Cultural Competent Health Care
Agenda
• Questions & concerns
• Discussion on culture, race, ethnicity, &
value
• Needs for cultural competent care
• Negotiation for dates for individual
presentations
Shrink the Earth’s Population to
100
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57 Asians
21 Europeans
14 North, Central and South Americans
8 Africans
70 would be non-white, 30 white
70 would be non-Christian, 30 Christian
Population in the U.S.
Year 2000
• Whites – 69.4%
• Black – 12.7%
• Hispanic – 12.6%
• Asian – 3.8%
Year 2050
• Whites – 50%
• Black – 14.6%
• Hispanic – 24.4%
• Asian – 8%
US Census Bureau, 2004
Registered Nurses in the U.S.
(2000)
• 86.6% - non-Hispanic white
(US dept of Health & Human Service, 2003)
Population in San Jose (2000)
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Whites - 47.5%
Hispanic - 30.2%
Asian - 26.9%
Black - 3.5%
U.S. Census Bureau (2006)
Globalization :
Q: How to define globalization?
A: Princes Diana’s death
Q: How come?
A: An English princess with an Egyptian boyfriend crashes in a French tunnel, in a German car
with a Dutch engine, driven by a Belgian who was
pissed on Scottish whiskey, followed closely by an
Italian paparazzi, on Japanese motorcycles, treated
by an American doctor, using Brazilian medicines.
And this is sent to you by a Israeli, using Bill Gates’
Technology which he stole from the Taiwanese.
Minorities Receive Lower Quality
Health Care Than Whites
• Institute of Medicine, 100 studies reviewed over
past 10 yrs.
• Full report www.nap.edu/books/030908265X/html
• Minorities less likely to receive sophisticated Txs
for AIDS
• More likely to have leg amputations for diabetes
• Poorer relationships with MDs
Other Cultural Domains
• Folk beliefs/religion - can be confused with
“religiosity”
• Stereotyping labels - avoid generalizations
• Ethnopharmacology - genetic influence, effect,
metabolism
• Herbal therapies - interactions with meds
• Folk healers & treatment approaches, e.g..,
hysteria, psychosis
Cultural competence &
impact on clinical outcomes
• Patients fear of being misunderstood or disrespected;
• Providers are not familiar with the prevalence of
conditions among certain minority groups
• Providers may fail to take into account differing
responses to medication
• Providers may lack knowledge about traditional
remedies, leading to harmful drug interactions
• Patients may not adhere to medical advice because they
do not understand or do not trust the provider;
• Providers may order more or fewer diagnostic tests for
patients of different cultural backgrounds
ethnic disparities in health care
• African American women are more likely than
European American women to die from breast cancer,
despite having a lower incidence of the disease.
• Infant mortality rates are 2.5 times greater for African
Americans and 1.5times greater for Native Americans
than for European Americans.
• Influenza death rates are higher for African Americans
and American Indian/Alaska Natives/Native Alaskans
than they are for European Americans.
• Mortality for colorectal cancer is highest for African
Americans, followed by Native Alaskans, and then
Hawaiians.
Needs for cultural competence
• American nurses experienced a lack of
cultural confidence in caring for culturally
diverse populations - Coffman, Shellman, &
Bernal (2004) and Hagman (2006)
• There were gaps in healthcare providers’
knowledge of other cultures and how to care
for them in culturally sensitive ways - Jones,
Cason, and Bond (2004)
Other evidences
• Negative racial stereotypes - rate black patients as
more likely to abuse drugs and alcohol, less likely
to comply with medical advice, and less likely to
participate in cardiac rehab than white patients Van Ryn and Burke (2000)
• Less Dx test - physicians were less likely to
recommend catheterization procedures for black
female patients than white or black male patients
if they experienced the same kind of symptoms.
