Lesson 1
A Diverse Nation
"Culture is a cluster of intangible and tangible aspects of life passed down from generation to generation."
Dr. Felipe Korzenny, Professor
In this lesson, you will:
Objectives
Culture is the system of shared attitudes, values, and beliefs that are common among a group of people.
Culture includes societal aspects, such as language, customs, values, art, and social norms, that are taught and passed down from generation to generation.
It can be as large as a society or as small as the culture within a household.
Culture
In order to give our patients the best possible care, we must first understand the importance of culture and its influences.
Culture
Our culture affects:
In 1976, American anthropologist Edward T. Hall developed what he called the iceberg analogy of culture.
Iceberg Analogy
He said that if the culture of a society was an iceberg, some aspects of culture would be easy to see, above the surface.
However, below the water, there is a much larger portion of culture, hidden beneath the surface.
Cultural Diversity
Cultural diversity is the cultural differences and variety that exist in the world, a society, or an institution.
Including, but not limited to:
Properly Handling Cultural Diversity
Properly handling cultural diversity significantly affects:
Healthcare professionals must be sensitive to the cultural practices of patients and take these practices into consideration in their communication and the delivery of treatment.
Cultural diversity not only exists among your patients, but also among your co-workers.
United States Census
The United States government collects an official count of the population, or census, every 10 years.
Respondents self-identify their race and ethnicity.
The data collected is used to inform many federal programs and policy decisions, especially related to civil rights and equal opportunities, including healthcare.
Demographics
Demographics - the statistical data of the population �in a specific area.
Demographics can help you identify the type of diversity you may encounter most often in your local area.
Personal Bias
Biases - feelings that lead to certain behaviors.
Personal bias - allowing your own feeling about a particular person or thing affect your actions or decisions.
Even the most enlightened, intelligent, and caring professionals have some personal biases, even if they are completely unintentional.
Recognizing and understanding your own personal biases can help you more easily avoid unfair judgments.
Personal Bias
Here are a few examples of personal bias:
1. Treating patients differently because of their weight
2. Prejudice related to a person’s sexual preference
3. Discrimination based on race or religion
4. Beliefs that someone who cannot afford health insurance should receive less care
5. Gender discrimination
6. Assuming a patient with broken English is uneducated
Generalizations vs. Stereotypes
A cultural generalization is made by looking at the majority of people in a cultural group and using their societal norms to make a generalization about the group’s behavior and patterns.
Stereotypes are made by automatically applying generalizations to every member �of a group, or making generalizations �about a group based on the behavior of a few individuals.
All athletes are party animals.
Some athletes like to celebrate and unwind after a game.
Generalizations vs. Stereotypes
Latinos are always closed to outsiders; they only do business among themselves.
Trust is important in the Latino community; to do business, you first need to build relationships.
Which statement is a generalization, and which is a stereotype?
Stereotype
Generalization
No individual is an exact generalization of their culture of origin.
People are a unique blend of the diversity from within their culture and an accumulation of personal experiences.
In this lesson, you:
Summary
Lesson 2
Effects on Healthcare
"We all should know that diversity makes for a rich tapestry, and we must understand that all the threads of the tapestry are equal in value no matter what their color."
Maya Angelou, Author, Poet, Activist
In this lesson, you will:
Objectives
Healthcare workers must be very aware of the effect a patient’s culture or religion may have on their medical treatment.
Where might you notice cultural and religious differences?
Differences are most evident in cultural and religious views on:�
Effect on Medical Treatment
The patient typically has the right to refuse treatment.
The patient may also want to supplement prescribed treatment with his or her own culturally-accepted methods.
Explain the treatment, why the doctor is recommending it, and ask the patient if they have any questions.
Effect on Medical Treatment
Culture and Religion
On the following slides, we will look at some generalizations surrounding culture and religion and their effects on healthcare.
It is important to keep in mind that this is just a small sampling of the different cultures and religions that you may encounter.
