Transcultural Diversity and Health Care

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Question Description

Read chapter 1 of the class textbook and review the attached Power Point presentation. Once done answer the following questions.

1. In your own words and using the proper evidence-based references define transcultural diversity and Health care and discuss how both term interact and how they help in the delivery of health care to different heritages.

2. Mention and discuss at least 4 variant characteristics of culture.

Assignment must be presented in an APA format, word document, Arial 12 font attached to the forum in the discussion tab of the blackboard title "week 1 discussion questions". A minimum of 2 evidence-based references no older than 5 years are required. You must post at least two replies to any of your peers sustained with the proper references. A minimum of 500 words are required.


You will find chapter 1 attached


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Chapter 1 Transcultural Diversity and Health Care Larry D. Purnell The Need for Culturally Competent Health Care Cultural competence has become one of the most important initiatives in health care in the United States and throughout most of the world. Diversity has increased in many countries due to wars, discrimination, political strife, worldwide socioeconomic conditions, and the creation of the European Union. Some of the diversity is driven by actual numbers of immigrants, but other dimensions come from the visibility of the “new ethnics” and the waning of the social ideology of the “melting pot” (O'Neil, 2008). Instead of the term melting pot, meaning everyone is expected to blend, many believe the term salad bowl is more appropriate because people can stand out and be seen as individuals. Health ideology and health-care providers have learned that it is just as important to understand the patient's culture as it is to understand the physiological responses in illness, disease, and injury. The health-care provider may be very knowledgeable about laboratory values and standard treatments and interventions for diabetes mellitus, heart disease, and asthma, but if the recommendations are not compatible with the patient's own health beliefs, dietary practices, and views toward wellness, the treatment plan is less likely to be followed (Giger et al., 2007). To this end, a number of worldwide initiatives have addressed cultural competence as a means for improving health and health care, decreasing disparities, and increasing patient satisfaction. These initiatives come from the U.S. Office of Minority Health, the Institute of Medicine, Healthy People 2020, the National Quality Forum, the Joint Commission, The American Medical Association, the American Association of Colleges of Nursing, and other professional organizations. Educational institutions—from elementary schools to colleges and universities—are also addressing cultural diversity and cultural competency as they relate to disparities; health promotion and wellness; illness, disease, and injury prevention; and health maintenance and restoration. Many countries are now recognizing the need for addressing the diversity of their societies. Societies that used to be rather homogeneous, such as Portugal, Norway, Sweden, Korea, and selected areas in the United States and the United Kingdom, are now facing significant internal and external migration, resulting in ethnic and cultural diversities that did not previously exist, at least not to the degree they do now. Several European countries, such as Denmark, Italy, Poland, the Czech Republic, Latvia, the United Kingdom, Sweden, Norway, Finland, Italy, Spain, Portugal, Hungary, Belgium, Greece, Germany, the Netherlands, and France, either have in place or are developing national programs to address the value of cultural competence in reducing health disparities (Judge, Platt, Costongs, & Jurczak, 2005). Whether people are internal migrants, immigrants, or vacationers, they have the right to expect the health-care system to respect their personal beliefs, values, and health-care practices. Culturally competent health care from providers and the system, regardless of the setting in which care is delivered, is becoming a concern and expectation among consumers. Diversity also includes having a diverse workforce that more closely represents the population the organization serves. Health-care personnel provide care to people of diverse cultures in long-term-care facilities, acute-care facilities, clinics, communities, and patients’ homes. All health-care providers—physicians, nurses, nutritionists, therapists, technicians, home health aides, and other caregivers—need similar culturally specific information. For example, all health-care providers communicate, both verbally and nonverbally; therefore, all health-care providers and ancillary staff need to have similar information and skill development to communicate effectively with diverse populations. The manner in which