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Pharm 110 > Module 6 > Flashcards

Module 6 Flashcards

1
Q

Define Culture

A

a set practices and behaviours defined by customs, habits, languages and geography that groups of individuals share
- Share values, beliefs, norms, understandings, symbols, practices of a group

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2
Q

The Nature of Culture

A

Above the Surface –> presented outwardly –> food, dress, film, dance, sports, games, art, music

Below the Surface –> Beauty standards, raise children, logic, justice, cleanliness, attitudes about the elderly, displays of emotion

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3
Q

Define Intercultural sensitivity

A
  • Level of awareness of other cultures
  • Increases when our exposure and experiences to other cultures increases
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4
Q

Define the Intercultural sensitivity continuum

A

DDMAAI
Denial
Defiance
Minimization
Acceptance
Adaptation
Integration

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5
Q

Define ethnocentrism and ethnology-relativism. Where do they meet on the continuum

A

Ethnocentrism –> Our values are superior and better than others
Ethno-relativism - accept/respect their values and who they are
Meet at acceptance

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6
Q

Denial

A

Limited contact with people unlike ourselves
The other is not viewed as a threat to the dominant group (little overt hostility)
- Assumptions are largely unconscious and unchallanged

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7
Q

Defence

A

Awareness of the other
- Seen as a threat; contact is discouraged
- Stereotyping is common
- Tendency to assert superiority of ones’s own culture

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8
Q

Minimization

A

Cultural differences are ‘acknowledged’ but ultimately seen as irrelevant.

  • Acknowledge etiquette and cutsoms, but deep down we are all the same

We are a “tolerant” society; but…
There is an expectation of eventual assimilation into the dominant culture.

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9
Q

Acceptance

A

Aware of the cultural complexity of others
Shift from ethno-centrism to ethno-relativism

Cultures seen as different but equal.
Differences are often viewed as interesting, positive and enjoyable.
Differences (including other worldviews) are acknowledged and accepted.

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10
Q

Adaptation

A

Consider the perspective of another culture in assessing how to respond to a particular situation.
Showing both empathy and cultural humility.

Growing awareness of your “cultural lens”
Begin to appreciate how others may see you through their cultural lenses.

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11
Q

Integration

A

Bicultural/multicultural in one’s worldview
Identity not ‘moored’ to any one culture

Able to move easily and intentionally between different cultural frames of reference

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12
Q

Why a greater cultural awareness in healthcare?

A

Patient populations are culturally diverse and becoming more so.

Can affect how a person perceives and/or experiences illness, who is consulted and how symptoms are reported.

Those providing care often have limited knowledge of the cultural background of their patients, or the effects of culture on the patient experience.

MUST understand how the cultural backgrounds of you and your patient can affect care.
Cultural differences in health seeking behaviour and health beliefs
Western bio-medical model of disease and care versus other health care traditions

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13
Q

Why do healthcare professionals have to recognize that they should be more culturally aware?

A

Professional and ethical reasons to be more culturally competent

Professional and moral obligation to provide the best possible care to your patient.

We understand that miscommunication and misunderstandings based on lack of awareness of relevant cultural factors and issues may limit our ability to provide optimum care.

If lacking, providers need to acquire the necessary knowledge and skills.

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14
Q

Define Cultural Competence in Health Care

A

To possess the attitudes, knowledge, and skills that support the acquisition and integration of the realities of different cultures into your practice, and into the profession.

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15
Q

Steps to be a successful practitioner:

A
  • Have a positive attitude towards your own cultural heritage as well as of patients
  • Appreciate, value and respect differences
  • Be aware of your personal biases and values
  • Increase understanding of cultures - seek out various worldviews of disease
  • Increase knowledge of how culture can affect the distribution of health disparities, communication, assumption of specific roles
  • Become familiar with cultural-specific resources
  • Communicate respectfully
  • Examine and explain issue for patients point of view
  • Advocate for patients based on their needs
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16
Q

How to increase cultural competence

A
  • Examine your cultural background
  • Asses your level of cultural sensitivity
  • Talk with pts from diverese backgrounds in your community
  • Read about cultural-specific diseases and evidence based interventions
  • Immerse yourself in the community –> Be seen
    Work with patient or community groups
  • Hold staff meeti ngs or seminars focused on cultural competency
  • Seek out traditional healers (in addition to…)
  • reach out to religious leaders and organizations
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17
Q

Define cultural humility

A

Intrapersonal:
Having an accurate view of oneself culturally, including an awareness of the limitations of one’s own perspective or ability to understand another’s background and experience.

