CULT UR AL SENSI T I V I T Y

A GUIDEBOOK FOR PHYSICIANS & HEALTHCARE PROFESSIONALS

Written for Doctors in Touch by Geri-Ann Galanti, Ph.D. with a forward by Michael S. Woods, M.D.

FORWARD

CULTURAL SENSITIVITY GUIDEBOOK

Michael S. Woods, M.D.

The World Is A Small Place.

AND THE SMALLER IT GETS, THE MORE IMPORTANT IT BECOMES THAT WE UNDERSTAND EACH OTHER. As physicians in the United States, were likely to count among our patients people from all over the globe. Hmong in Minneapolis. Chinese in Atlanta. Vietnamese in Wichita. Russians in Denver. Africans in Seattle. All of the above and more in New York, Chicago, and Los Angeles. These various peoples carry with them cultures and customs that affect the way they interpret the world, their experiences, and their relationships. When it comes to healthcare, the U.S. might have great technology and dedicated, intelligent doctors, but these advantages are lost if our patients cant understand the why and what of their care. If a patient, because of a cultural disconnect, cant appreciate what were prescribing or why its necessary, or if the information is delivered in a way that inadvertently frightens or offends the patient, how can we fulll our mission as healthcare providers?

THE ANSWER IS PATIENT-CENTERED HEALTHCARE.

Take a minute to think of the patient as a customer how would that change our behavior? Wed be obliged to give the patient what he or she wants. Doing that (within the boundaries of the right medical solution, of course) means being sensitive to each patients culture-driven expectations. If patients feel we understand and respect them as individuals, theyll be more likely to trust us and comply with our prescribed therapies and treatments. The greater the trust, the better the outcomes. The better the outcomes, the lower the risk of medical malpractice liability. Doctors in Touch has put together this guidebook as a service to our friends and colleagues in the healthcare industry. The information in this CULTURAL SENSITIVITY GUIDEBOOK comes from www.ggalanti.com Caring for Patients from Different Cultures, by Geri-Ann Galanti, Ph.D. Each section addresses a few core cultural patterns that can lead to misunderstandings. By using this guide, a physician can take an important step toward better patient relationships. If you have any questions, please contact Doctors in Touch at 708.697.6447 or see www.doctorsintouch.com.

Michael S. Woods, M.D.

A WORD OF CAUTION

CULTURAL SENSITIVITY GUIDEBOOK

GENERALIZATIONS SHOULD NOT

BE MISTAKEN FOR STEREOTYPES

If I meet Rosa, a Mexican woman, and say to myself, Rosa is Mexican; she must have a large family, I am stereotyping her. But if I think Mexicans often have large families and wonder whether Rosa does, I am making a generalization. A STEREOTYPE is an ending point. No attempt is made to learn whether the individual in question ts the statement. Stereotyping patients can have negative results. A GENERALIZATION is a beginning point. It indicates common trends, but further information is needed to ascertain whether the statement is appropriate to a particular individual. Generalizations may be inaccurate when applied to specic individuals, but when applied broadly, can indicate common behaviors and shared beliefs. (Of course, there are always differences among individuals.)

A FEW FUNDAMENTALS
Lets look at some of the core causes for cultural disconnects between healthcare providers and patients, beginning with VALUES, those things we hold as important. Simply put: different cultures promote different values. Right now, the U.S. culture values such things as money, freedom, independence, privacy, health and tness, and physical appearance. But another culturesay, the Mbuti of Africamight value social support. To punish a wrongdoer, the U.S. takes away his money (through a ne of some sort) or his freedom (with incarceration); the Mbuti, on the other hand, punish people by ignoring them. When the U.S. healthcare system makes decisions based on nances, people from a social-centric culture like the Mbuti may not get it. Similarly, in the U.S. the value of INDEPENDENCE is evident in children moving away from home as soon as nancially possible. In other cultures, children might not move out until marriage and often not even then. Our healthcare providers might tell a patient to take care of yourself without considering the role of family members in the dynamics of the individuals daily activities of life. PRIVACY is also important in the U.S., so hospitals try to limit visiting hours and rarely offer sleeping accomodations for visitors. Many non-Anglo patients, however, would prefer just the opposite. Similarly, the U.S. healthcare culture values self-control, but many patients come from cultures in which emotional expressiveness is the norm.

