The Facts About Cultural Diversity
Culture is a term that many people think they understand. However, because the word is often used for describing things other than culture, there is a lot of misunderstanding.
Culture is a social pattern of behaviors, beliefs, and characteristics of a group of people that is passed on from generation to generation. It is very important to understand that cultural characteristics are very different from physical characteristics. Many people who have similar physical characteristics do not have similar cultural characteristics.
Probably the biggest error in defining a culture is thinking in terms of race or gender. Far too often “cultural diversity” is used to refer to the mix of male/female employees, or persons of a certain race. To assume that all members of a certain race share a common culture is never correct. The cultural diversity among members of any race is likely to be very large, since there are many factors making up culture.
Especially if you work within a big city, there are many geographic cultures that greatly influence a patient’s views on diet and medical care. Keep in mind that these are very general, and will not apply to all patients. They are listed here to give you a better idea of the variety within these cultures, and not to provide specific information about an individual patient or family.
Eastern Asian and Pacific Islanders
(Chinese, Koreans, Japanese, Hmong, Indonesians, Filipinos, Samoans)
Dietary habits are varied, based on the culture, and there are often special diets to be taken during illness. Fish, fruits, vegetables, and rice are the primary diet, along with small amounts of chicken, pork, or beef. In most of these cultures, a meal is almost like a ceremony and should not be interrupted. There are several religions practiced, including Confucianism, Buddhism, Taoism, Islam, Shintoism (Japan), and Roman Catholic. Medicinal herbs and folk remedies and rituals are commonly used to prevent or treat illness. Most believe that good health is a result of harmony, and may use health healers and spiritual healers before seeking standard medical care. Drawing of blood is especially upsetting to many. There is a tendency to hide outward signs of pain, so it may be difficult to determine how much pain a patient is having. Many believe in some type of reincarnation.
Haitian, Puerto Rican, Cuban
Generally, diet is very important to maintaining good health. Many believe foods have “hot/cold” properties and these must be in harmony. Some believe illness is supernatural and caused by evil spirits or enemies of deceased relatives. They may wear amulets to protect against evils spirits. Most consult folk healers or spiritualists before seeking standard medical care. Use of herbs and rituals for healing is common. Many are suspicious and fearful of hospitals. Cuban-Americans are most likely to use the standard medical practices, in combination with religious or home remedies.
In addition to cultures passed on from different geographic areas, there are many general religious cultural beliefs you may find among your patients. Keep in mind that not all members of a particular religious group will hold the same beliefs. These are generally held beliefs and may not be those of each and every member. In most instances, the term “fasting” does not mean going without food totally. It usually refers to eating very light meals, with no snacks in between. And almost always, rules of fasting do not apply to the elderly or very ill.
(also called Seventh Day Adventists)
Most often Adventists do not eat meat, and do not drink alcoholic beverages, coffee, or tea. Most believe in the healing power of prayer as a first line of medical treatment, but they generally accept most forms of standard medical treatment. Adventists accept the Bible as absolute truth in every detail. Their day of worship is Saturday, rather than Sunday. The central head of the church is president of the General Conference.
Some groups are loosely united into conferences, but each church maintains independence. Almost all Baptist groups prohibit alcohol as a beverage. Many groups strongly believe in faith healing or “laying on of hands” by preachers or others empowered by God to heal. Many believe that when medical treatment cures them, it is because God is functioning through the doctors and nurses. They may refuse ventilators or resuscitation, believing it interferes with God’s will. Mission work is very much a part of most Baptist churches because many of them believe that only Christians will go to Heaven.
Church of Christ, Scientist
(also called Christian Scientist)
There are no dietary restrictions, although most Christian Scientists do not drink alcohol. They are generally opposed to all medications and medical treatment. There are Practitioners, or Readers, who assist families in times of illness. Even those who will accept some forms of standard medical care will not do so unless advised to do so by the Practitioner. The Christian Scientist Church does not have any type of clergy, priests, or preachers. Lay members lead all services. Headquarters for the Church is the Mother Church in Boston, Massachusetts.
Church of Jesus Christ of Latter Day Saints
(also called Mormons)
While meat is not forbidden, members are encouraged to eat meat “infrequently”, and they generally do not drink tea, coffee, or alcohol. Many will fast for 24 hours on the first Sunday of the month. They are strong believers in divine healing with anointing and “laying on of hands” by church elders, but do not prohibit standard medical care. On their wedding day they are given special undergarments that are always worn. Never remove these undergarments without discussing the process with patient or family. The church headquarters is in Salt Lake City, Utah.
(also called Muslim or Nation of Islam)
Muslims do not eat pork and port products and generally do not use alcohol. During Ramadan (the last month of the Mohammedan year) they do not eat during daylight hours. They accept standard medical care, and generally oppose faith healing. Muslims perform prayers five times daily. There is usually ritual washing after prayers. There are several different sects of Islam and each is somehow different.
Witnesses eat meat, but only if blood has been drained. They are absolutely opposed to blood transfusions, as well as any vaccines made with blood components. Otherwise, they accept most standard medical care. They do not participate in or celebrate non-religious holidays. They do not salute the flag, nor recite any pledges and will not bear arms in military service.
