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Four Core Values in Diversity: Autonomy, Dignity, Equality, Solidarity

Overview

  • Unit 2 for RAD 1,500: Human Diversity in the health care context. Recognize you will encounter all types of people in the health care workforce and the implications for care.
  • Diversity encompasses many dimensions (race, gender, hair/eye color, religion, age, etc.). No two people are exactly the same; identify unique attributes while also recognizing commonalities with others.
  • Learning about others' backgrounds enhances understanding, reduces barriers, and adds value through diverse perspectives, traditions, and ideas.
  • Personal anecdote: Caring for an Amish family in the ER illustrated cultural differences (non-adherence to modern health care, language barriers). This highlights the need to learn about backgrounds, needs, and expectations.
  • Cultural diversity is tied to globalization and diffusion of ideas across borders via media, travel, migration, and the Internet. Global cultural products (movies, fashion, music, sports) contribute to global awareness.

Key Concepts: Diversity, Multiculturalism, and Cultural Competence

  • Human diversity vs. cultural diversity: human diversity is the umbrella; cultural diversity refers to differences in cultures that enrich society and drive creativity and innovation.
  • Multiculturalism in the workforce: institutions (universities, hospitals, businesses) create roles/offices to foster diverse environments; ethical codes discourage discrimination.
  • Cultural competence in health care: openness to understanding and respecting cultural differences in beliefs, practices, and communication styles to provide personalized care and build trust.
  • Communication is critical: language barriers and jargon can hinder understanding; use interpreters, culturally appropriate strategies, and tailored educational materials.
  • Ethical implications: discrimination violates professional ethics; cultural competence is tied to legal and ethical requirements and ongoing education.

Diversity and Globalization: Cultural Diffusion and Exchange

  • Global mobility and cross-border care (e.g., seeking care in neighboring countries or cosmetic/medical travel) contribute to cultural exchange.
  • Diffusion occurs through media, travel, migration, and Internet/social media (Facebook, Instagram, etc.).
  • Global media accelerates the spread of cultural products and influences patient expectations and health care practices.

Multiculturalism in the Workplace

  • Multicultural workplace: diverse cultural backgrounds within teams; organizations may formalize diversity offices/practices (names may change with political climates).
  • Professional societies (e.g., ASRT, ARRT) promote culturally aware practices and anti-discrimination in ethics codes.
  • Ethical codes require non-discrimination and respect for diversity in patient care.

Language, Communication, and Interpreters

  • Language barriers can lead to miscommunication; rely on interpreters and culturally appropriate communication strategies.
  • Interpreting tools: in-hospital interpreter services (e.g., iPad-based translation apps); trained medical interpreters; visual aids (picture boards) and imagery.
  • When using interpreters: speak clearly, slowly, maintain eye contact with the patient, and ensure the interpreter can hear and relay accurately.
  • Do not rely on family members as interpreters due to risk of incomplete or altered history and loss of patient privacy; patient history completeness is critical.
  • Informed consent and patient understanding depend on clear communication; empathy and adequate explanation reduce anxiety and improve outcomes.
  • Medical documents in multiple languages in EMRs help meet diverse patient needs.

Characteristics of Human Diversity

  • Examples of diversity characteristics (non-exhaustive): language, age, disability, economic status, family status, lifestyle, national origin.
  • Reflection prompts: consider other attributes you possess not listed here; how might those affect care?
  • Bias and stereotyping: bias = negative judgments about others without justifiable reasons; stems from stereotypes and attitudes.
  • Explicit vs. implicit bias: explicit is conscious; implicit/implicit bias is unconscious and shaped by culture, media exposure, and personal experience.
  • Recognizing bias in real time and challenging assumptions is essential for equitable care.

