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Cultural Diversity image (Culture (There are four basic characteristics…
Cultural Diversity
Health care workers are involved with many different people
Not only will you take care of others but you will work with others
Respect individuality
Regard each person as a unique individual
Health care workers must be aware of the needs of each individual in order to provide total care
Some ways to achieve the goal or respecting and appreciating others:
Listen to pts as they express their beliefs
Appreciate the differences
Learn more about the culture and ethnic groups
Recognize and avoid bias, prejudice, and stereotyping
Ask questions to determine a person’s beliefs
Evaluate all information before forming an opinion
Allow pts to practice and express beliefs
You are not expected to adopt beliefs of others
Recognize and promote positive interaction with pt and family
Be sensitive to how a pt responds to eye contact, touch and invasion of personal space
Respect spirituality, religious beliefs, symbols, and rituals
Be aware of factors that cause each person to be unique
Uniqueness is influenced by many things including physical characteristics (sex, body size, hair, nails, and skin color) family life, socioeconomic status, religious beliefs, geographical location, education, occupational and life experiences
Greatest influence is cultural/ethnic heritage
Culture
Defined as values, beliefs, attitudes, language, symbols, rituals, behaviors, and customs unique to a particular group of people
Passed from one generation to next
Often defined set of rules because culture provides us with an individual blueprint or general design for living
It is the foundation of behavior but can have variances (culture Is not uniform among all members of a group and individuals within a cultural group)
Our family relationships, the way we bring our children up, education, occupational choices, social interactions, spirituality, religious beliefs, food preferences, health beliefs, and health care are all influenced by culture
There are four basic characteristics of culture:
Culture is learned, it does not just happen, it is taught by others
Children learn patterns by imitating others
Culture is shared
Common practices and beliefs are shared within a cultural group
Culture is social in nature
People in a cultural group understand appropriate behavior based on traditions that have been passed down generation after generation.
Culture is dynamic and constantly changing
Group can meet the needs by adapting to environmental changes
Ethnicity
Classification of people based on national origin and/or culture
Members of an ethnic group can share common heritage, geographic location, national origin, social customs, language, and beliefs
Every individual in an ethnic group might now practice all beliefs, they are still influenced by them
Common ethnic groups and their countries of origin
African American
Central and South Africa, Dominican Republic, Haiti, and Jamaica
Asian/Pacific American
Cambodia, China, Guam, Hawaii, India, Indonesia, Pacific Island, Japan, Korea, Laos, Philippines, Samoa, and Vietnam
Hispanic American
Mexico, Puerto Rico, Spain, and Spanish speaking countries in Central and South America
European American
England, France, Germany, the Netherlands, Ireland, Italy, Norway, Poland, Russia, Scandinavia, Scotland, and Switzerland
Middle Eastern/Arabic Americans
Egypt, Iran, Iraq, Kuwait, Lebanon, Yemen and so on
Native American
Includes Eskimos and more then 500 other tribes
It is also important to make note that within each of the ethnic groups , there are numerous subgroups each with its own lifestyle and beliefs within larger ethnic groups
European group includes Italians and Germans both with different language
Race
Classification of people based on physical or biological characteristics
Color of skin, hair, and eyes
Facial features
Blood types
Bone structure
Frequently used to label a group of people and explain patterns of behavior
Race cuts across multiple ethnic and cultural groups
There are white and black Hispanics, white Africans and Caribbean's, and white and black Asians.
Cultural diversity
Differences among people result from cultural, ethnic, and racial factors
These differences influence a person’s behavior
Very important to remember that differences exist within ethnic/cultural groups and in individuals within a group
In previous years the United States was called a “melting pot,” now it is striving to become more like a “salad bowl?”
