Chapter 3

Awareness

Career Planning

Multicultural Awareness


Career Planning

Introduction

The following information represents a bare bones approach to career planning. Check the references at the end of this section for more detailed information on various career planning alternatives.

This section is designed to help you review your career options. You will discover at least nine career alternatives. You will need to do a lot of writing to help you evaluate your goals. As an alternative you can use the format of this section as a basis to discuss your options with a friend or colleague. Also keep in mind the books and services available within your organization, in your public library and through various community programs.

You should review your career options regularly to make sure your choices fit in with your immediate and future personal, professional, family and social needs and wants. You may decide to stay in the position you presently have or you may choose to change your job or your career. On average we change our position every 3-5 years and our careers 2-3 times in our lifetime. Change is not always easy and requires real thought, research and planning. Enjoy the process and the opportunity!

Physicians need to choose their future career path much earlier now and some medical schools are hiring career counselors to assist them to look at all aspects of their lives while making these decisions. They encourage a balance of work, self, family and life interests in young trainee physicians. Physicians reaching mid-life or those seeking a new direction as a result of restructuring are also engaged in career review and planning for their future.

Elizabeth Latimer

Understanding Your Interests and Skills

Exercise #1

By completing the following exercise you will have a better understanding of your own interests and the skills you have developed over the years.

Write an autobiography of your life. Concentrate on the points listed below but do not edit yourself as you write, just continue to write until you have finished. Quickly read the whole list before you begin to write to get an idea of what you may want to write about.

The final biography should be about 20-200 pages long depending on how much time you are willing to spend. The results can be quite enlightening and exciting so have fun! Your family and friends may enjoy reading your biography too!

1.What have you done personally that you enjoyed doing? (This is so broad a question that it allows you to decide what is important for you to write about.)

2.Where have you travelled, lived, and studied?

3.How did your family, friends and personal needs fit in?

4.Where have you worked (paid and volunteer work):

What have you achieved personally and professionally (we have all achieved at least 20 major things so don't stop writing until you have found 20 major items)?

What skills have you developed?

Which parts of your work did you enjoy/dislike?

5.Brag about yourself -- no one will see your biography, unless you show it to them, so be proud.

6.What do you do in your spare time (honestly now!)?

7.What do you enjoy doing:

Hobbies

In what kind of environment do you enjoy being in (eg. out in the country, on a beach, in your favorite room at home, working in a small/large office)?

8.What do you dream about?

What skills do you want to develop?

Once you have finished your biography (it can well take a few days or more) go through your written work and circle, in a different colored pen, those points that can help you decide what you would like to have or to use in your work. Also circle points you do not want to have or use in your work. Use the sample chart to organize your points.

What I want to have or use in my present and future career(s)            What I want to avoid in my present and future career(s)





Once you have finished filling in the chart go back through each point:

Underline the most important points you have made about what you want to have or use (based on your priorities) in your future career.

Use a highlight pen to highlight your top 5-10 skills that you enjoy the most and do best.

Write a number beside the highlighted points in order of priority, i.e., #1 for the most enjoyable skill, #10 for the least favorite of the top ten.

Next take those last highlighted points and put them into a chart like the following sample. This chart can help you summarize your accomplishments as well as your professional goals.

Things I Have Already Accomplished            Things to be Accomplished (in order of priority)        Steps Needed to Accomplish the

                                                                                                                                                                        Things in Column 2







Career Options

There are 9 options available to anyone reviewing their career alternatives:

Researching

While continuing with your present career you use some free time to research, interview and test out other career ideas.

Staying Put

After reflection, you decide your present career situation is actually the right opportunity for your professional growth or personal life style.

If you cannot change positions or careers you might decide to look for further fulfillment through continuing education programs, volunteer work, or self-directed learning. These other activities can help you evaluate your skills and interests before making major changes in your professional life.

Moving Across

You use transferable skills and knowledge in your own field but in another area (e.g., a different job within your professional field), and you maintain the professional status and responsibilities you are presently comfortable with.

Returning to Previous Level

You return to a position you had previously to move back to more rewarding work, and to enjoy your work with less stress and professional tension.

Moving Up

You decide to move up in your present organization to increase the money you earn, to improve your professional status, and to increase your responsibilities.

Same Career Different Organization

After reflection you decide that you want to stay in the same career but in a different organization.

Different Career

You decide to change careers completely, either within your present organization or in another organization (including self-employment).

Stopping Work Temporarily

If circumstances permit, you may decide to stop work temporarily to further your education, raise a family, or take an extended trip.

Retiring

After reviewing your working life and economic status you may decide to retire earlier.

Take a look at the list you developed in the previous exercise under "Things to be accomplished". Which of the nine career option(s) allows you to accomplish some of your priority goals?

The Job/Career I Want

You have described the skills you enjoy and are most competent in doing. You have also chosen a specific option or two from the previous pages. Now you need to make some decisions about what job situation you actually want.

In what city, town or area of the country would you like to work?

What type of organization would you like to work in (e.g., large organization, smaller

department, self-employment, etc.)? 

What type of people do you want to work with (e.g., those who enjoy a very social atmosphere or people who enjoy working more alone and quietly)?

What goals, purposes, or values must the organization have that you want to work with?

What specific working conditions are important to you?

What level of pay and responsibility do you want to have?

What skills have you previously described that are transferable to this job?

How will this job affect your personal, family and social life?

What are the next 3 steps you need to take towards getting that job, e.g., call and ask for an information interview, research the organization, speak with your spouse and family, evaluate staying or leaving your present position, etc. Once you have listed these steps, give yourself some time lines for completing each one. Review after you have finished each step to follow or change your process until you have the job you want!

I have encountered the process of career planning several times in my life, the most significant step being in my change of career from nurse to doctor in 1976. This change involved a major examination of goals and wishes for life and work from a personal and professional viewpoint. It was a valuable and formative life review time.

Elizabeth Latimer

Researching Your Career Options

Once you have reviewed your autobiography and filled out the charts you will have a pretty good idea about what career options you are interested in. Now may be the time for you to use that information to do further research.

