Cultural Competency and Safety: A Guide for Health Care Administrators, Providers and Educators

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1 Cul ur al Compe enc yandsaf e y: AGu def orheal hcar eadm n r a or, Pr ov der andeduc a or Compé enc ee éc ur éc ul ur el l e: Gu deàl u agedeadm n r a eur, f our n eur eéduc a eur en an é J ul y / j u l l e2008

2 OAAPH[ knowna hena onalabor g nalheal hor gan z a on ( NAHO) ]r ec e vef und ngf r om Heal hcanada oa o under akeknowl edgeba edac v e, nc l ud ngeduc a on, r e ear c handd em na onof nf or ma on opr omo eheal h ueaf f ec ngabor g nalpeopl e.however, hec on en and c onc l u onof h r epor ar e ol el y haof heau hor andar e noa r bu abl e, nwhol eor npar, oheal hcanada. Cop eof h r epor maybeob a nedbyc on ac ng: Na onalabor g nalheal hor gan z a on 220L aur eravenuewe,su e1200 O awa,on ar ok1p5z9 Phone:( 613) Tol l f r ee: Fax:( 613) Ema l : nf c a Web e:www. naho. c a I SBN ( Na onalabor g nalheal hor gan z a on.pr n ) NAHO/ONSACul ur alcompe enc yandsaf e y: AGu def orheal hcar eadm n r a or, Pr ov der andeduc a or UnderSec on35of hecanad ancon u onac,1982, he er m Abor g nalpeopl er ef er of r Na on,i nu andmé peopl el v ng ncanada.however,c ommonu eof he er m noal way nc l u veofal l hr eed nc peopl eandmuc hof he ava l abl er e ear c honl yf oc u eonpar c ul ar egmen of he Abor g nalpopul a on.nahomakeever yef f or oen ur e he er m u edappr opr a el y. OAAPH[ c onnue oul e r ed Or gan a onna onal edel a an é au oc h one( ONSA) ]r eç o onpr nc palf nanc emendesan é Canadapouren r epr endr edeac v éba ée url ac onna anc e ec ompr enanl éduc a on,l ar ec her c heel ad ém na ondu avo r,v anàf a r ec onnaî r el epr obl èmede an éauxquel onc onf r on él epeupl eau oc h one. Cependan,l ec on enue l ec onc l u ondec er appor appar ennenen o al éaux au eur dur appor ene onauc unemena r buabl e,en ouou enpar e,àsan écanada. Onpeuob en rdec op edec er appor enc ommun quanavec: Or gan a onna onal edel a an éau oc h one 220,ave.L aur eroue, u e1200 O awa,on ar ok1p5z9 Tél éphone:( 613) Sanf r a : Tél éc op eur:( 613) Cour r el: nf c a S ei n er ne:www. naho. c a I SBN ( Or gan a onna onal edel a an éau oc h one.i mpr mé) Compé enc ee éc ur éc ul ur el l e:gu deàl u agedeadm n r a eur, f our n eur eéduc a eur en an édenaho/onsa Conf or mémenàl ar c l e35del al o url acon u on c anad ennede1982,l expr e on«peupl eau oc h one» den f el epr em èr ena on,l ei nu el emé v vanau Canada. Cependan,l u agec ommundec e eexpr e onn nc l upa ouj our l e r o peupl ed nc qu el l e den f eeunebonne par edel ar ec her c hed pon bl enepor eque urde egmen par c ul er del apopul a on nd gène.l ONSA ef f or c edef a r e en or equel expr e on o u l éedeman èr eappr opr ée.

