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The influence of culture on aged care delivery


Identify what culture is and how it operates in public mainstream society ... Australian Public Culture & Institutional Structure: Base of Society. Indigenous People ... – PowerPoint PPT presentation

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Title: The influence of culture on aged care delivery

The influence of culture on aged care delivery
  • Professor Olga Kanitsaki AM
  • Head
  • Division of Nursing and Midwifery
  • School of Health Sciences
  • RMIT University

  • Identify what culture is and how it operates in
    public mainstream society
  • Give an example of how culture care operates in
    ethno specific context
  • Give an example of how the ruling normality
    speaks for, undermines or subjugates other
    cultures care practices in a multicultural
    society like ours
  • Propose actions that can be taken to improve
    health services to ethnic aged in mainstream
    acute, community, residential and ethno specific
    care services

Stats Aged 65 and over
  • 2.4 Million aged 65 and over 12.5
  • 784, 600 or 33 born overseas
  • 479, 400 61 CALD/NESB or 19.9 of the total
    older population
  • 305, 200 39 ESB
  • By 2011 CALD 22.5 this is an increase of 66
    growth since 1996 compared to the same period of
    23 for the Australian born population
  • Italy, Greece, Germany, Netherlands Poland
  • ABS AIHW 2002 AIHW 2001

  • Human
  • Construction

meaning, Symbols, Language
Individual collective experience, History
Living within interacting with environment in
time place
Core values, Beliefs, Expectations, Goals, Pattern
s of social behaviour interactions
Rules practices, Rewards, Punishments
Cultural InterpretationsCommunicating Meaning
  • Members of the same culture share sets of
    concepts, images, and ideas which enable them to
    think and feel about the world, to be able to
    interpret the world in roughly similar ways.
    (Giles Middleton 1999, P 59 ).
  • It is not language alone that produces meaning,
    but also behaviours and practices.

Culture is
  • Internalised (embodied) by the individual
  • Forgotten as embodied history (cf structure of
  • Just as grammar (unconsciously) regulates our
    speech, so too culture regulates our action, i.e.
    through internalised individual dispositions.

Australian Public Culture Institutional
Structure Base of Society
Margins of Society
Indigenous People
Margins Society
Australian Dominant Public Culture
Margins of Society
Margins of Society
Transcultural Values and Moral Systems (Lay and
  • Values
  • Individuality versus collectivity
  • Privacy, confidentiality, truth telling
  • Independence versus paternalism
  • Dignity, privacy, quality of life etc..
  • Family structure and relations
  • Care practices
  • Decision making processes
  • Gender roles
  • Consent and informed consent

Mainstream/Dominant culture
  • Well internalized and embodied by majority or
    mainstream of people
  • Perceived as natural (like the laws of gravity)
    and hence objective, factual, true

Mainstream/Dominant culture, Cont
  • Anyone who fails to uphold the normal life way
    risks being labelled odd, different,
    inferior, other, difficult, not normal
    and even a threat to social cohesion

Levels of culture
Global Human Cultures
Societal National Culture
Regional Community Culture
Group Family Culture
Individual Culture
LEININGER, M. 1995 P 23
Greek Culture care
  • Family structure, roles, values expectations
  • Child centred
  • Reflects ideal moral universe
  • Gods family good father, mother, children
  • Interdependent
  • Family care trusted, strangers paid not trusted
  • Care institutions not trusted, family would go
    with member. HCP surveillance by family

Issues to be taken into account
  • Generational differences in expectations
  • Communication between generations
  • Children working
  • Elderly isolation
  • Economic linguistic dependence
  • Authority and respect for elderly may be
    diminished within family
  • Difference between groups and individual aged

Case exemplars
  • Case 1 Elderly Greek woman having a shower
  • Case 2 Elderly Greek woman who experienced both
    mainstream and ethnospecific aged care

Cultural relational spaces in the Home
Old Aged
Board CEO
Anglo Celtic Div 1 Managers
Aust Greek Born Div 1 Anglo Celtic
Greek Nursing Home Culture in Action
Ethnospecific Home Benefits
  • Greek residence, PCs, relatives Together share
    history, experience, language
  • Able to have a two way verbal communication with
    carers, share jokes, reminisce, play games, have
    arguments etc
  • Greek environment, space objects, artefacts,
    meaningful symbols
  • Greek food

Ethnospecific Home Benefits, Cont
  • Greek activities and religious practices
  • Greek entertainment, music, Greek TV, dancing,
    picnics and community visiting
  • Name days
  • National days

Privileging Mainstream Normality (Culture)
  • Official/formal language use English
  • All official and government documents in English
  • All meetings in English
  • General Manager Director of Nursing Anglo-Saxon
  • Formal Communication via the hierarchical system
  • Governments Health Family Services Planning
  • Approval Classification, Certification and
    Accreditation Funding Standards (management)
  • When Anglo Saxon staff leave gifted flowers and
    appreciation/Greek staff got nothing

  • Concepts in the official documents too hard for
    PCs to understand, thus no use translating them
  • PCs expected to learn English
  • Pressure to learn English
  • Classes compulsory, after hours without pay
  • Anglo Saxon/Celtic not expected or requested to
    learn Greek

Greek cultural capital devaluing
  • Greek RNs Div. 1 employed as SENs PCs
  • No systematic recruitment retention plans for
    Australian Greek or GA Born
  • Reasons
  • Funding Div 1 level 4 position required
  • Inexperienced, young
  • Greek women (ethnic, immigrants)
  • Felt demeaned and insulted

  • Greek RNs Div. 1 employed as SENs PCs
  • Because the other registered nurses and the
    other SENs knew I was registered as a Division
    1 nurse they would give me a little bit more to
    do. But their expectations of me were higher, and
    that was fine by me. I wanted to meet those
    expectations. So, yes, I think at that stage I
    didnt really know whether I was Arthur or Martha
    because I was an SEN (they were paying me as an
    SEN) and that was what my job description said I
    have to do. Yet there was that expectation from
    them that I would function as a Division 1 RN,
    and I also had that expectation of myself.

