Chapter 6: Diversity and Difference in Health Care: Dynamics of Health Care in Society

Subculture

. A subculture is a group of people who are members of a larger cultural group, but whose attitudes and behaviors reflect different beliefs and values from those of a larger culture. A subculture might be based on occupational status or age. Subculture can also be based on ethnicity or language

Dominant Group

A dominant group is the group within a society that tends to control that society's values. Although the dominant group is usually the largest group in a society, it does not have to be. The values of a dominant group strongly influence the value system of its society.

Minority Group

A minority group is usually has some physical or cultural characteristics that identify the people within it as different from the dominant group, such as: o Race, religion, beliefs, customs or practices

How do you belong to a specific ethnic group?

A person belongs to a specific ethnic group either through birth or through the adoption of that group's characteristics.

Acupressure: Nontraditional Healing

Acupressure: provider performs deep pressure massage at certain points in the body

Acupuncture: Nontraditional Healing

Acupuncture: originate din China, this therapy prevents, diagnoses, and treats pain and disease by inserting special needles into the body at specified locations

What size does a dominant gruop have to be?

Although the dominant group is usually the largest group in a society, it does not have to be.

Cultural Differences Related to Time

Another cultural difference related to time involves perceptions of past, present, and future. While the dominant American culture is future oriented, other cultures are more concerned with the present or the past

Acculturation

Another word for cultural assimilation: Assimilation occurs when an individual shifts his or her identify from the minority group to the dominant group and adopts the values, attitudes, and behaviors of the dominant culture

Ethnocentrism

As a rule, you should work to avoid ethnocentrism, the belief or assumption that a particular social or cultural group is superior in some way. Every person should be viewed as a unique, valuable individual

What happens when immigrants begin to immerse themselves in the dominant culture? Specifically what happens to their culture?

As immigrants go to work and to school and learn the dominant language, they often move closer to the dominant culture.

cultural assimilation or acculturation

Assimilation occurs when an individual shifts his or her identify from the minority group to the dominant group and adopts the values, attitudes, and behaviors of the dominant culture

What is culture influenced by and rooted in of in human society?

Beliefs, Habits, Likes, Dislikes, Customs, Rituals

How a person perceives situations and other people is influenced by their beliefs including:

Cultural Beliefs, Social Beliefs, Religious Beliefs, Personal Convictions

Cultural practices and beliefs may BLANK over time but?

Cultural practices and beliefs may evolve over time, but many traits remain constant.

What does culture influence?

Culture influences people's roles and interactions with others and is revealed in the attitudes, customs, and institutions unique to particular groups

Culture and Identity

Culture is shared by, and helps provide an identity for, members of a cultural group. It guides group members into behaviors that are acceptable to the group

Needs of a Culturally Diverse Population

Culture is shared by, and helps provide an identity for, members of a cultural group. It guides group members into behaviors that are acceptable to the group. Culture influences the way people in a group view themselves, what expectations they have, and how they behave in response to certain situations. The practices of a particular culture often can be traced to the group's social and physical environment. Cultural practices and beliefs may evolve over time, but many traits remain constant. Each new generation learns the norms, or expected behaviors, of its culture through formal teaching and by watching the behavior of elders. Language is a primary means of transmitting culture.

Food and Nutrition

Culture strongly influences food preferences, including both ingredients and how foods are prepared. Most cultures consider certain foods to be dietary staples.

Culture

Culture, is a shared system of beliefs, values, and behavioral expectations that provide structure for daily living. Culture influences people's roles and interactions with others and is revealed in the attitudes, customs, and institutions unique to particular groups

Cultures include what kind of groups?

Cultures include both dominant groups and minority groups

Cutaneous Stimulation: Nontraditional Healing

Cutaneous Stimulation: this technique involves stimulating the skin through massage, vibration, heat, or cold to reduce the intensity of pain

Each new generation learns the ?