A FEW FUNDAMENTALS
Obviously similar illustrations could be made for all the things people value. But the point has been made: Understanding peoples values is the key to understanding their behavior, for our behavior generally reects our values.

Another Source of Confusion: SOCIAL STRUCTURE The U.S. model is egalitarian: in theory, everyone is equal. Status and power come from an individuals achievements rather than from age, sex, family, or occupation. Other cultures, such as Asian, are hierarchical: everyone is not equal. Status comes from age, sex, and occupation. And these differences are considered important. One way to discuss the impact of culture on our thinking and behavior is through two anthropological concepts: ETHNOCENTRISM (the view that ones own cultures way of doing things is the right and natural way to do them). Most humans are ethnocentric; thats only natural. But ethnocentrism can impede cross-cultural communication and understanding. CULTURAL RELATIVISM (the attitude that other ways of doing things are different but equally valid). This is the attitude we should all strive for; it will lead to bettercommunication and trust. The practitioners of western healthcare tend to believe that their approaches to healing are superior to all others. But the goal of all healing is the same: to help people get well. If different cultures studied each others techniques with an open mind, the cause of modern medicine would be greatly advanced.

The best way to begin to appreciate a patients point of view is to ask a few important questions. And then, listenreally listento the answers. We suggest these questions, as suggested by psychiatrist and anthropologist Arthur Kleinman as a way to establish a meaningful dialogue: 1 1) What do you think has caused your problem?
2) Why do you think it started when it did? 3) What do you think your sickness does to you?

How does it work?

4) How severe is your sickness? Will it have a short or long course?

5) What kind of treatment do you think you

should receive?

6) What are the most important results you hope to receive from this treatment? 7) What are the chief problems your sickness has caused for you? 8) What do you fear most about your sickness?

1 Kleinman, A., L. Eisenberg, and B. Good. (1978) Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88: 251-58.

AFRICAN AMERICAN

AFRICAN AMERICAN
CAUTION: These are broad generalizations and should not be used to stereotype any individuals.

VALUES, WORLD VIEW AND COMMUNICATION

African American patients may not trust white institutions such as hospitals. When a child is hospitalized, an adult (female) may stay in or near the room at all times. African Americans may also be very sensitive to discrimination, even when it is not intended. For example, do not use the term gal to refer to a woman (it has the same connotations as boy for an African American male). Address the patient by title and last name. Religion is an important part of the lives of many African Americans. Clergy should be allowed to participate when appropriate. Privacy for prayer is important. Healthcare practitioners may offer to pray with a patient if all parties involved feel comfortable with it.

FAMILY/GENDER ISSUES

Family structure may be nuclear, extended, or matriarchal. Close friends may be part of a kin support system. The father or eldest male may be the spokesperson. Outside the household, decision making is egalitarian; within the household, the father may make nal decisions.

CRADLE TO GRAVE

Traditionally, only females attend birth, but this can vary. Practicing folk medicine in the old South, African American women would crave red clay dirt when pregnant (pica). Outside of the South, the clay was replaced by Argo starch. In large amounts, it can cause constipation. In small amounts, it may provide an important comfort. After birth, the mother may delay bathing and hair washing until post-partum bleeding stops. Offer a sponge bath. Since menstruation is thought to rid the body of dirty, excess blood, any variation may be feared. If the ow is too light, bad blood may back up; if its too heavy, the body can weaken.

CRADLE TO GRAVE (CONTINUED)

AFRICAN AMERICAN

AFRICAN AMERICAN
(continued) Keep these fears in mind when discussing birth control methods. Many have a present-time orientation and thus may not see the need to take preventative medication (such as for hypertension) or to nish antibiotics when symptoms disappear. Explanations may be important. Some may delay seeing a physician until symptoms are severe. Some consider it taboo to donate organs or blood, except to a family member, for fear that this will hasten ones own death.

HEALTH RELATED BELIEFS AND PRACTICES

Examples of natural causes of disease are improper diet and exposure to cold/wind; examples of unnatural causes are Gods punishment and voodoo. Treatment should t the cause. For example, patients (usually from the South or in rural areas) may interpret gastrointestinal distress (nausea, vomiting, diarrhea, loss of appetite) as a sign of voodoo poisoning, which must be treated by a voodoo practitioner (root doctor). Rich foods (red) may be thought by some (particularly those in the South) to cause high blood, which may be confused with high blood pressure. High blood may be treated with clear, white foods to lower blood. Since white foods can include such things as pickle juice, which is very high in sodium, this should be discussed in detail with the patient. Low blood is thought to result from too much vinegar, lemon juice, garlic, and not enough red meat. Be sure to clarify the difference between low blood, low blood count, and low blood pressure.
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The African American culture has a rich tradition of herbal remedies. Be sure to discuss the use of home or herbal remedies to prevent potential drug interactions.

