Online Class Quiz 1

Multicultural health

is the need to provide health care services in a sensitive, knowledgeable and nonjudgmental manner with respect for peoples health beliefs and practices when they are different from your own

What influences health?

Genetics, the environment, socioeconomic status and other cultural and social forces

Health beliefs and practices that are different from patient to patient include

people’s perception of health and illness, how they pursue and adhere to treatment, health behaviors on why people become ill and what is considered a health problem/ways to restore and maintain health

Why is culture important in the context of health?

It determines how people approach health and recognizing cultural similarities and differences is an essential component for delivering effective health care services

The goals of a multicultural approach to health care include

1. To provide health services in a culturally sensitive, knowledgeable and nonjudgmental manner

2. To challenge one’s own assumptions and ask the right questions

3. To integrate different approaches to care

4. To recognize the culture of the recipient while providing care in accordance with the legal/ethical norms and the medically sound practices of the practitioner’s medical system

Cultural competence

is an individual’s ability to work effectively with people from diverse backgrounds.

Culture refers to a group’s integrated patterns of behavior and competency is the capacity to function effectively. {NOT a one size fits all concept}

Stereotypes

are the mistaken assumptions that everyone in a given culture is alike

Generalization

is the awareness of cultural norms and it is a starting point to cultural competence

Race

refers to one’s physical characteristics and/or genetic or biological makeup. It is NOT a scientific construct but instead a social one.

Ethnicity

is the socially defined characteristic of a group of people who share common cultural factors such as race, history, national origin, religious belief and language.

Race is primarily based on ____ while ethnicity is based on____.

physical characteristics, social and cultural identities

How is ethnicity different from culture?

One can belong to a culture without having ancestral roots to that culture, with ethnicity the culture is a part of the ethnic background. Making culture embedded within the ethnic group

Ethnocentricity

is the belief that one’s own culture is superior to another one

Cultural relativism

puts all cultures at equal value and it attempts to take a neutral, objective view of differing cultures. It incorporates relativism with respect to culture’s varying moral codes

Cultural adaptation (Acculturation)

refers to the degree to which a person has adapted to the dominant culture while retaining traditional practices {There are different levels of acculturation}

The four levels of acculturation are

1. Assimilation: when an individual demonstrates high dominant and low ethnic society immersion

2. Integration: when a person has high dominant and high ethnic society immersion

3. Separation: when a person has a low dominant and high ethnic society immersion

4. Marginalization: when a person has low for both dominant and ethnic society immersion

Health disparities

are defined as differences in health outcomes and their determinants between segments of the population as defined by social, demographic, environmental and geographic attributes

Health disparities are based on

gender, age, ethnicity, socioeconomic status, geography, sexual orientation, disability, or special health care needs.

Discrimination

impacts health primarily through three pathways: psychological stress, access to health and social resources, violence and bodily harm

The five national goals for Healthy People 2030 are

1. Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury and premature death.

2. Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.

3. Create social, physical, and economic environments that promote attaining full poten-tial for health and well-being for all.

4. Promote healthy development, healthy behaviors and well-being across all life stages.

5.  Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all (Office of Disease Prevention and Health Promotion, 2020).

According to the 1974 Lalande report, the causes of health disparities can be identified by five health fields/areas

Environmental, Genetics, Lifestyle, Social Circumstances, and Medical Care.

How does the environment influence our health?

 The environment influences our health in many ways, including through exposures to physical, chemical, and biological risk factors and through related changes in our behavior in response to those factors

Title VI of the Civil Rights Act

prohibits federally funded programs or activities from discrimination on the basis of race, color or national origin. It has three key elements:

1. It established a national priority against discrimination in the use of federal funds

2. It authorized federal agencies to establish standards of nondiscrimination

3. It provided for enforcement by withholding funds or by any other means authorized by law

Laws that regulate (or deregulate) human choice or access can

directly/indirectly affect health care

CLAS

stands for Culturally and Linguistically Appropriate Services in healthcare.

It’s intended to advance health equity, improve quality and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services

Ethics

is standards or codes of behavior expected by the group to which the individual belongs

Morality

is the personal character and what the individual believes is right or wrong conduct

Ethical principles that most impact cultural issues in health care are

autonomy (self government)

veracity (truthfulness of something),

fidelity (faithfulness of something),

nonmaleficence (avoiding harm of others),

beneficence (promoting the well being of others)

and justice.

Beliefs about health are a combination of three major theories

personalistic, naturalistic and biomedical

Personalistic theory

is when illness is believed to be caused by a person’s misbehavior (could be a violation of social or religious norms) and the punishment (or illness) comes from a supernatural being or human with special powers.

Bad luck or karma is a common belief for this theory

American Indians, Asians and Latin American people hold the ____ belief systems.

personalistic theory

Naturalistic theory

is a theory that explains illness by a natural disequilibrium (imbalance) and when the body is in balance, health is achieved.

Biomedical theory

is the theory that the cause of illness is physiological in nature and spirituality is kept separate from health and healing matters.