Cultural Group | Medical Views | Family Care Structure | Communication Traits |
Western | Western medicine – rely on prescription medication and preventive medications | Individual, immediate family, and close friends | Direct communication, eye contact expected, not adverse to therapeutic touching, may challenge medical opinions, speak loudly |
African American/ Black Culture | Western medicine – rely on prescription medication and preventive medications | Extended family, close friends, relatives, neighbors, church family | Direct communication, eye contact expected, not adverse to therapeutic touching, may challenge medical opinions, may have regional dialects |
East Asian (including Chinese, Japanese, and Korean) | Mixture of Western medicine and holistic medicine. Rely on Confucian principals - ex. Balancing natural forces and energy in the body | Immediate family. In Asian culture, the opinion of family and elders is very important. | Indirect communication, avoid eye contact, may show little emotion, avoid therapeutic touching, may agree with what is said even when they don’t agree, speak softly |
Native American or South Sea Islander | Mixture of Western and folk medicine. Balance between the forces of nature is important. | Extended family, relatives, close friends, neighbors, tribal affiliations | Avoid eye contact, speak softly and slowly. |
Hispanic or Latino | Mixture of Western and folk medicine, combined with a strong belief in the intervention of God. | Extended family, relatives, church family, collective community. Collectivist culture with strong family values; many family members may be with the patient. | Make direct eye contact. May speak English, Spanish, or both. |
Muslim | Mixture of Western and folk medicine, combined with a strong belief in the intervention of Allah. Patients may not be examined by the opposite sex. | Immediate family. Opinions of the family and the male head of the household are very important. | Touching between men and women is not allowed for strict believers. Females do not make direct eye contact. Will not discuss many taboo subjects. May speak loudly to indicate importance. |
Religion
Hindu
Believe in reincarnation; death is a crucial transition.
A number of ceremonies accompany pregnancy and childbirth.
May express strong concerns about modesty.
Often strictly vegetarian. Some medicines are not suitable because they are derived from cows, pigs, or other animals.
Washing with running water is important.
Religion
Islam
May face Mecca (southeast in the U.S.) at five set times a day to pray to Allah.
May hesitate to express the need for pain management.
A family member may request to be present with a dying patient to whisper a proclamation of faith right before death.
After death, the family may request to wash the body and position the bed to face Mecca.
Great importance on cleanliness; washing with running water is important.
Organ donation acceptable; autopsy permitted only for medical or legal reasons.
Religion
Jehovah’s Witness
Prohibited from receiving blood or blood products, even in medical emergencies.
Name for God is Jehovah. Bible is the holy book.
The vast majority of medical treatments are acceptable.
Organ donation and transplant allowed, but often only components not affected by blood flow.
Do not believe in an immediate afterlife; last rites are not appropriate.
Religion
Judaism (Hebrew)
Required to eat kosher food: food fit to be eaten in accordance with Jewish law.
Medical procedures should not be scheduled during Sabbath (sunset Friday to sunset Saturday) or religious holidays (unless they are life-saving).
Jewish law encourages blood donation and allows blood transfusions.
Engage in a number of death rituals, traditionally carried out by the rabbi (Jewish spiritual leader).
Orthodox Jewish women prefer to have their bodies and limbs covered. Men keep their heads covered with hats or skull caps.
Religion
Roman Catholic
Healthcare important. The Roman Catholic Church is the largest
non-government provider of healthcare services in the world.
Infant baptism mandatory.
The anointing of the sick is administered to bring spiritual strength
near the time of death.
Sacraments and blessings by a priest are highly important.
Autopsy and organ donation acceptable.
Religion
Amish
Many use modern medical services, but others use alternative medicines.
Less likely to seek medical attention for minor aches or illnesses.
Follow home remedies, as well as other methods of natural healing including homeopathic remedies, health foods, reflexology, and chiropractors.
Not against surgery, but less inclined to intervene when elderly face terminal illness.
Vaccinations are not widely accepted.
Religion
Christian Scientist
Discourage organ donation.
May refuse medical interventions such as medicine, surgical procedures, and blood transfusions.
Teaches a reliance on God for healing instead of on medicine or surgery.
Often fearful of being forced to accept unwanted treatments which violate their beliefs.
