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									Culturally Responsive Nursing Care

            Geri-Ann Galanti, PhD

                  Los Angeles County
                  Department of Health Services
                  Office of Diversity Programs
Ground Rules

   Ask questions
   Don’t worry about political correctness
   Let us know if something offends you
   Assume any such statements are made out
    of ignorance, not malice.
Stereotype vs. Generalization

   Generalizations are statements about
    common cultural patterns; probability
    statements about a group that have to be
    checked in the individual case.

   Stereotypes are assumptions that an
    unchecked generalization is accurate in the
    individual case.
Primary Issues To Be Addressed

   Misunderstandings which are based on
    cultural differences in the meaning of
    behavior, and which can lead to lack of
    rapport or bad feelings

   Noncompliance (non-adherence) issues
    which are often based on different beliefs or
Communication: Gestures
Communication: Gestures
Communication: Gestures
Communication: Gestures
Lack of Eye Contact

     Anglo/African American
     Asian
     Middle Eastern
     Native American
Personal Space

                   Anglo American

  Asian American                    Middle Eastern American

   Idioms

      Step on it!   Don’t be crazy!
Language Confusion

   Same language, different meaning:

Language Confusion

   Same language, different meaning:

Language Confusion

   Different language, different meaning:

Language Confusion

 Different language, different meaning:

Saying "yes" when the answer is no

   Saving “face”
   Show respect
   Grammar
Style of Interaction

   Personalismo
Using Interpreters

   Studies show that an average of 70% of the
    interpreted exchanges by ad hoc interpreters
    contain clinically important errors.
   Family members, especially, are prone to edit
    both the clinician’s and patient’s utterances.
   Children are frightened or intimidated if
    asked to interpret. There are ethical
    problems involved.
   Confidentiality concerns must also be
Issues of Language Access
in Health Care

   DHHS guidance for language access under
    the Title 6, Civil Rights Act of 1964
   MediCal contract regulations
   Joint Commission on Accreditation of
    Healthcare Organizations (JCAHO) includes
    standards for cultural competence training
    and language services.
JCAHO Ruling

   JCAHO views the provision of linguistically
    appropriate care as an important quality and
    safety issue.

   JCAHO requires the inclusion of language
    and communication needs in the medical

   Interpretation and translation must be
    provided for patients who need it.
DHHS says:

   Assess patients’ language needs.

   Try not to use family or friends or whoever
    you can grab.

   Don’t use minors to interpret.

   Try to use trained medical interpreters
    whenever possible.

   Use telephonic interpreters for rare
What Can You Do?

   Honestly assess your own bilingual skills

   Understand the pitfalls in using untrained

   Use interpreters effectively

   Use telephonic interpreters skillfully
Are your bilingual skills really adequate?
Can you:

   formulate questions easily?
   ask a question in more than one way?
   understand nuance and connotation in the
    patient’s response to questions?
   understand regional variations?
   know terms for anatomy and healthcare
   convert biomedical terms into lay terms in
    the target language?
The Effective Use of Face-to Face

   Brief the interpreter first, if possible.
   Introduce the interpreter to the patient.
   Position the interpreter behind the patient
    or behind you.
   Speak and look directly at the patient.
   Use first person and expect the interpreter
    to do the same.
   Avoid interrupting the interpretation.
Using Telephonic Interpreters

   Use a speaker phone; do not pass a handset
    back and forth.
   Remember that the interpreter is blind to
    visual cues.
   Let the interpreter know who you are, who
    else is in the room, and what sort of patient
    encounter it is.
   Let the interpreter introduce her/himself.
What You Need to Know to Connect

   The language needed

   Dial 0 for hospital operator

   Tell operator to connect you with the
    Language Line.

   Remember that the telephonic interpreter is
    bound by confidentiality regulations, just as
    any other health care personnel.

   The things we hold as important
   They are generally related to the
    circumstances that lead to success within
    the physical and social environment
Dominant American Values and the
Health Care System

   Money
   Privacy
   Independence

   Individualism
When Family is the Primary Value

   “Too many” visitors
   Conflict with HIPPA regulations
   Deferring decision-making
   Lack of self-care
The 4 C’s of Culture

   What do you call the problem?

   What do you think caused the problem?

   What have you done to cope with the

   What concerns you most about the problem
    and about the treatment?

          Patient Diversity:
        Beyond the Vital Signs

      During   2 Days Later
Protection Against Evil Eye

    Mexico                    Mediterranean

               Middle East
Expression of Pain
Labor Pains

Some cultures         Some cultures
encourage stoicism    allow expressiveness
• Northern European   • Middle Eastern
• Anglo American
                      • Hispanic
• Asian
                      • Mediterranean
• Native American
Providing Culturally Responsive Care

   Learnabout the beliefs and practices of
   the patient populations you serve
   Develop a tolerant accepting attitude
   about views different from your own
   Keep in mind that there is always
   individual variation within a group
   Don’t   make assumptions; ask

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