1. Cultural Diversity and Health Care

4.  What is Culture? Definition: the sum total of the way of living; includes values, beliefs, standards, language, thinking patterns, behavioral norms, communications styles, etc. Guides decisions and actions of a group through time.

5.  Health, healing and wellness belief systems  Illness, disease and how causes are perceived  How health care treatment is sought and attitudes toward providers, impacting treatment  Delivery of health care services by providers who may compromise access for patients from other cultures do to a lack of diagnosis Culture and Language May Influence

6. Cultural Diversity and Health Care  The Culture of Western Medicine  Meliorism – make it better  Dominance over nature – take control  Activism – do something  Timeliness – sooner than later  Therapeutic aggressiveness – stronger=better  Future orientation – plan, newer=better  Standardization – treat similar the same

7.  Preventative care may not be practiced  Illness is God’s will and recovery is in His hands  Hot (diabetes, pregnancy, etc.) and Cold (pneumonia, colic, etc.) Principles apply  Expressiveness of pain is culturally acceptable  Family may not want terminally ill told as it prevents enjoyment of life left  Overweight may be seen as healthy/good well being  Diet is high in salt, sugar, starches and fat  High respect for authority and the elderly  Provide same sex caregivers if at all possible Hispanic Historical Cultural Health Beliefs and Practices

8.  Chinese, Filipino, Vietnamese, Korean, Japanese, Indian Asian  Traditional Asian definition of causes of illness is based on harmony expressed as a balance of hot and cold states or elements  Practices: ◦ Coining – coin dipped in mentholated oil is rubbed across skin – release excess force from the body ◦ Cupping – heated glasses placed on skin to draw out bad force ◦ Steaming, Herbs, Chinese Medical Practices – acupuncture  Norms about touch… head is highest part of body and should not be touched  Modesty highly valued  Communication based on respect, familiarity is unacceptable The Asian American Historical Beliefs

9.  Health encompasses three governing principles in the body: ◦ Vata – energy and creativity ◦ Pitta – optimal digestion ◦ Kapha – strength, stamina and immunity  Herbal Medicines and treatments may be used  Modesty and personal hygiene are highly valued.  Right hand is believed to be clean (religious books and eating utensils): left hand dirty (handling genitals)  Stoic/value self control; observe non verbal behavior for pain  Husband primary decision maker and spokesman for family  http://www.indiaoz.com.au/health/ayurveda/bodytype.shtml Asian Indian Historical Beliefs

10. TraditionalistBaby BoomerGeneration XMillennial 1922 –19451943 –19651963 – 19821978 – 2002 Greatest Generation Matures Silent Generation Veterans Boomers Baby Bust Gen X Xers Digital Generation Echo Boomers Generation E Generation Y Nexters N-Gens Net Generation Source: Generational Differences in the Workplace by Anick Tolbize, August 16, 2008 10 Ascribed Characteristics of 4 Generations

11. Traditionalist Baby Boomer Generation X Generation Y/ Millennial OutlookPracticalOptimisticSkepticalHopeful Work EthicDedicatedDrivenBalancedAmbitious View of Authority RespectfulLove/HateUnimpressedRelaxed, Polite Decision- making HierarchyConsensusCompetenceCollaboration RelationshipsSelf-sacrificeSelf- gratification NoncommittalLoyal, inclusive PerspectiveCivic-mindedTeam-orientedSelf-ReliantCivic-minded Turn-OffsVulgarityPolitical Incorrectness Clichés, HypeCynicism, Condescending Adapted from Talent Strategies Update: International Association for Corporate & Professional Recruitment, 2011-01. 11 Generational Differences

12.  Young people have an attitude problem  Want everything on their own terms  Don’t understand “paying dues” concept  Want expensive training right away  Work minimum hours and then go home  Have short attention span  I am doing more parenting than managing  They dress too casually for the workplace Traditionalist/Baby Boomer Perspectives

13.  I don’t like being stuck in a cubicle with nothing to do  Supervisor has hardly any contact with me  My skills have not been tested  I don’t want to be locked in a dead-end job  Nobody asks for my opinion  Nobody recognizes my contributions Generation X & Y Perspectives

14. Xers: Fall of Berlin Wall Watergate Women’s Liberation Desert Storm Energy Crisis AIDS Identified Schoolhouse Rock, Sanford and Son Single Parents Cell Phones/Real Computers Both parents working Millenials: School shootings Oklahoma City, Columbine Everyone Knows (Facebook) Child focused world Multicultural Techno Savvy, Smart Phones/IPAD Iraq/Afghanistan Everyone Hates Chris Reality Shows, Dancing with the Stars, Lost, American Idol Video Gamers Expectations for Telework Events and Experiences

15. Cultural Diversity and Health Care  Cultural Competence – Definition A set of congruent behaviors, practices, attitudes and policies that come together in a system or agency or among professionals, enabling effective work to be done in cross-cultural situations

16. The Cultural Competence Continuum

17. Cultural Diversity and Health Care  Cultural Competence Definitions  Cultural Destructiveness: forced assimilation, subjugation, rights and privileges for dominant groups only  Cultural Incapacity: racism, maintain stereotypes, unfair hiring practices  Cultural Blindness: differences ignored, “treat everyone the same”, only meet needs of dominant groups

18. Cultural Diversity and Health Care  Cultural Competence Definitions Cultural Pre-competence: explore cultural issues, are committed, assess needs of organization and individuals Cultural Competence: recognize individual and cultural differences, seek advice from diverse groups, hire culturally unbiased staff Cultural proficiency: implement changes to improve services based upon cultural needs, do research and teach

19. The LEARN Model Berlin and Fowkes Listen to the patient’s perception of the problem Explain your perception of the problem Acknowledge and discuss differences/similarities Recommend treatment Negotiate treatment

20. Working with Interpreters

21.  Translation factors  Language: how are new words created?  Navajo: Penicillin = “the strong white medicine shot you get for a cold”  Minimize jargon, e.g., “machine to look at your heart” instead of “EKG”  Nonverbal communication = 60% of all communication  Nodding may indicate politeness, not comprehension  Bilingual interviewing takes at least twice as long as monolingual interviews!

22. Caretakers’ Responsibilities  When speaking or listening, watch the patient, not the interpreter. Add your gestures, etc. while the interpreter is translating your message.  Reinforce verbal interaction with visual aids and materials written in the client’s language.  Repeat important information more than once. (continued on next page)

23. Caretakers’ Responsibilities  Always give the reason or purpose for a treatment or prescription.  Make sure the patient understands by having them explain it themselves.  Ask the interpreter to repeat exactly what was said.  Personal information may be closely guarded and difficult to obtain.  Patient often request or bring a specific interpreter to the clinic. (continued on next page)

24. Caretakers’ Responsibilities  In some cultures it may not be appropriate to suggest making a will for dying patients or patients with terminal illnesses; this is the cultural equivalent of wishing death on a patient.  Avoid saying “you must... Instead teach patients their options and let them decide, e.g., “some people in this situation would...”