This document discusses providing culturally competent end-of-life care to diverse populations. It outlines key cultural considerations and customs for Hispanic, African American, and Asian groups related to family structure, health beliefs, symptom management, rituals of death and dying, and grief. It emphasizes establishing trust, understanding cultural norms, avoiding stereotypes, and addressing individual needs and variations within cultural groups to provide effective end-of-life care.
This presentation provides an overview of cultural considerations for healthcare providers treating Cuban patients. It discusses the Cuban family structure, common health risks like hypertension and diabetes, and cultural interpretations of illness. The presentation advises healthcare providers to respect gender and parental roles, include extended family, and assess traditional remedies. It also provides strategies for culturally-competent care, like using interpreters and showing respect. A case study example illustrates how to effectively interview Cuban patients to identify and address barriers to treatment compliance.
The document discusses cultural considerations for end-of-life care among various ethnic groups. It aims to understand how culture affects medical care and decision making, and to learn about end-of-life traditions and beliefs in African Americans, Asian/Pacific Islanders, Latinos, and Native Americans. Key differences are noted in views on truth telling, technology use, and decision styles. Respecting cultural values is important for better clinical outcomes and care satisfaction.
This document discusses providing culturally sensitive medical care for Latinos. It notes that Latinos make up 12.5% of the US population. It then presents four case studies and discusses cultural presentations of illness and challenges faced by Latinos including language barriers, lack of insurance, and changes to family structure. It outlines Latino cultural characteristics like family-centeredness and respect. It also describes the Latino patient-provider relationship and expectations. The document concludes by discussing local Latino support networks in Dane County like the Latino Health Council which aims to promote health education and access to care.
Aetna Presentations Latinos and Mental DisordersDanny Santibanez
HISPANICS: Mental & Emotional Disorders
Eneida Gómez, MD, Child, Adolescent & Adult Psychiatrist, St. Johns County Health Department
August 26, 2005 - UNF Hispanic Health Issues Seminar
This is part 7 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
This document provides information on bipolar disorder, including its subtypes, diagnostic criteria, epidemiology, clinical presentation, etiology and risk factors, comorbidity, and treatment. It discusses bipolar disorder types I and II, as well as cyclothymic disorder. It outlines the DSM-5 diagnostic criteria for mania, hypomania, and depression. It notes the prevalence of bipolar disorder in adults and youth, gender and age of onset differences, burden of illness, and course of the disorder. It covers etiology, risk factors, and high rates of comorbidity with other psychiatric disorders. It also discusses clinical presentations, differential diagnosis, assessment, and treatment approaches including pharmacotherapy, sleep hygiene, psychosocial
The document provides information on Amish birthing practices and healthcare compared to care provided by midwives and obstetricians. It describes that Amish women typically have home births assisted by other women in the community. Midwives provide holistic prenatal, birth, and postpartum care focused on natural childbirth, while obstetricians view birth medically and can perform interventions like C-sections. The document also outlines some common prenatal tests and care provided by obstetricians during pregnancy.
A case study of a woman in a hispanic community who sought healthcare for a Urinary Tract Infection, but it was discovered that she was being seriously sexually abused. How it was handled and difficulties encountered.
Spiritualism, Santeria, and Fatalism
Otilia Salmon, PhD, College of Education & Human Services, University of North Florida
March 25, 2005 - UNF Hispanic Health Issues Seminar
This is part 2 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
This presentation provides an overview of cultural considerations for healthcare providers treating Cuban patients. It discusses the Cuban family structure, common health risks like hypertension and diabetes, and cultural interpretations of illness. The presentation advises healthcare providers to respect gender and parental roles, include extended family, and assess traditional remedies. It also provides strategies for culturally-competent care, like using interpreters and showing respect. A case study example illustrates how to effectively interview Cuban patients to identify and address barriers to treatment compliance.
The document discusses cultural considerations for end-of-life care among various ethnic groups. It aims to understand how culture affects medical care and decision making, and to learn about end-of-life traditions and beliefs in African Americans, Asian/Pacific Islanders, Latinos, and Native Americans. Key differences are noted in views on truth telling, technology use, and decision styles. Respecting cultural values is important for better clinical outcomes and care satisfaction.
This document discusses providing culturally sensitive medical care for Latinos. It notes that Latinos make up 12.5% of the US population. It then presents four case studies and discusses cultural presentations of illness and challenges faced by Latinos including language barriers, lack of insurance, and changes to family structure. It outlines Latino cultural characteristics like family-centeredness and respect. It also describes the Latino patient-provider relationship and expectations. The document concludes by discussing local Latino support networks in Dane County like the Latino Health Council which aims to promote health education and access to care.
Aetna Presentations Latinos and Mental DisordersDanny Santibanez
HISPANICS: Mental & Emotional Disorders
Eneida Gómez, MD, Child, Adolescent & Adult Psychiatrist, St. Johns County Health Department
August 26, 2005 - UNF Hispanic Health Issues Seminar
This is part 7 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
This document provides information on bipolar disorder, including its subtypes, diagnostic criteria, epidemiology, clinical presentation, etiology and risk factors, comorbidity, and treatment. It discusses bipolar disorder types I and II, as well as cyclothymic disorder. It outlines the DSM-5 diagnostic criteria for mania, hypomania, and depression. It notes the prevalence of bipolar disorder in adults and youth, gender and age of onset differences, burden of illness, and course of the disorder. It covers etiology, risk factors, and high rates of comorbidity with other psychiatric disorders. It also discusses clinical presentations, differential diagnosis, assessment, and treatment approaches including pharmacotherapy, sleep hygiene, psychosocial
The document provides information on Amish birthing practices and healthcare compared to care provided by midwives and obstetricians. It describes that Amish women typically have home births assisted by other women in the community. Midwives provide holistic prenatal, birth, and postpartum care focused on natural childbirth, while obstetricians view birth medically and can perform interventions like C-sections. The document also outlines some common prenatal tests and care provided by obstetricians during pregnancy.
A case study of a woman in a hispanic community who sought healthcare for a Urinary Tract Infection, but it was discovered that she was being seriously sexually abused. How it was handled and difficulties encountered.
Spiritualism, Santeria, and Fatalism
Otilia Salmon, PhD, College of Education & Human Services, University of North Florida
March 25, 2005 - UNF Hispanic Health Issues Seminar
This is part 2 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
Bipolar disorder is a mental illness marked by extreme mood swings from high (mania) to low (depression) and low to high. The mood swings may even become mixed, so you might feel elated and depressed at the same time.
The document provides guidance for conducting a psychiatric history and mental state examination. It outlines 9 sections to cover in the psychiatric history: date, informant, source/reason for referral, patient identifying data, complaint, history of present illness, past illnesses, family history, and personal history. It then describes the components of a mental state examination including appearance/behavior, emotion, thinking, speech, perception, sensorium/cognition, insight, judgement, and impulsivity. Key details are provided on what to assess within each section/component.
This chapter discusses self-care and when to seek professional medical help, provides an overview of conventional and complementary medicine, and offers guidance on choosing healthcare providers and treatments. It outlines options for self-treatment, signs that warrant medical attention, and how to get the most from appointments. Both conventional Western medicine and alternative therapies like acupuncture and herbal remedies are examined. Lastly, it covers factors to consider when selecting health insurance plans.
