Multicultural Opportunities for Success in Hospital ... · Multicultural Opportunities for Success...

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05142011 MC_HospitalPresentation_60Minutes_HAguiar

Multicultural Opportunities for Success in Hospital Services

60 Minute PPT Presentation Script

Instructions prior to presentation

This is a script to accompany the PPT “Cultural & Religious Considerations in End-of-Life Care &

the Donation Decision.” This presentation is one Hospital Services staff can use to provide

healthcare professionals with multicultural education. The instructor should follow the script

with the correlating slide number. Never remove slides if you chose not to use them. Only hide

them. This way the slide number will continue to correlate with the script. Verbiage in green

font are instructions for the instructor. Verbiage in black font are to be read or recounted to the

audience. Prior to using this presentation for the first time, the instructor should read through

the script with the PPT in slideshow view a few times to ensure they are comfortable with the

material. References do not need to be read, they are for the benefit of the instructor should

they wish to research the topic further. Important: Review slide 24 and 25 now and read the

instructions so you can hide the slides if you don’t want or can’t use them. Also, review the

instructions after slide 27. It is crucial you prepare the correct slides for your audience and

follow the instructions and script closely.

Be prepared with: handouts of the PPT presentation – the handout version, two self-

assessment tools per learner, one cultural self-reflection per learner

Make sure you place your name, title and organization on the title page.

Slide 1 (Title-slide)

Provide personal introduction and distribute self-assessment face-down, then read this text

before providing instructions about the self-assessment.

Today we are going to explore cultural & religious considerations in end-of-life care and the

donation decision. Before we start with the presentation, I want you to take 5-7 minutes to

complete this self-assessment. Please place your initials, first, middle, and last initial, using an

“’X” if you don’t have a middle initial and your birth-year at the top of the page. Don’t spend

time analyzing the questions, just answer what comes to your mind and please be as honest

with yourself as you can. When you are done, please turn the paper back face-down.

Give 5-7 minutes for self-assessment completion.

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Slide 2

As we go through this presentation I would like you to think about this question,

Read the questions to run on.

This is not a discussion question, just a thought question for them to consider.

So, let’s get started…

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Slide 3

If you saw this little girl, what would be the first thing that goes through your mind with regards

to her culture and possible religion?

Let the learner/s answer questions and stimulate them to express their thoughts and

assumptions about this girl, e.g. she’s Caucasian, probably loves watching TV, playing with her

dolls, eating chicken nuggets and fries, protestant or catholic, etc.

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Slide 4

Now if you see the little girl in this context, does it change your initial assumption?

What are you thinking now?

Allow a short discussion amongst learner/s or if the learners are not engaging, you can confirm

that the picture has changed significantly and changes our perspective.

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Slide 5

The objectives for this presentation are that by the end of the presentation you will be able to:

1. Understand the definitions of culture, race, and ethnicity

2. Recognize nursing theory supporting cultural competence

3. Recognize the risk of cultural assumption and imposition

4. Be empowered to draw upon their professional strengths

5. Be equipped with practical tips to become culturally skilled

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Slide 6

This presentation will be broken into four segments. During the first section we will lay the

foundations and clarify some operational definitions of culture, race, and ethnicity, to make

sure we are on the same page with our definitions as we go through the presentation.

During the second segment, we will discuss why it is important and also required to develop

multicultural skills.

In the third segment we will explore the risk of cultural assumptions and cultural imposition, we

will briefly review some cultural beliefs about death and dying and donation, as well as discuss

how to develop cross-cultural communication skills, and how to communicate with

patients/families of any culture.

Finally, we conclude with the forth segment, in which you will be provided with basic principles

and tips that you can apply as you work with and meet people of various cultures.

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Slide 7

So let’s start with laying some foundations and let’s talk about some definitions.

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Slide 8

A definition of culture must encompass various variables such as:

• Ethnography , e.g. nationality, ethnicity, language, and religion

• Demography, e.g. age, gender, place of residence, and generation

• Status, e.g. social, economic, and education

• Affiliations, e.g. formal and informal group memberships

Ref. Friedman, M.M., Bowden, V.R., & Jones, E.G. (2003). Family nursing. Research, theory, and practice. (5th

ed.)

Upper Saddle River, NJ: Pearson Education, Inc.