Cultural differences are appreciated and respected
Cultural and ethnic beliefs will affect behavior
Health care worker needs to be aware of these beliefs to meet the physical, social, emotional, and mental needs of individuals (Holistic Care)
Holistic care is care that provides for the well-being of the whole person and meets not only physical
Areas of cultural diversity include:
Family organization
The structure of family and the dominant or decision-making person in a family.
Nuclear family
Basic unit in European American Families but extended family is important
Mom, dad, children- it can also be a single parent and child(ren)
Extended family
Privilege to take care of the eldery in Asian families
Basic unit for Asians, Hispanic, and Native Americans is generally the extended family with several different generations living in the same household
Includes nuclear family and grandparents, aunts, uncles, and cousins
Patriarchal versus matriarchal
Patriarchal
The father or oldest son is the authority figure
Matriarchal
Mother or oldest female is the authority figure
Come across some people who say they have to check with their spouse to see if they are going to have the surgery.
To determine a patient’s family structure and learn about a patient’s preferences, the health care provider should talk with the patient or ask questions:
Who are the members of your family?
Do you have any children? Who will care for them while you are sick?
Do you have extended family? For example, aunts, uncles, cousins, nephews, nieces?
Who will be carrying for you while you are sick?
Who is the head of the household?
Where do you and you or family live?
What do you and your family do together for recreation?
Do you have family members who will be visiting you? (if admitted to a HCF)
Language
English is the main language in the US but the US Census Bureau verified that more then 20% of the population younger than 65 speaks a language other than English at home
Variations within a language caused by different dialects
German taught in school may be different from the language spoken by Germans from different areas of Germany
Talk with pts and ask questions:
Do you speak Enlgish as your primary language?
What language is spoken at home?
Do you read English? Do you read in another language?
Do you have a family member or friend who can interpret information for you?
Find an interpreter whenever possible, speak slowly, and use simple words or phrases
Most states require that any medical permission form requiring a written signature be printed in the patients language to ensure that the pt understands what they are signing.
Personal space and touching
Arabs are very close contact and touchy
French and Latin Americans tend to be very close with hugs and handshakes
African Americans prefer a little space of 2-4 feet between themselves and others
In Cambodia members of opposite sex may never touch each other in public, not even brother and sisters. Only a parent can touch the head of a child
Vietnamese allow only the elderly to touch the head of a child because the head is considered sacred
Take vitals– be slow and explain what you're doing to ease fears
Eye contact
Most European Americans regard eye contact during a conversation as interest and trustworthiness
Some Asian Americans consider direct eye contact very rude
Native Americans may use peripheral (side) vision and avoid direct eye contact
Some Hispanic and African Americans use little eye contact to indicate respect and attentiveness
Muslim women avoid eye contact as a sign of modesty
India avoid eye contact with those of different socioeconomic classes
Gestures
India is the opposite of us in terms of yes and no
Health care beliefs
Most common health care system in the US is biomedical healthcare or “Western” system
System of health care bases the cause of disease on such things as microorganisms, diseased cells, and the process of aging
If the cause of disease is found care is directed towards eliminating the cause
Physicians receive medical training and are licensed to practice
Beliefs include: learning about illness, teaching self care, using medications and technology to cure or decrease the effects of disease
Major change in practice of our healthcare system:
Alternative health care methods (in addition to, or as a replacement for biomedical care and include chiropractors, homeopaths, naturopaths and hypnotists)
South African
Health concepts
Maintain harmony of body, mind, and spirit; harmony with nature, illness can be prevented by diet, rest, and cleanliness
Cause of illness
Conflict, shame, or disharmony in life; punishment from God, spirits, and demons
Traditional healers
Root doctor and folk practitioners
Method of treatment
Restore harmony, prayer and meditation, herbs, roots, and charms
Response to pain
Tolerating pain is a sign of strength
Amish
No infant baptism (usually happens between the ages of 16-25)
Many give birth at home- birth control is not forbidden but usually not used since large families are a gift from God.