Religion
Buddhism
Believe illness is a result of karma (law of cause and effect); do not believe in healing through faith.
Medications acceptable in times of great discomfort, as along as they do not affect state of mind.
No restrictions on receiving blood or blood products, surgical procedures, organ donation, or autopsy.
Believe in reincarnation. The time of death requires peace and quiet for the dying person to enter the next life.
Culture & Religion
Although these generalizations offer a good starting point for understanding, they will not be accurate for every individual.
It is your job as a healthcare professional to refrain from judgment and address each patient individually.
Socioeconomic Status
Socioeconomic status relates to a person’s economic and social position in relation to others, based on income, education, and occupation.�
A person’s socioeconomic status can affect:
Knowing everything about every culture and group is impossible. However, we can learn techniques that we can apply universally to all patients.
It Starts with Trust
Building trust is one of the most important approaches for bridging cultural barriers.
4 steps to building trust
Demonstrate Empathy - Empathy is the ability to understand someone else’s feelings.
Show Respect - With respect, you show that you hold special regard for someone and will treat him or her in the proper way.
Be Genuine - If you are genuine, you are honest and sincere with others.
Listen Actively - Active listening means using verbal and non-verbal cues to let the speaker know that you have heard and understand what they have said. A good active listener will give the speaker feedback by restating or paraphrasing what they heard in their own words, to confirm their understanding.
In this lesson, you:
Summary
Lesson 3
Health Disparities and Health Equity
In this lesson, you will:
Objectives
Health Disparities
“Preventable differences in the burden of disease, injury, violence or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”
Centers for Disease Control and Prevention (CDC)
“Differences in health outcomes that are closely linked with social, economic, and environmental disadvantage.”
The Office of Minority Health of the U.S. Department of Health and Human Services
While health inequities as a term is utilized more often worldwide, health disparities as a term is used more often in the United States.
Health disparities are:
Health Disparities Example
Dropping out of school is associated with multiple social and health problems.
In general, the more education an individual has, the less likely they are to experience a number of health risks, including obesity, substance abuse, and chronic health conditions.
Disadvantaged people in the United States are at higher risk for developing a wide range of disabling conditions (such as asthma, diabetes, heart disease, and cancer) that can negatively impact their lives.
Equality vs. Equity
There is a major focus in healthcare today on �health disparities and how to reduce them.
Remember that internationally (and by the World Health Organization), health disparities are usually referred �to as health inequities.
Equality
Equity
means that everyone receives the same treatment or medication
means that access to doctors, medications, and care is offered in a fair and just manner to everyone
Equality vs. Equity
Health equity is about access to healthcare for all people.
Some people have a better opportunity to get treatment for diseases (and therefore have better health) than others.
The goal of public health is to increase health equity and decrease these health disparities.
In the United States, African Americans have a life expectancy that is nearly four years less than for Caucasians—and lowest in the District of Columbia, Mississippi, Alabama, and Louisiana.
Would this health disparity be decreased by equality or equity?
Health Disparity Example
The goal of public health is to reduce health disparities by increasing health equity.
Improving effective health communication with all patients is important to reducing health disparities and increasing health equity.
Effective Communication
Patients’ abilities to understand the health information they receive is impacted by:
Health literacy
Cultural competency
Linguistic competency
Health Literacy
Health Literacy is the degree to which an individual has the capacity to obtain, communicate, process, and understand health information and services in order to make appropriate health decisions.
-Title V (Subtitle A) of the Patient Protection and Affordable Care Act (PPACA) of 2010.
In addition to basic literacy skills (such as reading, writing, and verbal communication), health literacy also includes a knowledge of how to maintain health.
A lack of health literacy can affect a patient’s ability to:
A person who is severely allergic to bee stings can experience not only pain and swelling of the affected body part, but difficulty breathing and low blood pressure—leading to anaphylactic shock and death.
Health Literacy Example
Understanding that the difficulty in breathing and sudden feeling of weakness are symptoms of anaphylactic shock, the person could seek immediate medical help. Physicians often recommend that such severely allergic individuals carry an EpiPen on them (to self-inject epinephrine) to immediately counter an allergic attack if stung by a bee.
