Chapter 2

1. Chapter 2 Multicultural Therapeutic Communication

2. Developing Cultural Communication • Define culture • A pattern of concepts, beliefs, values, habits, skills, instruments and art of a given group of people in a given period • Define cultural communication • Ability to communicate effectively with individuals of other cultures while recognizing ones own personal cultural biases and prejudices and putting them aside. • Promote multicultural communication • Knowledgeable of beliefs, values • Develop techniques to build communication • Recognize barriers

3. Barriers to Therapeutic Cultural Communication • Lack of knowledge • Learn about other cultures • Fear, distrust because of differences • Learn about other cultures • Racism • Examine your attitudes and work to change negative ones • Bias, prejudice, ethnocentrism • Stereotyping • Avoid comments about cultures that stereotype

4. Barriers • Healthcare rituals-standardized procedures followed during client visit. • Be prepared to change routine for clients of other cultures • Language-ESL • Use interpreters • Speak slowly for those who need to translate from and into English. • Perceptions-Insights or intuitions we are aware of • Expectations- Events we anticipate based on experience. Ex: eye contact

5. Therapeutic Response • Know about culture’s communication style • Approach client slowly, respectfully • Create culturally comfortable environment • Listen to client, observe culture • Validate, ask questions and use paraphrasing to make sure you and client understand • Recognize nonverbal gestures, mannerisms • Do not jump to conclusions based on your own beliefs

6. Purnnel’s Cultural Domains • To understand cultures, know the following: • Body language, language, comfort zone, eye contact • Role extended family, principle caregiver, head of household and comfort zones • Pain, expectations, focus on health care, folk/holistic medicine, religious/traditional beliefs • Practitioner perception, gender of practitioner • Religion, use of prayer, meaning of life, • Find out by observation, research or asking questions

7. Cultural Diversity Manifestations • Low-context communication- uses few environmental or cultural idioms to convey an idea, relies on detailed language • High-context communication- relies on body language, reference to objects in environment and culturally relevant phrasing to convey idea • Care giving structure, HIPAA • Western Culture-individualistic, take responsibility for medical requirements and care • Other cultures- caregivers are relatives, client may not understand why the caregiver cannot have access to info. Hard to enforce HIPAA

8. Cultural Diversity Manifestations • Time focus- determined by cultural background and socioeconomic environment (Maslow’s Hierarchy of Needs) • Can be oriented toward future, present or past • Future-confident that basic needs will be met, willing to sacrifice for future, time conscious, plan day and lives • Present-less assured that needs will be met, Do not look at time as being important., see no reason to improve things in the future • Past- associated with culture and longstanding tradition, revere traditions, honor elders asian and Native Amer. Cultures, not time conscious but try to please out of respect so they are prompt

9. Cultural Diversity Manifestations • Religion versus race- Culture and religion affect attitudes toward medical treatment and therapeutic communication more than race and physical characteristics • Paradigms are the unconscious part of the culture that result in behavior or choices that may not make sense to patient or medical professional

10. Examples of Cultures-generalizations • Caucasian, Western • High acceptance of Western medicine (medications & surgery to treat illness) • Believe in preventative medicine • Not afraid to question medical opinion • Often research condition • Trend toward integrative medicine • Self-reliant with client or immediate family as caregiver.

11. Examples of Cultures-generalizations • African American, Western • Increasingly similar to Caucasian. • More likely to have a present time focus-punctuality not important • Less focus on preventative medicine • Extended family is predominant caregiver-causes HIPAA issues unless written authorization for release of info is given • May be distrustful of medical personnel of other cultures

12. Examples of Cultures-generalizations • Black, African or Caribbean • Accept western medicine but often have preference for home remedies and spiritualism • Primary caregiver is relative or extended family member (may be anyone the client looks to for trust and support) • Present time focused- not much importance on punctuality or preventative medicine

13. Examples of Cultures-generalizations • Asian • Includes many subcultures • In general, accepts western medicine, may be influenced by holistic medicine • Confucian principles of mind control, balance and foods used to treat illness • Strong feeling toward “Saving face”- don’t want to feel inferior or ignorant, wont insult • Present or past oriented but prompt as symbol of respect • Consider illness as shameful, esp. mental illness • Mother or grandmother is primary caregiver • Private, quiet, does not believe in touching esp. the head

14. Examples of Cultures-generalizations • Native American, South Sea Island • Accept Western Medicine but spirit beliefs may influence them • Reliance on holistic and spiritual cures • Do not speak of illnesses (jinx) • Unwillingness to discuss current illness or practice preventive medicine • Present focused • High-context communication, eye contact disrespectful, quiet, show little emotion • Primary caregiver is extended family & possibly tribe

15. Examples of Cultures-generalizations • Hispanic and Latino • Present focused • Accept Western medicine but strongly believe that God has control and illness my be result of sin • Eye contact shows respect • Extended family involved in health care-primary care giver is mother or grandmother

16. Religion-Based Cultures • Judaism • Sabbath- sunset Friday to sunset Saturday, kosher food, Passover-avoid leaven food • Mosts tests and procedures OK • Abortion prohibited • Mutilation of body forbidden- autopsy only when required by Police • Should be attended by chaplain or rabbi at death

17. Religion-Based Cultures • Hinduism and Buddhism • Vegetarian- due to belief in reincarnation • fasting, modesty-will often refuse hospital gowns • My refuse pain medication • Most medical procedures are OK- must not destroy life • Sex of medical professional only matters for priests

18. Religion-Based Cultures • Muslim • Male of household makes decisions even for female patients • Primary caregiver is immediate family • Modest in dress-may refuse hospital gowns • Females can not be touched by non-related male • Males may object to female in charge of nursing care • Non-pork or vegetarian diet, alcohol prohibited even in medication, daily prayers • Touching taboos, mental illness unacceptable, don’t accept terminal illness • High context communication

19. Medical Interpreters • Cultural broker, cultural facilitator- help mediate between people to reduce conflict • Legal use of interpreters-helpful when consent forms are required, can increase quality of care

20. Medical Interpreters • Best use of interpreters • When consent forms are required • When assessment questions are asked • When specific instructions are given

21. User Guidelines for Interpreter • Introduce interpreter • Be brief yet complete • Discuss confidentiality • Allow time for client, interpreter to think • Be sensitive of cultural differences • Continued use of same interpreter

22. Therapeutic Response • Assess if interpreter is needed • Discuss causes of illness: if, how treated • Ascertain use of holistic or folk medicine • Continue use of holistic or folk medicine, if possible

23. Types of Medicine • Western Medicine-based on Scientific Method • Most others are based on past experience, rational theory and religious precepts

24. Western Medicine • Bacterial, viral cause • Diagnosis by • Scientific tests • Observation of client symptoms • Treatment by • Surgery • Medications • Mental state contributes to wellness but receives less cosideration

25. Holistic Medicine • Personal accountability for one’s health • Body’s ability to heal itself • Balance of mind, body, spirit with environment • Treatment modalities • Acupuncture, biofeedback, chiropractic • Folk medicine, meditation, yoga • Spiritual healing, megavitamin therapy

26. Oriental Medicine • Body balance of energy, opposing states • Practiced in home, religious settings • Home remedy medications • Unlikely to share folk medicine usages • Treatment modalities • Acupuncture, massage, herbal medicine, meditation and exercise

27. Folk Medicine • Home remedy medication handed down • Many beneficial or not harmless, others dangerous • Practiced in homes, religious settings • Treatment modalities • Prayer, use of holy water, holy oil • Use herbal treatments • May not share treatments tried • Clients often wear charms, amulets or bracelets believed to protect