Cultural awareness Practical Nursing september 13 2016
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This document provides an overview of a cultural awareness presentation for practical nursing students. It includes the date, time, and presenter information. The presenter will share stories from their nursing experiences working with diverse populations. The objectives are to broaden understanding of the Platinum Rule, describe how to apply it, compare it to the Golden Rule, and explore cultural aspects of nursing care. Key topics that will be covered include invisible backpacks, definitions of culture, models of health, cultural competence, humility and safety. Quotes and examples will be used to illustrate these concepts. Contact information for the presenter is provided.
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Cultural awareness Practical Nursing september 13 2016
- 1. Cultural Awareness Practical Nursing September 13th , 2016 1330-1500 Greg Riehl RN BScN MA
- 2. Why am I here? • I ask myself this every day, and I also ask those who I am working with from time to time
- 3. Stories • I will use some of my experiences working in health, in the north, and as a nurse, often an outsider, working in different situations. • You are a part of the story.
- 4. Objectives To broaden the understanding of the Platinum Rule. To describe how to apply the Platinum Rule. Compare the Golden and Platinum Rules. To explore cultural aspects of nursing care. To identify the unique challenges faced by care providers working with diverse clients.
- 5. We Don’t SeeThings AsThey Are, We SeeThem As We Are Anaïs Nin “It has been well said that we do not see things as they are, but as we are ourselves. Every man looks through the eyes of his prejudices, of his preconceived notions. Hence, it is the most difficult thing in the world to broaden a man so that he will realize truth as other men see it.”
- 6. I try to be skeptical (question things) and not cynical (dismiss ideas & find fault with them)
- 7. Invisible Backpack “all of us carry an invisible ‘backpack’ of our culture, experiences, beliefs, values and morals.Whenever we encounter another person, our backpack is present with us and influences how we interact with our patients and their families”. Scott Harrison Invisible Knapsack Peggy McIntosh
- 10. What is Culture? • Behaviour is what you do… • Culture is how you do it…
- 11. What is Culture? • More than just the 3 or 4 F’s?
- 12. Everything is about CULTURE • Everybody knows about it • Everybody does it • Nobody talks about it • Kathleen Bartholomew, RN, MN
- 13. Culture is a world view • North American culture sees health as an individual problem, but we live in dynamic, intercultural communities. • Culture can be a barrier to caring for our clients. • We learn about disease models of health • We need to focus on wellness and resilience models of health • Health is multifaceted with issues related to mental, spiritual, emotional, and physical health.
- 14. Cultural Competence is a part of the Platinum Rule • Cultural Awareness • Cultural Sensitivity • Cultural Knowledge • Cultural Competence • Cultural Humility • Cultural Safety
- 15. Cultural Awareness Is really concerned about acceptance
- 16. Cultural Sensitivity Is about respecting differences and often uses neutral language, and neutral communication
- 17. Cultural Sensitivity Is about respecting differences and often uses neutral language, and neutral communication
- 18. What happens if a bird poops on you? • Bird poop brings good luck!There is a belief that if a bird poops on you, your car or your property, you may receive good luck and riches.The more birds involved, the richer you'll be! So next time a bird poops on you, remember that it's a good thing.
- 19. Cultural Knowledge Familiarization with selected cultural characteristics, history, values, belief systems, and behaviours of the members of another ethic group
- 21. Cultural Competence Is about understanding, knowledge skills and attitudes, working effectively in cross cultural and intercultural situations, this is the application of knowledge, creates the environment of cultural safety
- 22. Cultural Humility Focuses on self reflection and acknowledges power differences, and privilege.
- 23. Cultural Safety Stresses the importance of relationships and partnerships, power shifts to the client, to decide what is safe and what is not
- 25. An environment that is safe for people; where there is no assault, challenge or denial of their identity, of who they are and what they need. It is about shared respect, shared meaning, shared knowledge and experience, of learning, living and working together with dignity and truly listening. (Health Q. F., 2012) Cultural Safety
- 26. Physical Mental Emotional Spiritual My perspective is that each of these four parts can be treated as its own body. Each requires its own form of sustenance and exercise to be healthy
- 27. Seven Directions! East South West North Life Above the Earth Life Below the Earth Life on the Earth (and within ourselves)
- 28. Direction and Hierarchy • The more vertical an organization or a culture is in its hierarchy, the more complicated communication becomes.
