we should be talking about this…....bridging cultural communication we should be talking about...

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

(c) Fundamental Roots - HAguiar 2October 2019

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

October 2019 (c) Fundamental Roots - HAguiar 3

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


Laying Foundations

Operational Definitions of

Race, Ethnicity, and Culture


Which Group is Multicultural?


Laying Foundations – Defining Race

(c) Fundamental Roots - HAguiar

“…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)


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


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


Laying Foundations

• Culture requires a broad definition and should include:

• Ethnographic variables

• Demographic variables

• Status variables

• Affiliation variables


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)


Which Group is Multicultural?


(c) Fundamental Roots - HAguiar 14

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



Culture Assessed by Observation and Influenced by Unconscious Biases:

• Dress, Appearance

• Speech

• Body Language

• Eye Contact



• Culturally perceived attitudes in donation:• Preconceived ideas about cultures

– African-American– Hispanic– Asian– Middle Eastern

• Religious background– Jewish– Jehovah Witness– Hindu

• Bias vs.. reality


Trust and Communication

• Establishing TRUST → Effective Donation Conversation

• Influencing factor on the donation decision:

Cultural Identity Healthcare Professional

vs.

Cultural Identity Potential Donor Family



• Culture & communication

connected

• Communication –

driven by culture

• Connection forgotten =

risk for misunderstanding



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)



“Unspoken assumptions regarding

meaning of health, illness, and

death may affect communication

regarding donation.”

Dr. Hawryluck & Knickle (n.d.)


Generalization vs Stereotyping


http://www.sodahead.com/entertainment/priceline-killing-off-william-shatner-funniest-celebrity-tv-commercial/question-2406927/

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



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?



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?



Simply - the 4 Cs:

1. Call

2. Cause

3. Cope

4. Concerns

26October 2019 (c) Fundamental Roots - HAguiar

• Effective communication is your responsibility

• Anxiety

• Stereotypes and prejudice

• Language problems

• 6 barriers to communication:

• Nonverbals

• Ethnocentrism

• Assuming similarities vs. differences



October 2019

Basic Principles

Practical Tips in Working with

Different Cultures


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


Basic Principles – Practical Tips


Basic Principles – Practical Tips

(c) Fundamental Roots - HAguiar

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….”

31October 2019

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


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?


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


Remember - your culture is not superior.

October 2019

Finally…

“Cultural competence is

a journey,

not a destination.”

(Galanti, 2008)


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

38October 2019 (c) Fundamental Roots - HAguiar

we should be talking about this…....bridging cultural communication we should be talking about...

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