Culture Diversity-Health_Illness_Wellness

This PowerPoint aids nursing students in learning about diversity. It connects diversity to help determine how it impacts populations health, illness, and wellness. This ranges from cultural customs, religious beliefs, and many more areas that will directly impact the long term health of individuals. It also covers actual different cultures, its meanings, and characteristics of cultures. Values and beliefs is covered as it pertains to health practices. Ethnicity, race, and religion of different kinds are covered with statistics for each. This culminates with explaining how nurses can change their care tactics to better care of specific and different groups of people.

1. Factors Affecting Health, Illness, and Wellness

2. The Concept of: Culture and Diversity Culture is defined as a shared system of beliefs, values, and behavioral expectations that provides social structure for daily living. Culture influences roles and interactions with others, as well as within families and communities Diversity is defined as differences among people within a society in reference to their cultural background, racial and ethnic origin, religion, language, physical size, gender, sexual orientation, age, disability, socioeconomic status, occupational status, and geographic location Exemplar: Health and illness beliefs and practices

3. Concepts of Culture and Diversity ***Nurses must be sensitive to diversity by not imposing personal beliefs on others and avoiding stereotyping. Nurses must recognize the impact culture and diversity have on the healthcare decisions and practices of clients and their families.

4. What is Meant by Culture? “. . . the totality of socially transmitted behavior patterns, arts, beliefs, values, customs, lifeways and all the other products of human work and thought characteristics of a population of people that guides their worldview and decision making ” https://miro.medium.com/v2/resize:fit:1400/format:webp/0*lwOezQxnAslnPbwL.jpg)

5. Characteristics of Culture Culture consist of common beliefs and practices is both universal (everyone has it) and dynamic (it changes) exists at many levels such as: Material: art, writings, dress, or artifacts Non-materials: customs, traditions, language, beliefs and practices diverse Cultural beliefs provide identity and sense of belonging values, beliefs, and traditions are passed down from generation to generation assumptions and habits can be unconscious

6. Active Learning: Complete the Cultural Health and Illness Beliefs and Practices Assessment Answer Culture/Heritage Assessment section questions on yourself Turn to peer and complete the Health and Illness Beliefs and Practices section questions on each other ***How does culture affect hospitalized patients?

7. Cultural Values, Beliefs & Practices: Health What is a personal value or belief that has meaning to you? What is a practice that you follow? Do we all share the same answers?

8. Reflection What did you learn about your own culture/heritage influences? How did it feel to implement this assessment/ask someone these questions? How did it feel to answer questions like these?

9. Caribbean: - Afro Caribbean - Asian Caribbean - British African-Caribbean - Caribbean Reg. of Columbia - Indig . Peoples of Caribbean - Indo-Caribbean - West Caribbean - White Caribbean Culture: Ethnicity, Race & Religion Religion An ordered system of beliefs; determined by culture, also influence it Race Grouping of people based on certain criteria that groups and cultures find socially significant Ethnicity Members of a group sharing common social and cultural heritage from generation to generation For Example: - American Indian or Alaska Native - Asian - Black or African American - Caribbean/Caribbean American - Hispanic, Latino, or Spanish origin - Middle Eastern or North African - Native Hawaiian/Other Pacific Isl’d . - White (European Decent) Religions of Caribbean: - Christianity - Hinduism - Islam - Roman Catholic - Methodist - Non-Traditional Christian - Spiritual Baptist - African Religious Traditions : Voodoo , Pocomania, Yoruba Source: www.caricom.org

10. Vulnerable Population as Subcultures Vulnerable Populations are group that are more likely to develop health problems and poorer outcomes due to: Limited access to care High-risk behaviors Multiple/cumulative stressors Example: Homeless Mentally ill Physical Disabilities Very young and older adults ***vulnerable population are subcultures of all the major cultural groups.

11. Why Learn About Culture? The US population is diverse Future majority-minority Health disparities among racial and ethnic groups Healthy People 2020 Minorities experience higher rates of disease No insurance = less quality care Lacking access to preventive healthcare Challenge to provide culturally competent care Most common ethnicities amount RNs ≠ patient population

12. ANA Standards and Culture / Diversity ANAs Nursing: Scope and Standards of Practice, 3 rd Ed., 2015 Standard 8 - Advocacy : Nurses must demonstrate advocacy and support the needs of their patients, no matter their background Standard 9 - Respectful & Equitable Practice : Nurses must be respectful of all patients, families, healthcare consumers, and professionals; they must demonstrate equitable care for all patients in need Nurses must understand their own belief system as they develop culturally competent attitudes and behaviors through self-awareness - a life-long process