- 29. Classroom Seating Position and College Grades • Studies show that students who sit in the front and center (middle) of the classroom tend to achieve higher average exam scores. • One study discovered a direct relationship between test scores and seating distance from the front of class: students in the front, middle, and back rows of class scored 80%, 71.6%, and 68.1% respectively
- 30. • Cultural safety stresses the importance of reflection & acceptance of differences. • We should not treat everyone the same. • We do need to recognize and acknowledge our blind spots.
- 31. Standards and Best Practices • One of the problems with “best practices” are that they are inflexible, especially for social sciences, and they may not reflect the diversity of human worldviews or the underlying differences between Indigenous worldviews.Typically, this proposition creates oppression and discrimination. • Indigenous wise practices vsWestern educational system best practices
- 32. Good Hunters vs BadTipi Builder
- 33. Bronze Silver Gold Platinum Rules • Bronze • Do unto others as they have done unto you • Silver • What you do not want done to yourself, do not do to others • Gold • Do unto others as you would have them do unto you. • Platinum • Do unto others as they want done unto them
- 34. Bronze silver gold platinum rules The culture ofWestern medicine places diagnosis as a central goal Aboriginal medicine, see diagnosis as less central and pay more attention to finding a safe environment in which the patient may recover. For conditions such as mental disorders, this latter approach may prove more effective than struggling to attach a label to the disorder.
- 35. Bronze rule Do unto others as they have done unto you
- 36. Silver What you do not want done to yourself, do not do to others
- 37. Gold Do unto others as you would have them do unto you.
- 38. Platinum Do unto others as they want done unto them
- 39. THE PLATINUM RULE. TREAT OTHERS HOW THEY WANT TO BE TREATED
- 40. Nursing Process and the Medicine Wheel
- 41. Imbalance Creates Illness Holistic approach to address issues and factors that impact illness targeting not just the disease, but also the social determinants of health and economic circumstances. It is recognized that the whole family (broadly defined) is as impacted by disease and needs healing just as the individual who is ‘sick’ requires care, treatment and support.
- 42. Lateral Kindness • Please be kind to each other • Respectful and responsible relationships, there are no apps for that. • Be Grateful • Be Great!
- 43. Discussion, questions, comments!!! Thank you for your participation
- 44. WhereYou Sit In Class And What It Says About Your Personality • 8) In the back row.“I really don’t want to be here, so I’m going to sit in the very back where I can fall asleep, or surf Facebook without anyone looking over my shoulder at the screen.” • 7) In the front row.“I want the professor to see my face everyday and know who I am. That way, he’s more likely to bump up my grade when I need an extra half point. At least, that’s what the article in Seventeen Magazine told me.”
- 45. WhereYou Sit In Class And What It Says About Your Personality • 6) Close to an aisle.“I don’t care if people have to shuffle over my knees just to get in and out, I just want a quick exit when this class is over.” • 5) Right in the middle.“I’m most comfortable when I’m surrounded by people. Also, if this lecture hall is anything like a movie theater, I’ll have the best view in the house.”
- 46. WhereYou Sit In Class And What It Says About Your Personality • 4) Uncomfortably close to someone else. “I choose this desk right next to you, even when there’s two dozen other desks available just because I like to assert my dominance this way. Also, you smell nice.” • 3)Taking up two or more desks. “I need room for my laptop, my gigantic bag, my books, my purse, and my coat. And damn anyone who thinks I don’t deserve the extra space.”
- 47. WhereYou Sit In Class And What It Says About Your Personality • 2) In a different classroom. “I read the schedule wrong.” • 1) In your bedroom. “I don’t feel like going to class today.”
