The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper Introduction One of the greatest things about nursing is that we have the opportunity to share with different cultures and learn about them. Our patients are complex; they each have their religion, culture, and life choices. Delivering health advice and not knowing much about a patient’s cultural background will influence how the patient may perceive the nurses’ advice. The article that I did my research on was published in 2011, by Perez-Avila, Sobralske and Katz; the name of the article is “No Comprendo: Practice Considerations When Caring for Latinos With Limited English Proficiency in the United States Health Care System”. In the United States, Hispanics form the largest minority. The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The article does a nice job describing how this lack of cultural knowledge impacts the Hispanic culture. I chose this article because I find it interesting and of great help to any nursing and health care professional; I am Hispanic myself and constantly looking for better ways to help my community. I personally see my grandmother struggling whenever she needs to see her physician, as she sometimes does not understand what him and his staff are telling her. On another note nursing is an ever changing career and the Hispanic culture is growing at an enormous rate, becoming culturally competent does not only provide the patient with good care but can make the nurses’ job easier and more rewarding. I do feel that there should be more research on this subject; the best way to learn about a patient’s cultural beliefs is to ask the patient. I think that the population that the author intended to target is health care professionals; however, I know that any immigrant can benefit from reading this article. Conclusion Culture competence is a quality that any nurse should have. The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper
Cultural competence is a term that has been saturated in the news, in journals, and in the learning arena. But how does a nurse become culturally competent? Culturally competent care includes knowledge, attitudes, and skills that support caring for people across different languages and cultures.1 Culture influences not only health practices but also how the healthcare provider and the patient perceive illness.

Knowledge is being cognizant of the culture base of those in your service area, such as the shared traditions and values of that group. Being aware of your patients’ ethnicity—common genetic elements shared by people of the same ancestry—is also important. For example, the epidemiology, manifestation of disease, and effects of medications vary in different ethnic groups. In fact, there’s a whole area of study called ethnopharmacology that explores how different medications affect people from various ethnic groups.2 Research is also being conducted into how cultural beliefs impact medication choice and use The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

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Next, it’s important to address attitudes to evolve into a culturally competent caregiver. Becoming aware of how culture influences individual behavior and thinking allows you to plan the best care for your patients. Awareness of the rules of interactions within a specific cultural group, such as communication patterns and customs, division of roles in the family unit, and spirituality, will help you better understand the attitudes of your patients. Additionally, becoming aware of your own attitudes and tendencies to stereotype with regard to different cultural groups allows you to provide genuine care and concern.

Nurses today are providing care, education, and case management to an increasingly diverse patient population that is challenged with a triad of cultural, linguistic, and health literacy barriers. For these patients, culture and language set the context for the acquisition and application of health literacy skills. Yet the nursing literature offers minimal help in integrating cultural and linguistic considerations into nursing efforts to address patient health literacy. Nurses are in an ideal position to facilitate the interconnections between patient culture, language, and health literacy in order to improve health outcomes for culturally diverse patients. In this article the authors begin by describing key terms that serve as background for the ensuing discussion explaining how culture and language need to be considered in any interaction designed to address health literacy for culturally diverse patients. The authors then discuss the interrelationships between health literacy, culture, and language. Next relevant cultural constructs are introduced as additional background. This is followed by a description of how literacy skills are affected by culture and language, a note about culturally diverse, native-born patients, and a presentation of case examples illustrating how culture and language barriers are seen in patients’ healthcare experiences. The authors conclude by offering recommendations for promoting health literacy in the presence of cultural and language barriers and noting the need for nursing interventions that fully integrate health literacy, culture, and language.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Low health literacy, cultural barriers, and limited English proficiency have been coined the “triple threat” to effective health communication by The Joint Commission (Schyve, 2007). Nurses, who work with patients from increasingly diverse cultural groups, experience daily how these three threats offer a challenge to the effective provision of care at the system, provider, and patient levels. Over the past 15 years healthcare providers in the United States (US) have begun to address two of these threats to effective care, namely culture and language, and to demonstrate a growing awareness of the need for culturally and linguistically competent healthcare (Campinha-Bacote, 2003; Lester, 1998a, 1998b; Lockhart & Resick, 1997; Maier-Lorentz, 2008; Racher & Annis, 2007; Rees & Ruiz, 2003; Silva, 1994; Smith, 1998).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

…health literacy, both conceptually and in practice, has often been siloed from interventions designed to overcome cultural and linguistic barriers.However, health literacy, both conceptually and in practice, has often been siloed from interventions designed to overcome cultural and linguistic barriers. Because health literacy is an emerging field, examination of culture and language as determinants of patient health literacy has been limited (Andrulis & Brach, 2007; Chang & Kelly, 2007; Nguyen & Bowman, 2007; Zanchetta & Poureslami, 2006). To-date, strategies to address health literacy have often been distinct from, and at times inconsistent with, strategies to increase culturally and linguistically competent care (Andrulis & Brach). Integrating cultural and linguistic consideration with health literacy necessitates an expanded paradigm.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The purpose of this conceptual article is twofold. The first aim is to help nurses appreciate how culture and language can affect patient health literacy. The second aim is to demonstrate the need for nursing interventions that fully integrate health literacy, language, and culture. First we will describe key terms that serve as background for the ensuing discussion explaining how culture and language need to be considered in any interaction designed to address health literacy for culturally diverse patients. Next we will discuss the interrelationships between health literacy, culture, and language. We will then introduce relevant cultural constructs as additional background. This will be followed by a description of how literacy skills are affected by culture and language, a note about culturally diverse, native-born patients, and a presentation of case examples illustrating how culture and language barriers are seen in patients’ healthcare experiences. We will conclude by offering recommendations for promoting health literacy in the presence of cultural and language barriers and noting the need for nursing interventions that fully integrate health literacy, culture, and language.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

the technological advances of the past century tended to change the focus of medicine from a caring, service oriented model to a technological, cure-oriented model. Technology has led to phenomenal advances in medicine and has given us the ability to prolong life. However, in the past few decades physicians have attempted to balance their care by reclaiming medicine’s more spiritual roots, recognizing that until modern times spirituality was often linked with health care. Spiritual or compassionate care involves serving the whole person—the physical, emotional, social, and spiritual. Such service is inherently a spiritual activity. Rachel Naomi Remen, MD, who has developed Commonweal retreats for people with cancer, described it well:The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Helping, fixing, and serving represent three different ways of seeing life. When you help, you see life as weak. When you fix, you see life as broken. When you serve, you see life as whole. Fixing and helping may be the work of the ego, and service the work of the soul (1).

Serving patients may involve spending time with them, holding their hands, and talking about what is important to them. Patients value these experiences with their physicians. In this article, I discuss elements of compassionate care, review some research on the role of spirituality in health care, highlight advantages of understanding patients’ spirituality, explain ways to practice spiritual care, and summarize some national efforts to incorporate spirituality into medicine.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The word compassion means “to suffer with.” Compassionate care calls physicians to walk with people in the midst of their pain, to be partners with patients rather than experts dictating information to them.

Victor Frankl, a psychiatrist who wrote of his experiences in a Nazi concentration camp, wrote: “Man is not destroyed by suffering; he is destroyed by suffering without meaning” (2). One of the challenges physicians face is to help people find meaning and acceptance in the midst of suffering and chronic illness. Medical ethicists have reminded us that religion and spirituality form the basis of meaning and purpose for many people (3). At the same time, while patients struggle with the physical aspects of their disease, they have other pain as well: pain related to mental and spiritual suffering, to an inability to engage the deepest questions of life. Patients may be asking questions such as the following: Why is this happening to me now? What will happen to me after I die? Will my family survive my loss? Will I be missed? Will I be remembered? Is there a God? If so, will he be there for me? Will I have time to finish my life’s work? One physician who worked in the pediatric intensive care unit told me about his panic when his patients’ parents posed such questions. It is difficult to know what to say; there are no real answers. Nevertheless, people long for their physicians as well as their families and friends to sit with them and support them in their struggle. True healing requires answers to these questions (3). Cure is not possible for many illnesses, but I firmly believe that there is always room for healing. Healing can be experienced as acceptance of illness and peace with one’s life. This healing, I believe, is at its core spiritual.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

In a recent article, Heller, Oros, and Durney-Crowley (2000) note 10 trends to watch regarding the future of nursing education. The first trend listed relates to diversity and its impact on disease and illness and the subsequent challenge to change education and practice to be congruent and respectful of differing values and beliefs. In a like manner other authors (e.g., Bellack& O’Neil, 2000; Gibson, 2000 ; Hegyvary, 2000; Outlaw, 1997) have called attention to the need for closer scrutiny of our values and beliefs about diversity. Outlaw, for example, expressively requests “a call for scholarly inquiry on human diversity” (p. 69).