Schulman et al. (1999)
cultural competence is a process
• American Nurses Association published its first
guidelines on cultural diversity in nursing
curricula in 1986 - understanding the concept of
human diversity including cultural and racial
variations
• The Board of Registered Nursing of California
(2006) has required all nursing schools in
California to include cultural diversity and
competence into their curricula
Language barriers and disparity
• Utilization of health care services
– Fewer doctor visit and less preventive services
– More diagnostic test to compensate communication
problems
• Satisfaction
– Less satisfied unless with interpreter
• Adherence
– Miss the appointment or drop out
• Outcomes
• Patient education
Health Disparities
• President Clinton (1998) set the goal –
reduce health disparities by the year 2010.
• Target areas: (NIH, 2003)
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Infant mortality,
Cancer screening and management,
Cardiovascular disease,
Diabetes,
HIV/AIDS,
Immunization
Problems with Health Disparities
- with cultural factors
Flaskerud, J. et al (2002) – a review of 79
articles in the past 5 decades:
– Ignorance of certain groups (indigenous
peoples)
– Inappropriate lump together ie. Hispanic
members of disparate groups with their
own cultural identity eg., Puerto Ricans,
Mexicans, Cubans, Dominicans
Aday’s 2010 Priorities Showcase –
Needs within vulnerable population
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High-risk mothers & infants-of-concern
Chronically ill & disabled
Persons living with HIV/AIDS
Mentally ill & disabled
Alcohol & other substance abuses
Suicide- or homicide-prone behavior
Abusive families
Homeless persons,
Immigrants/refugees
Impact of Cultural Competency
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More successful patient education
Increases in pt’s health care seeking behavior
More appropriate testing and screening
Fewer diagnostic errors.
Avoidance of drug complications
Greater adherence to medical advice
Expanded choices and access to high-quality
clinicians.
Culture - Bound Syndromes
• A person living within a certain reality
• Learned way to interpret the world based
on enculturation
• Recurrent, locality- specific patterns of
aberrant behavior and troubling experiences
that may not be linked to a DSM-IV
diagnosis
Culture Bound Syndromes
Group
Disorder
Explanation
Caucasian
Anorexia
Preoccupied body wt. &
image
Nervosa
Bulimia
Binge eating followed by
vomiting
Low blood
Insufficient blood or
weakness of blood
High blood
Blood that is too rich
Thin blood
Susceptibility to illness
African American
Culture Bound Syndromes Cont.
Group
Disorder
Chinese/
Koro
Southeast Asian
Amok
Explanation
Fear that penis is
retracting into
body
Acute reaction to
loss,
Culture Bound Syndromes Cont.
Hispanic
Disorder
Explanation
Empacho
Food clings
stomach &
intestines: pain
Stranger’s attention
causes illness in
children
Mal ojo “evil eye”
Susto
Anxiety, phobias
Culture Bound Syndromes Cont.
Group
Disorder
Explanation
Native American
Ghost
Japanese
Wagamama
Hallucinations,
terror
Childish behavior
Korean
Hwa-Byung
Cambodian
Koucharang
“thinking too much”
Multiple somatic &
psychological
symptoms
Headaches, chest
pain, palpitations,
SOB, insomnia
Temporal Relations
• Time Orientation
• Past, present or
future-oriented
• Punctuality
Negotiation Process
• Listen: to the client’s perspective
• Teach: from your knowledge in language
appropriate for client & family
• Compare: similarities & differences, disagree but
do not devalue client’s view
• Compromise:
– if client treatment not harmful, promote
– If harmful, explain harm and suggest alternatives
The Health Promotion Matrix
Gorin, S. & Arnold, J. (1998). Health Promotion Handbook. St Louis: Mosby. P 92
Before Next Class
• Take extra care of yourself and your family
• Prepare by reading for class: get copies of articles
• Decide on group presentation medium for
presentation; bring IBM compatible disk one week
before if you want to use Power Point for your
presentation; limit slides to 30
• Continue work on your group for presentation
• Have a great week
The End