we should be talking about this…....bridging cultural communication we should be talking about...
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Bridging Cultural CommunicationWe Should Be Talking About This….
October 24, 2019SPARKS, A Donate Life Symposium
Minneapolis, MN
Fundamental Roots - Hedi Aguiar RN, MSN, CCRN-K
Sentinel Events & RCAs
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Objectives
By the end of the workshop, the learner will be able to:
1. Define culture
2. Verbalize the difference between generalizing and stereotyping
3. Explain the risk of cultural imposition
4. Describe Arthur Kleinman’s Explanatory model
5. Identify the meaning of cultural intelligence (CQ) and cultural humility
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Overview
• Laying Foundations
– Operational definitions of race, ethnicity, and culture
• Cross-Cultural Communication
– Applying cross-cultural communication in the work setting
• Basic Principles
– Practical tips in working with different cultures
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Laying Foundations
Operational Definitions of
Race, Ethnicity, and Culture
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Which Group is Multicultural?
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Laying Foundations – Defining Race
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“…political classification of human beings
and is based on physiological
characteristics, such as skin color, eye
shape, and texture of hair.” (Bomar, 2004)
It is a narrower term then ethnicity and denotes a human
biological definition7October 2019
Laying Foundations – Defining Ethnicity
“…refers to a common ancestry, a
sense of ‘peoplehood’ and
group identity. From a common
ancestry and a shared social and
cultural history and national origin
have evolved shared values and
customs.” (Friedman et al., 2003)
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Laying Foundations
Important Clarifications:
• There are no distinct,
pure races today
• Religion is very much
entwined with ethnicity and
culture, shaper of health
values, beliefs, and practices
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Laying Foundations
Important Clarifications:
• Race and ethnicity should NOT be confused
• People of one race can vary in terms of their ethnicity and culture
• Race is NOT considered a correct or useful means of classifying people
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Laying Foundations
• Culture requires a broad definition and should include:
• Ethnographic variables
• Demographic variables
• Status variables
• Affiliation variables
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Laying Foundations – Defining Culture
“Culture is defined as a specific set of social, shared, educational, religious, and
professional behaviors, practices and values that
individuals learn and ascribe to while participating in or
outside of groups with whom they typically
interact.” (Bomar, 2004)
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Which Group is Multicultural?
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Thought Question
Knowing that people of one race can vary in terms
of their ethnicity and culture, can we truly make
assumptions about someone based on their
biological looks or even based on the little we may
know of their “ethnicity” or “culture” ?
October 2019
Cross-Cultural Communication
Applying cross-cultural
communication in the work setting
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Cross-Cultural Communication
Culture Assessed by Observation and Influenced by Unconscious Biases:
• Dress, Appearance
• Speech
• Body Language
• Eye Contact
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Cross-Cultural Communication
• Culturally perceived attitudes in donation:• Preconceived ideas about cultures
– African-American– Hispanic– Asian– Middle Eastern
• Religious background– Jewish– Jehovah Witness– Hindu
• Bias vs.. reality
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Trust and Communication
• Establishing TRUST → Effective Donation Conversation
• Influencing factor on the donation decision:
Cultural Identity Healthcare Professional
vs.
Cultural Identity Potential Donor Family
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Cross-Cultural Communication
• Culture & communication
connected
• Communication –
driven by culture
• Connection forgotten =
risk for misunderstanding
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Cross-Cultural Communication
Risk of Cultural Imposition
“The [HCP] must examine his/her biases and prejudices
toward other cultures as well as explore his/her own
cultural background….Without becoming aware of the
influence of one’s own cultural values, a risk exist for the
[HCP] to engage in cultural imposition”.
(Campinha-Bacote et al 1996)
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Cross-Cultural Communication
“Unspoken assumptions regarding
meaning of health, illness, and
death may affect communication
regarding donation.”
Dr. Hawryluck & Knickle (n.d.)
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Generalization vs Stereotyping
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Cross-Cultural Communication Model
• Arthur Kleinman’s Explanatory model
• Unbiased approach to an individual
• Gain the emic perspective versus our etic perspective
• Both perspectives – most effective vantage point
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Cross-Cultural Communication Model
Explanatory Model – 8 Questions by Arthur Kleinman:
• What do you call your illness? What name does it have?