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Slide 9

Bomar (female) provides a great definition that captures those variables well:

Read the definition on the slide.

Ref. Bomar, P.J. (2004). Promoting health in families. Applying family research and theory to nursing practice. (3rd

ed.). Philadelphia, PA: Elsevier, Inc.

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Slide 10

Here is a clear and succinct definition of ethnicity:



ed.)


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Slide 11

Race is defined as - Read the definition on the slide.

It is a narrower term then ethnicity and denotes a human biological definition.

Ref. Bomar, P.J. (2004). Promoting health in families. Applying family research and theory to nursing practice. (3rd

.).

Philadelphia, PA: Elsevier, Inc.

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Slide 12

It is very important we make some clear distinctions and provide clarifications:

• Race and ethnicity should never be confused with each other

• Race is purely a reference of an individual’s physical characteristics such as skin color,

facial features, and hair texture

• However people of one race can vary in terms of their ethnicity and culture – for

example, in the white race there are perhaps a hundred or more different ethnic

groups. I am sure you can think of other examples.


ed.)


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Slide 13

Continue to read the script.

• Using race is not a correct or useful manner for classifying people. There has been

substantial genetic breeding within the world, consequently there is no such thing as a

distinct and pure race today.

• It is also important to remember that religion is very much entwined with ethnicity.

Religion can be a vital shaper of health values, beliefs, and practices.


ed.)


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Slide 14

So, after laying these foundational definitions, ask yourself:


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Slide 15

This leads us into this next segment, the need and requirement to develop multicultural skills.

There is nursing theory available to underpin care of patients of various cultures and there are

regulatory standards and requirements imposed upon hospitals to ensure staff are

multiculturally skilled.

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Slide 16

Madeleine Leininger is a nurse theorist who after living in a remote village and tribe and studied

anthropology, created the transcultural nursing theory and stressed the importance of cultural

competence and culturally congruent care. She also founded the Transcultural Nursing Society

and the Journal of Transcultural Nursing.

Ref. Founded in 1998: Transcultural Nursing Society website: www.tcns.org

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Slide 17

In 1994, Leininger stated that nurses are realizing the critical need to become more culturally

competent and knowledgeable in working with individuals of diverse cultures.

But how does one define cultural competence? Well, before we define cultural competence we

are going to look at the regulations and standards imposed upon hospitals requiring cultural

competence.

Ref. Leininger, M. (1994). Transcultural nursing education: A worldwide imperative. Nursing & Health Care, 15(5),

254-257.

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Slide 18

The Joint Commission and the Department of Health & Human Services have standards set

forth for the hospitals. Root cause analysis of sentinel events has demonstrated that many of

these occur due to poor communication, which has led to many standards set by The Joint

Commission, which reference the importance of understanding, acknowledging, and respecting

a patient’s culture.

Ref. The Joint Commission (2010). Advancing effective communication, cultural competence, and patient- and

family-centered care: a roadmap for hospitals. Retrieved from

http://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf.

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Slide 19

The DHHS has 14 national standards on Culturally and Linguistically Appropriate Services (CLAS)

divided into

• Culturally competent care

• Language access services

• Organizational supports for cultural competence

Office of Minority Health (2007). National standards on culturally and linguistically appropriate services (CLAS).

Retrieved from http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15.

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Slide 20

Read the slide.




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Slide 21

Another part to the Joint Commissions definition of cultural competence is the requirement of

the organization and their personnel to value diversity, assess themselves, manage the

dynamics of difference, acquire and institutionalize cultural knowledge, and adapt to diversity

and the cultural contexts of individuals and communities served; as well as to be culturally and

linguistically appropriate.




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Slide 22

Some may argue that cultural competence is not attainable. Galanti said it best when she

stated:

Read the slide.

Ref. Galanti, G.A. (2008). Caring for patients from different cultures. (4th

ed). Philadelphia, PA: University of

Pennsylvania Press.

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Slide 23

Now we are going to explore the risk of cultural assumptions and cultural imposition, review

some cultural beliefs about death and dying and donation and how to communicate with

patients/families of any culture. We will also discuss how to develop cross-cultural

communication skills.

NEXT SLIDE

The next two slides belong together and are optional. You will need internet connection for the

video to work. If you do not have video connection, right click on each of the two slides and

select to “hide slide”. When you have it in presentation mode, the hidden slides will not show

up. If you use the video, test the link in presentation mode to a) make sure it works and b) to

load the connection. It will speed up connecting to the video when you actually go through the

presentation.

