1. Cultural Diversity
Health care providers must work with and provide care to may different people.
Therefore, every health care provider must be aware of factors that cause each individual to be unique.

2. Uniqueness Uniqueness is influenced by many factors: Also:
Physical Characteristics
Gender
Body Size
Skin Color
Also:
Family Life
Socioeconomic status
religious Beliefs
Geographic Location
Education, Occupation and life experience

3. A major influence on a person’s uniqueness is Cultural and Ethnic Heritage

4. Culture Culture is defined as the : Values Beliefs Attitudes Languages
Symbols
Rituals
Customs of a particular group of people often passed down from generation to generation

5. Culture Culture provides a blueprint or set of rules for living.
Culture is learned – It is taught by others, ie: children learn behavior by imitating parents.
Culture is shared – common practices and beliefs are shared with others in cultural group.
Culture is social in nature – understand appropriate behavior based on traditions.
Culture is dynamic and ever changing – New ideas generate different standards this allows cultural groups to meet changing needs.

6. Ethnicity
Ethnicity – is the classification of people based on national origin and/or culture.
Members of a certain ethnic group may share common heritage, customs, language and beliefs.
Many different ethnic groups in US – Melting Pot:
African American
Asian American
European American
Hispanic American
Middle Eastern American
Native American
Within each group there are subgroups ie: German-Italian

7. Race
Race is a classification based on physical or biological characteristics such as color of skin, hair, eye color, facial features blood type or bone structure.
Race is usually used to label a group of people and to explain patterns of behavior.
In reality race cuts across multiple ethnic/cultural groups
African Blacks and Caribbean Blacks
Share same physical features : very different cultural beliefs and values

8. Cultural Diversity
Culture, Ethnicity and race do influence a person’s behavior, self- perception and judgment - this is called: Cultural Diversity
Cultural Assimilation – process where multiple cultures blend to become one – United States – Melting Pot
In reality U.S. is becoming a “Salad Bowl” – cultural differences are appreciated and respected – multicultural society
Sensitivity – the ability to recognize differences is essential in todays health care. ie: calling someone by first name is not acceptable in some cultures

9. Bias – Prejudice - Stereotyping
Bias – (You prefer one over another) a preference that inhibits and leads to impartial judgment
Age – young people are physically and mentally superior to older people
Education – College educated people are superior (smarter) to uneducated
Economic – Rich people are superior (deserve better treatment) to poor
Physical Size – Obese and short people are inferior
Occupation – Nurses are inferior to doctors
Sexual Preferences – Homosexuals are inferior to heterosexuals
Gender - Women are inferior to men

10. Bias – Prejudice - Stereotyping
Prejudice – means to pre-judge. A prejudice is a strong feeling or belief about a person without reviewing the facts.
Prejudice people view their ideas, beliefs or behaviors as right and others as wrong.
They are frequently afraid of things that are different.
Prejudices causes fear and distrust and interferes with relationships
Every individual is prejudice to some degree – we all want to feel like our beliefs are right.
However it is important to be aware of our prejudices and make every effort not let them influence our behavior in health care.
Obtain as much information as possible about other individuals to better understand them and communicate successfully.

11. Bias – Prejudices - Stereotyping
Stereotyping – assumption is made that everyone in a particular group is the same.
Labels individuals
ie: All blondes are dumb
Similar stereotypes exists with regard to race, gender, ethnic/cultural group, occupation, etc.
It is essential to remember everyone is unique.

12. Bias – Prejudice - Stereotyping
All are barriers to effective communication and relationships with others.
Health care workers must be alert/aware to the barriers and make every effort to avoid them.

13. Overcoming Bias, Prejudice, Stereotyping
Ways to avoid barriers in Health Care:
Know and be aware of your own values & beliefs
Obtain as much information on others as possible
Be sensitive to behaviors of others
Remember, you are not being pressured to adopt other beliefs – just respect theirs
Develop friendships with a wide variety of people from other groups.
Ask questions and encourage others to ask questions to share beliefs
Evaluate all information before making decisions
Be open to differences
Avoid jokes that may offend others
Remember, mistakes happen and apologize and/or forgive.

14. Family Organization
Refers to the structure of a family and the dominant or decision-making person in the family. Nuclear Family – usually consists of a mother, father and children, may also consist of single parent and children (European/American Families) Extended Family – includes nuclear family and grandparents, aunts uncles, cousins (Asian, Hispanic and Native American)

15. Family Organization Usually affects care of:
Children
Sick
Elderly
Extended Family usually care for its own while Nuclear tends to use outside assistance
Patriarchal – father or oldest male makes decisions
Matriarchal – Mother or oldest female makes decisions
Its important to ask questions and observe the family when making health care decisions

16. Family Organization Important to ask questions
Who are the members of family?
Do you have any children? Who will care for them when you are sick?
Do you have an extended family?
Who will care for you while you are sick?
Who is the head of household?
Where do you live?
Was your entire family born on the US?
Do you have family that will be visiting you?

