occurs when the hearing society views deafness as a medical deficiency whichmust be "fixed“.
- Deafness- loss of hearing functional and dependence upon visual communication.
- 4000-5000 babies born deaf yearly
- Secondary to many injury or illnesses
- Undesirable labels:
- –Hearing impaired
- –Deaf and dumb
- –Deaf mute
- –Disabled (many feel they belong to a
- cultural minority)
Technology for the Blind
- White cane
- Slate & styles
- Perkins Brailler
- Adapter computers
- Tape players
- Dictation Recorders
- Bookson Tape & CD
- Remote control calculators
- Talking microwaves