CULTURE IN HEALTHCARE

NUR AKMAR TAHA FACULTY OF PHARMACY UKM

CULTURE
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, behaviours & practices It affects health beliefs, behaviors, activities & medical treatment outcomes To provide optimum health care, health care professionals should be culturally competent

E.G.

CULTURAL 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 & problemsolving 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 patients cultural differences

LEVELS OF COMPETENCY
Level 1 Level 2 Level 3 Level 4 Level 5 No insight on the influence on culture on medical care Minimal emphasis of culture in medical setting Acceptance of role of cultural beliefs, values & behaviors on health disease & tx Incorporation of cultural awareness into daily medical practice Integration of attention to culture into all areas of professional life

COMPONENTS OF COMPETENCY
Knowledge Skills Attitude

KNOWLEDGE
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 patients Describe 3 traditional healing practices of specific ethnic groups in the local area

SKILLS
Inquire on beliefs, practices & values for patients & families relevant to medical problems Obtain medical history considering cultural information Consider cultural information in making diagnostic & therapeutic plans Work with interpreters in an effective manner Apply general cultural information as hypotheses and not as stereotypes

ATTITUDES
Respect 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

PRACTICING CULTURALLY COMPONENT HEALTHCARE

1. 2. Examine your own cultural attitudes & knowledge 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 or friends?

PRACTICING CULTURALLY COMPONENT HEALTHCARE

Individual 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) 3. Foster an Open, Sensitive Approach to Patient Health Care Beliefs Attitude, conveyed verbally and non-verbally, has a tremendous impact on the physician-patient relationship

Cultural status exam (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 long have you had this (these) problem (s)? a. Does anyone else have this problem that you know? If yes, describe them, how old they are, and their different presentations/symptoms 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?

3.

Cultural status exam (Pfifflering)(Pfifflering)-contd

4. Why has a. Why this problem happened to you, has it happened to (the and why now? involved part)? b. Why did you get sick and not someone else? 5. What do you think will help to clear up your problem? a. If they suggest specific tests, procedures, or drugs, ask them to further 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?

E.G.
A 65 year old Chinese woman who immigrated to the U.S. in 1995 to live with her eldest 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 mass in the liver. Biopsy reveals hepatocellular carcinoma. Serologies show chronic active hepatitis B status. As the attending physician, you ask the son to help translate and break the news to his mother that she has cancer. He is very concerned about his mothers diagnosis and prognosis, but asks you not to tell his mother that she has cancer. You feel that it is important that the patient know 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 issues such as when can she go home.

E.G. -contd
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.

CONCLUSION
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 BUT, there are common elements of belief that may be shared among members of cultural and ethnic groups and a general familiarity with these can be very helpful in further understanding a patients particular perspective