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Communicating with Clients & Families: Interviewing Skills Emily Eckley MS, RD [email protected] Celebrating Diversity Conference April 28, 2006 Objectives Describe the steps to take when preparing to interview a client & their family. List the skills needed to conduct culturally appropriate interviews. Ask culturally appropriate questions when working with a client & families from another culture. Describe the cultural influences on verbal and non verbal communication. Plan Define culture Discuss components of a culturally appropriate interview Before the interview During the interview After the interview Skill Building: Case Study Culture Integrated pattern of human behavior that includes: Thoughts, communications, languages Practices, beliefs, values, customs Courtesies, rituals, manners of interacting and roles, Relationships & expected behaviors Of racial, ethnic, religious or social group The ability to transmit the above to succeeding generations National Center for Cultural Competence, 2006. An Iceberg Concept of Culture Dress • Age Race/Ethnicity Gender • Language Eye behavior • Facial expressions Adapted by the Body language • Sense of self NCCC Notions of modesty Concept of cleanliness • Emotional response patterns Rules for social interaction • Child rearing practices Decision-making processes Approaches to problem solving• Concept of justice Value individual vs. group • Perceptions of mental health, illness, disability • Patterns of superior and subordinate role in relation to status by age, gender, class And much more…… National Center for Cultural Competence, 2006 An Iceberg Concept of Culture The iceberg concept of culture is widely used and available in the public domain, for example see: Culture Matters www.peacecorps.gov Or www.genderandpeacekeeping.org National Center for Cultural Competence, 2006 Culturally Sensitive Interviewing Before the Session During the Session Develop self-awareness Increase knowledge of commonly held cultural beliefs & interacting styles of patients/clients Complete an assessment by conducting a cultural interview After the Session Make a plan to negotiate between the culture of the patient/client & the medical culture Pachter & Harwood, 1996 The First Step – Increase Your Own Awareness “Know Thyself ” Beliefs Values Lifestyles Practices Complete Cultural Self-Assessment National Center for Cultural Competence http://gucchd.georgetown.edu/nccc/ Campinha-Bacote, 2003. Pederson, 2002. Ways to Increase Self Awareness Recognize communication styles Learn about cultural & linguistic differences Develop interest in other cultures Become sensitive to myths and stereotypes Be able to discuss your own culture Explore your own values Learn about relationships Pederson, 2002. Preparing for the Interview Seek to increase Cultural Knowledge Process of learning about basic world views of different cultures World view is: The set of explanations used by a group of people to explain life’s events Includes explanations about nature of: reality knowledge reason or logic relationships Boyle & Andrews, 1995. What Knowledge Is Needed? History of culture Roles of: Education Money Values Attitudes Behaviors Communication styles Language & slang Resources for teaching & learning How culture is perceived Other information Pederson, 2002. How To Prepare Read Ask Engage Observe Analyze Meaningful Exchange, 2005. During the Session Develop & utilize culturally appropriate interviewing skills Conduct a cultural interview Client centered interviewing Understanding a client’s social situation Navigate the complexities of communicating across cultures Cultural Interviewing Skills Awareness Solid knowledge foundation Clear communication Sense of humor Honesty & genuineness Innovation Flexibility Empathy Respect, value , care, & trust Bauer & Sokolik, 2002 Utilizing the Skills Listen respectfully Use the teaching & learning techniques of other cultures Establish empathic rapport with persons from other cultures Analyze feedback accurately Develop new ideas Make it fun! Pederson, 2002 Conducting Cultural Assessments EVERY client should have a cultural interview Information from the interview should be used to form a culturally relevant treatment plan Campinha-Bacote, 2003 Client Centered Interviewing Model Focuses on client experiences 4 dimensions of this experience: Ideas about what is wrong Feelings, especially fears, about being ill Impact of problems on own functioning Expectations about what should be done Stewart, 1995 Questions for Client Centered Interviewing “What do you call the problem?” “What do you think caused the problem?” “How bad is it?” “Why do you think it started when it did?” “How does it affect your life?” Kleinman, 1978 Questions for Client Centered