- 48. Contact information Greg Riehl RN BScN MA Aboriginal Nursing Student Advisor Aboriginal Nursing Student Achievement Program Saskatchewan Polytechnic Regina Campus Email: greg.riehl@saskpolytech.ca
- 49. Statement of Commitment to Co-workers As your co-worker with a shared goal of providing excellent service to people and families, I commit the following: I will accept responsibility for establishing and maintaining healthy interpersonal relationships with you and every member of this staff. I will talk to you promptly if I am having a problem with you. The only time I will discuss it with another person is when I need advice or help in deciding how to communicate with you appropriately. I will establish & maintain a relationship of functional trust with you and every member of this staff. My relationships with each of you will be equally respectful, regardless of job titles or levels of educational preparation. I will not engage in the '3B's (bickering, back-biting and bitching) & will ask you not to as well. I will not complain about another team member & ask you not to as well. If I hear you doing so, I will ask you to talk to that person. I will accept you as you are today, forgiving past problems, & ask you to do the same with me. I will be committed to finding solutions to problems rather than complaining about them or blaming someone, & ask you to do the same. I will affirm your contribution to quality service. I will remember that neither of us is perfect, & that human errors are opportunities not for shame or guilt, but for forgiveness and growth. (Adapted from Marie Manthey, President of Creative Nursing Management in Caroline Flint's Midwifery Teams and Caseloads 1993; p. 138)
Notas do Editor
- Cultural Awareness Greg Riehl
- Someone is always watching you,
- The Golden Rule “do unto other as you would have them do unto you” or treat others how we would like to be treated, is a value many people learn growing up. Nursing education reinforces this adage and supports nurses to treat clients with similar conditions in similar ways. But, the Golden Rule does not support holistic care of addressing physical, mental, spiritual, or emotional needs of the client who may be culturally, ethnically, or spiritually different from the person or group providing care. For social justice to support inclusivity there needs to be a shift to the Platinum Rule, “do unto other as they want do unto them” or treat others how they want to be treated. The challenge implementing the Platinum Rule is evident in practice and occurs when providers work with clients who are culturally, ethnically, or socially different from themselves or with clients who actively engaging in risky behaviours or unhealthy choices. The Golden Rule supports healthcare provider morals and personal values; the Platinum Rule supports clients’ values and realizes that all humans have certain rights, even the right to make “bad” choices. In nursing, we should not treat everyone the same; we are all different. Patients, families, groups, and communities possess the knowledge to be active consumers and partners in health programming. Acceptance of all clients, with a focus on genuine empathy, regardless of lifestyles, behaviours, and choices, is required to deliver optimal client-first health care. This presentation is about the Platinum Rule and you.
- http://quoteinvestigator.com/2014/03/09/as-we-are/ 1891, The Province of Expression: A Search for Principles Underlying Adequate Methods of Developing Dramatic and Oratoric Delivery by S. S. Curry (Samuel Silas Curry) (Dean, School of Expression: Instructor of Elocution, Harvard College), Quote Page 392, Published by School of Expression, Boston, Massachusetts. (Google Books Full View) link ↩
- http://www.albertahealthservices.ca/assets/Infofor/hp/if-hp-ed-cdm-div-cultural-safety-visioning-and-planning-day.pdf
- culture no one has to talk about it, it doesn’t have to be written down, yet everybody knows it. Aboriginal teachings encompass a totality of the human condition – physical, spiritual, mental and emotional – and the significance of balance is emphasized. All aspects of life are intricately interconnected. Relationships are fundamental to understanding the nature of events, and establishing standards of behavior. Separating things out from each other and studying them as singular entities without a wholistic viewpoint as an organizing point does not fall within the natural way of thinking in Aboriginal epistemology.
- Cultural Awareness – is concerned about acceptance Cultural Sensitivity – is about respecting differences often uses neutral language, and neutral communication Cultural Competence – is about understanding, knowledge skills and attitudes, working effectively in cross cultural and intercultural situations, this is the application of knowledge, creates the environment of cultural safety Cultural Humility – self reflection acknowledges power differences, white privilege Cultural Safety – relationships and partnerships, power shifts to the client, to decide what is safe and what is not This is how I learn.
