DIVERSITY, EQUITY, INCLUSION & COLLABORATION. SJMHS Nursing Residency

Transcription

1 DIVERSITY, EQUITY, INCLUSION & COLLABORATION SJMHS Nursing Residency Session: December 14,

2 SJMHS Diversity Statement There is strength in diversity. Here at Saint Joseph Mercy Health System we believe that each person makes a unique contribution to our culture and that we all have more in common than we realize. Our mission and values provide the foundation upon which our Diversity and Cultural Competency Strategy is built. The development of our diversity efforts is guided by: The principles of Relationship Centered Care The Institute Of Medicine Triangle The Culturally and Linguistically Appropriate Services Standards We welcome a multitude of perspectives, ethnicities, lifestyles, faiths and personalities. Utilizing diversity councils and interpreter services, we equip our team with the training and resources to deliver culturally competent care. We also celebrate with each other during ethnic recognition activities throughout the year. And we re proud to have earned local recognition as a Bronze Sponsor for the NAACP. Join us here and know we re committed to creating an inclusive, multicultural and diverse workforce. Our purpose statement: To achieve equity by eliminating disparities in health outcomes and access to health services by delivering remarkable, culturally competent care, while creating a culture that promotes inclusiveness and engagement. 2

3 Dimensions of Diversity 3

4 Understanding Differences Cultural Competence vs Cultural Humility Cultural Competence Cultural competence is having the knowledge to provide appropriate care across cultures. Knowledge can stem from classroom training or experience. Competence insinuates that there is a set goal of information to attain regarding diverse groups. Cultural and linguistic 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. (Cross, et al, 1989) " Cultural competence in healthcare has been broadly defined as the ability of healthcare providers and organizations to understand and integrate individual values, beliefs, and behaviors that are shaped by various factors including race, ethnicity, nationality, language, gender, socioeconomic status, and physical and mental ability, into the delivery and structure of the health care system [1]. It provides healthcare providers the ability to understand, communicate, and effectively interact with people from different cultures and social backgrounds " (Beig et. Al., 2014) Cultural Humility A humble and respectful attitude toward those of different cultures that encourages individuals to challenge their own cultural biases, realize they cannot possibly know everything about different cultures, and approach understanding cultures with a lifelong process of learning and openness. Three facets: 1. Lifelong commitment to self-reflection, self-critique, and learning 2. Checks power imbalances 3. Builds collaborative partnership Cultural humility was established due to the limitations of cultural competence and the tendency for some professionals to think of themselves as culturally competent after learning about varying cultures. This oftentimes leads to generalizations of clients and patients of particular social groups. Cultural humility encourages an active participation in order to learn about a patient or client's personal and social experiences. 4

5 Definitions Identities Race is a local geographic or global human population distinguished as a more or less distinct group by genetically transmitted physical characteristics. A race is a group of people united or classified together on the basis of common history, nationality, or geographic distribution. Ethnicity is the characteristic of a group of people that share a common and distinctive national, linguistic, or cultural heritage. Sexual orientation is an inherent or immutable enduring emotional, romantic or sexual attraction to other people. Gender identity is one's innermost concept of self as male, female, a blend of both or neither how individuals perceive themselves and what they call themselves. One's gender identity can be the same or different from their sex assigned at birth. Gender expression is the external appearance of one's gender identity, usually expressed through behavior, clothing, haircut or voice, and which may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine. 5

6 Beliefs Assumption is something taken for granted or accepted as true without proof. For example, if a limited English proficiency patient comes in to seek health care and is unable to communicate in English, we may make assumptions about her or his level of education or even intelligence. However, the patient may be highly educated and read and write well in her or his native language. Bias is an inclination or preference that interferes with impartial judgment; for instance a nurse s strong preference for a specific racial/ethnic group that does not allow viewing other patients from other groups objectively. Essentialism is the idea that people and things have "natural" characteristics that are inherent and unchanging. Essentialism does not take into account variation within cultures or identities and can lead nurses to stereotype their patients. Ethnocentrism is a belief that one s way of life and view of the world are inherently superior to others and more desirable. Power imbalances reflect power differences in patient-provider relationships. Those with power are often not aware of its daily effects. Patients past experiences of power differences, coupled with perceptions that providers have power over their current condition, have an impact on communication. Recognizing the power differences that patients may perceive, or that providers believe they hold, is important to improving communication. Prejudice is an irrational intolerance of or hostility toward members of a certain race, religion, or group; for instance, hostile feelings against a specific racial or ethnic group. Stereotype is an oversimplified conception, opinion, or belief about some aspect of an individual or group of people, for instance, simplified ideas of how a specific ethnic or racial group will behave. 6