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Slide 24

We are now going to watch a short video. It highlights well how we as individuals sometimes

think. We will talk about the video after you have seen it.

Click on the hyperlink. After the video is done, close the internet page and go back to the PPT.

This video actually ends with Elaine saying disappointingly, “so we are just a couple of white

people?” and Darrell says, “let’s go to the gap”.

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Slide 25

In watching this clip,….

Ask the questions and allow for a little discussion if the audience wants to give their input, if the

audience doesn’t engage in discussion, you can use the questions as rhetoric questions, asking

the learners to consider these questions.

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Slide 26

There is a tendency to make an assumption about someone’s culture by observation;

evaluation of the individual’s dress, appearance, speech, and education. For example,

sometimes people make the assumption that someone with a thick accent is not very intelligent

or not as educated. Or sometimes the attire can lead to the assumption that someone is not

well educated. Have you ever noticed how people treat you differently based on how you are

dressed, e.g. in jeans and with a sweater versus in professional attire? Another example – in

some cultures eye contact in a conversation or discussion is a sign of aggression or defiance and

it is considered more respectful to avert the eyes. However, in other cultures, a lack of eye

contact signifies a lack of respect of a lack of attention and/or interest.

The problem is that our unspoken assumptions based on our observations can influence and

direct our interactions and communication with the individual.

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Slide 27

We all have our preconceived ideas about cultures, how they may deal with their grief and

death, as well as their biases towards donation whether they are positive or negative. Some of

our ideas may be correct or partially correct, but never as a general assumption. Some of those

beliefs may be deeply rooted in mistrust towards the healthcare system, for example, the

Tuskegee incidence in the 30’s. Are you familiar with the Tuskegee incidence? If the learners

are familiar, you can move onto the next slide. If they are not familiar with this incidence then

read the next section:

(The incidence relates to a syphilis study that was conducted by the Public Health Service in

1932, in which 400 poor black men with syphilis were recruited into the study but were not told

they had syphilis, nor were they treated. The only thing they received was free medical exams,

free meals, and free burial insurance. Even after the study was completed and penicillin was

confirmed to be an effective course of treatment for syphilis, these men were still not offered

this treatment as the researchers wanted to study how the disease spreads and kills. This study

continued for 40 years and many men died and many others, women and children were

infected. In 1973 the National Association for the Advancement of Colored People (NAACP)

filed a lawsuit and a $9 million settlement was divided amongst the participants. It wasn’t till

1997 that the government formally apologized for this unethical study.

Ref. National Public Radio (2011). Remembering Tuskegee. Retrieved from

http://www.npr.org/programs/morning/features/2002/jul/tuskegee/)

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For the next segment, use two or three of the cultural slides which are most likely to be

representative of the nurse’s ethnicities represented in the room. For each slide you will follow

the same process.

(If, and this is very unlikely, there are no cultures represented in the room who relate to the

cultures represented on the next few slides, pick two or three of them that reflect the most

likely cultures represented in the community. Go over the slides and intro the slides by saying,

“taken from a book called ‘Culture & Nursing Care‘, we are provided with information about

various cultures and their values and practices in sickness, death and dying, and donation. I

have selected two/three cultures represented in our community. Interestingly, the book does not

provide any information about any of the Eastern European or White American culture. As we

have learned by now, we all have our own culture. Let’s look at what the book says about the

next few cultures.”)

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Intro the next few slides by using the sentence in the parenthesis above if you don’t have the

cultures represented in the room, otherwise use this intro sentence.

The information on the following slides was taken from the book ‘Culture & Nursing Care ‘:

Ref. Lipson, J.G., Dibble, S.L., & Minarik, P.S. (1996). Culture & nursing care: A pocket guide. San Francisco, CA: The

Regents, University of California.

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Slide 28

Who in this room, relates to the Cambodian culture? Encourage the audience members to raise

their hands.)

According to the book Cambodians have these beliefs and values:

If nobody in the room represents the cultures you are presenting, read the slide and then go to

the next slide now.

Otherwise, read the slide, then ask the next questions….(adjust / limit your question if there is

only one person representing the culture or if everyone of the culture agrees with the

information provided on the slide.)