Go to your public library and begin to research your career options.

What do you need to learn to accomplish your option?

Where can you find organizations that will meet your needs if your present organization can no longer do that for you? If you have chosen another town, city or area of the country to live in, are there organizations there that meet your needs?

What qualifications is that type of organization interested in? Is there a way around some of the qualifications so that you do not need to return to school?

What is the salary range for this career option?

Check with professional associations to find out as much as you can about your career option and which organizations they might recommend. Your public library has a Directory of Associations to help you find the right one to contact.

Talk with experts in the field to get their impressions and advice. Ask them what kind of questions you should be asking other people. Asking the right questions will give you the most valuable information you need so ask the experts what kind of questions they recommend you should use.

Talk with people who have the kind of job or career you would like. People love to give free advice and to help others further their career as long as they do not think you want them to help you get the job through references or hiring you themselves.

Take careful notes of what you are learning and write down new questions as they come to you.

Take as much time as you need to research, think, evaluate and plan. Spend time with your family and friends to get some of their ideas and their support.

The Information Interview

Sometimes during your research you may find it helpful to interview people who have the kind of job or career you would like or experts in the field you are researching. How do you handle a telephone or personal interview with them?

Make it very clear to them that you are not asking their help in getting a job. You want to talk with them only to get information to help you make some career decisions. Appeal to their interest in giving "free advice".

Write your questions in advance and leave enough room on the page for you to write in the answers. Prepare a master copy of these questions and use a photocopier to copy these pages so that you have a different set of questions and answers for each person you talk to.

The types of questions you want answered will depend on the person you are talking to. The questions will be similar to what you have been using for your research at the library. Questions about: the person's organization, what kind of education the person has, how did they get to the position they are in now, and what advice they could offer you based on your past experiences and education. Also ask them what questions they think are important for you to ask other people. Ask them if they could recommend anyone else to talk to, to get more information.

Before you actually visit someone for an interview, do a little research about them and their organization (through the library health care facility/team section or through contacts you have in that organization). If possible, arrive for a personal interview a little early and collect any information the organization has about themselves in their waiting room, e.g., an annual report, brochures, etc.

Always present yourself as a professional doing practical research. Your image is very important so dress professionally.

Remember that you are "in charge" of the interview. You are not there to get a job. You control the questions and, therefore, the interview. Tell the person in advance that you will take only 20 minutes of their time. Your question sheet should be specific enough to get the important information you want within 20 minutes.

Often the person you are interviewing will appreciate your respect for their time. They may also extend the interview time if they think they have more useful information to give you. Be flexible.

Note: There will be times when you will not get the kind of information or support you want from people. Do not get discouraged (at least not for too long!). You often have to go through some frustrating times to get what you want so consider each difficulty as one more step to get through the process of learning what you need to know.

One of the things that I found helpful when changing careers (moving from a hospital to being self-employed) was to make a list of people that I respected who were also self-employed in the health care field. I then spent some time interviewing these people and found that not only were they willing to share their experiences with me but I was able to apply what I learned from them to my own business.

Beverley Powell-Vinden

Summary

Where do you go from here? As I said at the beginning, this section is a start to understanding your present skills and career options. If you have enjoyed the journey in learning more about yourself then I strongly recommend you look at other resources in your library and bookstores that can give you a more in-depth process for career planning.

There are many organizations that provide career counseling, many of which are free through public programs. To find out more about these programs call or write your government employment center, your local community college or request assistance through your local library.

Without wanting to sound too melodramatic, dreams do come true. It requires you to understand yourself better than you have ever understood yourself before; to research the options that appeal most to you; to interview people who are presently in the kind of career you want to have; to make real changes and accept the positive (and possibly, negative) consequences of those changes.

The last question you must always answer is, "Am I happy with what I am doing now and, if not, what can I do to change that?" More often than not, there are changes you can make for yourself in the organization where you are working. Sometimes, however, you may need to move within that organization or move to a different job or career. There are always things that you can do if you take the time to do the required research to understand what options are available.

Dreams do come true, but it takes the dreamer working with the dream to make it so. Step by step, inch by inch, knowing that trying is more than half the battle. I failed every grade in high school because I was busy dating. My brothers were much more successful than I was. One teacher told me if I wasn’t so stupid, I might try learning something in school. I always thought that I was stupid. After high school I went to work for a large cosmetic company. They saw something in me and so taught me to model and teach about their products. I came to dislike the world of cameras and modeling. I announced one night at the dinner table that I was thinking of going to university. There was dead silence and everyone’s head ducked into their plate except my father who said I could not go. When my brother challenged this on my behalf, my father said, “I do not want Michèle to be hurt anymore by what school does to her.” I said just let me try. After my first year of university I had a C+ average. I wasn’t proud of it but at least I had a chance to return the following year.

Michèle Chaban

Resources

The following resources are only a few of the many useful resources that you can find in your local libraries, within your own organization, and in your local bookstores. Look for other books but also for journal articles, magazine reports, films, videos and audiocassettes. Also keep in mind how much you can learn from experts in the field, including people within your own organization!

Bette, C. (Ed.). (1997). Career planning for nurses. Albany, NY: Delmar.

Bolles, R.N. (1992). How to find your mission in life. Berkeley, CA: Ten Speed Press.

Bolles, R.N.& Nelson, R. (2000). What color is your parachute. Berkeley, CA: Ten Speed Press.

Charland, W.J., & Charland, W.A. (1993). Career shifting: Starting over in a changing economy. Holbrook, MA: Adams.

Danek, J., & Danek M. (1997). Becoming a physician: A practical and creative guide to planning a career in medicine. Toronto: Wiley & Sons.

Farr, J.M. (1997). The right job for you: An interactive career planning guide. Indianapolis, IN: JIST.

Gaither, R, & Baker, J. (1995). The wizard of work: 88 pages to your next job: A simple, straightforward job-search book for people who’d rather be working than reading a book. Berkeley, CA: Ten Speed Press.