Each new generation learns the norms, or expected behaviors, of its culture through formal teaching and by watching the behavior of elders. Language is a primary means of transmitting culture

Ethnicity

Ethnicity involves a sense of identification with a group based on a common heritage. A person belongs to a specific ethnic group either through birth or through the adoption of that group's characteristics. People within an ethnic group generally share unique cultural and social characteristics, including: Language and dialect, religious practices, literature, folklore, music, political interests, food preferences

Example of physical characteristics evolving due to enviornmental factors

Evidence suggests that humans first arose in Africa, and scientists believe that early humans had dark skin. Over time, some human population have developed much lighter skin. Scientists believe this change was an adaption to the environment: as pop moved to northern climates, they developed lighter skill to better synthesize vitamin D from sunlight

Socioecnomic Factors

Family income affects individual health and access to HC. While most middle-class families have the resources for health care when needed, many poorer Americans do not.

Folk Medicine

Folk medicine is a form of prevention and treatment that uses old-fashioned remedies and household medicines handed down from generation to generation within a particular culture.

Folk Medicine Popularity in the US

Folk medicine is widely practiced in the U.S. and throughout the world

HCP and Pain of Patient

HCP may assume that a patient who doesn't complain is not experiencing any pain. As a result, a patient who deals with pain quietly and stoically may have his or her need for pain treatment ignored

Food and Nutrition: HCP

HCP who teach abt diet should take these cultural differences into account. Dietary advice should also recognize cultural attitudes abt the social significance and sharing of food

Physical Characteristics Evolve due to?

Human physical features have evolved over time as a response to environmental demands. Skin color is an example

Cultures and Time Orientation

In other cultures, punctuality and completing tasks within an allotted amount of time may not be valued as highly. For example, in some South Asian cultures, being late is considered a sign of respect.

Cultural Diversity

In our society, cultural diversity is characterized by a wide range of distinctions, including: Race, National Origin, Religion, Language, Physical Size, Gender, Sexual Orientation, Age, Disability, Socioeconomic Status, Occupational Status, Geographic Location

Pyschological Characteristics

In social interactions, people interpret the behaviors of others around them. This is true for both HCP and patients. While you're assessing the attitude and behavior of a patient, the patient is probably evaluating your conduct as well

Hereditary

Inherited Genetically

It is natural to note differences among individuals but?

It is natural to note differences among individuals, you must never allow any preconceived notions about others to affect the quality of your work.

Keloids: Hereditary Disorders

Keloids: Overgrowth of connective tissue that forms during healing from an injury to the skin. Rather than healing level with the surrounding skin tissue, the wound heals with a rough, lumpy, or elevated scar. People with dark skin are much more likely to develop keloids. The tendency towards keloids seems to run in families, suggesting a genetic cause. Scientists haven't determined the genetic mechanism, however

Lactase Deficiency and Lactose Intolerance: Hereditary Disorders

Lactase deficiency and lactose intolerance: The milk of all mammals contain lactose, a sugar. The body needs the enzyme lactase to break down lactose during digestions. Without lactase, the lactose ferments in the intestines, resulting in gas, diarrhea, and bloating. Lactase deficiency and lactose intolerance are more common among certain groups, including Hispanic women and men and women of African, Chinese, and Thai descent. People w lactase deficiency can drink milk substitutes or dairy products that have been enriched with lactase

People within an ethnic group generally share unique cultural and social characteristics, including:

Language and dialect, religious practices, literature, folklore, music, political interests, food preferences

Culture Shock

Living in a dominant culture that differs from one's own can produce psychological discomfort or disturbance called culture shock. The patterns of behavior that an individual learned were acceptable and effective in his or her native culture are often not suited to the new one. Culture shock often produces stress and may lead an individual to feel foolish, fearful, inadequate, embarrassed, humiliated, or inferior

Difference between your view of a situation and your patient's view

Need to remember your view of a situation could differ from you patient's view. Even if a patient's concerns seem unreasonable of irrelevant, you must remember that these concerns are very real and important to the patient. In interactions with patients, then, you need to put aside your own opinions and try to look at the circumstances from the patient's point of view. Values and beliefs about health, illness, and treatments are shaped by cultural and ethnic influences

Example of HCP subculture

Nursing is a subculture of the larger health care system culture.

