Diversity Infusion Banner with navigation

HCR 230, Culture and Health
Faculty Member: Deanette Devereaux, RN, MS
Phone Number: 623-845-3212
College: Glendale Community College
Credits: 3

 

 OFFICIAL COURSE DESCRIPTION: TOP
Relationship between cultures of diverse groups and health/illness. Emphasis on cross-cultural communication, including awareness of own cultural influences and indigenous and complementary healing practices.

ABSTRACT OF DIVERSITY INFUSION WITHIN COURSE:TOP
: This course expands on the original content by focusing on the global aspects of heritage, health, illness and healing. The world is presented as a community in order for students to increase their awareness of the internationalization of health care needs and services. Students are offered an opportunity to see beyond their limited world views to a whole far greater than themselves. This global exchange occurs through direct verbal one-on-one encounters, via internet, exploration of literature, geographic and demographic research and other didactic and experiential assignments.

COURSE TEXTBOOK:TOP
Spector, R. (2000). Cultural diversity in health and illness. Upper Saddle River, NJ: Prentice-Hall.
Purnell, L. & Paulanka, B. (1998). Transcultural health care: A culturally competent approach. F.A. Davis: Philadelphia.

PRESENTATION OF DIVERSITY-RELATED MATERIAL:TOP
Weekly lecture topics covered diversity content related to culture, health or related topic. Lectures were in more of an informed discourse style with students participating equally and bringing in required items that added to the topic of the day; i.e., magico-religious item or sharing a health practice they had grown up using. Powerpoint was not utilized in this class. Written materials included: the required textbooks, handouts and readings from the classic text: “Culture, Curers and Contagion.” Visible aspects of multi-culturalism were introduced in the student’s group presentations through the artifacts they shared, music they played from other countries during the presentations, a film shown depicting the Bosnian-Serbian conflict from the people’s perspective, a film on shamanistic healing , book reports depicting both ethnic and non-ethnic subgroup’s experiences. Guest speakers were a sociologist who was an expert on Gypsy culture and a Japanese-American nurse whose mother was a nurse following the Hiroshima bombing. Several attempts were made to find a curandera(o) to speak to the class, but
this did not materialize.

Description of Student Assignments/Activities Related to Diversity:
Instruction: Descriptions for the following assignments and activities are available in the attached syllabus for the course. In class discussions were weekly, on the topic being studied as well as personal value systems and biases. Students collaborated and worked in groups for the majority of the course requirements; i.e., presentations. There were no individual class presentations—only the individual contributions toward the final group projects.

All students interviewed one representative member of a major ethnic group and a sub-culture. The ethnic group assessment was was written and submitted. Self-awareness questionnaires included in-class values clarification assignments, case studies, and a heritage assessment questionnaire. Students attended two diversity-related events with the instructor: teacher from China presenting on the status of women in present day China, noted speaker, lawyer and civil rights activist who discussed the future of race relations in the U.S. and Native American film writer and Executive Director Honor Forums lecture. The capstone event in the course is the multi-cultural feast where students bring dishes to serve that are representative of their own ethnic backgrounds or of the group they have studied for their
presentation. The students are required to interview an adult female member of their family for a heritage review and to obtain a cultural assessmentof a member of a major ethnic group, other than the one they are a member of.

This course explores the relationship between various components of culture and the dynamics of health and illness, and focuses on concepts of health and illness in non-U.S. countries (e.g. Mexico, China, Latin American countries) as well as cultures within the U.S. (immigrants, Native Americans, African Americans, etc.). The contributions of traditional systems of medicine (e.g. Mexico, China) to the Western health care delivery system are examined along with the reasons why Western health care providers often do not meet minority culture consumers? health care expectations. Students analyze their own feelings, beliefs and values in relation to their own culture and will utilize a generic framework to deliver culture-specific care to diverse groups. Ways to overcome intercultural communication barriers are also explored. This course has been approved by the ASU General Studies Council, and fulfills the global awareness (G) requirement.

