Training Material
Cultural diversity
Cultural awareness is a key component in responding to and communicating with all different types of people. It is important for homecare staff to recognize and understand the diversity of cultural forces that surround them. In order to perform their roles effectively, they must be aware of some common cultural differences and develop a respect for those differences.
Every patient has a different background or culture and will live his or her life in his or her home in a different way. As a homecare aide and clinician, it is important to respect how each patient wishes to live his or her life. Home is the primary place in which the patient and family live by their own cultural standards, so respect for those standards is even more important in homecare than in other areas of healthcare.
Culture is a social pattern of behaviors, beliefs, and characteristics of a group of people that are passed from generation to generation. It is very important to understand that cultural characteristics are very different from physical characteristics. Many people who have similar physical characteristics do not always have similar cultural characteristics.
Probably the biggest error in defining a culture is thinking in terms of race or gender. Far too often, “cultural diversity” is used to refer to the mix of male/female employees or persons of a certain race. To assume that all members of a certain race share a common culture is never correct. The cultural diversity among members of any race is likely to be very large, since there are many factors making up a culture.
When it comes to a patient’s culture, a home health staff member’s responsibilities include the following:
- You must recognize that cultural diversity exists in all of us, including you. You are going to encounter people of many different cultures. It is very important that you do not draw conclusions about a patient based on his or her culture. You must learn to consider every patient as an individual. You should recognize that people of different cultural groups might have very different views about eating habits, child rearing, cleanliness, privacy, and healthcare.
- You should learn as much about other cultural groups as you can, so that you can better understand them. Although some practices may not make sense to you, they are very important to the culture of the patients you are caring for. Always respect and do not interfere with their cultural beliefs. Remember that in every single household you visit, the people living there will have their own rules and standards. One of your biggest roles is to respect the rights of patients in their own homes.
- It is important for you to be able to identify what your own cultural beliefs are. Otherwise, you might not know how these beliefs might affect the manner in which you approach other people.
- You should never try to change patients’ cultural beliefs, and should especially avoid attempting to “convert” their cultural beliefs to your own.
- If you have reason to believe that some cultural practices are actually harming the patient, notify your supervisor. If you discover an important part of your job needs to be changed in order to respect the patient’s culture, notify the supervisor so the care plan can be changed.
- You must realize that not all members of the same cultural group will behave exactly the same.
Geographic culture
Some culture originates from the area of the world that the person is from – geographic culture. There are many geographic cultures that greatly influence a patient’s views on diet and medical care. This is often found more if your agency is located in a large city where there is often more diversity of cultures.
Geographic cultures are listed here to give you a better idea of the variety within these cultures and not to provide specific information about an individual patient or family. Keep in mind that these are very general and will not apply to all patients.
Eastern Asian and Pacific Islanders
Eastern Asian and Pacific Islanders contain many different ethnic groups. These groups include, but are not limited to, Chinese, Korean, Japanese, Vietnamese, Hmong, Indonesian, Filipino, and Samoan people. Dietary habits are varied, based on the culture, and there are often special diets to be taken during illness. Fish, fruits, vegetables, and rice are the primary diet, along with small amounts of chicken, pork, or beef. In most of these cultures, a meal is almost like a ceremony and should not be interrupted. There are several religions practiced, including Confucianism, Buddhism, Taoism, Islam, Shintoism (Japan), and Roman Catholic. Medicinal herbs and folk remedies and rituals are commonly used to prevent or treat illness. Most believe that good health is a result of harmony and may use health healers and spiritual healers before seeking standard medical care. Drawing of blood is especially upsetting to many. There is a tendency to hide outward signs of pain, so it may be difficult to determine how much pain a patient is experiencing. Many believe in some type of reincarnation.
Haitian, Puerto Rican, Cuban
Generally, diet is very important for maintaining good health for people of Haitian, Puerto Rican, or Cuban culture. Many believe foods have “hot/cold” properties, and these must be in harmony. Some believe illness is supernatural and caused by evil spirits or enemies of deceased relatives. They may wear amulets to protect against evil spirits. Most consult folk healers or spiritualists before seeking standard medical care. Use of herbs and rituals for healing is common. Many are superstitious and fearful of hospitals. Cuban-Americans are most likely to use the standard medical practices in combination with religious or home remedies.
Religious culture
In addition to cultures passed on from different geographic areas, there are many general religious cultural beliefs you may find among your patients. Keep in mind that not all members of a particular religious group will hold the same beliefs. These are generally held beliefs and may not be those of each and every member. In most instances, the term “fasting” does not mean going without food totally. It usually refers to eating very light meals, with no snacks in between. And almost always, rules of fasting do not apply to the elderly or very ill.