7 Behaviors Discrimination is treatment or consideration based on class or category rather than individual merit that results in unfair treatment. Microaggressions are everyday verbal, behavioral, or environmental interactions that communicate hostile, derogatory, or negative slights and insults toward marginalized groups, whether done intentionally or unintentionally. The perpetrator may be unaware of the behavior and effect on the receiver of the message. Microassualts (conscious) o Physically or verbally attacking an individual from a marginalized group through name-calling, avoidance, or purposeful discriminatory behavior. Microinsults (unconscious) o Communications that demean someone's identity. They include subtle snubs, frequently unknown to the perpetrator, but clearly convey a hidden insulting message to the recipient o Example: Telling a person of color, "wow, you're so articulate!" Microinvalidations (unconscious) o Invalidates or downplays an individual's thoughts or feelings. o Example: Dismissing an individual who brings up race/culture at work/school. "The only race is the human race." 7

8 Examples of Microaggressions Theme Microaggression Message Alien in own land Ascription of intelligence Color Blindness Myth of meritocracy Where are you from? Where were you born? You speak good English. You do so much for your race. You are so articulate. When I look at you, I don t see color. There is only one race, the human race. I believe the most qualified person should get the job. Everyone can succeed in this society, if they work hard enough. You are not American People of color are generally not as intelligent as Whites. Denying a person of color s racial/ ethnic experiences. Denying the individual as a racial/ cultural being. Individuals in marginalized groups are given extra unfair benefits. A person in a marginalized group is lazy and/or incompetent and needs to work harder. 8

9 Implicit/Unconscious Bias Where do implicit biases come from? Psychologists believe that the content of our implicit biases are learned from the society in which we live. From a very early age, we are exposed to certain ideas over and over from the people we interact with and from the media. Over time these ideas become so ingrained in us that they are activated automatically without us realizing it. Social Learning Theory o Modeling oneself in response to the expectations of others. Behaviors and attitudes develop in response to reinforcement and encouragement from the people around us. Why are implicit biases important? Over 200 published studies using the IAT have shown that implicit bias can influence behavior in important ways. For example, IAT scores can predict how we treat members of another race, whether we are likely to binge drink, and even whether we are likely to attempt suicide. In addition, several studies have shown that implicit biases can significantly affect the way people evaluate job candidates. We believe that by becoming more aware of implicit bias and how it can influence decisions, people may be able to limit the influence that implicit bias has on their own behavior. This is the rationale behind the REDE program. Greenwald, A. G., & Banaji, M. R. (1995). Implicit social cognition: attitudes, self-esteem, and stereotypes. Psychological review, 102, 4. 9

10 Three Ways to Mitigate Bias Emotion Regulation Partnership Building Perspective Taking (Empathy/ Compassion) Perspective-taking: "Perspective-taking can produce empathy, reduce bias, and inhibit unconscious stereotypes and prejudices. Clinician empathy positively affects patient satisfaction, self-efficacy perceptions of control, emotional distress, adherence, and health outcomes." Emotional regulation skills: "Clinicians who have effective emotional regulation skills and who experience positive emotion during clinical encounters may be less likely to view patients in terms of their individual attributes, and to use more inclusive social categories. It s easier to empathize with others when people view themselves as being part of a larger group." Partnership-building skills: "Clinicians who create partnerships with patients are more likely to develop a sense that their partner is on the same team, working toward a common goal." Implicit Bias in Healthcare. (April 2016). The Joint Commission, Division of Health Care Improvement: Quick Safety. Issue

11 Empathy Through Reflective Listening: OARS Open-Ended Questions Uses a non-judgmental stance and creates a safe environment to learn and understand an individual s thoughts, feelings, behaviors, beliefs, and goals. Allows for longer responses in their own words (Use "How", "What", "Tell me more"). No yes/no answers. i.e. How do you feel? ; Tell me more ; Help me understand Affirmations Recognizes strengths and difficulties. Validates an individual s experiences. i.e. I appreciate your courage ; You have accomplished a lot during this difficult time. Reflective Listening Listener repeats back or paraphrases what the individual said. Allows individuals to hear again what they said to clarify thoughts. i.e. What I am hearing you say is, correct me if I m wrong ; Based on what you said, I m wondering if you re feeling " Summarizing Creates deeper understanding by summarizing the individual s statements. Helps move the conversation forward to next steps. i.e. This is what I ve heard so far. Tell me if I missed anything ; What you said is important, are you open to moving forward? 11