the information is used may differ significantly based on the discipline, individual experiences, and specific circumstances of the patient, provider, and organization. If providers and the system are competent, most patients will access the health-care system when problems are first recognized, thereby reducing the length of stay, decreasing complications, and reducing overall costs. A lack of knowledge of patients’ language abilities and cultural beliefs and values can result in serious threats to life and quality of care for all individuals (Joint Commission, 2010). Organizations and individuals who understand their patients’ cultural values, beliefs, and practices are in a better position to be co-participants with their patients in providing culturally acceptable care. Having ethnocultural-specific knowledge, understanding, and assessment skills to work with culturally diverse patients ensures that the health-care provider can conduct a more targeted assessment. Providers who know culturally specific aggregate data are less likely to demonstrate negative attitudes, behaviors, ethnocentrism, stereotyping, and racism. The onus for cultural competence is on the health-care provider and the delivery system in which care is provided. To this end, health-care providers need both general and specific cultural knowledge when conducting assessments, planning care, and teaching patients about their treatments and prescriptions. World Diversity and Migration As of January 2011, the world's population estimate reached 6.8 billion people, with a median age of 27.7 years. The population is expected to approach 7.6 billion by 2020 and 9.3 billion by 2050. The estimated population growth rate remains relatively stable at 1.13 percent, with 19.86 births per 1000 population; 8.7 deaths per 1000 population; and an infant mortality rate of 44.13 per 1000 population, down from 48.87 in 2005. Worldwide life expectancy at birth is currently 66.12 years, up from 64.77 years in 2005 (CIA World Factbook, 2011). The ten largest urban populations where significant migration occurs are Tokyo, Japan with 36.7 million; Delhi, India with 22.2 million; São Paulo, Brazil with 20.3 million; Mexico City, Mexico with 19 million; New York–Newark, United States with 19.4 million; Shanghai, China with 16.6 million; Kolata, India with 15.6 million; Dhaka, Bangladesh with 14.7 million; and Karachi, Pakistan with 13.1 million (CIA World Factbook, 2011). As a first language, Mandarin Chinese is the most popular, spoken by 12.65 percent of the world's population, followed by Spanish at 4.93 percent, English at 4.91 percent, Arabic at 3.1 percent, Hindi at 2.73 percent, Portuguese at 2.67 percent, Bengali at 2.71 percent, Russian at 2.16 percent, Japanese at 1.83 percent, and Standard German at 1.35 percent. Only 82 percent of the world population is literate. When technology is examined, more people have a cell phone than a landline—with a ratio of 3:1. Over 1.6 billion people are Internet users, up by 62 percent from 2005 (CIA World Factbook, 2011). Language literacy has serious implications for immigration. Over two-thirds of the world's 785 million illiterate adults are found in only eight countries: Bangladesh, China, Egypt, Ethiopia, India, Indonesia, Nigeria, and Pakistan. Of all the illiterate adults in the world, two-thirds are women; extremely low literacy rates are concentrated in three regions: the Arab states, South and West Asia, and Sub-Saharan Africa, where around one-third of the men and half of all women are illiterate (2005 est.) (CIA World Factbook, 2011). The United Nations High Commissioner for Refugees estimated in December 2006, the latest year for which figures are available, a global population of 8.8 million registered refugees, the lowest number in 30 years, and as many as 24.5 million internally displaced persons in more than 50 countries. The actual global population of refugees is probably closer to 10 million given the estimated 1.5 million Iraqi refugees displaced throughout the Middle East. Migrants represent approximately 190 million people or 2.9 percent of the world population, up from 175 million in the year 2000. Moreover, international migration is decreasing, while internal migration is increasing, especially in Asian countries (U.N. Refugee Agency, 2009). In 1997, the International Organization for Migration studied the costs and benefits of international migration. A comprehensive update has not been undertaken since that time. According to the report, ample evidence exists that migration brings both costs and benefits for sending and receiving countries, although these are not shared equally. Trends suggest a greater movement toward circular migration with substantial benefits to both home and host countries. The perception that migrants are more of a burden on than a benefit to the host country is not substantiated by research. For example, in the Home Office Study (2002) in the United Kingdom, migrants contributed US$4 billion more in taxes than they received