Cultural Diversity and Sensitivity

The purpose of this CBL is to increase awareness of and respect

for diversity when delivering patient care in the workplace.

Revised June 2017

Introduction

• This CBL is designed to:

– Increase awareness of the need to respect diversity while delivering patient care or while working with other staff members.

– Provide background knowledge of the common cultures and religions encountered within the Blessing Health System.

Course Development

Definitions

• Prejudice -

– Quickly judging a person based on shallow information (like race, religion or appearance). Prejudice involves thoughts and feelings.

• Discrimination -

– Acting differently toward a person based on that shallow information. Involves outward behavior.

• Empathy -

– Identification with and understanding of another’s situation, feelings, and motives (compassion, understanding, insight, appreciation).

Definitions

• Diversity is defined as the occurrence of different and distinct cultural groups within an organization including individuals and groups with varying backgrounds, experiences, styles, perceptions, values and beliefs.

• The elements of diversity include, but are not limited to religion, ethnicity, national origin, gender, age, education, sexual orientation, or economic status.

Diversity

Definitions

• Values are a collection of guiding principles believed to be correct and desirable, such as trust and integrity.

• Each culture has its own set of values.

• Our values drive the decisions we make.

What are Values?

Definitions

• Worldview refers to the ideas and beliefs we hold that guide the way we interpret and interact with the world.

• Worldview becomes the basis for a person’s actions.

What is Worldview?

Definitions

• If a person with high blood pressure believes that God gives them both health and illness, he or she may be more inclined to believe that moral behavior is the key to good health rather than exercise and diet.

• Asian and Native American cultures view people as a part of nature and strive to stay in harmony with nature.

– They may look to nature for treatment of illness, such as using herbal remedies.

• Another part of worldview has to do with a person’s relationship with nature.

– The American culture believes that nature can be controlled.• If bacteria cause an illness, then the bacteria need to be destroyed (antibiotics).• If the kidneys do not function, then they need to be replaced.

Examples of Worldview

Cultures

• Knowing about other cultures helps us improve care for our patients and work with others better.

– We can understand each other better.

• Not understanding culture can result in conflicts and misunderstandings.

– Less than favorable outcomes for our patients can result.

– Conflict with coworkers can also result.

Why is Knowing About Other Cultures Important?

Cultures

• Anglo American (White American)

• African American

• Hispanic American

• Asian American

• Native American

What are the Cultures Most Commonly Served by BHS?

Cultures

• People of this culture tend to:

– Value independence and individuality.

– Value achievement and hard work as ways to provide for wealth and comfort.

– Believe in creating their own fate/outcomes.

White American Values

Cultures

• People of this culture tend to:

– Value family bonding.

– Seek the strength that lies in family, church, and the African American community.

African American Values

Cultures

• The Hispanic American culture tends to:

– Put great value on family.

– Place family members’ needs above individual needs.

– Invite extended family members to be present during hospitalization.

Hispanic American Values

Cultures

• This culture includes Japanese, Chinese, Filipino, Korean, Vietnamese, and Indian populations.

• This culture tends to:

– Place a high value on family over personal interests.

– Have a strong group orientation (often extends to the workplace).

– Readily set aside their own needs or interests to care for an ill family member.

Asian American Values

Cultures

• This culture tends to:

– Take pride in maintaining traditions and customs.

– Value extended family.

– Work for the good of the group over the individual.

– Accept the natural order of things such as illness or accidents.

Native American Values

Potential Communication Barriers

• Miscommunication is a common problem.

• The most obvious is when a person does not speak English.

• However, there can be more subtle barriers that may result from differences in culture.

• Understanding why people communicate in the ways they do may help avoid frustration and promote better relationships.

Potential Communication Barriers

• Americans tend to call each other by their first names.

– It is considered a sign of friendliness. However, in many other cultures this can be seen as inappropriate and discourteous.

• It is recommended to refer to adult patients as Mr., Miss, Mrs., or Ms. unless instructed otherwise by the patient.

First Names

Potential Communication Barriers

• In some cases, using a family member to translate may be fine; however, there are times when this may interfere with correct interpretation, due to cultural influences.

– For example, it is inappropriate for a Hispanic male to discuss private body issues with his mother; therefore, it would not be appropriate for a son to explain a hysterectomy to his mother in order to get informed consent. He may leave out vital information in order to be respectful to his mother.

• Blessing Hospital partners with Certified Languages International for interpretation assistance.

• At the time of service assignment you will be notified if an interpreter is needed.

