CHAPTER 5 CULTURE AND HEALTH CARE Acculturation Cultural competence Culture Ethnocentrism Ethnography Stereotyping Assimilation Journal question: How is one’s culture expressed?

Chapter 5 Learning Objectives Spell and define the key terms. Discuss eight specific examples of how cultural differences affect patient care. List at least three culturally sensitive questions for patient care. Explain why each may be sensitive in a patient’s culture.

Chapter 5 Learning Objectives Describe at least five guidelines to follow when using an interpreter. Describe five signs that may indicate a cultural barrier exists. List seven actions that can overcome cultural obstacles.

Culture Overview Importance of cultural values and connections on health care Patient’s culture Health care worker’s cultural background Culture Act of belonging to a designated group Colo, a Latin term that means “to cultivate” Effect is unconscious.

Many Aspects of Culture in Life Eating habits Language Dress Hobbies Living patterns Occupational choices Education Religious affiliations Political points Interpersonal relationships

Acculturation Learning cultural behaviors from one group or person Evolves slowly Always occurring Subcultures within each large cultural group Can be broad and varied United States Census Bureau Collects data on U.S. population every 10 years

Ethnic Groups in the United States

Ethnography Branch of anthropology Studies and records human cultures Ethnographic studies provide information to teach cultural competence

Cultural Impact on Health Care Every interaction with a patient has cultural implications.

Culturally Sensitive Questions

Wellness and Health Prevention Various cultures have different views on preventive medicine. Exercise Preventive doctor visits Immunizations

Touch and Physical Space Different views on close touching and human contact A health care worker must Always ask permission before touching any patient, regardless of cultural differences Be alert to positive or negative signs Discuss with students the positive and negative signs to be aware of when greeting patients. Use the class activity in the Lesson Plans for Chapter 5 associated with this discussion.

Communication Vital to our survival Language Assimilation Language barriers affect communication. Language is a form of cultural connection. Assimilation Process of accepting and exchanging cultural information Ask the students to give examples of ways to overcome communication barriers in a health care setting. Students can role-play situations as an activity.

General and Invasive Procedures The health care worker must be sensitive to patients who are not comfortable in removing clothing for examinations or who fear invasive procedures. All health care team members should announce their arrival and wait a few moments before entering a room. Discuss ways the health care worker can be compassionate toward a patient who is not comfortable in removing their clothing for an examination.

Dietary Needs Food is a social tool and biologic need. Food has many ethical and religious implications. All attempts should be made to meet the patient’s nutritional needs and preferences. Explain the term social tool as related to food.

Yin and Yang Foods Discuss the foods on the list of Yin and Yang foods. Ask students how the balance of Yin and Yang foods can be essential for good health.

Spirituality Beliefs are essential for recovery and strength for many ethnicities. Belief should be accepted and assistance offered when requested. Using incorrect terminology is a sign of great disrespect. Emphasize that the spiritual component is essential for recovery and strength for many ethnic groups. Stress the importance of respect for the person’s beliefs. Remind the student to always use the correct terminology when referring to a clergyman. When not obvious which term to use, remind the students that they can use generic terms such as spiritual leader or clergyman.

Death Views about death vary greatly. Many types of rituals are used. Deaths from suicide have many cultural implications. Remind students to be respectful and good listeners when dealing with family members of a person who has died.

Medications Actions and side effects vary according to patient ethnicity U.S. Food and Drug Administration (FDA) and Institute for Safe Medication Practices (ISMP) studies Antilipemic drugs BiDil Drug dosage Describe the potential side effects of some antilipemic drugs on specific ethnic groups. Antilipemic drugs are used to lower cholesterol and have an increased potential to cause serious muscle condition (rhabdomyolysis) when given to patients with Japanese or Chinese ethnicity. Describe and explain the drug combination BiDil that was approved to specifically treat congestive health failure in black patients – first drug targeted to one ethnic group.

Pregnancy Discuss the beliefs about pregnancy and childbearing listed.

Pain Management Beliefs about pain vary Important for the health care worker to use listening and assessment skills to look for nonverbal cues of pain Discuss the terms stoic and emotive and how they relate to pain management in different cultures.

Other Cultural Differences with an Impact on Health Care Refusal to give blood or get blood transfusions Refusal to donate or receive organ transplants Refusal to place aging parents into nursing home Fertility control Mental illnesses

Interpreters and Translation Some health care facilities provide interpreters to translate instructions for patients. In some cultures, it is important to have a member of the same sex as an interpreter. Interpreter should respect confidentiality of the patient’s information. Interpreter may be more objective than a family member or friend. Emphasize the importance of the health care worker providing clear instructions and speaking in simple language to make sure the patient understands.

Guidelines for Using an Interpreter

Signs of Cultural Barriers Important to listen to the patient closely and look for nonverbal cues Signs that cultural barriers exist Resistant to change Uncooperative Argumentative Overly agreeable and flaccid Noncompliant after multiple teaching attempts Have student role-play the verbal and nonverbal cues for signs of cultural barriers in communicating with a health care worker.

Obstacles to Cultural Competence Ethnocentrism Belief that one’s own culture is superior to another Often unconscious Seen in many daily activities Health care provider cannot allow this belief to interfere with providing care.

Obstacles to Cultural Competence Stereotyping Seeing or viewing all patients in one ethnic group molded together as one (assumes conformity) Patients need to feel trusted and safe. Prejudice and discrimination Stereotyping can lead to prejudice, which leads to discrimination. All health care providers must agree to care for patients regardless of race, age, color, sex or ethnic origin. Ask the students to give examples of stereotyping. Initiate a discussion about how students might have been stereotyped. Solicit examples of how certain cultures are stereotyped.

Overcoming Obstacles Explore personal ideas and perceptions about different cultures. Learn as much as you can about local cultures. Always use the patient’s family name unless given permission to use first name only. Be aware of eye contact.

Overcoming Obstacles Encourage patients to talk about their illnesses and look for areas of misunderstanding. Look for confusion and fear. Treat all patients with respect, concern, and compassion. Recognize that other cultures are not as time sensitive as Americans. Respect spirituality.

Summary Cultural differences can have an effect on health care. Differences in beliefs regarding preventive measures, preferences in close touching and physical space, and communication Different opinions regarding general procedures (e.g., blood draws, undressing), dietary practices, spiritual beliefs, views on death, beliefs about medications, beliefs about pregnancy and childbearing, and beliefs about pain.

Summary Cultural barriers may exist if the patient is resistant to change or appears uncooperative or argumentative, overly agreeable, or noncompliant after multiple teaching attempts.

Summary Although cultural heritage and beliefs are always present, the health care provider cannot allow stereotyping, prejudice, or discrimination to interfere with providing care. There are many methods to help the provider to overcome cultural obstacles.

Summary Examples of culturally sensitive questions Asking the patient if there is someone else who should help, because he or she may want a priest, rabbi, shaman, family member, or some other person to participate in the care Asking the patient if someone else has the same problem to allow the patient to “tell as a story” if preferred Asking the patient what treatment causes fear to allow the patient to describe concerns about care

Review Question Stereotyping can lead to all of the following except: a. Acceptance b. Discrimination c. Alienation d. Prejudice e. Lack of trust and respect

Review Question Stereotyping can lead to all of the following except: a. Acceptance b. Discrimination c. Alienation d. Prejudice e. Lack of trust and respect

Review Question Which cultural group prefers to eat foods that are indigenous? a. Muslim b. American Indian c. Asian d. Hispanic

Review Question Which cultural group prefers to eat foods that are indigenous? a. Muslim b. American Indian c. Asian d. Hispanic