Transcript Chapter_002
Chapter 2
Cultural Competency
Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
"It is not the strongest of the species that
survives, nor the most intelligent that survives. It
is the one that is the most adaptable to
change."--Charles Darwin
Cultural Competence
To be culturally aware is to understand
those aspects of the human condition that
differentiate individuals and groups and that
sometimes have an overpowering effect on their
health and medical care.
Understanding of a particular culture may be useful
in the solution of problems that may at first have
seemed intractable.
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A Definition of Culture
Culture in the broadest sense reflects the
whole of human behavior, including:
Ideas and attitudes
Ways of relating to each other
Manners of speaking
Material products of physical effort, ingenuity, and
imagination
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Culture
"Culture” includes:
Language
Beliefs
Morals
Education
Sets of dynamically evolving shared traits
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Physical Characteristics
The use of physical characteristics (e.g., gender or
skin color) to distinguish a cultural group can be a
trap.
There is a sharp difference between distinguishing
cultural characteristics and distinguishing physical
characteristics.
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Ways to Develop Cultural
Competence
Be willing to modify
care in keeping with
patient’s culture.
Recognize that cultural
diversity exists.
Demonstrate respect.
Do not expect all
members of a culture to
behave the same.
Examine own cultural
beliefs.
Appreciate that cultural
values are ingrained
and are hard to change.
Recognize that cultural
definitions of health and
illness differ.
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Impact of Culture
Influences on the way patients seek medical care
and the way clinicians provide care include:
Age
Gender
Race
Ethnic group
Cultural attitudes
Regional differences
Socioeconomic status
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Impact of Culture (Cont.)
Poverty and inadequate education
disproportionately affect various cultural groups.
Ethnic minorities and women
Socioeconomic disparities negatively impact the
health and medical care of individuals belonging to
these groups.
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A Lexicon of Cultural Understanding
Acculturation
Process of accommodating to another culture
Culture
Integrated system of shared values
Custom
Habitual activity of a group or subgroup
Enculturation
Process of assuming the traits and behaviors of a given culture
Ethnocentrism
Belief in the superiority of one’s own culture with disdain for others
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A Lexicon of Cultural Understanding
(Cont.)
Ethnos (ethnic group)
Group of same race or nationality with a common culture and traits
Minority
Group differentiated from the majority population with regard to
religion, race, or ethnic origin
Norm
Prescribed standard of allowable behavior within a group
Race
Physical differentiator based on a common heredity
Rite
Prescribed, formal, customary observance
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A Lexicon of Cultural Understanding
(Cont.)
Ritual
Stereotypical behavior regulating religious, social, and
professional behaviors
Stereotype
Simplified, inflexible conception of the members of a group
Subculture
Subgroup having distinctive traits that differentiate it from the
larger culture
Values
Ideals, customs, institutions, and behaviors within a group for
which the members have a respectful regard
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Primacy of the Individual in
Health Care
Predicting an individual patient's character merely
on the basis of common cultural traits is not
appropriate.
Cultural attitudes may constrain professional
behavior and confuse the context in which the
patient is served.
The individual is unique.
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Cultural Assessment Guide:
The Many Aspects of Understanding
Health beliefs and practices
Faith-based influences and special rituals
Language and communication
Parenting styles and role of family
Sources of support beyond family
Dietary practices
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Health Beliefs and
Practices
Patient view of health and illness
Attitudes about pain, illness, death, handicap
Hygiene practices
Common treatments of illness
Use of prevention measures
Preference of health professionals
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Faith-Based Influences
and Special Rituals
Religion to which patient adheres
Special religious practices and beliefs that affect
health care when patient is ill or dying
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Language and
Communication
Primary language, secondary language
Command of English, literacy
Special signs that demonstrate respect
or disrespect
Role of touch in communication
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Dietary Practices
Culturally forbidden or required foods
Foods used in rites or ceremonies, fasting
Food beliefs (e.g., foods believed to cause
or to cure illness)
Periods of required fasting
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Impact of Culture on Illness
Disease is shaped by illness, and illness is shaped
by the totality of the patient’s experience.
Health care providers must consider the substance
of illness―the biologic, emotional, and cultural
aspects―or else fail to offer complete care.
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Components of a Cultural
Response
Make sure you explore and understand the
patient’s cultural beliefs and practices.
Avoid making assumptions about cultural beliefs
and behaviors without validation from the patient.
Beliefs and behaviors that will have an impact on
patient assessment include the following:
Modes of communication
Health beliefs and practices
Nature of relationships within a family
Diet and nutritional practices
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Health Beliefs and
Practices
Patients have a view of health and illness, and an
approach to cure shaped by a cultural paradigm.
Patients with a “scientific view” are more
comfortable with Western medical care.
Patients with a “holistic” or natural approach may
be at odds with Western medical care.
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Family Relationships
Family structure and the social organizations to
which a patient belongs are among many imprinting
and constraining cultural forces in a person’s life.
One type of already known behavior may predict
another type of behavior.
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Diet and Nutritional
Practices
Beliefs and practices related to food, as well as the
social significance of food, play a vital role in
everyday life.
Some of these beliefs of cultural and/or faith-based
significance may have an impact on your care:
Orthodox Jew
Muslim
Chinese
Herbal, home, and natural therapies
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Summing Up
Meet patients on their own terms.
Resist stereotyping.
Understand yourself and your attitudes.
Constrain your prejudices and tendencies to be
judgmental.
Take these steps to make strides toward cultural
competence.
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