Adventist
Adventists are often also referred to as Seventh-day Adventists. Most often Adventists do not eat meat and do no drink alcoholic beverages, coffee, or tea. Most believe in the healing power of prayer as a first line of medical treatment, but they generally accept most forms of standard medical treatment. Adventists accept the Bible as absolute truth in every detail. Their day of worship is Saturday rather than Sunday. The central head of the church is president of the General Conference.
Baptist
Almost all Baptist groups prohibit alcohol as a beverage. Many groups strongly believe in faith healing or “laying on of hands” by preachers or others empowered by God to heal. Many believe that when medical treatment cures them, it is because God is functioning through the doctors and nurses. They may refuse ventilators or resuscitation, believing it interferes with God’s will. Mission work is very much part of most Baptist churches, because many of them believe that only Christians will go to heaven.
Church of Christ, Scientists
People who practice at the Church of Christ are often referred to as Christian Scientists. There are no dietary restrictions, although most Christian Scientists do not drink alcohol. They are generally opposed to all medications and medical treatment. There are Practitioners, or Readers, who assist families in times of illness. Even those who will accept some forms of standard medical care will not do so unless advised to do so by the Practitioner. The Christian Scientist Church does not have any type of clergy, priests, or preachers. Lay members lead all services.
Church of Jesus Christ of Latter-day Saints
People who practice at the Church of Jesus Christ of Latter-day Saints are commonly referred to as Mormons. While meat is not forbidden, members are encouraged to eat meat “infrequently,” and they generally do not drink tea, coffee, or alcohol. Most will fast for 24 hours on the first Sunday of the month. They are strong believers in divine healing with anointing and “laying on of hands” by church elders but do not prohibit standard medical care. On their wedding day, they are given special undergarments that are always worn. Never remove these undergarments without discussing the process with the patient or family.
Islam
People who practice Islam are referred to often as Muslims or Nation of Islam. Muslims do not eat pork and generally do not use alcohol. During Ramadan (the last month of the Mohammedan year), they do not eat during daylight hours. They accept standard medical care and generally oppose faith healing. Muslims perform prayers five times daily. There is usually ritual washing after prayers. There are several different sects of Islam, and each is somewhat different.
Jehovah’s Witness
Jehovah’s Witnesses eat meat, but only if blood has been drained. They are absolutely opposed to blood transfusions, as well as any vaccines made with blood components. Otherwise they accept most standard medical care. They do not participate in or celebrate nonreligious holidays, so holidays like Thanksgiving or Halloween are often not celebrated. They do not salute the flag nor recite any pledges and will not bear arms in military service.
Jewish
Dietary habits depend upon whether they are Orthodox, Reform, or Conservative. Jews do not eat pork, only meat that comes from animals that eat vegetables, have cloven hooves, or chew their cud. Meat must be ritually slaughtered to make it “kosher.” They do not eat seafood unless it has scales and fins. Orthodox and other Jews who strictly observe kosher laws never combine meat products and dairy products and do not sore them together. They may have two sets of dishes – one for meat and one for dairy. During Passover, they do not eat any leavened bread (bread containing yeast or other ingredients to cause it to ferment and rise). Jews may refuse surgery during the Sabbath (sundown on Friday until sundown on Saturday). Since kosher foods are high in sodium, patients on low-salt diets do not have to use kosher meats. Jews generally oppose prolonging life with life support. Amputated limbs and other parts of the body removed by surgery are given to family for burial. There is no single Jewish authority over all Jewish synagogues. All congregations are independent and control their own activities. On the Sabbath, Orthodox Jews do not use cars, do not cook, and do not do work of any kind.
Roman Catholics
Catholics fast and do not eat meat on Ash Wednesday or Good Friday. Most still do not eat meat on Fridays during Lent, and some Catholics may still follow the old practice of not eating meat on any Friday during the entire year. The church does not approve of contraceptives, abortion, or fertility treatments. Most request anointing of the sick during major illness. Homecare patients may refuse to eat or drink for an hour before someone is bringing them communion. The authority over all Roman Catholic churches is the Pope.
Russian Orthodox or Greek Orthodox
Russian and Greek Orthodox are different religions, but they share many beliefs. They do not eat meat/dairy products on Wednesday or Friday. Most believe in divine healing, but they are not opposed to standard medical care. Most Russian Orthodox wear a cross necklace. It is only removed when absolutely necessary and replaced as soon as possible. Never remove the cross without first checking with the patient or family.
Communication
Patients from different cultures will communicate in different ways. It is hard to know what is appropriate for patients of different cultural backgrounds. Observation between family members and nonverbal reactions to communication can be clues to aid you. Always address a person from a different culture by his or her formal name. In some cultures, direct eye contact may be c considered disrespectful and communicating with eyes downcast is a sign of respect. Be aware of personal body space. Some cultures may see a close body space as threatening, whereas others may maintain a close body space. Cultures vary with regard to comfort with physical contact, especially when from someone of the opposite sex. When providing personal care for someone from a different culture, ask permission to touch or uncover areas of the body and only expose one area at a time.
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