1. Angie Guggino, MS, ATC, LAT
Cultural Diversity
Angie Guggino, MS, ATC, LAT

2. Learning Target
How culture affects healthcare.

3. Answer the following
List the experiences common to most cultural groups.
What does it mean to prejudge?
How can prejudices be overcome?
What is the difference between cultural assimilation and acculturation?

4. You can’t pick the people you treat.
Must work with and provide care to a variety of people
Factors that cause each individual to be unique:
Physical characteristics
Family life
Socioeconomic status
Religious beliefs
Geographical location
Education
Occupation
Life experiences
One major influence is the person’s cultural/ethnic heritage

5. What is culture?
Values, beliefs, attitudes, languages, symbols, rituals, behaviors, and customs unique to a particular group of people and passed on from generation to generation
Childrearing
Education
Occupational choice
Social interactions
Spiritual beliefs
Healthcare choices

6. Characteristics of Culture
Learned
Shared
Social
Dynamic and constantly changing

7. What is ethnicity?
Classification of people based on national origin and/or culture
May share common heritage, geographic location, social customs, language and beliefs
African American
Asian American
European American
Hispanic American
Middle Eastern American
Native American

8. What is race?
Classification of people based on physical or biological characteristics such as color of skin, hair, eye color, bone structure, blood type, and facial features
In reality, it is the values, beliefs, and behaviors learned from the ethnic group that accounts for behaviors attributed to race.

9. What is cultural diversity?
Differences based on cultural, ethnic, and racial factors
Influence an individual’s behavior, self-perception, judgment of others, and interpersonal relationships
Differences exist within all ethnic/cultural groups and within the people that make up those groups

10. “Salad Bowl” vs. “Melting Pot”
Assimilation
Acculturation
Requires a newly arrived cultural group to alter unique beliefs and behavior adopting the ways of the dominant culture
The process of integration of members of an ethno-cultural group into an established community
Process of learning the beliefs and behavior of a dominant culture and assuming some of the characteristics
The original cultural patterns of either or both groups may be altered, but the groups remain distinct

11. Sensitivity
Healthcare workers must be able to recognize and appreciate the personal characteristics of others
Example: Calling an adult by their first name, in some cultures, is not acceptable except for family members

12. What is a bias? Preference that inhibits impartial judgment Age
Education
Economic
Physical size
Occupation
Sexual preference
Gender

13. What is prejudice? Pre-judge
Strong feeling or belief about a person or subject that is formed without review facts or information
Age
Nationality
Physical differences
Religious differences
Race

14. What is stereotyping?
An assumption is made that everyone in a particular group is the same

15. Avoiding bias, prejudice, and stereotyping
Be aware of you own personal and professional beliefs
Learn about the other cultural groups
Be sensitive to behaviors different from yours
You don’t have to adopt other beliefs, just respect them
Develop relationships with people from other cultures
Ask questions and encourage questions
Evaluate all information before you form an opinion
Be open to differences
Avoid offensive jokes
Mistakes happen, apologize of you hurt another person

16. Are we born bias?
Video

17. Family organization
Refers to the structure of a family and dominant decision-making person in the family

18. Family organization Nuclear family Extended family
Consists of mother, father, and children
May also consist of a single parent and children
Includes nuclear family plus grandparents, aunts, uncles and cousins.

19. What type of family do you have?
patriarchal
matriarchal
Father or oldest male is the authority figure
Dominant male makes decisions regarding healthcare
The mother or oldest female is the authority figure

20. Personal Touch and Space
Close-Contact
Distant-Contact
Greeting by kissing on both cheeks
Hispanic
French
Mediterranean
Africa
Greet by handshake or gesture
Close family members hug
United States
Asian
Middle Eastern
Canada

21. Gestures Used to communicate many things
Nodding for “yes” and side-to-side for “no”
In some countries, nodding and shaking head mean the opposite
Pointing is used to stress a specific idea
Pointing in Asian and Native American cultures represents a strong threat

22. Eye Contact
Many feel eye contact during a conversation shows interest and trustworthiness
Some culture consider eye contact to be rude and is avoided as a form of respect
Native Americans may use peripheral eye contact instead of direct eye contact
Direct Stares can be considered a hostile act in some cultures

