OHSU - Cultural Competencies Foundation Course (2008)
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Language and Culture This site provides information and resources for hospitals to improve communication with patients who face language or cultural barriers. National Center for Cultural Competence http://nccc.georgetown.edu The National Center for Cultural Competence provides information, technical assistance, and training for health and human service organizations to integrate cultural and linguistic competence into their service delivery systems. External Resources
OHSU - Cultural Competencies Foundation Course (2008)
- 2. Hardware requirements Sound card needed This training module requires a computer equipped with a sound card for the video portion of the training.
- 3. How to navigate this training module previous page click this button to go back next page click this button to go forward progression meter this marks how far you are into the module
- 4. To raise awareness regarding the need for cultural competency To increase curiosity about difference To encourage personal and professional development Goals of this training
- 5. Learning objectives Describe what cultural competence means in healthcare. Identify elements of your personal diversity. Identify situations where the diversity of others may require you to adapt your behavior in order to be culturally sensitive.
- 6. Cultural competency enables you to provide patient-centered care and to ensure safety and quality when serving diverse communities. Cultural competency also allows you to be a more effective member of a culturally diverse work team. Building your own cultural competence requires openness and lifelong learning. The Joint Commission & cultural competency
- 7. 1. Culturally competent healthcare at OHSU 2. “Cultural Competency: Just Good Healthcare” video Resources 3. Serving diverse communities Content index Content index To complete this training you will be guided through these three modules.
- 8. Content index 1. Culturally competent healthcare at OHSU 2. “Cultural Competency: Just Good Healthcare” video Resources 3. Serving diverse communities Content index To complete this training you will be guided through these three modules.
- 9. Three steps to developing cultural competence Start with self-awareness. Consider how your beliefs and values influence your behaviors, attitudes, and practices.
- 10. Three steps to developing cultural competence Next, consider others. Be curious about difference by observing and asking questions. Being curious will help you become aware of and sensitive to the different beliefs, values, and practices of others.
- 11. Three steps to developing cultural competence Finally, adjust your behavior. Work with others and provide service and care in a way that is respectful of these differences and the preferences of others. If you don’t know, just ask.
- 12. What is diversity? Elements of diversity, such as ethnicity, age, gender, sexual orientation, work classification, social class, physical ability, religion, and many other cultural differences are an important part of what makes each person unique. Let’s explore some elements of diversity that you or someone else may hold important.
- 13. Personality This is unique to each individual.
- 14. These are elements over which we have little control.
- 15. We have more choice about these elements.
- 16. Like other elements, we have some control over these and they can change over time.
- 17. Personality
- 18. Personality
- 19. As you can see, each of us has complex layers of diversity. Some things are unique to us and some we share with others. Personality
- 20. OHSU voices Click on the right arrow to learn more about what some of our OHSU employees have to say about the difference that cultural competency makes.