3 Culural Compeency and Safey: A Gude for Healh Care Admnraor, Provder and Educaor 1

4 Table of Conen Inroducon... 3 Background... 3 Inernaonal experence... 4 The need for culural compeency/afey n healh care... 6 Culural afey n healh care pracce: Some example... 9 The need for culural compeency/afey n educaon NAHO vew on culurally afe educaon Wha hould educaor do o enure a culurally afe envronmen for uden? Culural awarene n an educaonal eng: Some example Concluon: Culural afey and compeency n a Fr Naon, Inu and Mé conex 17 Appendx 1: NAHO poon aemen on culural compeency and afey Appendx 2: General gudelne for healh care Furher ource of nformaon on culural compeency and afey Gloary Work Ced Endnoe

5 Inroducon The erm culural afey and culural compeency have become par of common parlance whn he healh care ecor. Bu wha do hey mean? And why have hey permeaed o many apec of healh care, healh educaon and organzaonal healh, from local cenre o naonal and nernaonal organzaon acro he globe? Thee key erm have been ued by, among oher, he Maor workng wh New Zealand healh auhore o mprove Maor healh au and he Naonal Aborgnal Healh Organzaon (NAHO) n Canada o mprove he healh au of Fr Naon, Inu and Mé. 1 Th documen provde a background on he orgn of culural compeency and culural afey, hghlghng wo nernaonal experence a example. The gude explan he need for culurally compeen and afe care, denfe he akeholder n h proce, and oulne way we can evaluae healh care program and polce o enure ha hey are culurally afe. We alo look a culurally afe envronmen n educaon. Fnally, we examne how culurally afe envronmen n healh care and educaon are appled o Fr Naon, Inu and Mé. Th lvng documen mean o be a general gude or reource for reearcher, educaor and healh profeonal workng n Aborgnal 2 healh. A a general gude, doe no provde naonal or communy-pecfc deal, bu raher hare an overvew hoe akeholder hould employ. Addonally, h documen provde elec reource, conac and lnk for furher knowledge developmen. Background The erm culural afey wa developed n he 1980 n New Zealand n repone o he Maor people dconen wh nurng care. Maor nurng uden and Maor naonal organzaon uppored he heory of culural afey, whch uphold polcal dea of elf-deermnaon and decolonzaon of Maor people, and baed whn a framework of dual culure. In underandng culural afey a a heorecal and mehodologcal approach orgnang wh colonzed Indgenou People, we ee he mporance of applcaon acro he healh care pecrum. Culural afey move beyond he concep of culural envy o analyzng power mbalance, nuonal dcrmnaon, colonzaon and colonal relaonhp a hey apply o healh care. If we ue a workng defnon of culural compeence a a e of congruen behavor, aude, and polce ha come ogeher n a yem, agency, or among profeonal and enable ha yem, agency, or hoe profeonal o work effecvely n cro-culural uaon (U.S. Deparmen of Healh and Human Servce, 2007, 10), we can begn o ee how changng he yem hrough he ue of an Indgenou underandng of culural 3

6 afey can be poble. Culural afey whn an Indgenou conex mean ha he educaor/praconer/profeonal, wheher Indgenou or no, can communcae compeenly wh a paen n ha paen ocal, polcal, lnguc, economc, and prual realm. A culurally unafe pracce can be underood o mean any acon ha dmnh, demean or dempower he culural deny and well-beng of an ndvdual (Nurng Councl of New Zealand, 2002, 7). Culural afey requre ha healh care provder be repecful of naonaly, culure, age, ex, polcal and relgou belef, and exual orenaon. Th noon n conra o ranculural or mulculural healh care, whch encourage provder o delver ervce rrepecve of hee apec of a paen. Culural afey nvolve recognzng he healh care provder a brngng h or her own culure and aude o he relaonhp. Inernaonal experence The followng wo example of culurally compeen and afe care were choen for her ably o addre he Indgenou knowledge componen of culural afey and he organzaonal procee o whch change would be made. The Tkanga Be Pracce Gudelne (2004), produced by he Wakao Drc Healh Board, New Zealand, are a e of gudng prncple ha drecly e culurally afe care wh Maor ndgenou knowledge and pracce. They are he ba of NAHO gudelne for culural afey n healh care cenre. 3 The Tkanga gudelne are organzed around he followng heme: Whānau Room and general area (room for famly and exended famly) Karaka (bleng/prayer/ncanaon) Taonga/valuable Informaon and uppor Whanau uppor (famly) Food, olere and conuon Body par/ue/ubance (removal, reenon or dpoal) Organ ue donaon Pendng and followng deah Tūpāpaku (care of he body) The econd nernaonal example provdng key ngh no he culural compeence landcape a documen (2007) produced by he U.S. Deparmen of Healh and Human Servce Healh Servce and Servce Admnraon offce. In, he auhor ugge hree area of focu: Doman of culural compeence Focu area whn doman Indcaor relang o focu area, by ype of ndcaor 4

