1. CULTURAL AWARENESS

2. Cultural Awareness Descriptions will be based on 2010 US Census White
Black or African American
American Indian and Alaska Native alone
Asian alone
Native Hawaiian and Other Pacific Islander Alone
Some other Race alone
Two or More Races
Hispanic or Latino/Not Hispanic or Latino

3. Cultural Awareness
Minorities: a group differing, especially in race, religion, or ethnic background, from the majority of a population.
Legislation aims at providing equal rights for minorities.

4. Perceptions …the duck

5. Perceptions… are they real?

6. Cultural Awareness
Cultural Awareness is the foundation of communication and it involves the ability of standing back from ourselves and becoming aware of our cultural values, beliefs and perceptions.

7. Stereotypes What’s in your head???
Explicit stereotype, bias and attitude
Implicit stereotype, bias and attitude
Man with Bag Video 1:

8. Stereotypes The external doesn’t determine the internal:
The shopping video:

9. Race
Historically, you could only have one race – it was based on your external appearance.
White
Black or African American
American Indian and Alaskan Native
Asian
Native Hawaiian and Other Pacific Islander
Now people can claim two or more races or other category.

10. Race vs. Ethnicity Race is different from ethnicity.
Race is biologically based and refers to an individual’s physical
Characteristics e.g. skin, hair, bone structure, eye color etc.
Ethnicity is sociological and refers to cultural factors.
Ethnicity (2010 US Census)
Hispanic or Latino
Not Hispanic or Latino.

11. Ethnicity and Cultural Factors
Nationality
Regional Culture
Ancestry
Language(s)
Belief System
Customs
Historical Perspectives
An ethnic group or ethnicity is a category of people who identify with each other based on cultural factors and it is usually an inherited status.

12. 2010 US Census Total Population: 308,745,538 White – 72.4%
Black or African American %
American Indian and Alaska Native alone – 0.9%
Asian alone - 4.8%
Native Hawaiian and Other Pacific Islander Alone-0.2%
Some other Race alone -6.2%
Two or More Races -2.7%
Hispanic or Latino – 16.3%
Not Hispanic or Latino -83.7%

13. South Dakota 2010 US Census Total Population: 814,180 White – 85.9%
Black or African American - 1.3%
American Indian and Alaska Native alone - 8.8%
Asian alone - 0.9%
Native Hawaiian and Other Pacific Islander Alone -
Some other Race alone - 0.9%
Two or More Races - 2.1%
Hispanic or Latino – 2.7%
Not Hispanic or Latino -97.3%

14. You Can Run but You Can’t Hide!!!
33% of RH inpatients are Native American
What do they see when they walk in the hospital?
Our goal – include faces that look like them…
What do they think when they walk in the hospital?
What are their fears – small pox blanket incident

15. Cultural Awareness: Understand Fear
General Amherst, July 8, 1763: “Could it not be contrived to Send the Small Pox among those Disaffected Tribes of Indians? We must, on this occasion, Use Every Stratagem in our power to Reduce them.”
Colonel Bouquet, July 13: “I will try to inocculate the Indians by means of Blankets that may fall in their hands, taking care however not to get the disease myself.”

16. Cultural Awareness: Understand Fear
General Amherst, July 16: “You will Do well to try to Innoculate the Indians by means of Blanketts, as well as to try Every other method that can serve to Extirpate this Execreble Race.”
Colonel Henry Bouquet, July 19: “..all your Directions will be observed.”
Papers of Col. Henry Bouquet, ed. Stevens and Kent, ser , p. 161
These are the pivotal letters: Colonel Henry Bouquet to General Amherst, dated 13 July 1763, [262k] suggests in a postscript the distribution of blankets to "inocculate the Indians"; Amherst to Bouquet, dated 16 July 1763, [128k] approves this plan in a postscript and suggests as well as "to try Every other method that can serve to Extirpate this Execrable Race." (This postcript spans two pages.) These letters also discuss the use of dogs to hunt the Indians, the so-called "Spaniard's Method," which Amherst approves in principle, but says he cannot implement because there are not enough dogs. In a letter dated 26 July 1763, Bouquet acknowledges Amherst's approval [125k] and writes, "all your Directions will be observed."