- A thumbs-up or thumbs-down is a common hand gesture achieved by a closed fist held with the thumb extended upward or downward in approval or disapproval, respectively. What you think you are saying:"Ayyyyy! I'm the fuckin' Fonz!" What you are actually saying:"Ayyyyy! I'm going to jam my thumb in your anus!" Give the "OK" Sign in Brazil What you think you are saying:"Hi Brazil, I'm US President Richard Nixon, and I'm feeling terrific!" What you are actually saying:"Hi Brazil, I'm US President Richard Nixon, and I'm feeling that you should all go fuck yourselves!" (Note: The above examples are only valid if you are US President Richard Nixon)
- http://www.bigsisters.bc.ca/site-bbbs/media/BCLowerMainland/Cultural_Sensitivity_Awareness.pdf http://www.amazon.in/Big-Necessity-Adventures-World-Human/dp/1846270707
- Food Fun Fashion
- “Understand the differences; act on the commonalities.”Andrew Masondo, African National Congress
- white privilege http://dcgazette.com/2016/white-privilege/ Health Care Culturally based beliefs significantly influence how patients seek out and respond to medical care. As international populations grow, Hospitals and physicians nurses all need to understand the different cultural sensitivities, languages and religions that can confound caregivers and affect the quality of care. http://greenlining.org/blog/2015/a-case-study-in-white-privilege/
- http://pub209healthcultureandsociety.wikispaces.com/%27A+Tree+Without+Roots%27+-+The+Importance+of+Cultural+Safety+in+the+Healthcare+System Picture is from Yellowknife
- http://cjmcpherson.com/2012/02/28/physical-mental-emotional-spiritual/ This is one of the meanings of the four sections of the medicine wheel, along with the seasons, directions, stages of life and countless other things. It’s a symbol overflowing with meanings, most of which I don’t pretend to know or understand. Physical – The Body The medicine wheel represents mind, heart, body and spirit, among other things. The obvious of the four. The physical body and its physical, observable needs. Made of matter, driven by chemistry and studied by the physical sciences, most of us have some idea how our body works. The body is fed by chemical energy and nutrients from food and is exercised by movement and strenuous activity. When the body is well nourished and well exercised you get vitality, when it is not you get sickness. The body also includes our sexual needs. The body is designed to require sex in the same way it requires food, which is why prolonged abstinence is as unpleasant as it is. Why some religions are so fond of it I cannot understand. Despite all the fuss about weight loss and dieting, most North Americans don’t take good care of their physical bodies. Rates of obesity and other illness attest to this. I like to place the physical aspect at the base of the medicine wheel, as it forms the foundation that the other three build on. The body needs to be fed before you can even begin thinking about the needs of the mind or emotions. But if you have a healthy body, taking care of the rest of your being is easier. Mental – The Mind It could be said that the mind is made of thoughts, but I think it is more accurate to say thoughts are the actions of the mind. The mind works with relations of ideas, concepts and pattern recognition. It processes information sequentially, using words and other symbols to make sense of what it observes. Logic, memory and conscious thought are all within the domain of the mind. The mind is fed by knowledge and exercised by thinking. Solving challenging problems and creative work are examples of a workout for the mind. Like with physical muscles, the stronger the mind is, the more it needs to lift to feel challenged. An underused mind becomes bored. A well fed and challenged mind becomes intelligent. Emotional – The Heart Like thoughts are the actions of the mind, I like to think of emotions as the actions of the heart. The heart, or socio-emotional center if you want to sound scientific, goes much deeper than the emotions we are aware of. It contains all of our connections, desires and repressed feelings, among other things. The heart can be said to have an internal and external side. The internal is our own emotional state, while the external is our relationships with other people. As social beings, the relationships we have are extremely important. As I have learned the hard way, a lack of good quality relationships will make you miserable no matter how much attention you pay to your emotions. The heart is fed by supportive relationships and positive experiences. It is exercised by compassion, giving and generosity. Like how some foods are filling but bad for you, not all relationships are equally nutritious to the heart. Abusive relationships certainly fall under this category, but so does any relationship that isn’t what you as a person need. The same goes for experiences, what thrills one person would bore another to death. This specifics are different for everyone, so no one can tell you a relationship or experience is right for you but yourself, especially not the other people involved. A well fed heart creates joy, a neglected heart creates misery, guilt, resentment, anger and a host of other negative emotions. The heart is a very complicated area and I’ve only scratched the surface in terms of my understanding of it. More will come in this area when I know more. Spiritual – Spirit, Soul, Consciousness, Etc. . . This is the hardest area to really understand, as it forms the absolute core of our being. It is the innermost ‘us’ beyond all our self-identifiers, beliefs and experiences. It doesn’t matter of you believe the soul or consciousness has a spiritual or material origin, it still has its own workings that must be addressed. Like thoughts and emotions are the actions of the mind and heart, the spirit has its own form of activity. The spirit works with beliefs. It doesn’t reason or question these beliefs like the mind, but holds them. The spirit deals only with is, not with