Using Integrative Therapies at the End of Life: Connecting through the LifespanSophia's Garden Foundation
As hospice patients approach the end of life there are several valuable life tasks to perform. The use of integrative therapies allows patients and families to perform these tasks and connect the past, present, and future to self, each other and their community. Therapies such as aromatherapy, relaxation skills, massage, Reiki, music, animal assisted activities, or art, provide comfort to patients and families as well as helping them to incorporate important cultural traditions during the end of life. Aromatherapy, massage, Reiki and relaxation skills help to relieve pain, alleviate anxiety, and treat side effects from medication. Through techniques such as music, art, animal assisted activities and guided imagery, patients are able to find meaning in life, share feelings with others and connect to life events.
This workshop will give participants a clear understanding of how integrative therapies may be used at the end of life and the rationale for using specific methods. Case studies of an actual hospice patient, and her use of integrative therapies, will demonstrate the profound effect these techniques can have on patients and families, while on hospice. Case study include a 2 ½ year old pediatric patient with Niemann-Pick Disease, Type A. Finally, a template will be provided to help participants develop and implement their own Integrative Therapies Program.
Cultural traditions and healthcare beliefs of older adults 20090429151038Rishi Kumar
1. Cultural traditions and healthcare beliefs of older adults from various backgrounds can influence their expectations and perspectives on medical care. These traditions include beliefs about diet, mental illness, end-of-life practices, and views on the causes of illness.
2. It is important for healthcare providers to be aware of potential differences in expectations and communicate respectfully with patients to understand their needs and preferences, which may incorporate both traditional and Western medical approaches. Inquiring sensitively about cultural health practices is important for developing trust and providing culturally-appropriate care.
3. Respecting traditions, involving family members in decisions as preferred, explaining treatment plans clearly, and being aware of taboos can help nurses effectively care for older patients
This document provides an outline on eating disorders that includes:
- A brief history noting the first descriptions of anorexia nervosa in 1873.
- Definitions of key terms like body mass index and diagnostic criteria for conditions like anorexia, bulimia, and binge eating disorder.
- Statistics on the epidemiology, gender differences, and cultural factors related to eating disorders.
- Discussions of etiology, risk factors, physical and psychological symptoms, common comorbidities, course and burden of illness, treatment approaches, and prevention strategies.
Listen to the presentation for FREE on the Counselor Toolbox podcast or watch the video on our youtube channel https://youtube.com/allceuseducation.
Sign up for Counseling CEU webinars at https://www.allceus.com/live-interactive-webinars/
The document discusses care of the dying individual. It begins with an introduction to death and dying, including definitions of death and dying. It then outlines the 5 stages of dying according to Kubler-Ross: denial, anger, bargaining, depression, and acceptance. The stages are described in detail. The document also discusses assessing the physiological signs of approaching death and providing physical, psychological, social, and spiritual care for the dying individual. It emphasizes meeting the patient's needs, maintaining communication, and allowing for dignity in death.
Anne Fadiman claims that a Hmong girl's life was ruined not by medical issues but by cross-cultural misunderstanding between her family and American doctors. The summary highlights key points of cultural misunderstanding including language barriers, poor translation, differing cultural practices and beliefs, and lack of understanding between the Hmong family and hospital staff. These issues led to misdiagnosis and incorrect treatment of the girl's epilepsy, ruining her life.
Psychiatric disorder in elderly & consultation liaison psychiatry 2Nur Idris
This document discusses schizophrenia and mood disorders in elderly patients and consultation-liaison psychiatry. It provides details on the epidemiology, clinical features, diagnosis, management and prognosis of schizophrenia and mood disorders. It also describes the role of consultation-liaison psychiatry in assessing and treating psychiatric conditions that occur alongside medical illnesses.
Poverty and lack of health insurance contributes to higher rates of illness and earlier death from conditions like heart disease among lower-income Americans. Various religions have different views on treatments involving transplants, transfusions, and handling of human remains. It is important for healthcare providers to understand the perspectives of different ethnic groups regarding modern medicine and treatments to ensure patients receive culturally-competent care.
Tomasa Chavarria, a 71-year-old Hispanic widow, presented with numbness and tingling on her left side and difficulty walking for three days. She has a history of type 2 diabetes, hypertension, and a previous CVA six years ago. On examination, she had left-sided weakness, neglect of her left side, and difficulty swallowing and speaking clearly. Her diagnosis is a right cerebral vascular accident, and she was admitted to an inpatient rehabilitation center to receive physical and occupational therapy and manage her risk factors through diet, exercise, and medication compliance.
1. The patient is a 29-year-old Filipino man who was admitted to Banag-Laum Home for visual hallucinations and delusions.
2. He has a history of occasional alcohol and shabu (methamphetamine) use, with his last use being days before admission.
3. A mental status exam found the patient to be oriented with normal mood, affect, speech, and thought processes. He reported previous visual and olfactory hallucinations.
1. The document discusses how a chemistry major wants to become a doctor and help patients by combining their degree with a minor in medical anthropology.
2. This will allow them to better explain illnesses and treatments to patients from different cultural backgrounds by understanding how diseases and treatments are viewed in their cultures.
3. Two examples given are how medical anthropology could help explain depression treatment to someone from a culture that views their symptoms as "susto" and explain psychological treatment for "Navajo ghost sickness" in culturally understandable terms.
This document summarizes key aspects of bipolar disorder, including:
1) Bipolar disorder is characterized by recurring manic or hypomanic episodes that alternate with depressive episodes. It exists on a spectrum from bipolar I to bipolar II disorder.
2) Bipolar disorder has a lifetime prevalence of around 2.4% worldwide and is associated with significant disability. However, it often goes undiagnosed for around 10 years.
3) People with bipolar disorder have high risks of suicide, psychiatric comorbidities, and medical comorbidities. They also face impairments in education, work and development due to the disorder.
This document discusses diabetes management challenges among the homeless population in Utah County. It provides statistics on homelessness in Utah, including demographics. Rates of mental illness and other health risks like tuberculosis are higher among the homeless. The intervention discussed nutritional education on healthy, affordable foods and exercise benefits. Evaluating understanding and checking blood sugar levels would assess the intervention's effectiveness long term. This experience highlights barriers to diabetes care for the homeless like knowledge deficits and lack of resources, influencing future nursing to focus on prevention, education, and community support.
The document discusses several aspects of cultural awareness and sensitivity that are important for nurses to consider. It notes that visible minorities make up a large portion of the US and Canada's growing populations. Nurses need to appreciate different cultural health beliefs and practices, and be flexible in their approach, while also recognizing they cannot become fully competent in another culture. It is important for nurses to be aware of their own beliefs and seek background knowledge about patients' cultures to provide culturally sensitive care, while avoiding stereotyping, as there is variation between individuals. The document provides several examples of cultural practices and beliefs related to pregnancy, childbirth, and the postpartum period.