  • So here I was, experienced in terms of knowledge
    as a registered nurse, and I had the appreciation
    of the language and the culture, and so they
    expected me to establish a rapport with these
    residents and to do really well in my
    interpersonal relations in addition to my
    professional skills. I had them both, so the
    expectation was there. And from a gender
    perspective they saw me as a woman, a Greek
    woman, who should behave like a Greek woman.

  • The RNs saw me when I was on, Here's my little
    interpreter, and Here is my little second hand
    person. I didn't mind that. I loved the
    opportunity to be doing some other skills that
    reinforced what I was trained for.

  • Concepts in the official documents too hard for
    PCs to understand, thus no use translating them
  • PCs expected to learn English
  • Pressure to learn English
  • Classes compulsory, after hours without pay

  • RNs PCs used as interpreters for Australian
  • Messengers mediators to Greek staff and
  • Living in-between two ambivalent cultural worlds.
  • Identity problems

  • Constructed as ethnic and inferior
  • go and pick cherries or go and work down at
    Bosch a factory
  • Other times she will speak to us like we are
    the last rubbish of the rubbish. It is not right
    to have us here at 7 in the evening and to have a
    meeting to last till 10 pm.
  • Expected domestic staff who chipped or broke
    plates to pay for them.

Other Issues
  • Relatives
  • Complaint about the variety of food
  • Number of staff on night duty
  • Harassment on food, and harassment on water.
  • I was treated like I was a migrant. An
    illiterate migrant.

  • Anglo Saxon Celtic interpretation of dignity and
    privacy, for example, elderly was scared during
    the night and requested to put an intercom so
    that elderly can hear a voice. The manager
    dismissed the request and stated that this would
    violate the Residential Standards because of the
    noise and because of dignity and privacy. The
    relative stated that the elderly and those others
    sharing the room were concerned with safety not
    about dignity, noise or privacy.

  • MII She angrily instructed me to say to them,
    Take your sweets and go away from the nursing
    home. Then she went away. I thought if I send
    them away, it will be the wrong thing to do and
    we would not have accomplished anything.
  • It is because they mistrust the nursing home
    because of the restrictions imposed upon them by
    the nursing management and because of the way
    they have imposed those restrictions.

  • All of the above mitigated against
    trans-formative cross-cultural practices
  • Sustained mainstream culture superiority and
    domination and,
  • Reinforces Greek cultural inferiority and

Transcultural Issues
  • Patient family knowledge of health system
  • Professional roles, rules and practices
  • Cultural interpretations (whose prevail?)
  • Communication and communication styles
  • Ethnocentrism
  • Stereotyping V Generalisations
  • Transcultural ethical systems
  • Consent and informed consent

Transcultural care delivery at a professional
service level
  • Culture care preservation/maintenance
  • Culture care accommodation/negotiation
  • Culture care repatterning/restructuring
  • Results in culturally congruent nursing care that
    is healing and empowering
  • Can be applied face to face delivery in acute,
    community and home care, administrative,
    managerial and institutional level.

Transcultural care service delivery at
institutional level
  • Policies and guidelines cross-cultural outcomes
    that can be measured
  • Individual HCPs performance appraisals to take
    into account cross-cultural practices
  • Policies and guidelines that explicitly require
    the inclusion of family/significant others in the
    medical, nursing and other care planing and

TN Care Continues
  • Client/patient information sharing with
    family/significant others unless explicitly
    requested for information not to be given
  • Systematic use of interpreters
  • Establishing a multicultural work force,
    including transcultural nursing experts and
    staff. This should include increasing the number
    of bilingual and bicultural nurses, doctors and
    other health professional in aged care.
  • Conscious effort should be made not to assimilate
    such professionals but to help them to work
    effectively in this country

State National Levels
  • Legal system to recognise relationships and
    interdependence beyond husband and wife and/or
    children to include those others that are
    significant to the aged
  • Legal system to ensure that effective
    communication takes place and clients have
    relevant knowledge to participate in the
    decisions for their care and treatment

  • Additional funding to be geared for real ethnic
    aged needs in community, acute and residential
  • Specific funding to ethno specific homes to use
    for translation of government policies and
  • Specific funding for teaching the relevant
    language to staff, English to the ethnic carers
    and the ethnic language to English speaking staff

Ethno specific Services
  • Accreditation standards to measure
  • Consumer and staff communication and
    participation in decision making
  • All government policies, guidelines translated to
    relevant language in the service
  • All employees who work in the service to speak
    the relevant language(s)

  • Professionals to be educationally prepared to be
    able to transform government policies to serve
    the relevant ethnic group
  • Health professional to be cross culturally
    educated to transform and manage care delivery
    within ethnic context (particularly DONs )
  • Health professionals (RNs) in management to be
    representative of the ethnic group
  • Provision of group health needs as defined by

  • Level of appointment and quality of staff
  • Staffing levels quality with relevant salary
  • Continuous education Cross-cultural education
  • Relevant community involvement and support

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