Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Chapter 2 Cultural Competency Copyright © 2015 by Mosby, an imprint of Elsevier Inc.

"It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change."--Charles Darwin

Cultural Competence To be culturally aware is to understand those aspects of the human condition that differentiate individuals and groups and that sometimes have an overpowering effect on their health and medical care. Understanding of a particular culture may be useful in the solution of problems that may at first have seemed intractable. 3

A Definition of Culture Culture in the broadest sense reflects the whole of human behavior, including: Ideas and attitudes Ways of relating to each other Manners of speaking Material products of physical effort, ingenuity, and imagination 4

Culture "Culture” includes: Language Beliefs Morals Education Sets of dynamically evolving shared traits 5

Physical Characteristics The use of physical characteristics (e.g., gender or skin color) to distinguish a cultural group can be a trap. There is a sharp difference between distinguishing cultural characteristics and distinguishing physical characteristics. 6

Ways to Develop Cultural Competence Be willing to modify care in keeping with patient’s culture. Do not expect all members of a culture to behave the same. Appreciate that cultural values are ingrained and are hard to change. Recognize that cultural diversity exists. Demonstrate respect. Examine own cultural beliefs. Recognize that cultural definitions of health and illness differ. 7

Impact of Culture Influences on the way patients seek medical care and the way clinicians provide care include: Age Gender Race Ethnic group Cultural attitudes Regional differences Socioeconomic status 8

Impact of Culture (Cont.) Poverty and inadequate education disproportionately affect various cultural groups. Ethnic minorities and women Socioeconomic disparities negatively impact the health and medical care of individuals belonging to these groups. 9

A Lexicon of Cultural Understanding Acculturation Process of accommodating to another culture Culture Integrated system of shared values Custom Habitual activity of a group or subgroup Enculturation Process of assuming the traits and behaviors of a given culture Ethnocentrism Belief in the superiority of one’s own culture with disdain for others 10

A Lexicon of Cultural Understanding (Cont.) Ethnos (ethnic group) Group of same race or nationality with a common culture and traits Minority Group differentiated from the majority population with regard to religion, race, or ethnic origin Norm Prescribed standard of allowable behavior within a group Race Physical differentiator based on a common heredity Rite Prescribed, formal, customary observance 11

A Lexicon of Cultural Understanding (Cont.) Ritual Stereotypical behavior regulating religious, social, and professional behaviors Stereotype Simplified, inflexible conception of the members of a group Subculture Subgroup having distinctive traits that differentiate it from the larger culture Values Ideals, customs, institutions, and behaviors within a group for which the members have a respectful regard 12

Primacy of the Individual in Health Care Predicting an individual patient's character merely on the basis of common cultural traits is not appropriate. Cultural attitudes may constrain professional behavior and confuse the context in which the patient is served. The individual is unique. 13

Cultural Assessment Guide: The Many Aspects of Understanding Health beliefs and practices Faith-based influences and special rituals Language and communication Parenting styles and role of family Sources of support beyond family Dietary practices 14

Health Beliefs and Practices Patient view of health and illness Attitudes about pain, illness, death, handicap Hygiene practices Common treatments of illness Use of prevention measures Preference of health professionals 15

Faith-Based Influences and Special Rituals Religion to which patient adheres Special religious practices and beliefs that affect health care when patient is ill or dying 16

Language and Communication Primary language, secondary language Command of English, literacy Special signs that demonstrate respect or disrespect Role of touch in communication 17

Dietary Practices Culturally forbidden or required foods Foods used in rites or ceremonies, fasting Food beliefs (e.g., foods believed to cause or to cure illness) Periods of required fasting 18

Impact of Culture on Illness Disease is shaped by illness, and illness is shaped by the totality of the patient’s experience. Health care providers must consider the substance of illness―the biologic, emotional, and cultural aspects―or else fail to offer complete care. 19

Components of a Cultural Response Make sure you explore and understand the patient’s cultural beliefs and practices. Avoid making assumptions about cultural beliefs and behaviors without validation from the patient. Beliefs and behaviors that will have an impact on patient assessment include the following: Modes of communication Health beliefs and practices Nature of relationships within a family Diet and nutritional practices 20

Health Beliefs and Practices Patients have a view of health and illness, and an approach to cure shaped by a cultural paradigm. Patients with a “scientific view” are more comfortable with Western medical care. Patients with a “holistic” or natural approach may be at odds with Western medical care. 21

Family Relationships Family structure and the social organizations to which a patient belongs are among many imprinting and constraining cultural forces in a person’s life. One type of already known behavior may predict another type of behavior. 22

Diet and Nutritional Practices Beliefs and practices related to food, as well as the social significance of food, play a vital role in everyday life. Some of these beliefs of cultural and/or faith-based significance may have an impact on your care: Orthodox Jew Muslim Chinese Herbal, home, and natural therapies 23

Summing Up Meet patients on their own terms. Resist stereotyping. Understand yourself and your attitudes. Constrain your prejudices and tendencies to be judgmental. Take these steps to make strides toward cultural competence. 24