sarahwatsonplp

[sarahwatsonplp]

Literature Book Summary

Unfortunately, race, ethnicity, and culture have a negative effect on the medical care we receive in America. Some say this is due to historical heritage more than skin color. This statement means that a patient’s heritage is misunderstood more so than their race or ethnicity being externally judged. Language barriers and overall cross-cultural miscommunication can be the most harmful to a patient, especially when their life depends on having an understanding of their medical diagnosis or treatment needed. The Spirit Catches You and You Fall Down by Anne Fadiman is an example of how a family’s medical care was impacted by misunderstanding and judgement of historical heritage.

There are many examples of when the Lee family’s historical heritage affected their ability to negotiate the healthcare system. In the Hmong culture, health issues are seen in a more spiritual sense than medical sense. The Lee family believed that their daughter, Lia’s, first seizure stemmed from her soul leaving her body when her sister slammed a door. As one can imagine, it was hard for doctors to have an understanding of the Hmong people when they saw a treatable health condition in such a way. Lia’s mother, Foua, explains,

“The doctors can fix some sicknesses that involve the body and blood, but for us Hmong, some people get sick because of their soul, so they need spiritual things. With Lia it was good to do a little medicine and a little neeb, but not too much medicine because the medicine cuts the neeb's effect. If we did a little of each she didn't get sick as much, but the doctors wouldn't let us give just a little medicine because they didn't understand about the soul.” (page 100)

The MCMC hospital, where Lia received her care, sent nurses out to the house in attempts to improve the family’s compliance with Lia’s medications. Fadiman explains that the visiting nurses “tried putting stickers on the bottles, blue for the morning medications, red for the noon medications, yellow for the night medications”, (page 48) among other techniques to improve compliance. One of the visiting nurses, Effie Bunch, stated, “I don’t think the mom and dad ever truly understood the connection between a seizure and what it did to the brain. And I don’t know how else you get through to them that they have to give the meds” (page 48). This is an example of how the medical staff misunderstood the Lee family’s historical heritage. They tried so hard to take care of Lia and improve her medical condition, when they did not understand that no matter what they did to try and improve medication compliance, the Lees still did not see Lia’s condition as a medical condition because of their Hmong heritage. They did not understand the connection between a seizure and the brain.

Health literacy, communication, ethics, and health disparities are all pertinent in health care today. These concepts go hand-in-hand when it comes to how the delivery of healthcare can be improved in America. Limited health literacy can lead to health disparities due to misunderstanding or limited access and resources. In order to have better health outcomes, we must work to improve communication between providers and patients, as well as health literacy. In the article, “What Do Health Literacy and Cultural Competence Have in Common? Calling for a Collaborative Pedagogy”, the authors provide a framework for health professions to train providers with a skill-set for providing culturally competent care that focuses on reducing health disparities. This framework includes the importance of using case studies for problem-based learning, as well as referencing the L-E-A-R-N model (Listening, Explaining, Acknowledging, Reviewing and Negotiating). I believe that improving health literacy, communication and health disparities begins with improving cultural competency education for health care providers. This article recognizes the issue of health disparities in the U.S. and states that, “Moving upstream from health services research to health professions education as another solution is a logical, positive response to the call to action.” Change begins with effective education that is catered toward our growing, diverse population.

Fadiman, Anne. The Spirit Catches You and You Fall Down. Farrar, Straus and Giroux, 2012. Kindle.

Lie, D., Carter-Pokras, O., Braun, B., & Coleman, C. (2012). What do health literacy and cultural competence have in common? Calling for a collaborative health professional pedagogy. Journal of health communication, 17 Suppl 3(0 3), 13–22. https://doi.org/10.1080/10810730.2012.712625

[sarahwatsonplp]

Interdisciplinary Cultural Competence

Reflecting on cultural competence makes me more aware of my own actions in my day-to-day life that either support or hinder my cultural competency journey. Cultural competency can be defined as “the ability to effectively interact with people from cultures different from one’s own, especially through a knowledge and appreciation of cultural differences.” I believe that we can deepen our knowledge and appreciation of cultural differences in our workplace by having an open mind and treating others with respect. Cultural competency to me is a life long journey rather than a goal that is to be achieved. I believe that as human beings we will always have biases. However, we can strive to improve our cultural competency skills. We can make the decision to constantly be learning about one another and open to differences, rather than judgmental. This will ultimately improve our interactions with coworkers, clients, and patients. Having an awareness and willingness to improve our individual cultural competency can help us to become a more accepting society.