Kanchier, C. (2000). Dare to change your job and your life. (2nd ed.). Indianapolis, IN: Jist Works.

Sheldon, B., & Hadley, J. (1995). The smart woman’s guide to networking. Franklin Lakes, NJ: Career Press.

Tieger, P.D., & Barron-Tieger, B. (1995). Do what you are: Discover the perfect career for you through the secrets of personality type. Boston, MA: Little Brown and Company.


Diversity

Introduction

What must we know to provide compassionate care to our patients and to better understand our colleagues from outside our own cultural, racial and religious traditions? What must we understand about our own gender and the opposite gender to work more effectively? What must we know about a person’s sexual orientation so that we are inclusive in our work rather than exclusionary in our behavior?

We begin with a basic assumption: people are all equal. If we treat all people exactly the same, we are not treating them equally because we are not recognizing their unique physical, emotional, spiritual and informational needs. Therefore, treating people equally means not treating them the same.

This is not a study in cultures, races, religions, gender biases or sexual orientation. The following material is designed to be as practical as possible on a day-to-day basis. It concentrates on the one-to-one working relationship between care providers and those who receive services. It does not examine broad policy development or population studies.

In identifying how people from various cultures, races, religions and backgrounds are different, it is important to also identify how we are all fundamentally the same. Everyone is born and everyone dies. Everyone laughs and everyone cries. Smiles are universal just as love, compassion, empathy, prejudice, cruelty and violence are universal.


On a train trip home from university, I stopped into the station bookstore and picked up a little book, Mister God, This is Anna. I read about a girl who grows from five to eight years old through the book. A teenager named Fynn found her on the docks of London. He wrote years later about the genius and wonder of this young girl, Anna.

At one point in the book, Anna, 6 or 7, tries to identify a scientific way to see the commonality of all humanity. She didn't know about cellular biology or quantum physics. After much thought and experimentation she came up with this method. It is an excellent analogy for a discussion on the diversity and similarity of the people we care for.

1.Stand any person in front of a light and draw their outline on a piece of paper.

2.Cut out their silhouette and place it perpendicular to the light and draw its
shadow (a straight line).

3.Cut out the straight line and put it perpendicular to the light and draw its shadow (a dot). [This step is easier to do in one's head than on paper!]

Conclusion: Any person, regardless of their size, age, origin or background, will produce a dot by taking their shadow three times. Just as wonderfully, any dot on a piece of paper can be any person, past or present, in the whole world. For that matter it could also be an elephant, a house, the planet, a tree or any object made of matter. Anna was most impressed with her logic!

This analogy is to highlight the key point of this material -- while identifying an individual's differences from us, we must always begin with how fundamentally alike we are as members of the human family.

Harry van Bommel

The Universal Golden Rule

The following are specific sources for the golden rule found in ancient world religions. They strengthen our belief that at fundamental levels, we share many of the same beliefs.

Buddhism

Hurt not others in ways that you yourself would find hurtful.
(Undana-varqu: 518)

Christianity

As you would that men should do to you, do you also to them likewise. (Luke 6:31)

Hinduism

This is the sum of all true righteousness: deal with others as though wouldst thyself be dealt by. Do nothing to thy neighbor which thou wouldst not have him do to thee after. (The Mahabharata)

Islam

No one of you is a believer until he desires for his brother that which he desires for himself. (Sunnah)

Judaism

What is hateful to you, do not to your fellow men. That is the entire Law, all the rest is commentary. (The Talmus, Shabbat 31a)

Georges P. Vanier, Canada's Governor General in the 1960s wrote: "The more you know people, the better you will understand them and the more you will like them." Caring for others at the end of their lives is a time where this may be easier to practice than at other times. People tend to concentrate more on issues of fundamental value to them at these times than on who won the baseball game last night or who should win the next election.

Language

Words are immensely powerful. They can be comforting or disquieting, healing or hateful. The working assumption of this material is that everything is presented in the hopes of being helpful and educational. Anything that inadvertently offends a reader should be brought to our attention.

Definitions

These change over time as we struggle to find more accurate terms.

Community

One's own family, friends, neighbors, spiritual community, colleagues and acquaintances.

Culture

Social behavior patterns characteristic of a people.

Ethnic Group

A group of people with common characteristics that may, or may not, constitute a separate race. Country of origin is a common characteristic in identifying ethnicity.

Family

One's biological family and, perhaps, closest friends.

Race

A local geographic or global people distinguished by genetically transmitted physical characteristics such as skin color (e.g., Caucasian, black) or facial features (e.g., Chinese, Japanese).

For example, the Race Relations Directorate of the Ontario Government has divided populations in the following groups for statistical records since 1986:

Black includes African Black, Canadian Black, American Black, West Indian Black and other Blacks.

East Asian includes Chinese, Japanese, Korean, Fijian and Polynesian.

Native includes Canadian Native People (e.g., Inuit, Metis, Status and Non-status Indians); American Native People, and Central and South American Native People.

South Asian includes Indians (India), Pakistani, Sri Lankan and Bangladeshi.

South-East Asian includes Burmese, Cambodean (Kamuchean), Laotian, Vietnamese, Thai, Malaysian, Indonesian, Filipino, Singaporean.

West Asian/Arab includes Egyptian, Israeli, Iranian, Lebanese, Palestinian, Syrian, Turks and other Arabs.

White includes European Whites, North American Whites and other people of Caucasian background.

Other includes people with mixed racial heritage not listed above.

Sexual Orientation

One’s preference for either, or both genders. A preference for someone’s own gender is often referred to as “gay” or “lesbian”. Preferring either gender is “bisexual”. A person’s sexual preference should not interfere with their ability to provide compassionate health care to others.

Choosing the ‘Right Words’

In writing and speaking about various cultures, races and religions, as well as about age, gender, sexual orientation and other sensitive subjects it is easy to get caught up in finding the right words. The 'right' words are constantly changing. Within a few short decades we have moved from describing people in the U.S. with black skin as Negroes, to blacks to the more common term of African-American. At differing times, each word was common place and acceptable. Changing views required new words to describe the same population.

