Transcript Cultural Competency and awareness

WHAT IS CULTURAL COMPETENCY?
Culture is often described as the combination of a body of
knowledge, a body of belief and a body of behavior. It involves a
number of elements, including personal identification, language,
thoughts, communications, actions, customs, beliefs, values, and
institutions that are often specific to ethnic, racial, religious,
geographic, or social groups.
For the provider of health information or health care, these
elements influence beliefs and belief systems surrounding
health, healing, wellness, illness, disease, and delivery of
health services. The concept of cultural competency has a
positive effect on patient care delivery by enabling providers
to deliver services that are respectful of and responsive to
the health beliefs, practices and cultural and linguistic needs
of diverse patients (CDC, 2014).
Why is cultural competency important?
Cultural competency is critical to reducing health disparities and improving access to
high-quality health care, health care that is respectful of and responsive to the needs of diverse
patients. When developed and implemented as a framework, cultural comp etence enables
systems, agencies, and groups of professionals to function effectively to understand the needs of
groups accessing health information and health care or participating in research -in an inclusive
partnership where the provider and the user of the information meet on common ground
(CDC, 2014).
CULTURAL AWARENESS: TOGO, WEST AFRICA:
Togolese usually have two or three meals per day, each
consisting largely of a starch product, such as cassava,
maize, rice, yams, or plantains. A hot, spicy sauce is
served with midday or evening meals, consisting of a
protein, fish, goat, beans, or beef and often rich in palm
(red) oil or peanut paste. Fruits and vegetables, though
readily available, are eaten more by the bourgeoisie.
http://www.state.gov/p/
af/ci/to/
Traditional French staples, including baguettes, are mainstream in the cities. A
Togolese funeral is a most important event. Wildly extravagant (by Western
standards), funeral celebrations are a daily occurrence. Marching bands,
choirs, football tournaments, banquets, and stately services are as
fundamental as an expensively decorated coffin. Funerals often take place
over a month or more, and families frequently sell or mortgage land or
homes to pay for the funeral of a beloved and elderly relative. If the
person dies in an accident, however, or some other sudden tragedy (AIDS, for
example), this is considered a "hot death," and the funeral services are
concluded more quickly, with little circumstance.
HAITIANS: FOOD BELIEFS AND RITUALS
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Haitians believe that exposing the body to an imbalance of “hot” (cho) and “cold” (fret)
factors cause illness. Haitians also assess food in terms of heavy or light qualities; one should eat
heavy foods, such as cornmeal mush, broiled plantain, or Potato, during the day to provide
energy for work. One should eat light foods, such as hot chocolate milk, bread or soup, for
dinner because they are easily digested.
Method of preparation also important: Boiled green plantains are heavy, but fried yellow/ripe
plantains are light.
Food taboos and prescriptions
Food prohibitions are related to particular diseases and life stages.
For example, to avoid acne, teenagers should not drink citrus juices,
such as orange or
lemon.
After strenuous activity or anyactivity that makes the body hot, oneshould not eat cold food
because that will cause an imbalance chofret).
(
When ill, Haitians like pumpkin soup, bouillon,
or a special soup ofgreen vegetable, meat, plantain, dumplings and yam, all kinds of
porridge,
oatmeal, and akasan, a cornmeal cream prepared with milk, sugar, cinnamon, vanilla flavoring,
and a pinch of salt.
Hospitality: Haitians are very hospitable. Welcome guests to their home with food, refusal of
which is impolite. May offer child’s bed if guest stays overnight. Family offers most
comfortable space to guest.
Pain (doule)
Haitians can use numerical scales for symptoms if the scales are explained.
Have very low pain threshold. Whole demeanor changes.
Very verbal about what hurts. Sometimes moan.
Usually very vague about location of pain, believing that whole body is affected; because
disease travels, location of pain not important.
Prefer injections. In lieu of injections, order of preference is elixir, tablets, and capsules.
Accept alternative pain treatments.
Haitian can present him or herself in the clinical area and says,
“I am suffocating” (Map toufe) or “I cannot breathe” (Mwen-pa
ka respire). As a care provider, offer oxygen only when
absolutely necessary, as Haitians associate it with serious
disease.
Having a son a first born is extremely important because it
means he will carry on the family name. Father does not
participate in child bearing; he believes that birth is a
private event that
is best handled by women. Do not encourage male circumcision, believing that
it reduces sexual satisfaction. Females are not circumcised. Haitians have
inappropriate and undesirable attitudes about birth control. They are very
sensitive and suspicious when topic of discussion is about STIs and HIV
because, in 1982, Haiti was the first developing country blamed for the origin
of AIDS. They still endure stigma of “Haitians are AIDS carriers.” They do not
recognize male partner’s responsibility in preventing conception. Males resent
condom use, believing that condoms reduce sexual pleasure.
Dyspnea
A primary respiratory ailment is oppression.
Haitians use this term to describe asthma, a state of anxiety and
hyperventilation.
Consider oppression (like many respiratory conditions) a “cold” state.