https://www.dictionary.com/e/historical-current-events/cultural-competence/

[sarahwatsonplp]

Cross Cultural Communication

Many “culture-specific” training programs use an inventory of cultural characteristics of minority groups to help trainees understand and interact appropriately. I believe that this technique risks perpetuating stereotypes and offending ethnic groups and may not be necessary. In a study of culture-specific, culture-general, and culture theory-based assimilators, it was found that training programs focused on general principles were just as effective. This study mentions that the approach of culture-specific training may just be focusing on the differences between two cultures. Those who undergo non-theory based training and learn to be effective through trial and error will not have as good of an outcome when compared to those who have been taught through theories. Researcher Gutherie “proposed to look at culture learning from the perspective of a social behaviorist”, which means to “focus less on personality traits and more on external determinants of behavior to emphasize cognitive social learning theory.” This is true when applied to culture-specific training programs, as I feel like companies should avoid bringing attention to differences. We should be learning how to shift our behaviors based on others’ behaviors, rather than learning how to act when interacting with a specific group of people.

Reference:

Bhawuk. (1998). The Role of Culture Theory in Cross-Cultural Training: A Multimethod Study of Culture-Specific, Culture-General, and Culture Theory-Based Assimilators. Journal of Cross-Cultural Psychology, 29(5), 630–655. https://doi.org/10.1177/0022022198295003

[sarahwatsonplp]

Interprofessional Awareness

https://miota.org/docs/FAQCulturalSensitivity.pdf

The document above by the American Occupational Therapy Association (AOTA) discusses how occupational therapy can strive towards culturally sensitive practices. 

An area of similarity between the AOTA’s guide for cultural standards and the CLAS standards is communication and language assistance. The CLAS standards state that language assistance should be offered to those who need it at limited to no cost and that clear, easy to understand media in commonly used languages should be used. Similarly, the AOTA’s guide states that plain language and pictures should be used on written documentation and that effective interpreters should be used during occupational therapy treatment when their is a language barrier. Both guides touch on the importance of communication and language assistance in healthcare. Another similarity is that the CLAS standards promote conducting ongoing assessments of the organization’s CLAS related activities. In a similar way, the AOTA’s guide mentions that cultural sensitivity is an “ongoing, contextual and developmental process” as well as provides cultural sensitivity assessments for practitioners. 

The CLAS standards are a broad guide for healthcare organizations to follow. The AOTA’s cultural sensitivity guide is an occupational therapy specific guide that includes ways in which OT’s need to incorporate cultural competency into their practice. Different from the CLAS standards, the AOTA’s guide includes a “model of cultural sensitivity with occupational therapists”, including three key components: Cognitive (awareness/knowledge), Behavioral (developing appropriate skills), and Organizational (support for cultural competence). This is different from the CLAS standards because it is practitioner specific, whereas the CLAS standards are broader and to be used for an organization. 

[sarahwatsonplp]

Self-Assessment of Understanding Cultural Diversity Issues in Healthcare

Although I try to be considerate and embrace my patients’ different cultures, my own prejudices or biases can still influence my thinking as an occupational therapy assistant. For example, a large portion of my day as an OTA is assisting patients with their morning routine, or ADL (activities of daily living) routine. This can include everything a person does from getting out of bed in the morning, to styling their hair, to getting dressed. Obviously, the way a morning routine looks can vary greatly from person to person. I personally wake up rather early and get dressed right away. Sometimes, I will try to encourage my patients to do the same. I will go into their room in the early morning for our session and attempt to wake them up to begin their morning routine. However, if their culture values a slow start to the morning, including rituals of meditation and reflection, my patient will not be very happy with me. Maybe in the moment I do not know what kind of morning routine they value and I jump to the conclusion of laziness. This is how my prejudices and biases can have a negative affect on my patient’s treatment.