For those of you who are Cambodians, who agrees with the information provided by the book?

Please raise your hand. Take your time asking the questions. Who of you disagree with the

information provided by the book? Please raise your hand. You don’t need to elaborate on why

they agree or disagree, but if they volunteer information, let them speak and then move on.



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Slide 29

Let’s see what the book says about another culture.

Who in this room, relates to the Native American culture? Encourage the audience members to

raise their hands.)

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According to the book Native Americans have these beliefs and values:


the next slide now.

Otherwise, read the slide, then ask the next questions…. (adjust / limit your question if there is



For those of you who are Native Americans, who agrees with the information provided by the

book? Please raise your hand. Take your time asking the questions. Who of you disagree with

the information provided by the book? Please raise your hand. You don’t need to elaborate on

why they agree or disagree, but if they volunteer information, let them speak and then move

on.




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Slide 30


Who in this room, relates to the Hmong culture? Encourage the audience members to raise

their hands.)

According to the book, Hmongs have these beliefs and values:


the next slide now.




For those of you who are Hmongs, who agrees with the information provided by the book?




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Slide 31


Who in this room, relates to the Korean culture? Encourage the audience members to raise

their hands.)

According to the book, Koreans have these beliefs and values:


the next slide now.




For those of you who are Koreans, who agrees with the information provided by the book?







NEXT SLIDE

Slide 32


Who in this room, relates to the Filipino culture? Encourage the audience members to raise

their hands.)

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According to the book, Filipinos have these beliefs and values:


the next slide now.




For those of you who are Filipinos, who agrees with the information provided by the book?







NEXT SLIDE

Slide 33


Who in this room, relates to the Hispanic culture? Encourage the audience members to raise

their hands.)

According to the book, Hispanics have these beliefs and values:


the next slide now.




For those of you who are Hispanics, who agrees with the information provided by the book?





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Slide 34


Who in this room, relates to the Iranian culture? Encourage the audience members to raise

their hands.)

According to the book, Iranians or Persians have these beliefs and values:


the next slide now.




For those of you who are Persians, who agrees with the information provided by the book?







NEXT SLIDE

Slide 35


Who in this room, relates to the African American culture? Encourage the audience members to

raise their hands.)

According to the book African Americans have these beliefs and values:

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the next slide now.




For those of you who are African American, who agrees with the information provided by the

book? Please raise your hand. Take your time asking the questions. Who of you disagree with

the information provided by the book? Please raise your hand. You don’t need to elaborate on

why they agree or disagree, but if they volunteer information, let them speak and then move

on.




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Slide 36

Some of you may have agreed or disagree with some of these generalizations. Interestingly, the

book utilized as a reference for the previous slides does not discuss any of the European

cultures or various white ethnicities in their book. One thing we need to be careful of when we

learn about different cultures is what Dr. Hawryluck and Knickle caution:

Read the quotation.

We really need to be aware of this and remind ourselves continuously about this risk.

Ref. Hawryluck, L. & Knickle, K. (n.d.). Cultural considerations in donation. Retrieved from

http://www.cepd.utoronto.ca/endoflife/Slides/Organ%20Donation%20Cultural%20Considerations.pdf

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Slide 37

Furthermore we need to be aware of the risk of cultural imposition. Campinha-Bacote et al.

stated that:

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Read the quotation.

Ref. Campinha-Bacote, J., Yahle, T., Langenkamp, M. (1996). The challenge of cultural diversity for nurse educators.

The Journal of Continuing Education in Nursing, 27(2), 59-64.

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Slide 38

When we reviewed what some cultures believe about sickness, death and dying, and donation,

we were learning generalizations about some cultures provided by a reference book. It is very

important to recognize the difference between generalizations and stereotyping.

The difference between stereotype and generalization is not content, but usage of information.

E.g. “If I say to myself, ‘Rosa is Mexican; she must have a large family’, I am stereotyping her.

But if I think Mexicans often have large families and then ask Rosa how many people are in her

family, I am making a generalization.”

Remember, stereotype is an endpoint with no effort made to learn or change your perspective.

Generalization is a beginning point.

This point also highlights the risk of using cultural books, just like you may have agreed or

disagreed with the generalizations made about the cultures presented earlier. Often we have a

tendency to stereotype based on the content of a book and use it as an endpoint. It is

important to remember that cultural books provide generalizations. They are meant to provide

a beginning point to ask more questions and to learn from our interactions.

