cultural diversity nataliya lishchenko, md, ph.d, mhca

Cultural Diversity Cultural Diversity

Nataliya Lishchenko MD PhD Nataliya Lishchenko MD PhD MHCAMHCA

The strength and The strength and greatness of America greatness of America lies in the Diversity lies in the Diversity of its Peoplehellipof its Peoplehellip

Growing Diversity in America

During the Past 20 years 1048708 White population increased 10 1048708 African American population

increased 30 1048708 Native American population

increased 58 1048708 Hispanic population increased

125

Projected Demographics forr 2030 30

2000 White 60 1048708 Hispanic 19 1048708 Black 13 1048708 AsianPI 7 1048708 N AmAk N 1

Whites 70 1048708 Hispanic 13 1048708 African Am 12 1048708 Asian 4 1048708 N Am 1

In CaliforniaIn California

Population of 38 Million 13 of the population is of Hispanic origin Over 10 Asian Over 4 more than one race Nearly 17 identify as ldquoOther racerdquo


1 in 4 are foreign born 37 of these entered the US after 1990

Nearly 40 of the population over the age of 5 speaks a language other than English at home

Over 25 of the population is under the age of 18

Diversity related facts

The population is becoming increasingly diverse 1048708 underrepresented groups make up approximately

30 of the population 1048708 Health care workforce has not kept up with the

changing demographics 1048708 Physicians from underrepresented groups make up

only about 7 of the current workforce 1048708 Nurses only 3 1048708 Pharmacy only 3

Ethnic Health Disparities

African Americans 1048708 Highest death rate from colon and rectal

cancer of any ethnic group in the US 1048708 African Am women diagnosed with breast

cancer have a 71 survival rate vs an 86 rate for white women


Native Americans 1048708 2-3 times more likely to have diabetes

mellitus that the general population 1048708 Higher than average mortality rates

associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism

Reports of Disparities in HealthCare

Disparities in health care do exist

and are associated with higher

mortality among minorities

Reports of Racial and EthnicDisparities in Healthcare

Minorities are less likely to be given appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer

Minorities are less likely to receive kidney dialysis or transplants

Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)

Factors that Influence PerceptionFactors that Influence Perception

Past experiencePast experience Self-conceptSelf-concept Attitudes and valuesAttitudes and values ExpectationsExpectations SensesSenses RolesRoles CulturalCultural PrejudicePrejudice

Cultural Diversity and Health CareCultural Diversity and Health Care

We All Have ItWe All Have It Obvious ManifestationsObvious Manifestations

ReligionReligion Ethnicity Ethnicity National Origin (language)National Origin (language) GenderGender


Less Obvious ManifestationsLess Obvious Manifestations AgeAge EducationEducation Educational StatusEducational Status Mobility (including handicaps)Mobility (including handicaps)

Stereotypes and Cultural MythsStereotypes and Cultural Myths

Altering care or treatment procedures to Altering care or treatment procedures to accommodate cultural variables is unnecessary accommodate cultural variables is unnecessary because any intelligent person or even one with because any intelligent person or even one with some basic common sense can adjustsome basic common sense can adjust

Treating people differently because of racial Treating people differently because of racial religious ethnic cultural gender or other religious ethnic cultural gender or other characteristics implies prejudice and discriminationcharacteristics implies prejudice and discrimination

Minorities must adapt to the dominant culturersquos Minorities must adapt to the dominant culturersquos institutions rather than the institutions adapting to institutions rather than the institutions adapting to the needs of the minority group or individualthe needs of the minority group or individual

Cultural Self Assessment QuestionsCultural Self Assessment Questions

Lack of understanding of own feelings and reactions Lack of understanding of own feelings and reactions results in perpetuation of stereotypes and cultural results in perpetuation of stereotypes and cultural mythsmyths

Where did my family originateWhere did my family originate What do I believe about gender roles of men and women Are What do I believe about gender roles of men and women Are

my beliefs different or consistent with those of my parentsmy beliefs different or consistent with those of my parents How much physical distance do I need in social interactionsHow much physical distance do I need in social interactions Whom do I look for guidance in important mattersWhom do I look for guidance in important matters If I needed health care how would I respond to this need and If I needed health care how would I respond to this need and

what would be my expectationswhat would be my expectations In a health are situation what would be the role of my family In a health are situation what would be the role of my family