Difference in Cultures of Proxemics, Eye Contact

One person may feel that standing close to another person is a sign of respect while the other may view this as aggressive behavior. Some individuals consider a casual touch or direct eye contact to be courteous, while others find this same conduct disrespectful.

Pain

Pain is warning from the body that something is wrong. Pain is what a person says it is, and every complaint of pain should be accessed carefully

Religion: HCP

Patients' religious beliefs an values may affect how they wish to be treated by health care professionals. Health care providers must be sensitive to each patient's values and beliefs. For ex. Male Orthodox Jews may not be touched by women who are not members of their families. Because such patients would be uncomfortable interacting with a female care provider, it would be important to have a male care professional attend to them.

How does judgement lead to stereotypes?

People shouldn't be judged based on cultural or societal differences. Such prejudges leads to or results from stereotypes, mistaken perceptions that are typically rooted in strong feelings and lack of knowledge. Instead, these differences should be celebrated

Why is it imp to not make assumptions based on age?

Physical fitness and levels of health vary at every age. Sixty yr olds who exercise regularly and have no chronic conditions or disease may be healthier than younger adults who are obese and suffering from related conditions. Age is just oneself many different factors that affect health.

Race

Race is normally based on specific physical characteristics, such as skin pigmentation, body stature, facial features, and hair texture.

HCP can follow these guidelines to treat patients with cultural sensitivity

Recognize that culture is an important part of an individual's approach to the world and that each person holds (and has the right to hold) his or her own beliefs about health). Respect the patient's right to respond to health care issues in whatever manner he or she wishes. Never stereotype a patient's perceptions or responses based on his or her culture.

Reactions to Pain Culture

Researchers have discovered that many of the expressions and behaviors of people in pain are culturally influenced. Some cultures allow, and even encourage, the open expression of pain, while other cultures frown on such open display.

Sickle Cell Anemia: Hereditary Disorder

Sickle cell anemia: Sickle cell anemia is a hereditary disorder in which the body makes sickle-shaped, or c-shaped, red blood cells. These cells break down more rapidly than normal red blood cells. The sickle shape also prevents the red blood cells from moving easily through the smaller blood vessels in the body. This can cause blood vessels to be clogged by red blood cells, which can lead to many serious problems. Sickle cell anemia primarily affects people of African descent; Hispanics of Caribbean ancestry; and individuals with Middle Eastern, Indian, Latin American, Native American, or Mediterranean heritage

Types of Physical Characteristics Evolving to Environment

Skin Color (Absorption of Vitamin D). Nose shape and size may have also evolved because of different climates in which human groups lived. These adaptations were natural changes that helped improve the lives and well-being of humans

Is is possible to maintain minority group culture in the midst of a dominant group?

Some members of minority groups maintain their culture is the midst of the dominant culture. Others, however, lose the cultural characteristics that once made them different.

Minority Group and Dominant Group: Maintaining Cuture

Some members of minority groups maintain their culture is the midst of the dominant culture. Others, however, lose the cultural characteristics that once made them different.

Tay-Sachs Disease: Hereditary Disorders

Tay-Sachs disease: Condition is a rare genetic disorder that progressively destroys nerve cells in the brain and spinal cord. Infants born with this disease may develop normally for the first few months of their lives, but they later develop a growing inability to move and eventually die. The incidence of this disease has declined over the years due to genetic testing, but there is still no known treatment. Individuals of Eastern European Jewish descent are most likely to develop Tay-Sachs disease.