So, what would be the easiest way to work with an individual of another culture without ever

having to look at a cultural reference book and run the risk of cultural assumption?

There is an excellent model which was developed by Arthur Kleinman, called the Explanatory

model.

Arthur Kleinman’s Explanatory model allows for an unbiased approach to an individual and

allows us to gain an emic perspective and not just rely on our etic perspective.



Pennsylvania Press.

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Slide 39

Emic and etic are anthropological terms:

The emic perspective is the insider’s perspective - a native’s, native of a country or culture, view

of their own behavior.

The etic perspective is the outsider’s perspective of the behaviors of natives of a country or

culture.

Combining both perspectives is the best and most effective vantage point.



Pennsylvania Press.

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Slide 40

Arthur Kleinman provides 8 main questions with his model which we can apply to elicit what is

important to the individual we are communicating with and to hear what their thoughts are.

The questions are:

Read the slide.

Ref. Kleinman, A. (1981). Patients and healers in the context of culture: an exploration of the borderland between

anthropology, medicine, and psychiatry. Los Angeles, CA: University of California Press.

Management Sciences for Health (2005). Techniques for taking a history: Arthur Kleinman’s eight questions.

Retrieved from http://erc.msh.org/aapi/tt11.html.

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Slide 41

Read the slide.

Ref. Kleinman, A. (1981). Patients and healers in the context of culture: an exploration of the borderland between

anthropology, medicine, and psychiatry. Los Angeles, CA: University of California Press.

Management Sciences for Health (2005). Techniques for taking a history: Arthur Kleinman’s eight questions.

Retrieved from http://erc.msh.org/aapi/tt11.html.

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Slide 42

An easy way to remember Kleinman’s questions are the following four Cs:

1. Call – What do you call your problem? This also prompts the question - what do you

think is wrong?

2. Cause – What do you think caused your problem?

3. Cope – How do you cope with your condition? This also prompts the questions – what

have you done to treat your condition, and have you received treatment from anyone

else?

4. Concerns – What concerns do you have regarding this condition? This also prompts the

questions – how serious do you think it is, and what complications do you fear?



Pennsylvania Press.

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Slide 43

Many people do not realize or consider the fact that culture and communication are strongly

connected.

Communication – what it is, how to do it, and reasons for doing it, is driven by culture.

If this connection is forgotten there is an increased risk of misunderstandings.

Ref. Jandt, F.E., & Taberski, D.J. (1998). Intercultural communication. Workbook. (2nd

ed). Thousand Oaks, CA: Sage

Publications, Inc.

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Slide 44

Effective communication is each one of our responsibility. – We have a responsibility to

transmit our message and communicate in a manner that others can understand what we are

saying, and we equally have a responsibility to interpret other people’s messages in a manner

they were intended to be interpreted, regardless how effective or not effective they are in their

communication.

There are 6 main barriers to effective communication: - hit arrow down…

Anxiety – feeling nervous, causes the person speaking to focus too much on their feelings and

causes them not to listen to what the other person is saying.

Stereotypes and prejudice – stereotyping is assuming that a person has certain qualities – good

or bad, because they are a member of a specific group. Prejudice is feeling hatred or suspicion

towards people from a certain group, religion, race, or sexual orientation. Both negatively

impact communication and are learned behaviors. Unfortunately, this is perpetuated by the

media.

Language – challenges can emerge when language is translated. There is a lack of equivalences

in idioms, experiences, concepts, vocabulary, and grammar and syntax. Taken from a book

called “Caring for patients from different cultures”, there is an example of a Mexican family

requesting a different nurse to the Filipino nurse who had been caring for their baby. The

Filipino nurse was shocked as she had been caring for the baby for several days and she had a

good report with the family. The Filipino nurse asked a Spanish-speaking colleague to speak to

the family to explain the problem. They told her that they had overheard the Filipino nurse tell

another nurse that she had a puto. Puto, in Spanish, refers to a male prostitute. But puto, in the

Philippines is a rice cake. So, the Filipino nurse had been telling her colleague that she had had

a rice cake.

Hit arrow down again.

Nonverbals – nonverbal codes are not the same in all cultures, e.g. personal space is perceived

differently, silence can be meaningful or uncomfortable, touch might be used or may make

someone feel uncomfortable, eye contact can mean respect or aggression, etc.