because. For this reason, every belief is treated as an absolute. It doesn’t matter how accurate or inaccurate it is. It doesn’t matter where it came from or who first said it. Once the spirit believes something, the mind and heart will believe it as well. The spirit acts like a metronome keeping time for the rest of your being. The spirit is fed by meaning and exercised by spiritual growth. When the spirit is taken care of you get fulfilment, when it is neglected you get spiritual apathy, nihilism and depression. The spirit’s needs are the most subtle of all, because they work on a longer time scale than most human activities. A deficit in the spirit will take a long time to appear, but a well balanced spirit creates benefits over a lifetime. By meaning I’m referring to the sense our lives mean something within the larger scheme of things. Whether to the universe as a whole or to the human race, we as humans need to feel we’ve done something worthwhile. The specific meaning you give your life will depend on your beliefs about the world and how it works. The important thing is that your life has meaning within what those believes. This requires great introspection and consistent effort, but it is necessary. I’ve only taken a few steps down this road myself. Spiritual growth is increasing your understanding of the world and your place in it. It is finding more powerful beliefs and leaving behind old ones. It is becoming more aware and capable as a human being. Most people pay little, if any, attention to this area, but those who do can achieve amazing things within their lifetime. Just look at Jesus, Buddha and Gandhi. Separate but Connected These four areas are separate, but connected. They work independently of one another most of the time, but depend on each others’ existence and continued functioning. No one area can exist without the others. For example, the body and mind are never sure of what the other is doing. Out thoughts are separate from our autonomic functions. But should the mind be put under stress, it will cause a stress response in the body as well, raising heart rate, blood pressure and metabolism, among other things. The same is true of the reverse, stress to the body (like illness) will negatively impact the mind. Each of the four areas are equally essential and are equally ‘you.’ The key is to have them all working and in balance. Any one neglected area will throw the whole system out of balance, becoming progressively worse until it is addressed or causes a complete breakdown. But when all four areas are fed and used properly, happiness is the result. One area, once healthy, can help you to work through other areas. I certainly haven’t got it all figured out. There are some areas I’m only beginning to work on now, so don’t think perfection is necessary. All that’s necessary is being honest with yourself. The rest will follow from that. http://karenvelen.wordpress.com/2010/03/25/the-medicine-wheel-balance-within-and-without/
- ON THE EARTH: Honour yourself and all life, for that is one of the mainstays of your personal journey. It is the essential INNER self of each person which is every-changed and transforming, that moves you beyond time and beyond seasons. LIFE ABOVE THE EARTH: Father Sky the protector of the Universe, Star Nation. Planets are the keepers of the wisdom of the ages. LIFE BELOW THE EARTH: Provides balance, cohesion, connections and rootedness with Mother Earth and the four great winds that founds their origins in the lower world. http://www.shannonthunderbird.com/medicine_wheel_teachings.htm
- https://www.altoona.psu.edu/fts/docs/SeatingPositionGrades.pdf
- There is little recognition that the history of near extermination, cultural genocide, land loss, oppression, ongoing racism, and poverty are related to not only emotional, spiritual, and mental disease but also physical disease. http://www.med.uottawa.ca/sim/data/Aboriginal_medicine_wheel.pdf http://www.fourdirectionsteachings.com/transcripts/cree.html http://pub209healthcultureandsociety.wikispaces.com/%27A+Tree+Without+Roots%27+-+The+Importance+of+Cultural+Safety+in+the+Healthcare+System Cultural safety stresses the importance of reflection and acceptance of differences. We should not treat everyone the same, but we do need to recognize and acknowledge our blind spots.
- http://firstpeoplesofcanada.com/fp_groups/fp_groups_travel.html
- "People don't take drugs because Amy Winehouse takes drugs," added Kushlick. "It entirely misses the point. They take drugs because they make them feel better or they stop them feeling bad." http://prezi.com/v3b2mwjd7ucz/change-theory-medicine-wheel/ http://prezi.com/kquoc_divsqh/medicine-wheel-change-theory/ http://prezi.com/1mrkcpdxdc8g/change-theory-medicine-wheel/ http://xnet.kp.org/permanentejournal/winter00pj/wheel.html http://www.med.uottawa.ca/sim/data/Aboriginal_Medicine_e.htm
- Unfortunately this is often how nursing is, we had to endure certain hardships as new nurses, and many feel the need to see one, do one, and teach one in the same manner, putting new graduate nurses through the same hardships they endured.
- Confucius or One should not treat others in ways that one would not like to be treated
- This is really what we are trying to do with all people. Basically treat other people how they want to be treated. The Platinum Rule meets people where they are at, it is a balanced approach that gives power to the client. Just like all areas of the medicine wheel need to be balanced for (w)holistic health for the client, where the client is the person, family, group, or community. Indigenous teachings support addressing all areas of the person to achieve balance.
- We all know the Golden Rule “do unto others…” but in health care, this does not work all the time for all people receiving or providing care. The Platinum Rule supports acceptance of all and avoids value and moral judgments to support care. Learn about the Platinum Rule and you.
- http://www.dancingtoeaglespiritsociety.org/medwheel.php
- Practice what you Teach.