1. Cultural Diversity Nataliya Lishchenko, MD, Ph.D, MHCA

2. The strength and greatness of America lies in the Diversity of its People….

3. Growing Diversity in America During the Past 20 years White population increased 10% African American population increased 30% Native American population increased 58 % Hispanic population increased 125%

4. r 30 Projected Demographics for 2030 2000 White: 60% Hispanic: 19% Black: 13% Asian/PI: 7% N Am/Ak N: 1% Whites: 70% Hispanic: 13% African Am: 12% Asian: 4% N Am: 1%

5. In California Population of 38 Million 1/3 of the population is of Hispanic origin Over 10% Asian Over 4% more than one race Nearly 17% identify as “Other race”

6. In California 1 in 4 are foreign born, 37% of these entered the US after 1990 Nearly 40% of the population over the age of 5 speaks a language other than English at home. Over 25% of the population is under the age of 18

7. Diversity related facts: The population is becoming increasingly diverse underrepresented groups make up approximately 30% of the population Health care workforce has not kept up with the changing demographics Physicians from underrepresented groups make up only about 7% of the current workforce Nurses only 3% Pharmacy only 3%

8. Ethnic Health Disparities African Americans Highest death rate from colon and rectal cancer of any ethnic group in the U.S. African Am women, diagnosed with breast cancer, have a 71% survival rate vs. an 86% rate for white women.

9. Ethnic Health Disparities Native Americans 2-3 times more likely to have diabetes mellitus that the general population Higher than average mortality rates associated with heart disease, TB, suicide, Pneumonia, Influenza, homicide, and alcoholism

10. Reports of Disparities in Health Care Disparities in health care do exist and are associated with higher mortality among minorities.

11. Reports of Racial and Ethnic Disparities in Healthcare Minorities are less likely to be given appropriate cardiac medications or to undergo bypass surgery. There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer. Minorities are less likely to receive kidney dialysis or transplants. Racial differences have been reported in the provision of analgesics in the emergency room. (Bach et al. 1999- NEJM; Todd et al., 1993- JAMA)

12. Factors that Influence Perception Past experience Past experience Self-concept Self-concept Attitudes and values Attitudes and values Expectations Expectations Senses Senses Roles Roles Cultural Cultural Prejudice Prejudice

13. Cultural Diversity and Health Care We All Have It! We All Have It! Obvious Manifestations: Obvious Manifestations: Religion Religion Ethnicity Ethnicity National Origin (language) National Origin (language) Gender Gender

14. Cultural Diversity and Health Care Less Obvious Manifestations: Less Obvious Manifestations: Age Age Education Education Educational Status Educational Status Mobility (including handicaps) Mobility (including handicaps)

15. Stereotypes and Cultural Myths Altering care or treatment procedures to accommodate cultural variables is unnecessary because any intelligent person, or even one with some basic common sense can adjust Altering care or treatment procedures to accommodate cultural variables is unnecessary because any intelligent person, or even one with some basic common sense can adjust Treating people differently because of racial, religious, ethnic, cultural, gender, or other characteristics implies prejudice and discrimination. Treating people differently because of racial, religious, ethnic, cultural, gender, or other characteristics implies prejudice and discrimination. Minorities must adapt to the dominant culture’s institutions, rather than the institutions adapting to the needs of the minority group or individual Minorities must adapt to the dominant culture’s institutions, rather than the institutions adapting to the needs of the minority group or individual

16. Cultural Self Assessment Questions Lack of understanding of own feelings and reactions results in perpetuation of stereotypes and cultural myths. Where did my family originate? Where did my family originate? What do I believe about gender roles of men and women? Are my beliefs different or consistent with those of my parents? What do I believe about gender roles of men and women? Are my beliefs different or consistent with those of my parents? How much physical distance do I need in social interactions? How much physical distance do I need in social interactions? Whom do I look for guidance in important matters? Whom do I look for guidance in important matters? If I needed health care, how would I respond to this need and what would be my expectations? If I needed health care, how would I respond to this need and what would be my expectations? In a health are situation, what would be the role of my family? In a health are situation, what would be the role of my family?

17. Ethnicity Sense of identification of a collective cultural group Sense of identification of a collective cultural group Characteristic of an ethnic group: Characteristic of an ethnic group: - Common language - Same food preferences - Shared traditions - Religion - Shared values, symbols, literature, folklore, music

18. Definitions Ethnocentrism: Belief that one’s ideas, beliefs and practices are the best, superior or most preferred to other lifeways. Ethnocentrism: Belief that one’s ideas, beliefs and practices are the best, superior or most preferred to other lifeways. Minority: Groups having some physical/cultural characteristics that identify people within groups as different from dominant culture. Minority: Groups having some physical/cultural characteristics that identify people within groups as different from dominant culture. Race: categorizing people into subgroups according to physical characteristics (skin color, physical stature, facial features, hair texture) Race: categorizing people into subgroups according to physical characteristics (skin color, physical stature, facial features, hair texture) Stereotyping: assuming that all members of a culture or ethnic group act alike (i.e. racism, ageism, sexism) Stereotyping: assuming that all members of a culture or ethnic group act alike (i.e. racism, ageism, sexism)

19. Culturally Competent Care Transcultural nursing that involves sensitivity, knowledge and skill Nursing care is planned and implemented in a way that it’s sensitive to the needs of the individual, families, and groups representing diverse cultural population in society. Nursing care is planned and implemented in a way that it’s sensitive to the needs of the individual, families, and groups representing diverse cultural population in society. Cultural diversity is recognized and respected; cultural sensitivity is present. Cultural diversity is recognized and respected; cultural sensitivity is present. Accepts values and beliefs of others. Accepts values and beliefs of others. Cultural factors and influences are integral components of nursing care Cultural factors and influences are integral components of nursing care Recognize that the health care system is itself a culture and that ethnocentrism must be avoided. Recognize that the health care system is itself a culture and that ethnocentrism must be avoided.

