1、Diversity and CultureRobert F.Jex,RN,MHA,FACHEGoals and ObjectivesnEstablish a clear and shared understanding of the concepts of diversity and culturenDefine the concept of cultural competency and its relevance to health carenBe able to perform a self-assessment of individual cultural competencynDev
2、elop an awareness of the impact of culture on human dynamicsCultural Competency“A process of learning that leads to an ability to effectively respond to the challenges and opportunities posed by the presence of social cultural diversity in a defined social system.”Cultural Competency “To be cultural
3、ly competent doesnt mean you are an authority in the values and beliefs of every culture.What it means is that you hold a deep respect for cultural differences and are eager to learn,and willing to accept that there are many ways of viewing the world.”Okokon O.UdonTo respond to current and projected
4、 demographic changes in the United StatesnTo eliminate long-standing disparities in the health status of people of diverse racial,ethnic and cultural backgroundsnTo improve the quality of services.nTo enhance the workplace environmentnTo meet regulatory and accrediting mandatesnTo decrease the likel
5、ihood of liability/malpractice claims.Why Cultural Competency?Diversity encompasses issues related to.nracencolornclassnagenexperiencenabilityngendernethnicitynlanguage nreligionnpoliticsnsexual orientationnsexual identitynsocio-economic statusnresident statusUnderstanding CultureIndividual culture:
6、Is multifaceted and encompasses-npersonality,unique styleninternal factors-gender,race,age,sexual orientationnexternal influences-society,experiencesnwhere individuals grow up or live now,religious affiliationnorganizational influences-seniority,level within organization,work locationCommunity cultu
7、re:Exists within a network of relationships-between language and tradition,tradition and history,history and economicsOrganizational systems:Operate as complex“cultures”with specified“languages”traditions,codes of conductGroup ExerciseExploring the Individual:nGiven Names and one StorynEthnicities,L
8、anguages,Religions and Spiritual BeliefsnCurrent Roles in LifeAnother way to view the worldIf we could shrink the world into a village of 100 people:n52 would be female:48 would be malen33 would be childrenn6 would be over 65n58 would be Asiann79 would be people of colorn30 would be Christiann6 woul
9、d own half the villages wealthall 6 would be AmericanAnother way to view the world(contd)n9 would speak Englishn50 would suffer from malnutritionn80 would live in substandard housingn66 would not have access to clean,safe drinking watern1 would have a college educationChanging Demographicsn18%of US
10、residents over age 5 speak a language other than English in the homenPersons with physical and mental impairments are the largest single minority(45 million)n21-23%of the US population is“functionally illiterate”=“low literacy.(Most are English speaking native born)n35 million Hispanics.34.5 million
11、 Blacks.10.5 million Asian Americans.4 million Native Americans.The U.S.has moved beyond Black and White to become a complex mosaic of races and ethnicities.Changing Demographics(contd)nSince 1970 and the end of immigration limits imposed in 1924,the Asian American population has grown from 1.5 mill
12、ion to nearly 12 million in 2000.nBy 2030,1 in 4 elderly persons will be from a racial or ethnic minority groupnBy 2030,it is projected that:-the Hispanic population 65 and older will increase 328%-Asian and Pacific Islander 65 and older population will increase 285%DisparitiesAvoidable differences
13、in the incidence,prevalence,mortality,and burden of disease and other adverse health conditions that exist among specific population groups.Institute of Medicine 2002 Report on Disparities“Racial and ethnic minorities tend to receive lower quality health care than whites do,even when insurance statu
14、s,income,age,and severity of conditions are comparable.”-Alan Nelson M.D.Committee Chair March 20,2002Disparities in Health CarenInfant mortality for blacks is twice the rate of whitesnCancer deaths among blacks and Latinos are highnCervical cancer is 5 times more likely to strike Vietnamese women a
15、s white womennNative Americans have higher rates of diabetes and heart diseasenMinorities are less likely to be immunizednMinorities are less likely to have regular check-upsAggravating issuesn21-23%of the US population is“functionally illiterate”=“low literacy.(Most are English speaking native born
16、)n60%of Medicaid population has low literacy25%dont know diagnosis or name of drug50%dont know purpose of drug75%cant describe their diseaseImpact of low literacy on healthThose who lack basic literacy skills are much more likely than others to suffer from:nheart diseasendiabetesncancer and to have
17、health care expenses as much as six times higher than adults with average levels of literacy.Source:U.S.Programs Division of Pro-Literacy Worldwide March 2003Assumptions“At least half of the exercise I get everyday comes from jumping to conclusions.”Bruce DexterJournalistAssumptionsExercisenDescribe
18、 a time when assumptions were made about you that led to discriminationSuccessful Organizations have the ability to:nValue DiversitynConduct on going self assessmentnManage the dynamics of differencenAcquire and institutionalize cultural knowledgenAdjust to diversity and the cultural contexts of the
19、 communities they serveThe Elements of Cultural CompetencenAwareness of ones own culturenUnderstanding the dynamics of differencenAwareness and acceptance of differencenDevelopment of cultural knowledgenCelebration of diversityReflections “Each person is likely to have his personal system of values
20、which he believes to be preferable to some others.Those values he prefers are likely to be heavily weighted in favor of those in his own cultural background,whether or not he realizes it.”Condon and Yousef,1975Personal Culture on CommunicationnIncorrect assumptions about the othernLanguage and commu
21、nication style issuesnBias against the unfamiliarnPersonal values conflictnExpectations that others will conform to established norms(stereotypes)Adapted from Selma MyersCommunicationDoctors(and other health care providers)today devote far more time and thought to the words of a pathologist(words th
22、at are often not even heard,but read off a computer screen)than to the words of the man or woman for whose life they have taken responsibility.”Source:Nuland,Doctors and Deities:Medicine,Multiculturalism and the Duty of Physicians.New Republic October,13,1997,31-39.To offer culturally appropriate ca
23、re requires being open to the expectations,perceptions,and realities of various individuals and communities.Parting Thoughts Every relationship we have is successful because we are culturally competent with that individual.All hate is self hate.It is more important to know what sort of person this disease has than what sort of disease this person has.William OslerReferencesnNational Center for Cultural Competence Georgetown University,Bureau of Primary Health CarenAlliance Community Services,Jorge J.Arce-LarretanCultural Competency in Health and Human Services,CCHCP