Implicit or explicit in the works of these authors are the notions of culture and of values. Both words have many interpretations but each word has a primary association with a discipline. Culture’s primary homebase is anthropology. Value’s primary homebase is philosophy, especially as it relates to ethics. One can identify subsets of words associated with each. For culture, terms that immediately come to mind are ethnocentrism, cultural imposition, cultural importation, and cultural exportation. (See definitions and assumptions) For values, terms that immediately come to mind are belief systems and norms. The rubber meets the road when the two terms are joined: cultural values. Therefore, our purpose in writing this article is threefold: a) to clarify the relationships among cultural values, ethics, and ethical conflicts; b) to demonstrate with examples from the culture predominant in the United States how cultural attitudes and values in nursing may lead to conflict as a result of increasing globalization, and c) to formulate nursing strategies to decrease ethical conflicts related to cultural values.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Culture refers to characteristic patterns of attitudes, values, beliefs, and behaviors shared by members of a society or population. Members of a cultural group share characteristics that distinguish them from other groups. Cultural differences will affect the receptivity of a patient to patient education and willingness to accept information and incorporate it into his or her lifestyles. It is important to remember that every patient education interaction has a cultural dimension.

Transcultural nursing is an essential aspect of healthcare today. The ever-increasing multicultural population in the United States poses a significant challenge to nurses providing individualized and holistic care to their patients. This requires nurses to recognize and appreciate cultural differences in healthcare values, beliefs, and customs. Nurses must acquire the necessary knowledge and skills in cultural competency. Culturally competent nursing care helps ensure patient satisfaction and positive outcomes. This article discusses changes that are important to transcultural nursing. It identifies factors that define transcultural nursing and analyzes methods to promote culturally competent nursing care. The need for transcultural nursing will continue to be an important aspect in healthcare. Additional nursing research is needed to promote transcultural nursing.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The healthcare industry, specifically hospitals and clinics, are facing two key challenges today: high turnover rates and a shortage of qualified workers. The national hospital turnover rate is currently 17 percent overall, with the highest rate being among Certified Nursing Assistants, at 24 percent. Turnover is more than a personnel problem; it’s also a financial one. It costs hospitals an average of $44,380 to replace a registered nurse, which adds up quickly when one out of every four or five staff members changes jobs every year.

In addition to high turnover rates, filling nursing positions is compounded by a talent shortage, which continues to be an ongoing challenge. Mergers and acquisitions are not doing much to solve this problem because consolidations, which seem to be happening everywhere in healthcare organizations, often lead to layoffs. More nurses are also reaching retirement age, and the current supply of new employees is not sufficient to replace them, contributing to the shortage.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper


Culture is a way of living, thinking, and behaving. Culture is learned within the family and guides the ways we solve problems and live our daily lives. Ethnicity is closely related to culture, although ethnicity usually refers to a particular cultural group or race that interacts and has common interests. Often there is as much diversity within ethnic groups as between them. For example, Hispanics are often classified as an ethnic group; however, there are enormous differences between Spaniards, Cubans, and Mexicans.

Culture includes many elements, including language, customs, beliefs, traditions, and ways of communicating. Another way of defining culture is to describe is „as the way things are done around here.“ When you think back to various nursing settings you have worked in throughout your career, you can probably identify the „culture“ of each work group you have been part of as having characteristics that distinguish it from other work groups.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The American Academy of Nursing’s Expert Panel on Culturally Competent Care stresses the importance of cross-cultural information to nursing and emphasizes that it must be considered an essential component of patient care. At the beginning of this new millennium, one in every three Americans will represent an ethnically diverse culture. As a result of these sweeping demographic changes, significant attention is being focused on meeting the needs of all Americans. Greater awareness of diversity, attention to the needs of special populations, and training to meet their needs is now a JCAHO mandate. Cultural competence refers to a set of congruent behaviors, attitudes, and policies that enables nurses and other health care professionals to work effectively in cross-cultural situations. As you acquire increasing cultural competence, you become more effective in helping patients of many cultures.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Cultural Values, Ethics, and Ethical Conflicts

Cultural values refer to enduring ideals or belief systems to which a person or a society is committed. The values of nursing in the States are, for example, embedded in the values of the U.S. American culture with its emphasis on self-reliance and individualism (Davis, 1999). Basic to the value placed on individualism are the beliefs that “individuals have the ability to pull themselves up by their bootstraps” and that an individual’s rights are more important than a society’s.

However, many cultures do not share the primacy of the value of individualism. Consider the factual data presented by Davis that about 70% of all cultures are collectivistic (i.e., loyalties of a person to a group exceed the rights of the individual) rather than individualistic (i.e., the rights of the individual supercede those of the group). “With individualism, importance is placed on individual inputs, rights and rewards” (Andrews, 1999, p. 476). In many cultures, health decisions are not made by an individual but by a group: family, community and/or society. Socialized medicine or government sponsored health care for all residents is reflective of the value placed on collectivism.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Therefore, reflecting on the values that predominate in the culture you practice, attain an education, visit, or read about is a requirement for ethical thoughtfulness. Ethics has many definitions but, typically, ethics is viewed as a systematic way of examining the moral life to discern right and wrong; it also requires a decision or action based on moral reasoning. Ethical conflicts occur when a person, group or society is uncertain about what to do when faced with competing moral choices (Silva, 1990). Ethical conflicts and issues occur within or among cultures and are usually precipitated by cultural/subcultural values in opposition.

Conflict and Globalization

Certainly members of any culture may hold varying degrees of commitment to the predominant values of the culture, but being in opposition to those values sets the stage for conflict. Even countries where people were once relatively isolated from other cultures or were homogenous (e.g., Asian cultures) are also becoming more culturally diverse. Why? Through increased communication, travel, and trade, differing perspectives have been imposed upon the cultural beliefs and ethical values of people because they are believed to be right or better (ethnocentrism at work). For example, North Americans and others with Western ethical perspectives who live in their own homelands may, unwittingly, export products abroad like textbooks, curriculums, and used equipment. These products, even though well intentioned, may present a cultural imposition. In addition, the altered attitudes of international students who return to their homeland after a westernized education in a capitalistic culture are a source of inculcating new but perhaps unsettling ethical perspectives on a country or profession. Globalization, with its outcome of increased cultural diversity, has not only given nurses pause for thought but also has contributed to ethical conflicts. The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Davis (1999) recognizes how ethical conflicts and issues can arise, especially when nurses acknowledge the profound influence that the values of nurses in the United States have had on other countries worldwide. The value on individualism, for U.S. nurses, for example, can be examined in relation to the ethical principles of autonomy and justice. The ethical principle of autonomy is related to self- determination, that is, the individual’s right to make decisions for him or herself. Consistent with this principle is respect for the autonomy of others. Therefore, the lack of respect for the decision-making of culturally diverse people in nursing practice is unethical.

The other principle, justice, which deals with what is due or owed to an individual, group, or society, has numerous definitions. For this discussion, we focus on two conflicting material principles of justice that cause ethical conflict: 1) “to each person according to what can be obtained in a free market, ” 2) “to each person based on need.” The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The first material principle of justice has autonomy as its underpinning. It is in keeping with a supply and demand situation where some persons will possess or benefit more than other persons. A problem with this principle is that it can lead to inequalities in society’s burdens and benefits.

The second material principle of justice has fairness as its underpinning. It is sensitive to individual differences and to factors over which the person has no control. A problem with this principle is how to honor it when resources are finite or scarce.

While we have only examined ethical conflicts that evolve from the U. S. cultural emphasis on individualism and the related ethical principles of autonomy and justice, there are many other examples of conflicts that can be and should be examined, but go beyond the scope and purpose of this column. However, we leave the reader with two questions to consider that are particularly cogent to a discussion on ethical conflicts: “…is it justified to strive for uniformity of nursing practice on the basis of ethics across all cultures?” and “…are there ethical notions of caring, ethical principles and virtues, that could be endorsed as true for all nurses everywhere?” (Davis, 1999, p. 123). The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Nursing Strategies to Decrease Ethical Conflicts Related to Cultural Values and Diversity

Of the many nursing theories used in the United States today, the one most associated with culture and cultural values is Leininger’s (1991) Culture Care Diversity and Universality: A Theory of Nursing. In the mid-1950s she first observed that nursing practice lacked attention to cultural and humanistic factors. It was from these observations and from further writing and research on the topic that the preceding book was written (Leininger, 1996). Implicit to her theory is the importance of communication between patient/client and the provider(s) of care. As Donnelly (2000) succinctly states, “…ethical issues become more prominent when a lack of communication occurs” (p. 124). Lack of communication is more likely to occur when nurses care for international and culturally diverse persons. The resultant misunderstandings can lead to lack of respect for persons whose cultural values are different from one’s own and to potential and real harm to those persons, whether culturally, psychologically, physically, or spiritually.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Diversity in Healthcare Have you ever been to the doctor and don’t quite understand what the provider is telling you, or are you a healthcare worker and you don’t understand your patients? Should the healthcare provider get diversity training or should they maybe learn new languages? More than ever before, healthcare professionals are subjected to dealing with a number of immense and different cultural diversities. While diversity is often a term used to refer specifically to cultural differences, diversity applies to all the qualities that make people different. Diversity requires more than knowing about individual differences and it key for overcoming cross-cultural barriers in healthcare.Health in all cultures is an important aspect of life. A person’s cultural background, religion and/or beliefs, greatly influences a person’s health and their response to medical care (Spector, 2004). These diverse cultures guide decisions made in daily life; what food eaten, living arrangements made, medications taken and medical advice listened to. A nurse must be knowledgeable and respectful of these diverse cultures and understand their importance when providing care. This understanding helps to build a strong nurse/patient relationship, increasing patient compliance, which ensures positive outcomes are met.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

