Care Providers Culture_Dr Ibrahim Aziz

7/31/2019 Care Providers Culture_Dr Ibrahim Aziz

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Does the culture of care

providers affect outcomes inpatient care?

Dr. Ibrahim AzizMBBS(Dhk), M.Med., PGDip.Med (Palliative Care)

10th Malaysian Hospice Congress1st ~ 3rd June 2012


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Outline

What is culture?

Does the culture of care providers affectoutcomes in patient care?

In palliative care context

Case scenario How to improve outcome in patient care


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Introduction

Healthcare in a multicultural society

Ethnic groups

Cultural diversity

Malaysia as an example

But ethnicity is only one factor


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What is culture?Culture refers to patterns or standards of

behaviour that one acquires as member of aparticular group (Masi, 1988).

Our race, gender, religion, ethnicity and

socioeconomic status all contribute to shaping

our values and behaviours, as well as to how

we view the world.


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How they view the world


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Culture

Culture may not make our

hearts beat, but it shapesthe rhythm and texture of

our lives (Collen, 2011)


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Rhythm and texture


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Like a fish in the water


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Culture

Culture guides our thinking,

doing and being, andbecomes patterned

expressions of who we are(Basic Nursing, 2003)


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Swan lake ballerina dancer


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So does the culture of care providers

affect outcome in patient care?


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Gibson (2008)

Providers preconception =

barrier to competent care


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Brach and Fraser (2000).

Cultural competency = betteroutcome


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Smedley et al.(2003)

Cultural differences = deficiencies ofcare


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Dayasiri (2010)

Cross-cultural issues = hastendeterioration


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No effect physically


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How and why do the culture of providersaffect outcome in patient care?


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Perception and attitudes

Differ between cultures

About origin of disease Appropriateness of treatment

Health care providers

Robbins (2005)


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Disrespectful

Leads to mistreatment

Decreased patient compliance Lack of informed consent

Increase risk of liability for malpractice


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Behaviours and attitudes

Impact how illness is manifested

Including symptoms of the disease Whether or not patient will seek

treatment at all


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Judgement about beliefs and values

Be non-judgemental

Important for physicians


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Cultural differences

Influence what treatment options are

offered (Gibson, 2008) How services are organized and

financed


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Cultural competence

Can have real impact on clinical

outcomes


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Bias inherent

Naturally make assumptions about

others


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Guests of one of the Chinese resorts coated with black mud, 2May 2007. They say that mineral-rich mud has healing propertiesthat favorably affect the skin. (REUTERS / China Daily).


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Provider-patient relationships

Effective communication

Awareness of social and culturalconstructs

Respect for those differences


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Communication

Patients need

Understand diagnoses Given treatment options

Make cooperative decisions


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When language is a barrier

Translator needed

May have limitation Not only bilingual but also bicultural


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Physician as authority figure

May affect outcome in patient care


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Cleansing ritual child who conduct religious adherents Boss,July 15, 2007. Such women are called Komians, it is believedthat they possess supernatural healing powers. (REUTERS /Luc Gnago)


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Ethnic and cultural heritage

Influential

Shaping attitudes Beliefs

Behaviours

Health care (Taylors, 2011)


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Diverse values and belief systems

Have significant impact

On progression of disease Treatment outcome

Patient-physician relationship


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Cultural awareness

Foundation

Communication Acceptance

Success


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In palliative care context


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Patients view and perspective

Culture = glasses

View of life limiting illness


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When losing control

Culture = basic core beliefs

They hold on to (Thomas, 2001)


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Different cultures

Cultural sensitivity

Targets entire person Not just physical ailment


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Cultural diversity

Address this

Help maintain comfort & dignity Respect & value uniqueness


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Cross-cultural factors

Be receptive

Enhance provider-patient relationship Facilitate provision of care

Strengthen patients coping skills

Help adjust deteriorating clinical status

Gain family & social support


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Culturally appropriate care

Maintain QOL

Support individual Culture

Linguistic preference

Spiritual needs


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Cultural competence

Requires

Acquisition of specific knowledge Clinical skills

Attitudes


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Cultural competence (cont)

Facilitate

Cross-cultural negotiation in clinical setting Improved outcomes & decrease disparities


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Death & dying

Significant & sacred events

Respect & support Customs

Beliefs

Rituals

Practices


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Collusion

Asian family

Family member direct treatment(Chaturvedi, Loiselle & Chandra, 2009)


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Advancement in palliative care

Emotional & spiritual context

Easily untangled> If culture is considered (Todd et.al, 2006)


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Case scenario

Dr Tan, a palliative care physician, is

treating an elderly Malay woman whohas been diagnosed with an advancedliver cancer and general debility.

He found her generally uncooperative


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Case scenario (cont)

and her family told him that the patient

refuses to take the medicationsprescribed, refuse to get out of bed and

prefer rather to be left alone to die in

peace


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Dr Tan learns that she believes that her

illness is a punishment for her pastwrong doings.

As such, she is convinced that efforts tohelp her are pointless and that she is

destined to die for her sins.


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What would your reaction be if you were

in a similar situation?


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In discussion with the patient, Dr Tan

learns that she would like to be free ofpain and be able to go to the bathroomindependently, to wash and pray, so shecould ask forgiveness from God for her

past wrong doings.


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She agrees to participate in therapy to

pursue this goal. This represent a start for Dr Tan and his

patient to begin working together toestablish an open and trusting

relationship and further explore thegoals and options for therapy.


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Another example

Lets say youre doing an assessment of

a person who talks very quietly andkeeps their eyes on the ground.

What is your impression?


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How to improve outcome in patient care?


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No right answer

Each situation is unique

Be interested in your own culture Understand your own culture and value

system

Cultural awareness


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Perception of health and illness

How does the patient and the family view

illness?


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Role of family in decision making

Who makes the decision?

Patient? Family-on behalf?

In conjunction?


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Customs and rituals

How do these affect the delivery of

health care? Could the ritual be incorporated into

care?


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An understanding of specific culture andreligion

Practices around death, dying and

bereavement Identify and support

individual needs and preferences


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Medicine and palliative care in itself is aculture

Specific procedures and protocols

Standardized models Care providers must now rethink some

of these standardized models(Kavanaugh & Gardiner, 2003)


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Areas to observe

Staffing issues

Nutritional needs Traditional methods for healing

Spiritual needs and care

Beliefs regarding illness End-of-life care

Decision making


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Areas to observe (cont)

Past life experiences

Avoid stereotyping Care providers

Good communication

Language barriers Nonverbal communication


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Conclusion

Compromise and understanding are thekeys

Culturally sensitive care results in morepositive outcomes

Care Providers Culture_Dr Ibrahim Aziz

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