Angie Guggino, MS, ATC, LAT Cultural Diversity Angie Guggino, MS, ATC, LAT

Learning Target How culture affects healthcare.

Answer the following List the experiences common to most cultural groups. What does it mean to prejudge? How can prejudices be overcome? What is the difference between cultural assimilation and acculturation?

You can’t pick the people you treat. Must work with and provide care to a variety of people Factors that cause each individual to be unique: Physical characteristics Family life Socioeconomic status Religious beliefs Geographical location Education Occupation Life experiences One major influence is the person’s cultural/ethnic heritage

What is culture? Values, beliefs, attitudes, languages, symbols, rituals, behaviors, and customs unique to a particular group of people and passed on from generation to generation Childrearing Education Occupational choice Social interactions Spiritual beliefs Healthcare choices

Characteristics of Culture Learned Shared Social Dynamic and constantly changing

What is ethnicity? Classification of people based on national origin and/or culture May share common heritage, geographic location, social customs, language and beliefs African American Asian American European American Hispanic American Middle Eastern American Native American

What is race? Classification of people based on physical or biological characteristics such as color of skin, hair, eye color, bone structure, blood type, and facial features In reality, it is the values, beliefs, and behaviors learned from the ethnic group that accounts for behaviors attributed to race.

What is cultural diversity? Differences based on cultural, ethnic, and racial factors Influence an individual’s behavior, self-perception, judgment of others, and interpersonal relationships Differences exist within all ethnic/cultural groups and within the people that make up those groups

“Salad Bowl” vs. “Melting Pot” Assimilation Acculturation Requires a newly arrived cultural group to alter unique beliefs and behavior adopting the ways of the dominant culture The process of integration of members of an ethno-cultural group into an established community Process of learning the beliefs and behavior of a dominant culture and assuming some of the characteristics The original cultural patterns of either or both groups may be altered, but the groups remain distinct

Sensitivity Healthcare workers must be able to recognize and appreciate the personal characteristics of others Example: Calling an adult by their first name, in some cultures, is not acceptable except for family members

What is a bias? Preference that inhibits impartial judgment Age Education Economic Physical size Occupation Sexual preference Gender

What is prejudice? Pre-judge Strong feeling or belief about a person or subject that is formed without review facts or information Age Nationality Physical differences Religious differences Race

What is stereotyping? An assumption is made that everyone in a particular group is the same

Avoiding bias, prejudice, and stereotyping Be aware of you own personal and professional beliefs Learn about the other cultural groups Be sensitive to behaviors different from yours You don’t have to adopt other beliefs, just respect them Develop relationships with people from other cultures Ask questions and encourage questions Evaluate all information before you form an opinion Be open to differences Avoid offensive jokes Mistakes happen, apologize of you hurt another person

Are we born bias? Video

Family organization Refers to the structure of a family and dominant decision-making person in the family

Family organization Nuclear family Extended family Consists of mother, father, and children May also consist of a single parent and children Includes nuclear family plus grandparents, aunts, uncles and cousins.

What type of family do you have? patriarchal matriarchal Father or oldest male is the authority figure Dominant male makes decisions regarding healthcare The mother or oldest female is the authority figure

Personal Touch and Space Close-Contact Distant-Contact Greeting by kissing on both cheeks Hispanic French Mediterranean Africa Greet by handshake or gesture Close family members hug United States Asian Middle Eastern Canada

Gestures Used to communicate many things Nodding for “yes” and side-to-side for “no” In some countries, nodding and shaking head mean the opposite Pointing is used to stress a specific idea Pointing in Asian and Native American cultures represents a strong threat

Eye Contact Many feel eye contact during a conversation shows interest and trustworthiness Some culture consider eye contact to be rude and is avoided as a form of respect Native Americans may use peripheral eye contact instead of direct eye contact Direct Stares can be considered a hostile act in some cultures

Language Differences Speak clearly Speak so that they can hear easily Do not raise your voice or yell Speak in moderate tones Pronounce the entire word Summarize often and confirm understanding Clarify when necessary and do not assume they understand