As cultures within the U.S. …show more content…

However, nurses who dig deeper may discover these behaviors are a product of the patient’s cultural beliefs and values — deep-rooted ideologies that nurses can preserve or accommodate.
To be culturally competent the nurse needs to understand his/her own world views and those of the patient, while avoiding stereotyping and misapplication of scientific knowledge. Cultural competence is obtaining cultural information and then applying that knowledge. This cultural awareness allows you to see the entire picture and improves the quality of care and health outcomes such as a Hispanics not understanding how or when to take a medication. I feel the health staff should use all resources in obtaining an interpreter to make sure that the patient fully understands what they are taking, when, why and what it is for. “To be a true patient advocate, a nurse needs to be culturally aware,” says Sue Hasenau, RN, MSN, a certified neonatal nurse practitioner and member f the TransCultural Nursing Society

Racial and ethnic minorities have higher morbidity and mortality from chronic diseases. The consequences can range from greater financial burden to higher activity limitations.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Among older adults, a higher proportion of African Americans and Latinos, compared to Whites, report that they have at least one of seven chronic conditions — asthma, cancer, heart disease, diabetes, high blood pressure, obesity, or anxiety/ depression.(2) These rank among the most costly medical conditions in America.(3)

Diversity in the Nursing field is essential because it provides opportunities to administer quality care to patients. Diversity in Nursing includes all of the following: gender, veteran status, race, disability, age, religion, ethnic heritage, socioeconomic status, sexual orientation, education status, national origin, and physical characteristics. Communication with patients can be improved and patient care enhanced when healthcare providers bridge the divide between the culture of medicine and the beliefs and practices that make up a patient’s’ value system.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper
When the Nursing workforce reflects its patient demographic, communication improves thus making the patient feel more comfortable. A person who has little in common with you cannot adequately advocate for your benefit. Otherwise, you might as well have a history teacher in charge of advanced algebra.
If you have Nurses who understand their patient’s culture, environment, food, customs, religious views, etc, they can provide their patients with ultimate care. Every healthcare experience provides an opportunity to have a positive effect on a patient’s health. Healthcare providers can maximize this potential by learning more about patients’ cultures. In doing so, they are practicing cultural competency or cultural awareness and sensitivity.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

According to, Cultural competency, or cultural awareness and sensitivity, is defined as, “the knowledge and interpersonal skills that allow providers to understand, appreciate, and work with individuals from cultures other than their own. It involves an awareness and acceptance of cultural differences, self-awareness, knowledge of a patient’s culture, and adaptation of skills.”
Our demographics are changing and our healthcare providers would be wise to hire Nurses from a variety of backgrounds that reflect their changing patient population. Usually health systems that value representation are more valuable to its patients. For centuries, the United States has incorporated diverse immigrant and cultural groups and continues to attract people from around the globe. Currently minorities outnumber whites in some communities in the United States. The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper
Many cultural groups, including gay and lesbian individuals; individuals with disabilities; individuals with faiths unfamiliar to a practitioner; lower socioeconomic groups; ethnic minorities, such as African Americans and Hispanics; and immigrant groups receive no medical care or are grossly underserved for multiple reasons. Lack of diversity and inclusion of healthcare providers is one of the reasons these groups receive inadequate medical care.

Diversity and inclusion is the combination of different cultures, ideas, and perspectives that brings forth greater collaboration, creativity, and innovation, which leads to better patient care and satisfaction. This is the direction in which healthcare needs to go in order to better the health of our current and future demographics.
African Americans and American Indians/Alaska Natives are more likely to be limited in an activity (e.g., work, walking, bathing, or dressing) due to chronic conditions.(4)As the families grew, several members moved away. Diabetes and heart disease are prevalent with several family members. Growing up, one did not go to the doctor unless you were gravely ill. Today, several family members have chronic illnesses and visit a specialist regularly. Second Family’s Heritage Assessment The second family is from Nova Scotia. She lived there with three brothers and one sister, is Canadian-American, with English her native language. Many relatives lived nearby in her small town. Her family moved to the United States when she was little, lived here for many years, then moved back to Nova Scotia. She married young and currently resides in North Carolina. They are practicing Roman Catholics. Her faith is very important to her, along with strong family values. Holiday celebrations are spent preparing food and spending time with family. Family members usually die of old age with no chronic illnesses identified.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The population at risk for chronic conditions will become more diverse
Although chronic illnesses or disabili- ties may occur at any age, the likelihood that a person will experience any activity limitation due to a chronic condition increases with age.(5) In 2000, 35 million people — more than 12 percent of the total population — were 65 years or older.(6) By 2050, it is expected that one in five Americans — 20 percent — will be elderly. The population will also become increasingly diverse (see Figure 2). By 2050, racial and ethnic minorities will comprise 35 percent of the over 65 pop-ulation.(7) As the population at risk of chronic conditions becomes increasingly diverse, more attention to linguistic and cultural barriers to care will be necessary.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Access to health care differs by race and ethnicity
Having a regular doctor or a usual source of care facilitates the process of obtaining health care when it is needed. People who do not have a regular doctor or health care provider are less likely to obtain preventive services, or diagnosis, treatment, and management of chronic conditions. Health insurance coverage is also an important determinant of access to health care. Higher proportions of minorities compared to Whites do not have a usual source of care and do not have health insurance (see Figures 3A and 3B).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Of the more than 37 million adults in the U.S. who speak a language other than English, some 18 million people — 48 percent — report that they speak English less than “very well.”(8) Language and communication barriers can affect the amount and quality of health care received. For example, Spanish-speaking Latinos are less likely than Whites to visit a physician or mental health provider, or receive preventive care, such as a mammography exam or influenza vaccination.(9) Health service use may also be affected by the availability of interpreters. Among non-English speakers who needed an interpreter during a health care visit, less than half — 48 percent — report that they always or usually had one.(10)

Language and communication problems may also lead to patient dissatisfaction, poor comprehension and adherence, and lower quality of care. Spanish-speaking Latinos are less satisfied with the care they receive and more likely to report overall problems with health care than are English speakers.(11) The type of interpretation service provided to patients is an important factor in the level of satisfaction. In a study comparing various methods of interpretation, patients who use professional interpreters are equally as satisfied with the overall health care visit as patients who use bilingual providers. Patients who use family interpreters or non-professional interpreters, such as nurses, clerks, and technicians are less satisfied with their visit.(12)The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The 1992 National Adult Literacy Survey found that 40 to 44 million Americans do not have the necessary literacy skills for daily functioning.(13) The elderly typically have lower levels of literacy, and have had less access to formal education than younger populations.(14) Older patients with chronic diseases may need to make multiple and complex decisions about the management of their conditions. Racial and ethnic minorities are also more likely to have lower levels of literacy, often due to cultural and language barriers and differing educational opportunities.(15) Low literacy may affect patients’ ability to read and understand instructions on prescription or medicine bottles, health educational materials, and insurance forms, for example. Those with low literacy skills use more health services, and the resulting costs are estimated to be $32 to $58 billion — 3 to 6 percent — in additional health care expenditures.(16)The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

People with chronic conditions require more health services, therefore increasing their interaction with the health care system. If the providers, organizations, and systems are not working together to provide culturally competent care, patients are at higher risk of having negative health consequences, receiving poor quality care, or being dissatisfied with their care. African Americans and other ethnic minorities report less partnership with physicians, less participation in medical decisions, and lower levels of satisfaction with care.(17) The quality of patient-physician interactions is lower among non-White patients, particularly Latinos and Asian Americans. Lower quality patient-physician interactions are associated with lower overall satisfaction with health care.(18)The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

African Americans, Latinos, and Asian Americans, are more likely than Whites to report that they believe they would have received better care if they had been of a different race or ethnicity (see Figure 4). African Americans are more likely than other minority groups to feel that they were treated disrespectfully during a health care visit (e.g., they were spoken to rudely, talked down to, or ignored). Compared to other minority groups, Asian Americans are least likely to feel that their doctor understood their background and values and are most likely to report that their doctor looked down on them.(19)The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Individual values, beliefs, and behaviors about health and well-being are shaped by various factors such as race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability, sexual orientation, and occupation. Cultural competence in health care is broadly defined as the ability of providers and organizations to understand and integrate these factors into the delivery and structure of the health care system. The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, English proficiency or literacy. Some common strategies for improving the patient-provider interaction and institutionalizing changes in the health care system include:(20)The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

  1. Provide interpreter services
  2. Recruit and retain minority staff
  3. Provide training to increase cultural awareness, knowledge, and skills
  4. Coordinate with traditional healers
  5. Use community health workers
  6. Incorporate culture-specific attitudes and values into health promotion tools
  7. Include family and community members in health care decision making
  8. Locate clinics in geographic areas that are easily accessible for certain populations
  9. Expand hours of operation
  10. Provide linguistic competency that extends beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

In order to increase the cultural competence of the health care delivery system, health professionals must be taught how to provide services in a culturally com-petent manner. Although many different types of training courses have been developed across the country, these efforts have not been standardized or incorpo-rated into training for health profession-als in any consistent manner.(21) Training courses vary greatly in content and teaching method, and may range from three-hour seminars to semester-long academic courses. Important to note, however, is that cultural competence is a process rather than an ultimate goal, and is often developed in stages by building upon previous knowledge and experience.

