Week8 health assignment HSCI 430
Ayoosh
Chapter6Presentation430.ppt
Training for Knowledge and Skills in Culturally Competent Care for Diverse Populations
Objectives
To distinguish between cultural competence training focused on attitudes and training focused on knowledge and skills
To clarify principles that support knowledge and skills training in health care
To examine the essential knowledge and skills training for health care management
To examine the essential knowledge and skills training for persons involved in direct patient care
To describe how cultural competence knowledge and skills can enhance the therapeutic encounter
To describe how support service employees in health care can benefit from skills and knowledge training
To examine factors involved in assessing cultural competence training
To list some of the cultural competence training resources available
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Goals of Cultural Competence Skills and Knowledge Training
Increased quality of care to diverse populations
Clinical excellence and strong therapeutic alliances with patients
Reduction of health care disparities among the population served
Workforce that performs effectively within a diverse service community
Eight Principles for Knowledge
and Skills Training
1. There should be a broad and inclusive definition of cultural and population diversity including consideration of races, ethnic groups, social classes, age cohorts, genders, and LGBTs.
2. Training should not be a one-time undertaking but should be developmental and ongoing, moving from general information to the more specific.
8 Principles for Knowledge
and Skills Training
3. Knowledge and skills training should not be one-size-fits-all but should be focused on specific job-related functions and health care disciplines.
4. Knowledge and skill training should be focused on factual information and how-tos with practical application rather than theory or didactics. The training should be viewed as augmenting existing skills and knowledge bases.
8 Principles for Knowledge
and Skills Training
5. Cultural competence knowledge and skills training should be integrated into as many other types of training as possible.
6. Knowledge and skill training should be buttressed by ongoing self-assessment as well as feedback to the trainers and organization.
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8 Principles for Knowledge
and Skills Training
7. Whenever possible, there should be an attempt to build an evidence base for the training by looking at health outcomes, costs, and patient, provider, and consumer satisfaction data following implementation of training.
8. No cultural competence trainings should take place until and unless the sponsoring health care organization or institution is ready and able to support the knowledge and skills that are taught in the training.
Cultural Competence Knowledge & Skills for Administrators & Directors
Data – census data, community-based training, demographics of service area compared to market share
Diversity epidemiology – health care needs of specific groups within population base
HEDIS measures – health care outcomes by ethnic and racial groups, and other diversity dimensions
Cultural Competence Knowledge & Skills for Administrators & Directors
Legislation – national and state level
Accreditation requirements – Joint Commission, NCQA, etc.
Know enough to make good hires in key positions – see guide by the Industry Collaborate Effort (2006)
Oversee HR in selection of trainers
Must model the cultural competence they want to see from all staff
Diversity Training for Administrators
Often includes generational/gender differences in communication, LGBT employee concerns, mediating disputes, managing religious diversity
Case examples and interaction are excellent training tools
Executive coaches as needed
Only administrators who model cultural competence themselves can create a culture, climate, and infrastructure for culturally competent patient care and develop and lead a culturally competent health care organization.
Cultural Competence Training for Health Care Professional in Direct Patient Care
Good training models have been developed for nurses and physicians
Support exists from accrediting bodies (e.g. AACN, AAMC), practice organizations (ANA, ADA, NLN), and professional bodies of literature for cultural and linguistic competence education as part of professional knowledge and practice
Trends in Clinical Education
Legislation exists to require cultural competence training for physicians in NJ, CA, WA, NY, AZ and OH
More web-based programs and webinars now exist
Essential focus on care-giving relationship between provider and patient, as well as service delivery to diverse patient populations
Motivated by desire to deliver high quality care with good outcomes
Cultural Competence in Clinical Education
Model programs:
Medical education – Harvard Medical School
Nursing educators – National League of Nursing toolkit
Residency programs – White Memorial Medical center
Cultural Competence Training in Clinical Education
For those already in practice:
- Continuing education in-house
- Specialty-based conferences and seminars
- Integrated into existing training, i.e. cardiology, diabetes, HIV/AIDS
Universal Aspects of Culture Affecting Health Care
Cultural, trait-based lists promote stereotypes and have limits
Universal factors exist that are found in all cultures
Considering these allows for more personalized patient care
Cultural Factors Affecting
Health Care - 1
Meaning of symptoms
Perceptions of anatomy and bodily functions
Perceptions of appropriate treatment
Autonomy and self-efficacy
Gender roles
Childbirth and reproduction
Cultural Factors Affecting
Health Care - 2
Family involvement and inclusion
Orientation to prevention
Pain expression and management
Diets and dietary practices
Concepts of death and dying
Expectations of health professionals
Patient Care Impacts
Aspects of diagnosis
Treatment expectations
Ability to follow treatment plan
Expectations of family and care team
Training Implications
Developmental training – focusing on specific areas of service delivery
Cultural epidemiology – study of the way in which cultural norms, values, and behavior affects the onset, course, and outcome of disease, as well as its incidence and prevalence
The Eight Questions
Kleinman, Eisenberg, and Good (1978):
1. What do you think caused your sickness or problem?
2. Why do you think it started when it did?
3. What do you think the sickness does to you? How does it work?
4. How severe is your sickness? Do you think it will last a short time or a long time?
The Eight Questions
5. What are the chief problems the sickness has caused you?
6. What do you fear most about this sickness?
7. What kind of treatment do you think you need?
8. What are the most important results you hope from the treatment?
The Eight Questions
Yield insight into patient’s explanatory model
Provide an understanding of the patient’s subjective experience of the condition
Provide an opportunity to acknowledge differences between the patient’s and provider’s models for the illness
Negotiate agreement about treatment
Build trust and therapeutic alliance
LEARN (Berlin & Fowkes, 1983)
L = listen with empathy and understanding to the patient’s problem
E = explain your perception of problem
A = acknowledge and discuss differences and similarities
R = recommend treatment
N = negotiate treatment when necessary
Use of case studies
Can provide context
Form a basis for discussion
Interprofessional learning allowing for a collaborative approach
Lend themselves to video presentations to enhance discussion
Figure 6.1 - The Healing-by-Heart Model for Culturally Responsive Health Care
Source: Culhane-Pera, K. A., Vawter, D. E., Xiong, P., Babbett, B., & Solberg, M. M. (2003). Reprinted with permission
Training Obstacles
Provider resistance
Perception of “soft skill” training vs. evidence based medical training
Skill and experience level of the trainer
Cultural Competence Training for Support Staff
Support staff = service workers (security, food service, environmental service), non-clinical (clerks, transporters, receptionist)
Often left out of training, but are often the first and last point of contact for patients
Resource – Cultural Competence: It All Starts at the Front Desk from the National Center for Cultural Competence
Role of Assessment
Final step – feeds back into the training loop
Can be at the individual or organizational level, but difficult to measure and assess
Using pre- and post-test measures
Patient satisfaction surveys
Self-assessment instruments
Key Terms
Case studies
Community-based training
Continuing education
Cultural epidemiology
Developmental training
Didactic
Ethnomedical syndromes
Etiology
Evidence based medicine
Executive coaches
Job function
Market share
Mnemonic
Self-efficacy
Symptoms
Therapeutic alliance
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