Introduction to Health Science 1.04 Diverse Patients

Cultural Diversity and Health Care

“America is a nation of nations, made up of people from every land, of every race and practicing faith. Our diversity is not a source of weakness; it is a source of strength, it is a source of our success.” U.S. Secretary of State Colin Powell “America is a nation of nations, made up of people from every land, of every race and practicing faith. Our diversity is not a source of weakness; it is a source of strength, it is a source of our success.” U.S. Secretary of State Colin Powell

What is Diversity? Diversity includes all of the different aspects of people including age, culture, race, physical ability, gender, and religion. Diversity includes all of the different aspects of people including age, culture, race, physical ability, gender, and religion.

What is Culture? Culture is how and where someone is raised. Culture is how and where someone is raised. Culture is prevalent in a community that shares beliefs, speech, rituals, etiquette, what is important, and common rules for how people should behave. Culture is prevalent in a community that shares beliefs, speech, rituals, etiquette, what is important, and common rules for how people should behave. Culture includes many things such as how people associate with one another, the way they act, the food that is eaten, dress, work habits, and what is deemed as important. Culture includes many things such as how people associate with one another, the way they act, the food that is eaten, dress, work habits, and what is deemed as important.

Cultural Diversity and Health Care We All Have It! We All Have It! Obvious Manifestations: Obvious Manifestations: – Religion – Ethnicity – National Origin (language) – Gender

Cultural Diversity and Health Care Less Obvious Manifestations: Less Obvious Manifestations: – Age – Education – Educational Status – Mobility (including handicaps)

What is Ethnicity? Ethnicity describes the birthplaces of people. Ethnicity describes the birthplaces of people. People of the same ethnicity experience similar patterns of behavior, manner of speech and traditions. People of the same ethnicity experience similar patterns of behavior, manner of speech and traditions. – Examples of ethnic classifications include African Americans, Asian Americans, European Americans, Hispanic Americans, Middle Eastern/Arabic Americans, Pacific Islanders, and Native Americans.

US POPULATION WHITE 63.7% WHITE 63.7% BLACK 12.2% BLACK 12.2% HISPANIC 16.3% HISPANIC 16.3% ASIAN 4.7% ASIAN 4.7% NATIVE AMERICAN 0.7% NATIVE AMERICAN 0.7% PROJECTED 2030 PROJECTED 2030 WHITE 60% WHITE 60% BLACK 13% BLACK 13% HISPANIC 19% HISPANIC 19% ASIAN 7% ASIAN 7% NATIVE AMERICAN 1% NATIVE AMERICAN 1%

Cultural Diversity and Health Care Expressions of Culture in Health Care Expressions of Culture in Health Care – Health Belief Systems Define and categorize health and illness Define and categorize health and illness Offer explanatory models for illness Offer explanatory models for illness Based upon theories of the relationship between cause and the nature of illness and treatments Based upon theories of the relationship between cause and the nature of illness and treatments Defines the specific “scope” of practice for healers Defines the specific “scope” of practice for healers

Cultural Competence Two approaches Two approaches – Knowledge – Relationship Attitude Attitude – Self awareness – Subjective perspective – Focus on patient

CULTURAL COMPETENCY Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or social groups. Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or social groups. Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.

WHY IS CULTURAL COMPETENCY IMPORTANT? When health care services are delivered without regard for cultural differences, patients are at risk for sub-optimal care. When health care services are delivered without regard for cultural differences, patients are at risk for sub-optimal care. Patients may be unable or unwilling to communicate their health care needs in a culturally insensitive environment, reducing the effectiveness of the health care process. Patients may be unable or unwilling to communicate their health care needs in a culturally insensitive environment, reducing the effectiveness of the health care process. Understanding the fundamental elements of culturally and linguistically appropriate services is necessary when striving for cultural competency in health care delivery. Understanding the fundamental elements of culturally and linguistically appropriate services is necessary when striving for cultural competency in health care delivery.

CULTURAL COMPENTENCY Four Rationales for Cultural Competency in Health Care Delivery Four Rationales for Cultural Competency in Health Care Delivery – To respond to demographic changes. – To eliminate disparities in the health status of people of diverse racial, ethnic, and cultural backgrounds. – To improve the quality of health care services and health outcomes. – To gain a competitive edge in the health care market and decrease the likelihood of liability/malpractice claims.

Something To Talk About Lia Lee was a three-month-old Hmong child with epilepsy. Her doctors prescribed a complex regimen of medication designed to control her seizures. However, her parents felt that the epilepsy was a result of Lia "losing her soul" and did not give her medication as indicated because of the complexity of the drug therapy and the adverse side effects. Instead, they did everything logical in terms of their Hmong beliefs to help her. They took her to a clan leader and shaman, sacrificed animals and bought expensive amulets to guide her soul's return. Lia's doctors felt her parents were endangering her life by not giving her the medication so they called Child Protective Services and Lia was placed in foster care. Lia was a victim of a misunderstanding between these two cultures that were both intent on saving her. The results were disastrous: a close family was separated and Hmong community faith in Western doctors was shaken.

A Hmong child was born with a clubfoot. Doctors felt that the foot would cause social embarrassment and make ambulation difficult and recommended an operation to reshape the foot. The family believed that the foot was a blessing, a reward for ancestral hardships. Because the family believed "fixing" the foot would bring shame and punishment to the family and Hmong community, they refused treatment. The family went to the Supreme Court to defend their right to refuse treatment. They won.15 A Hmong child was born with a clubfoot. Doctors felt that the foot would cause social embarrassment and make ambulation difficult and recommended an operation to reshape the foot. The family believed that the foot was a blessing, a reward for ancestral hardships. Because the family believed "fixing" the foot would bring shame and punishment to the family and Hmong community, they refused treatment. The family went to the Supreme Court to defend their right to refuse treatment. They won.15 What do you think should have happened in the court case? Why? What do you think should have happened in the court case? Why? In this case, the operation did not involve life or death. But what if it had? In this case, the operation did not involve life or death. But what if it had?

Mrs. Lee was a 49-year-old Cantonese-speaking woman who had immigrated years ago from China to the U.S. She lived with her husband and youngest son, Arnold, 22. Studies revealed that Mrs. Lee suffered from lung cancer that had metastasized to her lymph nodes and adrenal glands. Arnold did not want Mrs. Lee's diagnosis known to her. Eventually, the cancer spread to her brain. Her physician, knowing her poor prognosis, suggested a DNR to her son, who refused to even discuss the possibility with his mother. Arnold felt that his role as son and family member meant he must protect his mother from "bad news" and loss of hope. He believed telling her the dim prognosis would be cruel and cause unnecessary stress. Though futile, the son insisted that all heroic methods be used, including a ventilator, to save his mother's life. He accused the house staff and physician of racism and threatened litigation. As a family member, he considered himself, not the doctors or patient, responsible for his mother's treatment. He felt an overwhelming family responsibility to save his mother from such an early and "bad death" as well as from perceived inadequate treatment.

Cultural Diversity and Health Care It is because we are different that each of us is special.