Cultural Diversity Health care providers must work with and provide care

to may different people.

Therefore, every health care provider must be aware of factors that cause each individual to be unique.

Uniqueness Uniqueness is influenced by many factors:

Physical Characteristics Gender Body Size Skin Color

Also: Family Life Socioeconomic status religious Beliefs Geographic Location Education, Occupation and life experience

• A major influence on a person’s uniqueness is Cultural and Ethnic Heritage

Culture

• Culture is defined as the :• Values• Beliefs• Attitudes• Languages• Symbols• Rituals• Customs of a particular group of people often passed down from generation

to generation

Culture

Culture provides a blueprint or set of rules for living. Culture is learned – It is taught by others, ie: children learn behavior

by imitating parents. Culture is shared – common practices and beliefs are shared with

others in cultural group.Culture is social in nature – understand appropriate behavior based

on traditions.Culture is dynamic and ever changing – New ideas generate different

standards this allows cultural groups to meet changing needs.

EthnicityEthnicity – is the classification of people based on national origin and/or culture.• Members of a certain ethnic group may share common heritage,

customs, language and beliefs.• Many different ethnic groups in US – Melting Pot:• African American• Asian American• European American• Hispanic American• Middle Eastern American• Native American

• Within each group there are subgroups ie: German-Italian

Race

Race is a classification based on physical or biological characteristics such as color of skin, hair, eye color, facial features blood type or bone structure.• Race is usually used to label a group of people and to explain patterns

of behavior.• In reality race cuts across multiple ethnic/cultural groups• African Blacks and Caribbean Blacks• Share same physical features : very different cultural beliefs and values

Cultural Diversity

• Culture, Ethnicity and race do influence a person’s behavior, self-perception and judgment - this is called: Cultural Diversity

• Cultural Assimilation – process where multiple cultures blend to become one – United States – Melting Pot• In reality U.S. is becoming a “Salad Bowl” – cultural differences are

appreciated and respected – multicultural society

• Sensitivity – the ability to recognize differences is essential in todays health care. ie: calling someone by first name is not acceptable in some cultures

Bias – Prejudice - Stereotyping

• Bias – (You prefer one over another) a preference that inhibits and leads to impartial judgment• Age – young people are physically and mentally superior to older people• Education – College educated people are superior (smarter) to uneducated• Economic – Rich people are superior (deserve better treatment) to poor• Physical Size – Obese and short people are inferior• Occupation – Nurses are inferior to doctors• Sexual Preferences – Homosexuals are inferior to heterosexuals• Gender - Women are inferior to men

Bias – Prejudice - StereotypingPrejudice – means to pre-judge. A prejudice is a strong feeling or belief about a person without reviewing the facts.• Prejudice people view their ideas, beliefs or behaviors as right and

others as wrong.• They are frequently afraid of things that are different.• Prejudices causes fear and distrust and interferes with relationships• Every individual is prejudice to some degree – we all want to feel like

our beliefs are right.• However it is important to be aware of our prejudices and make

every effort not let them influence our behavior in health care.• Obtain as much information as possible about other individuals to

better understand them and communicate successfully.

Bias – Prejudices - Stereotyping

Stereotyping – assumption is made that everyone in a particular group is the same.• Labels individuals• ie: All blondes are dumb

• Similar stereotypes exists with regard to race, gender, ethnic/cultural group, occupation, etc.• It is essential to remember everyone is unique.

Bias – Prejudice - Stereotyping

• All are barriers to effective communication and relationships with others.• Health care workers must be alert/aware to the barriers and make

every effort to avoid them.

Overcoming Bias, Prejudice, StereotypingWays to avoid barriers in Health Care:• Know and be aware of your own values & beliefs• Obtain as much information on others as possible• Be sensitive to behaviors of others• Remember, you are not being pressured to adopt other beliefs – just

respect theirs• Develop friendships with a wide variety of people from other groups.• Ask questions and encourage others to ask questions to share beliefs• Evaluate all information before making decisions• Be open to differences• Avoid jokes that may offend others• Remember, mistakes happen and apologize and/or forgive.

Family Organization

Refers to the structure of a family and the dominant or decision-making person in the family.

Nuclear Family – usually consists of a mother, father and children, may also consist of single parent and children (European/American Families)

Extended Family – includes nuclear family and grandparents, aunts uncles, cousins (Asian, Hispanic and Native American)

Family Organization

• Usually affects care of:• Children• Sick• Elderly

• Extended Family usually care for its own while Nuclear tends to use outside assistance• Patriarchal – father or oldest male makes decisions• Matriarchal – Mother or oldest female makes decisions• Its important to ask questions and observe the family when making

health care decisions

Family OrganizationImportant to ask questions• Who are the members of family?• Do you have any children? Who will care for them when you are sick?• Do you have an extended family?• Who will care for you while you are sick?• Who is the head of household?• Where do you live?• Was your entire family born on the US?• Do you have family that will be visiting you?