EthnicityEthnicity

Sense of identification of a collective cultural groupSense of identification of a collective cultural group Characteristic of an ethnic groupCharacteristic of an ethnic group- Common languageCommon language- Same food preferencesSame food preferences- Shared traditionsShared traditions- ReligionReligion- Shared values symbols literature folklore musicShared values symbols literature folklore music

DefinitionsDefinitions Ethnocentrism Belief that onersquos ideas beliefs and Ethnocentrism Belief that onersquos ideas beliefs and

practices are the best superior or most preferred to practices are the best superior or most preferred to other lifewaysother lifeways

Minority Groups having some physicalcultural Minority Groups having some physicalcultural characteristics that identify people within groups as characteristics that identify people within groups as different from dominant culturedifferent from dominant culture

Race categorizing people into subgroups according Race categorizing people into subgroups according to physical characteristics (skin color physical to physical characteristics (skin color physical stature facial features hair texture)stature facial features hair texture)

Stereotyping assuming that all members of a culture Stereotyping assuming that all members of a culture or ethnic group act alike (ie racism ageism sexism)or ethnic group act alike (ie racism ageism sexism)

Culturally Competent CareCulturally Competent Care

Transcultural nursing that involves sensitivity knowledge and Transcultural nursing that involves sensitivity knowledge and skillskill

Nursing care is planned and implemented in a way that itrsquos Nursing care is planned and implemented in a way that itrsquos sensitive to the needs of the individual families and groups sensitive to the needs of the individual families and groups representing diverse cultural population in societyrepresenting diverse cultural population in society

Cultural diversity is recognized and respected cultural Cultural diversity is recognized and respected cultural sensitivity is presentsensitivity is present

Accepts values and beliefs of othersAccepts values and beliefs of others Cultural factors and influences are integral components of Cultural factors and influences are integral components of

nursing carenursing care Recognize that the health care system is itself a culture and Recognize that the health care system is itself a culture and

that ethnocentrism must be avoidedthat ethnocentrism must be avoided

Cultural BlindnessCultural Blindness

Tendency to ignore cultural differences and to Tendency to ignore cultural differences and to proceed as if they did not existproceed as if they did not exist

A person who culturally blind does not A person who culturally blind does not deliberately entend to act in a culturally deliberately entend to act in a culturally insensitive way but simply is not aware of insensitive way but simply is not aware of cultural differences or does not consider them cultural differences or does not consider them important in providing careimportant in providing care


What is CultureWhat is Culture - shared lifestyle values beliefs ideals and - shared lifestyle values beliefs ideals and

behavior of a particular groupbehavior of a particular group- Picture it as a luggage that each of us - Picture it as a luggage that each of us

carries around for our lifetime It is sum of carries around for our lifetime It is sum of beliefs practices habits likes dislikes beliefs practices habits likes dislikes norms customs rituals and so forth that norms customs rituals and so forth that we learned from our families during the we learned from our families during the years of socialization In turn we transmit years of socialization In turn we transmit cultural luggage to our children cultural luggage to our children

Characteristics of CultureCharacteristics of Culture

Culture is learned not inheritedCulture is learned not inherited Culture is shared by its membersCulture is shared by its members Culture is implicitCulture is implicit Culture is dynamicCulture is dynamic Culture is diversifiedCulture is diversified

Differing Health Belief SystemDiffering Health Belief System

Magicoreligious HBSMagicoreligious HBS people believe that people believe that supernatural forces influence health and illnesssupernatural forces influence health and illness

Holistic Belief SystemHolistic Belief System the forces of nature must be the forces of nature must be kept in natural balance and harmonykept in natural balance and harmony

Scientific or Biomedical HBSScientific or Biomedical HBS health and illness are health and illness are controlled by a series of physical and biomedical controlled by a series of physical and biomedical process that can be analyzed and manipulated by process that can be analyzed and manipulated by humans Disease and illness are caused by humans Disease and illness are caused by microorganism or malfunction of bodymicroorganism or malfunction of body

