Transcultural Care

CultureThe shared values, traditions, norms, customs, arts, history, folklore, and institutions of a group of people that are unified by race, ethnicity, language, nationality, or religion.

Source: Office of Minority and Women’s Health, HRSA, NIH

Characteristics of CultureLearned roles, behaviors, values, attitudes

Human nature, time, relationships, traditionsHealth beliefs, religion or spirituality Communication, decision-making, food/diet, grief/dying, family roles, sick roles.

Characteristics of Culture

Stabilizing forces and change agentsSocial Structure

Family, politics, education, economics, art, history, physical environment, health care facilities, ethnicity

Criteria for Defining Culture

Common language/communication systemSimilarities in dietary preferencesCommon patterns of dressPredictable relationships and socialization patternsShared values and beliefs

Personal CulturePersonality, unique structureInternal factors such as gender, age, sexual orientationExternal factors such as society, personal experiencesWhere one grows up or now livesWith or without children, with or without religious affiliationOrganizational/work influencesPosition within work place and its location

Cultural Diversity

Difference in Race, ethnicity, language, nationality, or religion among various groups within a community is said to be culturally diverse if its residents include members of different groups.

Source: Office of Minority and Women’s Health. HRSA, NIH

DiversityDifferences can be found in communities that are bounded by similarities in ethnicity, language, religion, geography, history or politics.Every interaction is cross-cultural!

EthnicityIdentity one has based on ancestry and national, religious, tribal, linguistic or cultural origins.Sense of belonging to a reference group within a society

Race

Use of the term is debatedBiological term used to categorize people based on physical characteristics Disregards genetic variationsOften used in discriminatory manner

Acculturation Giving up traits of one culture and adopting those of another

Bicultural – function equally well in two culturesTraditional – retains traits from culture of originMarginal – no traits from either culture or origin or new one in which he/she livesAcculturated – gives up traits of original culture and adopts those of new culture

AssimilationSocial, political, and economic integration of a cultural group into a mainstream societyUsually requires a degree of acculturationMany cultural groups may resist or reject acculturation

Communities develop in which people are insulated from main streamLack of political voice may disadvantage group

Ethnocentrism

Viewpoint that one’s own way of believing or behaving is correct and preferredEthnosensitivity

Process of becoming more sensitive and respectful of cross cultural differences

Cultural CompetenceA set of academic and interpersonal skills that allow individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups. This requires a willingness and ability to draw on community-based values, traditions, and customs and to work with knowledgeable persons of and from the community in developing targeted interventions, communications and other support.

Source: Office of Minority and Women’s Health, HRSA, NIH

5 Elements of Cultural Competence

Awareness and acceptance of differencesSelf-awareness or individual or organizational cultureUnderstanding the dynamics of differenceIntegration of cultural knowledge within individuals and systemsAdaptation to diversity

Steps to Cultural Competence

AwarenessBecoming aware of other cultural viewpoints and taking into account the diversity in values, beliefs, practices, lifestyles and problem solving strategiesExamination of one’s own culture, learned biases and prejudices

KnowledgeLearning about historical, social, political and/or religious influences that affect another’s worldviewDistinguishing between an individual’s traits and those common to a community or people with similar originsGive and take of ideas and knowledge for effective interpersonal relationships

SkillsIntegrating awareness and knowledge into western bio-medical system during a cross-cultural encounter to achieve “culture-specific, individualized interventionsCollecting relevant cultural data in both a history and physical assessmentAbility to generate conversation not confrontationPartnerships instead of misunderstandings

Cultural EncountersCross-cultural interactions that allow new learning or refinement of knowledge and beliefsPrevent stereotyping as the experience of interaction reveals intra-cultural group variation

Medical InterpretersPeople who orally translates a message spoken in one language into another languagePeople who are fluent in both languagesPeople who are not relatives of the patientPeople who have received professional training

Use of Interpreters

Secure an interpreter for people who:

Are non-English speakingAre limited English proficientHave limited understanding of health care issues in the English language

Professional Interpreters VS

Untrained Interpreters

Professional interpreters have been screened to assure fluency in both languagesUntrained interpreters may:

Omit important informationAdd ideasAnswer for the patientGive advice even if they don’t understand

Family and Friends Used as Interpreters

May commit all of the errors as other untrained interpretersMay cause the patient to not feel comfortable sharing informationMay react to a situation or information rather than serve as an interpreterMay make decisions for the patientThere may be a breach of confidentiality

Acceptable InterpretersBilingual staff that is trained and demonstrates competenceContract interpretersCommunity volunteers who are competent interpretersTelephone interpreter services

Working Effectively Through an Interpreter

Conduct pre-session to introduce yourself and goals for the encounterSpeak directly to the patientSpeak slowly in short segments with pausesAsk that everything you and the patient and family says is interpretedBe aware there may not be linguistic equivalence for some terms

Things to Avoid

Highly idiomatic speechComplicated sentence structureSentence fragmentsChanging an idea in mid-sentenceAsking more than one question at a time

TipsHave the interpreter ask questions and alert you to cultural misunderstandingsRespect an interpreter’s opinion that a question may be culturally inappropriateAvoid patronizing or demeaning the patientBe patient as this may take more time

Roles of the InterpreterConduit of InformationClarifier: Facilitates understanding when no linguistic equivalence existsCulture Broker: Provides a cultural framework for understanding when cultural differences are leading to a misunderstandingAdvocate: Actions to eliminate systematic barriers to quality care