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Cultural competency, humility, and safety in paramedicine

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Sheryl Thompson & Polly Ford-Jones

As the paramedic profession in Canada continues to grow and advance, we hear increased discussion of equity, diversity, and inclusion [1-3. This discussion calls on individuals to consider the ways in which equity, diversity, and inclusion apply to practice and the field of paramedicine.  A number of principles were recently identified to guide the future of paramedicine in Canada, among them: prioritizing patients and their communities; providing health care along a health and social continuum; being socially responsive; and enacting a continuous learning environment4.  Recognizing the diverse range of communities that paramedics serve, and the need to prioritize not only the traditionally valued “technical” skillsets of paramedic work, but also the social care elements5, the importance of the roles that cultural competency, humility, and safety hold in paramedicine plays an integral role to the overall profession. We discuss the significance of cultural competency and explore where it may be missing in many health care settings. We discuss how if we can purposely apply cultural humility in care settings, we ultimately create a space that is culturally safe. Lastly, we touch on how these concepts may support the overall goals of paramedicine in Canada, the diverse communities served, and appropriately inclusive practice.  

The article gives a perspective of ‘culture’ quite broadly while stressing the importance of health professionals developing awareness of, and sensitivity to, the unique experiences of individuals from different cultural, ethnic, and racial backgrounds, across language differences, socioeconomic circumstances, religious values, sexual orientation, and gender identity6-10. Increased cultural competence has been instrumental in reducing health disparities among marginalized populations9 and supporting practitioner-patient relationships and communication9. Further education and training to enhance cultural competence and a shared understanding of cultural diversity early on in professional training have also been identified as important factors in patient centered care10.

 Working toward cultural competence involves knowledge and skills related to cultures and communities, however, development of cultural awareness and competence does not necessarily mean having full, in-depth knowledge of all cultures and all communities. Rather, it is important to have awareness of the potential for cultural differences that impact communication, interactions, and make a conscious effort to recognize and overcome barriers in providing healthcare11.  

An important part of being culturally competent is to practice cultural humility which is: “a constant process of awareness, learning and adapting to all the possible cultures a health care provider may encounter. ”11(p842) it is this lens that will support a commitment to reflective practice11, 12. To display cultural humility requires of an understanding of the worldview that each individual holds and the impacts it has on framing the ways in which paramedics work with and provide supportive care to the communities they serve. There is a need, within our Canadian context, to recognize where a Eurocentric worldview has shaped us, and where cultural humility is required to listen to and learn from the communities within which paramedics work. 

Moving beyond learning about cultures and communities, the concept of cultural safety requires that health practitioners examine and engage with the potential impact of their own worldview and culture on a given clinical interaction. This requires questioning their own biases (implicit or overt), attitudes, assumptions, stereotypes, and prejudices that may impact culturally safe patient care13. In order to create culturally safe environments and interactions, competence means having awareness of when you might be imposing your culture and worldview onto someone else. A clinician with cultural humility learns from their patients about their culture, needs, and perspectives. This knowledge is then incorporated into patient centered care. Together, both cultural competence and cultural humility have the potential to create safe environments and interactions that address power imbalances and establish trust so people can feel safe when receiving health care14. 

While the significance of cultural competence in health care is well documented6, 9, 15-18 there is a lack of research being conducted about cultural competency in first responders, with only a small amount of information about law enforcement and paramedicine in the American context11,19. Despite the recognition of the need for cultural competence in health care, systematic cultural competency training across medical professions remains limited10. Furthermore, factors of culture are frequently neglected during emergency situations when professionals are focused on immediate demands10.

Paramedics work in an emergency setting, encountering a broad diversity of patients. There is a need for significant cultural competence to work with and provide supportive care to the communities we serve. While paramedics often work in fast-paced settings with immediate demands, there are still many opportunities to consider relevant cultural experiences, needs, and the lived realities of our patients.  A thorough understanding for paramedics of the cultural competence continuum20 would support the ability to work in a fast-paced sector and meet the immediate demands of a diverse community. Additionally, early training in cultural competence has the potential to decrease anxiety and confusion of health professionals when working with diverse populations and may improve appropriate assessment and treatment outcomes10.  Incorporating cultural competence into training at the student level, as well as development of an ongoing reflective practice for professionals are two distinct opportunities for implementation in paramedicine.  

CulturalCompetenceContinuum

As we continue our learning and work to improve how we address equity, cultural competence, humility, and safety in paramedicine, there is room for us to learn from other professions who have long-since been embedded in anti-oppressive, trauma-informed, and other equity-oriented frameworks.  The National Association of Social Work has just recently added cultural competency as one of its pillars to their Code of Ethics and Standards of practice as a means to consider cultural competency as an important aspect of the way social workers serve marginalized communities. We might consider that paramedicine should be doing the same.  To adequately prioritize patients and their communities, provide appropriate care across the social continuum, and provide socially responsive care requires cultural humility – ongoing learning, reflection, and continuing to improve culturally competent patient care at each opportunity.  Culturally competent practice should be seen as an ongoing process rather than an outcome to be acheived.  With equity, diversity and inclusion, and the principles guiding paramedicine in Canada in mind, there is room to prioritize cultural competence, humility, and safety in our training and practice, and ensure we support and create a continuous learning environment in all aspects of health and social care.

