Culturally-Sensitive Care
As health-care professionals in a multicultural society, we have the opportunity to provide care to patients who have different backgrounds and beliefs. This article is intended to introduce registrants to the concept of culturally-sensitive care as part of a patient-centred practice.There is no right answer or formula for how to provide culturally-sensitive care. Rather, it requires both a commitment to put the patient's unique situation at the centre of the therapeutic relationship and a willingness to examine one's own assumptions.
We all have a culture which is shaped by a variety of factors, of which ethnicity is only one. Culture refers to patterns or standards of behaviour that one acquires as a registrant of a particular group (Masi, 1988). Our race, gender, religion, ethnicity, socioeconomic status and sexual preference all contribute to shaping our values and behaviours, as well as to how we view the world.
In Canada there are a wide variety of different linguistic groups and hundreds of cultural groups. Within each of these groups there are subgroups and individual differences. For example the linguistic group of "Spanish-speaking people" includes individuals from a variety of countries and backgrounds. While commonalities exist, group and individual differences will also be prevalent. While familiarizing oneself as much as possible with different cultural behaviours, assumptions and beliefs is a worthwhile endeavour, it would be virtually impossible to develop an in depth knowledge of a multitude of cultures. Further, focusing on expected group behaviours could lead to stereotyping that ignores individual variations.
Consider this scenario:
John, a physiotherapist, is treating an elderly woman who has been diagnosed with a resectable liver tumour and general debility. His intent is to mobilize and strengthen her in preparation for surgery. He tells the patient who he is and what his intent is. She refuses to cooperate with his efforts to get her out of bed and walking, preferring rather to be left alone to "die in peace".John learns that she believes that her illness is a punishment for her past wrongdoings. As such, she is convinced that efforts to strengthen her in preparation for surgery are pointless and that she is destined to die for her sins.
Consider what your reaction would be if you were in a similar situation. The following guidelines may help.
Understand your own culture and value system.
For example, western societies are often described as individualistic, where much credence is given to the notion of individual rights and autonomy. Health-care professionals raised and educated in this culture may expect patients to value privacy, make decisions independently, and feel free to ask questions or challenge the professional when they are unclear or unhappy with care. Persons from more "collectivist" cultures such as some African or Asian groups, may value group interaction over privacy, prefer to make decisions as a family, and may feel it is inappropriate to question a health professional directly.Think about how you personally value independence, family, spirituality, and respect for authority. How do you think these values impact on your interactions with patients?
Think about a time you were with a group of people from another culture. What were the differences you noticed? Did you discover any beliefs you held that were contrary to the group's beliefs?
Perception of health and illness
Adequately define the nature of the problem in terms the patient and the family can understand. This will require a dialogue where you are clear about the meaning that families may attach to illness. (e.g., some cultures view illnesses such as cancer as a punishment for previous wrongdoing which can be a source of shame for the individual and family).Role of family in decision making
Does the individual wish to make his or her decisions independently, in conjunction with family, or have the family make decisions on his or her behalf?Customs and rituals
How do these affect the delivery of health care? Could the ritual be incorporated into care?View of health-care professionals including traditional healers
Physiotherapists should understand that many people will want to incorporate traditional healing methods into their care plans. Families should be permitted to do so without fear of abandonment or disapproval by their health professional. Conversely some patients feel their health professionals are authority figures that should never be questioned. These patients should be encouraged to play a more participatory role in their care.Expectations and boundaries within professional and personal relationships including age and gender variations
(e.g., the appropriate distance between speaker and listener in Middle Eastern culture is about six inches closer than "acceptable" distance in North American culture)Communication preferences
(e.g., forms of address and familiarity, eye contact, direct versus indirect questioning)Let's return to our scenario:
After discussion with his colleagues, John realizes his own values are influencing his reactions. He was assuming that, like him, the patient would respond to a physiological explanation of the benefits of treatment and do what she could to work towards the goal of improving her health in preparation for surgery. He realizes, however, that her value system is different from his own and that he has not explored her needs and whether physiotherapy could help within the context of her beliefs.In discussion with the patient, John learns that she would like to be able to go the bathroom independently and she agrees to participate in therapy to pursue this goal. This represents a start for John and his patient to begin working together to establish an open and trusting relationship and further explore the goals and options for physiotherapy.
Compromise and understanding are the keys to developing a culturally-sensitive approach to care. The results will be improved communication, cooperation, patient satisfaction, and ultimately, better outcomes.