Interpersonal:
Openness to other cultures characterised by respect and lack of superiority. Recognize and accept that others may differ in beliefs, values, attitudes, and world views.

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18
Q

Why do minorities have poorer health outcomes?

A

Social Determinants of Health
- lower levels of education, lower socioeconomic status, and living in unsafe neighbourhoods
- Lack of acess to care

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19
Q

Uninsured individuals will….

A
  • do not have regular care
  • will prevent seeking care
  • more likley to report they have not recieved care
  • Avoidable hospitalizations, emergency hospital care, and adverese health outcomes
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20
Q

If minorities had same level and access to care….

A
  • SDOH not just the answer
  • If they did have acess and living conditions similar to whites, still experience bad health outcomes
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21
Q

Define healthcare equity

A
  • the principle that care should not vary based on patient characteristics such as race/ethnicity
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22
Q

What is the goal of culturally competent healthcare providers?

A

The goal is to improve the ability of health-care providers and the healthcare system to communicate effectively with and provide high quality care to patients from diverese sociocultural backgrounds

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23
Q

Why are disparities bad?

A

Unjust, unethical, costly and unacceptable

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24
Q

Why is cultural competency more important than ever?

A
  • Country is becoming more diverse
  • Research has demonstrated that sociocultural differences between patient and provider influence communication and decision making
  • Disparities result in more medical errors with greater clinical consequence
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25
Q

Why is cultural competency problematic?

A
  • Focus on language barriers
  • Checklist of what to do/what to say for certain cultures
  • E.g. Here is how you should interact with a Latino pt rather than learning about the culture
  • need to learn their values, beliefs, and customs. Need to learn about their historical experiences and how it may influence them
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26
Q

The relationship between cultural competency and stereotyping

A
  • A broad view of a cultural group (e.g. latino) can lead to stereotypes and generalizations
  • May assume all latinos have the same beliefs, values, norms, etc. when this isn’t the case. Many latin countries have different cultures eve though they share the same language (e.g. Spanish)
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27
Q

Difference between Patient-Centered Care and Cultural Competency

A
  • Impossible to learn the values, beliefs, family dynamics and health behaviours of all cultural groups
  • Focus on the individual; get to know the patient themselves rather than focus on trends associated with certain groups and making assumptions off those trends
  • Switching the ethics of care from checklist principles to a focus on the individual pt
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28
Q

What approach should be used in health care services/studies to be more culturally competent?

A
  • DO NOT USE a one size fits all approach; all though appears as equitable, does not address differences across cultures
  • Are we actually catering to the needs of these people?
  • Refine services to be culturally competent (through education) to reduce disparities
  • Collect data on race and language, find out what barriers to healthcare are being experienced, interpreters, make flexible hours, refer to peer support networks, train staff and clinicians in cultural competence
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29
Q

Accountable Care Organizations (ACO’s)

A
  • Group of doctors, hospitals, and other health-care providers that come together voluntarily to provide coordinated care to their patients
  • Minimize cost to pt; maintain effective care by meeting quality indicators
  • Benefits –> Increased quality of care, lower costs and improved population health
  • Cover diverse populations –> use anlaytics to predict barriers that atke into account race, socioeconomic status, education level
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30
Q

Community Health Workers

A

Community health workers, all with different cultural and linguistic backgrounds, will have the capacities to meet the needs of diverse communities

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31
Q

Cultural Competency in Healthcare Provider Education Issue

A
  • A push for training culturally competent healthcare providers
  • However, in this regard, cultural competency can be reduced/simplified to a “checklist” –> an item to be checked off in training
32
Q

First Nation Cultural Competency

A
  • When we aspire to learn about a person’s values, beliefs, family dynamics and health dynamics, we may disregard that all individuals are different
  • Just because someone belongs to a culture, does not mean that person has the same culture as another person
  • Healthcare providers cannot assume that all people within a culture are the same and have the same beliefs and values
33
Q

Bio-medical Culture

A
  • Healthcare professionals need to reflect on their own culture; including, the bio-medical culture
  • We need to reflect on the challanges that pts and families face in the healthcare system
34
Q

Humility over competence

A

Three dimensions

a) Lifelong learning
b) Recognizing and challanging power imbalance
c) Institutionalized accountability

35
Q

Culture

A

Learned and shared knowledge that specific groups generate their behavior and interpret their experience of the world

36
Q

Characteristics of Culture

A
  • Every group has a culture. Culture is fluid. No one has the same culture
  • Culture is shared and unique, fluid and transmitted
37
Q

Cultural Safety Definition

A

Cultural Safety ensures that service providers become respectful of all aspects of culture including (history, values, gender, socioeconomic status).
- Spiritually, socially and emotionally safe as well as physically safe
- No challenge or denial of their identity
- Shared knowledge, respect and learning together – establish trust

38
Q

What should service providers do?