• The RN case manager or Social Worker can assist in putting interpreter services in place and helping you use the service.

Using an Interpreter

Potential Communication Barriers

• A speaker phone is used to connect to a Certified Languages International Interpreter.

• Everything the caregiver says is interpreted for the patient and vice versa.

• Most cellular phones can be put in speaker mode

How Does it Work?

Potential Communication Barriers

• Blessing Hospice patient care staff have devices that will enable the use of video interpreting services.

• The person signs into the webcam, allowing someone on the other end to interpret and sign back to them.

• Contact the patient’s RN Care Manager, or Social Worker if assistance is needed.

Sign Language Interpretation

Potential Communication Barriers

• If you think a patient seems disinterested in what you are saying because of lack of eye contact, the reality may be that the patient is trying to show respect for your authority.

– For example many Asian people consider it disrespectful to look someone directly in the eye, especially if they consider the person to be in a superior position.

• Poor eye contact may also mean a patient doesn’t see well. Some people will tell their health care provider about their problems but many, especially the elderly, are embarrassed that they can no longer see well.

• Health professionals need to watch for signs that a patient may not see well.

• Patients with very poor sight may have a hard time finding a chair or walking around furniture.

• They may not make eye contact when talking, or they may not react when someone tries to hand them something

Eye Contact Vs. Visual Impairment

Potential Communication Barriers

• Few cultures share the American ideal of equality between men and women.

• While gender roles and authority figures vary, males generally hold the dominant position in most cultures.

• The health care provider must understand and accept the gender role differences.

Male and Female

Potential Communication Barriers

• All of us are socialized by our culture at a young age.

• Early conditioning is very difficult to change.

• Illness or times of stress are the very times when a person may find comfort in the ways that were reinforced in childhood.

• Do not assume that everyone has the same worldview that you do.

• Do not make assumptions or judgments.

• Respect the differences in others.

Things to Remember

Potential Communication Barriers

• Remember, improving your understanding of other cultures and communication with patients and staff is an ongoing process.

• Every new person you meet from another culture broadens your appreciation of diversity.

Things to Remember

Religious Aspects

• Roman Catholic

• Baptist

• Christian

• Methodist

• Lutheran

What are the Most Common Religions of the Patients We Serve?

Religious Aspects

• For newborns with a poor prognosis, the parents may want a priest called to perform an emergency baptism.

• A priest may be requested if a person is sick or near death, for an anointing.

• Fasting and food restrictions may be observed during Lent, the time before Easter.

Roman Catholic

Religious Aspects

• People of the Baptist faith do not practice infant baptism.

• Notify clergy if the patient desires Holy Communion.

Baptist

Religious Aspects

• They do not practice infant baptism.

• Notify clergy if the patient desires Communion.

• Church elders may be summoned to help with the patient’s spiritual needs as well.

Christian

Religious Aspects

• Notify clergy if:

– Parent desires baptism for a sick infant

– Patient requests Holy Communion prior to surgery or a health crisis

• Scripture reading and prayer are important at the time of death.

• Donation of the body or organs at death is encouraged.

Methodist

Religious Aspects

• Notify clergy if the patient desires Holy Communion.

• Patient may request clergy be called for an anointing blessing if prognosis is poor.

Lutheran

Obesity and Healthcare

• Obesity is when a person has a very high amount of body fat in relation to their lean body mass.

• Morbid obesity is a medical condition.

• 80% of obese adults have at least one other related condition.

• Obese individuals are:

– Two times more likely to die prematurely compared to those with normal weight

– Much more likely to need medical treatment compared to those with normal weight

– Coming to our hospital to seek care in increasing numbers

Obesity and Healthcare

• Morbidly obese persons experience great social isolation and are more likely than normal weight peers to suffer depression.

• Understand that many obese persons avoid the doctor or hospital because of embarrassment.

• It is common for very obese patients to feel anxious that they will injure a healthcare worker.

Walk in Their Shoes

Summary

• Culture is the combination of beliefs, behaviors, languages and traditions that are learned and shared by a group of people.

• Understanding the cultures of others helps us to better communicate and get along.

• Values are a collection of guiding principles believed to be correct and desirable, such as trust and integrity.

• Worldview is a culture’s basic assumptions about the nature of reality, such as if staying in harmony with nature will keep them well.

• The most common cultures encountered at Blessing Health System are White, African-American, Asian, Hispanic, and Native American.

• The most common religious groups encountered at Blessing Health System are Roman Catholic, Baptist, Methodist, Christian, and Lutheran.