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13 EMPATHIC RESPONSES University of Utah School of Medicine Naming Understanding Respecting Supporting Exploring I Wish This must be I can t even imagine I really admire your I will do my best Could you say I wish we had a Frustrating how difficult Faith to make sure more treatment Overwhelming this must be. Strength you have what about what you that would cure Scary Commitment to you need. mean when you you (make your Difficult your family say illness go away). Challenging Hard Thoughtfulness Love for your family I don t want to give up *[Remember we do have I m wondering if What you just said You (or your dad, Our team is here Help me I wish I had better you are feeling really helps me mom, to help you understand news. Sad understand the child, spouse) are/is through more about.. Scared situation better. such a strong person this. Frustrated and have/has been Overwhelmed This really helps through so much. Anxious me better Nervous understand what It sounds like you I can see how dealing I can really see how We will work Tell me more I wish the situation may be feeling with this might be (strong, dedicated, hard to get you were hard on you loving, caring, etc.) the resources different. frustrating you are. and support that challenging you need. scary In this situation I can see how You are such a (strong, We are Tell me more I wish that for you some people might important this is caring, committed to about too. feel to you. dedicated) help you in what [a miracle, person. any way we fighting, not [In response to I can t even imagine Dealing with this I m really impressed by We will go Can you say more I wish we weren t how (NAME illness has been all that you ve done to through about that? in this EMOTION) this such a big part of manage your illness this spot right now. must be. your life and taken so much energy. (help your loved one deal with their together. 13

14 P.A.U.S.E Before Reacting to Biases P A U S Pay attention to what s actually happening, beneath the judgments and assessments Acknowledge your own reactions, interpretations and judgments Understand the other possible reactions, interpretations and judgments that may be possible Search for the most empowering, productive way to deal with the situation E Execute your action plan 14

15 Self-Reflective Questions Before Acting 1. What are my biases and blind spots? 2. Do I have an automatic feeling or judgment about this person? 3. What is this person triggering in my background? 4. Am I being reminded of someone? 5. Do I notice any patterns in my decision making that might be impacted by my biases? 6. How can I pause and think about the impact of this bias before responding? 7. How can I use reflective listening to create more understanding? 15

16 How Will You Commit to Take Action? Based on what we have discussed today, identify concrete action-steps: What is the most important thing you learned today? What one thing could you do this week to improve patient care? What one thing could you do this week to improve a relationship with a peer? Come up with an idea for managing unhelpful biases. 16

17 Resources Implicit Association Test (IAT): Becoming Aware of Your Biases Take the test: How does the IAT work? The IAT asks individuals to complete several tasks where they are asked to quickly pair two concepts together. For example, you might be asked to pair women with math or women with liberal arts. Scoring of the IAT assumes that the more closely you associate two concepts in your mind, the faster you will be able to pair them together on the task. The IAT measures your reaction times and calculates a score accordingly. For more detailed information about the IAT and how it works please visit: 17

18 References Beig, M., Mayer, A., Chan, C., Kapralos, B., & Dubrowski, A. (2014, July). A serious game for medicalbased cultural competence education and training. In Advanced Learning Technologies (ICALT), 2014 IEEE 14th International Conference on (pp ). IEEE. Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Towards A Culturally Competent System of Care, Volume I. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center. Greenwald, A. G., & Banaji, M. R. (1995). Implicit social cognition: attitudes, self-esteem, and stereotypes. Psychological review, 102, 4. Human Rights Campaign: Sexual Orientation and Gender Identity Definitions. Retrieved September 04, 2017, from Implicit Bias in Healthcare. (April 2016). The Joint Commission, Division of Health Care Improvement: Quick Safety. Issue 23. Retrieved September 04, 2017, from Isaacson, M. (2014). Clarifying concepts: Cultural humility or competency. Journal of Professional Nursing, 30(3), Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. Guilford press. Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. Journal of health care for the poor and underserved, 9(2), Schuessler, J. B., Wilder, B., & Byrd, L. W. (2012). Reflective journaling and development of cultural humility in students. Nursing education perspectives, 33(2), Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: implications for clinical practice. American psychologist, 62(4), 271. Sue, D. W. (2010). Microaggressions in everyday life: Race, gender, and sexual orientation. John Wiley & Sons. Chicago Think Cultural Health. (n.d.). US Department of Health and Human Services Office of Minority Health. The Facilitator s Guide Culturally Competent Nursing Care: A Cornerstone of Caring. Retrieved September 4, 2017, from 18

19 University of Utah School of Medicine. (2015, August 28). Retrieved September 4, 2017, from 015/ _presentation_handout_empathetic_responses.pdf van Ryn, M., Burgess, D. J., Dovidio, J. F., Phelan, S. M., Saha, S., Malat, J.,... & Perry, S. (2011). The impact of racism on clinician cognition, behavior, and clinical decision making. Du Bois review: social science research on race, 8(1), Chicago 19