3/8/17 CROSSING CULTURE THROUGH COMPASSION Vicki Hicks, RN, MS, - - PDF document

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CROSSING CULTURE THROUGH COMPASSION

Vicki Hicks, RN, MS, APRN-CNS Gina Johnson, RN, MS INMED University of Kansas School of Nursing March 24, 2017

OBJECTIVES

• Relate the emphasis on Global Health to the growth of Global

Health Programs.

• Describe how a compassionate health professional can

provide culturally competent care.

• Describe how organizations can create a cooperative

environment for compassion.

• Applying the skill and attitudes of the Global Health

Competency of compassion through a simulation activity.

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BRIEF HISTORY OF GLOBAL HEALTH (GH)

• Alma Ata Conference WHO, addressed infectious disease vs. socioeconomic

influence on health.

• 1978 - Alma Ata Declaration - “Health for all in the Year 2000”, addressed

inequality of low-resource countries, primary health care addressed health at community level.

• 2000 - Millennium Development Goals - world leaders United Nations declared

goals –hunger, poverty, primary education, gender equality, child mortality, maternal health, HIV/AIDS, malaria, environmental health, global partnerships.

• 2009 - Institute of Medicine (IOM) Report - involvement by gov. agencies,

foundations, universities, commercial entities to achieve global health goals & Millennium Goals

• 2015 – Sustainable Developmental Goals (SDGs) - The SDGs, officially known as

Transforming our world: the 2030 Agenda for Sustainable Development is a set of seventeen aspirational "Global Goals" with 169 targets between them.

• 2016 – Global Health Workforce Alliance/Network (GHWFN) - Stakeholders

(multiple sectors - education, employment, finance, health and labor and different constituencies) foster coordination and alignment on activities enabling the implementation of the Global Strategy on Human Resources for Health: Workforce 2030 (Global Strategy) and the recommendations of the United Nations High-Level Commission on Health Employment and Economic Growth. Convened and managed by World Health Organization’s Health Workforce Department. http://www.who.int/hrh/network/en/

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GLOBAL HEALTH EMPHASIS

Global Health Emphasis Socio- Economic Determinants

• f Health

Environmental Determinants Human Rights, Ethics and [Social Justice] Cultural Diversity and Health Global Health Governance Health Systems Education Integration of Global Health Experiences Student Awareness Essentials of Baccalaureate Nursing Education Schools of Public Health Preparing competent health professionals to meet the globalization of our society. Initiate and Maintain Sustainability Emphasis on Interprofessional and multi-sectorial collaboration 4

GUIDING FRAMEWORK GH COMPETENCIES

GH COMPETENCIES FOR NURSES IN THE AMERICAS

I.

Global Burden of Disease

II.

Health implications of migration, travel and displacement

III.

Social and environmental determinants of health

IV.

Globalization of health and health care

V.

Health care in low resource settings

VI.

Health as a human right and development resource

INTERPROFESSIONAL GH COMPETENCIES

Domain 1 – Global Burden of Disease Domain 2 – Globalization of Health and Health Care Domain 3 – Social and Environmental Determinants Domain 4 – Capacity Strengthening Domain 5 – Collaboration, Partnering, and Communication Domain 6 – Ethics Domain 7 – Professional Practice Domain 8 – Health Equity and Social Justice Domain 9 – Program Management Domain 10 – Sociocultural and Political Awareness Domain 11 – Strategic Analysis 5

GUIDELINES FOR IMPLEMENTING CULTURALLY COMPETENT NURSING CARE

I.

Knowledge of Cultures

II.

Education in Training in Culturally Competent Care

III.

Critical Reflection

IV.

Cross-Cultural Communication

V.

Culturally Competent Practice

VI.

Cultural Competence in Health Care Systems and Organizations

VII.

Patient Advocacy and Empowerment

• VIII. Multi-Cultural Workforce

IX.

Cross Cultural Leadership

X.

Evidence-Based Practice and Research

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CULTURAL COMPETENCY

• “Culturally competent care is based on the principles of

social justice and human rights” (Wilson, et al, 2014, p. 109).

• A dynamic process in which individuals or institutions

achieve increasing levels of knowledge, awareness, and skills.

• Values diversity
• Participates in the process of critical reflection –

reflecting on ones own values, beliefs, and cultural heritage to gain awareness of how these qualities impact culturally congruent care (Wilson, et al, 2014).

• Adapts to diversity and cultural context in communities.

(Office of Minority Health (OMH), 2013) .

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PROVIDING CULTURALLY COMPETENT CARE

• Use stories to engage individuals to share how their reality is similar or

different from what you have learned.

• TED Talk, “The Danger of a Single Story”

https://www.ted.com/talks/chimamanda_adichie_the_danger_of_a_single_story

• Learn how different cultures define, name, and understand the world

around them.

• Engage individuals to share their own understanding of their culture or disease.
• Share experiences - participate in cultural, religious or social experiences in common

helps to see the world through their eyes.

• Develop relational trust
• Empathy- tremendous therapeutic force that can narrow the gap between patient

and health professional.

• Be present with another
• Interacting with openness, understanding, and willingness to hear different perceptions.
• Create a welcoming environment that reflects the diverse communities you serve.

(College of Nurses of Ontario, 2009, Nova Scotia Department of Health, 2005)

• Point of view of the other, becomes empathetic, put your thoughts aside, ability to be

present with another. Need more than sympathy –all people want respect & kindness.