Age: Generations and Age-Related Considerations

  • Generations (visualized):
    • Lost generation (born circa 1883 and earlier)
    • Silent generation (born around 1928–1945): tend to have high tolerance for pain and little complaint, historically.
    • Baby boomers (1946–1964): ~75,000,000 individuals; ~21 ext{ extperthousand} of population; currently a large portion in care, educated, and likely to remain in workforce longer due to increasing life expectancy.
    • Millennials (Gen Y)
    • Gen Z (Zoomers)
    • Gen Alpha (began in the 2010s, continuing into the 2020s)
  • Ageism and discrimination: Age Discrimination in Employment Act (federal) enacted in 1967; prohibits discrimination against individuals 40 years or older in hiring, promotions, wages, termination, and other employment practices.
  • Practical guidance: do not assume older adults are incapable; do not assume younger people cannot perform tasks; value different strengths across ages (e.g., tech-savviness vs. experience).
  • Health care implications: different generations may present different disease patterns, communication preferences, and care expectations; tailor approaches accordingly.

Ethnicity, National Origin, and Race; Ethnocentrism, Racism, Assimilation, Biculturalism

  • Race vs. Ethnicity:
    • Race: physical characteristics and outward appearance; how others see someone.
    • Ethnicity: cultural factors (nationality, language, religion, traditions); how individuals identify themselves.
  • Ethnocentrism: belief that one's own culture's norms/values are the only acceptable ones; biases inform judgments of other cultures.
  • Racism: belief in the superiority of one race over another; can lead to oppression and discrimination when combined with ethnocentrism.
  • Assimilation: process by which individuals from diverse cultures give up their original language/identity to blend into another culture; may erode minority traditions over time.
  • Biculturalism: individuals who maintain their own culture while conforming to mainstream culture.
  • Language barriers (linguistic diversity): English is widely used but not legally the official language of the entire U.S.; 31 states have English as an official language; others (e.g., Hawaii, New Mexico) recognize multiple official languages.
  • Practical approach in health care: ensure a common method of communication; use interpreters; avoid making assumptions based on language or ethnicity.

Language Barriers and Interpreting in Health Care

  • Interpreters reduce miscommunication and improve informed consent quality.
  • Methods for language access:
    • In-person interpreters (hospital-provided staff or contracted)
    • Telephone/video interpretation services (e.g., iPad-based apps with language options)
    • Written materials in patient’s native language
  • Key practice: maintain eye contact with patient and interpreter; speak to the patient, not just the interpreter.
  • For deaf or hard-of-hearing patients: provide sign language interpreters or other communication aids; consider picture boards and visual cues.
  • Informed consent clarity is critical across languages; empathy reduces anxiety and improves trust.
  • Pregnancy risk assessment (LMP) and pregnancy considerations require understanding the patient’s sex/biology; policy varies by institution.

Gender, Sex, Gender Identity, Sexual Orientation

  • Distinctions:
    • Sex: biological attributes (chromosomes, hormones, anatomy).
    • Gender: socially constructed roles/identity; sometimes conflated with sex.
    • Gender identity: internal sense of being male, female, both, neither, or other; may not align with biological sex.
    • Sexual orientation: attraction direction (heterosexual, homosexual, bisexual, etc.).
  • LGBTQIA+ umbrella: Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual, and others (plus sign for additional identities).
  • Intersex prevalence: about rac{1}{500} infants are intersex (~0.2%).
  • Patient preferences: use preferred name; avoid assuming pronouns; use patient-reported gender identity for sensitive interactions.
  • Language use in clinical settings: avoid gendered forms like Mister/Miss/Missus when unsure; ask for preferred identifiers and full legal name if needed.
  • Pregnancy considerations: ascertain patient sex and LMP to determine pregnancy risk (important for procedures involving radiation, etc.). Hospitals may have varying age ranges for LMP assessment (e.g., some settings may use 12-50 or similar ranges).
  • Avoid making assumptions about abilities or roles based on gender or sex; recognize evolving gender roles and professional diversity.

Mental and Physical Abilities; Disability Rights and Accommodations

  • Americans with Disabilities Act (ADA), 1990: protects individuals with visible and invisible disabilities; organizations receiving federal funding must provide reasonable accommodations.
  • Reasonable accommodations examples: ramps/elevators, accessible bathrooms, closed captions, disabled parking, note-takers, extended exam times.
  • Language: avoid labeling as “disabled”; focus on the specific disability and provide accommodations.
  • Practical scenarios: assist patients with paralysis or PTSD; respect autonomy and preferences; avoid assuming ability to perform tasks or stand for procedures.
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