NOTE: This material, drawn mainly from the work of Loudell Snow, applies largely to low income uneducated African Americans, especially in the South. See also Locks, S. and Boateng, L. (1996) Black/African Americans. In JG Lipson, SL Dibble, and PA Minarik (Eds.), Culture and Nursing Care: A Pocket Guide (pp. 37-43). San Francisco: UCSF Nursing Press.

ANGLO AMERICAN
CAUTION: These are broad generalizations and should not be used to stereotype any individuals.
ANGLO AMERICAN

VALUES, WORLD VIEW AND COMMUNICATION

The individual expects to know the details of his/her condition. Both direct eye contact and emotional control are expected. But try to avoid excessive direct eye contact with members of the opposite sex to avoid any hint of sexual impropriety. Privacy is important. Yet, the patient may want/expect nurses to provide psychosocial care.

FAMILY/GENDER ISSUES

Generally, family size is small; the immediate family refers to spouse, siblings, parents, children. The individual makes his/her own choices. Because husbands and wives may have equal authority, either parent makes decisions for the child.

CRADLE TO GRAVE

Prenatal care is generally sought. The husband is usually the preferred labor partner. Hospital births are generally preferred, even if an alternative birthing center is used. This may be related to a cultural desire to control events. This culture has no post-partum rituals. Breast feeding is generally practiced for 3-6 months. Patients will generally want to know a diagnosis and prognosis. Independence is highly valued; self-care will generally be accepted. Lower income people tend to be present-oriented; middle- and upper-class individuals tend to be future-oriented. Patients will tend to be stoic, although most will want pain medication. A patient may prefer to be left alone when sick. Stoicism is valued when someone dies. Organ donations and autopsies are acceptable, as are cremation or burial, unless any of these is forbidden by the patients religion.

ANGLO AMERICAN
HEALTH-RELATED BELIEFS AND PRACTICES
ANGLO AMERICAN

These patients generally prefer an aggressive approach to treating illness. Biomedicine is preferred, although many may also use complementary and alternative medicine. Be sure to inquire about the use of herbal medications. Germs are thought to be the cause of disease; patients expect treatment to destroy germs. Antibiotics are often requested, even for viral illnesses.

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ASIAN
CAUTION: These are broad generalizations and should not be used to stereotype any individuals.

VALUES, WORLD VIEW AND COMMUNICATION

To show respect, patients may agree to anything you say, without having any intention of following through. Make sure the reasons for compliance are explained and stressed. Avoid asking questions requiring a yes or no response. Find a way to have the patient demonstrate an understanding of what you expect. Also as a sign of respect, these patients might avoid direct eye contact. Do not assign other meanings to this. Avoid hand gestures in case they are offensive; for example, beckoning with the index nger is insulting to Filipinos and Koreans. Offer things several times; patients may refuse at rst to be polite. And realize that, since pronouns do not exist in most Asian languages, patients will often confuse he and she.

ASIAN

FAMILY/GENDER ISSUES

Allow family members to fulll their familial duty by spending as much time as possible with the patient and by providing non-technical care. Involve the family in decision-making. Accept that wives may defer to husbands in decision-making and that sons may be valued more than daughters. And recognize that Asian culture is hierarchical; tremendous respect is often accorded to the elderly.

CRADLE TO GRAVE

The patients birth partner may be her mother-inlaw or other female relative. Parents may avoid naming the baby for up to 30 days. New mothers might also avoid cold, bathing, and exercise for one month post-partum (doing the month). Respect post-partum prescriptions for rest. Sponge baths and warm liquids may be preferred.

