Cultural Sensitivity Training

1. Cultural Sensitivity Training Presented by: Shirley J. Knelly Chief Patient Safety Officer Chief Corporate Compliance Officer

2. Getting Started –Sensitivity Exercise Impressions you had when submersed in a very different culture for the first time Where you grew up THINK BEFORE YOU SPEAK!orJUST DO IT! One thing I would like to learn today Cultural messages you received as a child

3. Sensitivity Training Sensitivity training is designed to help people become more aware of their own biases and prejudices. It also focuses on helping people become more sensitive to others beliefs and cultures.

4. Why is Sensitivity Training so Important? Unfortunately, common sense isn't so common. It is rare to find a work environment that is free from grown-ups who are immature, insecure, hyper-sensitive, or who feel that they can manipulate and/or take advantage of co-workers.

5. Benefits of Sensitivity Training Improve communication Improve work relationships Reduce conflict and stress More time working Less time whining Improve customer service

6. What Is Culture? Culture teaches us how to think, feel, believe and value... All groups develop a common system which tells us: • What to pay attention to • What we ignore • What’s right • What’s wrong • What’s good; what’s bad Culture is the collective wisdom of hundreds of generations sharing core beliefs, values, assumptions about the world . “Cultures share the same problems; it ’s their solutions which differ… ” ------------ Margaret Mead, Anthropologist

7. The characteristics you were born with, the experiences that you have had, and the choices you’ve made are all considered Dimensions of Diversity.

8. ICEBERG What do we know about icebergs? So, if only 10% -15% of the iceberg is showing then that’s 85% - 90% of the iceberg that we don’t see! All of that is below the waterline!

9. So, with that is mind, how are people like Icebergs? When we first encounter someone, what is visible or audible are these above the waterline “dimensions”.

10. Iceberg Dimensions of Culture Who we REALLY are exits below the waterline!

11. Identifying Cultural Challenges Video: Silent Beats

12. Identifying Cultural Challenges Video: Silent Beats

13. Unconscious Bias • Our brains unconsciously make decisions on what feels safe, likeable, valuable, and competent. • We make decisions largely in a way that is designed to confirm beliefs that we already have. • Unconscious beliefs impact the way we perceive others, perceive ourselves, and as such influence our organizations.

14. “A father and his son are in a car accident. The father is killed and the son is seriously injured. The son is taken to the hospital where the surgeon says, “I cannot operate, because this boy is my son.”

15. Direct Communication C O N T E X T Verbal Non-Verbal • Meaning is in the verbal message • Speaking one’s mind • Face-to-face communication

16. Indirect Communication C O N T E X T Verbal Non-Verbal • Meaning is in the context • Vague and ambiguous language

17. Emotionally Expressive Communication Style • Emotions are an indicator of the importance of the matter • Trust and emotional commitment is developed and • credibility established through emotions

18. Emotionally Restrained Communication Style • Emotions are discredited as unprofessional • Trust is developed and credibility developed through • emotional suppression

19. Divergence of viewpoints may contribute to disparities • Healthcare professionals share a worldview • inter-relationship between body, mind, and environment informed by knowledge acquired through the scientific method • Patients view western medicine from distinct cultural vantage points • symptoms, diagnoses, behaviors and treatments are often perceived through spiritual and cultural beliefs • Divergence of viewpoints creates barriers to effective care • especially when the cultural backgrounds of the patient and provider are dissimilar

20. Cultural Diversity and Health Care • The Culture of Western Medicine • Meliorism – make it better • Dominance over nature – take control • Activism – do something • Timeliness – sooner than later • Therapeutic aggressiveness – stronger=better • Future orientation – plan, newer=better • Standardization – treat similar the same

21. “Ours” Make it Better Control Over Nature Do Something Intervene Now Strong Measures Plan Ahead – Recent is Best Standardize – Treat Everyone the Same “Others” Accept With Grace Balance/Harmony with Nature Wait and See Cautious Deliberation Gentle Approach Take Life As It Comes – “Time Honored” Individualize – Recognize Differences Cultural Sensitivity and Health Care

22. Cultural Sensitivity and Health Care • Cultural Competence – Definition A set of congruent behaviors, practices, attitudes and policiesthat come together in a system or agency or among professionals, enabling effective work to be done in cross-cultural situations

24. Cultural Diversity and Health Care • The Cultural Competence Continuum • Where Am I Now? • Where Could I Be?

25. Cultural Sensitivity and Health Care • Acquiring Cultural Competence • Starts with Awareness • Grows with Knowledge • Enhanced with Specific Skills • Polished through Cross-Cultural Encounters

26. The ASKED Framework A – Awareness S – Skill K – Knowledge E – Encounters D - Desire

27. Cultural Awareness Campinha-Bacote J. “A Model and Instrument for Addressing Cultural Competence in Health Care,” Journal of Nursing Education 1999; 38:204 “Cultural awareness is the deliberate, cognitive process in which health care providers become appreciative and sensitive to the values, beliefs, lifeways, practices, and problem solving strategies of clients’ cultures …This awareness process must involve examination of one’s own prejudices and biases toward other cultures and in-depth exploration of one’s own cultural background.”

