1. Diversity in health care
Dynamics of Care in Society
Diversity in health care 1

2. Objectives Differentiate between culture, ethnicity, and race
Identify some of the major ethnic groups in the US
Provide an example of acculturation in the US
Create an example of how bias, prejudice, or stereotype can cause barriers to effective relationships
Describe ways to avoid bias
Differentiate between a nuclear and extended family
Identify ways in which language, personal, space, touching, eye contact, and gestures are affected by cultural diversity
Compare and contrast the diverse health beliefs of different ethnic/cultural groups
Give examples of how health care providers can show respect for an individual’s beliefs & for cultural diversity

3. Watch “it’s a small world” 2 min

4. Do Now: Surgeon’s Dilemma
A young man who had been badly injured in a car accident has been brought into a hospital's accident and emergency department. The doctor determines that emergency brain surgery is required. Accordingly, the brain surgeon is paged. Upon seeing the patient, the surgeon exclaims, ‘My God, I can't operate on that boy! He's my son!’
That is so, but the surgeon is not the boy's father. How can the apparent contradiction be explained?

5. Culture
The values, beliefs, attitudes, languages, symbols, rituals behaviors, and customs unique to a particular group of people that is passed from on generation to another
Includes:
Family relations
Child rearing
Education
Occupational choice
Social interaction
Spirituality
Religious beliefs
Food preferences
Health beliefs
Health care

6. Culture Culture is learned. Culture is shared.
Culture is social in nature.
Culture is dynamic and constantly changing.

7. Ethnicity
A classification of people based on national origin and/or culture.
Members share a common heritage, geographic location, social customs, language, and beliefs.
Common Ethnic Groups
African American
Asian American
European American
Hispanic American
Middle Eastern / Arabic American
Native American

8. Race
Classification of people based on physical or biological characteristics including:
Color of skin, hair, and eyes
Facial features
Blood type
Bone structure
Cuts across multiple ethnic/cultural groups

9. Gender
Gender: refers to the cultural and social differences that distinguish men from women
Sex: refers to the biological differences that distinguish males from females
Gender equality: the conditions under which girls and boys, women and men, can reach their full potential without discrimination (through equal access to nutrition, health care, education, and opportunities to make decisions in their households and communities, it also includes legal equality)

10. Cultural Diversity
Includes:
Family organization
Language
Personal space
Touching
Eye contact
Gestures
Health care beliefs
Spirituality
Religion
Differences based on culture, ethnicity, and race that influence one’s behavior, self-perception, judgment of others, and interpersonal relationships

11. Cultural Assimilation
Absorption of a culturally distinct group into a dominant or prevailing culture
Requires that a cultural group alter their unique beliefs and behaviors and adopt the ways of the dominant culture
However, in the US, we are striving for a society where cultural differences are appreciated and respected.

12. Acculturation
The process of learning the beliefs and behaviors of a dominant culture and assuming some of the characteristics.
Occurs slowly over a long period of time.
Example:
Recent immigrants are more likely to use the language and follow the behavior patterns of their origin country than their children or grandchildren
ex: become more “Americanized”

13. DO NOW:
EVERYONE HAS CULTURE…ANSWER THE FOLLOWING & THEN RANK THEM IN ORDER OF IMPORTANCE
What music do you like to listen to?
What kind of traditions do you have?
What foods do you like?
What holidays are important to you?
What is most important in life to you?
Is you extended family important to you? Why or Why not?

14. Sensitivity
The ability to recognize and appreciate the personal characteristics of others.
It is essential for health care professionals to understand and respect these differences to provide care that meet the needs of all individuals.

15. Bias A preference that inhibits impartial judgment of others
Common biases:
Age
Education
Physical size
Occupation
Sexual preference
Gender

16. Prejudice
A strong feeling or belief about a person or subject that is formed without reviewing facts or information
Causes fear and distrust of others
Interferes with interpersonal relationships
Health care workers must be aware of our prejudices and to make every effort to obtain as much information about a situation as possible

17. Stereotyping
Process of assuming that everyone in a particular group is the same
It ignores individual characteristics and “labels” the individual
May occur with regard to:
Race
Gender
Body size
Occupation
Ethnicity

18. Stereotyping vs. Generalization
A stereotype is an ending point.
No attempt is made to learn whether the individual in question fits the statement.
Stereotyping can have negative results.
We often stereotype people simple on the basis of appearance.

19. Stereotyping vs. Generalization
A generalization is a beginning point.
It indicates common trends, but further information is needed to ascertain whether the statement is appropriate to a particular individual.
It is important to remember that there are always differences between individuals.
Do Now online: At Face Value: Issues with Stereotypes

20. Stereotypes vs Generalizations animation 4min
Clip Sneeches 12min
Mark’s Story Disabled (8 min) may have to use google chrome
Follow with ws “Stigma of Disease”

21. FOR STIGMA OF DISEASE back
com·pas·sion
a feeling of deep sympathy and sorrow for another who is stricken by misfortune, **accompanied by a strong desire to alleviate the suffering.
dig·ni·ty
1. bearing, conduct, or speech indicative of self-respect or appreciation of the formality or gravity of an occasion or situation.
2. nobility or elevation of character; worthiness: dignity of sentiments.

