cultural diversity

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Cultural Diversity and Health Cultural Diversity and Health CareCare


Cultural DiversityCultural Diversity

We all have it!We all have it! Obvious manifestations include:Obvious manifestations include:

religionreligion ethnicity (race)ethnicity (race) national origin (language)national origin (language) gendergender


Cultural DiversityCultural Diversity

Less obvious manifestations include:Less obvious manifestations include: ageage educationeducation socioeconomic classsocioeconomic class mobility (including handicaps)mobility (including handicaps)


What is Culture?What is Culture?

Culture is the sum total of the way of Culture is the sum total of the way of

living; includes values, beliefs, living; includes values, beliefs, standards, standards,

language, thinking patterns, language, thinking patterns, behavioral behavioral

norms, communications styles, etc. norms, communications styles, etc.

Culture guides decisions and Culture guides decisions and

actions of a group through time.actions of a group through time.


Expressions of Culture in Expressions of Culture in Health CareHealth Care

Health Belief SystemsHealth Belief Systems define and categorize health and define and categorize health and

illnessillness offer explanatory models for illnessoffer explanatory models for illness are based upon theories of the are based upon theories of the

relationship between cause and the relationship between cause and the nature of illness and treatmentsnature of illness and treatments

define the specific “scope” of practice define the specific “scope” of practice for healersfor healers


The Culture of Western The Culture of Western MedicineMedicine

Common Practices in Western MedicineCommon Practices in Western Medicine Meliorism – make it betterMeliorism – make it better Dominance over nature – take controlDominance over nature – take control Activism – do somethingActivism – do something Timeliness – sooner than laterTimeliness – sooner than later Therapeutic aggressiveness – Therapeutic aggressiveness –

stronger=betterstronger=better Future orientation – plan, newer=betterFuture orientation – plan, newer=better Standardization – treat similar the sameStandardization – treat similar the same


Comparing Our Beliefs to Comparing Our Beliefs to OthersOthers

““Western”Western” Make it betterMake it better Control over natureControl over nature Do somethingDo something Intervene nowIntervene now Strong measuresStrong measures Plan ahead – recent Plan ahead – recent

is bestis best Standardize – treat Standardize – treat

everyone the sameeveryone the same

““Others”Others” Accept with graceAccept with grace Balance/Harmony Balance/Harmony

with naturewith nature Wait and seeWait and see Cautious deliberationCautious deliberation Gentle approachGentle approach Take life as it comes Take life as it comes

– “time honored”– “time honored” Individualize – Individualize –

recognize differencesrecognize differences


Cultural CompetenceCultural Competence

Cultural competence is defined as a set Cultural competence is defined as a set

of congruent of congruent behaviors, practices, behaviors, practices,

attitudes and policiesattitudes and policies that come together that come together in a in a

system or agency or among professionals, system or agency or among professionals,

enabling effective work to be enabling effective work to be

done in cross-cultural situations.done in cross-cultural situations.


The Cultural Competence The Cultural Competence ContinuumContinuum

Requires Self ReflectionRequires Self Reflection Where am I now?Where am I now? Where could I be?Where could I be?

The Cultural Competence The Cultural Competence ContinuumContinuum


Cultural Competence Cultural Competence DefinitionsDefinitions

Cultural DestructivenessCultural Destructiveness:: forced forced assimilation, subjugation, rights and assimilation, subjugation, rights and privileges for dominant groups onlyprivileges for dominant groups only

Cultural IncapacityCultural Incapacity:: racism, maintain racism, maintain stereotypes, unfair hiring practicesstereotypes, unfair hiring practices

Cultural BlindnessCultural Blindness:: differences differences ignored, “treat everyone the same”, ignored, “treat everyone the same”, only meet needs of dominant groupsonly meet needs of dominant groups


Cultural Competence Cultural Competence DefinitionsDefinitions

Cultural Pre-competenceCultural Pre-competence: : explore cultural explore cultural issues, are committed, assess needs of issues, are committed, assess needs of organization and individualsorganization and individuals

Cultural CompetenceCultural Competence:: recognize individual recognize individual and cultural differences, seek advice from and cultural differences, seek advice from diverse groups, hire culturally unbiased diverse groups, hire culturally unbiased staffstaff

Cultural ProficiencyCultural Proficiency:: implement changes implement changes to improve services based upon cultural to improve services based upon cultural needs, do research and teachneeds, do research and teach


Acquiring Cultural Acquiring Cultural CompetenceCompetence

Begins with awarenessBegins with awareness Grows with knowledgeGrows with knowledge Enhanced with specific skillsEnhanced with specific skills Polished through cross-cultural Polished through cross-cultural

encountersencounters


The Explanatory Model The Explanatory Model Arthur Kleinman, Ph.D.Arthur Kleinman, Ph.D.

Use a culturally sensitive approach toUse a culturally sensitive approach toinquiring about a health problem. inquiring about a health problem. Ask your patient:Ask your patient:

What do you call your problem?What do you call your problem? What do you think caused your problem?What do you think caused your problem? Why do you think it started when it did?Why do you think it started when it did? What does your sickness do to you? How What does your sickness do to you? How

does it work?does it work? How severe is it? How long do you think How severe is it? How long do you think

you will have it?you will have it?


Ask Your PatientAsk Your Patient

What do you fear most about your illness?What do you fear most about your illness? What are the chief problems your sickness has What are the chief problems your sickness has

caused you?caused you? Do you know anyone else with the same problem?Do you know anyone else with the same problem? What have you done so far to treat your illness?What have you done so far to treat your illness? What treatments do you think you should receive?What treatments do you think you should receive? What important results do you hope to receive from What important results do you hope to receive from

the treatment?the treatment? Who else can help you?Who else can help you?


