Cultural Competence Flashcards
Core Paradox
- Bias; no evidence suggest that providers are most likely than the general public to express biases, but some evidence sugg. That unconscious biases may exits.
- Uncertainty; a plausible hypothesis , particularly when providers treat patients that are dissimilar in cultural or linguistic background
- Stereotyping; evidence suggests that physicians, like everyone else, use the “cognitive shortcuts”.
What is Culture
A set of shared guidelines, ideas, and beliefs (both explicit and implicit) which individuals inherit as members of a particular group that first them on:
- How to view the world
- How to experience it emotionally
- How to behave in it in relation to other people, supernatural forces, and the natural environment.
Culture helps define our ________
Identity
Culture is
Protective and promoting .
Culture is often invisible*
Cultural Misinterpretations
No one is born prejudiced, racist, or sexist.
Our attitudes are shaped by info received from family, school, church, community , society.
**Since culture is invisible , we may not be aware of our own prejudices
Cultural errors that may lead to Conflict
- Overgeneralization
2. Ethnocentrism
- Overgeneralization
- Individual variation exists within cultures
- Cultural descriptions will not apply to each individual within a culture.
- Ethnocentrism
The tendency to assume that one’s own way of life (culture) is superior to the culture of others.
“Our way, their way” mindset.
*Cultural differences are evaluated…judged.
Cultural background influences many aspects of life
Particularly of interest for us as physicians- Attitudes and practices regarding illness, pain and healing.
As well as: Beliefs and values, behaviors, perceptions, emotions, communication, religion, family structure, diet, body image, concept of space and time
System in all societies in place to address disease and death
Ethnomedical systems
Ethnomedical systems include 3 elements
- A theory of etiology of illness
- Techniques for diagnosing illness
- Methods for appropriate therapy.
Western cultures
Individualism
Eastern and African cultures
Group identity
Hot-Cold Theory of Disease
Latin America, Morocco
- To maintain health the body’s internal balance must be maintained between the opposing powers of hot and cold (not referring to temp, rather the symbolic power contained in most substances.
- In illness, health is restored by re-establishing the internal balance by exposing one’s self to , or ingesting, items of the opposite quality to that believed to be responsible for the illness.
Hot and Cold theory of disease, In pregnancy and mentruation
- Pregnancy and menstruation are considered to be “hot” states and are treated by the ingestion of cold foods and medicines.
- Women may avoid certain foods which they classify as a “hot” food to prevent clotting of mentiras blood or flood of birth.
- This may exacerbate vitamin deficiencies.
According to Hot-Cold theory , western medicines are
“Hot”
Explanatory Model of Illness
- An individuals personal interpretation of disease
- Open communication, beginning with the patient’s explanatory model, fosters mutual respect and is the key to cultural insight.
Kleinman model for eliciting a patient’s explanatory model of illness
- Who do you think has caused your problem?
- Why do you think it started when it did?
- What do you think your sickness does to you? How does it work?
- How bad do you?
- What do you fear most about this course of TX?
- Why do you resist their course of tx?
- What kind of treatment would you like to have?
- What are the most important results you hope to get from tx?
Culturally Competent Care
- Health care that is sensitive to the needs and health status of different population groups. It considers:Demographics, culture include health beliefs and behaviors, language (use of medical interpreter), risk factors, major disease.
Shaman
Hmong - predominate in the areas of Southeast Asia (most notably Thailand, Vietnam , and Laos.
Miao people.
Perform “soul calling” and chanting in a soft voice.
-believe that persons soul can be “caught by malevolent spirit”. E.g man with deceased wife - shaman perform spiritual inoculation to prevent late wife’s spirit from kidnapping his soul, thereby extending his”life visa”; ceremonies may require sacrifice of animals.
-believe that surgery, anesthesia, blood transfusions and other common procedures are taboo.
-Do not accept insurance or other payments although they have been known to accept a live chicken.
” Doctors are good at disease, the soul is the shaman’s responsibility.”
Doulas
For Somali women
- Staffed in hospital in Minneoplois to accommodate the large population of Somali women in the area
Medicine men
Navajo reservation , seen in northern Arizona.
Curanderos
Hispanic community
