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:
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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:
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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:
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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
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Integrated system of shared values
 Custom
 Habitual activity of a group or subgroup
 Enculturation
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Process of assuming the traits and behaviors of a given culture
 Ethnocentrism
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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)
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Group of same race or nationality with a common culture and traits
 Minority
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Group differentiated from the majority population with regard to
religion, race, or ethnic origin
 Norm
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Prescribed standard of allowable behavior within a group
 Race
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Physical differentiator based on a common heredity
 Rite
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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:
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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:
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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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