Approaches that focus on increasing knowledge about various groups, typically through a list of common health beliefs, behaviors, and key “dos” and “don’ts,” provide a starting point for health pro-fessionals to learn more about the health practices of a particular group. This approach may lead to stereotyping and may ignore variation within a group, however. For example, the assumption that all Latino patients share similar health beliefs and behaviors ignores im-portant differences between and within groups. Latinos could include first-generation immigrants from Guatemala and sixth-generation Mexican Americans in Texas. Even among Mexican Americans, differences such as generation, level of acculturation, citizenship or refugee status, circumstances of immigration, and the proportion of his or her life spent in the U.S. are important to recognize.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

It is almost impossible to know everything about every culture. Therefore, training approaches that focus only on facts are limited, and are best combined with approaches that provide skills that are more universal. For example, skills such as communication and medical history-taking techniques can be applied to a wide diversity of clientele. Curiosity, empathy, respect, and humility are some basic attitudes that have the potential to help the clinical relationship and to yield useful information about the patient’s individual beliefs and preferences. An approach that focuses on inquiry, reflection, and analysis throughout the care process is most useful for acknowledging that culture is just one of many factors that influence an individual’s health beliefs and practices.(22)

Many professional organizations representing a variety of health professionals, such as physicians, psychologists, social workers, family medicine doctors, and pediatricians have played an active role in promoting culturally competent practices through policies, research, and training efforts. For example, the American Medical Association provides information and resources on policies, publications, curriculum and training materials, and relevant activities of physician associations, medical specialty groups, and state medical societies.(23)The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Several organizations have instituted cultural competence guidelines for their memberships. For example, based on ten years of work, the Society of Teachers of Family Medicine has developed guidelines for curriculum material to teach cultural sensitivity and competence to family medicine residents and other health professionals. These guidelines focus on enhancing attitudes in the following areas:(24)

Awareness of the influences that sociocultural factors have on patients, clinicians, and the clinical relationship.
Acceptance of the physician’s respon-sibility to understand the cultural aspects of health and illness
Willingness to make clinical settings more accessible to patients
Recognition of personal biases against people of different cultures
Respect and tolerance for cultural differences
Acceptance of the responsibility to combat racism, classism, ageism, sexism, homophobia, and other kinds of biases and discrimination that occur in health care settings.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper
Accreditation standards are important tools that can have widespread effects on the cultural competence of medical students, health care professionals, and health care organizations. For example, the Liaison Committee on Medical Edu-cation (LCME) — the nationally recognized accreditation body for medical schools in the U.S. and Canada — recently mandated higher standards for curriculum material on cultural competence than were previously in place. As a result, medical schools must now provide students with the skills to understand how people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. Students must also be able to recognize and appropriately address racial and gender biases in themselves, in others, and in the delivery of health care.(25)The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Commitment to cultural competence is growing among health care providers and systems
Health systems are beginning to adopt comprehensive strategies to respond to the needs of racial and ethnic minorities for numerous reasons. First, there are increasingly more state and federal guidelines that encourage or mandate greater responsiveness of health systems to the growing population diversity. Second, these strategies may be seen as essential to meeting the federal government’s Healthy People 2010 goal of eliminating racial and ethnic health disparities. Third, many health systems are finding that developing and implementing cultural competence strategies are a good business practice to increase the interest and participation of both providers and patients in their health plans among racial and ethnic minority populations.

In addition to increasing the cultural competence of health care providers, organizational accommodations and policies that reduce administrative and linguistic barriers to health care are also important. Policies that strive to achieve cultural competence throughout the organization must address issues on all levels, from the organization’s top management to clinicians to office staff to billing and administrative staff. Organizational policies that address language and literacy barriers have been among the most successful efforts.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Traditionally, community health centers that serve the Asian American or Latino communities have the most fully developed linguistic capabilities. For example, Asian Counseling and Referral Services (ACRS) in Seattle is a community-based mental health organization that effectively addresses language needs. They try to provide bilingual and bicultural clinicians that match the client’s background. When this is not possible, ACRS provides trained staff to act as co-providers with a licensed mental health professional. These trained individuals act not only as interpreters, but also help provide a cultural context for the client’s beliefs and practices. Stemming from 30 years of experience in this arena, ACRS has developed a training curriculum, “Building Bridges: Mental Health Interpreter Training for Interpreters of Southeast Asian Languages.” This curriculum will be used as a model for a national mental health interpreter training project to address the needs of limited-English speaking people. This national project includes training for interpreters, trainers, and health providers, as well as a mental health interpreter certification process.(26)

Within the Latino community, the use of promotoras, also known as peer edu-cators, is becoming increasingly popular. Promotoras are generally ordinary people from hard-to-reach populations who act as bridges between their community and the complicated world of health care. They learn about health care principles from doctors or non-profit groups, and share their knowledge with their com-munities. The peer education model is not only cost-effective, but also has been shown to be more effective in terms of reaching populations who find the information more credible coming from someone with a familiar background.(27)The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Methods employed to assess literacy levels include the use of screening instruments that test for certain skills related to functional literacy or less formal tools that allow health care professionals to determine a person’s comfort level with various modes of communication. For example, at the To Help Everyone (T.H.E.) Clinic in Los Angeles, nurses and health care professionals speak individually with patients when they arrive at the health clinic to determine whether the patient prefers to learn by using written materials, pictures, verbal counseling, or some other technique. This method of assessment allows the patient to identify their own learning style preference without having to take a literacy test; it also reduces feelings of fear or humiliation that may occur when singled out.(28)The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper


  1. The Department of Health and Human Services has provided important guidance on how to ensure culturally and linguistically appropriate health care services. The Office for Civil Rights published “Title VI Prohibition Against National Origin Discrimination as it Affects Persons with Limited English Proficiency.” Very few states have developed standards for linguistic access. States that have developed such standards have focused on managed care organizations, contracting agreements with providers, and specific health and mental health services in defined settings.(29)
  2. In August 2000, the Health Care Financing Administration (now Centers for Medicare and Medicaid Services) issued guidance to all state Medicaid directors regarding interpreter and translation services, emphasizing that federal matching funds are available for states to provide oral interpretation and written translation services for Medicaid beneficiaries.(30)The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper
  3. In December 2000, the Office of Minority Health of the Department of Health and Human Services issued 14 national standards on culturally and linguistically appropriate services (CLAS) in health care. These standards are intended to correct current inequities in the health services system and to make these services more responsive to the individual needs of all patients. They are designed to be inclusive of all cultures, with a particular focus on the needs of racial, ethnic, and linguistic population groups that experience unequal access to the health care system. The CLAS standards provide consistent definitions of culturally and linguistically appropriate services in health care and offer a framework for the organization and implementation of services. CLAS standards can be found at
  4. In 2002, two guides were developed to assist managed care plans with cultural and linguisti-cally appropriate services: “Providing Oral Linguistic Services: A Guide for Managed Care Plans” and “Planning Culturally and Linguistically Appropriate Services: A Guide for Managed Care Plans.” Both guides can be found at The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and deliver culturally competent services. Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.(1) A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities. Examples of strategies to move the health care system towards these goals include providing relevant training on cultural competence and cross-cultural issues to health professionals and creating policies that reduce administrative and linguistic barriers to patient care.