People with disabilities have also seen dramatic changes in how they are described. For example, people with developmental disabilities used to be called mentally retarded or mentally disabled. A self-advocacy group for people with developmentally disabilities calls itself "People First" to remind people that "labels are for jars."

However, we must use words, no matter how imperfect or how often we change them, to identify specific groups of people apart from other groups of people so that we can discuss ways of caring for them in all of our communities.

If we begin with the assumption that no one in health care is purposefully trying to say things in ways to upset patients and families, then we can begin to concentrate on the message as well as how the message is delivered in an open and honest communication.

To help us understand some of the 'how the message is delivered', I suggest we need some common ground. There is a mixed consensus on what words are correct. The source that I use as a writer is the Canadian Press Stylebook. There are many different style books (e.g., The Chicago Manual of Style, The New York Times Stylebook, The Globe and Mail Stylebook). These are constantly updated to stay as current as possible as not to offend their readers. Regardless if one agrees with the ever-changing language used in these sensitive areas, these style books represent what can be best considered a general agreement on public language.

In the Canadian Press Stylebook, for example, there are sections on the common ways to write about native peoples in Canada. "Canada's Indians are not a homogeneous group with a standard set of interests and grievances. An effort should be made to reflect their diversity in stories specifically dealing with Indians and native groups; there are status (or reserve) Indians, non-status Indians (living outside reserves), Metis (people of mixed native and white origin) and Inuit. Collectively, they are known variously as Aboriginal Peoples, original peoples, aboriginals, indigenous peoples, the First Nations and other variations."

Some further tips:

Canadian Press uses uppercase for Aboriginal Peoples, which includes all Indian, Métis and Inuit people in Canada. First Nations is also uppercase. Other variations are lowercase.

In all references, be guided by the preference of those concerned.

Use Indian with discretion. Some people object to it because it originated with Columbus' misconception that they had landed in India. Others, especially status Indians, prefer it to be used.

Use native advisedly. Aboriginal is more specific and is preferred by many.

Tribe originally was reserved for primitive peoples. Some natives use it casually and it need not be entirely avoided. However, community, people, nation, band, language group are alternatives.

Disabilities

Disabilities are only one part of a person's humanity. Avoid such unqualified terms as disabled, crippled or people 'afflicted with' or 'suffering from'. Be specific. Afflicted with or suffering from imply that people's conditions are always painful, permanent, unavoidable. For example, many people in wheelchairs are not 'confined' to the chair. Their condition may, or may not, be permanent. People with life-threatening illness should not be 'suffering' physical pain if they are getting good palliative care. For example, 40% of people with cancer do not have physical pain associated with their condition at all.

Victim connotes helplessness. A child who is has a developmental disability (slow learner) is not necessarily mentally disturbed (ill). People with epilepsy have seizures, not fits. Avoid defining people by their disabilities: the disabled, the blind, the dying. Writing or saying people with disabilities emphasizes the people first and not their disabilities.

Names of Races

Capitalize the proper names of nationalities, peoples, races and tribes. For example, Aboriginal Peoples, Arab, Jamaican, Jew, Polish, Latin American.

Remember that black, mulatto, red, white and yellow do not name races and are lowercase.

The term black is acceptable in all references in Canada and the United States. In the U.S., African-American is increasingly in use. In Bermuda, colored is correct usage for both black and mulatto. In South Africa, the Cape Colored are regarded as an ethnic group of mixed blood, and the term is capitalized. In the U.S. there is a National Association for the Advancement of Colored People, usually identified as the NAACP.

Body Language

Verbal and written language, as we have described, are very powerful. Body language begins to speak to people before you begin to talk. Your body language is either comforting, intimidating or uncertain. People's cultures and personal backgrounds will 'screen' your body language and make conclusions that may, or may not, be correct. This is just as true for you as for the people you care for.

Some examples:

In Europe, men most often cross their legs at the knee. In North America, men tend to put the ankle of one leg over the knee of the other. This is often misinterpreted by Europeans as aggressive body language.

In many parts of Europe, people use a knife and fork throughout their meal. In North America, the trend is often to cut one's meal, put the knife down (usually held in right hand) and switch their fork over to their right hand to eat. American and Canadian spies during World War II were often spotted because of their table manners rather than their accents.

Distance between people is often very cultural. For example, Spanish-speaking people are often quite comfortable with close physical contact between themselves and others. People of British backgrounds tend to prefer people at more than arm's length away. Japanese people would be very uncomfortable with the physical touch so common in daily North American business contacts.

As a general rule: keep slightly more than arm's length away from others until you get to know their preferences. This is a safe distance both culturally and between men and women generally (the fear of violence against women is real in North America and must be understood as well).

Ask permission to touch someone in a gesture of comfort and understanding. One can do this verbally or one can place a hand near the person as an invitation to them to reach out and touch you.

When someone is sitting or lying down, it is best to be at eye level with them. Therefore, try to sit down next to them. Women tend to be comfortable with another woman directly opposite to them, while men often prefer to sit side-by-side. Kitty corner may be the best compromise so that people have some open space between you and them to avoid direct eye contact when they need to look away.

Many people carry pens, notes books and other objects in their hands. They are necessary some of the time, but for the rest, put them down. Keep your hands free from fidgeting so that your attention can remain with the person.

Demographic Information

The following statistics are a national snapshot. They may not reflect the reality of people in your program, service and community.

Faiths

The predominant faith in Canada continues to be Christian (1991 statistics). Since 1971 there have been more Catholics than Protestants. Between 1981-1991 there has been a 144% increase in Eastern non-Christian religions. Before 1971, less than 1% of Canadians reported having no religious affiliation. This went up to 12.5% in 1991. Almost one-third of British Columbians reported no religion while less than 2% of Newfoundlanders reported no religion.