Tachwest

References

1. Lunn TM, Logan S, Doiron M, Cameron C. Call to Action: Antiracism in Paramedicine. Canadian Paramedicine; 2021.

2. Mason P, Delport S, Batt A. Let’s make this our “thing”. Leveling the playing field for a brighter future in paramedicine. Faculty & Staff Publications – Public Safety. 2018.

3. Hirello L, Ford-Jones P, Mason P, Batt A, Cameron C, Cuthbertson T, Tavares W. McNally Project Inclusion and Equity Statement. McNally Project Paramedicine Research. 2020.

4. Tavares W, Allana A, Beaune L, Weiss D, Blanchard I. Principles to Guide the Future of Paramedicine in Canada. Prehosp Emerg Care. 2021 Aug 30:1-11.

5. Ford-Jones P, Daly T. Paramedicine and mental health: a qualitative analysis of limitations to education and practice in Ontario. J Ment Health Train Educ. 2020;16(6):331-345. 

6. Bristol S, Kostelec T, MacDonald R. Improving Emergency Health Care Workers’ Knowledge, Competency, and Attitudes Toward Lesbian, Gay, Bisexual, and Transgender Patients Through Interdisciplinary Cultural Competency Training. J Emerg Nurs. 2018;44(6):632–9. 

7. Kengis L, Goldstein J, Urquhart R, Mciver K. Evaluating paramedic comfort, confidence, and cultural competency in providing care to trans populations in a provincial ambulance system. Canadian Association of Emergency Physicians. 2019. S22. 

8. Mechanic OJ, Dubosh NM, Rosen CL, Landry AM. Cultural Competency Training in Emergency Medicine. J Emerg Med [Internet]. 2017;53(3):391–6. Available from: https://doi.org/10.1016/j.jemermed.2017.04.019

9. Padela AI, Punekar IRA. Emergency medical practice: Advancing cultural competence and reducing health care disparities. Acad Emerg Med. 2009;16(1):69–75. 

10. Slobodin O, Clempert N, Kula Y, Cohen O. Educating health professionals for cultural competence in emergency situations: A study protocol for a randomized controlled trial. J Adv Nurs. 2020;76(1):380–6. 

11. Khalsa S, Barnes L, Audet R, Sweeney M, Leggio W, Linder L, et al. The Impact of Cultural Humility in Prehospital Healthcare Delivery and Education a Position Paper from the National Association of EMS Educators (NAEMSE): Adopted by the NAEMSE Board of Directors on 7/15/2019. Prehospital Emerg Care [Internet]. 2020;24(6):839–43. Available from: https://doi.org/10.1080/10903127.2019.1709001

12. Greene-Moton E, Minkler M. Cultural competence or cultural humility? Moving beyond the debate. Health Promot Prac. 2020;21(1):142-145.

13. Curtis E, Jones R, Tipene-Leach D, Walker C, Loring B, Paine S et al. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int J Equity Health. 2019;18:174-191. 

14. First Nations Health Authority. FNHA’s policy statement on cultural safety and humility. 2016.

15. Almutairi AF, Rondney P. Critical cultural competence for culturally diverse workforces: Toward equitable and peaceful health care. Adv Nurs Sci. 2013;36(3):200–12. 

16. Desapriya E, Mehrnoush V, Bandara AN. Cultural competency and culturally safe clinical care. Cmaj. 2018;190(3):E84. 

17. Jongen C, McCalman J, Bainbridge R. Health workforce cultural competency interventions: A systematic scoping review. BMC Health Serv Res. 2018;18(1):1–15. 

18. Young S, Guo KL. Cultural Diversity Training: The Necessity of Cultural Competence for Health Care Providers and in Nursing Practice. Health Care Manag (Frederick). 2020;39(2):100–8. 

19. Amato BV. Cultural competence to patients with diverse backgrounds. EMS World. 2020;34-37. 

20. Berger G, Peerson A. Cultural competence lessons learned: The continuum model. Med Ed. 2015;49(5): 515-516.

21. Ansary A. Cultural competence – Principles, Importance, Components. Available from https://www.careercliff.com/what-is-cultural-competence-in-the-workplace-principles/

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Sheryl Thompson

Sheryl Thompson

Sheryl Thompson is a professor and program coordinator of the Emergency Telecommunications Program in the Faculty of Health Sciences and Wellness at Humber College. She holds a Masters in Social Work (MSW), Bachelor in Social Work (BSW), Diploma in Social Service Work (SSW) and Diploma in Emergency Telecommunications (EMTC). A registered social worker with 15+ years’ experience she has worked with various client populations and continues to do so through her private practice Sheryl Thomson Counselling and Consulting. With over 10+ years in teaching and a commitment to interprofessional education she has taught across disciplines including Fire and Emergency Services, Massage Therapy, Community Development and continues to teach in Social Work programs in Canada and the USA with a strong focus on diversity, equity, and inclusion. Sheryl is currently pursuing her PhD in Education

Polly Ford-Jones

Polly Ford-Jones

Polly Ford-Jones AEMCA, MA, PhD, is a Professor in Allied Health at Humber Institute of Technology & Advanced Learning in Toronto and a practicing Primary Care Paramedic in southern Ontario, Canada. She completed her PhD in Health Policy and Equity at York University and is a qualitative researcher.  Her research focuses on mental health and psychosocial care in the prehospital setting and issues of health equity. 

Women in Paramedicine

Women in Paramedicine

Women in Paramedicine is compromised of dozens of women in the paramedical field across Canada. Since 2019, they have been sharing their research, point of view, thoughts, and strength to Canadian Paramedicine through their voice and words.

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