The 2000 U.S. Census confirmed what demographers had been predicting all along—our country has become more diverse than ever before (U.S. Census, 2000). Our expansion has been fueled by growth of our minority populations, in addition to significant immigrant influx (Immigration Statistics, 2001). How will the United States respond to this increasing diversity? Ultimately, our success as a nation hinges on how we meet the challenges diversity poses, while capitalizing on the strengths it provides. Many sectors have responded proactively to our demographic evolution, understanding that there are financial and market imperatives to better understanding, communicating, servicing, and partnering with those from diverse backgrounds. This has resulted in major educational efforts, through training and corporate development, as to how better “manage” diversity at the workplace and in business/service relations (Chin, 2000).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

How will one of our largest industries – health care – respond? There is a growing literature that delineates the impact of sociocultural factors, race, and ethnicity on clinical care (Berger, 1998; Hill et al., 1990). Clinicians aren’t shielded from diversity, as patients present varied perspectives, values, beliefs, and behaviors regarding health and well-being. These include variations in patient recognition of symptoms, thresholds for seeking care, ability to communicate symptoms to a provider who understands their meaning, ability to understand the management strategy, expectations of care (including preferences for or against diagnostic and therapeutic procedures), and adherence to preventive measures and medications (Einbinder and Schulman, 2000; Flores, 2000; Betancourt et al., 1999; Denoba et al., 1998; Gornick, 2000; Coleman-Miller, 2000; Williams and Rucker, 2000).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Sociocultural differences between patient and provider influence communication and clinical decision-making (Eisenberg, 1979). Evidence suggests that provider-patient communication is directly linked to patient satisfaction, adherence, and subsequently, health outcomes (Figure 6-1) (Stewart et al., 1999). Thus, when sociocultural differences between patient and provider aren’t appreciated, explored, understood, or communicated in the medical encounter, the result is patient dissatisfaction, poor adherence, poorer health outcomes, and racial/ethnic disparities in care (Flores, 2000; Betancourt et al., 1999; Stewart et al., 1999; Morales et al., 1999; Cooper-Patrick et al., 1999; Langer, 1999). And it is not only the patient’s culture that matters; the provider “culture” is equally important (Nunez, 2000; Robins et al., 1998). Historical factors for patient mistrust, provider bias, and its impact on physician decision- making have also been documented (Gamble, 1997; Schulman et al., 1999; van Ryn and Burke, 2000). Failure to take sociocultural factors into account may lead to stereotyping, and in the worst cases, biased or discriminatory treatment of patients based on race, culture, language proficiency, or social status (Schulman et al., 1999; van Ryn and Burke, 2000; Donini-Lenhoff and Hedrick, 2000). Two studies for physicians highlight these points.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

First, Schulman et al. (1999) showed that differential referral to cardiac catheterization was based on race and gender. Second, van Ryn and Burke (2000) illustrated that physicians have different attitudes about patients based on race, as well. Similarly, one study involving 116 nursing students found that negative attitudes about racial/ethnic minorities was related to the absence of prior exposure, suggesting that these issues are not limited to physicians (Eliason 1998).

The meaning of “culture” has been widely debated and broadly defined, with certain common themes emerging. To summarize, culture can be seen as an integrated pattern of learned beliefs and behaviors that can be shared among groups and include thoughts, styles of communicating, ways of interacting, views on roles and relationships, values, practices, and customs (Robins et al., 1998; Donini-Lenhoff and Hedrick, 2000). Culture shapes how we explain and value our world, and provides us with the lens through which we find meaning (Nunez, 2000). It should not be considered “exotic” or about “others” (Shapiro and Lenahan, 1996; Like et al., 1996), but as part of all of us and our individual influences (including socioeconomic status, religion, gender, sexual orientation, occupation, disability, etc.). We all are influenced, and belong, to multiple cultures that include, but go beyond, race and ethnicity.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Sociocultural factors are critical to the medical encounter, yet cross-cultural curricula have been incorporated into undergraduate, graduate and continued health professions education only to a limited degree (Carrillo et al., 1999). Their goal is to enhance learners’ awareness of sociocultural influences on health beliefs and behaviors, and to equip them with skills to understand and manage these factors in the medical encounter (Carrillo et al., 1999; Culhane-Pera et al., 2000; Zweifler and Gonzalez, 1998). This includes understanding population-specific disease prevalence and health outcomes and ethnopharmacology (Lavizzo-Mourey, 1996; Zweifler and Gonzalez, 1998).

Although cross-cultural medicine has gained recent attention, it has been discussed in the literature since the 1960’s during the advent of the community health and civil rights movement. There was a clear call then for responsiveness to cultural differences in health attitudes, beliefs, behavior, and language (Chin, 2000). In the 1970’s, the seminal work of Kleinman et al. solidified the important link between culture, illness and health care (Kleinman et al., 1978). In the 1980’s and 1990’s, the focus shifted from “cultural sensitivity” to a demand for “cultural competence,” a more skill-focused paradigm (Rios and Simpson, 1998; Welch, 1998; LavizzoMourey 1996). Early work in the field is found in the literature of nursing, mental health, and family medicine (Shapiro and Lenahan, 1996; Kai et al., 1999; Kristal et al., 1983). An international interest in the intersection between culture and health has arisen, with work done in Australia, Great Britain, and Canada, among others (Louden et al., 1999).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Looking at undergraduate medical education over this time, we see interesting parallels. Since 1978, four surveys/literature searches have been conducted to determine whether medical schools were teaching cross-cultural issues in their curriculum (Louden et al., 1999; Wyatt et al., 1978; Lum and Korenman, 1994; Flores et al., 2000) (Figure 6-2). Although each study was limited by not determining curriculum specifics (whether a course was required, contact hours, approaches, etc.), the trend shows a decrease in specific cross-cultural courses, and an increase in incorporation of these issues into the overall curriculum. This last finding is deceiving, as it’s unknown to what extent cross-cultural issues are dealt with in other courses. This could simply mean that there are optional noon lectures or electives that cover cross-cultural issues during some part of the standard health professional academic year. Experts in the field remain skeptical about the results, which show a “mainstreaming” of cross-cultural education, and are concerned about how effectively these issues are addressed during medical education (Kai et al., 1999; Flores et al., 2000). There is no literature to document the extent to which these issues are covered in graduate or continuing medical education for either residents or practicing providers. The literature in nursing education is similarly sparse. Although material related to cultural di versity is considered an important part of baccalaureate curricula, there is virtually no information published on the extent to which cultural competence is included in undergraduate courses or the specifics of the material that is included (Clinton 1996; Janes and Hobson, 1998).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Cross-cultural education for health professionals has emerged because of three major factors. First, cross-cultural education has been deemed critical in preparing our providers to meet the health needs of our growing, diverse population (Welch, 1998). Second, it’s been hypothesized that cross-cultural education could improve provider-patient communication and help eliminate the pervasive racial/ethnic disparities in medical care seen today (Einbinder and Schulman, 2000; Williams and Rucker, 2000; Brach and Fraser, 2000). Third, in response to the Institute of Medicine Report on Primary Care which states that “there should be an understanding of cultural belief systems of patients that assist or hinder effective health care delivery,” and in response to the Pew Health Professions Commission, which states that “cultural sensitivity must be a part of the educational experiences of every student,” accreditation bodies for medical training (i.e. Liaison Council on Medical Education, Accreditation Council on Graduate Medical Education) now have standards that require cross-cultural curricula as part of undergraduate and graduate medical education (Liaison Committee on Medical Education, 2001; Accreditation Council for Graduate Medical Education, 2001; Committee on the Future of Primary Care, 1994; Pew Health Professions Commission, 1995). Although these standards are general in their language, they are being expanded in detail and remain enforceable. Similarly, leaders in nursing education recognize the importance of culture in the health of populations and patients. As early as 1977, the National League for Nursing required cultural content in nursing curricula and in 1991, the American Nursing Association published standards specifically indicating that culturally and ethnically relevant care should be available to all patients.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Training in cross-cultural medicine can be divided into three conceptual approaches focusing on attitudes, knowledge, and skills (Figure 6-3). Like the proverbial three-legged stool, each approach plays a crucial role, but is unable to support any weight when not fully supported by the other two.

The foundation of cross-cultural care is based in the attitudes central to professionalism—humility, empathy, curiosity, respect, sensitivity, and awareness of all outside influences on the patient (Bobo et al., 1991; Gonzalez-Lee and Simon, 1987). The added importance of these attitudes in cross-cultural medical encounters, where the desire to explore and negotiate divergent health beliefs and behaviors is paramount, has given rise to curricula designed to build or shape them within providers. The cultural sensitivity/awareness approach (see Figure 6-3) incorporates educational exercises and techniques that promote self-reflection, including understanding one’s own culture, biases, tendency to stereotype, and appreciation for diverse health values, beliefs, and behaviors (Culhane-Pera et al., 1997). Examples include open conversations exploring the impact of racism, classism, sexism, homophobia, and other types of discrimination in health care; determining how providers have themselves dealt with feeling “different” in some way; attempting to identify, using patient descriptors or vignettes, hidden biases we may have based on subconscious stereotypes; determining our reaction to different visuals of patients of different races/ethnicities; and discussing ways in which our family members have interacted with the health care system (Berlin, 1998; Donnini-Lenhoff, 2000; Tervalon and Murray-Garcia, 1998).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

From a practical perspective, efforts to change attitudes are labor intensive, difficult, charged, complex to evaluate, and can seem abstract to those who are more clinically oriented (Kai et al., 1999). Nevertheless, attitudes such as curiosity, empathy, respect, and humility are critical to engaging in effective communication during the clinical encounter, whether the patient is from a similar or a distinct cultural background.

