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Cultural Diversity: Issues in Education and Practice


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

Cultural Diversity Issues in Education and
  • Nataliya Lishchenko

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

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

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.

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

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

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

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

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

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

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

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

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

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.

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

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

Reported Racial and EthnicDisparities in
  • 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
  • (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)

Reports of Racial and EthnicDisparities in
  • 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
  • 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)

Client (Patient) NeedsSafe, Effective Care
  • 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

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

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

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

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

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

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

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

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

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

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 rituals vary from complete abstinence to
    consumption of only one meal per day

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

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

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

  • 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

  • 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
  • 5. Social organizations are strong within

  • 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

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

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

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
  • 5. Head nodding does not necessarily mean
  • 6. The word "no" is interpreted as disrespect
    for others

Asian Americans
  • Time orientation and space
  • 1. Oriented more to present
  • 2. Social distance is important
  • 3. Usually do not touch others during
  • 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

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,
  • Social organizations are strong within the

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
  • 2. A healthy body is viewed as a gift from
  • 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
  • 5. Illness is contributed to prolonged sitting or
    lying, or to overexertion

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

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
  • 6. Encourage involvement with family
  • 7. A healer may be consulted before an
    individualseeks out traditional treatment

  • 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
  • 4. Avoiding eye contact indicates respect and
  • 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

  • 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

  • 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

  • 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
  • 3. Illness occurs as a result of God's
    punishmentfor sins
  • 4. Folk medicine traditions

  • Health risks
  • 1. Lactose intolerance
  • 2. Diabetes mellitus
  • 3. Parasites
  • 4. Coccidioidomycosis

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

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
  • 5. Body language is important

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

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
  • 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
  • Religion and healing practicies are integrated
  • Community social organizations are important

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

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

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
  • In the home, assess for the availability of
    running water and modify infection control and
    hygiene practices as necessary

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

  • 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

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?"

  • 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
  • 2. Tell the client about the importance of
    theinstructions for the maintenance of health
  • 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

  • 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

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