Patient says, “I am suffocating” (Map toufe) or “I cannot breathe”
(Mwen-pa ka respire).
Offer oxygen only when absolutely necessary, as Haitians associate it
with serious disease.
Middle east Indians women
Middle Eastern
Considering the Middle Eastern culture, communication can be a challenge between Middle
Eastern patients and Western health care professionals. Middle Easterners approach life
differently in significant ways from Westerners in terms of time control, power distance, male
or female roles, personal space, and privacy. Ways of handling bad news should be consider.
The degree of exposure to Western or American culture greatly affects an individual’s
attitudes and behaviors. Religious affiliations are also extremely influential. While it is
useful to apply.
generalizations when learning about patterns of communication, it is also important to
avoid applying hard and fast rules in any cross-cultural interaction.
Time Control
Punctuality is less important in the Middle East than in the United States. A patient
might be late for an appointment, or not come at all, because another matter immediately at
hand was seen as more important than the previously scheduled appointment. The matter taking
precedence often involves meeting the needs of someone a person feels obligated to in a
reciprocal relationship. For example, a family member or close friend. Americans, being taskoriented, plan their days around getting things accomplished and are annoyed by a nonchalant
approach to time. Americans who are left waiting for more than a few minutes may feel
they are being disrespected; the late arriver should offer a good explanation for not
showing up on time. Middle Easterners on the other hand may be offended by the
Americans attention to getting things done rather than taking the time to establish a
relationship.
Middle Easterners touch more frequently, just like Togolese do. This difference in
personal conversing space can makeWesterns feel very uncomfortable. The collapsing of
personal space may feel invasive or even somewhat aggressive.
Privacy
Middle East individual may tend to resist disclosing detailed personal information to
. Data for health histories may not be willingly
strangers, including healthcare professionals
given and request for information may be viewed with some suspicion until it is clear why the
questions are being asked. Once trust with a caregiver is established, personal information is
given more freely.
Middle Easterners desire to please or to appear good, and less dominant persons must at
all costs placate stronger ones. Healthcare providers should be aware that Middle Easterner is not
likely to ask questions or give information that would contradict or show disrespect. Depending
on the degree of acculturation in the U.S, in religious views, a Middle Eastern person,
especially a male, may feel uncomfortable interacting with a female doctor as a person of
real authority.
Health and Illness Behavior
Middle Easterners have respect for Western medicine. However, in working with any immigrant
population, healthcare practitioners should be aware of common folk beliefs and practices.
Much like Latino people, Middle Easterners may believe in illness causation such as the Evil
Eye. In this belief, anything that provokes jealousy in another gives the envious person the
power to cause illness or misfortune for the lucky person or family. Often the object of envy is a
beautiful baby or child. Much like Latino and Asian people, Middle Easterners believe in
the importance of balancing “hot” and “cold” foods – qualities that do not necessarily have to
do with actual food temperature. Healthcare practitioners have frequently observed among
Middle Easterners a fatalistic acceptance of disease or death: it’s all in Allah’s hands.
Preventive care is not practiced as commonly in the Middle East as it is in the United States.
Middle Eastern patients may expect to receive a prescription because medication is heavily used.
Middle Easterners often fear hospital admission because hospitals are considered places of
misfortune where people go to die. Moslems are concerned that a family cannot be sure
that the body of one of its members will be treated correctly according to religious customs,
should a patient die in hospital. Family members do not plan for death and never give up hope
until a patient has actually died; grief is not permitted to be shown in the presence of a dying
person.
Once death has occurred, mourning may be loud and obvious. A person who is not
overcome with emotion is not admired. It takes more time to consult with a Middle Eastern
family, and that scheduling should be arranged accordingly when possible.
Mexicans:
Because family is very important to Mexicans, it may be helpful to speak with both the
patient and family members. However, to protect confidentiality, seek a patient’s permission
first. Do not assume that nonverbal cues, such as nodding “yes,” mean that a patient is agreeing
to take medications as prescribed (CDC, 2014).
The largest religions in Eritrea are Sunni Muslim (approximately 50%), Orthodox Christian
(approximately 40%), Eastern Rite and Roman Catholic (approximately 5%), and the
Evangelical Church of Eritrea (approximately 2%). Other minority groups include Seventh-Day
Adventists, Jehovah's Witnesses, Baha'is, Buddhists, and Hindus. Islam predominates in the
eastern and western lowlands while Christianity is dominant in the highlands. Along ethnic lines,
members of the Tigrinya group are primarily Orthodox Christian. Most of the Tigre, Nara, Afar,
Saho, Beja, Rashaida, and Blen are Muslim.
Over 50% of the Kunama are Roman Catholic.
Traditionally, the girls are taught to perform household tasks,
but with family roles changing due to immigration, the boys in
the family also help out with housecleaning and dishwashing. As
both spouses begin to work more outside the home, household
duties are more frequently shared
Infant Feeding, Care
Eritreans highly value breastfeeding and as a
result, most Eritrean women breastfeed their
babies. Women generally breastfeed for up to a
year and may stay home for the first 3 to 6
months of their infants’ lives in order to
accommodate breastfeeding.