Studies have shown that certain racial or ethnic groups possess specific characteristics that make them even more prone to developing particular diseases and conditions. Below are four examples of disorders that are, or may be, hereditary, or inherited genetically

Tay-Sachs, Keloids, Lactase Deficiency and Lactose Intolerance, Sickle Cell Anemia

The US and Culture

The U.S. is a multicultural, multiethnic, and multiracial country

Impact of Values of Dominant Group and Example

The values of a dominant group strongly influence the value system of its society From the time it was colonized until the early 1990s, South African's dominant group was made up on white people of European ancestry, despite the fact that this group accounted for only 13 percent of the country's population

Therapeutic Touch: Nontraditional Healing

Therapeutic Touch: healer uses touch to transfer energy to the patient in order to stimulate the patient's healing potential

B/c a culture is made of individuals?

There are differences within each culture, as members reflect cultural attitudes or behaviors in varying ways. Must be careful not to assume that every member of a particular culture or ethnic group is exactly the same.

How can time orientation be affected by cultural differences: patient care

These cultural differences in time orientation can affect patient care. For ex. Patients that focus on the present find it hard to understand the importance of long-term care. With such patients, HCP may need to take some extra time to explain the seriousness of a medical situation and then follow up to ensure that the patient fully understands all instructions

How can HCP help a patient with culture shock?

These feelings can lead to frustration, anxiety, and loss of self-esteem. These issues are intensified when the person is also trying to cope with a disease or illness. HCP need to understand and appreciate the differences among cultural and ethnic groups. When put into practice, this understanding can help reduce a patient's stress and improve his or her care experience.

Impact of Culture Shock

These feelings can lead to frustration, anxiety, and loss of self-esteem. These issues are intensified when the person is also trying to cope with a disease or illness. HCP need to understand and appreciate the differences among cultural and ethnic groups. When put into practice, this understanding can help reduce a patient's stress and improve his or her care experience.

Values and Beliefs regarding BLANK, BLANK, AND BALNK are shaped by cultural and ethnic influences

Values and beliefs about health, illness, and treatments are shaped by cultural and ethnic influences

Immigrate

When people immigrate, or settle in a new country, they may find that their values differ from those of the dominant culture. As immigrants go to work and to school and learn the dominant language, they often move closer to the dominant culture

Racial Groups in the US

When people speak of racial groups in the U.S, they usually distinguish among whites, African Americans, American Indians, and Alaska natives, Asian Americans, and native Hawaiians, and other Pacific Islanders. The U.S. government views Hispanics as an ethnic, rather, than a racial grou

Culture guides group members of a cultural group into?

behaviours that are acceptable to the group

Cultural differences related to time can also surface in interactions between

coworkers. A colleague who is habitually late for work or meetings may be viewed by others as lazy or irresponsible. However that individual may be an extremely hard-working, responsible, professional who simply comes from a culture that does not emphasize punctuality

Values and beliefs about health, illness, and treatments are shaped by

cultural and ethnic influences

As a HCP you must understand the different needs of a?

culturally diverse patient population

Individuals may vary frm their?

culture's norms

If you are providing direct patient care, you should be sensitive to signs that patients are in pain, even if they do not complain of pain. On the other hand, you should not consider patients who freely express their discomfort to be constant complainers whose requests for pain relief as?

excessive

Many poor families lack affordable or adequate housing, which can also affect the health of

family members. When low-income housing is available, or it may lack necessities like running water, heat, and electricity. To stretch their money and to pool resources, many poor people live in crowded conditions, with multiple families joining in one household.

In some cultures, the power to heal is thought to be a

gift from God bestowed on certain people. People in these cultures believe that healers know what's wrong with them through divine revelation.

Culture is shared by, and helps provide an?

identity for members of a cultural group.

Poverty particularly affects older Americans and families headed by single mothers

inadequate care of infants and children, poor preventive care, poor diet, and homelessness. In addition, many poor families cannot afford the transportation they need to get a HCP. All these factors affect HC.

Patients that focus on the present find it hard to understand the importance of

long-term care. With such patients, HCP may need to take some extra time to explain the seriousness of a medical situation and then follow up to ensure that the patient fully understands all instructions

Some providers choose to combine their

medical training with nontraditional healing techniques. For example, some physicians learn the Chinese practice of acupuncture. Regardless of their own treatment philosophy, you must be open and accepting of other professionals who use different methods in certain situations. You must also be conscience of your own perceptions of health, illness, and health care practices.

