Introduction to Health ScienceIntroduction to Health Science1.04 Diverse Patients 1.04 Diverse Patients

Cultural Diversity and Health CareCultural Diversity and Health Care

• ““America is a nation of nations, made up America is a nation of nations, made up of people from every land, of every race of people from every land, of every race and practicing faith. Our diversity is not a and practicing faith. Our diversity is not a source of weakness; it is a source of source of weakness; it is a source of strength, it is a source of our success.strength, it is a source of our success.”” U.S. Secretary of State Colin PowellU.S. Secretary of State Colin Powell

What is Diversity?What is Diversity?

• Diversity includes all of the different Diversity includes all of the different aspects of people including age, culture, aspects of people including age, culture, race, physical ability, gender, and religion. race, physical ability, gender, and religion.

What is Culture?What is Culture?

• Culture is how and where someone is raised.Culture is how and where someone is raised.• Culture is prevalent in a community that shares Culture is prevalent in a community that shares

beliefs, speech, rituals, etiquette, what is beliefs, speech, rituals, etiquette, what is important, and common rules for how people important, and common rules for how people should behave. should behave.

• Culture includes many things such as how Culture includes many things such as how people associate with one another, the way people associate with one another, the way they act, the food that is eaten, dress, work they act, the food that is eaten, dress, work habits, and what is deemed as important. habits, and what is deemed as important.

Cultural Diversity and Health CareCultural Diversity and Health Care

• We All Have It!We All Have It!• Obvious Manifestations:Obvious Manifestations:– ReligionReligion– Ethnicity Ethnicity – National Origin (language)National Origin (language)– GenderGender

Cultural Diversity and Health CareCultural Diversity and Health Care

• Less Obvious Manifestations:Less Obvious Manifestations:– AgeAge– EducationEducation– Educational StatusEducational Status– Mobility (including handicaps)Mobility (including handicaps)

What is Ethnicity?What is Ethnicity?

• Ethnicity describes the birthplaces of people. Ethnicity describes the birthplaces of people. • People of the same ethnicity experience similar People of the same ethnicity experience similar

patterns of behavior, manner of speech and patterns of behavior, manner of speech and traditions. traditions. – Examples of ethnic classifications include African Examples of ethnic classifications include African

Americans, Asian Americans, European Americans, Americans, Asian Americans, European Americans, Hispanic Americans, Middle Eastern/Arabic Hispanic Americans, Middle Eastern/Arabic Americans, Pacific Islanders, and Native Americans.Americans, Pacific Islanders, and Native Americans.

US POPULATIONUS POPULATION

• 20102010• WHITE 63.7%WHITE 63.7%• BLACK 12.2%BLACK 12.2%• HISPANIC 16.3%HISPANIC 16.3%• ASIAN 4.7%ASIAN 4.7%• NATIVE AMERICAN 0.7%NATIVE AMERICAN 0.7%

• PROJECTED 2030PROJECTED 2030• WHITE 60%WHITE 60%• BLACK 13%BLACK 13%• HISPANIC 19%HISPANIC 19%• ASIAN 7%ASIAN 7%• NATIVE AMERICAN 1%NATIVE AMERICAN 1%

Cultural Diversity and Cultural Diversity and Health CareHealth Care

• Expressions of Culture in Health CareExpressions of Culture in Health Care

– Health Belief SystemsHealth Belief Systems• Define and categorize health and illnessDefine and categorize health and illness• Offer explanatory models for illnessOffer explanatory models for illness• Based upon theories of the relationship between Based upon theories of the relationship between

cause and the nature of illness and treatmentscause and the nature of illness and treatments• Defines the specific Defines the specific ““scopescope”” of practice for healers of practice for healers

Cultural CompetenceCultural Competence• Two approaches Two approaches – Knowledge Knowledge – RelationshipRelationship

• AttitudeAttitude– Self awarenessSelf awareness– Subjective perspectiveSubjective perspective– Focus on patientFocus on patient

CULTURAL COMPETENCYCULTURAL COMPETENCY

• Culture refers to integrated patterns of human Culture refers to integrated patterns of human behavior that include the language, thoughts, behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or social groups. institutions of racial, ethnic, religious or social groups.

• Competence implies having the capacity to function Competence implies having the capacity to function effectively as an individual and an organization within effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. needs presented by consumers and their communities.

WHY IS CULTURAL WHY IS CULTURAL COMPETENCY IMPORTANT?COMPETENCY IMPORTANT?

• When health care services are delivered When health care services are delivered without regard for cultural differences, patients without regard for cultural differences, patients are at risk for sub-optimal care. are at risk for sub-optimal care.

• Patients may be unable or unwilling to Patients may be unable or unwilling to communicate their health care needs in a communicate their health care needs in a culturally insensitive environment, reducing the culturally insensitive environment, reducing the effectiveness of the health care process. effectiveness of the health care process.