17. Cultural Awareness: Understand Fear
The Tuskegee Syphilis Experiment was an infamous clinical study conducted between 1932 and 1972 by the U.S. Public Health Service studying the natural progression of untreated study in rural African-American men in Alabama under the auspices of receiving free health care from the United States government.
The Tuskegee Syphilis Study, cited as "arguably the most infamous biomedical research study in U.S. history",[8] led to the 1979 Belmont Report and the establishment of the Office for Human Research Protections (OHRP).[9] It also led to federal laws and regulations requiring Institutional Review Boards for the protection of human subjects in studies involving them. The Office for Human Research Protections (OHRP) manages this responsibility within the US Department of Health and Human Services (HHS).[10]

18. Cultural Awareness
- Cultural awareness becomes central when we have to interact with people from other cultures. - People see, interpret and evaluate things in a different ways. - What is considered an appropriate behavior in one culture is frequently inappropriate in another one. - Misunderstandings arise when I use my meanings to make sense of your reality.

19. Cultural Awareness THE WORLD IS A SMALL PLACE AND THE SMALLER IT GETS,
THE MORE IMPORTANT IT BECOMES THAT WE UNDERSTAND EACH OTHER.

20. Cultural Awareness
-If a patient, because of cultural “disconnect,” can’t appreciate what we’re prescribing or why it’s necessary, or if the information is delivered in a way that inadvertently frightens or offends the patient, how can we fulfill our mission as health care providers?
-Core causes for cultural “disconnects” between health care providers and patients include:
VALUES
INDEPENDENCE
PRIVACY
SELF-CONTROL
TIME ORIENTATION

21. AFRICAN AMERICAN ANGLO-AMERICAN ASIAN
CULTURE
HEALTH BELIEFS
PRACTICES
PAIN
AFRICAN AMERICAN
-SOME BELIEVE DISEASE IS DUE TO PUNISHMENT.
-RICH FOODS (RED) MAY BE THOUGHT TO CAUSE HIGH BLOOD PRESSURE
-CULTURE HAS A RICH TRADITION OF HERBAL REMEDIES.
-EXPRESSIONS OF PAIN VARY WIDELY.
-IT IS EQUALLY ACCEPTABLE TO BE EXPRESSIVE OR STOIC.
ANGLO-AMERICAN
-A PATIENT MAY PREFER TO BE LEFT ALONE WHEN ILL.
-GENERALLY PREFER AN AGGRESSIVE APPROACH TO TREATING ILLNESS.
-GERMS ARE THOUGHT TO CAUSE DISEASE AND PATIENTS EXPECT TREATMENT TO DESTROY GERMS.
-BIOMEDICINE IS PREFERRED, ALTHOUGH MANY MAY USE COMPLEMENTARY AND ALTERNATIVE MEDICINE.
-ANTIBIOTICS ARE OFTEN REQUESTED.
-MIDDLE CLASS PATIENTS COMMONLY USE THE INTERNET TO OBTAIN INFORMATION.
-PATIENTS TEND TO BE STOIC.
-ALTHOUGH MOST WILL WANT PAIN MEDICATION.
ASIAN
-IN CHINA AND KOREA, COINING AND CUPPING THERAPIES ARE TRADITIONAL.
-AVOID THE NUMBER 4 AS THE CHARACTER WORD MEANS DEATH.
-MENTAL ILLNESS CAN BE HIGHLY STIGMATIZING IN ASIAN COUNTRIES.
-FEVERS ARE OFTEN TREATED BY COVERING THE PATIENT IN WARM BLANKETS.
-AVOID GIVING ICE WATER WITHOUT ASKING IF THE PATIENT PREFERS ROOM TEMP. WATER.
-USE OF HERBS IS COMMON.
-STOICISM IS HIGHLY VALUED.
-PAIN MAY BE EXPRESSED ONLY BY A CLENCHED JAW.
-FILIPINOS MAY BE PARTICULARLY CONCERNED ABOUT ADDICTION TO PAIN MEDICATION.