- 21. “As an interpreter, there are times when it is important to be in the room with the patient, rather than providing the interpretation by phone. Many times I have entered a room and I can see the tension in either the parents or the patient. When I open my mouth and begin speaking their language, you can just watch people relax, their shoulders relax. And they begin to open up. I work mostly with Mexicans and they want to be very polite. The doctor may ask, ‘Do you have any questions?’ And they are likely to respond ‘No. Everything is fine.’This shows politeness. However, by the expression on their face I know they have questions. I will then say to the patient, ‘You can ask whatever you want.’ And they would then ask that question and this whole other thing would be discovered by the doctor - something they hadn’t been aware of.” Jaime Pláceres, Spanish Medical Interpreter OHSUTranslation & Interpreter Services OHSU voices
- 22. “As a 14-year nurse at OHSU, I deal with life and death issues. One patient I remember well. I learned that he was a professional singer in his homeland of India, a store owner in the States, a husband, a father of two, a grandfather and a recent Christian convert. It was important to him to allow God’s control over his life and death. His children did not share their father’s religious view. By allowing the individuals to deal with the end-of-life issue in their own way, it made it easier and more comfortable for both the patient and the family members.The father, from his Christian perspective, was focused on preparing for his new life, while his family members were focused on honoring his present life.” Amy Guthrie, Instructor Patient Relations OHSU voices
- 23. “Without question, the best part of working at OHSU is the people. It is a pleasure working with such gifted, talented, and passionate people who bend over backwards to get along with everyone.” John Ma, M.D. Professor and Chair Emergency Medicine OHSU voices
- 24. “Cultural competence is something that I need to apply every day. I cannot tell, nor should I judge, by looking at someone who they are. Once I served a transgendered woman who was very sick. I could see that she wanted to be referred to as female and to use her female first name, though her armband indicated a male name and sex. Following her wishes, I used her preferred name and pronouns and asked other providers to do the same. We did and it worked out well.The patient told us that she felt very comfortable with us.” Debbie Dixon-Smith, Registered Nurse Family Medicine at South Waterfront OHSU voices
- 25. Content index 1. Culturally competent healthcare at OHSU 2. “Cultural Competency: Just Good Healthcare” video Resources 3. Serving diverse communities Content index To complete this training you will be guided through these three modules.
- 26. Sound check Please plug in your headphones or make sure that the speakers are turned on. Ensure that the volume is comfortable to you and respectful of the people that may be around you.
- 27. ( video window )( video goes here )
- 28. Content index 1. Culturally competent healthcare at OHSU 2. “Cultural Competency: Just Good Healthcare” video Resources 3. Serving diverse communities Content index To complete this training you will be guided through these three modules.
- 30. In addition to working with people from different ethnic backgrounds, we also serve individuals who represent other culture groups such as: • Non-native English speakers • People with disabilities •Gay, lesbian, bisexual, and transgendered (GLBT) individuals Serving diverse communities Following are some best practices for serving members of some of these diverse communities.
- 31. Speakers with accents come from many backgrounds, educational levels, and have various linguistic abilities. A foreign accent only tells you that the person speaks more than one language. Serving non-native English speakers
- 32. Serving non-native English speakers • Listen carefully and slow down. • Allow pauses between sentences or after questions. • Repeat your sentence in different ways if needed. • Ask the individual to restate their understanding in their own words. • Know when to request an interpreter. Best Practices
- 33. OHSUTranslation & Interpreter Services TheTranslation and Interpreter Services Department operates 24 hours a day, 7 days a week. Orders can be placed either via the Epic system or by phone. It is the policy of OHSU to use only qualified healthcare interpreters. OHSU staff should not ask, suggest, or encourage that a patient’s friends or family members interpret for a patient except in urgent situations. If the patient decides to decline the help of the OHSU interpreter, he/she has to sign a Medical Interpreter ServicesWaiver Form. You can get it from the Ozone or call OHSUTranslation & Interpreter Services.This waiver form releases OHSU from any legal obligation to provide a qualified healthcare interpreter and from liability for any adverse consequences of a non-professional interpretation.
- 34. How to use interpreters more effectively • Look directly at the patient. • Use first person “I” statements. • Make appropriate stops. • Watch for the body language. • Ask the patient to repeat back their understanding. • Stay in the room until the communication is complete. Best Practices
- 35. Disabilities may or may not be visible. Disabling conditions can affect physical, sensory (hearing or vision), cognitive, or mental abilities. • Let the individual ask for assistance; don’t assume the need.The best practice is to ask “How may I help you?” as every person and their disability is unique. • Remember that this person is an expert concerning his/her disabilities and abilities and can best direct you as how you may assist them. • Address the individual, not the people accompanying him or her. • Respect personal space, including wheelchair, assistant devices, or service dog. • Ask how you can facilitate communication (braille or large print, speech reading, writing, sign language, etc.). Working with individuals with disabilities
- 36. At OHSU we welcome and serve equally all individuals regardless of their sexual orientation or gender identification. Avoid the assumption that patients or colleagues are heterosexual. Of every 100 patients that you work with, up to 10 may be lesbian, gay or bisexual and between one and 10 may be transgendered. Treat all patients with respect and protect patient confidentiality by following HIPPA guidelines. Obtain patients’ permission before documenting sexual orientation in the patient records as a matter of sensitivity. Be aware of your verbal and body language to create a welcoming atmosphere of care, openness, and non- judgment. Working with gay, lesbian, bisexual, and transgendered (GLBT) populations
- 37. Oregon law recognizes a registered domestic partner relationship as equivalent to a marriage, therefore, registered domestic partners should be treated the same as spouses. Domestic partnership & healthcare If a patient says they are in a domestic partnership, it is appropriate to ask if they are registered domestic partners. If the patient is in a registered domestic partnership, this should be identified in Epic. There is a field in Demographics Activity to document “registered domestic partner”, “single” or “married”.