COURSE OBJECTIVES:
At the completion of this course the student will be able to:
1. Evaluate the importance of the role culture plays in determining how different people perceive and shape their world.
2. Identify cultural influences on one’s own beliefs and values.
3. Describe the impact of US and non-U.S. cultural definitions of health, illness and disease causation on an individual’s health maintenance practices and response to healers.
4. Compare and contrast healing and treatment methods of various cultures with those of the Western health care delivery system and assess their influence upon that system.
5. Identify cultural strengths and barriers that influence utilization of health care services.
6. Explore variations in family structure and dynamics across U.S. and non-U.S. cultures.
7. Explore cultural components of the aging process, and dying and death across cultures.
8. Apply models for assessing client cultural orientations, health care expectations, psychosocial structures, language, and communication patterns to individuals from different ethnic groups.
9. Identify strategies for delivery of culture-specific care based on the evaluation of cultural assessment data.

METHODS OF INSTRUCTION & EVALUATION:
Various strategies will be employed, including:
Lecture
Small group discussion/exercises
Community interaction / interviews
Student oral presentations (group)
Poster presentation (group)
Internet assignments

OUTLINE OF CLASS SCHEDULE SHOWING DIVERSITY RELATED SEGMENTS: TOP
TOPICAL OUTLINE:
I. The role culture plays in determining how different people across the globe perceive and shape their world.
• Influence of value orientations
• Identification of differences and similarities across-cultures

II. The role of cultural relativism in health care
• Exploration of concepts of health and illness among cultures within and outside
of the United States
• International migration, acculturation, and assimilation
• Making cross cultural judgements in a culturally diverse environment
• Ethnocentrism and cultural imposition
• Moving from tolerance/intolerance, and acceptance/rejection to dialogue, understanding, and change

III. Cultural definitions of health, illness and disease causation, including how they affect an individual’s health maintenance practices and response to healers.
• Relationship between culture and definitions of health and illness
• Influence of immigration on physical and mental health problems in minority groups

IV. Healing and treatment methods of various cultures; how do they compare with those of the Western health care delivery system; how do they influence the US health care system.

V. The role of cultural strengths and barriers in utilization of health care services
• Cultural attitudes toward time and their affect on the individual’s health maintenance practice and interaction with the dominant health care system
• Ways health care professionals? own prejudices, stereotypes, cultural assumptions and communication patterns can interfere with effective health care delivery in a culturally pluralistic society
• Exploring the health care providers culture and the effect it has on relationships with multi cultural clients
• Communication: interaction styles, utilization of interpreters, recognizing who is involved in communication and decision making
• Influence of language and communication

VI. Variations in family structure and dynamics across cultures.
• Assessing how one’s own assumptions about family structure and family dynamics have been culturally-conditioned
• Factors which determine the value of children to a society

VII. Cultural components of the aging process, dying, and death across cultures.
• Cultural components in the aging process
• Cultural attitudes toward death and how they affect the health care of the terminally ill

VIII. Models for assessing client cultural orientations, health care expectations, psychosocial structures, language, and communication patterns to individuals from different ethnic groups

IX. Assessing the extent to which one’s own beliefs and values have been culturally determined.
• Assessing the extent to which one’s own concepts of health and illness have been culturally determined
• Definition of self and non-self (control/non-control) and how these definitions compare across cultures

X. Strategies for delivery of culture-specific care based on the evaluation of cultural assessment data.
• Developing interpersonal skills in cross-cultural encounters

XI. Showing respect for diverse values and preferences of other individuals and groups.

XII. Participating in interactive learning strategies to become sensitive to, and respectful of the mores and preferences of one’s own culture and those of others, the richness of cultural variations, and the influence of cultural variables on personal and professional interactions.

