Chapter 8 Cultural Influences on Context: The Health Care Setting

 The goal of any health-care system is to provide optimal care for all its clients.  The influx of immigrants from different ethnic and racial origins can make it difficult for care providers to provide safe and effective care.  Misunderstandings from ineffective communication may cause needless suffering.

 The American Medical Association now trains physicians in intercultural sensitivity.  Cross-cultural health care requires a complex combination of: knowledge, attitude and skill (competence).

Worldview and Healthcare Religion is not the only worldview that influences health and illness. Dualistic or holistic worldviews and mechanistic or nonmechanistic worldviews also determine how cultures perceive everything.

Dualism – people and nature are separate and distinct entities; emphasis on medical intervention that is carried out by doctors, nurses, and other health practitioners. Found in Western religions: Judaism, Christianity, & Islam. Holistic – sees the world as a unit; unifies body, mind, and spirit; the person’s entire body must be part of the healing process. Found in most Eastern cultures.

Mechanistic – common in the U. S Mechanistic – common in the U.S.; thought patterns are rational rather than mystic; the individual can manipulate the universe; one need not accept things as they are; they may work on it or redesign it so that it is more to their liking. Nonmechanistic – common in India, Tibet, Japan, China and Southeast Asia; exemplified by spiritual traditions such as Buddhism, Hinduism, Taoism and Zen. Intuition transcends the data of the senses; the manipulation of the mind is key to obtaining truths that lie beyond reason.

Health Care Belief Systems Biomedical System – follows from dualistic and mechanistic views; the dominant belief system in the U.S.; focuses on the objective diagnosis and scientific explanation of disease; illness is the result of abnormalities in the body’s functioning or structure (from bacteria and viruses.)

Personalistic System - disease is the result of intervention by a supernatural being (deity or god), a nonhuman being (ghost or evil spirit), or a human (witch or sorcerer). The person is a victim of punishment; treatment involves assuring positive association with spirits & deities.

Naturalistic System - tend to be nonmechanistic; explain illness as the result of natural conditions of cold, heat, winds, dampness and the upset in balance of the basic elements; disease can result from disequilibrium between hot & cold elements of the body. Found in Vietnamese cultures.

Cultural Diversity & the Causes of Illness See p. 261 Cultural Diversity & the Treatment of Illness Biomedical Treatments Personalistic Treatments Naturalistic Treatments Cultural Diversity & the Prevention of Illness See p. 264-265

Religion, Spirituality, & Health Care p Religion, Spirituality, & Health Care p.266 Spirituality includes all behaviors that give meaning to life and provide strength to the individual Religion & spirituality have a strong influence on the way people define illness and choose to prevent it. Religion has a strong influence over & shapes nutrition practices & health care practices.

Health Care For a Diverse Population In health care, culture intervenes at every step of the way. Family Roles Dominance Patterns – many cultures make distinctions between what is appropriate behavior for men and women. Modesty and Female Purity Pregnancy and Childbirth

• Self-Disclosure • Nonverbal Messages Eye Contact Facial Expressions Touch/haptics – some cultures are not accustomed to being touched by their physicians or nurses. Time/chronemics – a patient’s time orientation may affect when or whether he/ she shows up for appointments. • Formality

Improving Multicultural Health Care – the hospital can be disorienting and frightening to people of different cultures; successful treatment of patients requires that their beliefs concerning the causes of illness, how illness should be treated, and how it can be prevented in the future must be acknowledged.

Recognizing Diverse Medical Systems the ability to be sensitive to a patient’s beliefs requires a great deal of information: cultural knowledge, communication patterns, particular knowledge of the individual; how westernized is the patient?

Recognizing Ethnocentrism – there is no one answer to all health care questions; your ethnocentrism must be kept in check. Ask yourself: Am I imposing my own views about illness and treatment on other people without considering their needs?

Point: Cultures differ in: • their understanding of what causes illness • how illness should be treated • how illness can be prevented