1. Cultural Diversity in Health Care

2. Cultural Diversity Objectives Essential Questions
Identify the major ethnic groups in the United States
Examine the interrelationships of culture, religion, and ethnicity relative to health and illness beliefs and practices.
Identify, define, and discuss terms and factors relating to human relations Develop personal strategies for building good relationships
Explain the importance of human relations in an organizational setting Compare complementary medicine and alternative medicine
How does one’s culture influence health care decisions?
How does one's family influence heath care decisions?
Why do I have to be courteous to others of another culture?
What is Alternative and Complementary Medicine and why do we need to learn about it?

3. Culture
Set of values, beliefs, attitudes, languages, symbols, rituals, behaviors, customs of a group of people
Learned and shared
Dynamic and changing

4. Ethnicity Classification of people based on national origin or culture
Members of an ethnic group share heritage, national origin, social customs, and language
Examples: African American, Asian American, European American, Hispanic American, Middle Eastern/Arabic American, Native American

5. Race
Classification of people based on physical or biological characteristics
Involves multiple cultures and ethnic groups

6. Cultural Diversity
Differences based on cultural, ethnic, and racial factors
Culture is the way an ethnic group views the world
Traditions are passed on from one generation to the next
Healthcare providers must recognize and appreciate the characteristics of all patients

7. Cultural Diversity Impacts Beliefs
Birth
Death
Health
Illness
Health Care

8. Areas of Cultural Diversity
Family organization
Language
Personal space
Touching
Eye contact
Gestures
Health care beliefs
Spirituality
Religion

9. Areas of Cultural Diversity
Families form the basis of cultural social groups
Families organization determines who will make health care decisions

10. Areas of Cultural Diversity
Religious practices and spirituality
Give people a sense of wholeness and are influenced by cultural beliefs
Rituals are practiced by some religions, some involve objects that have religious significance
We must respect these rituals and treat religious objects with care

11. Guidelines for Developing Cultural Sensitivity
Review your own belief system
Consider how culture affects your own behavior
Look at all patients as individuals
Recognize that patients are a combination of heritage, culture, and community
Recognize that culture influences the way people behave and interact with others

12. Guidelines for Developing Cultural Sensitivity
Handle religious articles with respect
Provide privacy when a spiritual advisor is visiting or when the patient is practicing a devotional act
Learn about cultural beliefs and practices of the cultural groups in your community
Politely ask patients about unfamiliar practices
Attend staff development classes that promote cultural sensitivity

13. South African
Harmony with nature
Harmony of mind, body, and spirit

14. Asian Physical and spiritual harmony with nature
Balance of yin and yang

15. European
Personal responsibility with diet, rest, exercise, and prevention

16. Hispanic
Good luck
Reward from God
Balance between hot and cold forces

17. Middle Eastern/Arabic
Spiritual Causes
Cleanliness

18. Healthful Hints from Long Ago
“A sassafras root carried in the pocket guards against illness.” (superstition of Old Saint Simons)
“Asafetida worn on a string around the neck protects a child from many diseases, and a buckeye carried in the pocket protects against rheumatism.” (Blue Ridge and Great Smokey Mts.)

19. “ A single, pierced nutmeg, worn around the neck on a string, will protect you from boils, croup, body lice, and various lung diseases.” (New England)
“A well-ventilated bedroom will prevent morning headaches and lassitude.” (1914 Almanac)

20. Illness Abnormal functioning of a body’s system or systems
Causes vary based on cultural/ethnic background

21. South African
Spirits/demons
Conflicts in life
God’s punishment

22. Asian Imbalance of yin and yang Supernatural forces
Unhealthy environment

23. European
Sin
Outside sources: microorganisms, toxins

24. Hispanic
Sins
Fright
Evil Eye
Envy
Imbalance between hot and cold

25. Middle Eastern/Arab
Sins
Evil Eye
Spiritual causes

26. Native American Supernatural forces Violation of a taboo
Imbalance between man and nature

27. Folk Remedies Beliefs and practices ethnically similar
Religion plays a role in perception of, interpretation of, and behavior in health and illness
Women are usually the prime caregivers
Can create delay in seeking professional help

28. Preventions
Jewish: camphor around the neck in winter in a small cloth bag to prevent measles and scarlet fever
Black and Native Americans: blackstrap molasses
Black Africans (Ethiopia): eat hot & sour foods i.e. lemons, fresh garlic, pepper

29. Preventions
Germans: no sweets at meals, drink glass of water at meals, cod-liver oil, plenty of milk, spring tonic (sulfured molasses)
Islam: dress properly for the season & weather, keep feet from getting wet in the rain

30. Preventions: Irish Clean out bowels with senna for 8 days
Spring tonic of sulfured molasses
Onions under the bed to keep nasal passages clear
Bag of camphor around the neck during flu season

31. Preventions: Irish Never go to bed with wet hair
Don’t look in the mirror at night & close closet doors (prevents evil spirits)
Eat lots of oily food
Take Father John’s Medicine every so often

32. Preventions: Italian
Garlic cloves strung on a piece of string around neck of infants and children to prevent colds and “evil” stares
Red ribbon around neck of infant does the same thing
Never wash or bathe during period

33. Preventions: Italian Never wash hair before going outdoors or at night
Keep a pair of open scissors under mattress of crib to prevent “evil” in newborn
Wrap a bandage around the baby from the waist to the feet for 1st 6 months to prevent bowlegs

34. Home Treatments: Jewish
Sore throat: find salted herring, wrap it in a towel, put it around the neck, let it stay there overnight, gargle with salt water
Boils: fry chopped onions, make a compress and apply to the infections

