1. Transcultural Care

2. Culture
The shared values, traditions, norms, customs, arts, history, folklore, and institutions of a group of people that are unified by race, ethnicity, language, nationality, or religion.
Source: Office of Minority and Women’s Health, HRSA, NIH

3. Characteristics of Culture
Learned roles, behaviors, values, attitudes
Human nature, time, relationships, traditions
Health beliefs, religion or spirituality
Communication, decision-making, food/diet, grief/dying, family roles, sick roles.

4. Characteristics of Culture
Stabilizing forces and change agents
Social Structure
Family, politics, education, economics, art, history, physical environment, health care facilities, ethnicity

5. Criteria for Defining Culture
Common language/communication system
Similarities in dietary preferences
Common patterns of dress
Predictable relationships and socialization patterns
Shared values and beliefs

6. Personal Culture Personality, unique structure
Internal factors such as gender, age, sexual orientation
External factors such as society, personal experiences
Where one grows up or now lives
With or without children, with or without religious affiliation
Organizational/work influences
Position within work place and its location

7. Cultural Diversity
Difference in Race, ethnicity, language, nationality, or religion among various groups within a community is said to be culturally diverse if its residents include members of different groups.
Source: Office of Minority and Women’s Health. HRSA, NIH

8. Diversity
Differences can be found in communities that are bounded by similarities in ethnicity, language, religion, geography, history or politics.
Every interaction is cross-cultural!

9. Ethnicity
Identity one has based on ancestry and national, religious, tribal, linguistic or cultural origins.
Sense of belonging to a reference group within a society

10. Race Use of the term is debated
Biological term used to categorize people based on physical characteristics
Disregards genetic variations
Often used in discriminatory manner

11. Acculturation
Giving up traits of one culture and adopting those of another
Bicultural – function equally well in two cultures
Traditional – retains traits from culture of origin
Marginal – no traits from either culture or origin or new one in which he/she lives
Acculturated – gives up traits of original culture and adopts those of new culture

12. Assimilation
Social, political, and economic integration of a cultural group into a mainstream society
Usually requires a degree of acculturation
Many cultural groups may resist or reject acculturation
Communities develop in which people are insulated from main stream
Lack of political voice may disadvantage group

13. Ethnocentrism
Viewpoint that one’s own way of believing or behaving is correct and preferred
Ethnosensitivity
Process of becoming more sensitive and respectful of cross cultural differences

14. Cultural Competence
A set of academic and interpersonal skills that allow individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups. This requires a willingness and ability to draw on community-based values, traditions, and customs and to work with knowledgeable persons of and from the community in developing targeted interventions, communications and other support.
Source: Office of Minority and Women’s Health, HRSA, NIH

15. 5 Elements of Cultural Competence
Awareness and acceptance of differences
Self-awareness or individual or organizational culture
Understanding the dynamics of difference
Integration of cultural knowledge within individuals and systems
Adaptation to diversity

16. Steps to Cultural Competence
Awareness
Becoming aware of other cultural viewpoints and taking into account the diversity in values, beliefs, practices, lifestyles and problem solving strategies
Examination of one’s own culture, learned biases and prejudices

17. Knowledge
Learning about historical, social, political and/or religious influences that affect another’s worldview
Distinguishing between an individual’s traits and those common to a community or people with similar origins
Give and take of ideas and knowledge for effective interpersonal relationships

18. Skills
Integrating awareness and knowledge into western bio-medical system during a cross-cultural encounter to achieve “culture-specific, individualized interventions
Collecting relevant cultural data in both a history and physical assessment
Ability to generate conversation not confrontation
Partnerships instead of misunderstandings

19. Cultural Encounters
Cross-cultural interactions that allow new learning or refinement of knowledge and beliefs
Prevent stereotyping as the experience of interaction reveals intra-cultural group variation

20. Medical Interpreters
People who orally translates a message spoken in one language into another language
People who are fluent in both languages
People who are not relatives of the patient
People who have received professional training

21. Use of Interpreters Secure an interpreter for people who:
Are non-English speaking
Are limited English proficient
Have limited understanding of health care issues in the English language

22. Professional Interpreters VS Untrained Interpreters
Professional interpreters have been screened to assure fluency in both languages
Untrained interpreters may:
Omit important information
Add ideas
Answer for the patient
Give advice even if they don’t understand

23. Family and Friends Used as Interpreters
May commit all of the errors as other untrained interpreters
May cause the patient to not feel comfortable sharing information
May react to a situation or information rather than serve as an interpreter
May make decisions for the patient
There may be a breach of confidentiality

24. Acceptable Interpreters
Bilingual staff that is trained and demonstrates competence
Contract interpreters
Community volunteers who are competent interpreters
Telephone interpreter services

25. Working Effectively Through an Interpreter
Conduct pre-session to introduce yourself and goals for the encounter
Speak directly to the patient
Speak slowly in short segments with pauses
Ask that everything you and the patient and family says is interpreted
Be aware there may not be linguistic equivalence for some terms

26. Things to Avoid Highly idiomatic speech Complicated sentence structure
Sentence fragments
Changing an idea in mid-sentence
Asking more than one question at a time

27. Tips
Have the interpreter ask questions and alert you to cultural misunderstandings
Respect an interpreter’s opinion that a question may be culturally inappropriate
Avoid patronizing or demeaning the patient
Be patient as this may take more time

28. Roles of the Interpreter
Conduit of Information
Clarifier: Facilitates understanding when no linguistic equivalence exists
Culture Broker: Provides a cultural framework for understanding when cultural differences are leading to a misunderstanding
Advocate: Actions to eliminate systematic barriers to quality care