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Culture clash

The increasing internationalisation of the aged care workforce is not necessarily an enabling trend in the provision of culturally appropriate care. Linda Belardi reports.

Changing migration patterns means the global nursing workforce is not necessarily better equipped to cater for the diverse linguistic and cultural needs of residents.

Ljubica Petrov, manager of the Centre for Diversity in Ageing, says the cultural and linguistic origins of staff and residents do not always match.

Aged care employees are commonly from the newly emerging migrant communities, whereas elderly migrants in large originate from the long established post World War II communities.

Embedding culturally appropriate care will require organisational commitment, well-trained staff and the clear articulation of professional guidelines surrounding the use of bilingual skill.

Strengthening the professional strategies around cultural understanding will also encourage more targeted and meaningful recognition of the diverse linguistic and cultural needs of residents.

The end goal of cultural awareness training is to equip staff with the sufficient knowledge to be able to interact meaningfully and sensitively with all residents including those from culturally and linguistically diverse backgrounds, says Petrov.

The cultural mix and demographic make up of the resident population will change over time but the ability to interact sensitively with CALD residents is the ongoing and universal challenge.

“A person’s cultural diversity is more than simply an element of lifestyle. It should therefore inform all aspects of care provision from policy and service development, continuous improvement initiatives to all aspects of service delivery,” says Petrov.

Conducting culturally sensitive assessments includes identifying traditions and celebrations of cultural importance, taking into account their hobbies and social norms as well as their historical experience, says Maria Stephanou, manager of the NSW Transcultural Aged Care Service.

Victims of trauma, for example may have a troubled historical memory which may demand sensitivity when performing particular bureaucratic tasks. For example, clients who experienced World War II may choose to avoid regimented activity and respond negatively to depersonalised professional assessments, says Stephanou.

Care assessment should also be carried out in the preferred language of the resident so that the client is able to articulate their needs effectively.

Enlisting the services of professional interpreters will also minimise room for error whilst protecting client privacy, as family members usually edit information. In few cases there may be also conflict of interest, says Stephanou.

“Unfortunately the use of professional interpreters in aged care is minimal because of associated costs and lack of government financial support specifically for this purpose.”

Appropriate signage and access to interpreting services is particularly important to ensure effective communication with residents.

In a focus group study of 48 migrant elderly from six ethnic backgrounds, three quarters of those surveyed said they were unable to read and understand information written in English.

The survey conducted by the Centre for Cultural Diversity in Ageing also indicated that the vast majority relied upon news media in their own language and only five participants read their local English newspaper.

The experience of dementia also adds complexity to their care needs as many residents will often revert to their primary language or speak a mix of languages concurrently.

Without linguistic support, difficulties in communication may be misinterpreted as problem behaviour and the inappropriate care given. For example, studies have shown that when residents are unable to communicate in their preferred language a higher reliance on medication may occur.

Despite the critical importance of language skill, staff bilingualism in the aged care workforce is currently an under-utilised skill and an under-researched field, says Petrov

In response, the Melbourne-based Centre for Cultural Diversity in Ageing has developed a pilot program of draft guidelines.

“If workers are employed for their bilingual skill, then this skill needs to be acknowledged in the position descriptions and not be called upon in an ad hoc way,” says Petrov

The necessary assessment of staff language skills and their fluency is also necessary to ensure the quality of linguistic resources available to clients and their confidence to work in a second language.

It is important to place the individual firmly at the centre of care so as not to reduce an individual to set of cultural norms.

“Stereotyping is a common trap. However, by encouraging participants to contemplate variation within their own culture they gain respect for the diversity that exists within other cultures,” says Stephanou.

Culture is also not static which means cultural learning is a never ending cycle of learning, says Petrov.

When implementing culture sensitivity training, the dilemma of holding onsite or external training is an ongoing one.

“In an on site educational session, you can reach a wider number of staff, however time is a factor. Held externally, a seminar can take place across an entire day and staff may have the opportunity to concentrate more fully on topics,” says Stephanou.

A great deal of learning also takes place when sessions are interactive and there is an exchange of ideas from a broad range of participants, she says.

Regardless of structure, both Stephanou and Petrov agree that the dividends of cultural awareness training most successfully translate to everyday practice when management and senior staff are deeply involved.

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