Cross-Cultural Clinical Skills Flashcards
what makes up external v internal culture
- External (visible) - clothing, art, buildings, food, festivals, observable mannerisms
- Internal (less visible) - values, norms, worldviews, expectations, beliefs
what is cultural destructiveness
Actively berating a person or community based on cultural background
what is cultural incapacity
- Willing to support culturally oriented practices
- Unable to actually provide support
What is cultural blindness
- Attempting to treat everyone the same regardless of culture
- Can miss key elements attributable to culture
what is cultural precompetency
- Recognizes culture is influential
- Attempts to make some improvements and adaptations
- No continuous improvement plan
what is cultural proficiency
- Values diversity
- Continuously implements and evaluates new ideas to improve culturally related care
- Actively educating on or researching cultural care
what is cultural competency
- True, 100% cultural competency can never be fully achieved!
- There is always room for improvement and change
describe the difference betwen disease and illness
- Disease: malfunctioning of physiologic and/or psychological processes in a patient
- Illness: psychosocial experience and meaning of perceived disease for patient, family and friends
what isthe western biomedical model
- Method most providers are taught by and most comfortable with
- Attributes symptoms and diseases to pathophysiologic or
etiologic causes - In many world cultures, religion and spirituality are closely tied to beliefs about disease
- Overlooking or disregarding these can cause problems!
what is the explanatory model
8 questions geared towards evaluating patient beliefs about illness, its etiology, the treatment they want and where they want to go next with their care.
What do you think caused your problem?
Why do you think it started when it did?
What do you think your sickness does to you?
How severe is your sickness? Will it have a short or long course?
What are the chief problems your sickness has caused for you?
What do you fear most about your sickness?
What kind of treatment do you think you should receive?
What are the most important results you hope to get from treatment?
what is the BATHE model
- Designed to elicit the psychosocial context of a situation, or life in general. Acts as a rough screening test for anxiety, depression and situational stress.
- B:: Background - “What’s going on in your life?”
- A: Affect - “How do you feel about that?”
- T: Trouble - “What troubles you the most about this?”
- H: Handling - “How are you handling that?”
- E: Empathy - “That must be very difficult for you.”
what is the BELIEF model
- Similar to Explanatory Model; adds in explicit opportunity for patient to educate the provider and the opportunity to express empathy in the structure of the interview.
- B: Beliefs - “What caused your illness/problem?”
- E: Explanation - “Why did your illness/problem happen at this time?”
- L: Learn - “Help me to understand your belief/opinion.”
- I: Impact - “How is this illness/problem impacting your life?”
- E: Empathy - “This must be very difficult for you.”
- F: Feelings - “How are you feeling about it?”
what is the ETHNIC model
- Geared towards improving cultural competence in particular; invites discussion of alternative treatments and healers and negotiation of plan of care.
- E: Explanation - “How do you explain your illness?”
- T: Treatment - “What treatment have you tried?”
- H: Healers - “Have you sought any advice from folk healers?”
- N: Negotiate - Find mutually acceptable options.
- I: Intervention - Agree on intervention/plan of care.
- C: Collaboration - Collaborate between family, patient and healers.
what is the LEARN model
- Geared towards improving cultural competence in particular; general framework of visit with multicultural patients including negotiation of treatment.
- L: Listen - listen to the patient’s perspective
- E: Explain - explain and share one’s own perspective
- A: Acknowledge - acknowledge differences and similarities between points of view
- R: Recommend - recommend a treatment plan
- N: Negotiate -negotiate a mutually agreed-on treatment plan
what is the 4 C’s model
- A pared-down version of the explanatory model.
- Call - What do you call your problem? (What do you think is wrong?)
- Cause - What do you think caused your problem?
- Cope - How have you been coping with your condition?
- Concerns - What are your concerns regarding this illness and its treatment?
what is spirituality
The search for meaning, purpose, and truth in life and the beliefs and values by which an individual lives
what is religion
Attempts to answer the search and questions posed by spirituality with a specific set of beliefs and practices
what is the HOPE model
- HOPE Model (Spirituality)
- H: Sources of hope, meaning, comfort, strength, peace,
love, connection - O: Organized Religion (level of identification and participation)
- P: Personal Spirituality / Practices
- E: Effects on medical care and end-of-life issues
what is the FICA model
- FICA Model (Spirituality)
- F: Faith and Spirituality
- I: Importance
- C: Community
- A: Address in Care
SPIRIT Model (spirituality)
- SPIRIT Model (Spirituality)
- S: Spiritual belief system
- P: Personal spirituality
- I: Integration within a spiritual community
- R: Ritualized practices/Restrictions
- I: Implications
- T: Terminal illness
what are some problems that could occur with limited english proficiency patients
these pts have more problems and less satisfaction
Poorer clinician-patient communication
- Poorer physician-patient rapport
- Less patient input on medical decision making
- Weaker patient education
Poorer routine patient care patient visits
- Less likely to receive preventative care
- Less likely to have a regular PCP
- Fewer provider visits overall
- Less follow-up after an ER visit
providers who participate in medicaide, medicare or any other FEDERALLY funded program are required to provide what services to LEP patients
oral language assistance
Bilingual clinician >inperson interpreter>remote interpreter>family
Family/friend → reduced pt trust, decreased pt satisfaction, confidentiality breaches, inaccurate communication, misdiagnosis, and inadequate or inaccurate treatment
what are the guidlines for the use of interpreters
- meet w interpreter first to form team approach
- choose interpretor of same gener/age or older
- advise that visit will last longer than normal visits
what are traditional healers
- often use natural materials, traditional knowledge passed down by other traditional healers
- May include herbalism, acupuncture, massage, religious ceremony, prayer, personal or family counseling, voodoo, spiritual leaders, herbalists, mediums, divination
- Some methods may produce physical signs
- Coining, cupping, moxibustion, pinching of skin
disregarding traditional healing can lead to what
alienation, noncompliance, missed follow-ups