A

Service providers should also acknowledge that their own cultural beliefs and attitudes have the potential, consciously or unconsciously, to influence the power balance with their clients and each other.

39
Q

Cultural Continuum

A

Cultural safety on a continuum comes after cultural competence and proficiency but it is not about a checklist or memorizing different norms based on ethnicity.

40
Q

Cultural Shift

A

Cultural Shift - Shift the role of culture as checklist-based ethnicity to critical examination of power encounters in client relationships - healthcare provider has the power –> Shift that power to the pt

41
Q

How can we achieve cultural safety?

A

It is about understanding the person in front of you, creating trust and working together with the person so that your interactions do no harm to the individual. The major constructs to consider are historical oppressions and power in relationships.

42
Q

What is the social construction of knowledge?

A

Social Construction - Knowledge is created as we interact with all things in our environment. It is not static and not only what we learn in school.

43
Q

What should we do with assumptions?

A

Can have assumptions but must put them behind us. Get to know the person.

44
Q

Define oppression/inequity

A

Using power and authority to create inequity and or unfair treatment

45
Q

Institutional Racism

A
  • Need to understand how history has affected cultures
    Example: First nations –> residential schools –. poorer health outcomes –> genrational trauma
46
Q

Recommendation for equitable care

A

Cultural Safety

47
Q

Goal of cultural safety

A
  • improving the provision of care to minorities with the goal of reducing ethnic disparities
48
Q

Cultural Continuum

A

Cultural Destructiveness (e.g. genocide) to cultural proficiency (agencies that hold culture in high esteem who seek to add to the knowledge of culturally competent practice by conducting research and developing new therapeutic approaches based on culture)

49
Q

Major difference between cultural competency and safety

A
  • The distribution of power
50
Q

Cultural safety is about…

A

acknowledging the barriers to clinical effectiveness from the power imbalance
- Be aware of difference, decolonizing, considering power relationships, reflective practice
- WORKING WITH THE PATIENT NOT FOR THE PATIENT

51
Q

Major difference between cultural safety and competency

A

The focus of cultural safety moves to the culture of the clinician or clinical environment rather than the culture of the pt

52
Q

Is cultural safety another step on the continuum or complete paradigm shift?

A

Complete paradigm shift –> A need for self reflection

53
Q

Social Determinants of Health and Disparity

A
  • Inequities in access to the social determinants of health have their foundations in colonial histories and subsequent imbalances of power that have consistently benefited some over others
54
Q

Where should cultural safety change take place?

A

organizations and the individual

55
Q

Diabetes in Indigenous Individuals in Canada

A

Four times higher
- Routed in colonialism and history of residential schools

56
Q

Four categories of barriers and enablers of Cultural Safety in Quebec first nation community

A
  1. Colonialism and Social Determinants of Health
  2. Health Services Organization
  3. Language and Communication
  4. Traditional Practices and Cultural Perspectives of Health
57
Q

Colonialism and SDOH

A

Barriers:
- racism in health organizations
- many noted being treated differently due to their indigenous status
- Led people to not engage with the healthcare system
- Difficult to apply advice from healthcare providers because of socioeconomic position (e.g. healthy eating due to food desserts)

Enabler:
- focus education on sensitizing providers to discrimination and racism
- foster attitudes of acceptance, openness and respect
- Systemic regulation for handling complaints regarding racism

58
Q

Health Services Organization

A

Barriers:
- ill adapted to the social organization of first nations culture (did not let family into care/sessions)
- social support not facilitated within the system
- Congestion of health care system

Enablers:
- Organizing a system that favours the involvement of family in care
- Exclusive indigenous clinics ran by indigenous people
- Hiring more indigenous staff and profesisonals

59
Q

Language and Communication

A

Barriers:
- Unable to obtain services in their native tongue
- Use of medical jargon by healthcare professionals
- Lack of understanding of social/communication attitudes in the culture (e.g. not being able to look in the eyes as deemed inappropriate/disrespectful)

Enablers:
- Interpreter service
- learning basic terms in the language

60
Q

Traditional Practices and Cultural perspectives of Health

A

Barriers:
- Guidelines for diabetes management not adapted to the communities food and lifestyle
- Providers limited knowledge of traditional health practices and spiritual understanding of disease
- providers unsure of where to start learning and how to apply that knowledge

Enablers:
- An adapted nutrition guide to their food and lifestyle
- provide education about their culture to providers

61
Q

Why is communication important in pharmacy?