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BARRIERS TO CULTURAL COMPETENCY

• Language barriers
• Use translating services & certified medical interpreters
• Requires cultural sensitivity & formal training to avoid miscommunication.
• Service oriented approach
• Accommodate needs of travelers and family members
• Understand social services needed of medical visitor
• Transportation, religious services, shopping, banking, dining
• Quality of care
• Outcomes improved with greater emphasis on coordination of care &

improved communication. (Zein, 2016)

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UNDERSTANDING EMPATHY

• 1. Understand the patient’s situation, perspective &

feelings

• 2. Communicate that understanding & check its

accuracy.

• 3. Act on that understanding with the pt. in a helpful,

therapeutic way.

• 4. Impact of empathy devoid of sincerity- may not be

effective.

• 5. Empathy for foreigners seeking medical care is not

merely an act of kindness; rather it is a central piece

• f healing.

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COMPASSION

• Compassion – identity with suffering of all living beings (Crigger, et al,

2006).

• Merrian-Webster (2013)- “Sympathetic consciousness of others’

distress together with desire to relieve it”

• Authenticity – be yourself –not putting on a professional mask
• Communication – courage to be present as a human being.
• Unconditional acceptance- always respect, not always agreeing, try

to understand

• Health professionals may not be connected to life issues, need to

connect and reflect from your personal life, distance doesn’t work, importance of being with people to meet the needs of the patients.

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BECOMING A COMPASSIONATE HEALTH PROFESSIONAL:

CULTURALLY COMPETENT CARE.

• 1. Examine your values, behaviors, personal beliefs, and

assumptions.

• 2. Engage in activities that help to reframe your thinking,

allowing you to hear and understand other worldviews and perspectives.

• 3. Familiarize yourself with core cultural elements of the

community you serve, including physical and biological variations, concepts of time, space, and physical contact, patterns of communication, physical and social expectations, and gender roles.

• 4. Understand unique needs of international communities-

not new.

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COMPASSION AS MORAL VIRTUE

• Compassion involves action to relieve another’s distress
• More than an emotion -deep response to suffering requires action.

(Goetz, 2010, Schantz, 2007).

• Moral Virtue- individual cultivates as part of his/her character, not a

natural emotional response. (Bradshaw, 2009).

• Moral order, choice that places compassion above action out of

mere duty.

• Raises our level of consciousness through identification with suffering
• f another.
• Human connectedness in which suffering is ready to be recognized

& addressed by others. (McCaffrey, 2015)

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COMPASSIONATE PROFESSIONALS – A CLEARER VIEW

• Clearer view as citizens of the world
• Compassion is essence of care. Skilled, competent, value based

care that respects individual dignity.

• Concern for other people beyond giving health care
• Giving time, being there, getting to know the pt. –significant

expressions of compassionate care.

• Include other issues – global ethics, social justice, and public health.
• Emphasis not focused only on individual rights but responsibility to

society.

• Highest order of moral responsiveness is one of beneficence, wishing

goodwill and acting in accordance.

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COMPASSION: THE HUMAN TOUCH

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COMPASSION AND ORGANIZATIONS

• Culture of organization is important factor for the development
• f compassion.
• Important role of leaders/ managers can display nurturing &

enable compassion in organizations.

• Organization can create a cooperative environment for

compassion forming collective values, relations, personal skills, beliefs that employs compassion towards themselves and

• thers.
• Embrace interdisciplinary approach –
• Vital to practice of compassion to health care by the needs of pts and

clients rather than priorities set by discipline. (McCaffrey, 2015).

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CONCLUSION

• A compassionate professional is called to collaborate

with people of all nations to seek a better future and health for all.

• Call for all people to extend their moral responsibility

beyond local communities and national citizenship to become citizens of the world. Think locally, act regionally, go globally.

REFERENCES

• Alma Ata Declaration- 1978, World Health Organization.
• Bradshaw, A. (2009). Measuring nursing care and compassion: The McDonaldised

nurse? Journal of Medical Ethics, 35, 465-468.

• Clark M, Raffray M, Hendricks K, Gagnon AJ. Global and public health core

competencies for nursing education: A systematic review of essential competencies. Nurse Educ Today. 2016 May;40:173-80. Review. PMID: 27125169

• Goetz, J., Keltner, D. & Simon-Thomas, E. (2010). Compassion: an evolutionary analysis

and empirical review. Psychological Bulletin, 135(3), 351-374.

• Institute of Medicine Report (2009). CDC.
• Jogerst, K., Callender, B., Adams, V., Fields, E., Hall, T., Olsen, J., Rowthorn, B., Rudy, S.,

Shen, J., Simon, L., Torres, H., Velji, A., Wilson, L., (2015). Identifying interprofessional global health competencies for 21st -century health professionals, Annuals of Global

• Health. 1(2), 239-247.

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REFERENCES

• McCaffrey, G. and McConnell, S. Compasssion – A critical review of peer-reviewed

nursing literature. (2015). Journal of Clinical Nursing, 24, 3005-3015.

• Millennium Development Goals. (2000). United Nations.
• Office of Minority Health, (OMH), (2013).
• Papadopoulos, et al, (2016). International Study on nurses views and experiences on
• compassion. International Nursing Review. 63, 395-405.
• Wilson, L., Harper, D., Tami-Maury, I., Zarate, R., Salas, S., Farley., J., Warren, N., Mender,

I., Ventura, C., (2012). Global health competencies for nurses in the Americas. Journal of Professional Nursing, 28(4) 213-222.

• World Health Organization (2017). Global Health Workforce Network. Retrieved on

February 26, 2017 from: http://www.who.int/hrh/network/WHO_GHWN- Q_A_Jan2017.pdf?ua=1

• Zein, N. (2016). Seeking medical care abroad: A challenge to empathy. Cleveland

Clinic Journal of Medicine, 83(11),

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• Group Activity:

Branga Game

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