Ethnocentrism – “negatively judging another culture by your own culture’s standards”.

Assuming similarities rather than differences – it is a natural thing to do if you don’t know

anything about another culture. The tendency is to communicate in a manner we expect others

to understand which can cause us to miss important differences. Equally, it is dangerous if we

assume that everything is different. Best is to assume nothing and to ask.

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Pennsylvania Press.

Gudykunst, W.B. (2003). Bridging differences: effective intergroup communication. (4th

ed). Thousand Oaks, CA:

Sage Publications.

Jandt, F.E., & Taberski, D.J. (1998). Intercultural communication. Workbook. (2nd


Publications, Inc.

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Slide 45

Good intercultural communicators demonstrate:

• Personality strength – a strong sense of self and are socially relaxed

• Communication skills - verbal and nonverbal

• Psychological adjustment – an ability to adapt to new situations

• Cultural awareness – an understanding how people of different cultures think and act

Eight different skills to develop:

• Self-awareness - using knowledge about yourself to deal with difficult situations

• Self-respect - confidence in what you think, feel, and do

• Interaction - how effectively you communicate with people

• Empathy - being able to see and feel things from other people’s points of view

• Adaptability - how fast you can adjust to new situations and norms

• Certainty - the ability to do things opposite to what you feel

• Initiative - being open to new situations

• Acceptance - being tolerant or accepting of unfamiliar things

Ref. Jandt, F.E., & Taberski, D.J. (1998). Intercultural communication. Workbook. (2nd


Publications, Inc.

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Slide 46

Some cultural considerations we all need to make when working with a family during end-of-life

and the donation decision:

• Identify the decision maker in the family: While there may be a legal decision maker,

determined by law, in actuality, there may be a cultural decision maker. Maybe

grandma is in charge! Through getting to know the family well and learning about their

culture and family dynamics, the actual family decision maker will become evident. They

are the person who is integral to the donation communication as they will influence the

rest of the family. So communication must be maintained with that decision maker

specifically and trust needs to be established.

• Give the family what they need and want: Assess if the family has everything they need

and show them care and concern for their every needs, including basic needs.

• Do not project your own personal feelings: The family may be dealing with their grief

differently than you would and sometimes it is so different it is hard to relate to and

comprehend. We have to learn to become a student of the family and adjust to how

they are dealing with their grief and meet their needs as best as possible. Equally, if we

happen to not believe in donation, we have to remember that the family is entitled to

make the decision best for them and on behalf of what their loved one would have

wanted, and therefore has the right to know of all their opportunities in end-of-life care.

Do not share your personal feelings, just support the family.

• Assess their readiness – let the family guide the conversation: This point speaks for

itself, think it through and practice and apply it with all the families and patients you

care for. Asking them questions that will stimulate them to lead the conversation may

help to begin that communication, e.g. ask them about their loved one and ask them to

describe them, ask them what was important to them in life. Answer the questions the

family has clearly but making sure the donation process is followed, i.e. do not bring up

donation if the huddle has not yet occurred and this was not the timing for the donation

conversation as planned by the huddle.

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Slide 47

Always examine your motives:

- Are your concerns for the family that is losing their loved one? Or

- Are you more concerned about the potential recipient who is waiting out there for a

transplant? This can be particularly the case if you know someone who needs a

transplant.

- Or is your motive to a turn negative situation into a positive one and you believe

donation is that key for this family?

Whatever your motives keep them in check so you don’t project them onto the family in a way

that will make them feel that you are not putting their needs first. If you are genuine with the

family and let them guide you, they will feel it.

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Slide 48

Communication will also vary between cultures and individual preferences from overt and

direct to covert and indirect.

Those individuals who value overt and direct nonverbal communication have difficulties

understanding those who prefer covert and indirect communication.

Those who value covert and indirect communication will usually find overt and direct persons

to be aggressive and threatening.

At times you as the healthcare professional may need to be indirect to identify and uncover a

patient’s perception of the disease causation and treatment they expect.

Ref. Mullin, V., Cooper, S.E., & Eremenco, S. (1998). Communication in a South African Cancer Setting: Cross-

Cultural Implications, International Journal of Rehabilitation, 4(2), 69-82.