7 For he Healh Servce and Servce Admnraon Deparmen of he Uned Sae, who are addreng he dcoure on culural compeence, [he] doman of culural compeence are he crcal arena or phere n whch culural compeence hould be evden or manfe n an organzaon. Thee even doman reflec o a grea exen, alhough no excluvely, he underlyng conruc of culural compeence n healh care delvery organzaon and are area o examne for evdence of culural compeence. (U.S. Deparmen of Healh and Human Servce, 2007, 17.). The even doman (U.S. Deparmen of Healh and Human Servce, 2007, 17.) are: Organzaonal value Governance Plannng and monorng/evaluaon Communcaon Saff developmen Organzaonal nfrarucure Servce/ nervenon Thee wo key example have mlar rucural area of focu and way n whch culural afey pracce can be negraed no hoe rucure. 5

8 The need for culural compeency/afey n healh care Raonale There growng recognon of he need for culurally afe care n mprovng he healh of Fr Naon, Inu and Mé n Canada. The healh au of Aborgnal People below he naonal average (Shah, Svoboda & Goel, 1996). The experence of many Aborgnal People wh he manream healh care yem ha been negave, ofen due o culural dfference. Frequenly, culural dfference and he nably of healh provder o appropraely addre hee dfference have conrbued o hgh rae of noncomplance, relucance o v manream healh facle even when ervce needed, and feelng of fear, drepec and alenaon (NAHO, 2003, pp ). Adopng a culurally afe approach o healh care can benef ndvdual, provder and healh care yem. When culurally approprae care provded, paen repond beer o care. Learnng he kll needed o provde culurally afe care can benef healh provder. I can lead o ncreaed confdence on he job by havng he ably o addre he need of varou group n ocey. The reulng ncreae n job afacon may help o ncreae reenon rae n rural and remoe commune. Currenly, he domnan dcoure on culural awarene and culural envy. Thee concep largely focu on ncreang healh provder knowledge of varou culural belef or rend (Papp, 2005). Whle NAHO uppor culural awarene a an mporan par of culural afey, am o emphaze ha awarene only he arng pon of he learnng connuum. Culural afey near he end pon of h connuum. I herefore mporan o noe he dncon beween culural awarene, culural compeence and culural afey. The provon of culurally afe care nvolve lfelong learnng and connung compeence. Culural afey he oucome of culurally compeen 4 care. 5 Munderandng can ex beween healh profeonal and her clen and paen; h can affec he ably of healh profeonal o help her clen and paen acheve opmal healh. For example, healh profeonal may vew clen and paen who are culurally dfferen from hemelve a unnellgen or of dfferng nellgence, rreponble, or dnereed n her healh (Dowlng, 2002, 4). Th can reul n poor healh au, margnalzaon whn he healh care yem, ncreaed rk, and experence of racm for he Aborgnal paen. The healh care yem may be operang neffcenly, aff morale can be affeced, healh care co may re a paen reurn wh progreed llne, wa me may ncreae, healh cenre may be overburdened, and he overall ehcal andard of care dmnhed (Forer, 2004, 15). How doe change begn? Change o he way healh care educaon and pracce done mu occur hrough hree man area: 1. Governmen 6

