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Cultural Diversity: Issues in Education and Practice

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Cultural Diversity: Issues in Education and Practice Nataliya Lishchenko Cultural Diversity and Health Care We All Have It! Obvious Manifestations: Religion Ethnicity ... – PowerPoint PPT presentation

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Title: Cultural Diversity: Issues in Education and Practice


1
Cultural Diversity Issues in Education and
Practice
  • Nataliya Lishchenko

2
Cultural Diversity and Health Care
  • We All Have It!
  • Obvious Manifestations
  • Religion
  • Ethnicity (Race?)
  • National Origin (language)
  • Gender

3
Cultural Diversity and Health Care
  • Less Obvious Manifestations
  • Age
  • Education
  • Educational Status
  • Mobility (including handicaps)

4
Cultural Diversity and Health Care
  • What is Culture?
  • Definition the sum total of the way of living
    includes values, beliefs, standards, language,
    thinking patterns, behavioral norms,
    communications styles, etc. Guides decisions and
    actions of a group through time.

5
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

6
Cultural Diversity and Health Care
  • The Culture of Western Medicine
  • Meliorism make it better
  • Dominance over nature take control
  • Activism do something
  • Timeliness sooner than later
  • Therapeutic aggressiveness strongerbetter
  • Future orientation plan, newerbetter
  • Standardization treat similar the same

7
Cultural Diversity and Health Care
  • Ours
  • Make it Better
  • Control Over Nature
  • Do Something
  • Intervene Now
  • Strong Measures
  • Plan Ahead Recent is Best
  • Standardize Treat Everyone the Same
  • Others
  • Accept With Grace
  • Balance/Harmony with Nature
  • Wait and See
  • Cautious Deliberation
  • Gentle Approach
  • Take Life As It Comes Time Honored
  • Individualize Recognize Differences

8
Growing Diversity in America
  • During the Past 20 years
  • ?? White population increased 10
  • ?? African American population increased 30
  • ?? Native American population increased 58
  • ?? Hispanic population increased 125

9
Diversity Demographics for theyear 2000
  • Whites 70
  • ?? Hispanic 13
  • ?? African Am 12
  • ?? Asian 4
  • ?? N Am 1

10
Projected Demographics for2030
  • White 60
  • ?? Hispanic 19
  • ?? Black 13
  • ?? Asian/PI 7
  • ?? N Am/Ak N 1

11
In California
  • Population of 38 Million
  • 1/3 of the population is of Hispanic origin
  • Over 10 Asian
  • Over 4 more than one race
  • Nearly 17 identify as Other race

12
In California
  • 1 in 4 are foreign born, 37 of these entered the
    US after 1990
  • Nearly 40 of the population over the age of 5
    speaks a language other than English at home.
  • Over 25 of the population is under the age of 18

13
Diversity related facts
  • The population is becoming increasingly diverse
  • ?? underrepresented groups make up approximately
    30 of the population
  • ?? Health care workforce has not kept up with the
    changing demographics
  • ?? Physicians from underrepresented groups make
    up only about 7 of the current workforce
  • ?? Nurses only 3
  • ?? Pharmacy only 3

14
Ethnic Health Disparities
  • African Americans
  • ?? Highest death rate from colon and rectal
    cancer of any ethnic group in the U.S.
  • ?? African Am women, diagnosed with breast
    cancer, have a 71 survival rate vs. an 86 rate
    for white women.

15
Ethnic Health Disparities
  • Native Americans
  • ?? 2-3 times more likely to have diabetes
    mellitus that the general population
  • ?? Higher than average mortality rates associated
    with heart disease, TB, suicide, Pneumonia,
    Influenza, homicide, and alcoholism

16
Reports of Disparities in HealthCare
  • Disparities in health care do exist
  • and are associated with higher
  • mortality among minorities.

17
Reported Racial and EthnicDisparities in
Healthcare
  • Research has shown that clinicians spend less
    time with and prescribe more medication for
    blacks compared with whites.
  • Blacks are also more frequently labeled as
    psychotic.
  • (Segal et al., 1996- Psychiatr. Serv. Flaskerud
    and Hu, 1992- Am. J.Psychiatry)
  • Minority children with fractures of unknown
    origin had more skeletal studies ordered than
    white children with injuries of unknown origin.
    (Lane et al., 2002- JAMA)

18
Reports of Racial and EthnicDisparities in
Healthcare
  • Minorities are less likely to be given
    appropriate cardiac medications or to undergo
    bypass surgery. There is evidence to suggest
    significant racial differences in who receives
    appropriate diagnostic tests and treatment for
    cancer.
  • Minorities are less likely to receive kidney
    dialysis or transplants.
  • Racial differences have been reported in the
    provision of analgesics in the emergency room.
    (Bach et al. 1999- NEJM Todd et al., 1993- JAMA)