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Slide 49

Donation is an area of healthcare that nursing can really own as everything is governed by

legislation and referring the patient and following the correct approach process is not

prescribed by a physician. You can tap into your professional skills: Utilize your strengths and

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continue to develop and utilize your interpersonal skills and focus on the family. Take care of

the needs of the family by picking-up on cues from them. For example, be sensitive to when to

comfort a family, understand body language, and know when it is an appropriate time to touch

and hold them.

Give the family an opportunity to be involved in the care of the patient, particularly the physical

care of their loved one. This will help them to feel like they are doing something for their loved

one. For example, ask the mother if they want to help bathe their child, or show the father or

sibling how they can perform mouthcare, etc.

NEXT SLIDE

Slide 50

Now we will wrap up this training session with some basic principles and practical tips that you

can apply as you work with and meet people of various cultures.

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Slide 51

Distribute cultural self- assessment.

Spend time reflecting upon yourself and who you are and how you came to be the person you

are today. Please complete this cultural reflection tool from a personal perspective. Answer the

questions on the tool honestly. No one will see it, it is yours to keep. Answer:

• What is your culture? What are your beliefs? (pause)

• Have your culture and beliefs been influenced by your family? Has it evolved? (pause)

• If you have changed your perspectives from the family you were born into and what you

thought and believed when you were younger, what led you to change your perspective

and makes you who you are today? (pause)

Just answer the questions on the tool – take a few minutes.

Give the learner 5 minutes.

As we wrap this presentation up, I challenge you to continue to spend time reflecting on

yourself and your culture and how you have evolved to become who you are.

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Slide 52

If your patient and/or patient’s family is of a different culture to your own, if they speak

another language, show interest, ask them to teach you a greeting in their language, ask them

about their traditional foods, and build upon learning about their culture each time you see

them and apply what you have learned. It will make them feel valued and that you are

interested in them. It will keep the lines of communication open and allow them to build trust

with you as the healthcare provider. This will also make them feel like you truly care about

them and their loved one, which will pave the way for the difficult end-of-life conversations.

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Slide 53

Be careful with hand gestures. For example the V-sign in the US means peace. However, in

other countries, such as the UK it has another meaning. In the first picture, Winston Churchill is

depicted holding up his two fingers with the back of the hand facing the observer. His advisors

eventually explained to him that this gesture was not exactly giving the lower social orders a

positive message, as the V-sign in this manner, is equivalent to the middle finger in some other

countries. There may be some hand gestures we use, which may be offensive in other

countries. It is good to keep hand gestures at a minimum, but equally to remember that hand

gestures used by a patient or their family, which may be offensive to you, may not be intended

that way and may be normal and accepted in their culture.

Ref. Dave (2007). The top 10 hand gestures you’d better get right. Retrieved from

http://www.languagetrainers.co.uk/blog/2007/09/24/top-10-hand-gestures/

NEXT SLIDE

Slide 54

Overall, never assume you know someone’s culture. Seek to understand others and don’t be

too afraid to ask. But only ask if you are genuinely wanting to learn. Become a student of the

person or that family. Identify what provides value to them personally in death and life and the

moment you find yourself negatively questioning or judging another person’s culture is the

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moment you are considering yourself superior to the other person. Humble yourself. Become a

student of them.

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Slide 55

At the beginning of the presentation I asked you to consider the following questions:

Read the question to Run on.

Hopefully your answers to this question has taken more shape in your mind. This presentation

is just part of your learning curve to become culturally more skilled. Please continue to seek

opportunities to grow in your multicultural knowledge and skills and enjoy yourself. You will

find that you will be enriched and grow as an individual as you learn about and from others.

NEXT SLIDE – Last Slide

Slide 56

As we wrap up this session, please take a few moments to complete this quick assessment.

Distribute self-assessment.

Again, please place your initials, first, middle, and last initial, using an “’X” if you don’t have a

middle initial and your birth-year at the top of the page. Don’t spend time analyzing the

questions, just answer what comes to your mind and please be as honest with yourself as you

can. When you are done, please turn the paper face-down.

Give 5-7 minutes for self-assessment completion.

Read the slide.

Collect the pre- and post- assessment but not the cultural self-reflection. Use the scoring tool

later on to evaluate the efficacy of learning.

Multicultural Opportunities for Success in Hospital ... · Multicultural Opportunities for Success...

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