A Twist on Cultural Diversity

In the Bay Area, where diversity is the norm, caregivers often represent cultures from all over the world, while the residents they care for may be mostly white, Anglo-Americans whose only language is English.  Perhaps a look at Anglo-American culture will reveal ways to improve interactions between caregivers and residents.

In an ideal world, two people trying to communicate would each reach out to understand the other’s culture.  Realistically, residents may not be capable of learning about the caregiver’s culture to meet the caregiver halfway.  It defaults to the caregiver to bridge the gap.

Generalizations

Although no statement about someone in a particular culture holds true for all members of that culture, we can make useful generalizations that steer us in the right direction.  For example, Anglo-Americans tend to be:

• Time oriented and more rigid about times: 10:45 means exactly 10:45.
• Direct, with less socializing before getting down to business.
• Less formal, speaking and acting casually.
• In general, Anglo-Americans want to be pain-free and may not be as stoic as some other cultures.  They may ask for pain medication where a person from another culture might “tough it out.” 

Comfort zones

Anglo-Americans may be more open about discussing personal matters, illness, and dying than others. 

If a resident wants to talk about a subject that makes you uncomfortable, you may want to find someone else who might be able to interact with him more directly—perhaps someone from social services, a chaplain, or another caregiver.

Researchers have demonstrated that Anglo-Americans generally require a larger personal space around them—in other words, they don’t stand as close when talking as people of other cultures do.*  For instance, they may become uncomfortable and step back if they feel another person is standing too close.

Independence

Anglo-Americans as a whole tend to be more individually oriented and like control. They leave less to fate and want to direct their own lives. American law requiring informed consent is based on the principle of autonomy—freedom of choice for the individual.  In other cultures the family or physician may make decisions for a patient, whereas in the US the individual is considered more important to decision-making than the family. 

Many Anglo-Americans see themselves as having a pioneer spirit and prefer not to be dependent on their children for care or support, while in other cultures it is expected that older people will live with their adult children. 

Best practices

Whenever cultures differ there is plenty of room for misunderstandings.  Usually neither is right or wrong—just different.  The best practice for communicating smoothly is to ASK.  Ask family members or the resident about how things are done in their family.   People are usually grateful that you are asking and appreciate that you are trying to learn about how they like to do things.

*The New York Times, “In Certain Circles, Two Is a Crowd,” Nov. 16, 2006.

This article was originally published in Pathways & Partners Newsletter - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Walker Safety

Walkers are valuable tools that promote mobility.  They can help when a resident has poor balance (like after some strokes) or is weak.  But incorrect use can have disastrous results.  Here are some simple guidelines for helping residents use their walkers safely.

Right Walker

First, make sure the resident has the right walker.  There should be rubber hand grips and non-skid rubber tips or wheels on the legs.  A lightweight walker allows the resident to easily lift it over bumps or stairs.  Some have wheels on the front legs if the resident has trouble lifting the walker while walking.  Sturdy wheels are a must.  Other options are hand brakes, baskets for carrying and legs that are adjustable to varying heights. If the resident has a tendency to tip backwards, the height of the walker can be adjusted down slightly to redistribute his weight.

Starting Out

When getting up from a chair, put the walker directly in front of the chair.  Then have the resident slide forward in the chair, keeping the feet directly under him.  Then have the resident use the arms of the chair to slowly stand.  The resident should grasp the walker handles firmly and move forward into the center of the walker.  When walking, watch the resident to be sure he does not put the walker too far ahead of this body.

Sitting

When the resident is ready to sit down, have him back up to the chair such that he can feel the chair on the back of his legs.  If one leg is weaker than the other, have the resident put his weight on the stronger leg.  The resident should keep one hand on the walker while the other reaches for the arm of the chair.  When he has a firm grasp, he should move the other arm to the chair, then lower himself down.

Remember, to be safe using a walker:

• the resident must take small steps
• he should never tilt or pull on the walker when getting up from a sitting position
• chairs should have armrests
• walkers should be examined routinely to be sure wheels and tips are secure and not worn down. 

This article was originally published in Pathways Residential Care Journal - Issue 3.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.