Traditionally, cross-cultural education has focused on a “multicultural” or “categorical approach,” providing knowledge on the attitudes, values, beliefs, and behaviors of certain cultural groups (Paniagua, 1994). For example, methods to care for the “Asian” patient or the “Hispanic” patient would present a list of common health beliefs, behaviors, and key practice “do’s and don’ts.” With the huge array of cultural, ethnic, national, and religious groups in the United States, and the multiple influences such as acculturation and socioeconomic status that lead to intra-group variability, it is difficult to teach a set of unifying facts or cultural norms (such as “fatalism” among Hispanics, or “passivity” among Asians) about any particular group (Chin, 2000; Hill et al., 1990). These efforts can lead to stereotyping and oversimplification of culture, without a respect for its fluidity (Donini-Lenhoff and Hedrick, 2000; Carrillo et al., 1999). Research has shown that teaching “cultural knowledge” can be more detrimental than helpful if it is not done carefully (Shapiro and Lenahan, 1996).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

There are two instances where focusing on a knowledge-based approach can be effective. First, following the basic tenets of community-oriented primary care and community assessment, students and practitioners can learn about the surrounding community in which they train or practice. Some important factors include the social and historic context of the population (new immigrants or longstanding residents), the predominate socioeconomic status, the immigration experience (was the immigration chosen or forced), nutritional habits (diet high in protein, fiber, or fat), common occupations (i.e., blue collar or service industry), patterns of housing (i.e. housing development), folk illnesses and healing practices (i.e. empacho, “coining”), and disease incidence and prevalence. Several such models are described in the literature focusing on communities in U.S.-Mexican border towns, communities with a new influx of a specific immigrant group, and Native-American reservations (Kristal et al., 1983; Nora et al., 1994).

The second instance of an effective knowledge-based approach is knowledge that has a specific, evidence-based impact on health care delivery. Examples include ethnopharmacology; disease incidence, prevalence, and outcomes among distinct populations; the impact of the Tuskegee Syphilis Study and segregation as the cause of mistrust in African-Americans; the effect of war and torture on certain refugee populations and how this shapes their interaction with the health care system; and the common cultural and spiritual practices that might interfere with prescribed therapies (such as Ramadhan—the sunup-to-sundown fast observed by Muslims—and how this might affect people with diabetes), to name a few.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

When learning facts about “cultural groups,” it’s important for providers to ask themselves several questions to avoid falling prey to ecologic fallacy. How accurate and generalizable are these group assumptions? How current are they, given the fluidity of culture and diversity among groups? What are the limitations? How can I use this knowledge to deliver better care? (Shapiro and Lenahan, 1996). In summary, if a knowledge-based approach (see Figure 6-4) is taught, it should focus on communityoriented or specific, evidence-based factors. Absent this, learning as much as possible about the patient’s own sociocultural context and perspectives while minimizing the reliance on generalizations is ideal.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The cross-cultural approach teaches providers skills that meld those of medical interviewing with the ethnographic tools of medical anthropology (Shapiro and Lenahan, 1996; Carrillo et al., 1999). These framework-based approaches focus on communication skills, and train providers to be aware of certain cross-cutting cultural issues, social issues, and health beliefs, while providing methods to deal with information clinically once it is obtained (Nunez, 2000; Berlin and Fowkes, 1998, Clinton, 1996). Curricula have focused on providing methods for eliciting patients’ explanatory models (what patients believe is causing their illness) and agendas, identifying and negotiating different styles of communication, assessing decision-making preferences, the role of family, determining the patient’s perception of biomedicine and complementary and alternative medicine, recognizing sexual and gender issues, and being aware of issues of mistrust, prejudice, and racism, among others (see Figure 6-5) (Carrillo et al., 1999; Hill et al., 1990; Zweifler and Gonzalez, 1998; Culhane-Pera et al., 1997). For example, providers are taught that while it is important to understand all patients’ health beliefs, it may be particularly crucial to understand the health beliefs of those who come from a different culture or have a different health care experience. As such, frameworks including questions to obtain this and other information are taught. Instead of applying a deductive approach that applies broad rules and generalizations about cultures to the individual, this inductive approach focuses on the patient, rather than theory, as the starting point for discovery (Shapiro and Lenahan, 1996). With the individual patient as teacher, providers are encouraged to adjust their practice style accordingly to meet their patients’ specific needs. The cross-cultural approach has gained favor among educators who see its clinical applicability as a framework in caring for either diverse or targeted populations.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

There have been a variety of teaching methodologies utilized for cross-cultural education at different levels of training (Figure 6-6). In general, interactive, experiential, practical, case-based approaches that address cognitive, affective, and behavioral aspects of the learner are most effective (Welch, 1998). At the level of undergraduate and graduate medical education, strategies such as self-reflection (particularly for cultural sensitivity/awareness approach), focused didactics (especially for multicultural approach), and the use of vignettes, problem-based learning cases, medical encounter videos, and individual case-based discussion (usually for cross-cultural approach) are most common (Nunez, 2000; Carrillo et al., 1999; Louden et al., 1999; Culhane-Pera et al., 1997). Innovative educational strategies include learner community immersion (whereby students or residents rotate through community-based health care facilities), role-play (whereby students or residents practice interviewing techniques using scripted cases), patient narratives, video interviews of patients, and the use of patients or actors for faculty facilitated, simulated medical encounters (Gonzalez-Lee and Simon, 1987; Rubenstein et al., 1992). Continuing education for practicing providers has focused more on “culturally competent” approaches to treating specific clinical conditions in targeted populations (i.e. “Hypertension in African Americans”, or “Managing Diabetes in Latinos”). In these instances, a knowledge-based approach is most commonly employed, in which disease incidence and prevalence of a specific condition in a target population is presented, along with focused strategies for managing said condition. These strategies may include evidence for the use of specific medications in certain populations or methods for incorporating community based resources for clinical support. Although other “provider-patient communication” continuing education courses focus more specifically on the process of improving understanding in the medical encounter, few have “cross-cultural communication” as a central theme.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

There are various opportunities to incorporate cross-cultural issues in health professions education. In undergraduate and graduate medical education, courses have been taught during orientation, as part of established courses or electives, during retreats, as part of weekly conferences, or less frequently, as an optional or required stand-alone (see Figure 6-6). Since there is currently no clear focus on cross-cultural issues within undergraduate and graduate health professions curricula, stand-alone courses are favored for the time being, although integration into the standard curricula would be optimal (Kai et al., 1999).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

For practicing providers, integration of cross-cultural curricula as part of continuing education, or as part of the grand rounds series, or as part of faculty development, has been attempted. Certain states are considering requiring a standard number of continuing education credits in cross-cultural communication as part of professional licensure. Similarly, the National Board of Medical Examiners is exploring methods of incorporating questions that address cross-cultural issues in medical care on licensing exams. Certain medical malpractice insurers are offering premium discounts to providers who complete provider-patient communication courses, and are now considering applying the same discounts to providers who complete cross-cultural communication courses. Regardless of the setting, it is felt that cross-cultural education should be linked to the level of the learner’s training, with more theoretical approaches in the preclinical years and more practical approaches during the clinical years (Nunez, 2000).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

To date, there has been limited evaluation published on the impact of cross-cultural education. Building on the three-legged stool model of attitudes, knowledge, and skills described above, we see some studies that have primarily shown improvements in cross-cultural knowledge (the type of knowledge has varied relative to the individual curricula taught). For example, Rubenstein et al. used pre- and post-test methodology to demonstrate that students who completed a “Culture, Communication, and Health” course displayed an increase in knowledge regarding :

The way in which a physician’s ignorance of a patient’s health beliefs and practices can adversely affect the clinical encounter;The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The pervasiveness of non-conventional health beliefs and practices; and

The types of resources available for learning about patients’ health beliefs and practices. (Rubenstein et al., 1992)Similarly, Nora et al.used multiple-choice question methodology to show that an experimental group of students who completed a “Spanish Language and Cultural Competence Curriculum” had greater knowledge of Hispanic health and cultural issues, including disease prevalence, cultural perceptions of illness, and traditional health practices, compared with a control group (Nora, 1994). In addition, when compared with the control group, the experimental group was found to be less ethnocentric and more comfortable with others after the curricular intervention, based on the “Misanthropy Scale (Stevenson, 1954). In the area of graduate medical education, one published study found that family practice residents exposed to a three-year, multi-method cross-cultural curriculum displayed an increase in cultural knowledge and cross-cultural skills via self-report and faculty corroboration (Culhane-Pera et al., 1997). Research on continuing medical education courses for practicing providers targeted at improving communication skills (without a focus on cross-cultural communication) have shown mixed results (Haynes et al, 1984; Davis et al, 1992; Davis et al, 1995). Joos et al. showed no significant improvement in patient satisfaction for providers who had completed such courses versus those who hadn’t (Joos et al, 1996). Levinson et al. did show a moderate increase in patient satisfaction and a significant increase in provider satisfaction for those who completed a course on improving doctor-patient communication (Levinson et al, 1993). It is difficult to know whether one can extrapolate these results to continuing medical education focusing on cross-cultural communication as there is yet no evaluative data in this area.

