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1. Find out about the family’s internal dynamics, as family members’ beliefs, and what those beliefs mean to them and to the patient. For instance, ask what kind of significant illnesses the family has faced in the past and how the family handled them, advises Claire Creech, CRC, CCM, CDMS, CLCP, senior case manager for the Center for Diagnostics and Evaluation at Shepherd Center. Asking what happened when Uncle Joe had cancer can help you determine how family dynamics operate and what resources the family has to call on during crises. "What is more important than anything else is for case managers to show a willingness to learn," Creech says. "Let the family know that you respect their culture and want to understand it and incorporate it into the discharge plan."
2. Look at the length of time the family has been in the United States. This can give you an idea of how much the family has assimilated into American culture, and how much of the old culture remains.
3. Don’t make an assumption based solely on the country of origin. Cultures and beliefs vary according to regional and demographic differences. "I live in Atlanta, a large city, and there is a difference in how I view things from the way a person from a small town in Georgia may view things," Creech says.
4. Don’t make assumptions about why people act the way the do. For example, not making eye contact is a sign of respect in some cultures. You shouldn’t misinterpret it as the person being indifferent, Creech notes.
5. Don’t be afraid to ask questions in a respectful manner. "If there is something I don’t understand about a family’s behaviors or requests, I ask about it, " says Creech.
6. If you need an interpreter, find someone who is not a family member, if possible. If resources are available, use a neutral medical interpreter. "Try not to put the family in a dual role. I like to make sure the information that is being interpreted to me is a strict interpretation and not an opinion," explains Creech.
7. Compile a list of available translators and have it at your fingertips. Include information on who they are and what the costs are, and have a good understanding of the health plan with which you are working to know if the services will be paid for, advises Kathleen Moreo, RN, Cm, BSN, BPSHSA, CCM, CDMS, CEAC, co-founder of Professional Resources in Management Education in Miramar, FL.
8. Go out of your way as a clinician to learn basic language skills for members of the predominant patient groups you are likely to encounter.
9. Develop a "cheat sheet" of cultural issues that affect case management. For example, you might need a simple consent form signed for a pediatric case. From a legal standpoint, you could get either parent to sign. But in many cultures, the mother has no decision-making powers and you need to get the father’s signature. "Case managers need to be culturally sensitive so they don’t seek out the mom," says Moreo. "They may be fine legally, but they have breached a fundamental cultural belief and lost the trust of that family."
10. List the cultures you may be coming in contact with and do some basic research on their beliefs. "When I went to China, I was immediately faced with the fact that the Chinese never say no.’ They associate it with disrespect. If they disagree, they are silent," Moreo says. In the American culture, silence typically means confusion, and a case manager probably would prod the patient to answer. "That’s the worst thing you can do with a Chinese-American," says Moreo. "You’ve immediately lost their trust because they have made a decision and you are trying to prod them."
11. Find the resources you need to education yourself. "It’s not something we learned in nursing schools, although today’s schools are beginning to embrace the need for cultural competency," Moreo says. She suggests Internet-based programs and books from the local bookstore.
12. Above all, treat the families with respect and let them know that you care. "I am never going to be an expert on Hispanic culture, but I am an expert on family culture, and I can communicate to the family that I want to know their beliefs about wellness," Creech says.