Health Care Beliefs The most common health care system in the U.S. is based on “Western” system bases for disease is due to microorganisms, diseased cells and aging. Healthcare is directed toward eliminating the cause. Folk medicine is a collection of traditional beliefs and customs for treating pain or illness Natural materials like herbs, spices, and rituals Beliefs about a health care system vary among cultures, so patients regard healthcare differently Every culture has a system for health care based on values & beliefs that have existed for generations

Examples of Folk Medicine (pages 195-197) Asians Think health is a balance of yin and yang Pain must be endured silently Chinese Use cupping with heated bamboo Europeans Focus on treating illness with medication, surgery, diet, and exercise Hispanics Use heat and cold remedies to restore balance, belief health is reward from God Middle Eastern Believe in spiritual causes of illness such as the “evil eye”. Native American Some use a healer/shaman, believe health is harmony with nature, tolerance of pain signifies power and strength

Spirituality and Religion Beliefs individuals have about themselves, their connections with other, and their relationship with a higher power Need to find meaning and purpose in life An organized system of belief in a superhuman power or higher power

Atheist and Agnostic Atheist Agnostic Person who does not believe in any deity Individual who believes that the existence of God cannot be proved or disproved

Religion and Healthcare

Judaism Blood and blood products acceptable May wish major amputated limb to be buried in consecrated ground Consult Rabbi with issues of tube feeding and life support

Christian Science Believed to be the result of disharmony between mind and matter Belief that healing occurs when one draws closer to God and experiences moral and spiritual change Not completely opposed to medical treatment but may be fearful of being forced to accept unwanted treatments which violate individual personal beliefs Most do not donate body or organs

Jehovah’s Witness Likely to be strongly opposed to blood transfusion Medications from blood products may not be acceptable Use of extraordinary means to prolong life or right to die is individual choice

Mormon Faith healing (faith in Jesus Christ and power of priesthood to heal) and medical care/treatment used together No restrictions on blood, blood products or medications

Protestant In most denominations, decisions about blood, blood products, vaccines, biopsies, amputations and transplants are individual choice Prayer, anointing, Eucharist or other rituals may be important

Roman Catholicism Blood and blood products acceptable May wish major amputated limb to be buried in consecrated ground Sacrament of the Sick (anointing by a priest) may be very important May believe suffering is part of one’s fate or punishment from God

Seventh-day Adventist Believe healing can be accomplished both through medical intervention and divine healing Chaplains and physicians are inseparable Emphasize physical medicine, rehabilitation and therapeutic diets No restrictions on medications, blood or blood products or vaccines May not condone use of narcotics or stimulants No restrictions on surgical procedures although some may refuse interventions on Friday evening and Saturday Sabbath

Islam (Muslim) No restrictions on blood or blood products, medications, amputations, organ transplants, or biopsies Most surgical procedures permitted Doctors are seen as helpers of God’s will Abortion is prohibited except in cases of rape, incest and if the life of the mother is threatened. A fetus is considered a human being after 25-week gestation.

Buddhism Illness is a result of karma (law of cause and effect), therefore an inevitable consequence of actions in this or a previous life Health is holistic (connect between mind and body); mental cures are important. Healing and recovery promoted by awakening to wisdom of Buddha, which is spiritual peace and freedom from anxiety Do not believe in healing through faith No restrictions on blood or blood products, surgical procedures, organ donation, autopsy Medications acceptable if in great discomfort as long as they do not affect state of mind

Native American Spirituality Health care practices intertwined with religious and cultural beliefs May believe that ill health results from not living in harmony or being out of balance with nature and social and supernatural environments

Respecting Diversity Key is to regard each person as a unique individual Every individual adopts beliefs and forms patterns of behavior based on culture, ethnicity, race, life experiences, spirituality and religion Beliefs may change based on new exposures and experiences Must be aware of the needs of each individual in order to provide care

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