17. Language Language many times can be a barrier to communication.
Health care provider must determine patients ability to communicate not only to patient but to family.
Do you speak English as primary language?
What is language spoken at home?
Do you read English or another language?
Do you have a family member or friend that can interpret information for you?

18. Language
Important when speaking to someone who has limited English skills to:
Talk slowly
Use simple terms
Use gesture or pictures
Use non-verbal clues – smiles, gentle touch.
Avoid talking louder.
Try learning some words or phrases in patient’s language
Use translation services or translation cards or Translation App

19. Personal Space and Touch
Often called territorial space – the distance required between people to feel comfortable.
Varies greatly between cultures – some cultures like close contact ie: Arabs are very close contact, like touch and even smell of person. Women stand closer than men, children closer than adults
Cambodians never touch opposite sex in public, only parent may touch child on head.
Never assume something about a person’s personal space- always ask questions.

20. Personal Space and Touch
Health Care providers have to use touch and invade personal space to provide care.
Blood pressure cuff , use of a stethoscope, EKG electrodes
Health care provider should use slow movements, explain procedures, encourage patient to relax.
Patients sometimes still are uncomfortable so be alert to signals: tensing up, turning head, pulling away.

21. Personal Space and Touch
When providing personal care (BODY WASHING, ETC.) Ask patient if they have any preferences?
Do you prefer to do as much as you can on your own?
Would you like a family member to assist?
Are there any special routines you follow?
Do you prefer to bath in morning or evening?
Is there anything I can do to make you more comfortable?

22. Eye Contact Eye contact varies between cultures
Europeans Americans view it as trustworthy, show of interest.
Asian Americans sometimes consider it rude.
Native Americans – only side (peripheral) vision, direct vision is hostile and threatening.
Hispanic/African use brief contact but look away as sign of respect and inventiveness.
Health care workers must be alert to comfort levels of patients while using direct eye contact
Recognize cultural diversity – ie: Lack of eye contact is often interpreted as not listening while it can indicate respect (Asian Culture).

23. Gestures Gestures are used to communicate many different things:
Nodding head for yes, side to side for no
In India – head motions are exact opposite.
Pointing finger in US is common to stress a specific point
Asian and native American its considered a threat.
OK sign is considered insulting to Asians
Health care workers must be aware of how patients respond to hand gestures, if you notice a person uncomfortable, avoid using it.

24. Health Care Beliefs
Most common health care system in U.S. is biomedical or “Western Medicine”
Cause of disease based on microorganisms, diseased cells and process of aging. Value put on education and prevention
When cause is determined than health care is performed to eliminate the cause.
Use licensed doctors or practitioners
Other cultures believe in harmony of body and spirituality
Use Folk Practitioners – Spiritualists, Herbalists Native healers
Its important to remember not all individuals believe in and follow U.S. or Western Medicine.

25. Alternative Medicine
Nutritional Medicine – organic food, herbs, vitamins, anti-toxins
Mind and Body Control – relaxation, meditation, hypnotherapy
Body Movement Methods- Chiropractor, yoga, tai chi
Spiritual Methods – Faith healing, prayer and spiritual counseling
Every individual has the right to believe what they want and to choose what method they prefer
Healthcare workers need to be aware of the differences and accommodate when reasonably available.

26. Spirituality and Religion
Spirituality and religion are inherent part of every cultural group.
Spirituality – is defined as the beliefs individuals have about themselves, there connections with others and relationship with a higher power.
When a person’s spiritual beliefs are firmly established, they tend to have a basis for understanding life.
Beliefs can be varied
Atheist – don’t believe in any deity
Agnostic – believe existence in god can not be proved or disproved

27. Religion Do you have a religious affiliation?
Are there any religious practices that make you feel better?
Do you normally pray at certain times of the day?
Would you like a person of some religion to visit? Priest, etc.
Do you consult a religious healer
Do your beliefs restrict certain foods or drinks?
Do you observe any specific holidays, have objects that need certain care?
As long as they do not cause harm, every effort should be made to accommodate the religious needs of every patient.

28. Respecting Cultural Diversity
The key is to regard each person as a unique individual
Be ware of the needs of every patient
Respect the needs of each patient
Try to accommodate for every need as long as it does not harm the patient.