9 Federal, provncal and erroral level Agence and deparmen uch a provncal and erroral mnre of healh and educaon, Healh Canada, and he Deparmen of Indan and Norhern Affar 2. Educaonal nuon, accredaon and regulaory bode Educaonal nuon, accredaon and regulaory bode Medcal chool Unvere and college wh healh program Regulaory organzaon: he Royal College of Phycan and Surgeon Canada (RCPSC), he Aocaon of Facule of Medcne of Canada (AFMC), he College of Famly Phycan of Canada (CFPC) 3. Sakeholder group Naonal Aborgnal Organzaon: Aembly of Fr Naon (AFN), Inu Tapr Kanaam (ITK), Congre of Aborgnal People (CAP), Nave Women Aocaon of Canada (NWAC), Mé Naonal Councl (MNC) Naonal Aborgnal Healh Organzaon (NAHO); Indgenou Phycan Aocaon of Canada (IPAC); Naonal Indan and Inu Communy Healh Repreenave Organzaon (NIICHRO); Aborgnal Nure Aocaon of Canada (A.N.A.C.) Communy healh cenre Canadan Paen Safey Inue (CPSI) If hee hree area worked ogeher, harng gudance and wdom hrough change n polcy and plannng, a new healh yem would emerge. Th yem could help mprove he healh au of Aborgnal People, decreae healh care co, and creae greaer capacy for provder. Ideally, hee group could work oward he ame, muually benefcal goal. Wha o look for Accordng o he US Deparmen of Healh and Human Servce, culural compeence ervce delvery boh a qualy and bune mperave ha hould be ncorporaed a every level of an organzaon (U.S. Deparmen of Healh and Human Servce, 2007, 9). Bu wha role hould governmen, educaonal nue and akeholder group play? And how can hey be engaged o enure ha approprae andard are mplemened. Each akeholder need he ably o ae he level of culural afey whn her communy. Once hey eablh meaure o gauge he level of culural afey n he managemen of he organzaon/nue, aemen recommendaon can lead o connung culural afey a a prory. A aed n he execuve ummary of a U.S. Deparmen of Healh and Human Servce (2001) repor on andard for culurally and lngucally approprae ervce n healh care, experence from oher feld demonrae ha healh care organzaon, provder, polcymaker, and accredaon organzaon benef when expecaon are clear ye 7

10 flexble, reource for mplemenaon are made avalable, and mechanm for revew and overgh are pecfed (p. xv). Doe work? Once change n pracce and delvery occur, here are way o meaure wheher or no hey have worked. Accordng o Schyve (2002, 6), here are hree gn of pove culural change. They can be found n: Leaderhp here mu be a proacve rk reducon program n he organzaon ha enable leader o pay aenon o communcaon hroughou he organzaon. Informaon f omehng doe go wrong, he paen mu be nformed ha h reul wa no wha wa planned or ancpaed. Educaon he paen and h or her famly mu be nformed abou her reamen n a way ha hey can underand. Oher key area of culural afey o look a are: Paen afacon Comprehenon Adherence o reamen recommendaon Approprae ulzaon Accurae dagno Approprae reamen Organzaonal mprovemen Enhanced elf effcency Co benef Improved clncal oucome dpary reducon Conanng co Improvng clncal and organzaon qualy Relaonhp beween key akeholder, paen and care gver (Forer, 2002, 6-8). If pove change occur n any of he key area of culural afey led above hrough pracce and delvery, I.e., ncreaed paen afey, we can ay ha culural afey wa a facor n brngng abou hee change. And he pove change n pracce and delvery hould be connually appled and evaluaed. Evaluaon Evaluaon neceary o gauge he level of effecvene of change brough abou by ung culural compeency o creae culural afey. Indcaor hould reflec he ype of or level of paen afacon, he exen o whch he paen feel hey are a member of her own healh care eam, and he degree organzaonal change? Schyve (2002) argue ha hee hree area are mporan when lookng a ndcaor of change. 8

