Power and Cultural Considerations

Ophthalmology Wiki Project

Karena PoupardUniversity of North Florida

EEX 5998 Healthcare InterpretingDr. Sherry Shaw

(Group Members: Erik Hoover, Holly Jackson, Karena Poupard, Michelle Theiss)

What is Power?Definition: power relates to the status level of individuals involved in a communication exchange in order to influence behavior with or without resistance.

Education/Income/Background level indicates a sense of status

Examples:

Doctor/Patient

Professor/student

Speaker/audience member

Doctor/Interpreter/Patient

Lawyer/plaintiff or defendant (Judge/Lawyer)

High Class/Middle Class/Lower Class

Cultural ConsiderationsCulture:

Diverse EthnicitiesRaceReligionSocioeconomic statusGender IdentificationNon-dominant groups

Communication:Use of InterpretersCommunication stylePersonal SpaceEye ContactTouchTime OrientationView of Healthcare professionalsLearning Styles

Diverse EthnicitiesDefinition of Diverse: Diversity is a commitment to recognizing and appreciating the variety of characteristics that make individuals unique in an atmosphere that promotes and celebrates individual and collective achievement. http://www.lib.utk.edu/diversity/diversity_definition.html

Definition of Ethnicity: of or relating to large groups of people classed according to common racial, national, tribal, religious, linguistic, or cultural origin or background http://www.merriam-webster.com/dictionary/ethnic

Examples:WhiteHispanic or Latino and Non Hispanic or LatinoAfrican AmericanPacific Islander or HawaiianAsianAmerican Indian or Alaskan Native

Race

Definition: as “a human group defined by itself or others as distinct by virtue of perceived common physical characteristics that are held to be inherent…Determining which characteristics constitute the race…is a choice human beings make.

http://plato.stanford.edu/entries/race/#RacVerEth

Examples:

Hispanic/Latino

A Hispanic patient brings his family to his appointment. There is not enough room for the family to join in the patient room. The doctor allows for one family member to be present. Family is valued within Hispanic culture and consultation with family is important before making any decisions.

Eye contact is important. It is a sign of respect but do not stare as this is deemed as an invitation to fight or quarrel.

African AmericanGeneral “Good to Knows”Non-verbal Communication:

Personal space needs can be hard to determine. Ask the patient what is too far /too close. This helps avoid feelings that you are “in {their} face” or “far away because I am black.”

Patient may be reluctant to make eye contact. Make special efforts to seek and maintain eye contact and speak directly to the patient

Verbal – Show respect :Ask patient to self identify race to determine preference for Black/African American/ Negro/etc…

Refer to patient as Mrs., Mr., Ms. or Miss unless requested to use first name or other name.

To African American women in the northern parts of the U.S., use of the term “Ms.” may be offensive. Be certain to ask the patient how she prefers to be addressed.

http://www.bcm.edu/mpc/special-af.html

Asian/Pacific Islander/HawaiianIn collectivist societies, many decisions are not made by individuals, but by families and groups, presumably with the larger good in mind; for example, in focus groups in Hawaii, physicians said they modified their approach to families on the basis of their understanding of cultural decision making norms. Unlike the custom among white people, for whom the individual patient is the decision maker, many Japanese and Chinese families assign decision-making duties to the eldest son. In Pacific Islander families, it may be less obvious who the decision maker is. A member may be designated as decision maker, and others are assigned to other duties (for example, bringing food, telling stories, and running errands). Regardless of role, all family members customarily receive the same level of detail about the patient's diagnosis, prognosis, and treatment options.

http://www.thefreelibrary.com/Asian+and+Pacific+islander+cultural+values%3a+considerations+for+health...-a020816312

American Indian/Alaskan NativeListening and observing is highly valued in this culture when it comes to communication. It may take them longer to respond to a question or make a decision. Sometimes they may want to consult with their tribe before making any decisions.

Emphasis on watching, listening and observing as opposed to talking about what is going on in order to formulate a response.

Deaf American Indian/Alaskan Native: Home signs may be highly used between family members.