K is a 26-year-old married woman with two young children who was referred for ongoing mental health treatment. She experiences auditory and visual hallucinations, insomnia, paranoia, and a difficult relationship with her husband. Her history includes type 1 diabetes, multiple hospitalizations, childhood trauma, and a lack of social support. Assessment revealed depressed mood and a need for continued treatment to improve functioning and quality of life.
Somatoform disorders are mental disorders characterized by physical symptoms that cannot be fully explained by a medical condition. They are caused by psychological factors and result in significant distress or impairment. One such disorder is somatization disorder, which involves multiple somatic complaints in various organ systems over several years. It has an onset before age 30 and is diagnosed when symptoms cannot be explained medically or are excessive given the medical findings. Common features include pain, gastrointestinal, sexual, and pseudoneurological symptoms. Somatization disorder is associated with conditions like depression and anxiety.
This document discusses cinematography techniques used in a music video. It lists different types of shots like low angle, high angle, establishing, long, tracking, wide, close up, extreme close up, over the shoulder, and point of view shots that were purposely used during planning and filming to keep the video interesting and maintain audience attention through variety in camera angles.
This document summarizes assessments of challenges to implementing integrated water resources management (IWRM) in the Arab region. It discusses four major efforts to assess IWRM status in the region since 2000. The analyses show that while the water-scarce Arab region is committed to IWRM, levels of implementation vary. Key challenges include raising awareness of IWRM among stakeholders, generating political will for IWRM among decision-makers, and the need for more regional coordination. Progress has been made through national IWRM plans and policies, but full implementation is still required to achieve targets like those of the World Summit on Sustainable Development.
Bipolar disorder is a mental illness marked by extreme mood swings from high (mania) to low (depression) and low to high. The mood swings may even become mixed, so you might feel elated and depressed at the same time.
The document provides guidance for conducting a psychiatric history and mental state examination. It outlines 9 sections to cover in the psychiatric history: date, informant, source/reason for referral, patient identifying data, complaint, history of present illness, past illnesses, family history, and personal history. It then describes the components of a mental state examination including appearance/behavior, emotion, thinking, speech, perception, sensorium/cognition, insight, judgement, and impulsivity. Key details are provided on what to assess within each section/component.
This chapter discusses self-care and when to seek professional medical help, provides an overview of conventional and complementary medicine, and offers guidance on choosing healthcare providers and treatments. It outlines options for self-treatment, signs that warrant medical attention, and how to get the most from appointments. Both conventional Western medicine and alternative therapies like acupuncture and herbal remedies are examined. Lastly, it covers factors to consider when selecting health insurance plans.
Using Integrative Therapies at the End of Life: Connecting through the LifespanSophia's Garden Foundation
As hospice patients approach the end of life there are several valuable life tasks to perform. The use of integrative therapies allows patients and families to perform these tasks and connect the past, present, and future to self, each other and their community. Therapies such as aromatherapy, relaxation skills, massage, Reiki, music, animal assisted activities, or art, provide comfort to patients and families as well as helping them to incorporate important cultural traditions during the end of life. Aromatherapy, massage, Reiki and relaxation skills help to relieve pain, alleviate anxiety, and treat side effects from medication. Through techniques such as music, art, animal assisted activities and guided imagery, patients are able to find meaning in life, share feelings with others and connect to life events.
This workshop will give participants a clear understanding of how integrative therapies may be used at the end of life and the rationale for using specific methods. Case studies of an actual hospice patient, and her use of integrative therapies, will demonstrate the profound effect these techniques can have on patients and families, while on hospice. Case study include a 2 ½ year old pediatric patient with Niemann-Pick Disease, Type A. Finally, a template will be provided to help participants develop and implement their own Integrative Therapies Program.
Cultural traditions and healthcare beliefs of older adults 20090429151038Rishi Kumar
1. Cultural traditions and healthcare beliefs of older adults from various backgrounds can influence their expectations and perspectives on medical care. These traditions include beliefs about diet, mental illness, end-of-life practices, and views on the causes of illness.
2. It is important for healthcare providers to be aware of potential differences in expectations and communicate respectfully with patients to understand their needs and preferences, which may incorporate both traditional and Western medical approaches. Inquiring sensitively about cultural health practices is important for developing trust and providing culturally-appropriate care.
3. Respecting traditions, involving family members in decisions as preferred, explaining treatment plans clearly, and being aware of taboos can help nurses effectively care for older patients
This document provides an outline on eating disorders that includes:
- A brief history noting the first descriptions of anorexia nervosa in 1873.
- Definitions of key terms like body mass index and diagnostic criteria for conditions like anorexia, bulimia, and binge eating disorder.
- Statistics on the epidemiology, gender differences, and cultural factors related to eating disorders.
- Discussions of etiology, risk factors, physical and psychological symptoms, common comorbidities, course and burden of illness, treatment approaches, and prevention strategies.
Listen to the presentation for FREE on the Counselor Toolbox podcast or watch the video on our youtube channel https://youtube.com/allceuseducation.
Sign up for Counseling CEU webinars at https://www.allceus.com/live-interactive-webinars/
The document discusses care of the dying individual. It begins with an introduction to death and dying, including definitions of death and dying. It then outlines the 5 stages of dying according to Kubler-Ross: denial, anger, bargaining, depression, and acceptance. The stages are described in detail. The document also discusses assessing the physiological signs of approaching death and providing physical, psychological, social, and spiritual care for the dying individual. It emphasizes meeting the patient's needs, maintaining communication, and allowing for dignity in death.
Anne Fadiman claims that a Hmong girl's life was ruined not by medical issues but by cross-cultural misunderstanding between her family and American doctors. The summary highlights key points of cultural misunderstanding including language barriers, poor translation, differing cultural practices and beliefs, and lack of understanding between the Hmong family and hospital staff. These issues led to misdiagnosis and incorrect treatment of the girl's epilepsy, ruining her life.
Psychiatric disorder in elderly & consultation liaison psychiatry 2Nur Idris
This document discusses schizophrenia and mood disorders in elderly patients and consultation-liaison psychiatry. It provides details on the epidemiology, clinical features, diagnosis, management and prognosis of schizophrenia and mood disorders. It also describes the role of consultation-liaison psychiatry in assessing and treating psychiatric conditions that occur alongside medical illnesses.
Poverty and lack of health insurance contributes to higher rates of illness and earlier death from conditions like heart disease among lower-income Americans. Various religions have different views on treatments involving transplants, transfusions, and handling of human remains. It is important for healthcare providers to understand the perspectives of different ethnic groups regarding modern medicine and treatments to ensure patients receive culturally-competent care.
Tomasa Chavarria, a 71-year-old Hispanic widow, presented with numbness and tingling on her left side and difficulty walking for three days. She has a history of type 2 diabetes, hypertension, and a previous CVA six years ago. On examination, she had left-sided weakness, neglect of her left side, and difficulty swallowing and speaking clearly. Her diagnosis is a right cerebral vascular accident, and she was admitted to an inpatient rehabilitation center to receive physical and occupational therapy and manage her risk factors through diet, exercise, and medication compliance.
1. The patient is a 29-year-old Filipino man who was admitted to Banag-Laum Home for visual hallucinations and delusions.