13. Cultural competence: refers to the ability of a person to understand and respect the attitudes, values, and beliefs of people with different cultural backgrounds in nursing it is the ability of nurses to provide nursing care to patients while exhibiting cultural awareness toward the patient and their loved ones highlights the knowledge, skills, and attitudes nurses use to care for people from different cultural backgrounds The Concept of: Culture and Culturally Competent/Congruent Care

14. The Journey to Cultural Competence Cultural Awareness An appreciation of the external signs of diversity Sensitivity Awareness or knowledge of uniqueness of other culture Competence the ability to incorporate culture into the prison of care, to show respect, accept differences and empower decision making

15. Barriers to Culturally Competent Care Bias Ethnocentrism Cultural Stereotyping Prejudices Sexism / Male Chauvinism Racism Discrimination Language Barrier Lack of Knowledge Emotional Responses Self-knowledge

16. VS. The “Culture of Healthcare” The Indigenous Healthcare System Folk and traditional healing methods Different groups have different folk practices All groups use a healthcare system The Professional Healthcare System Professional healthcare providers Biomedical basis Western/allopathic medicine Alternative healthcare What aspects of indigenous or professional systems have you experienced? Give an example

17. How does cultural values, beliefs, and practices affect health? Or the question should be, “ How does it not affect health ?” Communication Space/territoriality Time orientation Social organization Environmental control Biological variations Other culture specifics Religion/philosophy, education, technology, politics/law, economy How could you use knowledge of culture to provide better care for your clients?

18. Nursing Strategies for providing culturally competent care Reflect and know yourself Keep learning Accommodate and Negotiate Collaborate RESPECT

19. Video Cultural Awareness in Healthcare: Understanding the Need

20. The Concept of: Spirituality Spirituality is anything that pertains to a person’s relationship with a nonmaterial life force or higher power. Spiritual health or well-being is the condition that exists when the person’s universal spiritual needs for meaning and purpose, love and belonging, and forgiveness are met Spiritual care and its application to your patient, combines spirituality and religion and how those two concepts relate to each other Holistic nursing is the care of patients based on their physical, psychological, emotional, and spiritual

21. Core Issues of Spirituality Faith, Hope and Love are expressed in all religions Religion Text/Scriptures Summary Symbol Buddhism The Tripitaka (Buddhist Canon) Journey of possession of spiritual power; Overcoming the illusion of self Christianity Reading the Holy Bible Belief in prayer, strive to adhere to the Ten Commandments Hinduism Dharma: Cosmic/natural law Spiritual truth toward discovery of truth Islam Reading the Quran Daily prayer, meditation, fasting Judaism Reading the Torah Ethnic identity as a Jew; relationship/eternal covenant with God

22. How Spiritual Beliefs Affect Health Religion and Spirituality have been shown to have a positive influence on a person’s physical and mental health; research cannot answer the “how” or the “why” Miracles allow for the presence of the transcendent; spiritual or otherwise, it can be difficult to explain; may occur according to natural law (do good, avoid evil) Nurses can learn about the differences and similarities of various religions, to offer complete and compassionate care. Make connections and validate key practices with your clients to always remain open and receptive

23. STUDENTS: YOU NEED TO KNOW THE INFORMATION ABOUT DIFFERENT RELIGIONS AND THEIR SPECIFICS FOR YOUR EXAM USING THE TWO SLIDES IN YOUR PPT VERSION AND THE TEXTBOOK

24. Religion Key Points Dietary Hygiene Health/Medical Buddhism Death is a new, reincarnated life Family may perform chants or read to patient Request peace and quiet for meditation Lacto-vegetarian due to non-violence; Avoid alcohol  mind Avoid foods strong smell Fasting predicted by moon Cleanliness fundamental; Wash after toileting Mindset is “Know the sickness and abandon the cause” Might decline analgesia Can meditate and deep breathe through pain Hinduism Westerners ↑ medicines Prayer is important Elders/family allowed to influence health decisions Modest and want same gender provider Many Vegetarian – no pork or beef; Delay eating until after prayer & bathing Handwashing prior to eating with hands Bathing & cleanliness, begins with face, and downward Illness/Wellness has spiritual element  Ayurveda; No medicines from animal/animal bi-product; Ceremonies w/ birth and death; Amulets worn by sick and newborn to ward off evil; The deceased are washed by family members/oldest son Islam Reading the Quran Daily prayer/meditation Avoid non-Halal foods; pork forbidden, products/gelatin. Fasting during Ramadan sunrise to sunset; handwash before eating, eat with right hand Must wash before prayers Perceived medical restrictions increase disease risk; gender preferences w/providers; disease misconceptions; might not consider organ transplant Native American Religions No designated place of worship – value use of land, rivers Desire quiet settings Some forbid taking notes during interview Health is state of harmony w/nature, in disharmony, illness/disease enters Rely on “medicine man/woman” over healthcare industry