- 38. At OHSU, we take someone at their word when they identify themself as a spouse or domestic partner of a patient. We would only require a domestic partner to provide legal documentation of registration under the same circumstance where we would require a spouse to provide documentation of legal marriage. Domestic partnership & healthcare
- 39. People define families in different ways.The healthcare team members must be sensitive to the diversity of cultures and familial relationships, particularly when handling consent, end-of-life decision making, and patient and family education. The OHSU Consent Policy and the policy of Do Not Resuscitate, Advance Directives, Physician Orders For Life-SustainingTreatment & End- Of-Life Decision-Making Process apply in the end-of-life decision making. Honoring family members
- 40. Closing thoughts Click on the right arrow to read each of these closing thoughts about the value of cultural competency in healthcare at OHSU.
- 41. Closing thoughts “As we work toward expanding and nourishing our culture of inclusion, here at OHSU, we give greater meaning to our commitment to honor the uniqueness of everyone.” Steven Scott, Associate Hospital Administrator Professional Services
- 42. Closing thoughts “Working in a diverse environment has taught me the value of understanding that we all come from different places and have different views about how the world works and that is what makes each one of us unique.” Sima Desai, M.D. Section Chief, Division of Hospital Medicine Associate Residency Program Director, Internal Medicine
- 43. “Every employee is responsible to live the diversity promise at OHSU Healthcare. Living the diversity promise means recognizing that people are different and personally committing to respecting those differences in every encounter, with every individual, every time.” Peter Rapp, ExecutiveVice President and Executive Director, OHSU Healthcare Closing thoughts
- 44. There is a lot to learn and know when developing cultural competence. You don’t need to be an expert about all things. The key is awareness and sensitivity.
- 45. Acknowledgements OHSU design team Arturo Pelayo Riikka Salonen KirstenWall OHSU contributors Priscilla Andres Alix Bach Nikki Bishop Join Elsenpeter Sue Orhard Pamela Pauli Samia Saad Steven Scott Riikka Salonen AmyVanderbroucke TammyWade KirstenWall DeanWestwood External resources Leslie Aguilar & Linda Stokes Coastal Productions Lee Gardenswartz & Anita Rowe Joint Commission Kaiser Permanente
- 46. CONGRATULATIONS! You have finished the Cultural Competency Foundations training.
- 47. Content index 1. Culturally competent healthcare at OHSU 2. “Cultural Competency: Just Good Healthcare” video Resources 3. Serving diverse communities Content index To complete this training you will be guided through these three modules.
