cult comp combined and revised 3

cult comp combined and revised 3 - Cultural Competency...

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Unformatted text preview: Cultural Competency Cultural Lisa Z. Killinger, DC Palmer College Diagnosis/Research What is “cultural competency”? “cultural What is “cultural competency”? What Set of skills, knowledge & attitudes related to a clinician’s: clinician’s: understanding and respect for patients’ values, understanding beliefs, expectations beliefs, awareness of his/her own assumptions and awareness value system value ability to adapt care to be congruent with ability patients’ expectations and preferences. patients’ Definitions Definitions Ethnicity : self-defined group identity in self-defined religion nationality nationality culture Culture: shared beliefs & values affecting social interactions interpretation of experience Race: A biological concept (Cannot change) Examples of different cultures of chiropractic patients chiropractic • Sex male/female male/female sexual sexual orientation orientation • Age children adolescents elderly • Income/education • Race/ethnicity • Religion WHY should DCs be “culturally competent”? competent”? • US population is increasingly culturally US diverse diverse • Different cultures have different health Different behavior and health risks behavior • Doctor-patient communication and rapport Doctor-patient are affected by cultural differences are This affects outcomes! When we improve cultural competency, we... competency, • “Reach” patients more effectively • Enhance the quality of the Enhance doctor/patient interaction doctor/patient • Improve patient compliance • Achieve better health outcomes!! And… • We enrich ourselves... Racial Distribution of US Population 2000 2000 Native Am. Native Asian Afr-Am Hispanic Caucasian Caucasian (72%) (72%) Oth er Racial Distribution of US Population 2020 2020 Na t. A m. As ian Caucasian ic nic pan pa His His Afr -Am Are we keeping pace with these changes? these Interesting Factoids: The “mixed Interesting mixed ethnicity” category is the fastest ethnicity category growing sub-population in the US. Hispanics are the fastest growing specific ethnicity in the US (aside from mixed ethnicity). (aside Our society’s growing diversity is not a problem (& it’s certainly not going away!) (& It’s an opportunity for us all to gain from each other’s cultural wealth. cultural So…. So…. how does diversity affect us here at Palmer, (and in practice) and how do WE become more “culturally competent”? become Diversity: Diversity: US population vs. chiropractic patients (% Non-Caucasian) General population (2000) DC patients (1974-82) DC patients (1997-98) 35-45% 4% 5% 5% Ethnic diversity in the US MD and DC workforce MD • • • • • % Non-Caucasian Non-Caucasian General population ~40% MDs 7% MD students (2000) 34% DCs 7% DC students (PCC 2002) 9% U.S. Chiropractors U.S. 1991 1991 Female 13.3% Female Asia n 0.8 Hispanic 1.6 African American 0.5 Native Amer. 0.2 1998 19.2% 1.8 1.7 0.6 0.8 0.8 Gen. Gen. pop. pop. 51% 51% 4 13 12 1 Some keys to cultural competency: Some • Fight your fear of Fight the unknown the • Learn about Learn someone different someone • Don’t let time Don’t pressures rob you of patience and tolerance tolerance • Ask questions, and Ask LISTEN! LISTEN! • Recognize that Recognize different does not = inferior. inferior. • Let your heart Let lead; (your head just wouldn’t understand!) Cultural Communication Issues Cultural • Language (spoken and written) Non-English speakers Educational level Acceptable topics • Voice Loudness/pitch Silence • Body language personal space touch gestures/facial expressions eye contact Hot Tip: Hot An African American patient may make great use of facial expressions to show approval or disapproval, or to influence the behavior/attitudes of others. Be aware of your patient’s facial expressions! Be Cultures, Cultures, in the clinic... • • • • • • Body language (examples, anyone?) Eye contact or no? Voice tone and vocal-ness Facial expressions Modesty RESPECT Your patient’s culture! Hot Tip: Hot Arab, Asian, or Indo-Pakistani students (and others) may show respect for you