Multicultural Opportunities for Success in Hospital Services

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Multicultural Opportunities for Success in
Hospital Services

• Hedi Aguiar RN, BA(Hons), CCRN
• Hospital Communications Specialist
• OneLegacy

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Questions to Run on

• Should Hospital Services staff be trained in
  multicultural sensitivity and what focus should
  the training have?
• How can we ensure that Hospital Services staff
  are addressing multicultural needs in their
  hospitals?

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Break Down the Walls and Boundaries
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Commitment

• Learn from each other
• Share our cultures with each other to maximize
  our learning experience
• Do not look down on or try to offend each others
  culture
• Be curious of each other and ask questions
• When being asked about your culture, know it is
  coming from a place of genuine interest and
  wanting to learn
• If an assumption is being made about your
  culture, gently redirect.

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Indonesia My Homeland
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Sleeping on the Floor
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Eating with our Hands
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Carrying Kids
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Two Monkeys ?
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Playing and Entertaining
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Objectives

• By the end of this presentation the audience will
• be able to
• Recognize the need for a training program for
  Health Care Professionals (HCPs) on multicultural
  sensitivity and adaptation
• Recognize the need for Hospital Services staff to
  be trained in multicultural sensitivity and
  adaptation
• Be more culturally aware

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Overview

• Working definitions of culture, race and
  ethnicity
• Hospital Services role in working with HCPs
  dealing with potential donor families of various
  cultures
• Hospital Services need for multicultural
  sensitivity training in dealing with HCPs of
  various cultural backgrounds
• Practical tips in working with different cultures

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Working Definitions

• Culture is requires a broad definition and so it
  should include
• Ethnographic variables (e.g., nationality,
  ethnicity, language, and religion)
• Demographic variables (e.g., age, gender, place
  of residence, and generation)
• Status variables (e.g., social, economic, and
  education)
• Affiliation variables (e.g. formal and informal
  group memberships) (Friedman et al, 2003)

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Definition of 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)

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Definition of Ethnicity

• Ethnicity
• is a key facet of culture and 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. (Giger
  Davidhizer, 1999, McGoldrick, 1993)

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Definition of Race

• Race
• is an ancient, nonscientific, political
  classification of human beings and is based on
  physiological characteristics, such as skin
  color, eye shape, and texture of hair.
  (Melville, 1988)
• It is a narrower term then ethnicity and denotes
  a human biological definition.

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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
• There are no distinct, pure races today
• Religion is very much entwined with ethnicity,
  shaper of health values, beliefs, and practices.

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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
  biologically looks or even based on the little we
  may know of their
• culture or ethnicity?

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Hospital Services role in Training Health Care
Professionals in Multicultural Sensitivity
Adaptation
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Why Cultural Competence?

• Leininger states Nurses are awaking to the
  critical need to become more knowledgeable and
  culturally competent
• to work with individuals
• of diverse cultures.
• (cited by Campinha-Bacote et al, 1996)

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Culture Assessed by Observation

• Dress
• Appearance
• Speech
• Educational Background

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Cultural Issues

• Identify the Decision Maker
• Give the family what they need and want
• Do not project your own personal feelings
• Assess their readiness let the family guide the
  conversation

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Motives

• Understand your motives
• Concerns for the family
• Concerns for the recipient
• Turning a negative situation around to be positive

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Professional Empowerment

• Hospital Services staff should help nurses to
  understand how to
• Developed their own interpersonal skills
• Utilize their strengths
• Focus on the family
• Time
• Taking care of their needs
• Pick-up on cues from the family
• Sensibility, sensitivity and adaptation

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Attitudes in Multicultural Donation

• Preconceived ideas about cultures
• African American
• Filipino
• Hispanic
• Asian
• Religious background
• Jewish
• Jehovah Witness
• Hindu
• Bias vs. reality

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Asians - Filipinos

• Values in Death and Dying
• Death is a spiritual event, family may want to
  wash the body, will want all the family to say
  good-bye prior to the body being taken
• Belief in Donation
• The body is given high respect, cremation is not
  common practice, may not allow donation