No last rites, body may be embalmed, buried in a plain coffin in a grave dug by hand, cremation is not used, organ donation is allowed
Believe in living a simple life in harmony with nature- important to keep body pure and spotless, do not buy health insurance– church establishes a mutual aid fund
Accepts blood transfusions, surgery, and chemo, may not use prescription and instead rely on herbal remedies
Asian
Health concepts
Health is a state of physical and spiritual harmony with nature, balance of two energy forces: Yin (cold) and Yang(hot)
Causes of illness
Imbalance between yin and yang, supernatural forces such as God or evil spirits, and an unhealthy environment
Traditional healers
Herbalist, physician, and shaman healer
Methods of treatment
Cold remedies, herbal remedies, acupuncture and acupressure, and energy restore of the yin and yang
Response to pain
Pain must be accepted and endured silently, displaying it in public brings disgrace– may refuse pain medication
Europeans
Health concepts
Health can be maintained by rest, diet, and exercise,
immunizations and preventive practices- good health is personal responsibility
Causes of illness
Outside source like germs, pollutants or punishment for sins, lack of cleanliness or self abuse.
Traditional healers
Nurse and doctor
Methods of treatment
Medications, surgery, prayers, religious rituals, diet and exercise, and home remedies
Response to pain
Some express themselves loudly, others value self control; pain can be helped by medications
Hispanic
Health concept
Health is a reward from God, health is good luck, balance between hot and cold.
Causes of illness
Punishment from God, susto (fright), malojo (evil eye), or envidia (envy)
Traditional healers
Native healers, spiritualist, and herbalist
Methods of treatment
Hot and cold remedies to restore balance, prayers, medals, candles, herbal remedies, massage, and wearing an azabache (black stone) to ward off the veil eye
Response to pain
Many will express pain verbally and accept treatment, others feel pain is a part of life and must be endured.
Middle Eastern
Health concepts
Health is caused by spiritual forces, cleanliness is essential for health, male individuals dominate and make decisions on health care
Cause of illness
Spiritual causes, punishment for sins, evil spirits, or evil eye
Traditional healers
Traditional healers and physicians
Methods of treatment
Medication, charms and amulets, surgery, meditation, and male health professionals cannot touch or examine a female patient
Response to pain
Tolerating pain is a sign of strength, self inflicted pain is used as a sign of grief
Native American
Health concepts
Health is harmony between man and nature, balance among mind, body, spirit, spiritual powers control body’s harmony
Causes of illness
Supernatural forces and evil spirits, violation of taboo, imbalance between man and nature
Traditional healers
Shaman and medicine man
Methods of treatment
Rituals, charms, masks, prayer and meditation to restore harmony, plants and herbs, and medicine bag
Response to pain
Pain is a normal part of life and tolerance signifies strength and power
Spirituality
The beliefs individuals have about themselves, their connections with others, and their relationship with a higher power, can also mean an individual trying to find the meaning to their life
Religion is an organized system of beliefs in a superhuman power or higher power
Atheist
A person who does not believe in any deity
Agnostic
An individual who believes that the existence of God cannot be proved or disproved
Islam (Muslim)
Believes that first words an infant should hear at birth are “There is no God but Allah and Mohammed is His prophet.”
Abortion not permitted after 120 days and the father must give permission if done before
Family must be with the dying person and the dying person must confess sins and ask forgiveness
Only family touches and cleans the body after dying and then the body is turned towards Mecca
Cremation not permitted
Illness is an atonement for sins. Face Mecca 5 times a day, there is a ritual washing before and after prayer, and they need to take medication with their right hand because the left hand is considered dirty
Holy day of worship is the sunset of Thursday to Friday
Oran is holy book of Islam
Fasts during daylight hours on month of Ramadan
May wear items with words from Koran on the arm, neck, or waist– do not allow them to get wet
Hinduism
Beliefs about birth
Abortion can only be performed to save the life of the mother :
No ritual at birth, the naming ceremony is performed 10-11 days after birth to obtain blessings from gods and goddesses
Belief about death
Believe in reincarnation as humans, animals, or even plants, ultimate goal is freedom from the cycle of death and rebirth, priest ties thread around the neck or wrist of the deceased and may pour water in the mouth. Only family and friends may touch and wash the body.