Nontraditional healing includes several different therapies, such as:

o Cutaneous Stimulation: this technique involves stimulating the skin through massage, vibration, heat, or cold to reduce the intensity of pain. o Therapeutic Touch: healer uses touch to transfer energy to the patient in order to stimulate the patient's healing potential o Acupuncture: originate din China, this therapy prevents, diagnoses, and treats pain and disease by inserting special needles into the body at specified locations. o Acupressure: provider performs deep pressure massage at certain points in the body

You must not presume to know a person's true feelings or intentions based solely on

on gestures or body language. Your understanding of a patient's actions may be different from the patient's true intentions. Keep in mind that people may interpret behaviors differently

Avoid making assumptions about others based solely on

on your own beliefs or cultural norm. This can lead to tensions in the workplace that produce unhealthy working conditions and can lead to poor patient care.

In addition to cultural influences on beliefs about health, illness, and treatments

other factors play significant roles in shaping every individual's view of health care. Economics, age, and religion all shape how patients and health care providers view one another. These same factors can also impact patient care.

While a modern medical care is the norm for HC in the US, many patients prefer other kinds of health care. These preferences may be the result of

poverty, language, availability of different kinds of care, lack of insurance, and preference for familiar and personal care.

The group's social and physical environment can be tied to the?

practices of a particular culture

Economics, age, and religion all shape

shape how patients and health care providers view one another. These same factors can also impact patient care.

If you are providing direct patient care, you should be sensitive to

signs that patients are in pain, even if they do not complain of pain

Within a given culture, ?

smaller groups or subcultures also express cultural differences

Studies have shown that certain racial or ethnic groups possess?

specific characteristics that make them even more prone to developing particular diseases and conditions.

The practices of a particular culture often can be traced to

the group's social and physical environment

. A patient accustomed to traditional healers may consider health care providers incompetent if they

they ask a list of questions before treating an illness. They also might not understand the need to undergo some laboratory tests. Traditional healers speak the patient's language and are often more accessible and are usually more understanding of the patient's cultural and personal needs.

Americans are very what regarding time?

time oriented

Studies have shown that people in upper-income groups tend to

to live longer and experience less disability than those in lower-income groups. Altho a # of programs help families with low income meet their health care needs, many poorer Americans still go without regular health care.

Crowded living conditions have been also associated with

with higher crime rates and can contribute to psychological problems, such as schizophrenia, alienation, and feelings of worthlessness. Such living conditions can also contribute to the spread of disease.

By avoiding making judgements abt others, you can?

you can learn to appreciate the things that make people different. Will help you treat others with the same care and respect. HCP who are aware and understand cultural differences provide better patient care.

Difference between traditional healing and health care professionals

· . Traditional healers speak the patient's language and are often more accessible and are usually more understanding of the patient's cultural and personal needs.

Age

· An individual's age affects his or her health in different ways. Younger people have different health care needs from older adults. Adults are better able to communicate their symptoms and responses to medication than children, although some older adults may also have communication problems.

Age and HCP

· HCP need to be sensitive to patients' changing physical and emotional needs as they grow older.

Other Differences Among Individuals

· In addition to cultural influences on beliefs about health, illness, and treatments, other factors play significant roles in shaping every individual's view of health care. Economics, age, and religion all shape how patients and health care providers view one another. These same factors can also impact patient care

Gender Roles

· In many cultures, males are dominant and generally make decisions for all family members. In some Muslim families, for ex, if approval for medical care is needed, the male head of the family gives that approval regardless of which family member needs care. In male-dominant cultures, women are usually passive. However, in other cultures, women are dominant and make the decisions.

Why is it important to know gender roles?

· Knowing which member of the family is dominant is an important consideration when planning patient care. If the dominant member is ill and can no longer make decisions, the whole family may be anxious and confused. If a non-dominant family member is ill, he or she may need help verbalizing needs, particularly if those needs differ from what the dominant member perceives as important.