ASIAN
CRADLE TO GRAVE (CONTINUED)
Since pregnancy is thought to be a yang or hot condition within traditional Chinese medicine, birth depletes the body of heat. Restoration of warmth is important. Offer liquids other than ice water, which may be deemed too yin or cold. Women are often stoic while giving birth. In fact, Asian patients generally may not express pain. Offer pain medication when the condition warrants it, even if patient does not request it. Insist upon giving it when necessary. When a patient is terminal, family members may wish to shield him/her from that fact. Ask the patient upon admission (or before the need arises, if possible) whom should be given information about his/her condition.

ASIAN

HEALTH-RELATED BELIEFS AND PRACTICES

In China, Korea, and Vietnam, coining and cupping are traditional medical practices, not forms of abuse. Fevers are often treated by wrapping in warm blankets and drinking warm liquids. Avoid giving ice water, unless requested. Patients may prefer hot liquids, such as tea. The use of herbs is common. Be sure to instruct on how to the use Western medication. Avoid the number 4; it may signify death for Chinese and Japanese patients. Mental illness can be highly stigmatizing in Asian countries. Patients with emotional problems are likely to present physical complaints. Patients may be reluctant to discuss emotional problems with strangers, even professionals.

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EAST INDIAN
CAUTION: These are broad generalizations and should not be used to stereotype any individuals.

Hindus, Sikhs, and Muslims from India, Pakistan, Bangladesh, Sri Lanka & Nepal.

VALUES, WORLD VIEW AND COMMUNICATION

Direct eye contact may be seen as rude or disrespectful, especially among the elderly. Silence often indicates acceptance or approval. In some regions, a side-to-side head bob may indicate agreement or uncertainty. An up-and-down nod may indicate disagreement, while acknowledging what the speaker is saying. Males should not shake hands with a female, unless she offers her hand rst. Some patients may not want to sign consents; they consider healthcare professionals to be the authorities and may prefer to have them make the decisions.

EAST INDIAN

FAMILY/GENDER ISSUES

Close female family members will often remain with the patient; family members will often take over activities of daily living (such as feeding, grooming, etc.) for the patient. Do not insist upon self-care unless medically necessary. The father or eldest son usually has decisionmaking power, but generally family members are consulted before decisions are made. Husbands may answer questions addressed to the wife. Due to their modesty, many patients may prefer same-sex caregivers.

CRADLE TO GRAVE

Pregnant Hindu women are often encouraged to eat nuts, raisins, coconuts, and fruits to have a healthy, beautiful baby. Dried ginger powder, celery seeds, nuts, and puffed lotus seeds may be given to the new Hindu mother to cleanse her system and restore her strength.

EAST INDIAN
CRADLE TO GRAVE (CONTINUED)
East Indian women practice a post-partum lying-in period. While they are expected to feed the baby, everything else is done for them. Traditionally, female relatives take over. If none are around, the patient may expect nurses to do so. Moaning and screaming are acceptable during the birth of the rst child. Otherwise, these patients are stoic. Muslims may not want narcotics for anything other than severe pain. Some patients may prefer to have a fatal diagnosis given to family member. Family will then decide whether and how much to reveal to the patient. Discuss this who of communication well in advance of need, if possible.

EAST INDIAN

HEALTH-RELATED BELIEFS AND PRACTICES

Sikhs are enjoined not to cut their hair or shave their beard. Their hair will usually be worn in a turban. Consider this before cutting or shaving any hair in preparation for surgery. Hindus will generally not eat meat or sh; some may not eat eggs. Muslims will not eat pork. Those who believe in Ayurvedic medicine (Hindus, Sikhs, and some Muslims) see food in terms of a hot/ cold classication, based on qualities inherent in the food rather than on the temperature. Hot foods (meat, sh, eggs, yogurt, honey, and nuts) are given for cold conditions such as fever or surgery, especially in winter. Cold foods (milk, butter, cheese, fruits, and vegetables) are eaten in the summer and for hot conditions, including pregnancy.

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NOTE: Most of the material contained in this prole is adapted from Rajwani, R., J. (1996) South Asians. In JG Lipson, SL Dibble, and PA Minarik (Eds.), Culture and Nursing Care: A Pocket Guide (pp. 264-279). San Francisco: UCSF Nursing Press.

HISPANIC (Primarily Mexican)

CAUTION: These are broad generalizations and should not be used to stereotype any individuals.

VALUES, WORLD VIEW AND COMMUNICATION

This culture values personal relationships. Ask about the patients family and interests before focusing on health issues.