Vedas (four books) are the sacred scripture
Will accept most medical procedures
Karma is determined by the accumulation of merits and demerits that results from all actions the soul has committed from past lives
Cows are sacred and feeding a cow is an act of worship
Christian Scientist
Abortions discouraged but regarded as an individual’s decision, same as birth control
No last rites and autopsy only when required by law
Organ donation discouraged but individuals decision
Cremation acceptable
May refuse blood transfusions, may NOT use medicine or surgical procedures, most will accept legally mandated immunizations
Bible is the holy book, rite of communion, prayer and faith will maintain health and prevent disease
Science and Health by Mary Baker Eddy is basic textbook for CS
Even though a religion may establish certain beliefs and rituals, it is important to understand that not everyone follows all of the beliefs or rituals of their own religion.
Monotheists
Believe in the existence of one God, a characteristic of Judaism, Christianity, and the Islamic religion
Polytheists
Worship and believe in many Gods, like the Chinese folk religion, Hinduism, and some believer of Buddhism
Examples of questions that can be asked:
Do you have a religious affiliation?
Are there spiritual practices that help you feel better?
Would you like a visit from a representative of your religion?
Do you wear clothing or jewelry with a religious significance?
Do you have religious objects that require a special care?
Do you prefer certain types of foods?
Should your food be prepared in a certain way?
Do you fast or abstain from eating certain foods?
Religion
Acculturation
Process of learning the beliefs and behaviors of a dominant culture and assuming some of the characteristics
Occurs slowly over a long period, usually many years
1st generation likely to use language of the country came from.
2nd-3rd generation would use English as main language
Every individual has unique blend of characteristics and as a healthcare workers it is important to remember these factors and also that not everyone is 100% anything
Need to develop sensitivity to differences
Sensitivity is the ability recognize and appreciate the personal characteristics of others
Example- For Native Americans or Asians- calling an adult by first name is not acceptable except for close friends and relatives
Bias
A preference or inclination that inhibits impartial judgment
People who have a bias may antagonize and alienate people from other cultures
Individuals who believe in the supremacy of their own ethnic group (ethnocentric). These people also believe their cultural values are better than everyone else.
Common biases can include:
Age- Young people are physically and mentally superior to older people
Education- College-educated individuals are superior to uneducated individuals
Economic- Rich people are superior to poor people
Physical size- Obese and short people are inferior
Occupation- Nurses are inferior to doctors
Sexual preference- Homosexuals are inferior to heterosexuals
Gender- Women are inferior to men
Prejudice
A strong feelings or beliefs about a person or subject; pre-judging others without reviewing facts or information; often based on fear
They regard their ideas or behavior as right and others as wrong
Every person is prejudice to some degree (we all want to feel that our beliefs are correct)
Stereotyping
Making the assumption that everyone in a group is the same
Ignore individual characteristics and labels an individual
All blondes are dumb
Bias, prejudices, and stereotyping are barriers to effective relationships with others. You need to be on alert to these and make every effort to avoid them
Health care workers need to avoid feelings and assumptions
Ways to avoid bias, prejudice, and stereotyping
Know and be consciously aware of your own personal and professional beliefs
Obtain as much information as possible about different ethnic/cultural beliefs
Be sensitive to behaviors and practices different then your own.
Remember you are not being pressured to adopt other beliefs, but you must respect them
Develop friendships with a wide variety of people from different groups
Ask questions and encourage questions from others to share ideas and beliefs
Evaluate all information before you form an opinion
Be open to differences
Avoid jokes that may offend
Remember that mistakes happen. Apologize and forgive
