Transcultural Guidelines for Health Care Givers

1
Transcultural Guidelines for Health Care Givers
2
YOU MIGHT BE AN EL PASOAN IF..

• When returning from an out of town trip,you see
  the ASARCO smokestack it gives you a warm,
  fuzzy feeling.
• The star on Mount Franklin is your guiding light
  home if you are lost in Juarez.
• You recommend Chicos Tacos as a place to eat..
• You stay home after a 1/4 inch snowfall.
• You refer to Ascarate Park as The Lake.
• You refer to Bowie High School as La Bowie.
• You think you speak proper Spanish.

3

World Religions vs E.P. by 2002

• Christianity 33.0 (Including Catholic
  others)
• Islam 20.0
• Hinduism 12.5
• Buddhism 9.0
• Judaism 0.5
• Other 25.0

• Catholic 58.0
• Other Christian 25.0
• Islam 0.3
• Judaism 0.8
• Other 16.9

4
Short Ethnicity Game

• As we go through the next several slides, jot
  down which ethnicity (or more likely,
  ethnicities) fit you.
• Think about how you might answer the census form?

5
Ethnicity

• Ethnicity Definitions (Cornell University)
  describes your family origins e.g.
• American Native or Alaskan Native
• Origins in any of the original peoples of North
  South America (including Central America), who
  maintains tribal affiliation or community
  attachment.

6
Ethnicity (cont)

• Asian
• Far Eastern countries
• Black/African American
• African or Caribbean
• Caucasian/White/Not of Hispanic origin
• Europe, Middle East, North Africa, Australia, New
  Zealand
• Mexican American
• Of Mexican culture or origin regardless of race

7
Ethnicity (cont)

• Native Hawaiian or other Pacific Islander
• Hawaii, Guam, Samoa, Pacific Islands.
• Puerto Rican
• Puerto Rican culture or origin, regardless of
  race.
• Other Hispanic
• Cuban, South or Central American, Dominican
  Republic, or other Spanish culture or origin,
  regardless of race.

8
WHATS YOUR SIGN?

• Do you have 1 clear ethnic identity?
• 2 3 ethnic identities?
• More?
• How many of us (here in El Paso) consider
  ourselves HISPANICS?

9
THINK ABOUT MAJORITIES MINORITIES!
10
Hispanic Population In El Paso

• 2002
• between 75 85
• Does this mean we are culturally similar or
  culturally diverse in general
• What other things contribute to diversity?
• If Im Hispanic is a non-Hispanic another
  culture? Maybe
• Maybe were all El Paso-ans!

11
Culture, Religion Language

• HAVE CONSIDERABLE EFFECT ON HOW WE ACCESS VIEW
  HEALTH CARE SERVICES

Age, Gender Many Other Things...
12
Culture

• What some think culture may determine about us
• Physical attributes
• hair color or skin color
• Diet
• Language
• Our religious spiritual beliefs

13
What Culture MAY NOT Contribute

• Dont fall into the trap
• Culture may have little
• to do with external characteristics
• Culture is multi-dimensional
• Dont judge a book

14
Despite the fact that we really know
that everyone is different, we still tend
to subconsciously believe that our culture
religion is the right one. We may view other
cultures
or religions as bizarre,
strange, inferior or unenlightened.
That is called
Ethnocentrism
15
How Can Ethnocentrism Cause Misunderstandings
Harm Patient Care?

• Incorrect diagnosis
• Failure to provide adequate pain relief
• Arrest of parents for child abuse due to
  misunderstood cultural childrearing beliefs and
  practices

16
Cultural Competency

• Understanding of own self
• Knowledge of various cultural characteristics
• Understanding of cultural characteristics
• Application of cultural knowledge understanding
  in the healthcare setting

17
Avoid STEROTYPING
We must not presume that all people of a certain
culture adhere to all aspects of their culture.
The healthcare provider must identify which
aspects are appropriate for each patient during
the admission process.
18
Leave Assumptions At Home!

• Be truly open-minded respectful toward their
  beliefs, values, practices, you can help
  patients feel more comfortable.
• Many of us belong to more than one ethnic group,
  as well as cultural groups, age groups and social
  groups.

19
Language Translation

• Those whose English is limited often wish to
  speak their native language when possible
• Feel that both their explanations their
  understandings can be more accurate
• It is more comfortable

20
Lost In Translation

• Family members are not good translators
• Privacy, confidentiality
• Interpreter errors could be a previously
  unrecognized root cause of medical errors
  (Healthcare Risk Management (2003)

21

• Flores, 2003 (University of Wisconsin)
• Omission by interpreter 52
• Addition by interpreter 8
• Substitution by interpreter 13
• Editorialization by interpreter 10
• False fluency 16

AVOID AD HOC INTERPRETERS
63 errors were found to have potential medical
consequences
22

• ATT Language Line
• 150 languages/professional interpreters
• The service is available 24 hours a day, 7 days a
  week
• Currently certify 22 languages for medical
  interpreting

23

• ATT Chosen because
• Most highly requested languages in the healthcare
  industry represent over 95 of our customer
  demand.
• Current Languages Arabic, Bosnian, Cantonese,
  Croatian, Farsi, French, German, Haitian Creole,
  Hmong, Italian, Japanese, Khmer, Korean,
  Mandarin, Polish, Portuguese, Russian, Serbian,
  Somali, Spanish, Tagalog, Vietnamese
• HIPAA JCAHO compliant

24
Policy Procedure

• FIND SOMEONE IN YOUR FACILITY WHO KNOWS POLICY
• IMPORTANT TO BE FACILITY SPECIFIC

25
FACE AND BODY MESSAGES

• Facial expressions, body language tone of voice
  play a much greater role in cultures where people
  prefer indirect communication talking around
  the issue.

26
The Search For Meaning

• A response such as Maybe or That would be
  difficult is probably a polite no.
• Avoiding yes/no questions by phrasing the inquiry
  as a multiple choice question is one way around
  this impasse.

27

Gestures

• Use care can have negative meanings in other
  cultures.
• Thumbs-up and the OK sign are obscene gestures in
  parts of South America the Mediterranean.
• Pointing or beckoning with the index finger with
  as a come here sign, or snapping fingers are
  seen as rude in some cultures.

28
Touch

• To touch or not to touch is only part of the
  question.
• Cultures also have different rules about who can
  be touched where.
• Even casual touching people of the opposite
  gender can be offensive in some cultures.

29
Questions???
You can ask

• What kinds of cultures do you see in your patient
  population?
• How do you adjust your care for patients of
  different cultures?
• What resources do you have for patients of
  different cultures?
• How do you translate for a patient that doesnt
  speak English or Spanish?

30
Thanks for your attention!!