35. Home Treatments: Blacks/Native Americans
Bloody nose: place keys on chain around neck
Sore throat: suck yolks out of egg shell, honey and lemon, baking soda, salt , warm water, onions around the neck

36. Home Treatments: Black African
Evil Eye: put some kind of plant root on fire and make the man who has the evil eye smile and the man talks about his illness

37. Home Treatments: Germans
Coughs: honey & vinegar; boiled onion water, honey, & lemon; hot water & Vicks
Swollen glands/mumps: put pepper on salt pork and tie around the neck
Earache: few drops of warm milk in the ear, laxatives when needed

38. Home Treatments: Germans
Sty: cold tea-leaf compresses
Fever: mix whiskey, water, & lemon juice to drink before bed (causes person to sweat and break fever)
Constipation: Ivory soap suppositories

39. Home Treatments: Islam
Sore throat: gargle with vinegar and water
Indigestion: baking soda and water
Sore muscles: alcohol and water
Rashes: apply corn starch

40. Home Treatments: Irish
See doctor only in an emergency
Earache: heat salt, put in stocking behind ear
Fever: spirits of niter on a dry sugar cube
Colds: hot lemonade and a tablespoon of whiskey; egg whites; ipecac

41. Home Treatments: Irish
Coughs: linseed poultice on chest; flaxseed poultice on back; red flannel cloth soaked in hot water and placed on chest all night
Menstrual cramps: hot milk sprinkled with ginger, glass of warm wine, hot-water bottle on stomach

42. Home Treatments: Irish
Nausea: castor oil, hot ginger ale, cup of hot boiled water
Sore throat: paint throat with iodine, honey and lemon, Karo syrup; paint with kerosene oil with rag then tie sock around the neck; paint with iodine or Mercurochrome and gargle with salt water, honey melted Vicks

43. Home Treatments: Italian
Chicken soup for everything
Boils: cooked oatmeal wrapped in a cloth (steaming hot) and applied to drain pus
Headache: kerchief with ice in it wrapped around the head
Cramps: crème de menthe

44. Home Treatments: Italian
Acne: apply baby’s urine
To build up blood: eggnog with brandy; Marsala wine and milk
Backache: place a silver dollar on the sore area and light a match to it, while the match is burning put a glass over the silver dollar and slightly lift the glass, this causes suction which lifts the pain out

45. Healthcare Providers’ Culture
Cultural Diversity in Health and Illness, Second Edition, p.70

46. Beliefs “Standardized definitions of health and illness
“The omnipotence of technology”

47. Practices
“The maintenance of health and the prevention of disease through such mechanisms as the avoidance of stress and the use of immunizations”
“Annual physical examinations and diagnostic procedures such as Pap smears”

48. Habits “Charting” “The constant use of jargon”
“ Use of a systematic approach and problem-solving methodology”

49. Likes
“Promptness”
“Neatness and organization”
“Compliance”

50. Dislikes
“Tardiness”
“Disorderliness and disorganization”

51. Customs
“Professional deference and adherence to the ‘pecking order’ found in autocratic and bureaucratic systems”

52. Customs
“Handwashing”

53. Customs
“Employment of certain procedures attending birth and death”

54. Rituals “The physical examination” “The surgical procedure”
“Limiting visitors and visiting hours”

55. Cultural Beliefs Concerning Epidemiology and Pain
Medical culture is in direct opposition sometimes
Bacteria/viruses/carcinogens/pollutants versus “soul loss”/”spirit possession”/voodoo/witchcraft
Free, open expression of feelings versus never revealing true feelings

56. Examples of Cultural Clashes
“Mr. Smith in room 222 is the ideal patient. He never has a single complaint.”
Are you sure he has no complaints or is it his cultural influence not to be a bother?

57. Examples of Cultural Clashes
“Mrs. Cohen in room 223 is a real complainer. She is constantly asking for pain medication and putting on her light.”
Is she really in pain or is it her cultural programming concerning dealing with pain?

58. Examples of Cultural Clashes
“Mr. Chen in room 225 says nothing. I often wonder what he is feeling.”
What is really happening with Mr. Chen?

59. Healthcare Providers
Must change to accommodate other cultural beliefs and behaviors towards health and illness

60. Religion and Healing Vital role in perception of health and illness
Rites surrounding birth and death
Diet

61. Traditional Etiology: Evil Eye
Power of eye strikes victim
Injury, illness, misfortune is sudden
Person with evil eye may not know it
Victim may not know source of evil
Prevented or cured by rituals/symbols, removal of spell or evil agent
Explains sickness and misfortune

62. Traditional Methods of Prevention

63. Protective Objects
Amulets
Bangles
Talismans

64. Protective Substances
Garlic
Onions
Chachayotel
1000 year old eggs
Kosher foods

65. Protective Religious Practices
Social, moral, dietary practices
Burning candles
Rituals of redemption
Prayer

66. Examples of Saints for Protection
Blessing of the Throats on St. Blaise Day
Virgin of Guadalupe
St. Anthony of Padua: barren women
St. Odilla: blindness
Our Lady of Lourdes: bodily ills

67. Beliefs Affecting Therapy
Use of healers with divine powers
Natural products: herbs, berries
Purgatives
Blood-letting
Removal of person with evil eye
Avoidance of provocation of envy

68. Forms of Spiritual Healing
Inner healing
Physical healing
Deliverance or exorcism
Auric healing
Pilgrimages

69. Healthcare Providers Must Be Aware of the Multitude of Sources Outside of Mainstream Medicine!
Embrace Diversity in Medicine. Teach Tolerance to Healthcare Providers!