Another example would be if I have a patient who speaks a different language than myself. This can make it difficult for me to explain to the patient what we are doing in therapy and why. Sometimes I will feel inconvenienced by the language barrier. I have to call an interpreter and what I had planned to do will take twice as long due to the interpretations. However, this is a patient’s right to be able to understand what their healthcare professional is explaining to them. Just because I speak English does not mean that all my patients should understand English. They should be able to get the most out of their treatment sessions, no matter what language they speak. 

[sarahwatsonplp]

The Danger of a Single Story Reflection

Novelist Chimamanda Ngozi Adichie discusses her experience with her “single story” as a young woman from Nigeria and the adversity she has faced throughout her life. She has faced people generalizing and stereotyping her due to her culture, even though she is much more than a single story. She discusses her experience of how her mother has given a single story to their house maid growing up, which affected the way Adichie perceived him. Adichie also discusses how she herself has been guilty of categorizing a specific group of people into a single story. 

I believe that everyone can relate to this TED Talk. As Americans, we come across people of all different ethnicities and backgrounds, whether it be in our personal lives or workplace. Unfortunately, I can think of many times in my life where I have overheard stereotypes of my coworkers or friends, because of where they are from or because of their gender preferences, etc. Just as Adichie, I have also been guilty of generalizing different groups of people because of stereotypes about them that I have heard over my lifetime. 

For someone who works in healthcare, this topic is prevalent, not only because of culture but also because of disability. As healthcare professionals, we often look at a patient’s chart and see nothing but the diagnosis that needs to be treated. We often think about all of the things that the patient cannot do because of their diagnosis. And, believe it or not, many times we sell patients short and discover that they can do much more than we thought, despite their disability. 

People are more than a “single story” of their culture stereotypes, disability, or gender. I have taken steps to counteracting the effects of a single story by changing my own way of thinking about my patients at work. I try to get to know my patients before judging them by what I read on their charts. Getting to know someone before judging their story is an important part of changing the single story mindset, and is something that we all could work on.

[sarahwatsonplp]

My Learning Goals

1. Identify how to address barriers to cultural competency in the workplace

Overall, this project has increased my awareness of my own workplace habits and has made me think twice about the way I speak to patients and coworkers. I feel as though I am more sensitive towards others’ cultures and have an increased desire to learn more about others’ culture.

2. Learn how to increase cultural competency in my personal life

Through this experience of reflecting and creating a personal learning profile, I have realized I do not branch out or try new things, specifically things that have to do with another culture. Perhaps I could watch more movies/read books about different cultures, try traditional foods from a different culture, etc., to have an appreciation of cultures other than my own.

3. Learn about one culture that is different than my own

I learned about the Hmong culture through reading the book, The Spirit Catches You and You Fall Down by Anne Fadiman. Prior to this book, I have never even heard of the Hmong people. It was eye-opening to learn about the Lee’s perspective on their daughter’s condition and other health conditions, such as pregnancy. 

[sarahwatsonplp]

My Experience With Diversity

As a occupational therapy assistant, I have had the opportunity to work with patients from many different cultural backgrounds. This has helped me to be accepting of people who are different than me.

In the field of occupational therapy, we have to be mindful of our patients’ cultural backgrounds, disability, socioeconomic status, and gender. Not only should a patient’s culture be respected, but it should also be acknowledged and embraced. This can be done by integrating the patient’s culture into their plan of care. For example, let’s say that going to church is something that my patient values and is an important part of their culture. After they recover, they would like to be able to stand long enough for the music portion of a church service. In therapy, we should work on their standing tolerance and even play  music as we stand to increase their motivation. This is just an example of how understanding diversity in healthcare can help providers to better meet the needs of their patients.

[sarahwatsonplp]

About Me

Hi! My name is Sarah and I am a 25 year old from New Jersey. I live with my husband, Connor, and my dog, Bean. I enjoy reading, running, going to the beach, and spending time with my family. I have been a certified occupational therapy assistant for four years. I provide occupational therapy treatment to adults and the geriatric population in multiple sub acute and long term care facilities in my area. I decided to further my education with the FLEX health sciences program to provide myself with more career opportunities in the future.