Also called allopathic medicine or theory and it is a biological based approach to healing with scientific data

The three widely practiced approaches to curing naturalistically are

humoral

ayurvedic

vitalistic

Humoral

is the ancient belief system that beliefs the body has four important fluids. These fluids are related t seasons and curing an illness involves discovering the complexion imbalance and rectifying it

Ayurvedic

is the ancient naturalistic approach to health that is used in India and other parts of the world. In this system illness is caused by energy imbalance.

Ayurvedic ways to restore balance include breathing exercises, yoga, massage, herbal oil and herbs to balance chakras

Vitalistic

is the concept that bodily functions are due to a vital principle or “life force” that is distinct from physical forces explainable by the laws of chemistry and physics. {Not detectable by scientific instrumentation}

Acupuncture needles help restore a proper flow of energy within the body

Germ theory

of disease is a core component of contemporary allopathic medicine and that microorganisms are the cause of many diseases.

Typical illnesses according to this belief are organic breakdown or deterioration, obstruction, injury, imbalance, malnutrition and parasites.

There are two general pathways to care

biomedical/allopathic and holistic. People may select a system based on culture, access to care, health beliefs and affordability

There are two cultural competence models

1. Campinha-Bacote’s Process of Cultural Competence in the Delivery of Health Care Services. It consists of five constructs

2. Purnell’s Model for Cultural Competence. Includes 12 cultural domains

The five constructs of Campinha-Bacote’s Process of Cultural Competence in the Delivery of Health Care Services

1. Cultural awareness: The process of conducting a self-examination of one’s own biases toward the cultures and an in depth exploration of one’s cultural and professional background

2. Cultural knowledge: The process in which the health care professional seeks and obtains a sound information base regarding the worldviews of different cultural and ethnic groups as well as biological variations, diseases and health conditions and variations in drug metabolism found among ethnic groups. 

3. Cultural skill: The ability to conduct a cultural assessment to collect relevant cultural data regarding the client’s problem as well as accurately conducting a culturally based physical assessment

4. Cultural encounter: The process that encourages the health care professional to directly engage in face to face cultural interactions and other types of encounters with clients from culturally diverse backgrounds to modify existing beliefs about a cultural group and to prevent possible stereotyping

5. Cultural desire: The motivation of the health care professional to “want to: rather than “have to” engage in the process of becoming culturally aware, culturally knowledgeable, culturally skillful and to seek cultural encounters

The twelve cultural domains for the Purnell Model of Cultural Competence include

workforce issues, nutrition, health care practitioner, heritage, biocultural ecology, spirituality, communication, high-risk behaviors, health care practices, pregnancy and childbearing, death rituals and family roles/organization

Worldview

is a set of cultural assumptions and beliefs that express how people see, interpret and explain their experiences

The three major facets of worldview are

Temporal relationships, space (proxemics) and social organization & family relationships

Temporal relationships

are how we view time and perception of time varies between cultures

Western cultures view time as___.

quantitative, meaning elements of the past, present and future, moving in measured units that reflect the march of progress

it can be visually thought of as a horizontal line

Eastern cultures view time as___.

an unlimited continuity and it does not have a defined boundary, it can be visually thought of as a circle

The value of elders and traditions comes from

past oriented people an example of this would be Asian culture. They value and perform traditional healing practices and herbal remedies.

Cultures that live in the moment are__.

present oriented and they are less focused on prevention

Future oriented people

understand the healthy behaviors in the present impact our health in the future and are likely to make sacrifices now for future benefits

Personal space

includes interpersonal space and boundaries and violating interpersonal space and boundaries can be seen as offensive.

People used to closeness will take someone creating space as evidence of coldness or lack of interest. While people who want space will see someone reducing the space as aggressive or pushy.

Social organization and family relationships refers to

the patterns of social interaction. Examples include how people interact and communicate, the kinship system, marriage residency patterns, division of labor, etc

The four impacts on health care include

Individualism vs Collectivism (group mindset)

Fate v. Free Will

Communication

Verbal Communication

Communication

is an interactive process that involves sending and receiving information. Like emotion, thoughts and ideas through verbal and nonverbal cues.

Effective communication

enables healthcare professionals to accurately exchange information, establish relationships, and understand the person’s needs and concerns.

It is important in all aspects of life but in healthcare it can be the deciding factor between life and death.

Advance directives are

are legal documents that enable people to convey their decisions about end of life care ahead of time

A living will is

a set of instructions that documents a person’s wishes about medical care intended to sustain life

A durable power of attorney for health care is

is a document that names your health care representative who can speak for you when you cannot

Euthanasia

is defined as good death and it is also known as a mercy killing. It is an act or practice of ending the life of an individual who is suffering from a terminal illness or an incurable condition by lethal injection or the suspension of extraordinary medical treatment.

Religion

is an organized approach to practicing a form of spiritual belief in and respect for a supernatural power or powers, which is regarded as a creator or a governing framework of the universe and is supported by personal or institutionalized systems grounded in belief and worship.

Spirituality

is often described as a belief in a higher power, something beyond the human experience.