25. Religion Key Points Dietary Hygiene Health/Medical Judaism Passover: special foods, utensils, dishes Yom Kippur – fasting if allowed, pray + rest, no oral meds with Orthodox patients Sabbath sunset Friday to sunset Saturday Not all observe strict dietary laws: Only Kosher foods Strict guidelines with meat: no pork, no meat with dairy, avoid certain seafoods Orthodox Women cover limbs/bodies, hair; Men cover head with skullcap The body is God’s property, must treat with respect in life/death Prevention = healing No contraceptives unless risk; males circumcised; no organ transplant Christianity (general) Rituals & practices vary Moral cleansing with Baptism (infant) Roman Catholic: Anointing of the sick/last rites; confession for forgiveness, Communion for hospitalized ***Ask patient if they need to call a priest Seventh Day Adventism: Death = sleep; avoid alcohol, drugs, caffeine, tattoos, piercings; vegetarian – no pork, shellfish, antiabortion/spare mom ***ask patient about choices to keep Sabbath day holy Non-specific; some no meat on Friday w/ Lent Jehovah’s Witnesses: Morally wrong to accept blood or blood products; anything that blood flows through not accepted; no drugs or drunkenness ***accept patient/family decision and remain non-judgmental Non-specific Mormonism: Many wear sacred undergarments most of the time, promote healthful living – no tea, coffee, alcohol, tobacco ***Ask if they need to call church leaders or family for support Most accept blood transfusions and organ transplants; birth control varies Christian Science Illness caused by faulty thinking; Okay with medical care for children but not selves; Western medicine not first choice; Promote proper nutrition Avoid alcohol/tobacco; Prayer for healing; May not believe in immunizations/vaccinations ***consider individualized preferences to incorporate their spiritual values into plan of care Rastafarianism Dress modestly forbid use of second-hand clothing/use disposable Vegetarian, no pork, shellfish, milk, coffee Deny care or treatments that contaminate their bodies Prefer alternative – herbals, etc., do not use contraception, ok for transfusions

26. Health and Illness Beliefs and Practices Health & Illness Belief Systems The scientific/biomedical health system The magico-religious system The holistic belief system Health & Illness Practices Efficacious Neutral Dysfunctional Traditional & Alternative Healing Traditional related to alternative beliefs Folk Medicine Complementary and Alternative Medicine

27. Let’s Look: Some Examples to Address in Practice Consider Verbal and Nonverbal Communication Know, or find out, whether touch is expected or prohibited (e.g., a handshake) Know, or find out, whether eye contact is expected or avoided. Avoiding eye contact, for some, is a sign of respect Ask clients how they wish to be addressed Consider Body Language Gestures that are acceptable in one culture may be taboo in another. Know what is acceptable Be aware that smiling does not universally indicate friendliness

28. Consider the Person’s Need for Personal Space Know the person’s cultural and religious customs regarding touching and contact Know the usual comfortable distance for conversing in the client’s culture Consider Social Organization Know which person in the family is the leader or decision-maker Know what dates are important and whether gifts are expected Know how special events, such as births and funerals, are celebrated, whether certain colors have meaning, and what the expected rituals are Continued…

29. Continued… Consider Time Orientation Ask clients what they expect regarding time, appointments, and so on Share your own expectations about time Be sure you know the times for and meanings of the client’s religious and ethnic holidays Consider the Person’s Perspective Environmental Control Know the general influence of the culture on perception/tolerance of pain Know what foods are forbidden, may or may not be eaten together, and what/how utensils used

30. Factors Affecting Health, Illness, and Wellness

31. The Concept of: Health, Illness and Wellness Health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO) Illness is interpreted as a disruption to health while Wellness is experienced as a way of life, balanced by optimal health and well-being in which body, mind, and spirit are integrated by the individual to live more fully within the human and natural community Exemplar: Health Care Disparities and Vulnerable Populations