FAMILY/GENDER ISSUES

Allow family members to express their love and concern by spending as much time as possible with the patient. Allow them to assist the patient with the activities of daily living if the patient is reluctant to do self-care. Realize that patients may not discuss emotional problems outside the family. Modesty is important, especially among older women; try to keep them covered whenever possible. Accept that older, more traditional wives may defer to husbands in decision-making, both for their own health and that of their children. Involve the family in decision-making.
HISPANIC

CRADLE TO GRAVE

Pregnancy is seen as a normal condition, so prenatal care may not be sought. In labor and delivery, the womans mother may be the preferred birthing partner. Laboring women often yell out aye yie yiea loud form of controlled breathing. Others will be stoic. Traditionally, new mothers avoid cold, bathing, and exercise for six weeks post-partum. Respect postpartum prescriptions for rest. Sponge baths may be preferred. Pregnancy is considered a hot condition; birth depletes the body of heat. Restoration of warmth is important. Offer liquids other than ice water, which may be deemed too cold.

HISPANIC (Primarily Mexican)

CRADLE TO GRAVE (CONTINUED)
While patients may tend to be expressive (loud) when in pain, males may be more expressive around family members than around healthcare professionals. The culture tends toward a present-time orientation, which may impede the use of preventive medicine and follow-up care. Family members may want to withhold a fatal diagnosis from the patient; ask the patient upon admission (or before the need arises, if possible) whom should be given information about his/her condition.

HEALTH-RELATED BELIEFS AND PRACTICES

HISPANIC

Patients may refuse certain foods or medications that upset a hot/cold body balance. Offer alternative foods and liquids. Avoid ice water, unless requested. Among traditional women, fat is seen as healthy. Many Mexican foods are high in fat and salt. Nutritional counseling may be necessary for diabetics and individuals with high blood pressure. Some may believe that complimenting a child without touching him/her can cause evil eye. To be safe, touch the child when admiring him/her. Ask what herbal remedies, if any, the patient uses. While most are effective or neutral, azarcn (a bright reddish-orange powder) and greta (a yellow to grayish-yellow powder), which are used to treat empacho (stomach pain) have lead and can be dangerous.

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MIDDLE EASTERN
CAUTION: These are broad generalizations and should not be used to stereotype any individuals.

VALUES, WORLD VIEW AND COMMUNICATION

Communication should be two-way. You many need to share information about yourself before these patients will share information about themselves. Healthcare providers may be expected to take a personal interest in their patients. Try to avoid direct eye contact with members of the opposite sex to avoid any hint of sexual impropriety. Islam is a dominant force in the lives of most Middle Easterners. Give patients the privacy to pray several times a day, facing east toward Mecca. Many have a fatalistic attitude regarding health: its all in Allahs hands, so they may see their health-related behavior as being of little consequence. They may not want to plan for birth or death, since doing so can be seen as challenging the will of Allah.

FAMILY/GENDER ISSUES

Be patient with demanding family members; they may see it as their job to make sure that the patient gets the best care possible. It is usually appropriate to speak rst to the family spokesman. Repetition of demands is often made to show emphasis, as is a loud tone of voice. Sexual segregation is usually extremely important. Assign same-sex caregivers whenever possible and respect a womans modesty at all time. Accept the fact that women may defer to husbands for decisionmaking about their own and their childrens health. In fact, the husband may answer questions addressed to his wife. Personal problems are usually taken care of within the family; they will probably not be receptive to counseling.

MIDDLE EASTERN

MIDDLE EASTERN
CRADLE TO GRAVE
These patients might not make many preparations for birth. It is acceptable for women to be very loud and expressive during labor and delivery, after someone has died, and when they are in pain. Male circumcision is common. They may be reluctant to agree to DNR (Do Not Resuscitate) or to plan for death. Also, they might not allow organ donation or autopsy, since, according to Islam, the body should be returned to Allah in the condition in which it was given.

HEALTH-RELATED BELIEFS AND PRACTICES

Damp, cold, and drafts may be thought to lead to illness. Strong emotions are also suspect. For example, the evil eye (envy) may be thought to cause illness or misfortune. Amulets to prevent this may be worn and should not be removed. The patient may feel slighted if not given a prescription. When providing meals, be aware that Muslims may not eat pork.
MIDDLE EASTERN WWW.DOCTORSINTOUCH.COM

NATIVE AMERICAN
CAUTION: These are broad generalizations and should not be used to stereotype any individuals.