2. He has a history of occasional alcohol and shabu (methamphetamine) use, with his last use being days before admission.
3. A mental status exam found the patient to be oriented with normal mood, affect, speech, and thought processes. He reported previous visual and olfactory hallucinations.
1. The document discusses how a chemistry major wants to become a doctor and help patients by combining their degree with a minor in medical anthropology.
2. This will allow them to better explain illnesses and treatments to patients from different cultural backgrounds by understanding how diseases and treatments are viewed in their cultures.
3. Two examples given are how medical anthropology could help explain depression treatment to someone from a culture that views their symptoms as "susto" and explain psychological treatment for "Navajo ghost sickness" in culturally understandable terms.
This document summarizes key aspects of bipolar disorder, including:
1) Bipolar disorder is characterized by recurring manic or hypomanic episodes that alternate with depressive episodes. It exists on a spectrum from bipolar I to bipolar II disorder.
2) Bipolar disorder has a lifetime prevalence of around 2.4% worldwide and is associated with significant disability. However, it often goes undiagnosed for around 10 years.
3) People with bipolar disorder have high risks of suicide, psychiatric comorbidities, and medical comorbidities. They also face impairments in education, work and development due to the disorder.
This document discusses diabetes management challenges among the homeless population in Utah County. It provides statistics on homelessness in Utah, including demographics. Rates of mental illness and other health risks like tuberculosis are higher among the homeless. The intervention discussed nutritional education on healthy, affordable foods and exercise benefits. Evaluating understanding and checking blood sugar levels would assess the intervention's effectiveness long term. This experience highlights barriers to diabetes care for the homeless like knowledge deficits and lack of resources, influencing future nursing to focus on prevention, education, and community support.
The document discusses several aspects of cultural awareness and sensitivity that are important for nurses to consider. It notes that visible minorities make up a large portion of the US and Canada's growing populations. Nurses need to appreciate different cultural health beliefs and practices, and be flexible in their approach, while also recognizing they cannot become fully competent in another culture. It is important for nurses to be aware of their own beliefs and seek background knowledge about patients' cultures to provide culturally sensitive care, while avoiding stereotyping, as there is variation between individuals. The document provides several examples of cultural practices and beliefs related to pregnancy, childbirth, and the postpartum period.
K is a 26-year-old married woman with two young children who was referred for ongoing mental health treatment. She experiences auditory and visual hallucinations, insomnia, paranoia, and a difficult relationship with her husband. Her history includes type 1 diabetes, multiple hospitalizations, childhood trauma, and a lack of social support. Assessment revealed depressed mood and a need for continued treatment to improve functioning and quality of life.
Somatoform disorders are mental disorders characterized by physical symptoms that cannot be fully explained by a medical condition. They are caused by psychological factors and result in significant distress or impairment. One such disorder is somatization disorder, which involves multiple somatic complaints in various organ systems over several years. It has an onset before age 30 and is diagnosed when symptoms cannot be explained medically or are excessive given the medical findings. Common features include pain, gastrointestinal, sexual, and pseudoneurological symptoms. Somatization disorder is associated with conditions like depression and anxiety.
This document discusses cinematography techniques used in a music video. It lists different types of shots like low angle, high angle, establishing, long, tracking, wide, close up, extreme close up, over the shoulder, and point of view shots that were purposely used during planning and filming to keep the video interesting and maintain audience attention through variety in camera angles.
This document summarizes assessments of challenges to implementing integrated water resources management (IWRM) in the Arab region. It discusses four major efforts to assess IWRM status in the region since 2000. The analyses show that while the water-scarce Arab region is committed to IWRM, levels of implementation vary. Key challenges include raising awareness of IWRM among stakeholders, generating political will for IWRM among decision-makers, and the need for more regional coordination. Progress has been made through national IWRM plans and policies, but full implementation is still required to achieve targets like those of the World Summit on Sustainable Development.
The document outlines the values of an organization, which include:
1) Asking "why" to challenge established orders and focus only on creating value.
2) Embracing trying things, welcoming feedback to learn from mistakes and tests.
3) Acting with transparency by sharing work, information, decisions, and being kind to others.
4) Aiming for scale by starting small, tracking learnings from past errors and optimizing processes.
Pourquoi 40% des entreprises ne testent pas leurs sites ou applications mobil...Ferpection
Soucieux d'écouter le marché, nous avons interrogé plus 100 décideurs digitaux pour comprendre leur démarche de test. Il en ressort une situation contradictoire, entre blocages pratiques et bénéfices indéniables.
This document provides a summary of an accounts professional with over 5 years of experience managing finance and accounts departments. Key responsibilities included managing cash flow, bank accounts, accounts receivable and payable, payroll, cost analysis, and import/export documentation. Education includes an M.Com and B.Com and training in import/export management. Skills include communication, problem solving, planning, teamwork, and systems knowledge.
This document provides a summary of Saravanan Rajalingam's work experience and qualifications. He has over 8 years of experience in application development and support using Microsoft technologies. His experience includes designing and developing applications, windows applications, and reports using tools like Crystal Reports and SQL Server Reporting Services. He has strong leadership skills and has mentored junior team members. He is proficient in technologies like TriZetto Facets, SQL Server, ASP.NET, and has worked on projects in the healthcare industry.
This document is a resume for Dario Di Felice, an experienced multimedia developer and senior front end developer. It outlines his technical skills which include languages like PHP, jQuery, CSS and tools like Photoshop. His professional experience includes roles developing websites for Rogers Communications and Bell Media. He is seeking a challenging position developing rich media and web applications where he can apply his skills in areas like user experience design, search engine optimization and social media.
Este documento presenta información sobre diferentes escuelas de pensamiento en administración. Habla sobre la administración científica de Frederick Taylor y su énfasis en la eficiencia y medición del trabajo. También menciona la escuela de las relaciones humanas que surgió en la década de 1920 para abordar problemas psicológicos de los trabajadores causados por la producción en masa. Además, introduce la teoría general de sistemas de Von Bertalanffy que propuso una visión interdisciplinaria para comprender los sistemas y su interdependencia
http://www.promaxnutrition.com/run-for-your-life-infographic | Learn more about the health benefits of running, proper stance, running statistics and more at PromaxNutrition.com.
The game Thief was released in 2014 by Eidos Montreal and Square Enix, returning to the franchise after nearly a decade. It is a stealth game where players take on the role of Garrett to uncover the cause of a mysterious plague in The City while reconciling past traumas. While the game has some technical issues, it immerses players in the role of a thief and rewards exploring stealthily and avoiding combat through mastering the environment and equipment. Overall, it provides a challenging stealth experience for those tired of first-person shooters but may not be for everyone.
This document provides information about an upcoming test presentation including the speaker, reasons to attend, venue details, and how to register. Venue and registration details are given to allow attendees to learn the location and sign up for the event being promoted in the document.
This document provides a summary of Saravanan Rajalingam's work experience and qualifications. He has over 8 years of experience in application development and support using Microsoft technologies. His experience includes 7 years in development and 1 year and 9 months in designing applications. He has worked on projects involving TriZetto Facets, SQL Server, ASP.NET, and other tools. He aims to deliver high quality work and provide leadership during critical timelines. He has an MCA and B.Com degree. The document then provides details on 8 projects he has worked on involving healthcare, insurance, and real estate applications.