19
Client (Patient) NeedsSafe, Effective Care
Environment
  • Acting as a client advocate
  • Client rights
  • Confidentiality
  • Respecting clients control of personal
    environment and property
  • Establishing priorities
  • Ethical practice
  • Legal responsibilities
  • Organ donation
  • Communicating the need for referrals to memebers
    of the health care team

20
Client (Patient) NeedsHealth Promotion and
Maintenance
  • Disease prevention
  • Family planning and family systems
  • Health and wellness
  • Lifestyle choices

21
Client (Patient) NeedsPsychosocial Integrity
  • Coping mechanisms
  • Religious and spiritual influences on health
  • Support systems
  • End of life
  • Therapeutic interventions

22
Client (Patient) NeedsPhysiological Integrity
  • Basic care and comfort practicies
  • Nutritional preferences
  • Therapeutical procedures
  • Practicies or restrictions related to procedures
    and treatments

23
Dietary Preferences
  • African-Americans
  • Fried foods
  • Pork, greens, rice
  • Some pregnant African-Americans engage in pica
  • Asian-Americans
  • Soy sauce
  • Raw fish
  • Rice

24
Dietary Preferences
  • European (White) Origin Americans
  • Carbohydrates (potatoes)
  • Red meat
  • Hispanic-Americans
  • Beans
  • Fried foods
  • Spicy foods
  • Chili
  • Carbonated beverages

25
Dietary Preferences
  • American Indians, Eskimos
  • Blue cornmeal
  • Fish
  • Game
  • Fruits and berries
  • Navajos prefer meat and blue cornmeal and tend to
    avoid consumption of milk

26
Religion and Dietary Practicies
  • Seven Day Adventist (Church of God)
  • Alcohol, coffee, and tea prohibited
  • Some groups prohibit meat
  • Baptist
  • Alcohol prohibited
  • Discourage consumption of coffee and tea
  • Buddhism
  • Alcohol and drug use discouraged
  • Some sects are vegetarian

27
Religion and Dietary Practicies
  • Roman Catholics
  • Avoid meat on Ash Wednesday and Good Friday
  • Optional fasting during lent season
  • During Lent, discourage meat on Friday
  • Children and the ill are exempt from fasting

28
Religion and Dietary Practicies
  • Church of Jesus Christ of Latter-Day Saints
    (Mormon)
  • Alcohol, prohibited
  • Limited consumption of meat
  • First Sunday of the month is time for fasting

29
Religion and Dietary Practicies
  • Hinduism
  • Beaf and veal prohibited
  • Many individuals are vegetarians
  • Limited consumption of meat
  • Fasting occurs on specific days of week according
    to which god the person worship
  • Children are not allowed to participate in
    fasting
  • Fasting rituals vary from complete abstinence to
    consumption of only one meal per day

30
Religion and Dietary Practicies
  • Islam
  • Pork prohibited
  • Any meat product not ritually slaughtered is
    prohibited
  • Avoidance of Alcohol and Drugs
  • During Ramadan (ninth month of Mohammedan year)
    fasting occurs during daytime

31
Religion and Dietary Practicies
  • Jehovahs Witness
  • Prohibition of any foods to which blood has been
    added
  • Can consume animal flesh that has been drained

32
Cultural features African-Americans
  • Communication
  • 1. Languages include English and Black English
  • 2. Head nodding does not necessarily
    meanagreement
  • 3. Direct eye contact is often viewed as being
    rude
  • 4. Nonverbal communication is very important
  • 5. It is considered to be intrusive to ask
    personal
  • questions of someone on initial contact or
  • meeting

33
African-Americans
  • Time orientation and space
  • 1 Oriented more to the present than the future
  • 2. Close personal space is important
  • 3. Touching another's hair is sometimes viewed as
    offensive

34
African-Americans
  • Social roles
  • 1. Large extended-family networks are important
  • 2. Many single-parent, female-headed households
  • 3. Religion is usually Protestant (Baptist)
  • 4. Strong church affiliation with community
    isimportant
  • 5. Social organizations are strong within
    com-munities

35
African-Americans
  • Health and illness
  • 1. Harmony with nature
  • 2. No separation of body, mind, and spirit
  • 3. Illness is a disharmonious state that may
    becaused by demons or spirits
  • 4. Illness can be prevented by nutritious meals,
    rest, and cleanliness

36
African-Americans
  • Health risks
  • 1. Sickle cell anemia
  • 2. Hypertension
  • 3. Coronary heart disease
  • 4. Cancer (especially stomach and esophageal)
  • 5. Lactose intolerance
  • 6. Coccidioidomycosis

