Download Trillium Health Centre, Canada

“Intercultural Communication
For Patient-Centred Care”
Gurwinder K Gill
Manager, Diversity Services
Trillium Health Centre,
Canada
“Transforming the Health Care
Experience”
September 2005
Ciao e
Benvenuti!
(Hello and Welcome!)
™ Bienvenue
™ Soo Dhawaada
™ Welcome
™ Bienvenidos
™ Dobrodosli
™ Willkommen
™ Mabuhay
Trillium Health Centre, Ontario, Canada
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One of Canada’s leading community
hospitals
• With expanding programs in Cardiac Care,
Orthopedics, Neurosurgery, Sexual
Assault, & Domestic Violence Services
• The busiest Emergency Service in the
country
• The largest free-standing day surgery
centre in North America
• Serving over one million residents in
surrounding areas
• Attracting international attention for its
innovative approach to the provision of
healthcare services
Trillium Health Centre, Canada
Embracing Change & Diversity
Towards Culturally Competent Care
“We are committed
to having a
workplace &
environment
that promotes
respect, equity &
diversity”
Ken White, CEO & President
“The goal of Inter-Cultural Communication
is to find a common ground through
which people from different cultures
can connect on many different levels
with each other”
(University of Maryland School of Nursing)
That means
understanding the diversity of the people
we provide services to
in our increasingly shrinking world
E.g. The Diversity of migrants in Canada
•
Over 49% in Toronto were born outside of Canada
•
Top 10 countries of birth of 1990’s Immigrants (Toronto)
− China, India, Philippines, Hong Kong, Sri Lanka,
Pakistan, Jamaica, Iran, Poland, Guyana
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Languages (Canada )
− English, French, Chinese, Italian, German, Punjabi, Spanish,
Portuguese, Polish, Arabic
•
In Toronto …
− Chinese, Italian, Tamil, Portuguese, & English
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In Peel, 39.5% indicated non-English & nonFrench as their first language
Religions: Statistics for Peel
(Census 2001)
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Catholic
Protestant
No Religious Affiliation
Sikh
Muslim
Hindu
Christian Orthodox
Buddhist
Eastern Religions
Other
985,565
242,940
116,740
58,315
53,470
46,965
24,000
14,985
2,345
775
Intercultural Communication is influenced
by both Verbal & Non-verbal
Communication
It has been said that as much as two thirds
of all communication is Non-Verbal
Tips on Verbal Communication …
Tips on Verbal Communication …
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• Use a skilled interpreter
• Make use of written translated material
• Avoiding slang or technical terms …
• “I’d like to touch base with you”
• Do not assume language proficiency
• Ask one question at a time, slowly, clearly
Rephrase questions … remember, poor language
skills are not a reflection of a hearing disorder
• Note differences in meanings of words
• Use visuals where possible …
Tip # 3
Cases:
Anan vs Davis The case concerned a refugee who
was sterilized after she consented to what she thought
was a procedure to treat an infection that had occurred
after birth. Ruling: The court ruled in the refugee’s favor
Romana: 62 year old Romana was admitted to
Hospital … she was told that the results of her Pap test
were negative. She went home depressed & became
suicidal. She had misinterpreted the results. She
thought she had cancer because she interpreted a
negative result to mean bad news
Research … to show the negative results
of communication barriers … from Canada’s Language Barriers
in Access to Health Care (www.hcsc.gc.ca/hppb/healthcare/pubs/barriers/index.html)
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Sample study, US, 1998 … adults who did not speak the
same language as their provider had a 70% greater
chance of being admitted to hospital (Lee et al, 1998)
Hampers et al, 1999 … where a language barrier existed,
patients were more likely to be given IV & admitted to
hospital
… the presence of a language barrier accounted for a $38
increase in charges for testing, & a 20 min longer stay
in hospital
Then there’s Non-Verbal
Communication
… and how this can have
an impact on the care
we give to
others who are ‘different’
It Starts with Self Awareness
of our Own Values, Attitudes, & Beliefs
It Means Respecting Others
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Do we respect diverse practices & requests
without judgment?
Do we recognize & actively accommodate
patients’ choices about their care?
How open are we really to differences
between cultures, & different ways of doing
things?