American Neo-Classicism was influenced by classical Greco-Roman architecture, sculpture, and symbols. In architecture, prominent styles included the Doric, Ionic, and Corinthian columns used on buildings like the Old State House in Boston, Virginia State Capitol, University of Virginia, and U.S. Capitol. Sculpture embraced the classical Roman portrait bust style as seen in works depicting George Washington. Painting incorporated symbolic neo-classical themes and references to Greco-Roman history as seen in works by John Trumbull and Benjamin West. Common symbols of American neo-classicism included references to Roman republican virtues in paintings and seals of states.
Minjar Cloud Solutions provides cloud operations and managed cloud services including cloud design, implementation, migration, optimization and specialized managed services. Their services are enabled through human and technology delivery focused on guaranteed outcomes, faster innovation, enhanced security, deeper insights and more with less. They utilize a comprehensive cloud management platform called Botmetric for cost and governance, security and compliance, and operations and automation. Minjar has experience with Fortune 500 customers across the US, India and South Asia and a 100% AWS certified workforce.
How culture influences health beliefsAll cultures have systems o.docxwellesleyterresa
How culture influences health beliefs
All cultures have systems of health beliefs to explain what causes illness, how it can be cured or treated, and who should be involved in the process. The extent to which patients perceive patient education as having cultural relevance for them can have a profound effect on their reception to information provided and their willingness to use it. Western industrialized societies such as the United States, which see disease as a result of natural scientific phenomena, advocate medical treatments that combat microorganisms or use sophisticated technology to diagnose and treat disease. Other societies believe that illness is the result of supernatural phenomena and promote prayer or other spiritual interventions that counter the presumed disfavor of powerful forces.Cultural issues play a major role in patient compliance. One study showed that a group of Cambodian adults with minimal formal education made considerable efforts to comply with therapy but did so in a manner consistent with their underlying understanding of how medicines and the body work.
Asians/Pacific Islanders are a large ethnic group in the United States. There are several important cultural beliefs among Asians and Pacific Islanders that nurses should be aware of. The extended family has significant influence, and the oldest male in the family is often the decision maker and spokesperson. The interests and honor of the family are more important than those of individual family members. Older family members are respected, and their authority is often unquestioned. Among Asian cultures, maintaining harmony is an important value; therefore, there is a strong emphasis on avoiding conflict and direct confrontation. Due to respect for authority, disagreement with the recommendations of health care professionals is avoided. However, lack of disagreement does not indicate that the patient and family agree with or will follow treatment recommendations. Among Chinese patients, because the behavior of the individual reflects on the family, mental illness or any behavior that indicates lack of self-control may produce shame and guilt. As a result, Chinese patients may be reluctant to discuss symptoms of mental illness or depression.
Some sub-populations of cultures, such as those from India and Pakistan, are reluctant to accept a diagnosis of severe emotional illness or mental retardation because it severely reduces the chances of other members of the family getting married. In Vietnamese culture, mystical beliefs explain physical and mental illness. Health is viewed as the result of a harmonious balance between the poles of hot and cold that govern bodily functions. Vietnamese don’t readily accept Western mental health counseling and interventions, particularly when self-disclosure is expected. However, it is possible to accept assistance if trust has been gained.
Russian immigrants frequently view U.S. medical care with a degree of mistrust. The Russia ...
Understanding cultural differences is a very important aspect of d.docxjolleybendicty
Understanding cultural differences is a very important aspect of delivering health care to various populations who have immigrated to the United States from various parts of the world. Collaborating with others to explore these differences allows you to gather varying viewpoints on these differences and how they might impact health care delivery.
Part I: Individual work
Select 1 chapter in The Spirit Catches You and You Fall Down that discusses Hmong history (Ch. 8 to 14) to read individually.
Write a 350-word summary of the chapter that includes the following:
·
Identify the historical events or cultural practices in your selected chapter.
·
Examine and describe how these differences create disparities between U.S. health care and the Hmong in California.
Share your summary with your team.
Part IA: Teamwork
Discuss as a team the key historical events or cultural practices you each found in your reading and summary.
As a team,
identify commonalities of Hmong history and cultural practices that recur throughout the chapters.
Create a list of 3 to 5 key cultural practices or factors that could impact health care program delivery to the Hmong community. Include a 2- to 3-sentence description to support your choices
.(All you need to do is come up with 1 key cultural with a 2-3 sentence description for this part)
Part B: Individual Reflection:
Write a 350-word summary explaining how the 3- to 5-key factors your team identified apply to the chapter you read. Describe how these factors impact the differences in disparities between U.S. health care and the Hmong in California.
Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).
PART2::: DISCUSSION QUESTION
Visit the
Child Welfare Information Gateway.
· What are the primary responsibilities of the health care industry in preventing child abuse and neglect, responding to child abuse and neglect, and supporting and preserving families?
· What circumstances should be present (or what considerations should be made) before removing a child from the guardianship of the parent?
Include sources/references to support your perspective.
Classmate1:
Summary There were many historical events and cultural practices in the Hmong culture. First of all it was so hard to appropriately treat Lia's epilepsy due to unfortunate circumstances. The family had their cultural beliefs and secondly there was a language barrier that stood in the way, that did not allow them to fully understand the diagnosis, and the severity if not treated. They believed that the seizures she was having made her special. They believed in traditional healing per their cultural beliefs, and this was was to call back her soul. They believed that tradi.
Cultural competence in healthcare means providing care that respects diverse cultures. There are over 2,500 global cultures, each with their own values and traditions. To be culturally competent, healthcare workers should not make assumptions but ask questions to understand how a patient's culture may impact their needs and preferences. Key areas like medication, communication, death and dying, and diet can have different meanings across cultures.
This document discusses the importance of cultural competence in psychiatric care for children on the Texas-Mexico border. It describes two cases of young Hispanic females who experienced hallucinations and were treated by both local curanderos (faith healers) and psychiatrists. The treatment team took time to understand the families' cultural beliefs and integrate them into the treatment plans. It emphasizes that cultural competence is essential for physicians due to increasing diversity and the role of culture in shaping illness perceptions and treatments.
The document discusses health beliefs and practices of the Roma (Gypsy) culture. It describes their social structure as being based on clans and families, with elders holding important roles. Roma attribute health and illness to ideas of purity and fortune. Traditional healers treat Roma illnesses, while mainstream doctors treat those brought by non-Romas. Rituals and herbal remedies are used. High rates of smoking, obesity and infectious diseases pose risks. Providing separate clean/unclean items and building trust are important for health promotion in this ethnocentric culture.
This document discusses health crisis intervention for people diagnosed with serious or terminal illnesses. It covers why crisis intervention is needed, examples of illnesses, who is affected, pre-crisis factors, getting help, how victims express feelings verbally and non-verbally, cultural differences to consider, skills needed for crisis intervention, and the impact of treatment versus no treatment. The goal of crisis intervention is to help patients properly cope with their diagnosis and build on their relationships, strengths, and ability to live fulfilling lives.
