cultural sensitivity the rev. george f. handzo, bcc director of health services research &...
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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.
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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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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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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 Competence
Facilitate- food, worship, prayer space & time
Provide- worship
Care- culturally sensitive care
Advise- policy making, accommodation
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Health Care Culture
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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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Cultural/Religious Issues
Beliefs Values Family structure Modesty Food Dress Daily Religious Observance Ritual Items End-of-life care Mourning
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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!
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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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Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals
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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Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals
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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Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals
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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Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals
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
Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals
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
ghandzo@healthcarechaplaincy.org
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