Patients from Diverse Cultures

1. Patients from Diverse Cultures

2. OpeningCase Patients from Diverse Cultures

3. Kadija—17-Year-Old Female • It’s 6:30 pm and classes are in session at City College. Kadija ate a large meal with her family just before heading to her college English As a Second Language (ESL) course. • She is now doubled over in pain and a classmate is calling 9-1-1. “She speaks Somali mostly,” the caller adds.

4. Scene • Kadija is holding her hands across her lower abdomen bilaterally. She is rocking back and forth. • She describes a sharp, cramping pain. • Vitals: R 26, P 120, SpO2 98%

5. SICK? Sick or Not-yet-sick? Why? or NOT YET SICK?

6. Additional information • Kadija shakes her body away when you try to help her with your left hand. • She ate “otka” and a “big meal” just before coming to class. She limps quickly away from her classroom leaning on your stretcher.

7. Why did Kadija pull away from you? • What are some of the cultural issues at play and how should you approach them?

8. “Please take me home,” pleads Kadija • Her last menstrual period was 6 weeks ago but she explains this is normal for her. She denies being pregnant.

9. She explains she has had multiple infections and points to her vaginal and lower pelvic area. She tells you she had “antibiotics last year.” • Her blood pressure is 90/40.

10. In Kadija’s case, which of the following conditions should you be most concerned about? • Possible ectopic pregnancy • Pelvic inflammatory disease • Cholecystitis • Abdominal aortic aneurysm

11. In Kadija’s case, which of the following conditions should you be most concerned about? • Possible ectopic pregnancy • Pelvic inflammatory disease • Cholecystitis • Abdominal aortic aneurysm

12. Introduction

13. The largest increase in U.S. population by ethnic group over the next forty years is projected to be • Non-Hispanic whites • Hispanics/Latinos • African Americans • Asian/Pacific Islanders

14. The largest increase in U.S. population by ethnic group over the next forty years is projected to be • Non-Hispanic whites • Hispanics/Latinos • African Americans • Asian/Pacific Islanders

15. Introduction • Differences in people, their beliefs, behaviors, and social structures are present in every community in the world • If you are respectful of the beliefs and values of your patients, and perform your job professionally in their time of crisis, your action will speak volumes

16. Introduction

17. One study by the American Medical Association concluded that blacks received poorer quality care than whites Other studies show that women do not receive the same care for cardiac-related complaints that men do Disparities in Health Care

18. Cultural Bias • Cultural bias: personal beliefs and values are based on your own cultural background and experiences • Patients will no doubt hold today’s paramedic to the same standards as other health care professionals

19. What Is Culture?

20. What Is Culture? • Customary beliefs, social forms, and material traits of a racial, religious, or social group

21. EMS–Fire–PoliceCulture • Can you think of some cultural behaviors that are unique to EMS?

22. Does everyone in your ambulance service carry clamps, scissors, or a pager? In a similar spot?

23. Culture impacts every patient interaction.

24. What Is Culture? • A stereotype is an incomplete or oversimplified attempt to draw conclusions about groups of people with a particular defining characteristic

25. Communicating with Diverse Populations

26. Communicating with Diverse Populations • You will face a situation in which you need to communicate with a non-English–speaking patient • You may want to consider different pocket-sized translation books

27. Communicating with Diverse Populations • Many dispatch centers have the ability to patch in a “language line” with a translator

28. Communicating with Diverse Populations • Consider the cultural value system of the person with whom you are communicating • Always consider the cultural implications of your communication

29. Illness and Pain Across Cultures

30. Which racial/cultural group has the highest incidence of diabetes? • Non-Hispanic whites • African Americans • Native Americans • Hispanic Americans

31. Which racial/cultural group has the highest incidence of diabetes? • Non-Hispanic whites • African Americans • Native Americans • Hispanic Americans

32. Illness and Pain Across Cultures • Culture groups also vary in their response to illness and injury • Cultural rituals and traditions also play an important role in how patients think about, grade, and express pain

33. Some cultures consider the display of pain as a sign of weakness but other cultures encourage the expression of pain

34. Health Care in Other Cultures

35. Which of the following is NOT a recognized method of alternative or traditional medicine? • Acupuncture • Chiropractic therapy • Transcendental meditation • Shamanism

36. Which of the following is NOT a recognized method of alternative or traditional medicine? • Acupuncture • Chiropractic therapy • Transcendental meditation • Shamanism

37. Health Care in Other Cultures • Traditional healing methods, healing rituals, and herbal remedies continue to play an important role in many cultures throughout the world

38. Acupuncture Chiropractic Herbalism Holistic therapies Homeopathy Osteopathy Shamanism Therapeutic massage Traditional Medicines and Therapies

39. Health Care in Other Cultures • Some cultures acknowledge a need for modern medicine and oppose only specific interventions • When treating a patient in a multigenerational environment, you should expect your patient and each generation of family onlookers to hold different beliefs and viewpoints

40. Is this child abuse?

41. Death and Dying

42. Death and Dying • The “appropriate response” to death will vary a great deal from one culture to the next • Most cultures have traditional views on the appropriate handling and aftercare of a lifeless body, but the specific rituals and customs vary from culture to culture

43. Death and Dying • Asianculture • Views illness as involving the whole family • Decisions about treatment and patient handling go through the extended family

44. Death and Dying • Europeancultures vary considerably • Most seem to generally mirror the range of contemporary Western views on illness and death

45. Death and Dying • Hispanic/Latino • Consider patient care decisions and outcomes, as they impact not only the patient but the entire family • Mexican culture maintains a very comfortable relationship with death and dying

46. Death and Dying • Middle Eastern views of illness and dying vary depending upon the faith • Jewish culture tends to encourage and reward exaggeration of symptoms • Muslim culture encourages denial and stoicism, especially in public or with strangers

47. Death and Dying • Native American cultures • Consider the spoken word to be very powerful, and may refuse to acknowledge a negative diagnosis • Death is viewed as an inevitable

48. You terminate a resuscitation. What should you tell the patient’s husband? • Your wife, Emily, has died. I’m so sorry. • I'm sorry, but your wife is deceased. • We did everything that we could, but she has passed on. • My ECG monitor shows no signs of electrical activity, so we are terminating CPR.

49. You terminate a resuscitation. What should you tell the patient's husband? • Your wife, Emily, has died. I’m so sorry. • I'm sorry, but your wife is deceased. • We did everything that we could, but she has passed on. • My ECG monitor shows no signs of electrical activity, so we are terminating CPR.

50. Step-by-StepDeath Notification