22. FOR Yellow case studies
Clubfoot is a congenital condition (which means it is present at birth) in which one or both feet turn inward and downward or up and out at the ankle.
The affected foot looks very similar to a golf club.
If the condition is not treated during infancy, or before the child begins walking, risks may include:
Smaller calf muscle of affected foot
Walk on the outside or top of the foot
Inability to walk normally
Inability to move ankle/foot up and down
May be related to another birth defect
Additional problems involving muscles, tendons, ligaments, and joints in ankle and foot
Increased risk of arthritis
Infection
Development of calluses

23. Respecting Cultural Diversity
Each individual must be regarded as a unique individual
Ways to achieve this goal is to:
Listen as patients express their beliefs
Appreciate individual different differences
Learn more about cultural and ethnic groups in your area
Recognize signs of prejudice, bias, or stereotyping

24. Overcoming Bias, Prejudice, and Stereotyping
Be conscious of your own personal and professional values and beliefs
Learn as much as you can about different ethnic/cultural groups
Be sensitive to behaviors and practices that are different from your won
Remember that you do not have to adopt others’ beliefs, but you must respect them

25. We need to feel listened to and valued so caring
Staff will need to have a good knowledge of many
different religions and cultures
Ask the individual or the family what it is that they need and what they want the staff to be aware of. Irrespective of whether or not a person belongs to a religious or cultural group they will have preferences and needs which are individual and personal.

26. If you have ever needed Health care– how did you feel?
Think!
If you have ever needed Health care– how did you feel?
ANXIOUS
IN PAIN/
FEELING ILL
CONFUSED
SCARED
ISOLATED

27. Group Exit Card:
What would you most like the staff caring for you to know about you, about your culture?
What would you most like them to understand?
In Groups make a list of the things you would like considered if you had to go into hospital

28. Main areas that people of various cultures will be concerned about:
Food
Modesty
Clothing/ jewelry
Hygiene
Family planning
Childbirth
Blood transfusions
Care of the dying/death
Post mortems
Organ transplantation

29. Overcoming Bias, Prejudice, and Stereotyping
Develop friendships with a wide variety of people
Ask and encourage questions from others to share ideas and beliefs
Evaluate all information before forming an opinion
Be open to all differences
Avoid offensive language and jokes
Understand that mistakes happen. Apologize and forgive.

30. Language
Health care provides must determine a patient’s ability to communicate and intervene to help those who do not understand English by use of:
Translators
Family members
Gestures or pictures
Cue cards (read handout)

31. Personal Space
The distance people require to feel comfortable when interacting with others
Varies greatly among ethnic/cultural groups
Health care providers must be alert to a patient’s verbal and nonverbal cues to determine personal space

32. Eye Contact Eye contact is affected by cultural beliefs
Lack of eye contact is usually interpreted as “not listening” but in some cultures is a sign of respect
Health care workers must be alert to an individuals comfort level when using direct eye contact and adjust accordingly

33. Gestures Are used to communicate (remember non verbal communication)
Can vary among ethnic/cultural groups
Health care providers must be aware of how a patient responds to gestures and avoid any that seem to be offensive

34. Health Care Beliefs Vary widely throughout all groups
Can affect an individuals response to health care
Most cultures have common conceptions regarding:
The cause of illness
Ways to maintain health
Appropriate response to pain
Effective methods of treatment

35. Health Care Beliefs Reactions to Pain & Other Health Issues
Response to pain is culturally influenced
Patient in pain may not show it
Listen to patients who freely express their discomfort
Recognize influence of cultural & individual beliefs about health
Respect patient’s right to react to health care issues any way he wants to
Don’t stereotype a patient’s perceptions or responses based on culture

36. Religion
An organized system of belief in a superhuman power or higher power
Are associated with a particular form or place of worship
May include beliefs about birth, life, illness, death, and dietary practices
Atheist – one who does not believe in any deity
Agnostic – one who believes that the existence of God cannot be proved or disproved

37. Religious Beliefs regarding blood transfusions
 Jehovah's Witnesses
Religious Beliefs regarding blood transfusions
Jehovah's Witnesses have sincerely held views, based on the Bible, that taking blood into one's body is morally wrong.
This includes whole blood or its components, such as packed red cells, plasma, white cells and platelets.
Jehovah's Witnesses are allowed to choose about whether to accept products such as albumin, immunoglobulin or clotting factors.
Blood samples may be taken for pathological testing as long as any unused blood is disposed of and not reused.
Dialysis will usually be accepted provided that no other source of blood is used.
Jehovah's Witnesses will accept medical treatment in all other respects apart from those involving the use of blood or blood components.
Jehovah's Witnesses do not usually celebrate birthdays or Christmas.
Article here

38. Culture & HC Activity
A Day in the Sleep Clinic (use handouts)

39. Diversity in Health Care Practices…
To Be Discussed in more depth in a later unit…. PPT CAM
Folk Medicine
Cutaneous stimulation
Therapeutic touch
Acupuncture
Acupressure
Natural Remedies
Herbs
Be aware of possible interactions with prescriptions
Keep personal opinions & biases to yourself

40. CDC Statistics
Health, United States is an annual CDC report on trends in health statistics
CDC data on Risk Factors & Health Indicators by Race/Ethnicity & Gender
Use detail view
Great web site 2016