Interviewing “What kind of treatment do you think will work?” “What do you fear most about the problem?” “How can I be of most help to you?” “What other remedies or treatments for your problem have you used?” Kleinman, 1978 Learning More About the Client How Environment has Changed Control Over Environment Social Stressors & Support Networks Literacy & Language How to Learn about Client’s Social Experience How Environment has Changed “Where are you from?” “Why did you decide to come to this country?” “When did you come?” Source: Carrillo, 1999 How to Learn about Client’s Social Experience Control Over Environment “How much of a problem is money in your life?” “Are you ever short of food or clothing?” “How do you keep track of appointments?” Carrillo, 1999 How to Learn about Client’s Social Experience Social Stressors & Support Networks “What is causing the most stress in your life?” “How do you deal with the stress?” “Do you have family or friends that you can call on for help?” Carrillo, 1999 How to Learn about Client’s Social Experience Literacy & Language “What trouble do you have reading your medication bottles or appointment slips?” “What language do you speak at home?” “Do you have a hard time communicating what you want to say to your healthcare providers?” Carrillo, 1999 Navigating the Complexities of Communication Most people assume that the most important aspect of communication is verbal Much of our meaning is communicated nonverbally Interpreting nonverbal communication can be challenging when interacting with someone of a different culture Mutha, 2002 Verbal Communication Language Spoken Written Degree of directness Loudness/Pitch Appropriate subjects for conversation Emotional expressiveness Randall-David, 1989 Nonverbal Communication Facial expressions Gestures Eye contact Distance Touch Silence Body movements Randall-David, 1989 Ways to Become Actively Involved in the Communication Process Learn proper forms of addressing in the client’s language Learn basic words & sentences in the client’s language Work effectively with interpreter Use a positive tone of voice Repeat important information more than once Reinforce verbal instructions with written materials Watch the client’s non verbal communication Randall-David, 1989 After the Interview Debrief & analyze What went right? What went wrong? How can I improve? Seek additional information Put together ALL the information Form a plan Forming a Plan Goal: Negotiate between the culture of the client & the medical culture Tailor the treatment/intervention to meet the client & family’s needs Make the client & family feel comfortable & part of the process Wrap Up We live & work in very culturally diverse environments Through preparation & directed use of skills, we can work effectively cross-culturally This is a continual process Skill Building: Case Study Questions??? References Auger S, Colindres M. Latino Cultural Competency Training Curriculum. Raleigh, NC: North Carolina’s Women’s Preventive Health Branch, Division of Maternal & Child Health, North Carolina Department of Environment, Health, & Natural Resources; 1994. Bauer K, Sokolik C. Basic Nutrition Counseling Skill Development. Belmont, CA: Wadsworth/Thompson Learning; 2002. Boyle J, Andrews M. Transcultural Concepts in Nursing. Boston: Scott Foresman; 1995. Campinha-Bacote J. The Process of Cultural Competence in the Delivery of Healthcare Services: A Culturally Competent Model of Care. 4th ed. Cincinnati, OH: Transcultural C.A.R.E. Associates; 2003. Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann of Intern Med. 1999; 130: 829-34. Eckley EE, Haughton B. Meaningful Exchange: Enhancing Cultural Competence of Public Health Personnel. Knoxville, TN: Department of Nutrition, the University of Tennessee; 2005. Georgetown University. National Center for Cultural Competence. Available at: http://gucchd.georgetown.edu/nccc/. Accessed February 20, 2006. Kleinman A, Eisenber L, Good B. Culture, illness, & care: clinical lessons from anthropologic & crosscultural research. Ann Intern Med. 1978; 88: 251-8. Mutha S, Allen C, Welch M. Towards Culturally Competent Care: A Toolbox for Teaching Communication Strategies. San Francisco: Center for the Health Professions University of California; 2002. Pachter LM, and Harwood RL. Culture and child behavior and psychosocial development. J Dev Behav Pediatr. 1996; 17: 191-198. Pederson PB, et. al. Counseling Across Cultures. 5th ed, Thousand Oaks, CA: Sage Publications, Inc.; 2002. Randall-David E. Strategies for Working with Culturally Diverse Communities & Clients. Bethesda, MD: Association for the Care of Children’s Health; 1989. Stewart M, Brown JB, Weston WW, McWilliam CL, Freeman TR. Patient-Centered Medicine: Transforming the Clinical Method. Thousand Oaks, CA: Sage Publications; 1995.