37
African-Americans
  • Implementation
  • 1. Avoid stereotyping
  • 2. Do not label Black English as an
    unacceptableform of language
  • 3. Clarify meaning of client's verbal and
    nonverbalbehavior
  • 4. Be flexible and avoid rigidity in scheduling
    care
  • 5. Encourage involvement with family
  • 6. A folk healer or herbalist may be consulted
    before an individual seeks medical treatment

38
Asian Americans
  • Communication
  • 1. Languages include Chinese, Japanese,
    Korean,Vietnamese, English
  • 2. Silence is valued
  • 3. Eye contact is considered rude
  • 4. Criticism or disagreement is not expressed
    verbally
  • 5. Head nodding does not necessarily mean
    agreement
  • 6. The word "no" is interpreted as disrespect
    for others

39
Asian Americans
  • Time orientation and space
  • 1. Oriented more to present
  • 2. Social distance is important
  • 3. Usually do not touch others during
    conversation
  • 4. Touching is unacceptable with members of
    opposite sex
  • 5. The head is considered to be sacred therefore
  • touching someone on the head is disrespectful

40
Asian Americans
  • Social Roles
  • Devoted to tradition
  • Large extended-family networks
  • Loyalty to immediate and extended family
    andhonor are valued
  • Family unit is very structured and hierarchical
  • Man have the power and authority, and women are
    expected to be obedient
  • Education is viewed as important
  • Religions include Taoism (Buddhism), Islam,
    Christianity
  • Social organizations are strong within the
    community

41
Asian Americans
  • Health and illness
  • 1. Health is a state of physical and spiritual
    harmony with nature and a balance between
    positive and negative energy forces (yin and
    yang)
  • 2. A healthy body is viewed as a gift from
    ancestors
  • 3. Illness is viewed as an imbalance between yin
    and yang
  • 4. Yin foods are cold, and yang foods are hot
    cold foods are eaten when one has a hot illness,
    and hot foods are eaten when one has a cold
    illness
  • 5. Illness is contributed to prolonged sitting or
    lying, or to overexertion

42
Asian Americans
  • Health risks
  • 1. Hypertension
  • 2. Cancer (stomach and liver)
  • 3. Lactose intolerance
  • 4. Thalassemia
  • 5. Coccidioidomycosis

43
Asian Americans
  • Implementation
  • 1. Avoid physical closeness and excessive
    touching only touch a client's head when
    necessary, in-forming the client before doing so
  • 2. Limit eye contact
  • 3. Avoid gesturing with hands
  • 4. Clarify responses to questions
  • 5. Be flexible and avoid rigidity in scheduling
    care
  • 6. Encourage involvement with family
  • 7. A healer may be consulted before an
    individualseeks out traditional treatment

44
Hispanic-American
  • Communication
  • 1. Languages include Spanish and Portuguese, with
    various dialects
  • 2. Tend to be verbally expressive, yet
    confidentiality is important
  • 3. Eye behavior is significant for example, the
    "evileye" can be given to a child if a person
    looks atand admires a child without touching the
    child
  • 4. Avoiding eye contact indicates respect and
    attentiveness
  • 5. Direct confrontation is disrespectful, and the
    expression of negative feelings is impolite
  • 6. Dramatic body language, such as gestures or
    facial expressions, is used to express emotion or
    pain

45
Hispanic-American
  • Time orientation and space
  • 1. Oriented more to present
  • 2. Comfortable with close proximity to others
  • 3. Very tactile and use embraces and handshakes
  • 4. Value the physical presence of others
  • 5. Politeness and modesty are essential

46
Hispanic-American
  • Social roles
  • 1. The nuclear family is the basic unit also,
    there are large extended-family networks
  • 2. The extended family is highly regarded
  • 3. Needs of the family take precedence over
    individual family members' needs
  • 4. Men are the decision makers and breadwinners,
    and women are the caretakers and homemakers
  • 5. Religion includes Catholicism
  • 6. Strong church affiliation
  • 7. Social organizations strong within the
    community

47
Hispanic-American
  • Health and illness
  • 1. Health may be a reward from God or a result
    ofgood luck
  • 2. Health results from a state of balance
    be-tween "hot and cold" forces and "wet and
    dry"forces
  • 3. Illness occurs as a result of God's
    punishmentfor sins
  • 4. Folk medicine traditions

48
Hispanic-American
  • Health risks
  • 1. Lactose intolerance
  • 2. Diabetes mellitus
  • 3. Parasites
  • 4. Coccidioidomycosis