Humphrey J. & Alcorn B. (1994, 1995, 2001). So You Want to be an Interpreter: An Introduction to Sign Language Interpreting. Interpreting with Native Deaf people, 3.23 – 3.24.

Religion

Definition: a set of beliefs concerning the cause, nature and purpose of the universe, especially when considered as the creation of a superhuman agency or agencies, usually involving devotional and ritual observances and often containing a moral code governing the conduct of human affairs.

http://dictionary.reference.com/browse/religion

Example:

A person walks in to an Ophthalmology appointment with a religious belief that does not allow them to accept medication or treatment. This could have an end result of visual impairment if proper treatment is not obtained.

Socioeconomic Status

Definition: Socioeconomic status is commonly conceptualized as the social standing or class of an individual or group. It is often measured as a combination of education, income and occupation.

Examinations of socioeconomic status often reveal inequities in access to resources, plus issues related to privilege, power and control.

http://www.apa.org/topics/socioeconomic-status/index.aspx

Example:

Individuals who are earning an income below the National poverty level are at risk of receiving poor quality treatment based on insurance coverage such as Medicaid.

Specific testing is not covered, doctors are rushed and inundated with patient care, and proper treatment is not provided.

Gender Identification

Definition: Gender identity is defined as a personal conception of oneself as male or female (or rarely, both or neither).

This concept is intimately related to the concept of gender role, which is defined as the outward manifestations of personality that reflect the gender identity. Gender identity, in nearly all instances, is self-identified, as a result of a combination of inherent and extrinsic or environmental factors; gender role, on the other hand, is manifested within society by observable factors such as behavior and appearance.

http://emedicine.medscape.com/article/917990-overview

Lesbian/Gay/Bisexual/Transgender

Discrimination can be occur when an Ophthalmologists harbors unintentional/intentional biases against patients who identify as LGBT.

LGBT patients tend to avoid medical attention due to discrimination factors.

Non-Dominant GroupsA category of people whose physical appearance or cultural characteristics are defined as being different from the traits of the dominant group and that result in their being set apart for different and unequal treatment. This definition of a minority group takes into account both race and ethnicity and can, indeed, subsume sex/gender, age, religion, disability. http://cnx.org/content/m33866/latest

As diverse beings, there are times in which we may belong to the dominant (or majority) group and there are times in which we belong to the non-dominant (or minority) group. Therefore, we each experience moments and situations in which we have power and privilege, and others in which we may experience discrimination and oppression.

A variety of reactions occur associated with being a member of the non-dominant culture/group: fear, anger, sadness, pride, helplessness, excitement, rejected, blaming, challenged, respectful, empowered, etc. These reactions can also impact how we view ourselves and how we engage with others. We may become more isolated, we may experience difficulties in finding success, and these could lead to anxiety and depression. When we experience these challenges, it can be helpful to look for others to connect with and to share our experiences. Conversely, as a member of the non-dominant culture/group, we may feel motivated to engage with others and affect change, thus helping to improve the conditions for our community. http://www.marquette.edu/counseling/diversity.shtml

ResourcesDiverse Ethnicities

http://www.lib.utk.edu/diversity/diversity_definition.htmlhttp://www.merriam-webster.com/dictionary/ethnic

Racehttp://plato.stanford.edu/entries/race/#RacVerEth

Religionhttp://dictionary.reference.com/browse/religion

Socioeconomic Statushttp://www.apa.org/topics/socioeconomic-status/index.aspx

Gender Identificationhttp://emedicine.medscape.com/article/917990-overview

Non-Dominant Groupshttp://cnx.org/content/m33866/latesthttp://www.marquette.edu/counseling/diversity.shtml

Resources Continued

African Americanhttp://www.bcm.edu/mpc/special-af.html

American Indian/Alaskan NativeHumphrey J. & Alcorn B. (1994, 1995, 2001). So You Want to be an Interpreter: An Introduction to Sign Language Interpreting. Interpreting with Native Deaf people, 3.23 – 3.24.