Cultural and Spiritual Diversity: Improving Our Communication and Understanding

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Cultural and Spiritual Diversity Improving Our
Communication and Understanding

• Marita Grudzen, MHS
• Ronald Y. Nakasone,PhD
• Stanford Geriatric Education Center
• Stanford University School of Medicine

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Multicultural Framework for Serving Diverse Elders

• Cultural Diversity
• Cultural identity enculturalization and
  acculturalization
• Spiritual Diversity
• Multi-Multicentered universe
• relative valuesno one belief is absolute
• Shifting-centers
• Jusoseimultilayered experiences
• Ever-evolvingcentered universe
• shifting centers
• relative valuesno one belief is absolute
• Jusosei
• porously laminated and multilayered
• ever-evolving

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Ethnogeriatric Imperative

• Increasing numbers of elders from diverse ethnic
  and religious backgrounds
• Increasing heterogeneity within older ethnic and
  religious populations
• One-third of U.S. population 65 are projected to
  be from one of the four minority categories

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Diversity for Care Providers Clients and Team
Members

• CELEBRATE THE DIVERSITY-
• APPRECIATE THE COMPLEXITY!
• NEED FOR CULTURAL COMPETENCE

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Definition of Cultural Competence
A set of congruent behaviors, attitudes and
policies that come together in a system, agency,
or amongst professionals that enables that
system, agency, or those professionals to work
effectively in cross-cultural situations.
Cross et al., 1989
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Strategies for Effective Cross Cultural
Communication

• Recognize our own cultural background and
  expectations, biases, and that of your care
  system (e.g., hospice, Jewish Family Services)
• Recognize every encounter is a cross cultural
  encounter
• Recognize and expect within group differences

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The LEARN Model of Cross-Cultural Communication

• LISTEN to your patient from his or her cultural
  perspective.
• EXPLAIN your concerns and reasons for asking for
  personal information, e.g. lifestyle and family
  issues.
• ACKNOWLEDGE your patients concern.
• RECOMMEND a course of action.
• NEGOTIATE a plan with your patient/client that
  takes into consideration his or her cultural
  norms and personal lifestyle.
• Source Berlin E, Fowkes, W. A.Teaching Framework
  for Cross-Cultural Health Care. Western Journal
  of Medicine. 1983139934-938

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Guidelines for MULTICULTURAL CARE

• Assessment
• Cross-cultural communication
• Language barriers

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ASSESSMENT

• The cultural identity of the person
• The cultural factors related to the persons
  psychosocial environment
• The cultural elements of the relationship
• between the individual and the provider
• Cultural explanations of the individuals
• presenting concern and need.

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EXPLANATORY MODELS

• Explanatory models is a concept developed by Dr.
  Authur Kleinman
• for clarifying the different perceptions of
• cause, explanation and treatment for a health
  problem.
• The patient, family and practioner often have
  different explanatory model and ones that are in
  conflict.

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Cross Cultural Communication Patterns (1)

• High Context Low Context
• Relationships Relationships
• Process Task
• Collective Individual
• Hierarchical Egalitarian

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Cross Cultural Communication Patterns (2)

• High Context Low Context
• Communication Communication
• Use of nonverbal Low use of nonverbal
• Message implicit Message explicit
• Indirect Direct
• Message art form Message literal
• Disagreement Disagreement
• Personalized Depersonalized

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Additional Skills/Competencies

• Working with translators/interpreters
• alternative therapies and healers
• Working with family members

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Modalities for Improving our Communication and
Understanding

• Evaluation of practitioners includes
  professionalism and compassion
• Use of verbatim for interdisciplinary team
  education
• Community-based models of education that are also
  multi-disciplinary and multi-faith.
• Professional and community education Religion
  of my Neighbor
• Multi-faith collaboration in response to
  community need (e.g. Japanese American
  Religious Federation formed as a response to
  Japanese Americans internees need for
  housing.)

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Ethnogeriatric Websitesmen

• Stanford Geriatric Education Center
• http // sgec.stanford.edu
• Ethnogeriatric Core Curriculum
• http//stanford.edu/group/ethnoger/index.html