ADHA Access May-June : Page 29

Ethics: Culture Adds a Challenge to Conventional Ethical Decision Making By the ADHA 2011-2012 Ethics Committee: Mary Bobbett, BA, RDH; Cynthia Carlson, PH-RDH, BS; Winnie Furnari, RDH, MS, FAADH; and Angela Pavicic-Demko, RDH  A of opposite sexes who are strangers do not touch one another as a norm. Being mindful of the differences in manners from s was discussed in-depth in the April issue of Access , the one culture to another not only helps deter uncomfortable situ-$PHULFDQ'HQWDO+\JLHQLVWV¶$VVRFLDWLRQ¶V&#0b;$'+$¶V&#0c;GH¿QLWLRQRI ations, but also earns patient and societal trust from a public ethics reminds us that ethics are general standards of right and appreciative of our considerations. wrong that guide behavior. When these standards are met, the 'LI¿FXOW\LQEHLQJXQGHUVWRRGLVDKXJHFKDOOHQJHEHWZHHQ public’s trust—on which professional privilege and status are people who do not share a language. Problems can occur founded—is enhanced. Fundamental principles and core values throughout the process of care, from scheduling an appoint-are stated in ADHA’s Code of Ethics. 1 ment to understanding the patient’s primary concern/need Ethical challenges often arise in the workplace and can be DQGKHDOWKKLVWRU\&RPPXQLFDWLQJWKHRI¿FH¶VSURWRFRODQG compounded by differences between cultures. A dictionary expectations, as well as explaining treatment options, can be GH¿QLWLRQRIFXOWXUHLV³&XVWRPDU\EHOLHIV&#0f;VRFLDOIRUPVDQGPD -GLI¿FXOW:HQHHGWRPDNHVXUHWKDWFRPPXQLFDWLRQVDUHXQGHU -WHULDOWUDLWVRIDUDFLDO&#0f;UHOLJLRXVRUVRFLDOJURXS´7KHGH¿QLWLRQ VWRRGDQGSDWLHQWVDUHJLYHQRSSRUWXQLWLHVWRDVNIRUFODUL¿FD -DOVRLQFOXGHV³WKHDFWRIGHYHORSLQJWKHLQWHOOHFWXDODQGPRUDO tion; this takes extra time and patience. Language misunder-faculties especially by education.” 2 Patients who present with standings can also occur when a patient is hearing-impaired. a toothache and just want an extraction need to be educated How do we approach language barriers? It is not easy to dis-on other alternatives; patients who just want a cleaning when cern a stranger’s level of education if we are unable to commu-a more detailed procedure is warranted need to be educated nicate with them, and (just as with patients who do speak our on the possible results of their choices. Their beliefs need to be language) even if we know that the person is highly educated, respected, but they need to be given the opportunity to make we cannot assume an equally high level of dental awareness. an educated choice. It must never be assumed that they know special feature continued on page 30 all pertinent information. Haven’t we all encountered the parent who believes that since his or her child will lose the primary teeth, there is no need to restore them? And the patient who believes that eventually, with age, everyone will wear dentures? One facet of culture to be FRQVLGHUHG³FXOWXUHVKRFN´²WKH sense of confusion, uncertainty The First Dental Hygiene Program in the Nation and sometimes anxiety that Th e University of Bridgeport’s Fones School of Dental Hygiene can affect people exposed to off ers Associate of Science, Bachelor of Science and Master an unfamiliar culture. Some of our foreign patients experience of Science degrees in Dental Hygiene. At UB’s Fones School culture shock when moving to the of Dental Hygiene, students experience a program United States and assimilating to American culture. Consider the that prepares them for expanding roles in public health, science of dentistry a culture all education, administration and clinical practice. its own. With many possible op-portunities for culture shock, we Th e Fones School of Dental Hygiene off ers students a as health care providers should brand new, state-of-the-art facility equipped with the be updated and educated to the many differences we may encoun-latest digital technology, ergonomic workstations, and ter, and gather tools for applying “smart” classrooms. We invite you to discover the convenience our ethical judgments with con-of our full-time, part-time and online programs. sideration for different cultures. After all, patients are not the only ones experiencing culture shock; To ﬁ nd out how the University of Bridgeport can help you practitioners can, too. advance your career in dental hygiene, call 1.800.EXCEL.UB In our culture, we usually or visit us at www.bridgeport.edu speak face-to-face and eye–to-eye with our patients. In some cultures, men and women do not look into the eyes of people of the opposite sex. The handshake with BRIDGEPOR T 1 ST AMFORD 1 W A TERB UR Y which we greet others is not a custom in some cultures; people What Will UBecome? access MAY-JUN 2012 29

Ethics

