Diversity in health care

1. Dynamics of Care in Society 1 Diversityin health care

2. Differentiate between culture, ethnicity, and race Identify some of the major ethnic groups in the US Provide an example of acculturation in the US Create an example of how bias, prejudice, or stereotype can cause barriers to effective relationships Describe ways to avoid bias Differentiate between a nuclear and extended family Identify ways in which language, personal, space, touching, eye contact, and gestures are affected by cultural diversity Compare and contrast the diverse health beliefs of different ethnic/cultural groups Give examples of how health care providers can show respect for an individual’s beliefs & for cultural diversity Objectives

3. Watch “it’s a small world” 2 min

4. Surgeon’s Dilemma A young man who had been badly injured in a car accident has been brought into a hospital's accident and emergency department. The doctor determines that emergency brain surgery is required. Accordingly, the brain surgeon is paged. Upon seeing the patient, the surgeon exclaims, ‘My God, I can't operate on that boy! He's my son!’ That is so, but the surgeon is not the boy's father. How can the apparent contradiction be explained? Do Now:

5. Culture • The values, beliefs, attitudes, languages, symbols, rituals behaviors, and customs unique to a particular group of people that is passed from on generation to another Includes: • Family relations • Child rearing • Education • Occupational choice • Social interaction • Spirituality • Religious beliefs • Food preferences • Health beliefs • Health care

6. Culture is learned. Culture is shared. Culture is social in nature. Culture is dynamic and constantly changing. Culture

7. Ethnicity • A classification of people based on national origin and/or culture. • Members share a common heritage, geographic location, social customs, language, and beliefs. Common Ethnic Groups • African American • Asian American • European American • Hispanic American • Middle Eastern / Arabic American • Native American

8. Classification of people based on physical or biological characteristics including: • Color of skin, hair, and eyes • Facial features • Blood type • Bone structure • Cuts across multiple ethnic/cultural groups Race

9. Gender: refers to the cultural and social differences that distinguish men from women Sex: refers to the biological differences that distinguish males from females Gender equality: the conditions under which girls and boys, women and men, can reach their full potential without discrimination (through equal access to nutrition, health care, education, and opportunities to make decisions in their households and communities, it also includes legal equality) Gender

10. Cultural Diversity • Differences based on culture, ethnicity, and race that influence one’s behavior, self-perception, judgment of others, and interpersonal relationships • Includes: • Family organization • Language • Personal space • Touching • Eye contact • Gestures • Health care beliefs • Spirituality • Religion

11. Absorption of a culturally distinct group into a dominant or prevailing culture Requires that a cultural group alter their unique beliefs and behaviors and adopt the ways of the dominant culture However, in the US, we are striving for a society where cultural differences are appreciated and respected. Cultural Assimilation

12. The process of learning the beliefs and behaviors of a dominant culture and assuming some of the characteristics. • Occurs slowly over a long period of time. • Example: • Recent immigrants are more likely to use the language and follow the behavior patterns of their origin country than their children or grandchildren • ex: become more “Americanized” Acculturation

13. DO NOW: • EVERYONE HAS CULTURE…ANSWER THE FOLLOWING & THEN RANK THEM IN ORDER OF IMPORTANCE • What music do you like to listen to? • What kind of traditions do you have? • What foods do you like? • What holidays are important to you? • What is most important in life to you? • Is you extended family important to you? Why or Why not?

14. The ability to recognize and appreciate the personal characteristics of others. It is essential for health care professionals to understand and respect these differences to provide care that meet the needs of all individuals. Sensitivity

15. A preference that inhibits impartial judgment of others • Common biases: • Age • Education • Physical size • Occupation • Sexual preference • Gender Bias

16. A strong feeling or belief about a person or subject that is formed without reviewing facts or information Causes fear and distrust of others Interferes with interpersonal relationships Health care workers must be aware of our prejudices and to make every effort to obtain as much information about a situation as possible Prejudice

17. Process of assuming that everyone in a particular group is the same • It ignores individual characteristics and “labels” the individual • May occur with regard to: • Race • Gender • Body size • Occupation • Ethnicity Stereotyping

18. Stereotyping vs. Generalization • A stereotype is an ending point. • No attempt is made to learn whether the individual in question fits the statement. • Stereotyping can have negative results. • We often stereotype people simple on the basis of appearance.

19. Stereotyping vs. Generalization • A generalization is a beginning point. • It indicates common trends, but further information is needed to ascertain whether the statement is appropriate to a particular individual. • It is important to remember that there are always differences between individuals. Do Now online: At Face Value: Issues with Stereotypes

20. Stereotypes vs Generalizations animation 4min Clip Sneeches 12min • Mark’s Story Disabled (8 min) may have to use google chrome • Follow with ws “Stigma of Disease”

21. dig·ni·ty 1. bearing, conduct, or speech indicative of self-respect or appreciation of the formality or gravity of an occasion or situation. 2. nobility or elevation of character; worthiness: dignity of sentiments. FOR STIGMA OF DISEASE back com·pas·sion a feeling of deep sympathy and sorrow for another who is stricken by misfortune, **accompanied by a strong desire to alleviate the suffering.

