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CHAPTER 5
CULTURE AND HEALTH CARE
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
1
Culture Overview

Importance of cultural values and
connections on health care
Patient’s culture
 Health care worker’s cultural background
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
Culture
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

Act of belonging to a designated group
“Colo”
• Latin – to cultivate
Effect is unconscious
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
2
Culture Is Reflected in Many
Aspects of Life
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Eating habits
Language
Dress
Hobbies
Living patterns
Occupational choices
Education
Religious affiliations
Political points
Interpersonal relationships
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
3
Acculturation

Learning cultural behaviors from one group or
person

Evolves slowly
 Always occurring
 Subcultures within each large cultural group
 Can be broad and varied

United States Census Bureau

Collects data on U.S. population every 10 years
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
4
Table 5-1
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
5
Ethnography



Branch of anthropology
Studies and records human cultures
Ethnographic studies provide information to
teach cultural competence
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
6
Cultural Impact on Health Care

Every interaction with a patient has cultural
implications
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
7
Wellness and Health Prevention

Various cultures have different views on
preventive medicine

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
Exercise
Preventive doctor visits
Immunizations
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
8
Touch and Physical Space


Differing views on close touching and human
contact
As a health care worker:
 Always
ask permission before touching any
patient, regardless of cultural differences
 Be alert to positive or negative signs
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
9
Communication


Vital to our survival
Language

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Language barriers affect communication
Language is a form of cultural connection
Assimilation

Process of accepting and exchanging cultural
information
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
10
General and Invasive Procedures


Important for the health care worker to be
sensitive to patients who are not comfortable
in removing clothing for examinations or who
fear invasive procedures.
All health care team members should
announce their arrival and wait a few
moments before entering a room.
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
11
Dietary Needs

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
Social tool and biological need
Many ethical and religious implications with
food
All attempts should be made to meet the
patient’s nutritional needs and preferences
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
12
Box 5-1 Yin and Yang Foods
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
13
Spirituality



Essential for recovery and strength for many
ethnicities
Belief should be accepted and assistance
offered when requested
Using incorrect terminology is a sign of great
disrespect
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
14
Death



Views vary greatly
Rituals vary greatly
Deaths from suicide have many cultural
implications
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
15
Medications

Actions and side effects vary based on
patient ethnicity

FDA and ISMP studies
• Antilipemic drugs
• BiDill
• Drug dosage
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
16
Pain Management

Beliefs about pain vary

Important for the health care worker to use
listening and assessment skills to look for
nonverbal cues of pain
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
17
Other Cultural Differences That
Have an Impact on Health Care
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Refusal to give blood or get blood
transfusions
Refusal to donate or receive organ
transplants
Refusal to place aging parents into nursing
home
Fertility control
Mental illnesses
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
18
Signs of Cultural Barriers
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Important to listen to the patient closely and
look for nonverbal cues
Signs that cultural barriers exist:
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Resistant to change
Uncooperative
Argumentative
Overly agreeable and flaccid
Noncompliance after multiple teaching attempts
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
19
Obstacles to Cultural Competence

Ethnocentrism
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Belief that one’s own culture is superior to another
• Often unconscious
• Seen in many daily activities
Health care provider cannot allow this to interfere
with providing care
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
20
Obstacles to Cultural Competence
(Continued)

Stereotyping

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
Seeing or viewing patients in one ethnic group all
molded together as one
• Assumes conformity
Patients need to feel trusted and safe
Prejudice and discrimination

Stereotyping can lead to prejudice, which leads to
discrimination
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
21
All health care providers must agree to care
for patients regardless of race, age, color, sex
or ethnic origin.
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
22
Overcoming Obstacles

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
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Explore personal ideas and perceptions
about different cultures
Learn as much as you can about local
cultures
Always use the patient’s family name unless
given permission to use first name only
Be aware of eye contact
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
23
Overcoming Obstacles (Continued)
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Encourage patients to talk about their
illnesses and look for areas of
misunderstanding
Look for confusion and fear
Treat all patients with respect, concern, and
compassion
Recognize that other cultures are not as time
sensitive as Americans
Respect spirituality
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
24