Cultural Influences The Health Care Setting

1. Cultural Influences The Health Care Setting If you are not in tune with the universe, there is sickness in the heart and mind.—Navajo saying He who has health has hope, and he who has hope has everything.—Arabian saying

2. “Professional health care providers frequently assume that people’s cultures are more similar than they actually are.” Gropper, p 285

3. Children lean what is culturally appropriate health care behaviors from parents, family and school. • Culture teaches children what makes people sick or causes injury.

4. Culture and Health Care: Diverse Worldviews Dualistic and Holistic Worldviews

5. Dualistic Worldview • People and nature separate and distinct • Values medical intervention--doctors, nurses, meds. • Western cultures (Judaism, Christianity, Islam…. “because they see two separate parts to reality—God and creation.”)

6. Holistic Worldview • Sees the world as a unit. Humans -- unified body, mind, and spirit existing in a world that is holistic. The person’s entire body must be part of the healing process. • Eastern philosophy. Chinese medicine teaches that health is a state of spiritual and physical harmony with nature.

7. Belief Systems (Mechanistic and Non-mechanistic Worldviews) Mechanistic(U.S.) deals with the ways of knowing • Universe is a physical system operating in a determinate manner according to discoverable scientific laws…because they view the universe as a mechanism. Believe individuals can manipulate the universe. • Reason versus intuition Reasoning is considered to be humankind’s “highest faculty and achievement.” • Objectivity versus subjectivity • Science versus religion • Facts are more reliable and dependable than subjective evaluations based on feelings and intuition. • Strong belief in the benefits of science and technology.

8. Non-Mechanistic Worldview A perspective that historically has emerged from India, Tibet, Japan, China, etc. (Buddhism, Hinduism, Taoism, and Zen) • Intuition transcends the data of the senses and the manipulation of the mind to perceive truths that seem to lie beyond reason. • Faith, magic, and supernatural forces can be employed as a means to good health.

9. Health Belief Systems • Scientific/Biomedical belief • Magico-Religious belief • Holistic/Naturalistic belief • Alternative Health Care Systems

10. Scientific/Biomedical health belief--USA • Life processes are controlled by physical and biochemical processes that can be manipulated by humans. • Illness is caused by viruses, bacteria, or a breakdown of the human machine, and a pill, treatment or surgery will cure the problem.

11. Magico-religious health belief • Supernatural forces predominate. Supernatural or folk medicine approach. • Health and illness are controlled by supernatural forces. • Getting well is dependent on a Supreme Being’s will. • May view illness as possession of an evil spirit and require magical treatments to get well. Widely accepted in traditional Hispanic, Caribbean, African, and other cultures. Views illness as a sign of weakness, a punishment or retribution for shameful behavior such as lying, cheating, stealing, or a failure to show respect to elders!

12. (magico-religious—the Hmong) • The Hmong “believe an individual’s spirit is the guardian of the person’s well-being. If the spirit is happy, then the person is happy—and well. • A severe shock may cause the individual’s spirit to leave, resulting in unhappiness and ill health. • Laotians believe similarly—illness also may be caused by losing one of the body’s 32 souls or by a sorcerer who can cast a spell by projecting foreign objects into a person’s body. (examining the yolk of a freshly broken egg will tell a Laotian healer the exact cause of illness.) • Vietnamese—believe health problems such as th3e common cold, mild fever and headache are caused by the natural element caogio, which is associated with bad weather and cold drafts.

13. California hospital welcomes Hmong Shamans Coining Shaman in Madrid

14. Magico-religious, cont. • Latinos (some) believe health and disease to be consequences of God’s approval or disapproval of one’s behavior. • The evil eye—belief that someone can project harm by gazing or staring at another. • Southern Europe, the Middle East, and North America (immigrants)

15. Holistic health belief view • The forces of nature must be kept in balance or harmony, and when the natural harmony or balance is disturbed, illness results. • (non-mechanistic) Illness is a result of impersonal forces or conditions, including cold, heat, wind, dampness, and an upset in the balance of the basic body elements. • All foods, medicines, conditins, and emotions are ascribed hot and cold qualities. • (Vietnamese –poor health from eating spoiled food or being exposed to inclement weather. Must restore person’s hot/cold balance. • Native American, Chinese, and Spanish cultures all have beliefs related to balance or harmony (the Medicine Wheel, yin-yang, hot-cold). Candling Folk Medicine in Taiwan

16. Alternative Health Care Systems • Includes diet therapy (macrobiotics and megavitamins), mind/body control methods (relaxation, counseling, prayer, hypnotherapy), working with the body structure (chiropractic, massage, and therapeutic touch), and pharmacologic and biologic therapies (antioxidants, oxidizing agents, and chelating therapy).

17. Health care considerations for a culturally diverse population • Family Roles Male dominance Modesty and female purity Pregnancy and childbirth • Language/Cultural Barriers • Nonverbal Messages Eye contact Facial expressions Touch Time orientations—Monochronic and Polychronic • Formality

18. How can health-care workers become more culturally effective? Know Diverse Systems/Beliefs Acknowledge patient’s beliefs concerning cause of illness, how to treat it, and how to prevent in future. Ask patient series of questions Recognize Ethnocentrism