1. Learn About Cultural Diversity Competencies

2. Diversity
“Our flag is red, white and blue, but our nation is a rainbow—red, yellow, brown, black and white—and we’re all precious…”
Jesse Jackson, July 16, 1984.

3. What Is Diversity? It’s the differences that make each person unique!
In the past
Today

4. In the Past
This country has been called “the great melting pot.” Customs and cultures from many lands were expected to blend together, like ingredients in a cream soup.

5. Today
We’re starting to realize that the U.S. is more like a tossed salad -- a variety of flavors, textures, colors and shapes.

6. Why Should I Learn About Diversity?
Because diversity can enrich your life -- and your world. Understanding and appreciating differences helps:
Individuals
Communities
Groups

7. Individuals
Who can gain new insights and outlooks - while enjoying new relationships.

8. Communities
Which can tap the varied talents of their members to help meet common goals.

9. Groups
Of every size - from classrooms to boardrooms. When uniqueness is respected, morale and productivity improve. Businesses that appreciate diversity have the leading edge in today’s global marketplace.

10. Diversity Transforming Our Nation
For centuries - American education, business and government have reflected the culture of the vast majority: white people of European descent.

11. In the Year 2000 In the year 2000 - out of every 100 workers:
10 were immigrants
16 were U.S.-Born Hispanic, African American or other people of color
47 were women (including 12 women of color)

12. In the Year 2000 (cont)
32 were U.S.-Born white men
Note: total is more than 100 because immigrant women and women of color were counted twice
Out of every 100 children in American classrooms, 33 were children of color

13. What Makes Each Person Unique?
Many things make each of us an individual. These include:
Appearance (gender, body size, skin color, hairstyle, clothing, etc.)
Ethnicity and culture (customs, traditions, language, etc.)
Age
Family life (values, family size, etc.)

14. What Makes Each Person Unique?
Religious, spiritual or philosophical beliefs
Income or social status
Sexual orientation
Physical and mental abilities
Life experiences
Educational background

15. Take a Look at Others.
We all make judgments about people based on our experience with them.
But…
When we make a judgment before getting to know someone, we “pre-judge” the person (the source of the word “prejudice”).
When we assume everyone in a certain group is the same, we stereotype and don’t see people as individuals.

16. Prejudice and Stereotypes Hurt Everyone
Avoid forming prejudices and stereotypes. Whether they’re negative (“only wimps cry”) or positive (“all African-American women are strong”).

17. Prejudice and Stereotypes Hurt Everyone
They can:
Keep us from knowing individuals
Cut us off from fresh ideas
Limit a person’s opportunities
Make a person feel rejected or resentful. He or she may even come to believe the stereotype!

18. People Differ in Many Ways.
For example, cultural background (including ethnicity) can influence the way people communicate through:
Body language
Listening
Speaking
Expressing opinions
Working style

19. Body Language
In some cultures, people often stand close together. The closeness may be uncomfortable to a person from another culture.

20. Body Language
In other cultures, people often stand farther apart. The distance may seem unfriendly to a person from another culture.
Direct eye contact is considered rude in many cultures.

21. Listening
In some cultures, listeners tend to look at speakers and not, say “uh-huh,” etc., To show they’ve understood.
In other cultures, listeners tend to look silently away while someone is talking. A person from a different culture may interpret this as a lack of interest or understanding.

22. Speaking
In some cultures, speakers tend to look away from their listeners. A listener from a different culture may interpret this as discomfort or avoidance.
Speakers in other cultures tend to look at their listeners intently. A listener from a different culture may interpret this as aggression.

23. Expressing Opinions
People in some cultures believe it’s rude to complain or say no. They signal discomfort in more subtle ways. A person from a different culture may miss these signals and assume all is well.

24. Working Style
In some cultures, people put a lot of value on hard work and saving time.
In other cultures, good relationships and a relaxed atmosphere may be more important than strict deadlines.

25. But, Watch Out!
Cultural background is only one thing that makes people unique. It’s important not to assume that a person’s culture explains his or her words or actions. Always make a point to get to know the person as an individual.

26. You Can Get More Out of Relationships.
Here are some tips:
Be open about differences
Don’t assume anything
Encourage questions
Develop friendships
Don’t make someone a spokesperson

27. You Can Get More Out of Relationships.
Don’t tell ethnic or sexual jokes
Make your feelings known
Remember that mistakes happen

28. Be Open About Differences
-- don’t ignore them. Share how your background has influenced you. Invite others to do the same.

29. Don’t Assume Anything -- check it out. For example:
Find out if David Harris prefers to be called “Mr. Harris,” “David” or “Dave.”
Ask a working mother if she’d like to work overtime or go on a business trip -- don’t assume she’d rather be home.

30. Encourage Questions
About the things that make you different. Ask questions in return. (“I’d like to learn about the holidays you celebrate. Will you tell me about them?”)

31. Develop Friendships
With people who are different from you. Share any concerns. For example, if a new friend has a disability, you might ask, “does it help if I hold the door for you, or would you rather I not?”