The The LEARNLEARN Model ModelBerlin and FowkesBerlin and Fowkes

LListenisten to the patient’s perception of to the patient’s perception of the problem.the problem.

EExplainxplain your perception of the your perception of the problem.problem.

AAcknowledge cknowledge and discuss and discuss differences/similarities.differences/similarities.

RRecommendecommend treatment. treatment. NNegotiateegotiate treatment. treatment.


InterpretersInterpreters

Qualifications:Qualifications: Bilingual, bicultural, Bilingual, bicultural, Understands English Understands English

medical vocabularymedical vocabulary Comfort in the medical Comfort in the medical

setting, understands setting, understands significance of the health significance of the health problemproblem

Preserves confidentialityPreserves confidentiality


Multiple Roles of Multiple Roles of InterpretersInterpreters

Interpreters have multiple roles Interpreters have multiple roles including:including: translator of languagetranslator of language culture brokerculture broker patient advocate: convey patient advocate: convey

expectations, concernsexpectations, concerns


Working with InterpretersWorking with Interpreters

Use language to identify the interpreterUse language to identify the interpreter

as the go-between, not as the person to as the go-between, not as the person to

be blamed, e.g., the interpreter might be blamed, e.g., the interpreter might

say, “The doctor has ordered tests and say, “The doctor has ordered tests and

this is what he says.”this is what he says.”


Working with LanguageWorking with LanguageTranslation ConsiderationsTranslation Considerations

Language: consider meaningful description Language: consider meaningful description Navajo: Explain Penicillin as “the strong white Navajo: Explain Penicillin as “the strong white

medicine shot you get for a cold”medicine shot you get for a cold” Minimize jargon, e.g., “machine to look at Minimize jargon, e.g., “machine to look at

your heart” instead of “EKG”your heart” instead of “EKG” Nonverbal communication comprises 60% of Nonverbal communication comprises 60% of

all communicationall communication Nodding may indicate politeness, not Nodding may indicate politeness, not

comprehensioncomprehension Bilingual interviewing takes at least twice as Bilingual interviewing takes at least twice as

long as monolingual interviews!long as monolingual interviews!


Responsibilities of Health Responsibilities of Health Care ProvidersCare Providers

Learn and use a few phrases of greeting Learn and use a few phrases of greeting and introduction in the patient’s native and introduction in the patient’s native language. This conveys respect and language. This conveys respect and demonstrates your willingness to learn demonstrates your willingness to learn about his/her culture.about his/her culture.

Tell the patient that the interpreter will Tell the patient that the interpreter will translate everything that is said, so they translate everything that is said, so they must stop after every few sentences.must stop after every few sentences.


Responsibility of Health Responsibility of Health Care ProvidersCare Providers

When speaking or listening, watch the When speaking or listening, watch the patient, not the interpreter. Add your patient, not the interpreter. Add your gestures, etc. while the interpreter is gestures, etc. while the interpreter is translating your message.translating your message.

Reinforce verbal interaction with visual Reinforce verbal interaction with visual aids and materials written in the client’s aids and materials written in the client’s language.language.

Repeat important information more Repeat important information more than once.than once.


Your ResponsibilitiesYour Responsibilities

Always give the reason or purpose for a Always give the reason or purpose for a treatment or prescription.treatment or prescription.

Make sure the patient understands by Make sure the patient understands by having them explain it themselves.having them explain it themselves.

Ask the interpreter to repeat exactly Ask the interpreter to repeat exactly what was said.what was said.

Personal information may be closely Personal information may be closely guarded and difficult to obtain.guarded and difficult to obtain.

Patient may request or may bring a Patient may request or may bring a specific interpreter to the clinic.specific interpreter to the clinic.


ConsiderationsConsiderations

In some cultures it may not be In some cultures it may not be appropriate to suggest making a will for appropriate to suggest making a will for dying patients or patients with terminal dying patients or patients with terminal illnesses; this is the cultural equivalent illnesses; this is the cultural equivalent of wishing death on a patient.of wishing death on a patient.

Avoid saying “you must”, instead teach Avoid saying “you must”, instead teach patients their options and let them patients their options and let them decide, e.g., “some people in this decide, e.g., “some people in this situation would...”situation would...”


Additional InformationAdditional Information

JCAHO requires education for all health care JCAHO requires education for all health care providers regarding cultural diversity. providers regarding cultural diversity.

Visit these sites for more information:Visit these sites for more information:

www.ggalanti.com/articles.htmlwww.ggalanti.com/articles.htmlwww.ggalanti.com/concepts.htmlwww.ggalanti.com/concepts.htmlwww.ggalanti.com/cultural_profiles.htmlwww.ggalanti.com/cultural_profiles.htmlwww.nursingworld.org/ojin/topic20/tpc20_2.htmwww.nursingworld.org/ojin/topic20/tpc20_2.htmwww.diversityrx.org/www.diversityrx.org/www.health.qld.gov.au/multicultural/cultdiv/www.health.qld.gov.au/multicultural/cultdiv/default.aspdefault.asp


Cultural Diversity and Health Cultural Diversity and Health CareCare

It is because we are different that each of us is It is because we are different that each of us is special.special.

cultural diversity

Business

setcultural competence

obvious manifestations

naturewith nature

time honored time

better control

health carecare

nature of illnessbetween

dominant groups onlyprivileges