11 Paen afacon: Paen and famle are more afed wh he care hey receve when hey feel hey ve engaged n ucceful communcaon. More mporanly, an amophere ha foer communcaon acually affec healh oucome. If he caregver ge he nformaon hey need from he paen, and f he paen underand wha beng adved, he oucome mprove When paen fully parcpae n decon-makng abou her care, hey ncreae her own afey (Schyve, 2002, 7). Member of healh care eam: The paen mu be condered a crcal member of he healh care eam. [and] need o know ha he or he wll no only be heard, bu underood and valued. Th how ru bul (Schyve, 2002, 8). Organzaonal change: The organzaon doe a elf-aemen every 15 o 18 monh, mdway hrough he accredaon cycle, whch gve urveyor wha hey call a prory focu (Schyve, 2002, 11). The U.S. Deparmen of Healh and Human Servce developed he Naonal Sandard for Culurally and Lngucally Approprae Servce n Healh Care (2001), an aemen ool for organzaonal compeency/afey ha e an organzaon ably o: Develop an analyc framework for aeng culural compeence n healh care delvery organzaon. Idenfy pecfc ndcaor ha can be ued n connecon wh an evaluaon framework. Ae he uly, feably and praccal applcaon of he framework and ndcaor. Underand he relaonhp beween culurally compeen healh ervce and paen afacon/clncal oucome/healh au. An evaluaon framework hould be degned o reflec he prore and defnon of culurally afe care a e ou by Fr Naon, Inu and Mé. Evaluaon hould be an ongong proce. Culural afey n healh care pracce: Some example How doe a healh care provder rea omeone n a culurally afe way? Here are ome example of how a healh care worker can modfy h or her behavour n order o beer erve a clen/paen. Communcaon Dcuon and explanaon hould be n plan language, recognzng ha he language of care may no be he paen fr language. Care provder mu learn o no ue jargon, echncal or academc erm, and explan hng mply and clearly However, mporan ha plan language hould no be ued n a way ha make he paen feel hey are condered le nellgen.. 9

12 Non-verbal behavour vare among culure and people. Some paen may feel uncomforable mananng eye conac, epecally n reful uaon or wh ranger. A healh provder hould no make aumpon abou wha non-verbal behavour mean, bu hould mply accep ha he paen behavng n a way ha comforable or mporan o hm or her. The caregver hould alo ry o adap h or her own non-verbal behavour o he paen n approprae way. For example, a caregver workng wh Inu paen and her famle hould be aware ha many Inu ue blnkng a a confrmaon of underandng. Paen are more lkely o feel afe and empowered o ell caregver abou her need and concern f phycan encourage hem o ak queon. Healh provder who come acro a more concerned wh paen queon han wh me conran are more lkely o provde afe care. Decon-makng A healh worker can how repec for he ndvdual by offerng he clen/paen explanaon and nvolvng hem n decon abou her care, raher han makng demand on hem or ung unexplaned drecve. For example, havng he clen/paen go hrough he uaon and advce wh he healh worker o ee f make ene o hem and for hem. People need nformaon o be able o decde f hey wan and need o follow hrough, or f a coure of acon f wh her conex, need or able. For example, he healh worker could ay omehng lke, There are a couple of hng I can ugge ha mgh work. You could ry Th can be helpful becaue How doe ha ound o you? If mporan ha he paen do a pecfc hng, he healh worker hould gve hem a pecfc explanaon, and o on. For example, f a paen mu ake medcaon everal me a day for a perod, raher han ju ayng, Take one pll every four hour for a week, a healh worker hould explan he reaonng behnd : I really mporan ha you ake all of accordng o he chedule. You ll probably ar o feel beer afer a couple of day. However, even hough you feel beer, he germ are ll n your body. I ake all h medcaon, pread ou over a week, o kll all he germ. If any of hem are lef, hey ll mulply and you ll ge ck agan. If a healh worker preen a coure of acon, and he paen/clen ay he can do ha whou fr dcung wh her huband, he healh worker need o be repecful of ha. The coure of acon may no requre a poue approval, bu he healh worker mu underand he paen lfe conex and value, n pe of her dfference: Good, you dcu wh hm. Can you come by agan omorrow and le me know? Then we can dcu he deal. 10