A
  • patients need to understand how to effectively and safely use their medications
62
Q

What must a provider establish?

A

Trust, Informed Consent, Good-decision making (need to know what pt knows and what they are willing and able to do), effective self-management of disease

63
Q

Ritual Model of Communication

A
  • Communication based on “shared” patterns
  • Risk is higher as pt does not express actual experiences

Any questions about med? No

64
Q

Transmission Model of Communication

A
  • focus on providing information in a singular or one-way direction (dat dump)
  • activ ept participation possible, but, not encouraged
    ASSUMED POWER DIFFERENCE (PHARMACIST HAS THE POWER)
65
Q

Transaction Model of Communication

A
  • Two way conversation
  • Information sent and recieved in stages by pharmacist and pt
  • feedback and discussion create context for further discussion
66
Q

Language as a barrier

A
  • difficult to establish rapport
  • lack of appropriate health information resulting in poor understanding of medications and potential adverse effects
  • over reliance on informal social networks and social media
67
Q

Low-context communication

A
  • sender assumes the receiver knows very little and must be told everything
  • reciever expects communication to be explicit
68
Q

High-context communication

A

the sender assumes the receiver knows the relevant situation/circumstance.
the receiver quickly understands concerns and messages with minimum information from the sender
–> more concerned with emotional quality than the meaning of individual words/sentences
–> tend to make greater use of silence

69
Q

Monochronic vs polychronic time

A

Monochronic time: emphasis on creating and maintaining schedules, and being on time.

Polychronic time: values involvement with others versus keeping appointments and schedules.

70
Q

Healthcare provider and silence

A

Important for the HCP to promote/support reflection and not try to fill in “gaps” in the conversation

71
Q

Individualism vs Collectivism

A

Individualism: social pattern in which the person is primarily motivated by own preferences, needs, rights and desires
Wants of the group are secondary

Collectivism: the person gives greater priority to the needs of the group (family, work unit, community).
Motivated by group norms and duties

72
Q

Emotional Expression

A

In some cultures, loud or raised voices indicate tension or aggression

In other cultures, indicates an exciting and enjoyable conversation among friends.

Correct interpretation critical
- People who speak quietly or slowly…
Struggling with a second language
Sign of respect and reflection

73
Q

Non-verbal Communication

A

Expressions, touches and gestures
Often convey stronger messages than verbal communication
Can re-enforce or contradict the verbal message.

Appropriate amount of touching based on cultural norms
Such as handshakes, hugs, kisses, etc.
Significant differences across cultures; also within cultures based on age or status.
Changes in norms also occur over time within cultures

74
Q

Power Distance and Communication

A

Refers to the distribution of power within a group or society

Vertical: concentration of power “at the top”. Many with little or no power
Tendency to be more formal with deference to those in positions of authority
Hesitancy to give one’s opinion or ask questions of those seen as authorities/experts

Horizontal: power more widely shared with a more egalitarian view of one another
Less deference and less hesitancy to ask questions

75
Q

Tool for effective cross-cultural communication

A

L - Listen with empathy and for understanding
- How does the patient view the problem
E - Explain your view of the problem to the patient
- After demonstrating active listening
A - Acknowledge similarities AND differences
- Done by both patient and provider
R - Recommend appropriate treatment
- “For consideration” approach vs. “Prescriptive” approach
N - Negotiate with the patient over what is possible for the patient
- The best solution may not be the best solution

76
Q

Pharmacists role in language barrier

A
  • We are aware of resources and can refer people to more reliable multi-lingual information sources rather than social media or the internet
  • Encourage multi-lingual staff and health professionals
  • Use dual language label
  • Use pictograms to help identify what a patient is trung to communicate –> Put them on med labels
  • ## Use support of interpreters

Pharm 110 (8 decks)

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