Dietary habits depend on whether they are Orthodox, Reform, or Conservative. Jews do not eat pork, only meat that comes from animals that eat vegetables, have cloven hooves, or chew their cud. Meat must be ritually slaughtered to make it “kosher”. They do not eat seafood unless it has scales and fins. Orthodox and other Jews who strictly observe kosher laws never combine meat products and dairy products, and do not store them together. They may have two sets of dishes – one for meat and one for dairy. During Passover, they do not eat any leavened bread (bread containing yeast or other ingredients to cause it to ferment and rise). Jews may refuse surgery during the Sabbath (sundown on Friday until sundown on Saturday). Since kosher foods are high in sodium, patients on low salt diets do not have to use kosher meats. Jews are generally oppose prolonging life with life-support. Amputated limbs and other parts of the body removed by surgery are given to family for burial. There is no single Jewish authority over all Jewish synagogues. All congregations are independent and control their own activities. On the Sabbath, Orthodox Jews do not use cares, do not cook, nor do work of any kind.
Catholics fast and do not eat meat on Ash Wednesday or Good Friday. Most still do not eat meat on Fridays during Lent, and some Catholics may still follow the old practice of not eating meat on any Friday during the entire year. The church does not approve of contraceptives, abortion, or fertility treatments. Most request anointing of the sick during major illness. Homecare patients may refuse to eat or drink for an hour before someone is bringing them communion. The authority over all Roman Catholic churches is the Pope.
Russian Orthodox or Greek Orthodox
(while different, they share many beliefs)
They do not eat meat/dairy products on Wednesday or Friday. Most believe in divine healing, but they are not opposed to standard medical care. Most Russian Orthodox wear a cross necklace. It is only removed when absolutely necessary and replaced as soon as possible. Never remove the cross without first checking with the patient or family.
What this means to you as a home health aide
You must recognize that cultural diversity exists in all of us, including you.
- As a home health aide you are going to encounter people of many different cultures. It is very important that you do not draw conclusions about a patient based on his or her culture. You must learn to meet every patient as an individual. You should recognize that people of different cultural groups might have very different views about eating habits, child rearing, cleanliness, privacy, and health care.
- You should learn as much about other cultural groups as you can, so that you can better understand them. Although some practices may not make sense to you, they are very important to the culture of the patients you are caring for. Always respect and do not interfere with their cultural beliefs. Remember that in every single household you visit, the people living there will have their own rules and standards. One of your biggest roles is to respect the rights of patients in their own homes.
- It is important for you to be able to identify what your own cultural beliefs are. Otherwise, you might not know how these beliefs might affect the manner in which you approach other people.
- You should never try to change patients’ cultural beliefs, especially not to “convert” them to your own.
- If you have reason to believe that some cultural practices are actually harming the patient, notify the supervisor. Do not interfere directly. If you discover an important part of your job needs to be changed in order to respect the patient’s culture, notify the supervisor so the care plan can be changed.
- Most importantly, you must realize that not all members of the same cultural group will behave exactly the same.
Case Study: Cultural Diversity in Action
Ester is a new home health aide who has been asked to meet with her supervisor. The supervisor says she has received several telephone calls from Ester’s patients and that some of them felt very uncomfortable when Ester began to pray aloud, and asked them to pray with her. They also were concerned that she had brought them copies of the Bible. Some of the patients had complained that Ester had criticized the foods they eat, as well as some of their ways of life.
Ester began by saying how important her church is to her. She goes on to say that some of these patients don’t believe in Jesus, and that she is only trying to help them. She says, “Mrs. Goldstein is a Jew,” then she says about the “crazy” ways they do things at Mrs. Goldstein’s. “Do you know they have two refrigerators? The care plan even says what to put in which refrigerator – as if it really matters.”
Then Ester talks about Mr. Johnson. “He’s Catholic, and has all those statues of Mary around. He worships Mary, instead of Jesus!” She goes on, “And Mrs. Gonzales said that thing she wears around her neck protects her from spirits! I told her nobody but Jesus could protect her.” Ester continues, “And that Mr. Ahmed – I had to stop what I was doing because he said it was time to pray to Allah!” About Mrs. Peters she said, “She’s one of those Mormons, and she wears the same underwear everyday, and she wears it on top of her other underwear! I told her that was crazy and she shouldn’t do that.” Finally she said, “And that Mr. BevanNyen – the smell of that food in that house. I don’t know why they can’t eat like the rest of us.”
As Ester continues to talk about her different patients, she explains to the supervisor that she has been trying to help them. “I know they are going to Hell if they don’t accept the Lord Jesus Christ. I thought if I could help them, and give them a Bible, it would be a good thing. I can’t understand why they would get upset. About the other stuff, here is how I look at it – if you’re going to live in America, then you better decide to act like an American. If not, then stay in your own country.”
Something to think about
- What are some indications that Ester does not respect other cultures?
- How would you talk with her if you were the supervisor?
- Does your agency have a policy about sharing religious beliefs with patients? If not, what are your own thoughts about sharing your religious beliefs with patients?
- Think about the different patients you have had in the past month. Can you identify some of their cultural beliefs?