20. Cultural Blindness Tendency to ignore cultural differences and to proceed as if they did not exist Tendency to ignore cultural differences and to proceed as if they did not exist A person who culturally blind does not deliberately entend to act in a culturally insensitive way, but simply is not aware of cultural differences or does not consider them important in providing care A person who culturally blind does not deliberately entend to act in a culturally insensitive way, but simply is not aware of cultural differences or does not consider them important in providing care

21. Cultural Diversity and Health Care What is Culture? What is Culture? - shared lifestyle, values, beliefs, ideals and behavior of a particular group. - shared lifestyle, values, beliefs, ideals and behavior of a particular group. - Picture it as a luggage that each of us carries around for our lifetime. It is sum of beliefs, practices, habits, likes, dislikes, norms, customs, rituals and so forth that we learned from our families during the years of socialization. In turn, we transmit cultural luggage to our children.

22. Characteristics of Culture Culture is learned, not inherited Culture is learned, not inherited Culture is shared by its members Culture is shared by its members Culture is implicit Culture is implicit Culture is dynamic Culture is dynamic Culture is diversified Culture is diversified

23. Differing Health Belief System Magicoreligious HBS: people believe that supernatural forces influence health and illness Magicoreligious HBS: people believe that supernatural forces influence health and illness Holistic Belief System: the forces of nature must be kept in natural balance and harmony Holistic Belief System: the forces of nature must be kept in natural balance and harmony Scientific or Biomedical HBS: health and illness are controlled by a series of physical and biomedical process that can be analyzed and manipulated by humans. Disease and illness are caused by microorganism or malfunction of body Scientific or Biomedical HBS: health and illness are controlled by a series of physical and biomedical process that can be analyzed and manipulated by humans. Disease and illness are caused by microorganism or malfunction of body

24. Factors that influence Health Beliefs and Behaviors of Culturally Diverse Ind/Grp Traditional health and illness practices: Natural folk medicine Natural folk medicine Magico-religious medicine Magico-religious medicine Use of food] Use of food] Religious practicies Religious practicies Use of Healers Use of Healers Social organizations – refers to family unit; environment in which people grow up and live. Social organizations – refers to family unit; environment in which people grow up and live. - Description of family in this cultural group - Gender and age roles that affect choice of whom to communicate

25. Factors that influence Health Beliefs and Behaviors of Culturally Diverse Ind/Grp  Communication – language differences  Space and territoriality - How complicated is it to navigate the health care system - How complicated is it to navigate the health care system - Is the hospital culture friendly or hostile? - Distance to the health care system?  Time orientation

26. Barriers to Providing Culturally Competent Care Language Language Stereotyping Stereotyping Ethnocentrism Ethnocentrism Cultural ipmosition Cultural ipmosition Labeling a practice as dysfunctional Labeling a practice as dysfunctional

27. Nursing Skills and Competencies Awareness of Diversity – first step. Move beyond recognition or awareness of diversity to the celebration and appreciation of diversity Awareness of Diversity – first step. Move beyond recognition or awareness of diversity to the celebration and appreciation of diversity Cultural sensitivity – response to a person or situation that is considerate, compassionate, empathetic and sensible Cultural sensitivity – response to a person or situation that is considerate, compassionate, empathetic and sensible Cultural knowledge – acquiring knowledge of client’s cultural beliefs Cultural knowledge – acquiring knowledge of client’s cultural beliefs Recognition of spirituality – implies a quality of transcendence, a guiding force; it’s what brings peace and joy to their lives, gives them inner strength Recognition of spirituality – implies a quality of transcendence, a guiding force; it’s what brings peace and joy to their lives, gives them inner strength Cultural assessment – systematic examination of individuals, groups and communities based on their values, beliefs and behavior Cultural assessment – systematic examination of individuals, groups and communities based on their values, beliefs and behavior

28. Acceptance Acceptace of both self and others is a critical part of the therapeutic process. Acceptace of both self and others is a critical part of the therapeutic process. Acceptance is understading that what others believe or feel is their true belief and that others have a right to believe or feel that way. Acceptance is understading that what others believe or feel is their true belief and that others have a right to believe or feel that way. It is not blaming others for anything they do even if behavior is wrong or has to be changed to protect the individual and society. It is not blaming others for anything they do even if behavior is wrong or has to be changed to protect the individual and society. The key is to allow another the freedom to think or feel – does npt mean going along with whatever is said or done The key is to allow another the freedom to think or feel – does npt mean going along with whatever is said or done It is accepting the behavior and responding without judging It is accepting the behavior and responding without judging

29. Resources About Cultural Groups Dept of Health Services Dept of Health Services Senior Centers Senior Centers Support Groups – single parents, newly divorces, 12 step program Support Groups – single parents, newly divorces, 12 step program Gay and lesbian organizations Gay and lesbian organizations AIDS alliance AIDS alliance REACH Project (for Latinos) REACH Project (for Latinos) Social Services Department Social Services Department Churches Churches

32. Cultural Diversity and Health Care It is because we are different that each of us is special.