DIVERSITY & DIFFERENCE IN HEALTH CARE

CULTURAL DIVERSITY – includes:• Race• National Origin• Religion• Language• Physical size• Gender• Sexual orientation• Age• Disability• Socioeconomic status• Geographic location

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.

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

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……

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

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

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

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

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

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

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

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

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

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

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

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

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

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 -

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