13 Underandng and munderandng Belef People do no wan o look lly, and may feel uncomforable queonng auhory. For many reaon, hey may ay ye when n fac hey mean no, or no when n fac he anwer ye. For example, when a healh worker ha explaned medcal requremen and procedure and ak, Any queon? Anyhng you don underand?, he paen may ay No, even when hey do no underand. Ung clear and plan language can help avod problem. I may be helpful o wre down nformaon and nrucon o he peron can hnk abou n prvae. Bu keep n mnd he clen leracy level. Some furher explanaon may be helpful oo, uch a We docor don alway explan hng oo well. I really would apprecae f you d ge back o me f you have any queon. I wll help boh of u. I ll know wha I med, and you ll ge he rgh nformaon. Clen/paen may have belef abou caue and cure ha do no f wh eablhed medcal vew. For example, f a clen/paen explan ha he full moon make hm/her ac n range way (he role of he moon n menal llne/aberran behavour ll wdely beleved around he world), he healh provder hould mply accep he explanaon and work wh/around : Ye, he moon ad o affec people. Le look a wha happenng n your uaon. There may be way we can reduce he effec. Example of culural awarene In he Canadan conex, a healh profeonal ha culurally aware would: Be aware ha a clen/paen of Fr Naon, Inu or Mé herage may have conuled a radonal healer, and be prepared o ak abou h. Be aware of he level of drecne n queonng ha would be culurally approprae for an Aborgnal peron, whle recognzng he dvery of Fr Naon, Inu and Mé culure. Be aware ha ome Aborgnal people end o mnmze a healh problem, and accommodae accordngly for any underaemen a paen mgh make n he aemen of her healh. I mporan o noe ha hee example do no apply o all culural group. Example of culurally afe or unafe pracce Culurally afe pracce nvolve buldng healh care provder communcaon kll o hey: Are aware of wha need or ue her clen/paen mgh have. 11

14 Are able o ak queon o ge he nformaon needed o be erve her clen/paen. Pay cloe aenon o and do no negavely judge verbal and non-verbal nformaon ha paen provde. Here are ome example of ome culurally afe and unafe pracce: Nure praconer a he Wabano Cenre for Aborgnal Healh n Oawa offered h example of culural afey. I well known among healh provder a h cenre ha many of her Mé and non-au Fr Naon paen do no have acce o nured healh benef. 6 Thu, when he nure gve ou precrpon, hey know ha paen may no be able o ge hem flled. Nure ake alernave acon o enure ha paen receve he care neceary o manan good healh or fgh llne. For example, hey may offer free drug ample o paen, or refer hem o employmen earch ervce and food bank, or engage n oher paen advocacy acve. An arcle (Browne, Fke and Thoma e al, 2001) on Fr Naon women encouner wh manream healh care gve he followng example of a culurally unafe experence: An Aborgnal woman come no he hopal wh a black eye and a walng chld. Healh care worker mmedaely apprehend he chld o chld and welfare ervce whou fr checkng he paen medcal or peronal hory. Culurally unafe aumpon abou abue and he woman ably o ake care of her chld underle hee acon (17). The prevalence of exual abue n commune mean ome Aborgnal women may be relucan o eek ou healh care encouner nvolvng bodly expoure n order o avod feelng nvaldaed or hamed. A a reul, hey do no wan o draw aenon o her bode or are afrad of havng a docor or nure examne or ouch her bode, epecally f hey are male. A healh care worker who communcae effecvely wh he paen o enure comfor durng he examnaon would be acng n a culurally afe way. The need for culural compeency/afey n educaon Raonale The need for culurally afe care n mprovng he healh of Fr Naon, Inu and Mé mached by he need for culurally afe learnng o mprove educaonal oucome for Aborgnal uden. Aborgnal uden experence wh he manream educaon yem are ofen negave due o culural dfference n he learnng envronmen. Unforunaely, h common becaue educaor ofen lack he kll and knowledge needed o appropraely addre culural dfference n he currcula and claroom. Thee dfference have 12