Language

Language many times can be a barrier to communication.Health care provider must determine patients ability to communicate not only to patient but to family.• Do you speak English as primary language?• What is language spoken at home?• Do you read English or another language?• Do you have a family member or friend that can interpret information

for you?

Language

Important when speaking to someone who has limited English skills to:• Talk slowly• Use simple terms• Use gesture or pictures• Use non-verbal clues – smiles, gentle touch.• Avoid talking louder.• Try learning some words or phrases in patient’s language • Use translation services or translation cards or Translation App

Personal Space and Touch

• Often called territorial space – the distance required between people to feel comfortable.• Varies greatly between cultures – some cultures like close contact ie:

Arabs are very close contact, like touch and even smell of person. Women stand closer than men, children closer than adults• Cambodians never touch opposite sex in public, only parent may

touch child on head.• Never assume something about a person’s personal space- always ask

questions.

Personal Space and Touch

• Health Care providers have to use touch and invade personal space to provide care.• Blood pressure cuff , use of a stethoscope, EKG electrodes• Health care provider should use slow movements, explain procedures,

encourage patient to relax.• Patients sometimes still are uncomfortable so be alert to signals:

tensing up, turning head, pulling away.

Personal Space and Touch

When providing personal care (BODY WASHING, ETC.) Ask patient if they have any preferences?• Do you prefer to do as much as you can on your own?• Would you like a family member to assist?• Are there any special routines you follow?• Do you prefer to bath in morning or evening?• Is there anything I can do to make you more comfortable?

Eye Contact

• Eye contact varies between cultures• Europeans Americans view it as trustworthy, show of interest.• Asian Americans sometimes consider it rude.• Native Americans – only side (peripheral) vision, direct vision is hostile

and threatening.• Hispanic/African use brief contact but look away as sign of respect and

inventiveness.• Health care workers must be alert to comfort levels of patients while

using direct eye contact• Recognize cultural diversity – ie: Lack of eye contact is often interpreted

as not listening while it can indicate respect (Asian Culture).

Gestures

Gestures are used to communicate many different things:• Nodding head for yes, side to side for no• In India – head motions are exact opposite.• Pointing finger in US is common to stress a specific point• Asian and native American its considered a threat.

• OK sign is considered insulting to Asians

Health care workers must be aware of how patients respond to hand gestures, if you notice a person uncomfortable, avoid using it.

Health Care Beliefs

Most common health care system in U.S. is biomedical or “Western Medicine”• Cause of disease based on microorganisms, diseased cells and process of

aging. Value put on education and prevention• When cause is determined than health care is performed to eliminate the

cause.• Use licensed doctors or practitioners

Other cultures believe in harmony of body and spirituality• Use Folk Practitioners – Spiritualists, Herbalists Native healers

Its important to remember not all individuals believe in and follow U.S. or Western Medicine.

Alternative Medicine

• Nutritional Medicine – organic food, herbs, vitamins, anti-toxins• Mind and Body Control – relaxation, meditation, hypnotherapy• Body Movement Methods- Chiropractor, yoga, tai chi• Spiritual Methods – Faith healing, prayer and spiritual counselingEvery individual has the right to believe what they want and to choose what method they prefer• Healthcare workers need to be aware of the differences and accommodate

when reasonably available.

Spirituality and Religion

Spirituality and religion are inherent part of every cultural group.Spirituality – is defined as the beliefs individuals have about themselves, there connections with others and relationship with a higher power.• When a person’s spiritual beliefs are firmly established, they tend to

have a basis for understanding life.• Beliefs can be varied• Atheist – don’t believe in any deity• Agnostic – believe existence in god can not be proved or disproved

Religion• Do you have a religious affiliation?• Are there any religious practices that make you feel better?• Do you normally pray at certain times of the day?• Would you like a person of some religion to visit? Priest, etc.• Do you consult a religious healer• Do your beliefs restrict certain foods or drinks?• Do you observe any specific holidays, have objects that need certain

care?• As long as they do not cause harm, every effort should be made to

accommodate the religious needs of every patient.

Respecting Cultural Diversity

• The key is to regard each person as a unique individual• Be ware of the needs of every patient• Respect the needs of each patient• Try to accommodate for every need as long as it does not harm the

patient.