Religion                    Canadian #        Percentage

Roman Catholic          12,335,255        45.7%

Protestant                    9,780,710        36.2%

Eastern Orthodox            387,395        1.4%

Jewish                             318,070        1.2%

Eastern non-Christian:     747,455        2.8%

Buddhist            163,415

Hindu                157,015

Islam                253,260

Sikh                  147,440

No reported religion        3,386,365    12.5%


Language (1991 most recent statistics):

Language            Canadian #

English alone        16,516,180

French alone           6,505,565

Aboriginal alone        169,615

Languages other     3,384,255

than English, French

or Aboriginal



Culture (1991 most recent statistics):

Heritage                                                                            Canadian #        Percentage

Reporting Aboriginal Origin                                                1,002,670            3.7%

Reporting British alone or with some other origin             12,047,920            44.6%

Reporting French alone or with some other origin              8,389,180            31.1%

Reporting neither English or French Origin                        8,336,160             30.9%

Reporting single Asian origin                                             1,607,230              6%

Reporting single African origin                                               26,430                .1%

Reporting single Latin, Central or South American origin       85,535              .3%

Reporting single Caribbean origin                                           94,395               .4%

Reporting other single origin                                                1,011,870            3.7%


Urban versus Rural Living (1991): There has been a consistent number of urban Canadians over the past 25 years. Provinces east of Ontario have become more rural while west of Ontario, there has been an increased urban population. Ontario has remained constant at over 80% urban.

Where Canadians Live    Canadian #    Percentage

Urban                                20,907,957            76.6%

Rural                                    6,388,902            23.4%

Designing a Cultural, Racial and Religious Self-Study Guide: A Practical Tool

The underlying assumption of this work is that trends within societies and peoples do exist but that individuals should not be forced to fit within those trends. We must examine a person's unique story within the context of common and distinct personal experiences, ask questions and enhance our own knowledge and skills to meet the physical, emotional, spiritual and information needs of people receiving care. We must be aware of time constraints in our practice and who else might better meet the specific needs of the individual and their family.

We often hear, "Do not stereotype people" as if this were possible. It is not possible. In order to deal with the magnitude of information we hear/see/feel everyday, we automatically categorize information and 'stereotype' others to make sense of this information overload. The suggestion would be more usefully put as, "Find out if your stereotype is correct." Stereotypes, which constantly change in us as we learn more about others and more about ourselves, are excellent starting points to discover which parts of our assumptions about people are correct.


For example, in Europe, Dutch people have a reputation for being very careful with their money and not spending it quickly. Although this is a trend within the Dutch culture it is often not apparent to Canadian visitors who continue to be treated royally as liberators of Holland during World War II. A Canadian may not understand this trend to 'stinginess' while other Europeans make regular jokes about it. Which view is correct? It depends on the individual Dutch person, how long they have lived in Canada, when they immigrated, etc.

Harry van Bommel

It is necessary for professional and volunteer caregivers to try and understand the racial, cultural and religious needs of their clients. The more one works with a specific population (regardless of race, religion or culture) the more one must understand that population. Included in this understanding are the typical kinds of illnesses people of specific populations get. For example, Francophones in Canada are more likely to suffer from smoking-related illnesses, therefore, caregivers must learn as much as possible about those illnesses and trends by Francophones in coping with such illnesses.

Some of the questions we will try to answer include:

What specific behaviors demonstrate cultural, racial and religious respect for the people receiving service?

What specific behaviors must be avoided so as not to show disrespect?

How is illness, aging, dying, death and grieving generally seen within this person's community?

Is illness, aging, dying, death and grieving easily discussed within this person's community?

What areas of conversation are supportive to the person?

What areas of conversation would feel threatening or uncomfortable for the person (for example, truth telling about a prognosis)?

How are decisions made by this person and within their family? Who in the family is the person's 'spokesperson', both for when the person is able to speak for themselves and for when the person cannot speak for themselves?

Are children included in the day-to-day events happening to the person and how are they included in discussions about dying, death and grieving (if at all)?

Is Western medicine seen as helpful or harmful to the person? What alternative healing practices are seen as helpful? In their experience, are there negative side effects to mixing Western medicine with treatments of personal choice? Are hospitals or other health care facilities seen as helpful or harmful?

Is pain and suffering viewed as something one should experience fully, partially or not at all?

What dietary practices should we know about to help the person be as comfortable as possible?

How are the person's cultural, racial and/or religious beliefs uniquely practiced? How can we be supportive of those beliefs within the confines of our own fundamental beliefs?

What does the person 'expect' will happen? Is that accurate to the best of your knowledge?

Who can help us understand this person's life story better? (So often a person or their family is asked to explain the most basic elements of their beliefs to well meaning strangers. How can you minimize intruding into their time together? How can you help other caregivers learn more about the person and family indirectly so as not to bother them even more?)

How long has this person lived in Canada (e.g., born here, 2nd generation, recent immigrant)?

Does the person live in a identifiable community (little Italy, Chinatown, Rosedale) which may contribute to how they are dealing with their illness?

Aside from multicultural issues, we must not forget how other factors influence their decision-making, their communication style, their behavior and their needs. For example, how does their gender, age, career, education, and economic standing affect them? How does their family dynamics (size, grief history, geographic location) affect them?

Exercise #1

Look at your own background first and answer the questions above as clearly as you can. Show your answers to others you work with to see if they understand your background better through your replies.

Exercise #2

Identify someone from a different race, culture or religion and ask them to answer the questions above. Do their answers help you understand them better? Compare your answers from Exercise #1 with their answers and ask each other questions about areas that are unclear. It is through specific conversations with people of diverse backgrounds that we learn both the specifics of the individual and some generalities about people with similar backgrounds. For example, all Christians have certain beliefs in common while each individual Christian has beliefs specific to them which may, or may not, be part of the religion's theology.

Collect similar information for any major group that is different from your own background. Write out specific information that will help you work with members of that group or clients from that group. Constantly update your information so that you are being as accurate as possible. Remember, there are trends within identifiable groups of people but each individual is different. Find out as much as you can in any given situation and help others to do the same with you so they better understand your background. This is a mutual endeavor.

