Cultural Competence Flashcards
Behavioral
Distinction between disease & Illness
disease: degree of organ pathology (diagnosed by physician)
illness experience: different reports of pain and distress (suffered by pts)
Illnesses: experiences of disvalued changes in states of being & social fxn
(illness may occur in absence of disease)
Define culture
- the sum total of knowledge passed on from generation to generation withing a given society (including ideas about illness and healing)
Culture’s function
- adaption to or coping with the human condition (must deeply respect a patient’s cultural context)
Cultural Competence
- understanding the health beliefs, customs, and characteristics of specific groups of people
Physician Attitude
- acknowledge and do not judge cultural beliefs and practices
ex. if pt believes ..
- certain food will cure- help them get it
- curse has cause their illness- inquire as to who can help remove the curse and involve the person
- folk remedy could compromise pt- explain & substitute for something in harmony with pt
What influences illness experience
Culture- culture teaches us how to be ill
illness experience in an intimate part of social systems of meaning and rules for behavior (culture- based subjective experience)
How one perceives & cope with disease
- based on their explanations (specific to the socio-cultural context and systems of meaning they employ) of sickness
Explain Dhat Syndrome
- clinical/cultural example in India (cultural meaning sys)
- 7 types of dhatus (essential element in Sanskrit) that comprise the physical body
- dhatus determines the bodys immunity or vulnerability to disease (semen loss in men leas to physical and mental weakness)
- most common symptom: fatigues, weakness, body aches, severe headaches, depression, anxiety, loss of appetite, insomnia, heart palp, suicidal feelings
- in western orthodox paradigm of biomedical psychiatry, its considered major depression or persistent depressive disorder
The two ways culture affects clinical reality
- culture based subjective experience (reason for illness)
- culture based idioms of distress (ways people behave to express they are ill)
cultural page relate to cultural meaning
no negotiation required (btwn Mr. Patel and an Indian Practitioner) because they share the same cultural meaning thus on the same cultural page
If the cultures of the clinician and patient are different …
…the illness experienced by the patient is not likely to be the same as the disease diagnosed by the clinician .. leading to a poor outcome due to cultural competence barriers
(THUS, a greater degree of negotiation must occur in constructing clinical reality when disparities in meaning systems exist btwn patient and clinician)
Define Explanatory Models
- the way a person explains the cause of illness
patient-doctor interaction are transactions btwn explanatory models
Benefits of eliciting the patients explanatory model
It provides the physician with ..
- beliefs the pt hold
- personal and social meanings attached
- pt expectations about what the doctor will do
- pts own therapeutic goals
Questions to elicit pt explanatory model ..
- What do you think cause the problem ?
- Why do you think it started?
- What does your sickness do to you?
- How severe is your sickness?
- What kind of treatment do you feel you should receive?
(DO NOT ATTEMPT TO CHANGE PATIENT’S BELIEFS)
Educate if you believe pt model will compromise treatment (ex. educate Mr. Patel on SSRI effectiveness)
Ataque de nervios
Attack of the nerves- syndrome of Latino , charcterized by symptoms of intense emotional upset including anxiety, anger grief, crying, screaming, shouting, heat in the chest rising to head ect. Occurs as a direct result of a stressful event relating to the family.
Cultural specific disorders of distress
Khyal Attacks
Wind Attacks- found among Cambodians. Symptoms: panic attack, dizziness, palpitations, cold extremities, tinnitus and neck soreness. Centered on the concern Khyal (windlike substance) may rise in the body and cause all of the listed symptoms. Khyal attacks usually meet panic attack criteria.
Cultural specific disorders of distress
Kufungisisa
Thinking too much- idiom of distress among the Shona of Zimbabwe. Considered to be causative of anxiety, depression, and somatic problem (my heart is painful because I think too much). Indicative of interpersonal and social difficulties (marital problems, no money to take care of children).
Cultural specific disorders of distress
Maladi Moun
Humanly caused illness- sent sickness in Haitian communities for diverse medical and psychiatric disorders. Interpersonal envy and malice cause people to harm their enemies by sending sickness.
Cultural specific disorders of distress
Nervios
Nerves- distress among Latinos. Refers to general state of vulnerability to stressful life exp and difficult circumstance leading to emotional distress and inability to function. Most common symptom include headache and brain aches (occipital neck tension), irratability, stomach disturbance, dizzness with vertigo ect.
Cultural specific disorders of distress
Susto
Fright- explanation for distress and misfortune among Latinos and people in Mexico, Central Amer, and South Amer., NOT the carribean. Characterized by frightening event that causes the soul to leave the body resulting in unhappiness and sickness. No exact symptoms: can include inadequate sleep, appetite disturbance, low self worth ect.
Cultural specific disorders of distress
Taijin Kyofusho
Interpersonal Fear Disorder- in Japanese. Characterized by anxiety about and avoidance of interpersonal situations due to felling ones appearance and actions in social interactions are inadequate or offensive.
In the US, variant involves having an offensive body odor and termed, Olfactory Reference Syndrome
Cultural specific disorders of distress