VALUES, WORLD VIEW AND COMMUNICATION

Anecdotes or metaphors may be used by the patient to talk about his/her own situation. For example, a story about an ill neighbor may be a way of saying the individual is experiencing the same symptoms. Long pauses generally indicate that careful consideration is being given to a question. Do not rush patient. Loudness is often associated with aggressiveness and should be avoided. Due to history of misuse of signed documents, some may be unwilling to sign informed consent or advanced directives. And some may display hostility toward healthcare providers due to history of treatment of Native Americans by whites.

FAMILY/GENDER ISSUES

Extended family is important, and any illness concerns the entire family. Decision-making varies with kinship structure. Patients will generally make their own decisions.

CRADLE TO GRAVE

A female relative may be the birth attendant. Stoicism is encouraged during labor and delivery. The mother and infant may stay inside and rest for 20 days postpartum or until the umbilical cord falls off, depending upon custom. Many may want to save the umbilical cord, since it may be seen as having spiritual value. Overall, patients may not express pain, other than by mentioning I dont feel so good or Something doesnt feel right. Offer pain medication when the condition warrants it, even if patient does not appear to be in pain. These patients are generally oriented to activities, rather than the clock. Indian time may run very late.

NATIVE AMERICAN

NATIVE AMERICAN
CRADLE TO GRAVE (CONTINUED)
Some tribes may prefer to avoid discussion of terminal prognosis or DNR, since they believe that negative thoughts hasten death. Others will use the information to make appropriate preparations. Some tribes may avoid contact with the dying, while others will want to be at the bedside 24 hours a day. Visitors may display a jovial attitude so as not to demoralize patient. Mourning is done in private, away from the patient. The names of deceased relatives may be avoided, but relationship term (e.g., brother, father, sister) may be used. After death, wailing and shrieking may occur. Some may want to leave a window open for the soul to leave at death; others may orient the patients body to a cardinal direction before death.

HEALTH-RELATED BELIEFS AND PRACTICES

Before cutting or shaving hair, check to see if the patient or family wants to keep it. Realize that in some tribes, cutting hair is associated with mourning. A medicine bag may be worn by the patient. Do not treat it casually or remove it without discussing it with the patient. If its absolutely necessary to remove it, allow a family member to do so, keep it as close to the patient as possible, and return it as soon as possible. Food which is blessed (in a traditional religion or Christianity) may be thought to be harmless. Nutritional guidance should take this into account. Many traditional foods are high in fat. Traditional healers may be combined with use of Western medicine. Allow traditional healers to perform rituals whenever possible.
NOTE: The material contained in this prole is adapted from Kramer, J. (1996) American Indians. In JG Lipson, SL Dibble, and PA Minarik (Eds.), Culture and Nursing Care: A Pocket Guide (pp. 11-22). San Francisco: UCSF Nursing Press.

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RUSSIAN
CAUTION: These are broad generalizations and should not be used to stereotype any individuals.

VALUES, WORLD VIEW AND COMMUNICATION

To help allay the anxiety of family members, provide frequent updates on patient treatments and progress. These patients may expect nurses to be friendly, warm, and caringthat is, to feel for them. They may speak loudly and seem abrasive; this was likely necessary in Russia to get attention in the healthcare system. Make direct eye contact, be rm, and be respectful. Use hand gestures and facial expressions when English prociency is minimal. Address patients as Mr. or Mrs.

FAMILY/GENDER ISSUES

The gender of the provider is usually not an issue, but a patient may prefer to have a family member of the same gender present when receiving personal care.

CRADLE TO GRAVE

Exercise and lifting heavy objects are often avoided during pregnancy. A female relative is often the preferred labor and delivery partner. Russian women tend to have a high pain threshold and stoic attitude. Encourage appropriate pain management and pre-medicate for dressing changes or daily care that causes discomfort. Patients and their families may frequently offer small gifts of food or chocolate. Accept them, as it may be perceived as rude to turn them down.
RUSSIAN

Autopsies and organ donations may be refused due to the sacredness of the body. Since family members may want to withhold a fatal diagnosis from the patient, ask the patient upon admission (or before the need arises, if possible) whom should be given information about his/her condition.

