This document summarizes key points from a physical therapy lecture on diversity and cultural competence. The lecture covered bias and prejudice, becoming culturally competent healthcare professionals, definitions of culture and cultural competence, models of cultural competence, why cultural competence is important, elements of different cultures like Native American, Asian, Latino/Hispanic, and Black American cultures, and solutions for developing cultural competence like asking patients what care they want, individualizing care, and avoiding stereotypes. The lecture also included upcoming assignment reminders.

1. Fall 2011: Week 7, Lecture 1 PTHA 1301: The Profession of Physical Therapy

2. Today’s Theme Song Taylor Swift :)

3. Goals for Today: Diversity Part 2 & Disability/Chronic Conditions Discuss multicultural perspectives and cultural competence as they relate to physical therapy care Explain the effect of patient diversity on physical therapy care Summarize the importance of communication on physical therapy care Describe family needs, roles, & responsibilities on patient care Practice Generic Abilities (Interpersonal Skills, Communication Skills, and Professionalism)

4. Bias and Prejudice Unjustified negative attitude based on a person’s group membership May become part of a normative pattern of thinking Often exists even when we are not aware Exists even if we believe we feel otherwise May result in actions that are discriminatory

5. Becoming Unbiased, EmpathicHealth Professionals Understand yourself Acknowledge presence of prejudice and bias Respect differences Shed unhelpful bias

6. Discussion Questions Where do you think that your unintended biases come from? What are the effects on patient care? What are the effects on the members of your health care team? What do you think you could do to make changes for yourself or others?

7. Culture Definition: the customary beliefs, social forms, and material traits of a racial, religious, or social group; also: the characteristic features of everyday existence (as diversions or a way of life} shared by people in a place or time <popular culture> <southern culture> Acquired set of beliefs, values, behaviors, practices Impact on daily experiences and choices Subcultures (example: High School)

8. Cultural Competence What is Cultural Competence? APTA states that “acquiring cultural competence as a PT/PTA is a process that is cultivated within the individual through acquisition of knowledge, attitudes, and behaviors specific to culture, language, and communication”. Cross model: “Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations”. Campinha-Bacote model: “the process in which the healthcare professional continually strives to achieve the ability and availability to effectively work within the cultural context of the client – family, individual, or community”.

9. Why is Cultural Competence Important? Society is changing and so are the faces of our clients Critical core component of professional practice in PT Considered part of “best practice” in providing PT care Cultural competence will affect our clinical outcomes. How???

10. 5 Essential Elements : Cultural Competence (from Cross, et al) Value diversity Have the capacity for cultural self-assessment Be conscious of the dynamics inherent when the cultures interact Institutionalize cultural knowledge Develop adaptations to service delivery reflecting an understanding of diversity between and within cultures.

11. Continuum of Cultural Competence Cultural destructiveness Cultural incapacity Cultural blindness Cultural pre-competence Cultural competency Cultural proficiency

12. L.E.A.R.N. Model A model for culturally effective communication proposed by EA Berlin and WC Fowkes in “Teaching framework for cross-cultural Care: Application in Family Practice” Listen – Identify and greet patient & others Elicit patient’s health beliefs Assess – Potential attributes/problems in patient Recommend – A plan of action Negotiate – with the patient after you have made your recommendations

13. Elements of Culture Nationality Language spoken Class Religion/spirituality Education Income Age Race Ethnicity

14. Key Concepts Assimilation Definition: the process of receiving new facts or of responding to new situations in conformity with what is already available to consciousness Acculturation Definition: cultural modification of an individual, group, or people by adapting to or borrowing traits from another culture; also: a merging of cultures as a result of prolonged contact Bicultural Definition: of, relating to, or including two distinct cultures

15. More Key Concepts Ethnocentrism Definition: characterized by or based on the attitude that one's own group is superior Importance as a barrier Impact on interactions with others

16. Specific Cultural Perspectives Native American There is often distrust and suspicion of non-native providers Harmony of mind-body-spirit is important Harmony with the natural world is important for health Healing is closely tied to religion and sacred religious narratives and rituals Illness, disability and death are not discussed

17. Specific Cultural Perspectives Asian Culture Harmony in body and spirit is the foundation for good health and well-being Disruption will lead to illness Loyalty and harmony within the family lead to harmony with the environment and within the self Hierarchy and respect for elders are an essential part of harmony Traditional healing practices are valued and widely used

18. Specific Cultural Perspectives Latino/Hispanic Good health is a gift from God Poor health is a result of fate There is no way to overcome this Illness and disability may come as punishment for bad deeds Respetoand personalismoare essential traits for health care providers

19. Specific Cultural Perspectives Black Americans Distrust of medical providers caused by legacy of slavery and other historical factors Reluctance to pursue care unless the illness is extreme Strong faith in God and letting His will be done Prayer is a valuable healing tool Many folk practices and reliance of family and community

20. Solutions The key to eliminating fear and distrust by people of other cultures is to develop knowledge about, and respect for, other traditions and practices Develop cultural competence Be flexible and open-minded DO NOT stereotype Learn a new language and/or use interpreters Develop knowledge and skill about communication with clients from different backgrounds Develop skill interviewing clients from different cultural backgrounds

21. More Solutions ASK the client what they would like from the medical encounter What kind of care would they like to receive? Do not treat all patients the same Care must be individualized and congruent with cultural beliefs and practices

23. How might the relationships change?

24. What additional roles and responsibilities might you need to assume?

25. How might this have changed your life as a 10 year old? 15 year old?Disability Discussion #1

27. What types of coping strategies might you employ?Disability Discussion #2

29. Received a BBA from Angelo State University

30. Received a MBA from Angelo State University

31. Has worked at SPC as the registrar for 3.5 years!GuestSpeaker

32. Upcoming Assignments Outline of Research Paper due NEXT TUESDAY 10/18/11, 11am via Blackboard  PAHC page 259,#2 - Assignment NOT due  PAHC page 136, #1 - Assignment NOT due  Show Elaine 5 additional notecards PER source (50 total notecards) TODAY before you leave class!!! Watch Darius Goes West video on Blackboard, before 2:30pm next Tuesday 10/18/11 – QUIZ!!! Complete the MBTI, score it, and do calculations (this will be in your PTA mailbox on Thursday 10/13/11. MBTI assignment will be due AT THE BEGINNING of class next Tuesday, 10/18/11. Test #2 – Friday, 10/21/11 – Review Information will be given to you next Tuesday, 10/18/11.