Culture in healthcacre

8/12/2019 Culture in healthcacre

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CULTURE INCULTURE INCULTURE INCULTURE IN

HEALTHCAREHEALTHCAREHEALTHCAREHEALTHCARE

NUR AKMAR TAHANUR AKMAR TAHANUR AKMAR TAHANUR AKMAR TAHA

FACULTY OF PHARMACYFACULTY OF PHARMACYFACULTY OF PHARMACYFACULTY OF PHARMACY

UKMUKMUKMUKM


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CULTURECULTURECULTURECULTURE

Culture consists of learned beliefs, traditions & guides for

behaving & interpreting behavior that are shared among

members of a particular group

Includes values, beliefs, customs, communication styles,

It affects health beliefs, behaviors, activities & medical

treatment outcomes

To provide optimum health care, health care professionals

should be culturally competent


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E.G.E.G.E.G.E.G.


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CULTURAL COMPETENCYCULTURAL COMPETENCYCULTURAL COMPETENCYCULTURAL COMPETENCY

Cultural competency consists of:Awareness & acceptance of cultural difference

Awareness of ones own cultural values

Recognition that people of different cultures have different

ways of communicating, behaving, interpreting & problem-

solving

Recognition that cultural beliefs impact health beliefs,

health seeking, interactions, health care practices, outcomes

including adherence to Mx

Ability & willingness to adapt way of work to fit patientscultural differences


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LEVELS OF COMPETENCY

Level 1Level 1Level 1Level 1 No insight on the influence on culture on medicalcare

Level 2Level 2Level 2Level 2 Minimal emphasis of culture in medical setting

Level 3Level 3Level 3Level 3 Acceptance of role of cultural beliefs, values &

behaviors on health disease & tx

Level 4Level 4Level 4Level 4 Incorporation of cultural awareness into daily

medical practice

Level 5Level 5Level 5Level 5 Integration of attention to culture into all areas of

professional life


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COMPONENTS OF

COMPETENCYKnowledge

Skills

Attitude


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KNOWLEDGEKNOWLEDGEKNOWLEDGEKNOWLEDGE

Define culture & list various factors that influence culture

Describe cultural beliefs, values & behaviors belonging to a

different cultural group

Discuss important cultural influences of certain patientsescr e tra t ona ea ng pract ces o spec c et n c

groups in the local area


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SKILLSSKILLSSKILLSSKILLS

Inquire on beliefs, practices & values for patients & families

relevant to medical problems

Obtain medical history considering cultural information

Consider cultural information in making diagnostic &

Work with interpreters in an effective manner

Apply general cultural information as hypotheses and not as

stereotypes


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ATTITUDESATTITUDESATTITUDESATTITUDESRespect patients and families behaviors & values

Be aware of the influence of socio-cultural factors on patients,

providers, the clinical encounter and interpersonal

relationships

Appreciate the heterogeniety that exists within and across all

cultural groups and the need to avoid overgeneralization and

negative stereotyping

Be aware of own cultural beliefs, values, and practices that

influence self as a cultural person


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PRACTICING CULTURALLYPRACTICING CULTURALLYPRACTICING CULTURALLYPRACTICING CULTURALLY

COMPONENT HEALTHCARECOMPONENT HEALTHCARECOMPONENT HEALTHCARECOMPONENT HEALTHCARE1. Examine your own cultural attitudes & knowledge

2. Use of culturally sensitive tool

a. Eliciting illness prototypes and patient requests

Individual or family illness prototypes:

1. What are your ideas or concerns about your illness

based on your previous personal experience?

2. What are your ideas or concerns about your illness

based on the experiences of other family members orfriends?


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PRACTICING CULTURALLYPRACTICING CULTURALLYPRACTICING CULTURALLYPRACTICING CULTURALLY

COMPONENT HEALTHCARECOMPONENT HEALTHCARECOMPONENT HEALTHCARECOMPONENT HEALTHCAREIndividual or family patient requests:

1. What type of help would you (your family member) like

(hope, wish, want) to receive form the practitioner?

b. Cultural status exam (Pfifflering). oster an pen, ens t ve pproac to at ent ea t are

Beliefs

Attitude, conveyed verbally and non-verbally, has a

tremendous impact on the physician-patient relationship


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Cultural status examCultural status examCultural status examCultural status exam

(Pfifflering)(Pfifflering)(Pfifflering)(Pfifflering)1. How would you describe the problem that has brought you to me?

a. Is there anyone else with you that I can talk to about your problem? (If yes,

to significant other: Can you describe Xs problem?)

b. Has anyone else in your family/friend network helped you with this problem?

2. How lon have ou had this these roblem s ?

a. Does anyone else have this problem that you know? If yes, describe them,

how old they are, and their different presentations/symptoms

3. What do you think is wrong, out of balance, or causing you problem?

a. Who else do you know who has, or gets this kind of problem?

b. Who, or what kind of people dont get this problem?


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Cultural status examCultural status examCultural status examCultural status exam

(Pfifflering)(Pfifflering)(Pfifflering)(Pfifflering)----contdcontdcontdcontd4. Why has this problem happened to you, and why now?

a. Why has it happened to (the involved part)?

b. Why did you get sick and not someone else?

5. What do you think will help to clear up your problem?. , , ,

define what they are and how they will help.

6. Apart from me, who else do you think can help you get better?a. Are there things that make you feel better, or give you relief, that

doctors dont know about?


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E.G.E.G.E.G.E.G.A 65 year old Chinese woman who immigrated to the U.S. in 1995 to live with hereldest son and his American wife is brought in for a one week history of malaise,nausea and vomiting, and sudden jaundice.

She is admitted to the hospital where diagnostic studies reveal an obstructive massin the liver. Biopsy reveals hepatocellular carcinoma. Serologies show chronicactive hepatitis B status.

,his mother that she has cancer.

He is very concerned about his mothers diagnosis and prognosis, but asks you notto tell his mother that she has cancer. You feel that it is important that the patientknow her diagnosis, but he is firm that he does not wish his mother to know this.

Despite his wifes recommending that she be told, he refuses.

You try to discuss end of life issues such as hospice care and do-not-resuscitate(DNR) orders, but when you bring up these subjects, he tries to discuss other issuessuch as when can she go home.


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E.G.E.G.E.G.E.G. ----contdcontdcontdcontd

Cultural Issues that may be involved in this case:

1. Protection of elderly

2. Karma - discussing an illness or death/dying is bad luck. By

talking about something bad, it may come true.

3. Increased incidence of liver cancer related to Hepatitis B in

Chinese immigrants.


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CONCLUSIONCONCLUSIONCONCLUSIONCONCLUSION

All cultural and ethnic groups hold concepts related to health,

illness & associated practices for maintaining well-being or

providing treatment when it is indicated

Caution is needed to avoid stereotyping,

among members of cultural and ethnic groups and a general

familiarity with these can be very helpful in further

understanding a patients particular perspective

Culture in healthcacre

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