RUSSIAN
HEALTH-RELATED BELIEFS AND PRACTICES
Many, especially the elderly, believe that illness results from cold. Therefore, keep a patient covered, close windows, keep the room warm, and avoid iced drinks, especially if he/she has a fever. These patients will often prefer sponge baths to showers. They may not like taking a large number of pills. Space out medication administration so that as few pills as possible are given at one time. And they may prefer non-pharmacologic interventions for nausea, including lemon slices, ginger ale, mineral water, or weak tea with lemon. Be aware that Russians may practice cupping; resulting marks should not be misinterpreted as abuse or a symptom.

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RUSSIAN

NOTE: Information for this prole is based on the work of Peter Anderson, R.N. and from Evanikoff, L.J. (1996) Russians. In JG Lipson, SL Dibble, and PA Minarik (Eds.), Culture and Nursing Care: A Pocket Guide (pp. 239-249). San Francisco: UCSF Nursing Press.

SOUTHEAST ASIANS
CAUTION: These are broad generalizations and should not be used to stereotype any individuals.

VALUES, WORLD VIEW AND COMMUNICATION

Keep in mind that many are refugees who ed to the United States to save their lives, rather than simply to improve them. When accompanied by relatives, address the conversation to the eldest presentespecially if male. Realize that it may be difcult to obtain an accurate health history, since patients are rarely told the name of illnesses or medicines given or diagnostic procedures performed.

FAMILY/GENDER ISSUES

The area from the waist to the knees extremely private and should never be exposed. Same sex practitioners and interpreters are best. Their method of calculating age may vary from ours. For example, a baby may be considered one year old at birth.

CRADLE TO GRAVE

They may not give an accurate count of pregnancies because many only count live births. A baby may not be seen as human until several days oldprobably to discourage mothers from bonding too closely in an environment with high infant mortality rates. Some Hmong new mothers may want to take home the placenta for burial. The head is the seat of life and is thus very personal, vulnerable, honorable, and untouchable (except by close intimates), so avoid putting IV lines in infants scalp unless necessary, and then, only with explanation.

SOUTHEAST ASIANS

SOUTHEAST ASIANS
CRADLE TO GRAVE (CONTINUED)
Vietnamese mothers may appear to have difculty bonding; this is an illusion. If they pay little attention to their newborns, it is probably out of fear that if they call attention to how attractive they are, spirits may want to steal the child, which could result in its death. Children may wear spirit-strings around their wrist. They should not be cut. Nor should the neck rings that carry the life-souls of babies be cut. Some may believe that at death parents and grandparents become ancestors who should be worshipped and obeyed, and since these ancestors shape the well-being of living descendants, a child (no matter his/her age) may have trouble agreeing to terminate the care of a parent.

HEALTH-RELATED BELIEFS AND PRACTICES

These patients (especially rural non-Christians) often fear surgery since many believe that souls are attached to different parts of body and can leave, thus causing illness or death. Some Hmong believe that when people are unconscious, their souls can wander at large, so anesthesia may be seen as dangerous. Some may also believe that if the body is cut or disgured or parts are amputated, it will forever be in a state of imbalance, and the damaged person will become frequently ill and may be physically incomplete during their next incarnation. Some believe that verbal statements in and of themselves can cause the event and for this reason may not want to discuss potential risks and dangers. A patient may want to consult a shaman.

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SOUTHEAST ASIANS

NOTE: Most of the information for this prole was adapted from Muecke, M.A. (1983) Caring for Southeast Asian Refugee Patients in the USA. American Journal of Public Health 73(4): 431-438. Information on Hmong beliefs was taken from Fadiman, A. (1997) The Spirit Catches You and You Fall Down. New York: Farrar, Straus and Giroux and Johnson, S. (1996) Hmong. In JG Lipson, SL Dibble, and PA Minarik (Eds.), Culture and Nursing Care: A Pocket Guide (pp. 155-168). San Francisco: UCSF Nursing Press.

Copyright 2004 by Doctors in Touch. All rights reserved. Reproduction of this work in whole or in part without the expressed permission of the author is prohibited.

