1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 13: Diversity and Difference in Health Care

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Cultural Diversity Race National origin Religion Language Physical size Gender Sexual orientation Age Disability Socioeconomic status Geographic location

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Personal Beliefs Cultural beliefs Social beliefs Religious beliefs Personal convictions

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural and Ethnic Differences Definition of Culture –A shared system of beliefs, values, and behavioral expectations that provide structure for daily living

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural and Ethnic Differences (cont’d) Factors Influencing Culture –Beliefs –Habits –Likes –Dislikes –Customs –Rituals

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural and Ethnic Differences (cont’d) Facts About Culture –Provides shared identity for cultural group –Influences member’s view of: Self Expectations Behavior –Is shaped by social & physical environment –Is transmitted via language, formal teaching, & observation of elders

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural and Ethnic Differences (cont’d) Shared Characteristics of an Ethnic Group –Language & dialect –Religious practices –Literature –Folklore –Music –Political interests –Food preferences

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural and Ethnic Differences (cont’d) Characteristics Distinguishing Minority Group –Race –Religion –Beliefs –Customs or practices

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural and Ethnic Differences (cont’d) Physical Characteristics: Genetically Inherited Diseases –Tay-Sachs disease –Keloids –Lactase deficiency & lactose intolerance

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural and Ethnic Differences (cont’d) Psychological Characteristics –Consider patient’s perspective & concerns –Remember that different cultures & individuals interpret behaviors differently

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural and Ethnic Differences (cont’d) 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

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural and Ethnic Differences (cont’d) Gender Roles –Dominant male role in many cultures –Recognize who is culturally dominant member of family

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural and Ethnic Differences (cont’d) Time Orientation –U.S.: punctuality is important –Other cultures (e.g., South Asian): punctuality not valued as highly –Different perceptions of past, present, & future

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural and Ethnic Differences (cont’d) Food and Nutrition –Culture influences food preferences –Certain cultures have particular staple foods –Take cultural food differences into account when teaching about diet

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Differences Among Individuals Socioeconomic Factors –Family income affects health & access to health care –Upper income groups live longer & have fewer disabilities –Poverty often leads to inadequate care of infants & children –Poor housing conditions affect health

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Differences Among Individuals (cont’d) Age –Children & older adults less able to communicate symptoms, medication responses –Different health needs in young vs. old –Don’t make assumptions based on age of patient alone

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Differences Among Individuals (cont’d) Religion –Be sensitive to each patient’s values & beliefs

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Diversity in Health Care Practices Folk Medicine –Cutaneous stimulation –Therapeutic touch –Acupuncture –Acupressure

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Diversity in Health Care Practices (cont’d) Natural Remedies –Herbs –Be aware of possible interactions with prescriptions –Keep personal opinions & biases to yourself

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Diversity in Health Care Practices (cont’d) Complementary or Alternative Medicine –Healing through: Nutrition Exercise Relaxation –Emphasis on preventive medicine –Often borrowed from the practice of ethnic or cultural groups

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Diversity in Health Care Practices (cont’d) Acupuncture: a healing practice that originated in China