Hospital staff need cross-cultural training
Hospital staff need cross-cultural training
Intercultural framework is needed
Hospital ethics boards should take the lead in promoting greater intercultural understanding between clinical staff and patients, according to an expert. This begins with education focusing around cultural awareness.
"Health care professionals from different cultural backgrounds from patients have an ethical responsibility to be aware of cultural differences," says Marcia Carteret, MEd, director of intercultural communications at the Colorado Children's Healthcare Access Program (CCHAP) in Aurora, CO. Carteret also is an instructor in the department of pediatrics at the University of Colorado School of Medicine in Aurora.
"Everyone experiences reality differently, largely based on their culture," she says. "So it's an ethical responsibility to recognize cultural differences and interact at a level that demonstrates being more aware and responsive."
Intercultural education can begin with teaching health care professionals a framework of cultural differences.
For instance, audiences often chuckle when Carteret asks them to think about the American culture's relationship with time. In the United States, people think of time in adversarial terms.
"Americans as a group are the only ones in the world who have an adversarial relationship to time," Carteret says. "We think of time as something we're battling, that we have a shortage of it, and we're always worried about making the most of the time we have."
Americans also are multitaskers who think of time as a commodity, she adds.
"Even our language indicates this: saving time; never wasting time, and even 'killing time,'" she says. "We take for granted that this is the way time functions in the world, but in actuality in many places in the world, people have a much more fluid sense of time."
So when someone is late, people in other parts of the world do not attach a value to this occurrence, thinking the late person is inconsiderate, Carteret says.
"In the U.S., health care appointments are set at such specific intervals and people are always in a hurry, and the doctor can never get through his day with all the patients he has to see," she explains. "To the person who has a different cultural perspective, this person can't even slow down long enough to see him or her as a person or relate to this patient's reality and life."
So when health care professionals are dealing with people from other cultures, time is their number one challenge, Carteret says.
"People from other cultures might not show up for appointments, or they'll arrive 45 minutes late and not understand why they can't see the doctor," she says.
Another common cultural clash involves the issue of self-sufficiency. In the U.S. culture, people value independence and self-sufficiency above reciprocity and group integration.
"You pull yourself up by your bootstraps and figure things out, not relying on other people unless you have to," Carteret says. "Many cultures are more group-oriented or people are collectivists, and their society is glue."
In these cultures, reciprocity is what keeps things running.
"You learn to rely on a network of close family and friends, and we're not talking about Facebook friends," Carteret says. "That's your safety net in life."
When American health care workers work with patients form a collectivist culture, they'll likely find that the patients do not demonstrate self-sufficiency.
This cultural difference is compounded by the formal and structured nature of the U.S. health care system. But there are strategies health care professionals can employ to bridge the cultural gaps.
For instance, clinicians can learn how to ask questions in a culturally sensitive way. There is a list of such questions available for a free download at a CCHAP website: www.dimensionsofculture.com. Among those listed are questions under the category of family dynamics and decision-making. Here are several examples of questions on that list:
- Who helps you make decisions about health care for your child?
- Who else have you asked for help/advice about the problem?
- Who should be told about the doctor's diagnosis? (In your culture would you give bad news to the patient directly?)
Another strategy is for health care facilities to give patients information about how to navigate the system. For example, Americans might be used to having to deal with automated telephone responses and pressing buttons to obtain the information that is needed. But these types of systems can turn into barriers to treatment for people from other cultures.
So providers should give patients from other cultures phone numbers to call where they can speak with a person, rather than an automated response. Or, at the very least, they could give patients a handout that describes how patients can talk to their doctors. The dimensionsofculture.com website provides an English and Spanish-language, one-page sheet on this topic.
Perhaps the most important strategy is for clinicians to acknowledge and examine their own cultural attitudes, such as ethnocentrism, in which one believes his or her own culture is central to reality, Carteret says.
CCHAP provides a framework called ETHNIC that offers suggestions for improving one's cultural competence. Here is a sample of questions suggested by the ETHNIC framework:
- Explanation: What do you think may be the reason you have these symptoms?
- Treatment: What kind of medicines, home remedies, or other treatments have you tried for this illness?
- Healers: Have you sought any advice from alternative/folk healers, friends, or other people (non-doctors) for help with your problems? Tell me about it.
- Negotiate: Negotiate options that will be mutually acceptable to you and your patient and that do not contradict, but rather incorporate your patient's beliefs.
- Intervention: Determine an intervention with your patient. It may include alternative treatments.
- Collaboration: Collaborate with the patient, family members, other health care team members, healers, and community resources.
The idea is to help providers understand that their own approach to a patient's medical problem may not be the same approach the patient will have.
"When you're in a dominant cultural group, you accept that your culture is normal," Carteret says. "We need to understand that all cultures are equally complex, and understanding that complexity of culture requires a framework for learning about cultural differences."
Source
- Marcia Carteret, MEd, Director of Intercultural Communications, Colorado Children's Healthcare Access Program, Aurora, CO. Email: [email protected]. Website: www.dimensionsofculture.com or www.cchap.org.
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