15 conrbued o low reenon and compleon rae, poor performance, decreaed peer neracon, and poor aendance. Moreover, uden may experence apprehenon, margnalzaon, racm, drepec, and oppreon whn he learnng envronmen. Developng a culurally afe learnng envronmen benef uden, educaor, educaonal nuon, and educaon yem. A uden more lkely o repond povely o he learnng encouner when hey feel afe, repeced and able o voce her perpecve. An educaor more lkely o experence more job afacon when aendance beer, when he qualy of cholarhp good, and when he claroom an envronmen of equal engagemen beween dfferen way of knowng. Th come from an educaor creang a culurally afe learnng envronmen and delverng culurally afe currculum. Hgh reenon rae of an Aborgnal populaon can be nerpreed a a reflecon of an educaonal nue commmen o uch an envronmen, a well a her commmen o human rgh and race relaon. Such nuon produce more graduae, whch arac more uden and hereby ncreae enrollmen. A culurally afe learnng envronmen would lkely lead o an ncreaed number of Aborgnal healh care provder. More Aborgnal people n he healh care feld could mprove healh oucome for Fr Naon, Inu and Mé. Peron who develop curren compeence and creae learnng envronmen are recognzng h need and are begnnng o look a how he uaon can be mproved. How doe change begn? Educaon n culural afey a he po-econdary level an mporan arng pon for ncreang he number of healh profeonal ha provde afe care. Inroducng a culural afey approach early on wll enure uden, know how o provde he mo effecve care o dvere populaon when hey ener he healh care workforce. Wha o look for In upporng culural afey educaon, he followng approache are recommended: Recognzng he horcal conex Focu on eachng uden abou colonzaon and he economc, polcal, horcal, and ocal caue of curren healh problem raher han focung on ncreang knowledge abou Aborgnal cuom, healh belef, ec. Educae uden on he horcal procee behnd curren plgh wll help hem o avod vcm-blamng. 7 Recognzng dvery of populaon Make uden aware of he dvery beween Aborgnal People Fr Naon, Inu and Mé and he dvery whn. There are 630 Fr Naon each wh her own culure, language, ec., and urban, rural and remoe populaon. 13

16 Provdng culurally afe care may mean dfferen hng for each of hee group and even whn he group. Underandng healh care worker paen power relaon Focu on underandng he power mbalance ha can ex (n favour of he healh care worker) beween he healh care worker and he paen. Suden hould learn how o exchange and negoae power wh he paen a hey would whn he eacher/uden dynamc. Rang organzaonal awarene Gve aff orenaon on culural afey ue o everyone nvolved n he Aborgnal educaon program dean, profeor, eachng aan, lecurer, admnrave aff, and counellor. Doe work? Care can be een a becomng more culurally afe a change move hrough a culural afey educaon connuum. Culural compeency/afey educaon connuum Culurally Compeen Educaor Culurally Compeen Currcula Culurally Safe Envronmen Suden Culurally Compeen Healh Care Profeonal Culurally Safe Care Evaluaon Some of he ndcaor ha can be ued o meaure he degree of engagemen an organzaon ha wh culural compeency and afey nclude: Increae n reource for Aborgnal healh. 8 Increae n number of Aborgnal uden. Increae n reenon of Aborgnal uden. 14

17 Increae n negraon wh and avalably of radonal form of healh and healng. Increae n Aborgnal-degned and Aborgnal-nformed culurally compeen healh currcula. Increae n Aborgnal healh educaor. Increae n Aborgnal uden compleon rae. Marked uppor of and parcpaon n culural compeency/culural afey workhop and profeonal developmen opporune by non-aborgnal healh educaor. NAHO vew on culurally afe educaon To underand wha culurally afe educaonal pracce are, help o conder fr wha unafe. NAHO denfe culurally unafe pracce n educaon a: Value, ehc and epemologe (way of knowng) for Fr Naon, Inu and Mé ha may be dfferen from he manream are no recognzed or valued. Indgenou knowledge no acknowledged, or reaed a nferor o non- Indgenou knowledge. There are negave porrayal of Fr Naon, Inu or Mé n currcula. Horcal experence and effec of colonzaon on Fr Naon, Inu and Mé are no acknowledged. There are barrer o bac acce o educaon. 9 Converely, culurally afe educaon occur when all uden ake on he reponbly o: Self-evaluae by underandng her role and be wllng o examne her own value, ehc and epemologe (way of knowng). Recognze ha hey may have concou or unconcou concepon of culural/ocal dfference n healh care. Idenfy pre-exng aude and be wllng o ranform her aude by racng hem o her orgn and eeng her effec on pracce hrough reflecon and acon. The educaor hen ake on he reponble o: Develop and each currcula ha reflec he Aborgnal experence and conex. Engage n dmanlng barrer. Recognze and how repec for Indgenou knowledge. When boh uden and educaor work from a place of culural compeency, culural afey become aanable. 15