28. Cultural Awareness Key Points Within-group diversity is often greater than between-group diversity There is no cookbook approach to treating patients Avoid stereotyping and overgeneralization Every encounter is a cross-cultural encounter

29. Cultural Skills Campinha-Bacote J. “A Model and Instrument for Addressing Cultural Competence in Health Care,” Journal of Nursing Education 1999; 38:204 “Cultural skills is the ability to collect relevant cultural data regarding the clients’ health histories and presenting problems as well as accurately performing a cultural specific patient assessment.”

30. Cultural Skills Key Points Cultural identity of the client Cultural explanations of the client’s illness Cultural factors related to psycho-social environment and disabilities Intercultural considerations on the healthcare professional-client relationship

31. Cultural Skills LEARN Guidelines L - Listen with sympathy and understanding to the patient’s perception of the problem. E - Explain your perceptions of the problem A - Acknowledge and discuss the differences and similarities R - Recommend options/treatment N - Negotiate agreement

32. Cultural Knowledge Campinha-Bacote J. “A Model and Instrument for Addressing Cultural Competence in Health Care,” Journal of Nursing Education 1999; 38:204 “Cultural knowledge is the process of seeking and obtaining a sound educational foundation concerning the various world views of different cultures…The process also involves obtaining knowledge regarding specific physical, biological, and physiological variations among ethnic groups.”

33. Cultural Knowledge Key Points Historical and contemporary experiences of multicultural populations Changing demographics in the general population and health professions workforce Disparities and inequities in access to healthcare, utilization, quality, and outcomes

34. Cultural Encounters Campinha-Bacote J. “A Model and Instrument for Addressing Cultural Competence in Health Care,” Journal of Nursing Education 1999; 38:205 “Cultural encounter is the process which encourages health care professionals to engage directly in cross-cultural interactions with clients from culturally diverse backgrounds.”

35. Strategies to Overcome Linguistic and Cultural Barriers Bilingual/Bicultural healthcare professionals Bilingual/Bicultural Community Health Workers Language Access options Professional interpretation access Written Translation Materials (ACO 1557)

36. Cultural Desire Campinha-Bacote J. “A Model and Instrument for Addressing Cultural Competence in Health Care,” Journal of Nursing Education 1999; 38:205 “Cultural desire is the motivation of health are professionals to “want to” engage in the process of cultural competence.”

37. Cultural Desire Key Points • A lifelong commitment to self-evaluation and self-critique • Redressing power imbalances • Developing mutually beneficial partnerships with communities on behalf of individual sand defined populations.

38. Patient Sensitivity Tips Do… Develop a tolerant, accepting attitude about views different from your own Include family members in the patient teaching, if a family member will be caring for a patient at home Respect a woman’s concern for modesty. Try to assign same-sex healthcare providers when possible, especially for Middle Eastern patients Be sensitive to the fact that most African Americans have been subjected to much radical prejudice and discrimination Respect patients’ religious beliefs; involve spirituality in their care when appropriate Learn about the beliefs and practices of the patient populations you serve

39. Guidelines for dialogue across cultures Listen and speak without judgment Respect differences Reexamine all positions Search for strengths and values in the way others see things Explore common ground Focus on learning Release the need for outcomes Seek to walk in another’s moccasins

40. Principles & Practices for Effective Multicultural Communication • Check Your Assumptions at the Door • Understand the Cultural Context(s) of your Group • Invest Before you Request • Develop Authentic Relationships • Build Shared Ownership • Walk Your Talk • Relate, Don’t Translate • Anticipate Change

41. Tips for Leading: Patient Sensitivity Don’t… Try to stereotype people. Remember that the information given for each culture group is meant to be broad, a general guideline, to serve as starting points. Judge a patient’s level of pain based upon their expressiveness. Some cultures encourage expressiveness, others encourage stoicism Wait to offer pain medication until a patient asks for it; many Asian patients will suffer in silence Assume lack of eye contact indicates lack of interest, guilt, or any other negative point. Judge people as “pushy” or “cold” based upon how close they stand to you Don’t expect that all patients will make their own decisions. Don’t treat the patient in the same manner you would want to be treated. Don’t discount or laugh at beliefs that are not held by you.

43. Stephanie Pace Marshall “Adding wings to caterpillars does not create butterflies - - it creates awkward and dysfunctional caterpillars. Butterflies are created through transformation.