by respect lowering their gaze (not making eye contact). Such behavior does not reflect a lack of interest or respect. lack Cultures Cultures in the clinical setting…. • • • • The challenges The great communication divide Crossing the divide with grace The right ‘match’ Hot Tip: Hot A practicing Muslim or Orthodox Jewish female patient or student may be unwilling to be partnered with a male student/doctor, and may not wish to uncover her hair, arms, legs or torso due to the value placed in these faiths on modesty. value Case Study: Hispanic Culture Case • Family over Family individual individual • Respect for Respect hierarchy hierarchy • Belief in spirits, Belief and the evil eye and • Includes family in Includes health decisions health • Patient may expect Patient Dr. to wear a white coat, (and to perform miracles!) perform • Provider, while Provider, respecting beliefs, may need to stress the importance of adhering to care plan plan WARNING!!! WARNING!!! • Since every patient (of any ethnicity Since or faith) is an individual, NEVER assume anything about their beliefs. (See next slide) (See • Remember all minority persons are Remember Bi-Cultural (at least!). They meld 2 or Bi-Cultural more value systems every day! more • Identify strengths in your Identify patient/students cultural orientation and build on them. build Different cultures and ethnicities Different have different health behaviors and health risks US Health Disparities (Behavior): Reduced Physical Activity Reduced • • • • Women Lower income/education African-Americans and Hispanics Older adults by age 75, 33% men, 50% women by have no physical activity at all have S o urc e : He althy Pe o p le 2010 US Health Disparities (Behavior): Smoking Smoking • Teens: 39% Caucasian 33% Hispanic 20% African American • Adults: Highest in Native Amer, blue collar and Highest military military HS dropouts 3x rate of college grads Health Disparities (Behavior): Overweight/obesity* Overweight/obesity* • >60% of Americans are >60% overweight/obese!! overweight/obese!! • Esp. low income women and teens • African American/Mexican American African women have highest rates of obesity women *overweight: BMI ≥ 25; obese: BMI ≥ 30 Chronic Low Back Disability Chronic (by race) • Activity limitation, rate per 1000 adults: Asian 15 Hispanic 28 Caucasian 32 African American 36 Native American 68 Health Disparities: Health Chronic Low Back Disability Chronic by income and education 77 54 24 poor mid/high 35 hs hs hs hs drop grad drop grad 28 some some coll coll Activity limitation, rate per 1000 adults Health Disparities: Health Diabetes Diabetes 18% 25 20 15 14% 16% 8% 10 5 0 a g e s 50-59 Cauc. Afr-Am Mex-Am Native Native Am. Am. Disparities in Health Risk: Intentional Injury Intentional • • • Homicide 3rd COD ages 5-14 Homicide 2nd COD ages 15-24 Homicide rate for Afr. Am. aged 15-24 Homicide 2x rate for Hispanics and 14x rate for Caucasians Caucasians • Suicide 3rd COD ages 15-24; Suicide Caucasians highest Caucasians OK, OK, I GET IT. There are differences between cultures! between So, what should I do? Developing Cultural Competency in Yourself: in • • • • Turn pre-conceived notions into questions Turn questions Use or develop empathy Tread lightly, and if you don’t know, ask Tread ask Express respect for the patient’s Express values/culture/faith values/culture/faith • Become familiar with your own attitudes about Become cultures/faiths. Do you stress assimilation or value maintenance of patient’s/students cultural traditions? cultural To gain information about a patient’s health beliefs, ASK! patient’s ASK! • • • • What do you think caused your problem? Why do you think it started when it did? How severe do you think it is? What are the main problems this has What caused for you? caused • What kind of care do YOU think you What should receive? should • What results do you hope to receive? Read all about it…. Read • Kiss, bow , or shake hands? (Morrison) • Cultural Health Assessment-Mosby’s Cultural Pocket Guide (D’Avanzo and Geissler) (D’Avanzo Try not to be a cultural klutz. Your patients will thank you! will ...
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