22. FOR Yellow case studies Clubfoot is a congenital condition (which means it is present at birth) in which one or both feet turn inward and downward or up and out at the ankle. The affected foot looks very similar to a golf club. If the condition is not treated during infancy, or before the child begins walking, risks may include: Smaller calf muscle of affected foot Walk on the outside or top of the foot Inability to walk normally Inability to move ankle/foot up and down May be related to another birth defect Additional problems involving muscles, tendons, ligaments, and joints in ankle and foot Increased risk of arthritis Infection Development of calluses

23. Each individual must be regarded as a unique individual • Ways to achieve this goal is to: • Listen as patients express their beliefs • Appreciate individual different differences • Learn more about cultural and ethnic groups in your area • Recognize signs of prejudice, bias, or stereotyping Respecting Cultural Diversity

24. Be conscious of your own personal and professional values and beliefs Learn as much as you can about different ethnic/cultural groups Be sensitive to behaviors and practices that are different from your won Remember that you do not have to adopt others’ beliefs, but you must respect them Overcoming Bias, Prejudice, and Stereotyping

25. We need to feel listened to and valued so caring Staff will need to have a good knowledge of many different religions and cultures Ask the individual or the family what it is that they need and what they want the staff to be aware of. Irrespective of whether or not a person belongs to a religious or cultural group they will have preferences and needs which are individual and personal.

26. Think! If you have ever needed Health care– how did you feel? ANXIOUS IN PAIN/ FEELING ILL CONFUSED SCARED ISOLATED

27. Group Exit Card: • What would you most like the staff caring for you to know about you, about your culture? • What would you most like them to understand? • In Groups make a list of the things you would like considered if you had to go into hospital

28. Main areas that people of various cultures will be concerned about: • Food • Modesty • Clothing/ jewelry • Hygiene • Family planning • Childbirth • Blood transfusions • Care of the dying/death • Post mortems • Organ transplantation

29. Develop friendships with a wide variety of people Ask and encourage questions from others to share ideas and beliefs Evaluate all information before forming an opinion Be open to all differences Avoid offensive language and jokes Understand that mistakes happen. Apologize and forgive. Overcoming Bias, Prejudice, and Stereotyping

30. Health care provides must determine a patient’s ability to communicate and intervene to help those who do not understand English by use of: • Translators • Family members • Gestures or pictures • Cue cards(read handout) Language

31. The distance people require to feel comfortable when interacting with others Varies greatly among ethnic/cultural groups Health care providers must be alert to a patient’s verbal and nonverbal cues to determine personal space Personal Space

32. Eye contact is affected by cultural beliefs Lack of eye contact is usually interpreted as “not listening” but in some cultures is a sign of respect Health care workers must be alert to an individuals comfort level when using direct eye contact and adjust accordingly Eye Contact

33. Are used to communicate (remember non verbal communication) Can vary among ethnic/cultural groups Health care providers must be aware of how a patient responds to gestures and avoid any that seem to be offensive Gestures

34. Vary widely throughout all groups • Can affect an individuals response to health care • Most cultures have common conceptions regarding: • The cause of illness • Ways to maintain health • Appropriate response to pain • Effective methods of treatment Health Care Beliefs

35. Reactions to Pain & Other Health Issues • Response to pain is culturally influenced • Patient in pain may not show it • Listen to patients who freely express their discomfort • Recognize influence of cultural & individual beliefs about health • Respect patient’s right to react to health care issues any way he wants to • Don’t stereotype a patient’s perceptions or responses based on culture Health Care Beliefs

36. An organized system of belief in a superhuman power or higher power Are associated with a particular form or place of worship May include beliefs about birth, life, illness, death, and dietary practices Atheist – one who does not believe in any deity Agnostic – one who believes that the existence of God cannot be proved or disproved Religion

37. Jehovah's Witnesses Religious Beliefs regarding blood transfusions Jehovah's Witnesses have sincerely held views, based on the Bible, that taking blood into one's body is morally wrong. This includes whole blood or its components, such as packed red cells, plasma, white cells and platelets. Jehovah's Witnesses are allowed to choose about whether to accept products such as albumin, immunoglobulin or clotting factors. Blood samples may be taken for pathological testing as long as any unused blood is disposed of and not reused. Dialysis will usually be accepted provided that no other source of blood is used. Jehovah's Witnesses will accept medical treatment in all other respects apart from those involving the use of blood or blood components. Article here

38. A Day in the Sleep Clinic (use handouts) Culture & HC Activity

39. To Be Discussed in more depth in a later unit…. PPT CAM • Folk Medicine • Cutaneous stimulation • Therapeutic touch • Acupuncture • Acupressure • Natural Remedies • Herbs • Be aware of possible interactions with prescriptions • Keep personal opinions & biases to yourself Diversity in Health Care Practices…

40. CDC Statistics • Health, United States is an annual CDC report on trends in health statistics • CDC data on Risk Factors & Health Indicators by Race/Ethnicity & Gender • Use detail view Great web site 2016 http://www.ggalanti.org/cultural-diversity-in-healthcare/