LEC 9: Cultural Safety & Cultural Competence Flashcards
Can you ever truly be competent in another’s culture?
No, you will never truly know what someone’s view and beliefs are
- Need to take a client based approach
Why cultural competence and safety?
- Increasing number of minority populations
- 19.1% if Canadiens identify as members if visible minorities (Statistics Canada, 2015)
- 8.4% of Canadian nurses graduated from an international program (CNA, 2010) - Notable health disparities for minority porpulations
- Despite efforts to develop CC policies, strategies, and interventions, culturally unsafe care persist
- Cultural issues are intertwined with socio-economic and political issues
What is culture?
- Culture is the processes that happen between individuals and groups within organizations and society that confer meaning and significance (CNA, 2010)
- Cultures and cultural norms are not discovered, rather they are constructed (Allen, 1999)
- We all belong to many different cultures at once, we never really belong to one culture
Cultural Competence (CC)
- The application of knowledge, skills, and personal attributes to maximize respectful relationships with diverse populations of clients and co-workers (CNA, 2010)
- Congruent behaviours, attitudes, and policies that align in a system or agency enabling providers to work effectively in cross-cultural care (CNA, 2010)
- Shown to lead to improve health outcome
- CC is supported by cultural diversity
What are key values in cultural competence (CC)?
- Inclusivity
- Respect
- Valuing differences
- Equity
- Commitment
What can cultural diversity catalyze?
Cultural diversity can catalyze new:
- Ideas
- Knowledge
- Creativity
- Productivity
- Partnership
Cultural Safety (CS)
- Action to protect from danger and reduce risks to health and well-being hazards (Racine, 2014)
- Action or inaction that does not respect the cultural background of a client is considered cultural unsafe care (Racine, 2014)
- Fostering cultural safety (CS) is addressing root causes of health inequities
What is situated vulnerabilities?
Everyone is in a place of vulnerability since we have all felt excluded at some point in our lives
Cultural Competence & Safety in Practice
- Expression of cultural Intolerance persist within health disciplines
- The same level of safety and proficient care is provided for individuals from any type of cultural or ethnic background
- Employers must create environments that value diversity
- Clients are responsible for choosing the information they share that will impact their healthcare
- CC is an expected standard for all professional interactions
- RNs must engage in critical self-reflection and critique of structures, discourses, power relations, and assumptions
Why do health professions struggle with being culturally competent?
- How we understand culture can be problematic
- Unease with the unknown
- It’s not prioritized
Since CC and CS is not prioritized- what does the system value?
- System is set up based on a biomedical approach
- Desire measurable outcomes
- Structural contraints/ violence
What are some cultural approaches RNs can take?
- Getting an interpreter
- Using client centered care approach; finding out what the client’s goal is
- Being sensitive with how you are promoting health care to others
- Co-ordinate with other traditional healers
What is structural violence?
- Policies we have in place that do not make it easy for everyone to access
- Its about looking at the system as a whole and where the disadvantage effect different people
Why we don’t teach about “culture”
- Medical anthropology
- Nursing in Canada, it’s not what we do
- Culture is very individualized to the person and group
Medial Anthropology
The study of how culture and society organizes/ influences health and health care
How is culture very individualized to the person and group?
- May be variations across groups of same “culture”
- May be variations across individuals within a group
- May be different levels of practice or understanding/belief
- Do NOT assume that because you “know” about culture, you “know” about your client’s culture
US: What can RNs do?
Focus on “Transcultural Nursing” which originally was influence by medical anthropology
- Still has more “anthropology” feel to it
- US textbook: cultural “information” which may be stereotyped, inaccurate, or not accepted by individuals
Canada: What can RNs do?
Use cultural competency and cultural safety
- Models that can apply to anyone in any setting
- Not “culture” (ethnicity) specific knowledge but more general approaches to client care encounters
What are the five things that Campinha-Bacote’s Model of Care focuses on?
- Awareness
- Knowledge
- Skill
- Encounters
- Desire
Campinha-Bacote’s Model of Care: Awarness
Self-examination of your own background and biases
- Avoid cultural imposition
Campinha-Bacote’s Model of Care: Knowledge
Seek knowledge from the client and family
Campinha-Bacote’s Model of Care: Skill
- What information is relevant to providing care?
- Are there assessments you can do?
Campinha-Bacote’s Model of Care: Encounters
Interactions with clients without judgment
Campinha-Bacote’s Model of Care: Desire
The WANT to be culturally competent to improve quality of care
Campinha-Bacote’s Model of Care: Key Points
- Developments of Cultural Competence is a process which takes time and place
- Key stating point is to look at our own assumptions, biases, values, and prior experiences with others
- Have we had negative experiences? If so work through these - Start with the client and work out from there
- Use additional resources as “guidelines not gospel”
- May or may not be right for/used by your client
What are the six things that Griger & Davidhizar’s Transcultural Assessment Model focuses on?
- Communication
- Space
- Social
- Time
- Environment control
- Biology
Griger & Davidhizar’s Transcultural Assessment Model: Communication
Verbal and non-verbal communication
Griger & Davidhizar’s Transcultural Assessment Model: Space
Personal space preferences and/or needs
Griger & Davidhizar’s Transcultural Assessment Model: Social
Social roles, family, culture, and religion values
Griger & Davidhizar’s Transcultural Assessment Model: Time
Time orientation may impact on health practices
Griger & Davidhizar’s Transcultural Assessment Model: Environment Control
Internal or external control and factors
Griger & Davidhizar’s Transcultural Assessment Model: Biology
- Think of “personalized medicine”
- Each person’s own body system reacts to medical treatment
Griger & Davidhizar’s Transcultural Assesement Model: Key Points
- Use TAM in client encounters as a way to determining what you need to know to work with this person
- Takes their own unique situation into account
- Lets you find out about their own cultural needs/ practices - Environmental control: More about perceptions of internal control (I’m the boss of me_ vs external control (it’s up to God/fate/ etc) than about the “environment”
- Biology: May be links to ethnicity but don’t assume. Treat each client in an individual way
Summary: CC & CS
- In Canada, treat each client as an individual and work with the client to determine care needs and preferences
- Golden rule: “Do unto others as you would have done unto you”
- Can use models as “starting points” for conversations with your client- but have the conversation
- Be aware of stereotypes and biases- work to reduce these