49
Hispanic-American
  • Implementation
  • 1. Communicate with male head of family
  • 2. Protect privacy
  • 3. Offer to call priest or other clergy because
    of
  • the significance of religious practices related
    to
  • illnesses
  • 4. Always touch a child when examining him or her
  • 5. Be flexible and avoid rigidity in scheduling
    care

50
Native Americans
  • Communication
  • 1. Languages include English, Navajo, and
    othertribal languages
  • 2. Silence indicates respect for the speaker
  • 3. Speak in a low tone of voice and expect others
    to be attentive
  • 4. Eye contact is avoided because it is a sign
    ofdisrespect
  • 5. Body language is important

51
Native Americans
  • Time orientation and space
  • Oriented more to present
  • Personal space is very important
  • Will lightly touch another person's hand during
    greetings
  • Massage is used for the newborn infant to promote
    bonding between infant and mother
  • Touching a dead body is prohibited in some tribes

52
Native Americans
  • Social roles
  • Very family oriented
  • Basic family unit is the extended family, which
    often includes people from several households
  • I some tribes, grandparents are viewed as family
    leaders
  • Elders are honored
  • Children are taught to respect traditions
  • The father does all the work outside the home,
    and the mother assumes responsibility for
    domestic duties
  • Sacred myths and legends provide spiritual
    guidance
  • Religion and healing practicies are integrated
  • Community social organizations are important

53
Native Americans
  • Health and illness
  • Health is a state of harmony between the person,
    the family, and the environment
  • Illness is caused by supernatural forces and
    disequilibrium between person and environment
  • Traditional health and illness beliefs may
    continue to be observed natural and
    magicoreligious folk medicine tradition
  • Traditional healer medicine man or woman

54
Native Americans
  • Health risks
  • Alcohol abuse
  • Accidents
  • Heart disease
  • Diabetes mellitus
  • Tuberculosis
  • Arthritis
  • lactose intolerance
  • Gallbladder disease
  • American Eskimos are susceptible to glaucoma

55
Native Americans
  • Implementation
  • Clarify communication
  • Understand that the client may be attentive even
    when eye contact is absent
  • Be attentive to own use of body language
  • Obtain input from members of extended family
  • Encourage client to personalize space in which
    health care is delivered for example, encourage
    client to bring personal items or objects to the
    hospital
  • In the home, assess for the availability of
    running water and modify infection control and
    hygiene practices as necessary

56
PROLONGATION OF LIFE
  • Christian Science religion is unlikely to use
    medical means to prolong life
  • Jewish faith generally opposes prolonging life
    after irreversible brain damage

57
DEATH AND DYING PRACTICES
  • Autopsy may be prohibited, opposed, or
    discour-aged by Eastern Orthodox religions,
    Muslims, Jeho-vah's Witnesses, and Orthodox Jews
  • Organ donation is prohibited by Jehovah's
    Wit-nesses and Muslims
  • Buddhists in America encourage organ donationand
    consider it an act of mercy
  • Cremation is discouraged, opposed, or
    prohibitedby the Mormon, Eastern Orthodox,
    Islamic, andJewish faiths
  • Hindus prefer cremation and cast the ashes in a
    holyriver

58
Try your knowledge...
  • A nurse in an ambulatory care clinic is
    performingan admission assessment for an
    African-Americanclient scheduled for a cataract
    removal with anintraocular lens implant. Which
    of the followingquestions would be inappropriate
    for the nurse toask on an initial assessment?
  • 1. "Do you have any difficulty breathing?"
  • 2. "Do you have a close family relationship?"
  • 3. "Do you ever experience chest pain?"
  • 4. "Do you frequently have episodes of headache?"

59
  • A nurse is providing discharge instructions to
    aChinese client regarding prescribed dietary
    modifi-cations. During the teaching session, the
    clientcontinuously turns away from the nurse.
    Whichnursing action is most appropriate?
  • 1. Continue with the instructions, verifying
    clientunderstanding
  • 2. Tell the client about the importance of
    theinstructions for the maintenance of health
    care
  • 3. Walk around the client so that the
    nursecontinuously faces the client
  • 4. Give the client a dietary booklet and return
    laterto continue with the instructions

60
  • A nurse is preparing a plan of care for a
    client whosereligion is Jehovah's Witness. The
    client has beentold that surgery is necessary.
    The nurse considersthe client's religious
    preferences in developing theplan of care and
    documents that
  • 1. Surgery is prohibited in this religious group
  • 2. The administration of blood and blood
    productsis forbidden
  • 3. Medication administration is not allowed
  • 4. Faith healing is primarily practiced

61
Cultural Diversity and Health Care
  • It is because we are different that each of us is
    special.
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