Some Cases

A Chicago Children's Aid worker removes a Vietnamese 4-year old child with scratches, bruises and angry red inflammation of the skin. The boy's father commits suicide out of shame and confusion before a caseworker, familiar with Vietnamese culture, could explain the traditional home treatment of 'scratching out the wind'. In this treatment, Vietnamese people believe that painting alcohol or oil on the skin brings the illness to the surface where it is scraped off, often with a porcelain spoon.

A common practice amongst many European and Asian families is to crowd into a patient's room during visiting hours even though this is against hospital rules. Culturally, the family is very important to the well being of the patient and the greater the number, the greater the respect shown the patient. They may also believe that a patient should remain immobile (e.g., a mother after birth in Mexico is not to get out of bed or must be carried for days after the birth).

In Chinese families where a baby has been born, they may refuse to bathe the child in 'raw' water but come to a hospital with many thermoses of boiled or 'cooked' water. In general, many Chinese people also believe in a balancing of hot and cold (ying and yang) so they may accept only hot water when other patients are routinely given only ice water.

Hindu women can often be seen with a dot on their foreheads. Often assumed to have religious significance, this dot ('Bindi') is actually an ornamentation; a fashion thing. Originally married women in villages were the only ones who wore them, but in Canada women will wear different colored Bindi just as other women wear different coloured lip stick. Non-Hindu people have been making assumptions about these 'dots' and their significance for years without realizing their ornamental use.

Kosher meat in the Jewish tradition is called "halal" meat in the Muslim faith. Their dietary rules are quite similar. Meat (excluding pork for Jews and cow for Hindu and Sikh) must be drained slowly of all blood and blessed by a spiritual leader before it can be eaten. Jains eat no meat at all. How does a lack of this information affect one's care of Jewish, Muslim, Hindu, Sikh and Jain clients?

A Quiz

The following modified quiz is based on the complete quiz in Pamela Brink's book Transcultural nursing: A book of readings (p. xi-xvi). The purpose is to help you become aware of any misconceptions involved in multicultural health care issues. Place a check mark beside the answer you think is most correct.

1.Cardiovascular diseases and malignant neoplasms are the two leading causes of death for:

(a) everyone(b) whites

(c) Asians (d) Hispanics

2.Pallor in the dark-skinned individuals is observable by the absence of the underlying ____________ tones that normally give the brown or black skin its 'glow' or 'living color'.

(a) blue(b) white

(c) red(d) gray

3.Faith healing is practiced in which church?

(a)Church of Christ Scientist

(b)Seventh Day Adventist

(c)Eastern Orthodox

(d)Church of Jesus Christ of Latter-Day Saints

(e)None of the above

(f)All of the above (depending on specific groups).

1.Which statement is true?

(a)Yang represents the female, negative force.

(b)Yang represents the female, positive force.

(c)Ying represents the female, negative force.

(d)Ying represents the female, positive force.

2.Western-based culture, as opposed to most other cultures,

(e)does not distinguish between physical and mental illness.

(f)treats the whole person rather than concentrating only on the system involved.

(g)places the client's difficulties in the light of spiritual and religious values.

(h)distinguishes rather sharply between physical and mental illness.

3.

Friendly inquisitiveness is considered _________ by traditional Native North Americans.

(a)necessary

(b)nosiness

(c)helpful

(d)good manners.

Answers 1 (a) 2 (c) 3 (f) 4(c) 5(d) 6(b)

Cultures

The underlying assumption of this work is that trends within societies and peoples do exist but that individuals should not be forced to fit within those trends. We must examine a person's unique story within the context of common and distinct personal experiences and ask questions and enhance our own knowledge and skills to meet the physical, emotional, spiritual and information needs of people receiving care.

Some general points for discussion first:

Cultural Differences

People the world over have a different sense of the proper use of space and time. People of some cultures like to be physically close to others while others prefer a more comfortable distance apart. People of some cultures or geographic locations (e.g., southern U.S. versus New York State) have a different sense of time and the urgency of punctuality. They also choose to eat supper at different times (e.g., New Yorkers and Mexicans eat later in the evenings while Southerners often eat earlier to have more evening time with family and friends.)

People have a different sense of priorities. People of some cultures or within some families, put family values ahead of work values, income values or accumulation of assets.

People have gender differences. These relate specifically to what is labeled one's feminine and masculine sides. Men may have more feminine characteristics just as women may have more masculine characteristics but typical trends divide along gender lines.

People from around the world have different traditional dress, food and beverage preferences. Certainly multicultural events tend to highlight the uniqueness of each culture in these areas.

We have different expectations of behavior.

In Costa Rica in the mid 1970s, I found that people, out of respect, would give me directions to a place I was trying to find, even if they did not know the correct directions. They could not say, "I'm sorry. I don't know where that is." So they made up elaborate directions. This was frustrating at first until I realized they were trying to be helpful and to save face.

Harry van Bommel

Barriers to Cross-Cultural Communication

Language and non-verbal communication barriers are common. For example, many European men cross their legs at the knees while many North American men cross their legs with one ankle resting on the opposite knee. This North American body language is consciously or unconsciously seen as aggressive in Europe while North Americans often misinterpret the European preference as weak.

Stereotyping is a barrier when no effort has been made to identify the accuracy of your stereotype. Some people from a particular culture do fit the stereotype while many others have a part of that stereotype in their character.

Dutch people have a stereotype of being 'cheap' (Dutch treat). The stereotype, in fact, does fit many Dutch people in some circumstances while in others, Dutch people are seen as highly sociable and generous hosts. It depends on the situation but the stereotype has legitimacy and can be used as a starting point to find out about a particular person.

Harry van Bommel

Different value systems arise from one's cultural background, education level, family and environment. Some values are mutually exclusive (e.g., one believes war is justifiable while another believes it is never justifiable). One must determine if the difference in values will prevent one from helping someone who is ill or dying.

Overcoming Barriers

One must identify those perceptions that are correct from those that are incorrect. Then one must determine if one's differences with someone else make it impossible to work together (rare) or not. The way someone eats or what they eat should not usually prevent one from helping that person.