32. Don’t Make Someone a Spokesperson
For his or her group (“so, what do Hispanics think about this?”). Don’t suggest the person is an exception, either (“you’re not like other African Americans I’ve met.”).

33. Don’t Tell Ethnic or Sexual Jokes
-- even jokes about your own group. They just encourage more of the same. Be careful with other kinds of humor (such as the “friendly insult”) until you know how others feel about it.

34. Make Your Feelings Known
… if someone makes unfair remarks about a group. Let them know their comments are not right.

35. Remember That Mistakes Happen
Especially when people are under stress. Changing old habits and ways of thinking takes time.
Apologize, if you’ve been unfair.
Forgive, if you’ve been offended.

36. Get More Information About our diverse society: Watch TV documentaries
Listen to radio stations
Read magazines
Attend workshops
Contact organizations
Get firsthand experience

37. Get More Information
Watch TV documentaries... Plays and movies about different groups. (But don’t assume a show about customs, dress, etc., In another country reflects the lives of its immigrants here.).
Listen to radio stations that broadcast music and programs from around the world.

38. Get More Information
Read magazines - books and newsletters written by -- and for -- people of other backgrounds.
Attend workshops - on understanding diversity, communication skills, conflict resolution, etc.

39. Get More Information
That support different groups. They may offer literature, videos, exhibits or speakers.
Get firsthand experience by traveling, attending cultural and community events, etc.

40. Celebrate Diversity! Take pride in your own uniqueness.
Welcome others as individuals with special qualities.
Enjoy your similarities -- and your differences.

41. What Are Cultural Competencies?
They’re the skills you use to work well with patients of all cultures. These skills include:
Considering a patient’s culture when giving care
Treating each patient as an individual

42. Considering a Patient’s Culture When Giving Care
Culture -- the values, beliefs and practices shared by a group -- can affect how a patient views health care. A patient may belong to ethnic, regional, religious and other groups.

43. Treating Each Patient As an Individual
It’s important to consider culture. But it’s also important to:
Avoid stereotyping
Consider other factors that may affect care, such as age
Learn about each patient’s unique views on health care

44. Why Learn About Cultural Competencies?
Because developing cultural competencies benefits everyone. You can:
Help patients receive more effective care
Help your facility meet JCAHO standards
Improve your job performance

45. Help Patients Receive More Effective Care
Taking patients’ cultural views on health into account helps maintain their right to be treated with respect. They also respond better to their care.

46. Help Your Facility Meet JCAHO Standards
Awareness of cultural factors can improve patient and family education -- one area of focus for the JCAHO (joint commission on accreditation of healthcare organizations) survey.

47. Improve Your Job Performance
Helping patients get the best possible care can also increase your job satisfaction.

48. Caring for Patients From Many Cultures Is an Important Part of Health Care Today!

49. Know Your Own Cultural Beliefs and Practices.
Think about how your culture and upbringing affect you. For example, you may have certain ideas about:
How to show politeness when talking with someone.
Acceptable ways to express pain.
How often to seek medical care.
Appropriate ways to treat children or older people.

50. Be Aware of the Culture of Health Care in the U.S.
For example:
Patients are expected to arrive at exact appointment times. But some patients may think of a time as referring to a general part of the day -- for example, 2:15 as mid-afternoon.
Self-care is often promoted in treatment. But in some cultures, family and others are expected to play a leading role.

51. Use the Information in This Booklet As a Starting Point to Develop the Skills You Need for Your Job.

52. There Are Many Cultural Factors to Be Aware of.
They include a patient’s:
Country of origin
Preferred language
Communication style
Views of health
Family and community relationships
Religion
Food preferences

53. Country of Origin
Most people who live in the U.S. have roots in other countries. How long a person has lived here may affect his or her views toward health.

54. Preferred Language
Patients who are encouraged to talk or read about care in their own language may:
Feel more at ease.
Understand their care better.

55. Communication Style
Nonverbal and verbal styles may differ. For example, culture may affect how -- or whether -- a patient expresses pain.

56. Views of Health The patient may see an illness as:
Having a supernatural cause, such as punishment for sins.
Needing a certain traditional cure, such as an herbal remedy or a specific diet.

57. Family and Community Relationships
A patient may expect certain people to be:
Involved in his or her care
Allowed to visit

58. Religion A patient’s religion may affect his or her:
Consent to treatment
Schedule of care or room arrangement (because of certain prayer practices, for example)
Birth and death practices

59. Food Preferences
Religious, healing and other cultural practices all can affect what foods a patient may eat or avoid.

60. Developing Cultural Competencies
Does not mean knowing everything about every cultural group you work with. It does mean:
Being aware of cultural factors
Taking appropriate steps to learn about each patient, such as asking questions
Developing the cultural competencies needed for your job means you can help patients of all cultures feel better about their care

61. Take Time to Learn About Each Patient.
Ask questions to avoid cultural stereotypes.
Learn the patient’s views about health.
Learn about accepted ways to show respect.
Understand relationships.
Consider privacy needs.