22. HISPANIC/LATINO JEWISH MIDDLE EASTERN
CULTURE
HEALTH BELIEFS
PRACTICES
PAIN
HISPANIC/LATINO
-BELIEVE ILLNESS RESULTS FROM AN UPSET IN BODY BALANCE.
-AMONG THOSE FOLLOWING TRADITIONAL CULTURAL PRACTICES, FAT IS SEEN AS HEALTHY.
-ASK WHAT REMEDIES THE PATIENT HAS TRIED BEFORE COMING IN.
-PATIENTS MAY TEND TO BE EXPRESSIVE (LOUD) WHEN IN PAIN.
JEWISH
-THE HIGHEST JEWISH LAW IS THAT YOU MUST DO EVERYTHING YOU CAN TO SAVE A LIFE.
-OBSERVANT JEWS FOLLOW A KOSHER DIET.
-FOR ORTHODOX AND CONSERVATIVE JEWS, THE SABBATH (SUNDOWN FRIDAY TO SUNDOWN SATURDAY) IS FOR REST AND RELIGIOUS OBSERVANCE.
-EAT ONLY RITUALLY SLAUGHTERED MEAT, NO PORK OR SHELLFISH AND DO NOT MIX MEAT AND DAIRY PRODUCTS.
-AN OPEN EXPRESSION OF PAIN IS ACCEPTABLE.
-PATIENTS MAY BE MORE CONCERNED WITH THE MEANING AND REPERCUSSIONS OF WHAT IS CAUSING THEIR PAIN THAN WITH THE SENSATION ITSELF.
MIDDLE EASTERN
-MAY NOT ALLOW ORGAN DONATION.
-FAMILY MEMBERS ARE OFTEN EXPECTED TO TAKE CARE OF PATIENTS.
-DAMP,COLD AND DRAFTS MAY BE THOUGHT TO LEAD TO ILLNESS.
-MAY NOT TAKE MEDICATIONS, EAT OR DRINK FROM SUNRISE TO SUNSET DURING RAMADAN.
-INJECTIONS MAY BE PREFERABLE TO PILLS.
-THE PATIENT MAY FEEL SLIGHTED IF NOT GIVEN A PRESCRIPTION.
-OBSERVANT MUSLIMS DO NOT EAT PORK AND ARE EXPECTED TO ABSTAIN FROM ALCOHOL.(WHICH MAY BE IN COUGH SYRUP)
-PATIENTS TEND TO BE VERY EXPRESSIVE ABOUT PAIN.
-PARTICULARLY IN FRONT OF FAMILY.
-PAIN IS FEARED AND SHOULD BE MINIMIZED.
-EXPLAIN THE SOURCE OF PAIN AND THE PROGNOSIS TO IMPROVE COPING.

23. RUSSIAN SOUTH ASIAN SOUTHEAST ASIAN
CULTURE
HEALTH BELIEFS
PRACTICES
PAIN
RUSSIAN
-ELDERLY BELIEVE THAT ILNESS RESULTS FROM COLD.
-THEY MAY NOT LIKE TAKING A LARGE NUMBER OF PILLS.
-THEY MAY PRACTICE CUPPING THERAPY.
-THEY MAY PREFER NONPHARMACOLOGIC INTERVENTIONS FOR NAUSEA.
-PATIENTS TEND TO BE VERY STOIC.
-FEAR OF DRUG ADDICTION, SO DISCUSS THE IMPORTANCE OF PAIN MEDICATION.
SOUTH ASIAN
-USE OF HOME AND FOLK REMEDIES IS COMMON.
-OBSERVANT HINDUS WILL GENERALLY NOT EAT MEAT OR FISH AND SOME MAY NOT EAT EGGS.
-THOSE WHO PRACTICE AYURVEDIC MEDICINE (HINDUS, SIKHS, AND SOME MUSLIMS) CLASSIFY FOOD IN TERMS OF EITHER HOT OR COLD.
-PATIENTS ARE GENERALLY STOIC, EXCEPT DURING CHILDBIRTH.
-GREAT CONCERN REGARDING DRUG ADDICTION.
SOUTHEAST ASIAN
-SOME HMONG BELIEVE THAT WHEN PEOPLE ARE UNCONSCIOUS, THEIR SOULS CAN WANDER, SO ANESTHESIA IS DANGEROUS.
-BELIEF THAT VERBAL STATEMENTS CAN CAUSE ILLNESS OR DEATH.
-CUPPING OR COINING
-FEAR OF BLOOD BEING DRAWN BECAUSE IT MAY SAP THEIR STRENGTH.
-PATIENTS ARE GENERALLY STOIC. ATTENTION TO NON-VERBAL INDICATIONS.
-ANTICIPATE THE NEED FOR PAIN MEDICATION EVEN IF THE PATIENT DOES NOT ASK FOR IT.

