1. DIVERSITY & DIFFERENCE IN HEALTH CARE CULTURAL DIVERSITY – includes: Race National Origin Religion Language Physical size Gender Sexual orientation Age Disability Socioeconomic status Geographic location

2. Personal beliefs Patients & providers each have their own beliefs & values which impact personal principles Some influences include: Cultural beliefs Social beliefs Religious beliefs Personal convictions Ethnocentrism –should be avoided by health care workers - Stereotypes – mistaken perceptions that are typically rooted in strong feelings and a lack of knowledge Differences among people should be appreciated and respected.

3. CULTURAL & ETHNIC DIFFERENCES Culture – a shared system of beliefs, values, and behavioral expectations that provide structure for daily living Factors Influencing Culture Beliefs Habits Likes dislikes Customs Rituals

4. FACTS About Culture: Helps provide a shared identity for cultural groups Influences member’s view of self, expectations, & how they behave in response to certain situations Practices can be shaped by social & physical environment Each new generation learns the norms, or expected behaviors of its culture through language, formal teaching, observation of elders Culture is made up of individuals – this means differences within each culture – HCP must not assume every member of a particular culture or ethnic group is exactly the same……

5. Subculture Group of people who are members of a larger cultural group – but whose attitudes/beliefs differ form the main group/culture ETHNICITY Sense of identification based on a common heritage through birth – adoption of group’s characteristics RACE Based on specific physical characteristics - skin pigmentation, body stature, facial features, hair texture Whites – African Americans-American Indians- Alaska natives – Asian Americans – native Hawaiians and other Pacific islanders(census cat.) Dominant Group – tends to control the society’ s values Minority Group – usually some difference that separates them from DG -race-religion – beliefs – customs/practices

6. Cultural Assimilation or ACCULTURATION Group loses cultural characteristics that once made them different They adopt attitudes of a group or new country Culture shock - - can produce stress, feel foolish, fearful, embarrassed, inferior - these feelings lead to frustration, anxiety, loss of self-esteem

7. PHYSICAL CHARACTERISTICS Some diseases that are/may be hereditary: Tay-Sachs Disease - rare genetic disorder - progressively destroys nerve cells in brain & spinal cord - Infants – normal first few months- but develop inability to move and eventually die - incidence has declined due to genetic testin g - Eastern European Jewish descent

8. KELOIDS -Overgrowth of connective tissue - Forms during healing from injury to skin - Does not heal level – heals rough, lumpy, or elevated scar - People with dark skin - more likely to develop - Seems to run in families which suggest genetic cause

9. LACTASE DEFICIENCY – (Lactose Intolerance) - all mammals milk contains lactose(a sugar) - Body needs lactase to breakdown lactose during digestion - w/o lactase – lactose ferments in intestine Lactase deficiency & lactose intolerance more common among: - Hispanic women & men - women of African, Chinese, Thai descent -People w/ lactase deficiency can drink milk substitutes or dairy products enriched w/ lactase

10. SICKLE-CELL ANEMIA - Hereditary disorder - body makes sickle-shaped or c-shaped red blood cells - breakdown more rapidly - shape prevents movement into smaller vessels in the body - can cause a blockage of red cells – - Primary groups affected: -People of African descent -Hispanics of Caribbean ancestry -Individuals w/ Middle Eastern, Indian, Latin American, Native American, or Mediterranean heritage

11. Psychological Characteristics People evaluate each other – attitude/behavior HP view can differ from patients view Patients concerns are very real to the patient – do not dismiss People interpret behaviors differently - standing close to someone - casual touch or direct eye contact

12. Reactions to pain Culturally influenced - some allow/encourage open expression of pain - some frown on open display HCP needs to understand patient display of pain - not all will complain or show Pain is a warning from the body that something is wrong Pain is what a person says it is & should be assessed carefully

13. Cultural Sensitivity for HCP Recognize culture is important part of an individual’ approach to the world Each person holds his/her own beliefs about health Respect the patient’s right to respond to HC issues in whatever manner they want Never stereotype a patient’s perceptions or responses based on their culture GENDER ROLES Some cultures-Males dominant and generally make decisions for family members Family confusion – who decides?? Some cultures – women are dominant and make the decisions

14. Time Orientation Americans – very - value promptness & punctuality - time perception is future- oriented OTHER CULTURES South Asians – some cultures view being late as sign of respect Some cultures more concerned with the present or past These views can impact patient care – Example – a patient whose culture focuses on the present may have issues understanding long-term care - HCP may have to explain need Some workers who are habitually late may be viewed as lazy/irresponsible – however – that person may be a hard worker whose culture does not value punctuality

15. FOOD & NUTRITION Discuss cultural differences France – corn is considered animal feed Asians – rice is a staple of many diets Southern Italians – pasta Some Hispanics cultures – beans – not all Mexicans – chili peppers & tortillas Caribbean Hispanics – beans w/ rice African Americans – fried food

16. Eating Patterns Based on Culture White Americans – 3 meals /day = eggs/bacon – sandwich/soup meat & potatoes Vietnamese – soup with almost every meal Middle Eastern Countries – often eat cheese/olives for breakfast Native American/Latin American people usually eat only 2 meals/ day Rural Southern African Americans eat large amounts of the weekends – with less during the week Holy days or Religious Holidays influence food choices in most cultures

17. Socioeconomic factors Middle & Upper middle class – have access to health care Low income – generally do not Upper income groups – tend to live longer & less disability Poverty – impacts older Americans and single mom families - leads to inadequate care – infants/children - poor diet - less preventative care - some cannot afford transportation - lack affordable/adequate housing(heat- h/c water, etc) - crowded living conditions leads to spread of disease - leads to low esteem, not taking care of self

18. age Younger people vs older people - Mind set Age, physical condition impacts health Communication – old vs. young As we age, body and health can change, but young people can be less healthy than older people RELIGION Beliefs & values will impact how HCP treat patients How to treat, what may be allowed Orthodox Jews may not be touched by women who are not family members Jehovah Witnesses – consider it a sin to receive the blood of another person in a transfusion -

19. Folk medicine A form of prevention & treatment that uses old-fashioned remedies & household medicines handed down from one generation to the next Nontraditional Healing: Cutaneous simulation – Therapeutic touch – Acupuncture – Acupressure – Natural remedies – herbs – herbal tea’s Complementary/Alternative Medicine – nutrition/exercise/relaxation = preventative medicine