This document discusses a health assessment of a 23-year-old Native American male who reports experiencing anxiety, smoking marijuana, and drinking alcohol. It notes his family history of diabetes, hypertension, and alcoholism. The document summarizes several research articles discussing health issues that disproportionately impact Native American communities, such as high rates of tobacco and alcohol use, heart disease, and diabetes. It also provides guidance on conducting a sensitive health assessment, including monitoring the patient's behavior, asking open-ended questions, and considering factors like age, eye contact, and use of an interpreter if needed.
This document discusses a health assessment of a 23-year-old Native American male who reports experiencing anxiety, smoking marijuana, and drinking alcohol. It notes his family history of diabetes, hypertension, and alcoholism. The document summarizes several research articles discussing health issues that disproportionately impact Native American communities, such as high rates of tobacco and alcohol use, heart disease, and diabetes. It also provides guidance on conducting a sensitive health assessment, including monitoring the patient's behavior, asking open-ended questions, and considering factors like age, eye contact, and use of an interpreter if needed.
Latinos and depression presentation 12 (2)Julie Radford
This document examines mental illness statistics with an emphasis on depression in the Latino population in the US. It discusses that depression rates are higher in Latinos than other ethnic groups. Cultural factors like familismo and traditional gender roles influence the experience and expression of depression in Latinos. Barriers like poverty, language difficulties, and lack of access to care contribute to low treatment rates. The document recommends culturally-appropriate community interventions and treatments to improve mental health services for vulnerable Latino populations.
The document provides an overview of cultural practices and beliefs related to health and healthcare among people of Chinese heritage. It discusses topics like family roles, communication styles, nutrition, pregnancy, death rituals, spirituality, and traditional and western health practices. The role of advanced practice nurses is to address healthcare issues and disparities in the Chinese American population by improving access to care, building trust, providing education to encourage earlier treatment-seeking, and collaborating with community leaders.
Culture has significant effects on health behaviors and illness experiences. When people move to a new culture, they may experience culture shock which involves phases like a honeymoon period, crisis as excitement fades, and eventual adjustment. Illness is understood differently across cultures, with some viewing it as natural and others supernatural. Patients bring culturally influenced ideas about symptoms, treatment, and decision-making. Dietary taboos also vary between cultures. Health care providers must consider these cultural factors to effectively serve diverse patient populations.
Culture has significant effects on health behaviors and illness experiences. When people move to a new culture, they may experience culture shock which has phases like honeymoon, crisis, adjustment, and acceptance. Cultural factors influence how symptoms are perceived and treated, with some cultures attributing illness to natural causes and others to supernatural factors. Culture also shapes illness behaviors, roles of family in healthcare decisions, and views of issues like pain, gender roles, and food taboos. Healthcare providers must be aware of cultural differences to effectively communicate with patients from diverse backgrounds.
The document provides an overview of the Amish culture and practices related to health. Some key points:
- The Amish are a religious group that originated in Europe and settled in the U.S. in the late 17th century for religious freedom.
- They have a strong communal and family-centered culture, with most men working in farming or carpentry and women taking care of the home and family.
- Their beliefs emphasize humility, acceptance, and living a simple lifestyle without modern technologies like computers or vehicles.
- Healthcare providers are considered outsiders, so the Amish prefer to seek care from traditional healers first but will see Western providers when needed.
At the end of this session, participants will be able to:
Identify and define their philosophical orientation
Become Acquainted with Appreciative Inquiry
Identify Intergenerational patterns in their clients
Assess the value of Portraiture as a qualitative mode of inquiry to gain valuable data about an individual and family themes as a nonjudgemental way into story
Demonstrate pictorially family resilience and wounds and use this as broad map for clinical interventions ( in private practice, in interventions and in behavioral health centers
Listen to the presentation for FREE on the Counselor Toolbox podcast or watch the video on our youtube channel https://youtube.com/allceuseducation.
Sign up for Counseling CEU webinars at https://www.allceus.com/live-interactive-webinars/
Cultural competence with african american patients with audio lecutresoftballmom378
This document provides an overview of demographic information and cultural aspects related to African Americans. It notes that the African American population in the US is over 37 million and discusses differences in age, identifiers, and heritage. Key cultural features mentioned include family orientation, importance of elders, religious influences, and traditional healing practices. Health risks and challenges accessing care are also summarized.
African American culture is rooted in African traditions but is a unique blend with some European American influences. Family and church are core values, with kinship bonds extending to grandparents, aunts, uncles and cousins. While Protestant Christianity is most common, some African Americans also practice Islam, Catholicism, or traditional African religions. Culturally competent care requires understanding the impact of historical discrimination and showing respect for health beliefs, which may include spiritual causes of illness and home remedies in addition to biomedical treatment. Diet plays an important role, as traditional soul foods can increase risk of obesity and related diseases if not prepared healthfully.
The document discusses strategies for improving diabetes management programs to better serve racially and ethnically diverse patient populations. It emphasizes the importance of cultural competence and addressing health beliefs, alternative treatments, language barriers, and family roles that are specific to different ethnic groups. Effective programs elicit patients' cultural health beliefs, educate practitioners, provide language assistance, and address social factors like racism that can influence health outcomes.
Similar to Diversity_and_End_of_Life2with_ref (20)
1. Diversity and End of Life
Care
Terri Hanlon M.D.
Medical Director
Solari Hospice
2. Objectives
To meet the needs of an increasing culturally diverse
population we need to broaden the criteria in defining
“a good death”
Basic concepts of culturally effective EOL care
Cultural sensitivity
Cultural competence, knowledge and technical skills
Culture of medicine
Avoidance of stereotypes
Cross-cultural palliative care
Grief and bereavement
3. Cultural Competence
Attitudinal Issues
Establishing trust
Negative attitudes
Technical Issues
Communication
Language barriers
Social gestures
Caring for specific populations
Conflicting values
4. Culture of Medicine
Assuming the authority of science
Death as a medical event
Values held by medicine
Individual autonomy
Disclosure
Informed consent
Medical futility
5. Avoidance of
Stereotyping
Magnitude of cultural diversity impossible to master
Cultural beliefs are not static and unchanging
Wide variation within generation of a particular group
Intragroup variations due to socioeconomic positions and
education
Culture and cultural beliefs difficult to communicate
Guidelines useful for understanding but do not rigidly apply to
everyone
Assess individual for relevance of specific cultural values, beliefs
and practices
6. Cross-Cultural Palliative
Care
Barriers to symptom control may exist when the role of
culture in EOL is not recognized
Pain Control
Diet and Nutrition
Biological Variation
Decision Making
Distress (psychosocial and spiritual)
Bereavement
7. Demographics-USA
Cultural diversity is increasing in the five panethnic
groups, White, Black, Asian/Pacific Islander and
American Indian
By 2030 the Hispanic and Asian/P.I. group will double
from that of 1998
Immigrants and their children will account for one half
of U.S. growth
By 2050 50% of Americans will claim a relationship to
a minority ethnic group
8. Demographics-Nevada
Las Vegas was America’s fastest growing city from
1960-2000 with 2.5 million in the metro area today
Racial Distributions
65% White American
20% Hispanic or Latino
7.1% African American
6-10% Asian
2% American Indian, Pacific Islanders
9. Ethnicity and Hospice
Retrospective study 38,519 CA medicaid/medicare pts ‘96-
06
66.9% female
Mean age 78.9
61.1% white
14.8% Asian/P.I.