24. -Long pauses of indicate that careful consideration is being given.
CULTURE
HEALTH BELIEFS
PRACTICES
PAIN
NATIVE AMERICAN
-A MEDICINE BAG MAY BE WORN BY THE PATIENT.
-TOBACCO IS SACRED AND HAS IMPORTANT CERMONIAL USE.
-A TRADITIONAL RITUAL THAT MAY BE USED FOR HEALING IS THE SWEAT LODGE.
-FOOD THAT IS BLESSED MAY BE THOUGHT TO BE HARMLESS.
-TRADITIONAL HEALERS MAY BE COMBINED WITH THE USE OF WESTERN MEDICINE.
-PATIENTS TEND TO BE STOIC.
-NOT EXPRESSING PAIN OTHER THAN BY MENTIONING THEY DO NOT FEEL GOOD.
-Anecdotes or metaphors may be used by the patient to describe his or her own health.
-Long pauses of indicate that careful consideration is being given.
-Loudness and a firm handshake are associated with aggressiveness.
-A present time orientation is common.

25. Cultural Awareness: White Privilege
White privilege (or white skin privilege) is a term for societal privileges that benefit people identified as white in Western countries, beyond what is commonly experienced by non-white people under the same social, political, or economic circumstances.
In order to reach out to minorities, we must understand that experiences are different.

26. Cultural Differences

27. Cultural Differences

28. Cultural Differences

29. Cultural Differences

30. Cultural Differences
A person acts according to the values and norms of his or her culture; another person holding a different worldview might interpret his or her behavior from an opposite standpoint. This situation creates misunderstanding and can lead to conflict.
A person acts according to the values and norms of his or her culture;
another person holding a different worldview might interpret
his or her behavior from an opposite standpoint.
This situation creates misunderstanding and can lead to conflict.

31. Cultural Differences Understanding Cultural Differences Eating Habits
Pork not eaten by Muslims considered dirty
Christians keep horses, dogs and cats as pets
Fish is neutral
Understanding
Cultural Differences
Communication
Language is culture specific
Avoid use of idiomatic expressions
Humor

32. Cultural Idiosyncrasies
NON -VERBALS
OTHER CULTURES
WESTERN CULTURE
SPACE
Personal space is influenced by status. A person of high status is normally granted more space.
No status Discrimination.
EYE CONTACT
Eye Contact is very brief, especially with superiors or members of the opposite gender
Generally engage in more eye contact. Considered to be more effective in communication.
VOICE VOLUME
Raised voices may simply imply an exciting conversation.
Americans typically interpret raised voices as a sign of anger or hostility.
SILENCE
Silence indicates respect, submit to guidelines of elders.
Indicates thinking, sickness etc. Else they feel uncomfortable with silence conversation.
TOUCH
Touch with much greater frequency. It is common for two men to hug and hold hands. Touching by opposite gender is considered uncomfortable.
Compared to other cultures, Americans rarely touch each other limiting themselves to handshakes and occasional pats on the shoulder or arms.
SMILE
Smile is used with greater frequency to smooth over awkward or embarrassing situations.
A smile is used with frequency to communicate friendliness and goodwill.
FACIAL EXPRESSION
Facial Expressions may vary to different situations like illness, excitement, embarrassment etc.
Japanese have most control on their facial expressions i.e. little to none variation.
TIME
Time is not considered as important. No respect of time.
Show respect of time by their punctuality.

33. Escalating Situations

34. De- Escalating Situations
Officer White Video One:

35. De- Escalate We must get rid of stinking thinking
We must speak up for truth and injustice
Don’t tolerate it…don’t be wall flower
There is distrust because the majority don’t speak up for the minority
It’s a common occurrence for minorities to be isolated and treated differently – let’s change that culture.
Officer White Video Two:

36. De- Escalate Respect for differences.
Walk down the hospital/clinic hall way…what do you see?
What are the ongoing solutions because they keep changing??
It’s not about who is right or wrong but being strong together (one will put to flight 1000, two 10,000).

37. Cultural Sensitivity Don’t be easily offended
Give the benefit of the doubt
Forgive
Laugh

38. Degrees of Cultural Awareness
My way is the only way (parochial stage)
I know their way, but my way is better (ethnocentric stage)
My way and their way (synergistic stage)
Our way (participatory third culture stage)

39. Developing Cultural Awareness
Develop awareness- take a look at your own:
Biases
Prejudices
Admit that you don’t know it all
Suspend judgment
Empathize
Systematically check your assumptions
Be comfortable with ambiguity
Celebrate diversity
Become aware of:
Cultural norms
Attitudes
Beliefs

40. Developing Cultural Awareness
Developing sensitivity and understanding of other ethnic groups.
It involves internal changes in terms of attitudes and values.

41. Cultural Knowledge
Intentionally familiarizing oneself with selected cultural characteristics, history, values, belief systems and behaviors of the members of another ethnic group.

42. Developing Cultural Awareness

43. Questions