23. Language Differences Speak clearly Speak so that they can hear easily
Do not raise your voice or yell
Speak in moderate tones
Pronounce the entire word
Summarize often and confirm understanding
Clarify when necessary and do not assume they understand

24. Health Care Beliefs
The most common health care system in the U.S. is based on “Western” system
bases for disease is due to microorganisms, diseased cells and aging.
Healthcare is directed toward eliminating the cause.
Folk medicine is a collection of traditional beliefs and customs for treating pain or illness
Natural materials like herbs, spices, and rituals
Beliefs about a health care system vary among cultures, so patients regard healthcare differently
Every culture has a system for health care based on values & beliefs that have existed for generations

25. Examples of Folk Medicine (pages 195-197)
Asians
Think health is a balance of yin and yang
Pain must be endured silently
Chinese
Use cupping with heated bamboo
Europeans
Focus on treating illness with medication, surgery, diet, and exercise
Hispanics
Use heat and cold remedies to restore balance, belief health is reward from God
Middle Eastern
Believe in spiritual causes of illness such as the “evil eye”.
Native American
Some use a healer/shaman, believe health is harmony with nature, tolerance of pain signifies power and strength

26. Spirituality and Religion
Beliefs individuals have about themselves, their connections with other, and their relationship with a higher power
Need to find meaning and purpose in life
An organized system of belief in a superhuman power or higher power

27. Atheist and Agnostic Atheist Agnostic
Person who does not believe in any deity
Individual who believes that the existence of God cannot be proved or disproved

28. Religion and Healthcare

29. Judaism Blood and blood products acceptable
May wish major amputated limb to be buried in consecrated ground
Consult Rabbi with issues of tube feeding and life support

30. Christian Science
Believed to be the result of disharmony between mind and matter
Belief that healing occurs when one draws closer to God and experiences moral and spiritual change
Not completely opposed to medical treatment but may be fearful of being forced to accept unwanted treatments which violate individual personal beliefs
Most do not donate body or organs

31. Jehovah’s Witness Likely to be strongly opposed to blood transfusion
Medications from blood products may not be acceptable
Use of extraordinary means to prolong life or right to die is individual choice

32. Mormon
Faith healing (faith in Jesus Christ and power of priesthood to heal) and medical care/treatment used together
No restrictions on blood, blood products or medications

33. Protestant
In most denominations, decisions about blood, blood products, vaccines, biopsies, amputations and transplants are individual choice
Prayer, anointing, Eucharist or other rituals may be important

34. Roman Catholicism Blood and blood products acceptable
May wish major amputated limb to be buried in consecrated ground
Sacrament of the Sick (anointing by a priest) may be very important
May believe suffering is part of one’s fate or punishment from God

35. Seventh-day Adventist
Believe healing can be accomplished both through medical intervention and divine healing
Chaplains and physicians are inseparable
Emphasize physical medicine, rehabilitation and therapeutic diets
No restrictions on medications, blood or blood products or vaccines
May not condone use of narcotics or stimulants
No restrictions on surgical procedures although some may refuse interventions on Friday evening and Saturday Sabbath

36. Islam (Muslim)
No restrictions on blood or blood products, medications, amputations, organ transplants, or biopsies
Most surgical procedures permitted
Doctors are seen as helpers of God’s will
Abortion is prohibited except in cases of rape, incest and if the life of the mother is threatened. A fetus is considered a human being after 25-week gestation.

37. Buddhism
Illness is a result of karma (law of cause and effect), therefore an inevitable consequence of actions in this or a previous life
Health is holistic (connect between mind and body); mental cures are important.
Healing and recovery promoted by awakening to wisdom of Buddha, which is spiritual peace and freedom from anxiety
Do not believe in healing through faith
No restrictions on blood or blood products, surgical procedures, organ donation, autopsy
Medications acceptable if in great discomfort as long as they do not affect state of mind

38. Native American Spirituality
Health care practices intertwined with religious and cultural beliefs
May believe that ill health results from not living in harmony or being out of balance with nature and social and supernatural environments

39. Respecting Diversity
Key is to regard each person as a unique individual
Every individual adopts beliefs and forms patterns of behavior based on culture, ethnicity, race, life experiences, spirituality and religion
Beliefs may change based on new exposures and experiences
Must be aware of the needs of each individual in order to provide care

40. The End