• Understanding the fundamental elements of Understanding the fundamental elements of culturally and linguistically appropriate services culturally and linguistically appropriate services is necessary when striving for cultural is necessary when striving for cultural competency in health care delivery. competency in health care delivery.

CULTURAL COMPENTENCYCULTURAL COMPENTENCY

• Four Rationales for Cultural Competency in Four Rationales for Cultural Competency in Health Care DeliveryHealth Care Delivery– To respond to demographic changes.To respond to demographic changes. – To eliminate disparities in the health status of To eliminate disparities in the health status of

people of diverse racial, ethnic, and cultural people of diverse racial, ethnic, and cultural backgrounds.backgrounds.

– To improve the quality of health care services To improve the quality of health care services and health outcomes.and health outcomes.

– To gain a competitive edge in the health care To gain a competitive edge in the health care market and decrease the likelihood of market and decrease the likelihood of liability/malpractice claims.liability/malpractice claims.

Something To Talk AboutSomething To Talk About

Lia Lee was a three-month-old Hmong child with epilepsy. Her Lia Lee was a three-month-old Hmong child with epilepsy. Her doctors prescribed a complex regimen of medication designed to doctors prescribed a complex regimen of medication designed to control her seizures. However, her parents felt that the epilepsy control her seizures. However, her parents felt that the epilepsy was a result of Lia "losing her soul" and did not give her was a result of Lia "losing her soul" and did not give her medication as indicated because of the complexity of the drug medication as indicated because of the complexity of the drug therapy and the adverse side effects. Instead, they did everything therapy and the adverse side effects. Instead, they did everything logical in terms of their Hmong beliefs to help her. They took her logical in terms of their Hmong beliefs to help her. They took her to a clan leader and shaman, sacrificed animals and bought to a clan leader and shaman, sacrificed animals and bought expensive amulets to guide her soul's return. Lia's doctors felt her expensive amulets to guide her soul's return. Lia's doctors felt her parents were endangering her life by not giving her the medication parents were endangering her life by not giving her the medication so they called Child Protective Services and Lia was placed in foster so they called Child Protective Services and Lia was placed in foster care. Lia was a victim of a misunderstanding between these two care. Lia was a victim of a misunderstanding between these two cultures that were both intent on saving her. The results were cultures that were both intent on saving her. The results were disastrous: a close family was separated and Hmong community disastrous: a close family was separated and Hmong community faith in Western doctors was shaken.faith in Western doctors was shaken.

• A Hmong child was born with a clubfoot. Doctors felt that the A Hmong child was born with a clubfoot. Doctors felt that the foot would cause social embarrassment and make ambulation foot would cause social embarrassment and make ambulation difficult and recommended an operation to reshape the foot. difficult and recommended an operation to reshape the foot. The family believed that the foot was a blessing, a reward for The family believed that the foot was a blessing, a reward for ancestral hardships. Because the family believed "fixing" the ancestral hardships. Because the family believed "fixing" the foot would bring shame and punishment to the family and foot would bring shame and punishment to the family and Hmong community, they refused treatment. The family went to Hmong community, they refused treatment. The family went to the Supreme Court to defend their right to refuse treatment. the Supreme Court to defend their right to refuse treatment. They won.15They won.15

• What do you think should have happened in the court case? What do you think should have happened in the court case? Why? Why?

• In this case, the operation did not involve life or death. But what In this case, the operation did not involve life or death. But what if it had? if it had?

Mrs. Lee was a 49-year-old Cantonese-speaking woman who 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 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 and youngest son, Arnold, 22. Studies revealed that Mrs. Lee suffered from lung cancer that had metastasized to her lymph nodes and adrenal from lung cancer that had metastasized to her lymph nodes and adrenal glands. Arnold did not want Mrs. Lee's diagnosis known to her. glands. Arnold did not want Mrs. Lee's diagnosis known to her. Eventually, the cancer spread to her brain. Her physician, knowing 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 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 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 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 hope. He believed telling her the dim prognosis would be cruel and cause unnecessary stress. Though futile, the son insisted that all heroic cause unnecessary stress. Though futile, the son insisted that all heroic methods be used, including a ventilator, to save his mother's life. He methods be used, including a ventilator, to save his mother's life. He accused the house staff and physician of racism and threatened accused the house staff and physician of racism and threatened litigation. As a family member, he considered himself, not the doctors or litigation. As a family member, he considered himself, not the doctors or patient, responsible for his mother's treatment. He felt an overwhelming patient, responsible for his mother's treatment. He felt an overwhelming family responsibility to save his mother from such an early and "bad family responsibility to save his mother from such an early and "bad death" as well as from perceived inadequate treatment.death" as well as from perceived inadequate treatment.

Cultural Diversity and Health Cultural Diversity and Health CareCare

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