Language Barriers

If people speak completely different languages, it is hard to communicate. There are hand gestures and facial expressions to help understand where someone is experiencing pain but it becomes much harder to help with their other physical, emotional, spiritual and information needs without adequate translation. Translation, even in diverse cultural communities is difficult because the vocabulary of medicine and health are often not well understood by translators. Finding a suitable translator can be difficult. Family members may translate only that thing that they agree with and will not translate what you think is important. For example, in cases where one is trying to explain a terminal illness, if the family member does not want their loved one to hear the news, they will not translate the information correctly.

In situations where there is no one to translate, it is perhaps, only possible to attend to the physical needs and use one's body language of empathy, love and spirituality to convey the best support one can. It may not be enough but it is more than would otherwise occur.

Practical help: if you are working with people from a particular culture quite often, it is important to learn a few key phrases to offer support and ask the right questions. Have a pad with a few important phrases written out in the different languages you encounter so that a person can point to those phrases they want to communicate to you.

If you do not know what language a person is speaking, create another pad of paper with the sentence "Hello, my name is _________, and I speak ___________." If the person is literate they can point to the sentence of their language. Underneath will be the name of that language in English.

Speak slowly at a normal volume. Ask the person to repeat their name as often as necessary until you can say it properly. Write it out phonetically so you can remember it the next time.

I find that mindset and way of thinking are most crucial. One must celebrate diversity of all kinds and seek uniqueness of people and cultures, rather than emphasizing difference. For example, “what makes this person unique”, rather than, “how are they different”. Where significant language barriers exist, I find that kindness and respect, as conveyed by demeanor, tone and facial expression are universally understood as caring.

Elizabeth Latimer

Phonetics

In writing down foreign words phonetically, the biggest challenge is getting the vowel sounds correctly. Consonants can be spelled out fairly clearly. For example, clear would be written as kl-ear. Here are a few tips to help from the Oxford paperback dictionary:


a as in hat

ah as in palm

air as in chair

ay as in hay


e as in bed

ee as in beet

ear as in beer

er as in her

ew as in dew


i as in tin


I as in cry

I as in eye

o as in stop

on as in lemon

oh as in most

oi as in join

oo as in spoon

oor as in poor

or as in horn

ow as in wow


u as in cup

us as in circus

uu as in look

y as in yes


Religious Beliefs & Rituals

The Similarities We Share

In 1993 the World Parliament of Religions held its second Parliament to look at the similarities and differences between world religions and faiths. This parliament is held every 100 years. At the 1993 Parliament, a global world ethic was presented in draft form and signed by 141 leading figures from all the world's ancient religions.

This document was based on the common elements within all world religions, namely, that all people be treated humanely and equally. It further described all humans committing to: (a) a culture of non-violence and respect for life, (b) a culture of solidarity and just economic order and (c) a culture of tolerance and a life of truthfulness with equal rights and partnership between men and women. It noted that what was taught in all ancient religions was often not practiced and, therefore, there is often global confusion about what someone of another faith is directed to believe and practice.

Religious Beliefs

Another way to learn more about each other's religious beliefs is to begin with some basics. The following gives a brief sketch of some of the major faiths represented in Canada. They are a starting point for discussion. Ask someone of a particular faith to tell you how accurate the summary is.

Buddhism

The word Buddha means 'one who has woken up'. The purpose of one's faith is to take advantage of being born as a human being, by developing energetically the qualities of kindness and awareness in order to achieve freedom from suffering, and to help others to do the same.

Christianity

The Crucifix is a symbol used to represent life, death and resurrection. There are many denominations within the Catholic and Protestant faiths but a belief in Jesus Christ as the Son of God is common to all. One's purpose is to live according to the loving nature of God as revealed through Christ's life and death helped by the Holy Spirit and through prayer. Christianity is the second Abrahamic faith.

Hinduism

OM expresses the complete nature of God. "Hindu" is originally a Persian word for Indian. It has no founder nor is there a specific prophet but is a complex religious tradition. Buddhism, Jainism and Sikhism arose within the Hindu tradition. One's faith helps them to learn how to be reunited with God and to learn this through study, devotion, prayer and service to others.

Islam

Islam is an Arabic word meaning 'submission' (to God). It prescribes patterns of right and wrong ways of behaving in business, dress, etiquette, family life, and food. It is over 1400 years old. There are 72 sects including major ones of Sunnis and Shi'ites. The Ismaelis sect began in the 9th century and is led by the Aga Khan. The Islamic crescent symbolizes the new moon that determines the Islamic calendar. One's purpose is to submit life to the will of Allah as revealed by the prophet Muhammad through the Qur'an and to do so through a declaration of faith, regular prayer, almsgiving, fasting and pilgrimage. Islam is the third Abrahamic faith.

Judaism

With roots back some 4,000 years, Jews are generally affiliated to an Orthodox, Conservative, Reconstructionist, Reform or Liberal synagogue. Their faith is based on the Torah to help Jews live according to God's laws as revealed by Moses. The most important law is to believe in one God and to learn to love God through study, through prayer and by celebrating the yearly cycle of holy days. Judaism is the first Abrahamic faith.

Religious Holidays

The following holy days will mean very little to you unless you ask people in your community, your colleagues and your clients about what they mean. It is most logical to begin to talk to those people you have the most contact with to understand their religious holy days. You may want to get a calendar with the following holy days specific to this year’s dates.

The dates are in general order from January to December. Most change dates every year. Look for multicultural or multi-religious calendars each year for accuracy. See the Resource list for examples. Capitalized days are the holiest and work may be abstained.


