1. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 1 CHAPTER 5 CULTURE AND HEALTH CARE

2. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Culture Overview   Importance of cultural values and connections on health care   Patient’s culture   Health care worker’s cultural background   Culture   Act of belonging to a designated group   “Colo” Latin – to cultivate   Effect is unconscious

3. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Culture Is Reflected in Many Aspects of Life   Eating habits   Language   Dress   Hobbies   Living patterns   Occupational choices   Education   Religious affiliations   Political points   Interpersonal relationships

4. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Acculturation   Learning cultural behaviors from one group or person   Evolves slowly   Always occurring   Subcultures within each large cultural group   Can be broad and varied   United States Census Bureau   Collects data on U.S. population every 10 years

5. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Table 5-1

6. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Ethnography   Branch of anthropology   Studies and records human cultures   Ethnographic studies provide information to teach cultural competence

7. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Cultural Impact on Health Care   Every interaction with a patient has cultural implications

8. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Wellness and Health Prevention   Various cultures have different views on preventive medicine   Exercise   Preventive doctor visits   Immunizations

9. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Touch and Physical Space   Differing views on close touching and human contact   As a health care worker:  Always ask permission before touching any patient, regardless of cultural differences  Be alert to positive or negative signs

10. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Communication   Vital to our survival   Language   Language barriers affect communication   Language is a form of cultural connection   Assimilation   Process of accepting and exchanging cultural information

11. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 11 General and Invasive Procedures   Important for the health care worker to be sensitive to patients who are not comfortable in removing clothing for examinations or who fear invasive procedures.   All health care team members should announce their arrival and wait a few moments before entering a room.

12. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Dietary Needs   Social tool and biological need   Many ethical and religious implications with food   All attempts should be made to meet the patient’s nutritional needs and preferences

13. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Box 5-1 Yin and Yang Foods

14. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Spirituality   Essential for recovery and strength for many ethnicities   Belief should be accepted and assistance offered when requested   Using incorrect terminology is a sign of great disrespect

15. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Death   Views vary greatly   Rituals vary greatly   Deaths from suicide have many cultural implications

16. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Medications   Actions and side effects vary based on patient ethnicity   FDA and ISMP studies Antilipemic drugs BiDill Drug dosage

17. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Pain Management   Beliefs about pain vary   Important for the health care worker to use listening and assessment skills to look for nonverbal cues of pain

18. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Other Cultural Differences That Have an Impact on Health Care   Refusal to give blood or get blood transfusions   Refusal to donate or receive organ transplants   Refusal to place aging parents into nursing home   Fertility control   Mental illnesses

19. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Signs of Cultural Barriers   Important to listen to the patient closely and look for nonverbal cues   Signs that cultural barriers exist:   Resistant to change   Uncooperative   Argumentative   Overly agreeable and flaccid   Noncompliance after multiple teaching attempts

20. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Obstacles to Cultural Competence   Ethnocentrism   Belief that one’s own culture is superior to another Often unconscious Seen in many daily activities   Health care provider cannot allow this to interfere with providing care

21. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Obstacles to Cultural Competence (Continued)   Stereotyping   Seeing or viewing patients in one ethnic group all molded together as one Assumes conformity   Patients need to feel trusted and safe   Prejudice and discrimination   Stereotyping can lead to prejudice, which leads to discrimination

22. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 22 All health care providers must agree to care for patients regardless of race, age, color, sex or ethnic origin. All health care providers must agree to care for patients regardless of race, age, color, sex or ethnic origin.

23. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Overcoming Obstacles   Explore personal ideas and perceptions about different cultures   Learn as much as you can about local cultures   Always use the patient’s family name unless given permission to use first name only   Be aware of eye contact

24. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Overcoming Obstacles (Continued)   Encourage patients to talk about their illnesses and look for areas of misunderstanding   Look for confusion and fear   Treat all patients with respect, concern, and compassion   Recognize that other cultures are not as time sensitive as Americans   Respect spirituality