Cross-cultural education poses significant challenges for evaluation. For example, it’s difficult to evaluate change in provider attitudes given the potential for social desirability bias on surveying, and the difficulty in observing encounters in real time. Assessing knowledge is perhaps easier, and can be assessed with standard evaluation tools such as pretest-post-tests and essays (Louden et al., 1999; Nora et al., 1994; Rubenstein et al., 1992). Skills can be evaluated in undergraduate and graduate health professions education using techniques such as the objective structured clinical examination, or videotaping actual clinical encounters(Nunez, 2000; Robins et al., 1998; Robins et al., 2001). For practicing providers, one might assess patient satisfaction improvements among those who have completed cross-cultural communication courses. All in all, we should be able to evaluate some dimensions of attitudes, knowledge, and skills.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Another approach to evaluation asks three questions about the impact of curricula, building towards the link to outcomes. First, do providers learn what is taught? Second, do they use what is taught? And third, does what is taught have an impact on care?

These questions can be assessed using mixed methodologies that include both quantitative and qualitative techniques (Figure 6-7) (Nunez, 2000; Like et al., 1996). These include pre-and post-tests, unknown clinical cases, qualitative physician and patient interviews, medical chart review, audio or videotape of medical encounter, objective structured clinical exams, patient and provider satisfaction, and processes of care (i.e. completion of health promotion/disease prevention interventions). It’s important that we not hold cross-cultural curricula to unfair evaluation standards, as detractors have asked for a direct link between curricula and the improvement of hard clinical outcomes Any assessment should match the educational objectives and be carried out in a careful, step-wise fashion, controlling for all possible confounders and focusing first on process measures (such as patient and provider satisfaction).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

There are several challenges ahead for cross-cultural education (Figure 6-8). First, given the biomedical focus of health professions education, there is significant resistance to curricula that are viewed as “soft” or lacking an evidence base (Culhane-Pera et al., 1997). Second, given that providers are accustomed to factual, practical learning, they are often disappointed when specific group cultural knowledge (“Hispanic patients believe…or behave…”) is not presented (Kai et al., 1999). Third, providers feel that they don’t have the time needed to explore and negotiate complex sociocultural issues with patients, due to the short length of today’s medical encounter. Fourth, there is lack of consensus on fundamental, conceptual approaches and teaching methodologies, and lack of institutional support (both formal and informal) (Shapiro and Lenahan, 1996; Kai et al., 1999). Fifth and finally, although there is circumstantial evidence that would substantiate the claim that improving provider cross-cultural communication will help eliminate disparities in health care, there are yet- to- be published studies to support this hypothesis.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Two examples illustrate ways to deal with questions related to meaning in life. Many studies have shown that people desire to be remembered (4). Some wish to fulfill this desire through their family, and others through their life’s accomplishments or impact. One of my patients has had ovarian cancer for 7½ years. Recently, the cancer metastasized and is no longer as responsive to chemotherapy. She has been involved in lecturing to a class of my medical students for a 2-week period each semester, talking about medical care from a patient’s perspective. Now that she is facing the end of her life, she is determined to continue those lectures; she finds purpose in the significant impact they have had on future physicians. Her treatment team was able to work around certain therapeutic protocols to enable her to achieve her dreams and goals. Another patient was dying of breast and ovarian cancer in her early 30s, and she was depressed. Antidepressants weren’t helping. Through talking with her, I understood the cause of her suffering: a fear that her 2-year-old daughter would not remember her. I suggested that she keep a journal to leave to her daughter; the hospice nurses videotaped her messages to her children. These activities helped resolve her depression.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Erik Erikson has written about certain developmental tasks that he suggests children, adolescents, and adults need to accomplish as part of the normal developmental and maturing process (5). Spirituality has been recognized by many authors as an integral developmental task for those who are dying (6, 7). Unfortunately, people who are dying are often ignored. DNR—do not resuscitate—is often interpreted as “do not round.” As these patients deal with issues of transcendence, they need someone to be present with them and support them in this process. We need to advocate for systems of care in which that can happen.

Attending the dying patient is an important experience for physicians as well. In an article entitled “When mortality calls, don’t hang up,” Sally Leighton wrote: “The physician will do better to be close by to tune in carefully on what may be transpiring spiritually, both in order to comfort the dying and to broaden his or her own understanding of life at its ending” (8). One Baylor nurse I spoke with said that her patients give back 400% more than she gives them. I have to echo that sentiment. Being in the presence of people who are struggling and are able to transcend suffering and pain and see life in a different way is inspiring for me, and I’m grateful for those experiences.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

The effect of spirituality on health is an area of active research right now. Besides being studied by physicians, it is studied by psychologists and other professionals. The studies tend to fall into 3 major areas: mortality, coping, and recovery.

Some observational studies suggest that people who have regular spiritual practices tend to live longer (9). Another study points to a possible mechanism: interleukin (IL)-6. Increased levels of IL-6 are associated with an increased incidence of disease. A research study involving 1700 older adults showed that those who attended church were half as likely to have elevated levels of IL-6 (10). The authors hypothesized that religious commitment may improve stress control by offering better coping mechanisms, richer social support, and the strength of personal values and worldview.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Patients who are spiritual may utilize their beliefs in coping with illness, pain, and life stresses. Some studies indicate that those who are spiritual tend to have a more positive outlook and a better quality of life. For example, patients with advanced cancer who found comfort from their religious and spiritual beliefs were more satisfied with their lives, were happier, and had less pain (11). Spirituality is an essential part of the “existential domain” measured in quality-of-life scores. Positive reports on those measures—a meaningful personal existence, fulfillment of life goals, and a feeling that life to that point had been worthwhile— correlated with a good quality of life for patients with advanced disease (12).

Some studies have also looked at the role of spirituality regarding pain. One study showed that spiritual well-being was related to the ability to enjoy life even in the midst of symptoms, including pain. This suggests that spirituality may be an important clinical target (13). Results of a pain questionnaire distributed by the American Pain Society to hospitalized patients showed that personal prayer was the most commonly used nondrug method of controlling pain: 76% of the patients made use of it (14). In this study, prayer as a method of pain management was used more frequently than intravenous pain medication (66%), pain injections (62%), relaxation (33%), touch (19%), and massage (9%). Pain medication is very important and should be used, but it is worthwhile to consider other ways to deal with pain as well.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Spiritual beliefs can help patients cope with disease and face death. When asked what helped them cope with their gynecologic cancer, 93% of 108 women cited spiritual beliefs. In addition, 75% of these patients stated that religion had a significant place in their lives, and 49% said they had become more spiritual after their diagnosis (15). Among 90 HIV-positive patients, those who were spiritually active had less fear of death and less guilt (16). A random Gallup poll asked people what concerns they would have if they were dying. Their top issues were finding companionship and spiritual comfort—chosen over such things as advance directives, economic/financial concerns, and social concerns. Those who were surveyed cited several spiritual reassurances that would give them comfort. The most common spiritual reassurances cited were beliefs that they would be in the loving presence of God or a higher power, that death was not the end but a passage, and that they would live on through their children and descendants (17).

Bereavement is one of life’s greatest stresses. A study of 145 parents whose children had died of cancer found that 80% received comfort from their religious beliefs 1 year after their child’s death. Those parents had better physiologic and emotional adjustment. In addition, 40% of those parents reported a strengthening of their own religious commitment over the course of the year prior to their child’s death (18).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

These findings are not surprising. We hear them repeated in focus groups, in patients’ writings and stories: When people are challenged by something like a serious illness or loss, they frequently turn to spiritual values to help them cope with or understand their illness or loss.

