1.04 Diverse Patients
Introduction to Health Science
Cultural Diversity and Health Care
• “America is a nation of nations, made up
of people from every land, of every race
and practicing faith. Our diversity is not a
source of weakness; it is a source of
strength, it is a source of our success.”
U.S. Secretary of State Colin Powell
What is Diversity?
• Diversity includes all of the different
aspects of people including age, culture,
race, physical ability, gender, and religion.
What is Culture?
• Culture is how and where someone is raised.
• Culture is prevalent in a community that shares
beliefs, speech, rituals, etiquette, what is
important, and common rules for how people
should behave.
• Culture includes many things such as how
people associate with one another, the way
they act, the food that is eaten, dress, work
habits, and what is deemed as important.
Cultural Diversity and Health Care
• We All Have It!
• Obvious Manifestations:
– Religion
– Ethnicity
– National Origin (language)
– Gender
Cultural Diversity and Health Care
• Less Obvious Manifestations:
– Age
– Education
– Educational Status
– Mobility (including handicaps)
What is Ethnicity?
• Ethnicity describes the birthplaces of people.
• People of the same ethnicity experience similar
patterns of behavior, manner of speech and
traditions.
– Examples of ethnic classifications include African
Americans, Asian Americans, European Americans,
Hispanic Americans, Middle Eastern/Arabic
Americans, Pacific Islanders, and Native Americans.
US POPULATION
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2010
WHITE 63.7%
BLACK 12.2%
HISPANIC 16.3%
ASIAN 4.7%
NATIVE AMERICAN 0.7%
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PROJECTED 2030
WHITE 60%
BLACK 13%
HISPANIC 19%
ASIAN 7%
NATIVE AMERICAN 1%
Cultural Diversity and
Health Care
• Expressions of Culture in Health Care
– Health Belief Systems
• Define and categorize health and illness
• Offer explanatory models for illness
• Based upon theories of the relationship between
cause and the nature of illness and treatments
• Defines the specific “scope” of practice for healers
Cultural Competence
• Two approaches
– Knowledge
– Relationship
• Attitude
– Self awareness
– Subjective perspective
– Focus on patient
CULTURAL COMPETENCY
• Culture refers to integrated patterns of human
behavior that include the language, thoughts,
communications, actions, customs, beliefs, values, and
institutions of racial, ethnic, religious or social groups.
• Competence implies having the capacity to function
effectively as an individual and an organization within
the context of the cultural beliefs, behaviors, and
needs presented by consumers and their communities.
WHY IS CULTURAL
COMPETENCY IMPORTANT?
• When health care services are delivered
without regard for cultural differences, patients
are at risk for sub-optimal care.
• Patients may be unable or unwilling to
communicate their health care needs in a
culturally insensitive environment, reducing the
effectiveness of the health care process.
• Understanding the fundamental elements of
culturally and linguistically appropriate services
is necessary when striving for cultural
competency in health care delivery.
CULTURAL COMPENTENCY
•
Four Rationales for Cultural Competency in
Health Care Delivery
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To respond to demographic changes.
To eliminate disparities in the health status of
people of diverse racial, ethnic, and cultural
backgrounds.
To improve the quality of health care services
and health outcomes.
To gain a competitive edge in the health care
market and decrease the likelihood of
liability/malpractice claims.
Something To Talk About
Lia Lee was a three-month-old Hmong child with epilepsy. Her
doctors prescribed a complex regimen of medication designed to
control her seizures. However, her parents felt that the epilepsy
was a result of Lia "losing her soul" and did not give her
medication as indicated because of the complexity of the drug
therapy and the adverse side effects. Instead, they did everything
logical in terms of their Hmong beliefs to help her. They took her to
a clan leader and shaman, sacrificed animals and bought
expensive amulets to guide her soul's return. Lia's doctors felt her
parents were endangering her life by not giving her the medication
so they called Child Protective Services and Lia was placed in foster
care. Lia was a victim of a misunderstanding between these two
cultures that were both intent on saving her. The results were
disastrous: a close family was separated and Hmong community
faith in Western doctors was shaken.
• A Hmong child was born with a clubfoot. Doctors felt that the
foot would cause social embarrassment and make ambulation
difficult and recommended an operation to reshape the foot.
The family believed that the foot was a blessing, a reward for
ancestral hardships. Because the family believed "fixing" the
foot would bring shame and punishment to the family and
Hmong community, they refused treatment. The family went to
the Supreme Court to defend their right to refuse treatment.
They won.15
• What do you think should have happened in the court case?
Why?
• In this case, the operation did not involve life or death. But what
if it had?
Mrs. Lee was a 49-year-old Cantonese-speaking woman who had
immigrated years ago from China to the U.S. She lived with her husband
and youngest son, Arnold, 22. Studies revealed that Mrs. Lee suffered
from lung cancer that had metastasized to her lymph nodes and adrenal
glands. Arnold did not want Mrs. Lee's diagnosis known to her.
Eventually, the cancer spread to her brain. Her physician, knowing her
poor prognosis, suggested a DNR to her son, who refused to even
discuss the possibility with his mother. Arnold felt that his role as son
and family member meant he must protect his mother from "bad news"
and loss of hope. He believed telling her the dim prognosis would be
cruel and cause unnecessary stress. Though futile, the son insisted that
all heroic methods be used, including a ventilator, to save his mother's
life. He accused the house staff and physician of racism and threatened
litigation. As a family member, he considered himself, not the doctors or
patient, responsible for his mother's treatment. He felt an overwhelming
family responsibility to save his mother from such an early and "bad
death" as well as from perceived inadequate treatment.
Cultural Diversity and Health
Care
It is because we are different that each
of us is special.