E.g. Our Reactions to Individuals/Migrants who
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Are indirect in their speech
Do not take the initiative to ask questions
Make decisions inter-dependently vs
independently
Refuse to deal with women
Bring whole family/children to appointments
Refuse to shake hands
Look to decision-making from the male
partner
Dress & look differently …
Black History
The Sari
The Turban
Our Gestures & Facial
Expressions …
The world’s many cultures &
migrants differ vastly in their
interpretation of some gestures …
what might be polite & acceptable
to you, may mean something
different to someone else …
Eye Contact
“Look at me when I’m talking to you”
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Not making eye contact could be perceived
as a sign of deceitfulness or disinterest
But in some cultures avoiding one’s eyes is a
sign or respect
Or looking at others of the opposite sex is
seen as flirting
A Nod …
• Saying no is considered rude
behavior in many cultures
because it upsets the harmony of
relationships, and
• Did You Know …
• Shaking one’s head may actually
mean yes, and not no
Intercultural Communication also
means respecting different belief
systems - Biomedical, Supernatural,
Holistic …
• What causes illness
• What should be done to
diagnose illness, &
• How to treat illness
The Supernatural …
A 10 year old boy from a rural Mexican
family had cancer … according to the
father, his son’s cancer began when the
boy was kicked by a child from a
neighboring family with whom the father
was feuding. The father believed that his
neighbors had case an evil spell …
because of the belief in the supernatural,
the belief was that the evil spell would
have to be removed for the boy to be
cured
By Using
Intercultural
Communication
Effectively, we can
Plan Care,
Explain, & Instruct
Model A:
Kleinman’s questions re: the Explanatory
Model
(The Spirit Catches You and You Fall Down, Anne Fadiman)
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What do you think has caused the problem?
Why do you think it started when it did?
What do you think your sickness does to you? How does it
work?
How severe is your sickness? Will it have a short or long
course?
What kind of treatment do you think you should receive?
What are the most important results you hope to receive
from this treatment?
What are the chief problems your sickness has caused for
you?
What do you fear the most about your sickness?
Model B:
LEARN
(from A Teaching Framework for Cross-Cultural Health Care,
Berlin EA, Fowkes WCJ)
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L Listen with sympathy &
understanding to the patient’s
perception of the problem
E Explain your perceptions of the
problem
A Acknowledge & discuss the differences
& similarities
R Recommend treatment
N Negotiate agreement
Model C: Cultural Assessments –
recommended questions to consider when caring for
people from cultures other than your own (Australia)
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Where was the patient born, or how long … in this country?
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What is the patient’s ethnic affiliation?
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Who are the patient’s major support people?
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What are the patient’s primary & secondary languages?
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What is the patient’s religion, its importance in daily life, &
current practices?
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What are the food preferences & prohibitions?
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What are the health & illness beliefs & practices?
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What are the customs & beliefs around life events such as
births, illness, & death?
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Perception or cultural explanations of the individual’s illness:
How does the person & family perceive the illness? What
meaning does it have for them? How do they interpret what
is happening?
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What is the decision making process in the family? Who
makes the decisions?
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What does emotional support mean
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to the individual & family? “Talk”
We’ve learned to …
fly the air like birds
We’ve learned to …
swim the seas like fish
And yet, we haven’t learned to walk
the earth as brothers and sisters
Dr Martin Luther King Jr
References
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“… Cross-Cultural Communication Improves Care” MisraHerbert, Cleveland Clinic Journal of Medicine, April 2003
Intercultural Business Communication, Lillian H Chaney &
Jeanette S Martin
Transcultural Communication in Nursing, Cora Munoz &
Joan Luckmann
“Cultural Diversity at End of Life: Issues & Guidelines for
Family Physicians”, H Russell Searight, PH.D., M.P.H., & J
Gafford, PH.D
Checklist for Cultural Assessment – Communication,
www.health.qld.gov.au/multicultural.asp.
“Managing Diversity”, Lee Gardenswartz & Anita Rowe
“When the Spirit Catches You & You Fall Down”, Anne
Fadiman
Interpersonal Relationships, Elizabeth Arnold & Kathleen
Underman Boggs
Thank you …
for your time and
patience.
GRAZIE!