1. Chapter 6: Diversity and Difference in Health Care

2. Types of Cultural Diversity
Race
National origin
Religion
Language
Physical size
Gender
Sexual orientation
Age
Disability
Socioeconomic status
Geographic location

3. Cultural and Ethnic Differences
Culture
A set of values, beliefs, attitudes, languages, symbols, rituals, behaviors, and customs of a group of people
Learned, shared, and social
Dynamic and changing
Ethnicity- Classification of people based on their national origin or culture ex. African American, Hispanic, Asain
Race- Classification of people based on their physical or biological characteristics. Involves multiple cultures and ethnic groups

4. Cultural Diversity “Melting Pot”
Must be considered when providing healthcare
Holistic care (treatment of a whole being) must be developed to include the cultural diversity of America
Holistic well-being:
1. Mental or emotional
2. Physical
3. Social

5. Cultural and Ethnic Differences (cont’d)
Facts About Culture
Provides shared identity for cultural group
Influences member’s view of:
Self
Expectations
Behavior
Is transmitted via language, formal teaching, & observation of elders

6. Cultural and Ethnic Differences (cont’d)
Shared Characteristics of an Ethnic Group
Language & dialect
Religious practices
Literature
Folklore
Music
Political interests
Food preferences

7. Cultural Impact
Each interaction with a patient will have cultural implications
11 areas of potential conflict have been studied
However, each patient must be viewed independently

8. Areas of Potential Conflict
Wellness and Health Prevention
Touch and Physical Space
Communication
General Procedures
Dietary Needs
Spirituality
Death
Medications
Pregnancy
Pain Management
Other

9. Wellness and Health Prevention
Examples of cultural impact on health care:
Americans tend to focus on healthy living and disease prevention
American Indians view weight gain as a normal occurrence in adulthood, so dieting is seen as senseless
Some cultures do not value immunizations, and others view it as injecting a poison

10. Touch and Physical Space
Examples of cultural impact on health care:
In some cultures , close touching and human contact is a sign of respect and friendship
A simple handshake and smile shows warmth and caring
In other cultures direct hand contact is not welcomed and is seen as an invasion of privacy
Muslim women cannot be touched by men who are not immediate family members
Personal distance varies, so be alert to + and – signs that tell whether the patient is comfortable with the amount of space allowed

11. Communication Examples of cultural impact on health care:
Obviously, language barriers will affect our ability to communicate
Some cultural groups find it taboo and/or insulting to discuss sexual activity, while other groups are more willing to
In matriarchal societies, the oldest woman makes all the health care decisions, but in a patriarchal society, the eldest male make all those decisions
In some cultures, the woman must look at her husband for permission to speak

12. General Procedures Examples of cultural impact on health care:
Removing clothing and wearing hospital gowns can be difficult, a health care worker must be sensitive to this
Before entering a room, announce your arrival
Some cultures fear invasive procedures
Hmong people fear with surgical incision, the soul may become frightened and leave the body

13. Dietary Needs Examples of cultural impact on health care:
Food has many ethnic and religious implications
All attempts should be made to accommodate a patients nutritional needs in conjunction with his/her requests
Americans view meat and milk products as staples, but in India these foods are considered taboo
Explain why certain foods should be avoided for specific diseases, i.e., high cholesterol and diabetes
Many cultures require fasting rituals, all attempts should be made to accommodate these rituals

14. Spirituality Examples of cultural impact on health care:
For many cultures, the spiritual component is essential to recovery and strength
Regardless of belief, the patient’s belief should be accepted and assistance offered when requested
The health care worker should try and use correct terminology when discussing this, it is a sign of respect
Recent studies have shown that prayer is powerful and may provide harmony and balance to the patient
All attempts should be made to allow privacy during these times

15. Death Examples of cultural impact on health care:
Views on death vary greatly
Some cultures welcome death, others see it is as finality
Therefore views on extending life, via life support will be different
Ritual surrounding death also vary
Muslim patients should have their heads tilted and facing mecca
Mexican Americans prefer to be in the room with the patient, while Japanese Americans prefer not to be in the room
Death from suicide also has many cultural implications
Some cultures believe that suicide brings shame on the family and in other cultures it may be strictly forbidden, so family members may refuse to listen to any information regarding a suicide

16. Medications Examples of cultural impact on health care:
Actions and side effects of some medications may vary on the basis of patient ethnicity
Women from Islamic and African countries with vaginal yeast infections prefer oral drugs to vaginally inserted medications
Latin Americans prefer injections over oral medications, they perceive oral medications as less effective
Some cultures practicing religious fasts, which can affect medication schedules or interfere with drug absorption

17. Pregnancy Examples of cultural impact on health care:
Many beliefs exist
In North America, male partners may be involved with prenatal care visits, whereas other cultures do not encourage such involvement
Some cultures have specific post-placenta delivery rituals
Having ceremonies and burying it in the ground
Some cultures participate in “placentaphagia”, which is eating of the placenta for medicinal value

18. Pain Management Examples of cultural impact on health care:
Some cultures believe that pain is caused by demons and is a sign from above that the spirits are upset, thus the patient may refuse to admit to pain
Other cultures see pain as a symptom of an illness, while others may see it as a sign of weakness

19. Other Examples of cultural impact on health care:
Refusal to give blood or to get blood transfusions
Refusal to donate or receive organ transplants
Refusal to place aging patients into nursing homes despite the ability to care for them at home
Fertility control
Mental illnesses