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Asians - Cambodians

• Values in Death and Dying
• Monks need to recite prayers, family members
  should be present, family faces death quietly,
  incense may be burned.
• Belief in Donation
• Unlikely to allow donation, body cremated, due to
  belief in reincarnation, desire for body to be
  intact

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Who / What Do You See?
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Hospital Services Role in Working with Health
Care Professionals ofVarious Cultural Backgrounds
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Minority Nurses by Ethnicity

• 4.9 African American
• 3.7 Asian or Pacific Islander
• 2.0 Hispanic
• 0.5 American Indian or Alaska Native
• 1.2 Multiracial
• 1996-2000 Number of minority RNs increased by
  35 vs. 2 of non-minority RNs

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Supporting Research

• Minimal supporting research for this topic
• Some research attitudes toward donation
• Some research addressing racism in HCPs and
  differential treatment of patients (Racial
  stereotyping and medicine the need for cultural
  competence. H J Geiger
• Recommendations Education for Health Care
  Professionals / Providers

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Education Real-Time Hospital Services

• Opportunity for in-the-moment education
• Raises questions and concerns
• Brings to light perceptions
• Moments for intimate conversations

Win them one-by-one.
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Research on Why Families Decline

• In research families who oppose donation are
  often identified as people who
• have a lack of education
• who distrust of the healthcare system
• who fail to communicate
• who are apathetic
• who are operating on superstitious or religious
  beliefs

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Interesting Quote
What is most frustrating then, is to see this
cultural bias of a perceived elite group those
who promote transplants as they express their
views of people who raise very legitimate ethical
questions about organ donation.
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Be Aware
Unspoken assumptions regarding meaning of
health, illness, and death may affect
communication regarding donation.Dr.
Hawryluck Presentation Cultural Consideration
in Donation
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Reflection

• What assumptions were being made in this clip?
• What were the characters basing their assumptions
  on?
• Have you ever made an assumptions about someones
  culture / religion / race purely based on their
  looks?
• Did you ever discover that your assumption was
  completely wrong?

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Practical Tips to Enhance Cultural Awareness
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Developing a Multicultural Sensitivity Tool

• Listen
• Reading facial expressions
• Communicate
• Assess their knowledge
• Explain process of death
• Clarify

• Strategic planning phase
• Next steps
• Be prepared
• Implementation phase
• Evaluation phase

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Leiningers 9 Domains for a Cultural Assessment
Tool

• Patterns of lifestyle
• Specific cultural values and norms
• Cultural taboos and myths
• World view and ethnocentric tendencies
• General features that client perceives as
  different or similar to other cultures

• Health and life care rituals and rites of passage
  to maintain health
• Degree of cultural change
• Caring and behaviors
• Folk and professional health-illness systems that
  are used

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Risk of Cultural Imposition

• The nurse 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 ones own
  cultural values, a risk exist for nurse to engage
  in cultural imposition. (Campinha-Bacote et al
  1996)

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Tips - Reflections

• Understand yourself
• What is your culture? Your beliefs?
• Has your culture and beliefs been influenced by
  your family? Has it evolved?
• If you have changed your perspectives, what led
  you to change your perspectives?

Reflect. Know yourself.
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Tips - Practicalities

• Do not assume you know the culture
• Seek to understand
• Dont be afraid to ASK!
• Become a student of the person / the family
• Identify what provides value in death to that
  individual

Your culture is not superior.
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In Conclusion

• Beginning thoughts and discussions of
  multicultural needs within HS
• Empowerment to begin the journey of becoming more
  multicultural sensitive and not be afraid
• Recommended further exploration of these
  perspectives

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Questions to Run On

• Should Hospital Services staff be trained in
  multi-cultural sensitivity?
• How can we ensure that Hospital Services staff
  are addressing multi-cultural needs in their
  hospitals?

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Thank you for your attention!
Questions ?