14.3% Latino
9.4% Black
Whites and Latinos more likely to use hospice than Asians
and Blacks
Blacks and Latinos more likely to die at home
10. Hispanic
80-90% Roman Catholic
Ethnic subgroups: Mexican, Cuban, Puerto Rican,
Central American, Dominican, Latin American
Language:
Majority are bilingual, Spanish-varied dialect and syntax
Need to assess reading skills
Translator-same gender, non-familial
Do not use Spanish word “hospicio” – infirmary setting
Use Usted form
11. Hispanic
Keys to Relationship, Establishing Trust
Respeto-address adults by title and family name
Personalismo-establishing a professional relationship
Simpatia-shaking hands, showing interest
May avoid eye contact
Silence may represent lack of agreement
Ask patient “what do they believe is the cause of the
complaint?”
12. Hispanic
La Familia
Extended family
Patriarchal (mothers still have great deal of influence)
Information- family spokesperson, oldest son or dtr
Decision maker-head of household, father or eldest male
Important issue often require whole family
Often difficult for family to turn over patients care to
professionals
Believe in withholding truth of illness to family member
Females are primary caregivers
Women defer to their husbands
13. Hispanic
Health Concerns
Variable—depending on level of education,
socioeconomic status, generation and time in US
Higher incidence of alcoholism and drug abuse
NIDDM
TB
Illness = social crisis
Fatalism—may believe serious illness is beyond tx
14. Hispanic
Daily Living Issues
Privacy—information about patient kept within family
Modesty—especially females
Bedside commodes and bedpans are unclean and
immodest
Humoral theory—prohibition of certain foods,
processed foods are bad, no meat on Fri. during Lent
15. Hispanic
Folklore
Illness thought to be result of negative or evil forces
and be a punishment
Illness may be the result of an imbalance
Yellow flowers = death
Good health = luck
Curanderismo
Sobador
Partera
Santero or brujeria
Botanica
16. Hispanic
Folk Illnesses
Ataque
Bilis
Diseases of “hot and cold” imbalances
Mal de ojo
Susto (soul loss)
Embrujado
17. Hispanics
Symptom Management Issues
Pain—stoic, don’t complain, need to assess by nonverbal
queues. For men, pain is a sign of weakness
“Silent suffering”—religious
Moaning (aye, yie, yie)—may be a way to reduce pain
GI symptoms (N/V. bowels)—only will talk about if asked
Oxygen—viewed as something serious is wrong if used
Depression and weakness—common reactions to stress
18. Hispanics
Rituals of Death and Dying
Many try to keep prognosis of death from the patient
Discussions of death discouraged
Having a priest available for Sacrament of the Sick
May have religious items and rosaries on the ill
Death is a spiritual event
Whole family participates in funeral arrangement
Dying in a hospital the “spirit” may get lost
19. Hispanics
Grief Rituals
Death is an important spiritual event
Wailing is common and is sign of respect
Novenas (prayers) said in the 9 days following the burial
Family members throw handful of dirt in the grave
Day of Dead—meal taken to cemetery
Burial happens soon after death, limiting the grieving
period
Pregnant females prohibited from caring for dying or
attending funeral
Friends and even acquaintances feel obligated to attend
funeral
20. African American
Keys to Relationship, Establishing Trust
Death, violent death familiar
General lack of trust in health care profession
Address with title and surname, handshake
Maintain eye contact
Will provide personal information if trust and respect
established
Silence may indicate lack of trust
Affectionate, hugging and touching
21. African American
Religious groups—Baptist, Jehovah’s Witness,
Muslim, Protestant
“Church” is an important institution
“Faith based communities
22. African American
Family Issues
Nuclear, extended, matriarchal, includes friends
Spokesperson—father or the eldest son
Father has final decision, but family community is all
involved in important decisions
Patient maintains independence but attention from
family expected
“Illness” means that usual roles can’t be fulfilled
Caregiver wife or oldest daughter
Elders are a source of wisdom and demand respect
23. African American
Health Concerns
Higher incidence of HTN, DM, CAD, AIDs
Have h/o being “abused as research subjects”
Skeptical of medical procedures
Shielding patient from diagnosis
In terminal illness have family conference with elder or
minister, may help selectively reveal diagnosis
Avoid medical jargon and illicit feedback for
understanding
24. African American
Folklore
Belief in forces of nature, use things like Farmer’s
Almanac, Zodiac Signs, Numbers (3,9)
Humoral Theory
High Blood
Low Blood
Natural Causes—”God’s plan”
Cold, dirt, improper diet or conduct
Unnatural Causes—evil or of the devil
Worriation, evil influences
25. African American
Folk Healers
Grannies, herbalists and physicians
Spiritual Healers
Supernatural Healers
Hougan
Mambo
Charms or amulets
Patients fear ridicule, reluctant to admit using folk
healers
26. African American
Symptom Management Issues
Pain—expression open and public
Dyspnea--may accept oxygen and opioids if explained
Depression—tiredness
Fear of addiction—avoid pain medications
Nausea/vomiting /diarrhea—believe to be caused by
sorcery
Erythema, cyanosis and jaundice more difficult to
detect
27. African American
Rituals of Death and Dying
Reluctant to sign living will or DNR (limit access to
care)
Consider denial of death a healthy response
Death in the house may bring “bad luck”
Want to live as long as possible
Palliative care—denial of access to care or “giving up”
Prefer professionals to clean and prepare body
Importance of laying the dead out properly
Cremation avoided
28. African American
Grief Rituals
Bereaved may get loud and agitated
Funeral is an “all out ceremony”
“Sisters” from the church come to help and prepare
meals
“Say their words”
Church “nurses”
“Flower girls”
Reception line importance of music and choir
29. Asian
As a group they total more half the worlds population
and are the 4th largest group in Las Vegas
Ethnic subgroups “East and Southeast Asians”
Chinese Thai
Japanese Laotians
Koreans Hmong
Vietnamese Cambodians
“Chinese Influence
30. Asian
Keys to Relationship and establishing trust
Most prefer to be addressed by surname
Very expressive when speaking English, “abrupt”
Silence and looking away may be sign of respect
Avoid “yes and no” questions
Respectful distance
Awareness of body posture
31. Asian
Family issues
Collectivism
Filial piety
Hierarchal
Patriarchal
Humility
Achievement
Elders respected and honored
32. Asian
Daily Living Issues
Harmony of yin and yang
Lactulose intolerant
Soybeans lessen s/s menopause
Aversion to raw vegetables
Family may bring food from home
Chicken and rice soup
Beef and eggs not served to ill
Dietary matters should be discussed with wife or
mother
33. Asian
Symptom Management Issues
Pain---watch for nonverbal cues
Medication dosage---pts may decr. dose or stop meds
Form and delivery of medication
Harmony and Face
Blood equates a “person’s essence”
Organ donation and autopsy discouraged
Importance of the head--sacred
34. Asian
Western physicians-
Sought for illnesses such as dentistry, fever, allergy,
eyes, MI, CVA, DM, CA and surgery
May be visited for diagnosis only
A diagnosis may be rejected if it bears negative
prognosis or if surgery advised
Traditional Chinese Medicine and Herbalists
Treat ailments such as asthma, arthritis, bruises,
sprains, lumbago, stomach problems, HTN
Many Asians don’t disclose use of TCM
35. Asian
Yin and Yang---illness is an upset in the balance of hot
and cold
Qi or Chi---flow of blood or energy force through
meridians
Acupuncture
Coining and pinching
Cupping
Herbal and home remedies
36. Asian
Utilization of hospice not common
Reluctant to discuss diagnosis and prognosis
Family may prefer that patient is not told of terminal
illness
Discussion of dying
Like a “death wish
Dying = Hopelessness
Pts final day should be calm
37. Asian
Belief in Afterlife
Prefer to die at home—spirit might get lost in hosp.