32. How Do People Experience Health and Illness? Health and illness elicit a unique response from each client due to: Biological Factors Nutrition Physical Activity Sleep and Rest Meaningful Work Lifestyle Choices Personal Relationships Culture, Religion and Spirituality* Environmental Factors Finances *apply concepts of Health, Illness and Wellness to previously reviewed content

33. Variables influencing Health and Health beliefs and practices Internal Variables Developmental Stages Intellectual background Perception of functioning Emotional factors Spiritual factors External Variables Family Roles and Practices Social Determinants of Health (SDOH) Economic stability Education Health and health care Social and community context Neighborhood and built environment Cultural health beliefs

34. Health Promotion Health Promotion is the process of equipping people to have control over and to improve physical, emotional, and social health (WHO) Goal: To decrease illness or disease and increase well-being Would you talk to a healthy patient about health promotion? Why or why not? What is the difference between health promotion and health protection? Who are some of the key stakeholders in health promotion -- who has a vested interest?

35. Levels of Preventive Care Primary Prevention The goal is to prevent or slow the onset of disease e.g. eating healthy, exercising, wearing sun screen, etc. Secondary Prevention Involves screening activities and education for detecting illnesses in early stages. e.g. regular physical exams, bp and diabetes screening, etc. Tertiary Prevention Focuses on stopping the disease from progressing and returning the individual to pre-illness phase Restoration and rehabilitation is the main Intervention during this level

36. Acute vs. Chronic Illness Acute Illness is characterized by a sudden onset, lasting for a limited duration of time Examples might be a musculoskeletal injury, influenza, appendicitis Chronic Illness refers to a health issue/condition that persists over time, six months or more, perhaps lifelong Examples include lung disease, childhood diabetes, auto-immune disease ***Some chronic illnesses might begin as acute, such as an injury, or an illness, and can then become chronic due to mismanagement, lack of access to resources. For example, back pain Can you have an acute and chronic illness simultaneously?

37. Healthcare Disparities and Vulnerable Populations Concept: Health care disparities are differences in health outcomes between populations that are closely associated with a social, economic, or environmental disadvantage influenced by such factors as race and ethnicity, poverty, biological sex, age, mental health, educational level, disabilities, sexual orientation, health insurance, and access to health care

38. Healthcare Disparities and Vulnerable Populations Vulnerable Populations are group that are more likely to develop health problems and poorer outcomes due to: Limited access to care High-risk behaviors Multiple/cumulative stressors Example: Homeless Mentally ill Physical Disabilities Very young and older adults Source: https://pubmed.ncbi.nlm.nih.gov/23385323/#:~:text=Vulnerable%20populations%20include%20patients%20who,exacerbated%20by%20unnecessarily%20inadequate%20healthcare .

39. Healthcare Literacy https://www.proquest.com/nahp/docview/2376167217/1779EA88F2794B8EPQ/4?accountid=14636 SDOH 8-1p.212

40. Social Determinants of Health (SDOH) https:// health.gov /: Healthy People 2030, initiated 1979, targets every 10 years https://www.youtube.com/watch?v=2UK7NrHOsmA&t=14s

41. Data on Health & Health Care by Race and Ethnicity (2023) Nonelderly AIAN* (21%) and Hispanic (19%) people were more than twice as likely as their White counterparts (7%) to be uninsured Among adults with any mental illness, Black (39%), Hispanic (36%), and Asian (25%) adults were less likely than White (52%) adults to receive mental health services Roughly, six in ten Hispanic (62%), Black (58%), and AIAN (59%) adults went without a flu vaccine, compared to less than half of White adults (46%) Black (13%) and Hispanic (11%) children were over twice as likely to be food insecure than White children (4%) Black infants were more than two times as likely to die as White infants (10.4 vs. 4.4 per 1,000), and AIAN infants were nearly twice as likely to die as White infants (7.7 vs. 4.4 per 1,000) At birth, AIAN and Black people had a shorter life expectancy (65.2 and 70.8 years, respectively) compared to White people (76.4) Black and AIAN women have the highest rates of pregnancy-related mortality . *AIAN: American Indian & Alaska Native Source: https://www.kff.org/racial-equity-and-health-policy/report/key-data-on-health-and-health-care-by-race-and-ethnicity/#:~:text=One%20quarter%20of%20AIAN%20adults,fair%20or%20poor%20health%20status

42. Interesting Statistics: Percent of Adults with 14 or More Unhealthy Days in the Past 30 Days by Race/Ethnicity (2021) 14+ Physically Unhealthy Days 14+ Mentally Unhealthy Days Source: https:// www.kff.org