in benefits. In the United States, the National Research Council (1998) estimated that national income had expanded by US$8 billion because of immigration. Thus, because migrants pay taxes, they are not likely to put a greater burden on health and welfare services than the host population. However, undocumented migrants run the highest health risks because they are less likely to seek health care. This not only poses risks for migrants but also fuels sentiments of xenophobia and discrimination against all migrants. • What evidence do you see in your community that migrants have added to the economic base of the community? Who would be doing their work if they were not available? If migrants (legal or undocumented) were not picking vegetables (just one example), how much more do you think you would pay for the vegetables? U.S. Population and Census Data As of 2010, the U.S. population was over 308 million, an increase of 16 million since the 2000 census. The 2010 census data include changes designed to more clearly distinguish Hispanic ethnicity as not being a race. In addition, the Hispanic terms have been modified to include Hispanic (used more heavily on the East Coast), Latino (used more heavily in California and the West Coast), and Spanish. The most recent census data estimate that 65.1 percent of the U.S. population are white, 15.8 percent are Hispanic/Latino, 12.9 percent are black, 4.6 percent are Asian, 1.0 percent are American Indian or Alaskan Native, and 0.2 percent are Native Hawaiian or other Pacific Islander. These groupings will be more specifically reported as the census data are analyzed. The categories as used in the 2010 U.S. Census are as follows: • 1. White refers to people having origins in any of the original peoples of Europe and includes Middle Easterners, Irish, German, Italian, Lebanese, Turkish, Arab, and Polish. • 2. Black, or African American, refers to people having origins in any of the black racial groups of Africa and includes Nigerians and Haitians or any person who self-designates this category regardless of origin. • 3. American Indian and Alaskan Native refer to people having origins in any of the original peoples of North, South, or Central America and who maintain tribal affiliation or community attachment. • 4. Asian refers to people having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent. This category includes the terms Asian Indian, Chinese, Filipino, Korean, Japanese, Vietnamese, Burmese, Hmong, Pakistani, and Thai. • 5. Native Hawaiian and other Pacific Islander refer to people having origins in any of the original peoples of Hawaii, Guam, Samoa, Tahiti, the Mariana Islands, and Chuuk. • 6. Some other race was included for people who are unable to identify with the other categories. • 7. In addition, the respondent could identify, as a write-in, with two races (U.S. Census Bureau, 2010). The Hispanic/Latino and Asian populations continue to rise in numbers and in percentage of the overall population; however, although the black/African American, Native Hawaiian and Pacific Islanders, and American Indian and Alaskan Natives groups continue to increase in overall numbers, their percentage of the population has decreased. Of the Hispanic/Latino population, most are Mexicans, followed by Puerto Ricans, Cubans, Central Americans, South Americans, and Dominicans. Salvadorans are the largest group from Central America. Three-quarters of Hispanics live in the West or South, with 50 percent of the Hispanics living in just two states: California and Texas. The median age for the entire U.S. population is 41.8 years, and the median age for Hispanics is 27.2 years (U.S. Census Bureau, 2010). The young age of Hispanics in the United States makes them ideal candidates for recruitment into the health professions, an area with crisis-level shortages of personnel, especially of minority representation. Before 1940, most immigrants to the United States came from Europe, especially Germany, the United Kingdom, Ireland, the former Union of Soviet Socialist Republics, Latvia, Austria, and Hungary. Since 1940, immigration patterns to the United States have changed: Most are from Mexico, the Philippines, China, India, Brazil, Russia, Pakistan, Japan, Turkey, Egypt, and Thailand. People from each of these countries bring their own culture with them and increase the cultural mosaic of the United States. Many of these groups have strong ethnic identities and maintain their values, beliefs, practices, and languages long after their arrival. Individuals who speak only their indigenous language are more likely to adhere to traditional practices and live in ethnic enclaves and are less likely to assimilate into their new society. The inability of immigrants to speak the language of their new country creates additional challenges for healthcare providers working with these populations. Other countries in the world face similar immigration challenges and opportunities for diversity enrichment. However, space does not permit a