DIVERSITY & DIFFERENCE IN HEALTH CARE

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 testing • - 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