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Transcultural Transcultural Guidelines for Guidelines for Health Care GiversHealth Care Givers

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World ReligionsVS. El Paso

World 2005 Statistics:

Christianity 33%

Islam 21%

Hinduism 14%

Buddhism 6%

Judaism 0.22%

Other 25%

El Paso 2002 Statistics:

Catholic 58%

Other Christian 25%

Islam 0.3%

Judaism 0.8%

Other 16.9%

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Definitions (Cornell University) - Describes your family “origins” e.g.

American Native or Alaskan NativeOrigins in any of the original peoples of North & South America (including Central America), & who maintains tribal affiliation or community attachment

Ethnicity

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AsianFar Eastern countries

Black/African AmericanAfrican or Caribbean

Caucasian/White/Not of Hispanic originEurope, Middle East, North Africa, Australia, New Zealand

Mexican AmericanOf Mexican culture or origin regardless of race

Ethnicity

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Native Hawaiian or other Pacific IslanderHawaii, Guam, Samoa, Pacific Islands

Puerto RicanPuerto Rican culture or origin, regardless of race

Other HispanicCuban, South or Central American, Dominican Republic, or other Spanish culture or origin, regardless of race

Ethnicity

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Hispanic vs. Non-Hispanic 2006 StatisticsApproximately 81.4% Hispanic Non-Hispanic 14.2%

What other things contribute to diversity?If I’m Hispanic is a non-Hispanic another culture? Maybe…

Reviewed October, 2008

El Paso’s Population

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Including culture, religion, language, age, and gender….

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

Many Things..

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Some may think culture determines certain things:

• Physical attributes

• hair or skin color

• Diet

• Language

• Our religious & spiritual beliefs

Culture

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Ethnocentrism

• Despite the fact that we understand 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. This is called ethnocentrism.

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Ethnocentrism

• It can cause misunderstandings and harm patients by:– Incorrect diagnosis– Failure to provide adequate pain relief– Arrest of parents for child abuse due to

misunderstood cultural childrearing beliefs and practices

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Understanding of own selfKnowledge of various cultural characteristicsUnderstanding of cultural characteristicsApplication of cultural knowledge & understanding in the healthcare setting

CulturalCompetency

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AvoidStereotyping

We must not presume that all people of a certain cultures adhere to all aspects of their culture

The healthcare provider must identify which aspects are appropriate for each patient during the admission process

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Do Not AssumeAnything

Be truly open-minded & respectful toward other’s beliefs, values, & practicesYou can help patients feel more comfortableMany of us belong to more than one ethnic group, cultural group, age group, and social group

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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

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Family members are not good translators

Issues of privacy and confidentiality

Interpreter errors could be a previously unrecognized root cause of medical errors (Healthcare Risk Management (2003)

Lost inTranslation

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Avoid Ad HocTranslators

Flores, 2003 (University of Wisconsin)

Omission by interpreter 52%

Addition by interpreter 8%

Substitution by interpreter 13%

Editorialization by interpreter 10%

False fluency 16%

63% of errors were found to have potential medical consequences

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Translation Line Services

• Find someone in your facility who knows the policy

• It is important to be facility specific

• Should be HIPAA & Joint Commission Compliant

Policy &Procedure

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• Facial expressions, body language & tone of voice play a much greater role in many cultures.

Face & BodyLanguage

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Some Cultures:

• May perceive a response like “maybe” or “that would be difficult” as a polite no

• Some cultures prefer indirect communication and talking around the issue

Cultural Differences

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Gestures

Use with care – may have negative meanings in other culturesThumbs-up and the OK sign are obscene gestures in parts of South America & the MediterraneanPointing or beckoning with the index finger as “come here”, or snapping fingers are seen as rude in some cultures

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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

Touch

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In Summary

• Observe the kinds of cultures you see in your patient population

• Adjust your care for patients of different cultures

• Look for resources available for patients of different cultures

• Provide translation for a patient that doesn’t speak English