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Culture

Providing culturally and linguistically appropriate care goes beyond patients rights. In fact, these issues are critical in the delivery of safe, quality patient care.
-JCAHO

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Our e-learning course covers nine different ethnic groups:
African American Anglo American Asian East Indian Hispanic Middle Eastern Native American Russian Southeast Asian

Critical health-related cultural information is provided for each ethnic group, including Values and World Views, Family and Gender Issues, Cradle-to-Grave Traditions, and Health-Related Beliefs and Practices. Designed for any individual caring for patients- MDs, RNs, Aids, Pharmacists, Techs, and Therapistsour course is easy to use, even without prior e-learning experience. A colorful laminated booklet may compliment this course.

Call 708.697.6448 or email culture@doctorsintouch.com today!

Annual License Fee*

per facility

$10,000.00

plus
per user
< 10,000 10,000 - 20,000 20,001 - 30,000 >30,000

$5.00 $4.50 $4.00 $3.50

Doctors in Touch

2005
Copyright 2005, DIT. Patent Pending.

*Licensing fee grants one calendar year (365 days) of non-exclusive, unlimited access to the course material within the organization and its licensed sites for the total number of employees in the organization. The course can be accessed from DITs organizational access page, or via the organizations intranet. The licensing fee is capped for umbrella organizations with multiple facilities at $25,000.00 per year regardless of number of physical locations under the umbrella organization. The maximum fee for any organization, regardless of number of physical sites and users is $160,000.00 per year. Fees includes software updates. Licenses are renewable annually. CME/CEU are available for additional fees. Users are employees plus staff physicians.

Enabling patientcentered healthcare by enhancing cultural competence.

African American

East Indian

Native American

Anglo American

Hispanic

Russian

Asian

Middle Eastern

Southeast Asian

Packed with unique features

Designed by an expert
Culture and Healthcare was written by Geri-Ann Galanti, PhD, who has over 20 years of experience in teaching health care cultural diversity and cultural competence. She has lectured to thousands of physicians, nurses, and other healthcare professionals on this critically important topic. She is the author of the highly acclaimed book Caring for Patients from Different Cultures, now in its 3rd edition. Her cable TV show Culture and Health has received numerous awards. She is on the faculty of the Doctoring Program at the David Geffen School of Medicine at UCLA, the Division of Nursing at Cal State University, Dominguez Hills, and the Anthropology Department at CSU Los Angeles.

A clear advantage
Providing a high quality, multicultural educational experience for your healthcare employees shouldnt be difficult or expensive. For organizations who want to create awareness of ethnic beliefs and practices, and drive home key beliefs that can affect the quality and safety of healthcare, the choice is clear: DITs Culture and Health Care e-learning course.

Integrated Beauty
Exceptional design... and ease of navigation
Not only is Culture and Health Care beautifully designed and attractive to look at, navigation is a snap. It was specifically designed for individuals with no prior e-learning experience. The user is a mere two clicks away from any part of the course!

Take us for a test drive

We would be pleased to provide you with a link via email to our to our on-line DEMO. Please provide us with your contact information by calling us at 708.697.6448 or email us at culture@doctorsintouch.com. Please include name, mailing address, and telephone number in the email.

Unparalleled features
Doctors in Touch has developed a truly unique offering with unquestionable advantages over other options you might be evaluating. Here are just a few compelling reasons to choose Culture and Health Care: Comprehensive, systematic overviews of nine ethnic groups Automatic updates and add-on modules with additional case studies when available Case studies from multiple perspectives, including physicians, nurses, and pharmacists Key cultural aspects reinforced using interactive, immersive e-learning tools, such as Quick Checks Attractive, intuitive interface designed for ease of use and assumes individuals have no prior e-learning experience Laminated companion booklet available CME/CEU credits available Unparalleled cost-per-user

The Cultural Sensitivity Booklet... a perfect compliment

Our companion booklet is the perfect accompaniment to the e-learning course. Buy one for each of nursing unit or place in some other central location. It puts the important cultural aspects of each of the nine ethnic groups at the fingertips of anyone needing a quick refresher before seeing a patient!

Individual User Pricing

individual- online individual-CD

$79.00 $83.50 5% 10% 15% 20% 25% 30%

Volume discounts
10 - 99 100 - 149 150 - 249 250 - 299 500 - 999 1000 or more

DOCTORS IN TOUCH 1100 LAKE STREET, SUITE 230 OAK PARK, IL 60301 TEL: 708.697.6448

CULTURE@DOCTORSINTOUCH.COM

Individual pricing does not allow viewing of course material after post-test is completed.

Copyright 2005, DIT. Patent Pending.