Family prayers help spirit depart this world
Body disposal is individual preference
Body must remain intact and whole for afterlife
38. Asian
Grief rituals
After death family may want to stay with deceased for~ 8
hrs
Family may want to bathe patient and dress with special
clothes or amulets
Best not to “drop a tear”
White, yellow and black worn in mourning
Eldest son makes funeral arrangements
Objects wrapped in white, money and candy given to
mourners to give to deceased
7 days time 7 weeks, 49 days relatives gather to help soul
depart to PureLand
39. American Indian
Genetically similar to Chinese and Koreans
Culturally they exhibit trait of one of many tribes
350 Tribes in US
By law must have at least ¼ Native American ancestry
Values and beliefs vary from nation to nation
Religious life has Christian and Tribal Elements
40. American Indian
Keys to Establish Relationship and Trust
Respectful distance
Light touch handshake
Don’t rush answers
Speak plainly
Avoiding eye contact shows respect
41. American Indian
Language, Dialects, Idioms
150 indigenous languages
Prefer adult same gender interpreter
Use anecdotes and metaphors to discuss a situation
Tone of voice conveys urgency
Long pauses are part of conversation
42. American Indian
Family Issues
Cultures vary in kinship structure
The extended family important in EOL decision making
and assist patient in self care and healing
The disease is felt by the family
Spokesperson
Decision maker
Reluctant to sign documents
Prognosis discussion varies with tribe
43. American Indian
Value and Belief System
Embrace the present
Maintain positive attitude
Natural and Unnatural ill health
Traditional medicine
Spiritual healers
Blessing way chants
Hand trembler or stargazer
Herbalist
Ceremonialist, singer
44. American Indian
Health Concerns
Shorter life expectancy by 5-6 yrs
Highest incidence of DMII in the world
Alcoholism 7x higher incidence
Cardiac disease, accidents, DM, ESLF, pneumonia,
influenza, homicide, suicide, COPD
45. American Indian
Symptom Management Issues
Pain—undertreated
Dyspnea—the “air is heavy”
Fatigue—psychosocial origin
Depression—cultural metaphors. “heart problems” or
“being out of harmony”
46. American Indian
Rituals of Death and Dying
Avoid contact with dead and dying
Name of deceased avoided
May open window or orient body in certain direction
Avoid autopsy and cremation
Return to reservation for burial
Family prepares, dresses and stays with the body,
which may remain in state for up to 3 days
Medicine bag and sacred items kept on body
“turning and flexing body”
Sweet grass smoke
47. American Indian
Belief in Afterlife—varies with tribe
Apache—dead body is an empty shell
Lakota Sioux—dead body is sacred
Navajo—do not believe in afterlife
48. American Indian
Grief Rituals
Family may hug, touch, sing and stay close to
deceased
Wailing, shrieking, self-inflicted body damage
Admonitions, prayer and community meal
Distribution tobacco
Deceased persons possessions given away
Assist in filling in grave
Wanagi Yuha—dead person’s hair kept in home for a
year of mourning followed by a memorial church
service
50. Overcoming Barriers
Cultural competence
Curricula of professional schools
Annual professional meetings
In-service staff training
Inclusion and integration of ethnic group in policy
making and hierarchy of health professions
Research, especially in regards to end of life issues
Reallocation of funds
51. Cultural Assessment Questions
Country of birth, if immigrant, how long in this country?
Ethnic affiliation and strength of identification with group.
Does pt life in an ethnic community and who forms major support?
What are primary and secondary languages, speaking and reading
ability?
Type of religious practice and its’ importance?
Food preferences and prohibitions?
Current economic situation?
What are the health and illness beliefs of the pt?
What are birth, illness and death customs?
Lipson, J., and Meleis, A. “Culturally appropriate care: The case of immigrants.” Topics in Clinical Nursing, 7 (3): 48-56, 1985.
52. Questions Regarding Cultural
Death Traditions
What are the prescribed rituals for handling dying, the
dead body, body disposal and loss rituals?
What are groups beliefs about what happens after death?
What could be some of their emotional responses to
death?
What are the gender rules for handling the death?
Are there any stigmas or fears regarding death
DeSpelder, L. “Developing Cultural Competence.” In Living with , K Doka Griefand J. Davidson, eds., Philadelphia:
Hospice Foundation of America, 1998, pp. 97-106
53. In Closing…
It is our hope that in this venture “we come to
understand the differences with our heads but our
common humanity with our hearts.”
J. Davidson, “Living with Grief”
54. References
Salimbene, Suzanne, What Language Does Your Patient Hurt In? A Practical
Guide to Culturally Competent Patient Care. Amherst, MA: Diversity
Resources, Inc., 2000, 2005, pp. 105-118; 57-74; 77-92; 57-67.
Snyder, Lois, Physicians Guide to End-of-Life Care. Philadelphia, PA; ACP-
ASIM, 2001, pp. 35-53.
Forman, Walter B., Kitzes, Judith A., Anderson, Robert P., Sheehan
Kopchak, Denice. Hospice and Palliative Care Concepts and Practice,
Sudbury, MA; Jones and Bartlett Publishers, 2003, pp. 177-193
Irish, Donald P., Lundquist, Kathleen F., Nelson Jenkins, Vivian. Ethnic
Variations in Dying, Death and Grief. Philadelphia, PA; Taylor and Francis,
pp. 67-77; 51-65; 101-112
Webb, George E., Urbansky, Donna. Cultural Diversity in America: How
Different Cultures Approach End of Life Issue. Louisville, KY; Alliance of
Community Hospices and Palliative Care Services 2001, pp. 40-43; 4-7; 18-
20; 8-12
55. References
D’Avanzo Erickson, Carolyn. Cultural Health Assessment. Newport,
New Hampshire; Mosby Elsevier, 2008, pp. 477-481; 158-164
Bidar-Sielaff, Shiva. “Cultural Aspects of Pain Management” Fast Facts
AAHPM, 2007 pp. 1-3
Crossno, Ronald J. “The Impact of Ethnicity and Hospice Use on the
Site of Death” AAHPM/PC-FACS, Sept 2005