62. Ask Questions to Avoid Cultural Stereotypes.
It’s important to have general knowledge about a culture. But, it’s also important to assess each individual patient because:
Differences exist among members of the same cultural group.
Cultures change over time.
Climate, war, etc., In another country may have affected an immigrant’s health.

63. Learn the Patient’s Views About Health.
For example, ask:
What are you doing to care for your illness? How has it worked?
Is anyone else treating your illness?
What is he or she doing?

64. Learn the Patient’s Views About Health.
For example, ask:
Accept the patient’s practices whenever possible. (When needed, discuss any health risks of the patient’s remedies or diet -- including drug, or food and drug, interactions.)

65. Learn About Accepted Ways to Show Respect
For example, ask how a patient prefers to be addressed.

66. Understand Relationships
For example:
Ask about the patient’s family. Allow extended family to visit, take part in care or be present during death, if these are the expected practices.
Ask about healers and spiritual leaders who may be involved in care -- and other ways the patient’s community may provide support.

67. Understand Relationships
For example:
Ask whether the patient takes part in any support groups.

68. Consider Privacy Needs
For example:
Ask about privacy concerns, such as being touched or being unclothed. Respect privacy as much as possible -- by letting a patient keep a certain garment on, bathe him- or herself, etc.
Build trust. A patient may need time to feel comfortable discussing a problem or undergoing a procedure.

69. Work With the Patient and Others to Find the Best Approach to His or Her Care.

70. Communicate Effectively.
Listen to how the patient talks about his or her condition.
Ask indirect questions, if needed.
Look for clues.

71. Communicate Effectively.
Talk with others who know the patient.
Ask for the patient’s views on treatment.
Use interpreters effectively.

72. Listen to How the Patient Talks About His or Her Condition.
For example:
Ask how he or she refers to it. (For example, some cultures classify illnesses as “hot” or “cold” and treat each type differently.) Ask for any details you may need to understand better.

73. Listen to How the Patient Talks About His or Her Condition.
For example:
Ask what he or she thinks is causing it.
Some patients may expect you to have answers -- not questions. Explain that knowing the patient’s views helps you give better care.

74. Ask Indirect Questions, If Needed.
Direct questions may make some patients uneasy. For example, ask how a healer or someone else from the culture would treat the illness.

75. Look for Clues. For example, take note of whether the patient:
Wears or displays objects that may be religious
Makes or avoid eye contact
Keeps a certain distance away or tries to be closer

76. Talk With Others Who Know the Patient.
If a spouse or other family or community member is involved in care, ask for his or her views of the condition.

77. Ask for the Patient’s Views on Treatment.
Explain the recommended treatment and procedures.
Ask the patient (and family, if necessary) if the approach sounds like it will work for him or her. Consider other approaches, if needed.

78. Use Interpreters Effectively.
For example:
Use a trained medical interpreter whenever possible
Avoid using family members. They may lack medical knowledge, or other issues may prevent full discussion of the patient’s condition

79. Never Assume You Know Something About a Patient -- Even One Who Does Not Appear to Have Any Cultural Differences From You.

80. Consider Other Factors That May Affect Care.
These include:
Age
Gender
Sexual orientation
Socio-economic status
Presence of a physical or mental disability

81. Age
For example:
An older patient may assume certain problems are a normal part of aging and not mention them.
An adolescent may be sensitive about privacy or how treatment will affect his or her appearance.

82. Gender
For example:
A patient may prefer to receive care from someone of the same sex.
Cultural values may prohibit touching between members of the opposite sex -- including spouses during certain times, such as childbirth.

83. Sexual Orientation
A patient who is unsure of a health-care provider’s response may not mention being gay, lesbian or bisexual. Asking questions that avoid assuming sexual orientation can help put him or her at ease.

84. Socio-economic Status
For example:
Financial hardship may keep a patient from seeking or following treatment.
Classes may exist within a cultural group, based on income or other factors. A patient’s beliefs and practices may be related to his or her class.

85. Presence of a Physical or Mental Disability
Patients may have different views about:
How disabling a certain condition is
How to explain a psychological condition -- for example, some may consider it a mental illness, others the result of a supernatural force

86. Use Cultural Competencies With Co-workers, Too.
You may work with people from many cultures. When staff members make the effort to work well together:
Job satisfaction increases
Patients receive the best care

87. Learn More About Cultural Competencies in Patient Care.
Find out about the cultural groups
Find out more about the skills involved

88. Find Out About the Cultural Groups Your Facility Serves
Borrow materials from our facility’s library. Also check local libraries.
Attend a group’s event, such as a festival.
Contact co-workers, community leaders and organizations from different groups. Ask if they have any information to share.

89. When You Appreciate Diversity, You Enrich Your World.

90. Learn About Cultural Diversity Competencies
This educational opportunity has been developed by Education, Training and Development (ETD) Southern Arizona VA Health Care System Adapted by the James A. Haley Learning Resources Subcommittee and Information Management Service Click here for the Competency Quiz
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Learn About Cultural Diversity Competencies