18 Wha hould educaor do o enure a culurally afe envronmen for uden? Learn abou he healh and ocal challenge (and her ocal, economc, horcal, and polcal deermnan) faced by Fr Naon, Inu and Mé. Expec ha hee ue may be of parcular nere o Aborgnal uden. Be able o underand Aborgnal healh concep. Underand he hory of colonzaon and mpac on curren healh and ocal au of Fr Naon, Inu and Mé. To be elf-aware, evaluae he value, belef and aumpon hey are brngng o he educaor uden relaonhp. How doe an educaor rea omeone n a culurally afe way? Communcaon Recognze when you are ung a uden communy a an example n problembaed learnng (PBL) and ha hey may be able o offer alernave ngh. Be open o radonal or Indgenou approache o healh when engaged n dcuon. Recognze ha ome of he healh or well-beng ue dcued are poenally ome uden reale (e.g., uberculo, over-crowded houng, ec). Eablh he learnng envronmen a a place of repec and open dalogue where uden are equal. Decon-makng Whenever poble engage uden n decon-makng abou he educaonal pah, uch a praccum locaon/chedulng and coure elecon. Provde he uden wh opon on accepable reource; he opporuny o ue Indgenou ex, reearch, and oher meda. Encourage uden o ugge gue peaker or e up e vaon. Underandng and munderandng Avod generalzaon. Ue pecfc example, e.g., dabee rae dffer grealy among and beween Fr Naon, Inu and Mé. Do no burden an Aborgnal uden by makng hem he Fr Naon, Inu or Mé exper n he cla. Be able o adequaely addre he dfference beween Aborgnal rgh and healh ue o ha of new Canadan populaon. Eablh a clear lne of counel and recoure hould problem uch a racm come up. Acknowledge ha you a an educaor are no an exper on all apec of Fr Naon, Inu or Mé ndvdual and commune. 16

19 Belef Fr Naon, Inu and Mé ofen nclude prual healh a an apec of healh and healng. A an educaor you need o be open o and accepng of hee opc n uden dcuon, analy or wrng. Recognze and repec uden need o parcpae n ceremone oude of he andard relgou holday, arrangng for me off or when neceary. Culural awarene n an educaonal eng: Some example A healh educaor ha culurally aware would: Addre he ocal deermnan ha may lead o a healh ue uch a obey. For example, when addreng rae of obey n Aborgnal commune, realze ha norhern commune have lmed acce o low-co freh food and eay acce o low-co hgh fa food. Include n he coure pove example ha are relevan o Fr Naon, Inu and Mé. Recognze approprae ermnology and ue, uch a naon and/or communy name. Concluon: Culural afey and compeency n a Fr Naon, Inu and Mé conex Culural afey rooed n he educaon of healh care provder. If he healh profeonal or paraprofeonal able o creae a culurally afe envronmen, hen we can aume ha hey have nernalzed he ably o be ympahec, enve and empahc, and are wllng o ncorporae he neceary meaure o brdge he gap beween gver and recever and learn ha ofen he one who beleve hey are he gver ofen he recever. Th lead o brdgng he gap beween aff/organzaon and paen/uden. The crocung foundaonal prncple of culural afey dcued earler are applcable o Fr Naon, Inu and Mé. However, mperave ha he educaor/praconer recognze he dncvene of Fr Naon people a mlar ye dfferen han Inu, and mlar ye dfferen hen Mé, and o on. Whle hey hare a common hory and have been ubjec o mlar conran of colonalm, each populaon ha whn own populaon grea dvery. Th no o ay ha he ool provded n h ex are no ueful, bu only o ay he educaor/provder ha a reponbly o learn, acknowledge and apprecae he Indgenou knowledge of he group o whch hey are workng wh, when feable. When hnkng abou how o be mee he group healh prore, he educaor need o ake 17

20 no accoun he dfferen deermnan of healh each group face, uch a geography, economy, communy coheon, acce and capacy, and educaonal aanmen. 18

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