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Cultural Competency – Module 2: Making a Difference: Video Transcript

Health practitioners want to make a difference, we want to contribute to improved health or better outcomes for patients. Let’s face it; almost everybody working in health wants to make a positive difference. This module is just about a starting point for you to think about how to contribute to that positive difference in terms of your cultural competence, in terms of your delivery of services to patients from cultures other than your own.

So there are lots of places to be involved and for you to get started. We’ve identified 3 key areas for you to think about when planning your cultural competence journey: Recognising your own culture and reflecting on difference. Communication, pronunciation and information, patient preferences and checking with the patient. And review and audit.

Also check with your registration authority, each registration authority will be publishing standards for cultural competence, and many have started work on resources to support you.

Special Guest Presentation: Dr Peter Jansen – If we are to provide equitable care that is the right amount of care to every patient, every time then we are going to need some tools to help us. There are 3 sorts of tools that I think are really important, the first one is to make sure that we have the right knowledge and we’re all involved in continuing education programmes that help us understand diseases and patients and their responses. The second set of tools is around giving us feedback on how we’re going, that involves things like practice audit or peer review and also we could ask the patients what their experience was of care. Lastly we need to check that our new found knowledge and skills are embedded in our practice, so we need to measure and re-measure over time to make sure that we are delivering that equitable care for every patient. End

Irihapeti Ramsden developed an approach she called ‘cultural safety’ which has significantly contributed to the international literature and the conversations about cultural competence. This approach has been influential for nursing and many other health professional disciplines. It is predicated on the idea that as a health practitioner we need to understand ourselves first, to recognise our own cultural preferences, our own biases. From this starting point we can respectfully acknowledge and appreciate the cultures of our patients. Cultural Safety is therefore about the health practitioner rather than the patient.”

For health practitioners who come from different disciplines it is useful to consider our own values and biases, our values, and our preferences. This personal reflection can help us to recognise things about ourselves and be responsible for managing these. The Medical Council and other registration authorities provide guidance about cultural competence and advise practitioners that “you must be aware of cultural diversity and function effectively and respectfully when working with and treating people of all cultural backgrounds.”

So activities that you can undertake include anything that assists you to reflect on your own beliefs and values and also to reflect on your own practice. You might do this on your own or with others, you might write this down, or you might discuss this with a group of your colleagues. There are some resources that have been developed to support this type of activity. And for many of us we can register credits for this activity in our professional development programmes.

We probably all agree that good communication is important to good relationships, and effective relationships with patients and their families. We know from the international literature that patients like to feel that they are the focus of your attention, that they are being listened to, being heard, being included in the conversations about their health. We can show them that by looking at them when we are talking, not at your computer screen or papers. Body language often helps to reinforce this – lean forward, demonstrating that we are interested in what patients are saying to us. Nodding your head and of course our expressions also show interest.

It is important to reflect and note our own preferences, and to avoid making assumptions about what patients and their families may prefer. And we should expect variation and diversity.

Special Guest Presentation: Mihiteria King – In terms of cultural competence I’m talking about in relationship with my clients and so therefore it’s competence within a therapeutic relationship, and about being effective in that relationship no matter who I’m sitting with, because I guess the reality is that we all have different world views where some things may over lap, but there is a diversity even within Māori culture or whichever culture we are engaged with there’s diversity. I guess to be effective we have to find a way to sit with that. So we are looking at distilling this into three stages, the stage of awareness and insight of yourself and of others. Then we are looking at developing sensitivity to others now that we have that level of awareness. And then we move to a level of acceptance, the legitimacy of difference and the power dynamics that occur in a relationship. And those three things lead us into a safe and skilful practice. End

Our healthcare environments often send the message to our patients that “we are very busy, very efficient” or even “I am very important.” This usually makes patients feel less important and that health practitioners are too busy and important to spend time listening to them or learning about their needs.

Different cultures have different body language. If you come from a culture where no eye contact means you’re respectfully listening, and you are talking to someone from a culture where sustained eye contact means you’re listening, then you will interpret their body language in a very different way.

You can see how important our own beliefs are, so next time you wonder if maybe you’re not ‘getting through’ to someone, consider body language and cultural preferences. Is there another way for you to explain things or can you show this in a different way?

Special Guest Presentation: Assoc Prof Jonathan Koea – Overall poor experiences of Māori most commonly reflect difficulties with communication – particularly when the provider is perceived to be rushed or busy or unsympathetic to the predicament of the patient. When one looks at patients overall really that’s what most people want, they want a health provider that listens to them, responds to their needs and at least tries to solve their problems, overall Māori patients value competence, respect, compassion and a caring attitude in their health providers. It’s worth the extra time to do this right. End

Pronunciation is very important, especially when we are pronouncing someone’s name. Taking the time to learn how to pronounce your name or my name is very important, it is something that we want from our colleagues and something that our patients want from us.

To ensure what you are doing is effective it is important to take time to review and audit your cultural competency practices. This could be at a personal level, or at an organisational level. You could review policies and procedures, or carry out clinical audits. A review of training manuals, recruitment of staff, induction and orientation programmes could be a worthwhile project.

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