• What do you think has caused the illness?
• Why and when did it start?
• What do you think the illness does? How does it work?
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Cross-Cultural Communication Model
Explanatory Model – 8 Questions (cont.)
• How severe is it? How long do you think you will have it?
• What kind of treatment do you think the patient should receive? What are the most
important results you hope he/she receives from this treatment?
• What are the chief problems the illness has caused?
• What do you fear most about the illness?
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Cross-Cultural Communication
Simply - the 4 Cs:
1. Call
2. Cause
3. Cope
4. Concerns
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• Effective communication is your responsibility
• Anxiety
• Stereotypes and prejudice
• Language problems
• 6 barriers to communication:
• Nonverbals
• Ethnocentrism
• Assuming similarities vs. differences
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Cross-Cultural Communication
October 2019
Basic Principles
Practical Tips in Working with
Different Cultures
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Basic Principles – Cultural Considerations
• Identify the cultural decision maker
• Use younger generation support
• Use questions to learn
• Negotiate and compromise
• Do not project your own personal feelings
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Basic Principles – Practical Tips
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Basic Principles – Practical Tips
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Cultural-Communication Tips
• Learn and use a few phrases of greeting and
introduction in the patient’s native language –
conveys:
– Respect
– Demonstrates your willingness to learn about their culture
• Avoid saying “you must….”, use, e.g., “some people in
this situation would….”
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Cultural Intelligence (CQ)
• CQ Action
– Ability to flex verbal and non-verbal behavior – conveys respect and builds trust
• CQ Drive
– Willingness to work with diverse others and ability to overcome biases and persist
• CQ Knowledge
– Understanding of culture and cultural differences, especially hidden differences
• CQ Strategy
– Ability to flex mentally – being open to new or integrative ideas
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Basic Principles – Develop Cultural Humility
Reflections – know & understand yourself:
• What is your culture? Your beliefs? Your biases?
• Have your culture and beliefs been influenced by your family? Have they evolved?
• If you have changed your perspectives, what led you to change your perspectives?
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Reflect. Know yourself.October 2019
Basic Principles – Develop Cultural Humility
• Do not assume you know the culture
• Seek to understand –
Don’t be afraid to ASK!
• Become a student of the person / the family – let them be your teacher!
• Identify what provides value in death to that individual
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Remember - your culture is not superior.
October 2019
Finally…
“Cultural competence is
a journey,
not a destination.”
(Galanti, 2008)
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Thank you for your attention!Hedi Aguiar – fundamentally [email protected]
References
37
• http://www.jointcommission.org/assets/1/18/Root_Causes_by_Event_Type_2004-2Q2013.pdf
• The Joint Commission (2010). Advancing effective communication, cultural competence, and patient- and family-
centered care: a roadmap for hospitals
• Campinha-Bacote, J., Yahle, T., Langenkamp, M. (1996). The challenge of cultural diversity for nurse educators. The
Journal of Continuing Education in Nursing, 27(2), 59-64.
• Hawryluck, L. & Knickle, K. (n.d.). Cultural considerations in donation. Retrieved from
http://www.cepd.utoronto.ca/endoflife/Slides/Organ%20Donation%20Cultural%20Considerations.pdf
• Bomar, P.J. (2004). Promoting health in families. Applying family research and theory to nursing practice. (3rd ed.).
Philadelphia, PA: Elsevier, Inc.
• Friedman, M.M., Bowden, V.R., & Jones, E.G. (2003). Family nursing. Research, theory, and practice. (5th ed.) Upper
Saddle River, NJ: Pearson Education, Inc.
October 2019 (c) Fundamental Roots - HAguiar
References
• Galanti, G.A. (2008). Caring for patients from different cultures. (4th ed). Philadelphia, PA: University of
Pennsylvania Press.
• Kleinman, A. (1981). Patients and healers in the context of culture: an exploration of the borderland between
anthropology, medicine, and psychiatry. Los Angeles, CA: University of California Press.
• Management Sciences for Health (2005). Techniques for taking a history: Arthur Kleinman’s eight questions.
Retrieved from http://erc.msh.org/aapi/tt11.html.
• Office of Minority Health (2007). National standards on culturally and linguistically appropriate services (CLAS).
Retrieved from http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15
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