Having the health literacy knowledge of how the body responds to allergens (such as bee sting venom, peanuts, or animal hair) can help the allergic person treat exposure to them—and stay healthy.
How would health literacy help a severely allergic individual?
Health Literacy
People with limited health literacy are:
Health Literacy
The responsibility for improving health literacy lies with healthcare professionals and the healthcare system.
If a patient does not speak or understand English, �an interpreter can make a huge difference in the outcome of the hospital or clinic visit for medical treatment.
Healthcare workers must work to ensure that their health information and services can be properly communicated and understood by the patients, or health inequities will continue in the healthcare setting.
Cultural Competency
Cultural competency refers to a set of behaviors, attitudes, and policies of healthcare professionals that enable them to better work with patients from diverse backgrounds and ethnic groups.
Cultural competency involves:
A lack of culturally-competent care can make patients from other cultures fearful of seeking healthcare.
Cultural Competency
Training in cultural competency is now being included in a variety of healthcare settings, especially where the majority of patients being treated are from a disadvantaged or minority population.
Examples of strategies to help improve culturally-competent care:
Linguistic Competency
Linguistic competency is the ability of the healthcare system to effectively deliver language-appropriate healthcare to patients in the United States who speak limited or no English.
When an individual in the United States has �limited English proficiency (LEP), the lack of linguistic competency is often a barrier to the ability to access health information and healthcare -- as well as follow instructions for treatment from doctors after discharge from the hospital.
Linguistic Competency
The use of interpreters and translators is one method that can help to improve linguistic competence in the healthcare environment.
They may be able to speak English well, but still not be able to read Informed Consent forms or write down instructions given by their health providers.
The main focus of linguistic competency is to remove language barriers to limited English-speaking populations in order to decrease health disparities and inequities.
What three things impact a patient’s ability to understand the health information they receive?
Health literacy
Cultural competency
Linguistic competency
Check Your Understanding
In this lesson, you:
Summary
Lesson 4
Customer Service
In this lesson, you will:
Objectives
Patient experience and quality customer service is increasingly important in healthcare.
The healthcare market is competitive, and your patients are your customers.
Patients have choices as to what providers and facilities they use.
Customer Service
Healthcare workers are responsible for the satisfaction of their patients. �
If a patient’s expectations are not met, they are likely to seek another provider for care.
Patients will take their entire experience into account when evaluating their healthcare experience.
Customer Service
of the population suffers from “white coat syndrome.”
White coat syndrome - the patient’s feeling of anxiety in a medical environment is abnormally high
20%
If these people do seek healthcare…
Tips for Good Customer Service
What can you do to help make sure that your patients have a good experience?
2. Always speak warmly and with compassion.
3. Speak professionally and use the patient’s name.
4. NEVER tell your patients your personal information or problems.
5. Keep your focus on the needs of the patient.
Despite our best efforts, conflicts and complaints happen.
70%
of patients who make a complaint will return if the complaint is handled and resolved properly.
Conflicts and Complaints
What should you do if a patient complains to you?
Service Recovery
When a customer is dissatisfied, healthcare professionals need to take responsive action to “recover” the customer. This is often referred to as service recovery.
Many facilities have a “service recovery log” which allows them to look for trends in customer dissatisfaction to continually improve their customer service.
4 Steps to Service Recovery
1. Apologize - As easy as it seems, a simple “I’m sorry” is an important step in moving a situation away from negative and toward positive.
2. Acknowledge the patient’s feelings - Service recovery begins when we see that a patient’s expectations are not being met. After apologizing, it is vital that the problem and the patient’s feelings are acknowledged right away.
3. Offer alternatives - Instead of telling a patient what they can’t have, focus on what options are possible.
4. Make amends - Making amends is a way of righting a wrong. It can be a simple sincere apology or more complex, such as calling an insurance provider and sending a follow-up letter. Sometimes, it may include a small gift or token of appreciation.
In this lesson, you:
Summary