- 48. Resources to continue learning about diversity and cultural competence are available to you on: The Learning and Change Management site for OHSU Healthcare http://ozone.ohsu.edu/ healthsystem/dept/ nursingeducation/ Resources
- 49. OHSU Center for Diversity & Multicultural Affairs (CeDMA) Serves as a university resource supporting collaboration with the academic units, hospitals, and other campus and community resources in promoting an environment that values and nurtures an inclusive environment of diversity through various resources and programs for students, staff and faculty including Student Access and the Cultural Competency Lecture Series. Affirmative Action & Equal Opportunity (AAEO) A resource for staff, faculty, students, patients, and employment applicants in their effort to support diversity and prohibit discrimination in all facets of the University's activities including providing information on reasonable accommodation requests, diversity recruitment and diversity education. Internal Resources
- 50. Chaplaincy Services Provides spiritual support OHSU staff and patients. Chaplains are available to provide spiritual guidance, prayer, emotional support and comfort. A prayer/ meditation room is available in Doernbecher Children's Hospital, room 10301. The Coalition for Health and Affirmation of Sexual Minorities (CHASM) OHSU's campus-wide organization for lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) students, faculty, and employees and their allies, friends, and family. Index ofTranslated Patient Education Material A list of patient education handouts available in multiple languages including: English, Russian, Spanish,Vietnamese, Chinese, and Serbo-Croatian. Internal Resources
- 51. The Oregon Institute on Disability & Development (OIDD) Located at the Child Development and Rehabilitation Center, it is one of 67 University Centers for Excellence in Developmental Disabilities, located in major universities throughout the U.S. We have a more than 40-year history of working to improve quality of life for people with disabilities and their families. We embrace the right of the persons with disabilities to determine the course of their lives and to live as fully integrated, contributing members of their communities. Our research and projects are all developed with those missions in mind, and we welcome your feedback, participation and input. http://www.ohsu.edu/oidd/index.cfm Internal Resources
- 52. Culture CluesTM http://depts.washington.edu/pfes/CultureClues.htm This site by the University ofWashington Medical Center includes tip sheets for clinicians to increase awareness about patients from diverse cultures. End-of-life care information is also included. Cross Cultural Health Care Program (CCHCP) http://www.xculture.org The CCHCP offers online information, books, videos, and cultural competency training programs for physicians and interpreters. Internal Resources
- 53. Diversity Rx http://www.diversityrx.org DiversityRx has information on how to meet the health care needs of minorities, immigrants, refugees and other populations.The site also includes interpreter information and models for designing programs. Ethnomed http://ethnomed.org This site contains information about cultural beliefs and medical issues related to the health care of recent immigrants.The site also has links to foreign language patient education materials. External Resources
- 54. The Joint Commission: Hospitals, Language, and Culture http://www.jointcommission.org/PatientSafety/HLC/ The Joint Commission views the issue of the provision of culturally and linguistically appropriate health care services as an important quality and safety issue and a key element in individual-centered care. It is well recognized that the individual’s i involvement in care decisions is not only an identified right, but is a necessary source of accurate assessment and treatment information. The Joint Commission has been studying these issues through its Hospitals, Language, and Culture: A Snapshot of the Nation (HLC) study, and HLC staff have developed several resources that highlightThe Joint Commission standards that support the provision of care, treatment, and services in a manner that is conducive to the communication, cultural, language, health literacy, and spiritual/religious needs of individuals. External Resources
- 55. National Center for Cultural Competence (NCCC) http://www11.georgetown.edu/research/gucchd/nccc NCCC resources include full-text publications, definitions of cultural and linguistic competency, tools and processes for self-assessment, and a Spanish language portal. Office of Minority Health http://www.omhrc.gov/templates/browse.aspx?lvl=1&lvlID=3 The OMH’s cultural competency site includes recommendations for national standards for Culturally and Linguistically Appropriate Services (CLAS).The site also has statistics, publications, and links to other cultural competency resources. External Resources
- 56. Provider’s Guide to Quality and Culture http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=provider&language=English This website helps health care organizations provide culturally competent services to multi-ethnic populations. It includes information on patient-provider interaction, health disparities, cultural groups, and culturally competent organizations. Think Cultural Health https://www.thinkculturalhealth.org This site, sponsored by the U.S. Office of Minority Health, offers free online cultural competency continuing education programs, guides for physicians and nurses on culturally competent care, and more. CulturedMed https://culturedmed.sunyit.edu External Resources