Chapter 6: Diversity and Difference in Health Care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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