Ethics: Culture Adds a Challenge to Conventional Ethical Decision Making By the ADHA 2011-2012 Ethics Committee: Mary Bobbett, BA, RDH; Cynthia Carlson, PH-RDH, BS; Winnie Furnari, RDH, MS, FAADH; and Angela Pavicic-Demko, RDH As was discussed in-depth in the April issue of Access, the American Dental Hygienists' Association's (ADHA's) definition of ethics reminds us that ethics are general standards of right and wrong that guide behavior. When these standards are met, the public's trust-on which professional privilege and status are founded-is enhanced. Fundamental principles and core values are stated in ADHA's Code of Ethics.1 Ethical challenges often arise in the workplace and can be compounded by differences between cultures. A dictionary definition of culture is "Customary beliefs, social forms and material traits of a racial, religious or social group." The definition also includes "the act of developing the intellectual and moral faculties especially by education."2 Patients who present with a toothache and just want an extraction need to be educated on other alternatives; patients who just want a cleaning when a more detailed procedure is warranted need to be educated on the possible results of their choices. Their beliefs need to be respected, but they need to be given the opportunity to make an educated choice. It must never be assumed that they know all pertinent information. Haven't we all encountered the parent who believes that since his or her Child will lose the primary teeth, there is no need to restore them? And the patient who believes that Eventually, with age, everyone will wear dentures? One facet of culture to be considered "culture shock"-the Sense of confusion, uncertainty and sometimes anxiety that can affect people exposed to an unfamiliar culture. Some of our foreign patients experience culture shock when moving to the United States and assimilating to American culture. Consider the Science of dentistry a cuIture a II its own. With many possible opportunities for culture shock, we as health care providers should be updated and educated to the many differences we may encounter, and gather tools for applying our ethical judgments with consideration For different cultures. After all, patients are not the only ones experiencing culture shock; practitioners can, too. In our culture, we usually speak face-to-face and eye-toeye with our patients. In some cultures, men and women do not look into the eyes of people of the opposite sex. The handshake with which we greet others is not a custom in some cultures; people Of opposite sexes who are strangers do not touch one another as a norm. Being mindful of the differences in manners from one culture to another not only helps deter uncomfortable situations, but also earns patient and societal trust from a public appreciative of our considerations. Difficulty in being understood is a Huge challenge between people who do not share a language. Problems can occur throughout the process of care, from scheduling an appointment to understanding the patient's primary concern/need and health history. Communicating the office's protocol and expectations, as well as explaining treatment options, can be difficult. We need to make sure that communications are understood and patients are given opportunities to ask for clarification; this takes extra time and patience. Language misunderstandings can also occur when a patient is hearing-impaired. How do we approach language barriers? It is not easy to discern a stranger's level of education if we are unable to communicate with them, and (just as with patients who do speak our language) even if we know that the person is highly educated, we cannot assume an equally high level of dental awareness. These are just a few of the myriad of challenges health care providers may encounter when dealing with culturally different populations. How do we make choices when we face so many dilemmas? Certain decision-making tools can be used to achieve culturally sensitive and ethical decisions. Along with our conscience, our own personal standards of behavior will influence our behavior in different situations. Other tools that will help us make decisions are our knowledge, education, experience and common sense. You need to recognize the ethical issue, collect all the facts, evaluate alternative actions, make a decision and test it, act and, finally, reflect on the outcome.4 Gaining a patient's trust will help with the outcome. Most of the time, we make choices based on doing the right thing. We make decisions quickly at times, and sometimes the consequences can last a lifetime. It is important to take all into consideration, identify options, gather all