There is often a push to introduce solid foods to
infants at 4 months, which is a few months earlier
than recommended by American pediatricians.
Eritreans believe in the healing powers of different
plants, although they generally see a medical practitioner
first. If Western medicine does not work, Eritreans may
return home as a last resort to utilize natural native
remedies. Eritreans may not realize that large quantities of
some plants may interact with pharmaceutical drugs and
therefore it should be explained that although herbs may
not seem like medication to the
patient, doctors should be
informed if the patient is using them.
Female circumcision is practiced in Eritrea and traditionally
performed by lay healers. The type of female circumcision varies
from region to region. Eritreans wish to have all males circumcised.
Most Eritreans used hospitals in much the same way as here in the
United States (Cooper, 2010).
In the United States
Eritreans generally try Western medicine first for treatment and
believe that doctors in this country are able to help them. They may
be concerned that too much blood is drawn for testing and would
prefer to avoid this unless absolutely necessary.
They may be resistant to blood transfusions but also understand
that if absolutely necessary they will comply. If blood is being
drawn, providers should explain exactly what the purpose is and
what tests are being done on the blood. It should also be
explained that blood tests do not necessarily provide a total
medical overview and sometimes blood tests are looking for one
specific variable.
Gender concordance between the health care provider and the
patient is considered important by many Eritreans. Eritrean men
would prefer to be cared for by male health care providers.
Eritrean women strongly wish to be cared for by female providers
and if an interpreter is needed, a female is preferred (Cooper,
2010).
If an Eritrean is diagnosed with a life-threatening illness, they
first follow the Western medical plan. Eritreans strongly wish that
the family be informed first of a serious illness or poor prognosis
rather than the patient, this way the family can inform the
patient.
If the patient is expected to die, it should be explained to the
family that organs will not be harvested without consent. This
information is especially important if an autopsy is to be
performed (Cooper, 2010).
Vietnamese Cultural Profile
To
avoid confrontation or disrespect, many will not vocalize disagreement.
Praising someone profusely is often regarded as flattery, and sometimes even mockery.
Most people are very modest and deflect praise.
Insults to elders or ancestors are very serious and often lead to severed social ties.
General Etiquette
Many will smile easily and often, regardless of the underlying emotion, so a smile cannot
automatically be interpreted as happiness or agreement.
Vietnamese often laugh in situations that other cultures may find inappropriate. This
laughter is not intended as ridicule.
Breaking a promise can be a serious violation of social expectation. It is very difficult to reestablish a lost confidence.
When inviting a friend on an outing, the person who offers the invitation usually offers to
pay to the bill.
During social gatherings, Vietnamese will often arrive late so as not to appear overly
enthusiastic. However, they are punctual to appointments in professional settings.
Infant Feeding, Care
Most Vietnamese women breastfeed their infants for the first 6-12 months (both in the U.S. and in
Vietnam). In the Country of Origin, Western medicine in Vietnam consisted of many things, mostly
antibiotics, Vitamin B12 shots for "feeling bad," and IV fluids. Attitudes towards suffering: Many see
suffering and illness as an unavoidable part of life. Some also feel (the Hmong in particular) that the
length of one's life is predetermined, and life prolonging or lifesaving care is futile. Also within the
community, stoicism, a masculine trait among mostly older gentlemen, is a highly respected personal trait
which can prevent people from seeking care. Poor physician-patient communication: Southeast Asian
cultures value politeness, respect for authority, and avoidance of shame. Because of this, many will not ask
questions, will not voice disagreement or concern, and will not reveal intentions or actions that seem in
contrast to the physician’s wishes. If patients disagree or do not understand, they may simply listen and
answer yes in respect, then not return for further care or comply with recommendations (Doan and Gruen,
2010).
Establishing trust with our patients is the key for success in
caring for different individuals in our communities.
References
Carteret, M.
(2011). Health Care for Middle Eastern Patients & Families.
Retrieved from
http://www.dimensionsofculture.com/2010/10/health-care-for-middleeastern-patients-families/
Centers for disease control and prevention. (2014). Chapter 2. Overview of
Mexican Culture. Retrieved from
Colin, J, M. (n.d.). Cultural and Clinical Care for Haitians. Retrieved from
http://www.in.gov/isdh/files/Haiti_Cultural_and_Clinical_Care_Present
ation_Read-Only.pdf
Cooper, D. (2010). Eritrean Cultural Profile. Retrieved from
https://ethnomed.org/culture/eritrean/eritrean-cultural-profile
References cont’
Doan, O and Gruen, S. (2010). Vietnamese Cultural Profile. Retrieved
October 20, 2014, from
https://ethnomed.org/culture/vietnamese/vietnamese-cultural-profile
Everyculture.com. (2014). Culture of Togo. Retrieved October 15, 2014,
from http://www.everyculture.com/To-Z/Togo.html
http://www.worldatlas.com/webimage/countrys/namerica/caribb/ht.htm
http://www.worldatlas.com/webimage/countrys/namerica/caribb/ht.htm