Bahá'í

(All holy days begin at previous sundown before the indicated date)

Intercalary Days

Ala

Na Ruz - New Year

RIDVAN

Declaration of the Bab

ASCENSION OF BAHA'U'LLAH

Martyrdom of the Bab

Birth of the Bab

Birth of the Baha'u'llah

Day of the Covenant

Ascension of Abdu'l-Baha

Buddhism

CHINESE/VIETNAMESE NEW YEAR (1997 = 4692)

SONGRAN (NEW YEAR) - Asia

WESAK

Wassa

Dhamma Day

Pavarana

Kathina


Christian (Georgian=Western)

Epiphany

Ash Wednesday

Palm Sunday

Holy Thursday

GOOD FRIDAY

EASTER

Ascension

Pentecost

Assumption

Advent begins

CHRISTMAS


Christian (Julian = Eastern)

ARMENIAN CHRISTMAS

CHRISTMAS

Theophany

Lent

Palm Sunday

Holy Thursday

HOLY FRIDAY

EASTER

Ascension

Pentecost

Assumption - Armenian

Assumption


Hinduism

Lohri

Basant Panchami

Shivratri

Holi

BAISAIKHI

Ram Navami

Raksha Bandhan

JANMASHTAMI

Ganesh Chaturthi

Navratri

Durga Puja

Dussehra

DIWALI


Islam

(Holy days are subject to sighting of the moon)

First of Ramadan

EID-UL-FITR

Day of Hajj

EID-UL-ADHA

First of Muharram

Ashura

Eid-Maulad-un-Nabi

First of Ramadan


Jainism

MAHAVIRA JAYANTI

Akshaya-tritiya

PARYUSHANA-PARVA

Dashalakshani-parva

Samvatsari

Ananta-chaturdasi

Ksamavani

Mahavira Nirvana

Lokashah Jayanti


Judaism

(All holy days begin at previous sundown before the indicated date)

(*Some Jews may abstain from work)

Purim

Pesach*

Shavuoth*

ROSH HASHANAH*

YOM KIPPUR*

Sukkot*

Shemini Atzeret*

Simchat Torah*

Hanukkah


Sikhism

Birthday of Guru Gobind Singh

Hola Mohalla

BAISAIKHI

Martyrdom of Guru Arjan Dev

Parkash

DIWALI

BIRTHDAY OF GURU NANAK

Martyrdom of Guru Tegh Bahadur


Zorastrianism

Fravardeghan Days

Gahambar Hamaspathmaedem

NAW RUZ - NEW YEAR (Fasli)

Birthday of Prophet Zarathustra

Gahambar Maidyozarem

Gahambar Maidyoshem

NAW RUZ - NEW YEAR (Shenshai)

Gahambar Paitishem

Gahambar Ayathrem]

DEATH OF PROPHET ZARATHUSTRA

Gahambar Maidyarem

Ethical Questions

1.When should health care providers insist on Western treatments (if ever) over someone's alternative treatments?

2.What are the ethical issues inherent in imposing North American medical values and practices on people who have different beliefs?

3.How does one deal with a patient/family's fundamental beliefs when they conflict with one's own beliefs? For example, if one believes strongly that euthanasia is wrong and immoral, what does one do when asked to help a patient to commit suicide?

Summary

The more you work within a specific community, the greater the importance that you understand their customs, language, beliefs and common experiences.

As long as you work with others, it is important to follow the advice of Georges Vanier: The more you know people, the better you will understand them and the more you will like them.

Help people to relax by being relaxed yourself. A few moments of informal conversation or a body language that projects respect and understanding of the person's dying process can often reduce stress and build rapport.

Determine what language a person speaks using the "Hello, my name is .." form described earlier.

Do not criticize people for speaking their own language amongst themselves. They need to be comfortable in their communications whenever possible.

Prescribe meals containing foods common to the person's diet whenever possible. Encourage family and friends to bring food which may help the patient feel more in control of their environment and their health.

Allow family members to visit as often as possible with a specific cultural norm. Encourage one or two family members to act as a spokesperson so that you can provide consistent and necessary information to the family.

Avoid commenting on a person's culture, religion or beliefs with colleagues in hallways, elevators, etc. These comments are often overheard and reflect badly on you and your colleagues.

Take advantage of opportunities to learn about people from other cultures, especially those cultures that have a high ratio in your catchment area. Accept invitations to social events that highlight the important rituals of a culture. Attend alternative theatre and films to see how a culture is represented by members of that culture.

Learn a few key phrases of different groups with whom you work. Often the effort is more important than the actual phrase or pronunciation.

Ask permission before you do things. Explain anything that may be new to the person or their family before you do it so they can tell you if it will be perceived as helpful and respectful.

Follow the customs of the home. If people do not wear their shoes in the house, bring slippers to wear. If people do not smoke, follow that lead. Never use profanity or criticize a person's home or their belongings (especially with your body language).

Recap important information in different ways to try and ensure that people have understood you. Write out specific information for them, or someone else, to read.

Resources

The following resources are only a few of the many useful resources that you can find in your local libraries, within your own organization, and in your local bookstores. Look for other books but also for journal articles, magazine reports, films, videos and audiocassettes. Also keep in mind how much you can learn from experts in the field, including people within your own organization!

Brink, P. J. (1976). Transcultural nursing: A book of readings. Englewood, NJ: Prentice-Hall.

Buckley, P. (Ed). (1995). Canadian Press stylebook: A guide for writers and editors. Toronto: The Canadian Press.

Fynn. (1974). Mister God, this is Anna. London: William Collins.

Lind Infeld, D.; Gordon, A. K., & Harper, B. C. (Eds). (1995). Hospice care and cultural diversity. New York: Haworth Press.

The Oxford paperback dictionary (1994). Oxford, England: Oxford University Press.

Saint Elizabeth Visiting Nurses' Association of Ontario. (1988). Caring across cultures: Multicultural considerations in palliative care. Toronto: Self-Published.

The Vanier Institute of the Family. (1996). Canada's families: They count. Nepean, Ontario: Self-Published.

For a yearly Multicultural Calendar of holy days within 10 religious groups in Canada, contact Sheena Singh at Creative Cultural Communications, (416) 203-3595. For a catalogue of wall posters of religious and folk festival days, contact The Festival Shop in England at 0121 444 0444.

Practical Leadership


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Copyright © 2000 Harry van Bommel

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