Spiritual commitment tends to enhance recovery from illness and surgery. For example, a study of heart transplant patients showed that those who participated in religious activities and said their beliefs were important complied better with follow-up treatment, had improved physical functioning at the 12-month follow-up visit, had higher levels of self-esteem, and had less anxiety and fewer health worries (19). In general, people who don’t worry as much tend to have better health outcomes. Maybe spirituality enables people to worry less, to let go and live in the present moment.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Related to spirituality is the power of hope and positive thinking. In 1955, Beecher showed that between 16% and 60% of patients—an average of 35%—benefited from receiving a placebo for pain, cough, drug-induced mood change, headaches, seasickness, or the common cold when told that the placebo was a drug for their condition (20). Now placebos are used only in clinical trials, and even there, generally about 35% of people respond to them. Study of the “placebo effect” has led to conclusions that our beliefs are powerful and can influence our health outcomes. Herbert Benson, MD, a cardiologist at Harvard School of Medicine, has renamed the placebo effect “remembered wellness” (21). I see this as an ability to tap into one’s inner resources to heal. Benson, myself, and others see the physician-patient relationship as having placebo effect as well—i.e., the relationship itself is an important part of the therapeutic process. Benson suggests that there are 3 components that contribute to the placebo effect of the patient-physician relationship: positive beliefs and expectations on the part of the patients, positive beliefs and expectations on the part of the physician or health care professional, and a good relationship between the 2 parties (21).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Specific spiritual practices have been shown to improve health outcomes. In the 1960s, Benson began research on the effect of spiritual practices on health. Some people who practiced transcendental meditation approached him in the 1960s and asked him to determine if meditation had beneficial health effects. He found that 10 to 20 minutes of meditation twice a day leads to decreased metabolism, decreased heart rate, decreased respiratory rate, and slower brain waves. Further, the practice was beneficial for the treatment of chronic pain, insomnia, anxiety, hostility, depression, premenstrual syndrome, and infertility and was a useful adjunct to treatment for patients with cancer or HIV. He called this “the relaxation response.” Benson concluded: “To the extent that any disease is caused or made worse by stress, to that extent evoking the relaxation response is effective therapy” (22).

Different studies suggest that 60% to 90% of all patient visits to primary care offices are related to stress. I teach the relaxation response to many of my patients, and I have found it particularly useful for patients with chronic pain, high blood pressure, headaches, and irritable bowel syndrome. It takes only a few minutes to describe the meditation and to practice it with your patient in the office. The patient then needs to practice the technique at home. I usually suggest people follow up with me in the office more frequently initially as they are learning the technique. After a few semimonthly visits, they switch to brief monthly visits, which can then be tapered. Some of my patients follow up with me by phone if coming to my office frequently is difficult.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Do patients want physicians to address their spirituality? Research studies have also addressed this issue. In the USA Weekend Faith and Health Poll, 65% felt that it was good for doctors to speak with them about their spiritual beliefs, yet only 10% said a doctor had had such a conversation with them (23). A study of pulmonary outpatients at the University of Pennsylvania found that 66% agreed that a physician’s inquiry about spiritual beliefs would strengthen their trust in their physician; 94% of patients for whom spirituality was important wanted their physicians to address their spiritual beliefs and be sensitive to their values framework. Even 50% of those for whom spirituality was not important felt that doctors should at least inquire about spiritual beliefs in cases of serious illness (24).

From a physician’s standpoint, understanding patients’ spirituality is quite valuable as well:The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Spirituality may be a dynamic in the patient’s understanding of the disease. For example, when I was a resident I saw a 28 year-old woman whose husband had just left her. She found out that her husband had AIDS, and she asked to be tested. When I met with her to tell her that the test result came back positive, I tried to explain that her illness was diagnosed early and that there had been recent advances in the treatment of HIV that were allowing people to live longer with their illness. She kept referring to God and about why God was doing this to her. I recognized that we weren’t connecting, so I asked her about her comments. She proceeded to tell me about being raped as a teenager and having an abortion. In her belief system, that was wrong. I remember her exact words: “I have been waiting for the punishment, and this is it.” She did not want to discuss treatment or preventive care such as immunization. I encouraged her to see a chaplain, which she did regularly. In the meantime, I kept seeing her, and I talked with her about her issues of guilt and punishment as well as some education about HIV. But it was not until 1 year later that she was willing to seek treatment. She needed time to work out her own issues of guilt before being able to accept her illness and deal with it. Now, she tells me that had I not addressed her spiritual issues in that first visit, she would never have returned to see me or any other physician. In many patients’ lives, spiritual or religious beliefs may affect the decisions they make about their health and illness and the treatment choices they make. It is critical that we as physicians and health care providers listen to all aspects of our patients’ lives that can affect their decision making and their coping skills.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Religious convictions may affect health care decision making. Jehovah’s Witness patients rejecting blood transfusions is a classic example, but there are also beliefs around use of ventilators and feeding tubes. One of my patients was an 88-year old man dying of pancreatic cancer in the intensive care unit. He was on a ventilator. When the treatment team approached his family about withdrawing support, at first they refused, saying that their father was in God’s hands and keeping him on support might make a miracle possible. After an ethics consult and a consult with a chaplain, the family had the chance to reframe their own thinking. Eventually, they saw that a peaceful death and their father’s union with God could be the miracle. The critical elements in helping the family deal with the situation were the medical team’s respecting and not ridiculing the family’s beliefs and the chaplain’s skill in counseling and helping the family reconcile their religious beliefs with the reality of their father’s dying.

Spirituality may be a patient need and may be important in patient coping. This was true of a patient of mine who died 2 weeks ago. She used her religious beliefs and practices to help her live with serious chronic illness. Many of the 1500 people at her funeral commented on her deep faith and how her spirituality helped her cope with her multiple strokes and diabetes. Towards the end of her life, she was in a coma. Her family asked me to join them in their prayer around their mother’s bedside. During the prayer, the family was able to express both their hope in her recovery, but also their request to God for strength to deal with her death if that was to be the outcome. So, for both my patient and my patient’s family, spiritual beliefs and practices were the main resource they used to cope with suffering and loss. And this patient and her family wanted me, their physician, to be aware of these beliefs and to be open to hearing their spiritual expressions in the clinical setting. Patients may want to discuss their spirituality with their physician, to use their church group as a social support, or to join faith-based organizations for support and guidance.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

An understanding of the patient’s spirituality is integral to whole patient care. One of my patients, a 42-year-old woman with irritable bowel syndrome, had several signs of depression, including insomnia, excessive worrying, decreased appetite, and anhedonia. Overall, she felt she had no meaning and purpose in life. She did not respond to medication and diet changes alone. I taught this patient the relaxation response as an adjunct to the medical treatment and counseling she received. She improved when meditation and counseling were added to the treatment regimen. As shown in the first example of the woman who was HIV positive, some spiritual stances can lead to negative coping: more depression, poorer quality of life, and callousness towards others. This is seen when patients view a crisis as a punishment from God, have excessive guilt, or have absolute belief in prayer and a cure and then can’t resolve their anger when the cure does not occur. Generally, however, spirituality leads to positive coping. Patients seek control through a partnership with God, ask God’s forgiveness and try to forgive others, draw strength and comfort from their spiritual beliefs, and find support from a spiritual or religious community. These actions lead to less psychological distress (25).The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

What is involved in serving patients and providing compassionate care? Physicians can begin with the following:

Practicing compassionate presence—i.e., being fully present and attentive to their patients and being supportive to them in all of their suffering: physical, emotional, and spiritual

Listening to patients’ fears, hopes, pain, and dreams

Obtaining a spiritual history

Being attentive to all dimensions of patients and their families: body, mind, and spirit

Incorporating spiritual practices as appropriate

Involving chaplains as members of the interdisciplinary health care team The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Throughout these activities, it is important to understand professional boundaries. In-depth spiritual counseling should occur under the direction of chaplains and other spiritual leaders, as they are the experts. The physician should not initiate prayer with patients, as this blurs the boundary of physician and clergy. Leading prayer involves specific skills and training that physicians do not have. Furthermore, a physician leading a prayer might lead a prayer from his or her tradition, which could be offensive or inappropriate for the patient. If the patient requests prayer, the physician can stand by in silence as the patient prays in his or her tradition or can contact the chaplain to lead a prayer. Finally, the spiritual history is patient centered, and proselytizing and ridiculing patients’ beliefs are not acceptable.

It is important to recognize that patients come to physicians to seek care for their medical condition. In delivering this care, physicians can be respectful and understand the spiritual dimension in patients’ lives. But to go beyond that, e.g., to lead prayer or provide in-depth spiritual counseling, is inappropriate. Physicians are in a position of power with patients. Most patients come to us in vulnerable times. If the physician suggests a certain religion/spiritual belief or ridicules a patient’s belief, the patient might adopt that physician’s belief or lack of belief out of fear of disagreeing with a perceived authority. Therefore, it is critical that when discussing spiritual issues with patients, the physician listens and supports and does not guide or lead.The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

Many physicians are not familiar with spiritual histories. I’ve developed the “FICA” questions to guide the conversation (Table ​(Table11). I teach medical students and physicians to take a spiritual history as part of a social history, at each annual exam, and at follow-up visits as appropriate. A spiritual history helps physicians recognize when cases need to be referred to chaplains. It opens the door to conversation about values and beliefs, uncovers coping mechanisms and support systems, reveals positive and negative spiritual coping, and provides an opportunity for compassionate care. The Influence Of Cultural And Health Belief Systems In Health Care Practices Essay Paper

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