Factors that influence Health Beliefs Factors that influence Health Beliefs and Behaviors of Culturally Diverse and Behaviors of Culturally Diverse

IndGrpIndGrpTraditional health and illness practicesTraditional health and illness practices Natural folk medicineNatural folk medicine Magico-religious medicineMagico-religious medicine Use of food]Use of food] Religious practiciesReligious practicies Use of HealersUse of Healers Social organizations ndash refers to family unit environment in Social organizations ndash refers to family unit environment in

which people grow up and livewhich people grow up and live- Description of family in this cultural groupDescription of family in this cultural group- Gender and age roles that affect choice of whom to Gender and age roles that affect choice of whom to

communicatecommunicate


IndGrpIndGrp Communication ndash language differencesCommunication ndash language differences Space and territorialitySpace and territoriality

- How complicated is it to navigate the health - How complicated is it to navigate the health care systemcare system

- Is the hospital culture friendly or hostileIs the hospital culture friendly or hostile- Distance to the health care systemDistance to the health care system Time orientationTime orientation

Barriers to Providing Culturally Barriers to Providing Culturally Competent CareCompetent Care

LanguageLanguage StereotypingStereotyping EthnocentrismEthnocentrism Cultural ipmositionCultural ipmosition Labeling a practice as dysfunctionalLabeling a practice as dysfunctional

Nursing Skills and CompetenciesNursing Skills and Competencies Awareness of Diversity ndash first step Move beyond recognition Awareness of Diversity ndash first step Move beyond recognition

or awareness of diversity to the celebration and appreciation of or awareness of diversity to the celebration and appreciation of diversitydiversity

Cultural sensitivity ndash response to a person or situation that is Cultural sensitivity ndash response to a person or situation that is considerate compassionate empathetic and sensibleconsiderate compassionate empathetic and sensible

Cultural knowledge ndash acquiring knowledge of clientrsquos cultural Cultural knowledge ndash acquiring knowledge of clientrsquos cultural beliefsbeliefs

Recognition of spirituality ndash implies a quality of Recognition of spirituality ndash implies a quality of transcendence a guiding force itrsquos what brings peace and joy transcendence a guiding force itrsquos what brings peace and joy to their lives gives them inner strengthto their lives gives them inner strength

Cultural assessment ndash systematic examination of individuals Cultural assessment ndash systematic examination of individuals groups and communities based on their values beliefs and groups and communities based on their values beliefs and behavior behavior

AcceptanceAcceptance Acceptace of both self and others is a critical part of the Acceptace of both self and others is a critical part of the

therapeutic processtherapeutic process Acceptance is understading that what others believe or feel is Acceptance is understading that what others believe or feel is

their true belief and that others have a right to believe or feel their true belief and that others have a right to believe or feel that waythat way

It is not blaming others for anything they do even if behavior It is not blaming others for anything they do even if behavior is wrong or has to be changed to protect the individual and is wrong or has to be changed to protect the individual and societysociety

The key is to allow another the freedom to think or feel ndash does The key is to allow another the freedom to think or feel ndash does npt mean going along with whatever is said or donenpt mean going along with whatever is said or done

It is accepting the behavior and responding without judgingIt is accepting the behavior and responding without judging

Resources About Cultural GroupsResources About Cultural Groups

Dept of Health ServicesDept of Health Services Senior CentersSenior Centers Support Groups ndash single parents newly divorces 12 Support Groups ndash single parents newly divorces 12

step programstep program Gay and lesbian organizationsGay and lesbian organizations AIDS allianceAIDS alliance REACH Project (for Latinos)REACH Project (for Latinos) Social Services DepartmentSocial Services Department ChurchesChurches


It is because we are different that each It is because we are different that each of us is specialof us is special

The strength and The strength and greatness of America greatness of America lies in the Diversity lies in the Diversity of its Peoplehellipof its Peoplehellip





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cultural diversity nataliya lishchenko, md, ph.d, mhca

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