comprehensive analysis of migration patterns. • What changes in ethnic and cultural diversity have you seen in your community over the last 5 years? Over the last 10 years? Have you had the opportunity to interact with these newer groups? Racial and Ethnic Disparities in Health Care A number of organizations have developed documents addressing the need for cultural competence as one strategy for eliminating racial and ethnic disparities. In 2005, the Agency for Healthcare Research and Quality (AHRQ) released the “Third National Healthcare Disparities Report” (AHRQ, 2005), which provided a comprehensive overview of health disparities in ethnic, racial, and socioeconomic groups in the United States. This report was a companion document to the “National Healthcare Quality Report” (2006), which was an overview of quality health care in the United States. Healthy People 2010's (www.healthypeople.gov) goals were to increase the quality and the length of a healthy life and to eliminate health disparities. Healthy People provided science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to (1) encourage collaborations across communities and sectors, (2) empower individuals toward making informed health decisions, and (3) measure the impact of prevention activities (http://www.healthypeople.gov/2020/about/default.aspx). The Healthy People 2020 (www.healthypeople2020.gov) report had a renewed focus on identifying, measuring, tracking, and reducing health disparities through determinants of health such as the social and economic environment, the physical environment, and the person's individual characteristics and behaviors. Although the term disparities is often interpreted to mean racial or ethnic disparities, many dimensions of disparity exist in the United States, particularly in health. If a health outcome is seen in a greater or lesser extent among different populations, a disparity exists. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual's ability to achieve good health. During the past two decades, one of Healthy People's overarching goals focused on disparities. Indeed, in Healthy People 2000, the goal was to reduce health disparities among Americans; in Healthy People 2010, it was to completely eliminate, not just reduce, health disparities; and in Healthy People 2020, the goal was expanded to achieve health equity, eliminate disparities, and improve the health of all groups. Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.” Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion. In addition, powerful, complex relationships exist among health and biology, genetics, and individual behavior, and among health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies. These factors, which influence an individual's or population's health, are known as determinants of health (Healthy People 2020). • What health disparities have you observed in your community? To what do you attribute these disparities? What can you do as a professional to help decrease these disparities? More specific data on ethnic and cultural groups are included in individual chapters. As can be seen by the overwhelming data, much more work needs to be done to improve the health of the nation. Space does not permit an extensive discourse on racial and ethnic disparities in other countries, but documents with frequent updates that include other countries, conditions, and policies are listed as a resource on DavisPlus. Culture and Essential Terminology Culture Defined Anthropologists and sociologists have proposed many definitions of culture. For the purposes of this book, which is primarily focused on individual cultural competence instead of the culturally competent organization, culture is defined as the totality of socially transmitted behavioral patterns, arts, beliefs, values, customs, lifeways, and all other products of human work and thought characteristics of a population of people that guide their worldview and decision making. Health and health-care beliefs and values are assumed in this definition. These patterns may be explicit or implicit, are primarily learned and transmitted within the family, are shared by most (but not all) members of the culture, and are emergent phenomena that change in response to global phenomena. Culture, a combined anthropological and social construct, can be seen as having three levels: (1) a tertiary level that is visible to outsiders, such as things that can be seen, worn, or otherwise observed; (2) a secondary level, in which only members know the rules of behavior and can articulate them; and (3) a primary level that represents the deepest level in which rules are known by all, observed by all, implicit, and taken for granted (Koffman, 2006). Culture is largely unconscious and has powerful influences on health and illness. An important concept to understand is that cultural beliefs, values, and practices are learned from birth: first at home, then in the church and other places where people ...
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