information, and consider the pros and cons. Some dental offices and other dental facilities have an everyday-decision-making plan implemented. They even have written scripts to follow for certain common scenarios that may arise. Having a code of ethics as our guide is vitally important. It will help us make careful, smart decisions. Most importantly, our code gives us direction in our professional lives. These standards are not regulatory and therefore do not have the force and effect of law. They are not mandatory, but they greatly assist health care providers and organizations in responding effectively to their patients' cultural and linguistic needs. The CLAS standards are primarily directed at health care organizations; however, individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible. The principles and activities of CLAS should be integrated throughout an organization and undertaken in partnership with the communities being served. Five of the standards are provided here: • Health care organizations should ensure that patients/consumers receive from all staff members effective, understandable and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language. • Health care organizations should implement strategies to recruit, retain and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area. • Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery. • Health care organizations should maintain a current demographic, cultural and epidemiological profile of the community, as well as a needs assessment, to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area. • Health care organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLAS-related activities. A dental hygienist who is not culturally competent could contribute to a lack of trust and inconsistent patient compliance. A culturally competent dental hygienist adapts care in a manner consistent with the culture of the individual patient. Education is imperative to improve and effect a mutual understanding of provider and patient health beliefs. Attaining cultural competence is a continuing process and will fulfill our ethical responsibilities to all our patients. References 1. ADHA Code of Ethics. Available at: www.adha.org 2. Webster's Ninth New Collegiate Dictionary, Merriam Webster Inc, Springfield, Mass., 1989, p. 314. 3. Culturally and Linguistically Appropriate Services in Health Care. Available at: 0 minorityhealth .hhs.gov/templates/browse .aspx?lvl= 2&lvIID= 15. 4. Santa Clara University. Ethical decision making. Available at www.scu.edu/ ethics/practicing/decisions. Parting Messages: I have been honored to serve on the ADHA Ethics committee with other dental hygienists who came forward to do what we could to keep ethics in the forefront in dental hygiene practice. Thank you for the opportunity and experience. - Winnie Furnari, RDH, MS, FAADH It has been a privilege to serve on the ADHA Ethics committee. I feel our professional ethics speak to the core of who we are and how we serve others. Hopefully we have educated and motivated others to become aware of and strengthen our professional ethics through action. - Cynthia Carlson, PH-RDH, BS Mary Bobbett, BA, RDH, has been a registered dental hygienist since 1996 and active in ADHA on the local and state level since graduating. She works two days a week with her sister who is a dentist and works one day a week in another office. She comes from a military family who settled in Las Vegas. Mary loves to travel and has visited all seven continents. Cynthia Carlson, RDH, BS, is the past president of the Nebraska Dental Hygienists' Association. She served four years as a state delegate and is the current legislative co-chair. She is the recipient of Nebraska State Hygienist of the Year Award and a member of the Medical Reserve Corp. She has practiced clinical dental hygiene over 30 years. She is a volunteer who gives dental education programs for the elderly and literacy groups. Winnie Furnari, RDH, MS, FAADH, is past president of the New Jersey and New York Dental Hygienists' Associations. She is a recipient of the ADHA Distinguished Service and the Philips/ ADHA Excellence in Dental Hygiene Award. She is an assistant professor at New York University College of Dentistry where she served on the Ethics and Professionalism Council and serves as ADHA student chapter co-advisor. She has extensive experience in lecturing and work in forensic odontology. Angela Pavicic-Demko, RDH, is past president of the Ohio Dental Hygienists' Association and has served on workgroups at all levels of the association. She has been practicing clinical dental hygiene for 15 years.

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