Date Topics and Objectives
Upon completion of the assigned learning activities the student will have had the opportunity to:
Required Readings & Assignments
Class #1 Introduction to course, syllabus, assignments and Heritage
Assessments; Get Acquainted Exercises
Text: Spector
pp. 78-84; App.
Class #2

General concepts of health and illness; introduction to health assessment tool; health diary analysis guideline sheet
1. Describe fundamental differences between health care provider’s and consumer’s belief systems.
2. Discuss the relationship among an individual’s definition of health, health beliefs and cultural influences and identify how these factors may affect an individual’s perception of health.
3. Explain and examine health belief model, health traditions, and cultural phenomena affecting health from the health care provider perspective and consumer perspective.
4. Explore various definitions of health and conclude with personal definition of health.
5. Explore various definitions of illness and conclude with personal definition of illness.
6. Compare and contrast preventive care and health maintenance.
7. List the two broad goals of Healthy People 2010.
8. Explain the role of public health statistics in determining the health status of the nation.

Text: Spector, Chapter 1 Preface: PP. 1-2
Heritage Tool
Assignment: 1.Bring in
an artifact Jan. 31
2. Heritage
Assessment Due Jan 31
Class #3 Culture defined and described (Culture as more than ethnicity)
1. Complete the Heritage Assessment Tool (Spector, pp. 295-297) Considering the completed Heritage Assessment Tool, decide how closely you identify with your traditional heritage.
3. Define natural folk medicine and magicoreligious folk
medicine.
4. Interview a familial female older adult and collect information regarding health maintenance, protection, and restoration.
5. Compare and contrast familial health practices with personal health maintenance, protection, and restoration.
6. Reanalyze the concepts of health and illness considering familial health practices.
7. Identify and explain similarities and differences in health practices across cultures. Text: Spector, Chapter 2
Video
Assignments:
1. Turn in the Heritage Assessment Tool on yourself
and adult female relative. Collect information regarding health maintenance, protection, and restoration. Be prepared to discuss in class.
Culture: Its effect on the perception of health and illness
1. List the four basic characteristics of culture.
2. Define and describe culture in terms of personal experience and expectation.
3. Analyze theories relating to the Americanization of health and illness beliefs.
4. Define and discuss socialization, acculturation, assimilation, and heritage consistency.
5. List and explain the three major components of heritage consistency.
6. Define and explain the health-care provider’s culture.
7. Define epidemiology.
8. Explain epidemiology’s relationship to illness and disease.
9. Explain the role culture has on an individual's response to pain.
Text: Spector, Chapter 4
 

Class #4
Feb. 7 Introduction to the Purnell Model
1. Define, and identify the components of cultural competence
2. Describe the progression from unconscious incompetence to unconscious competence in relation to culture.
3. Define: worldview, subculture, acculturate, assimilate, transcultural
4. Identify the macroaspects and microaspects of the Purnell Model for Cultural Competence.
5. Describe the twelve domains of the Purnell model.
Purnell Model (Cont.)
1. Identify cultural subcultures that are not based on ethnicity.
2. Form groups to study selected subcultures.
3. Using the Purnell model, develop questions for interviews with cultural subgroups.

Communication:
1. Discuss the process of working with an interpreter.
Compare translator and interpreter.
2. Describe effective techniques for communicating with patients who do not speak English.
3. Describe effective techniques for communicating with patients who speak English as a second language.
4. Describe common errors in communicating with patients who have limited or no English speaking ability.
5. Describe the purpose and process of "back translation."

Class Assign.

Text: Purnell & Paulanka, Chapter 2

Class #5 1. Define values and describe how values influence our health behaviors.
2. Define norms.
3. Define ethnicity.
4. List six functions of values.
5. Analyze how values serve to influence health care providers.
6. Analyze how values serve to influence health care consumers.
7. Compare and contrast the values of health care consumers with the values of health care providers.
8. Define subculture and minority group.
9. Compare and contrast subculture and minority group.
10. Explain major value orientations in the United States.
11. Debate the statement: The United States is a “melting pot” culture.
12. Define worldview.
13. Identify and explain your personal worldview.
14. Explain how worldviews relate directly to culture and health.
15. Describe the process of moving from tolerance/intolerance, and acceptance/rejection to dialogue, understanding, and change Assignment: Values exercises will be conducted in class (2% of course grade)

Barriers to health care delivery
1. Describe historical trends of the health care system in the United States
2. Describe common problems in the US health care delivery system that may be barriers to care
3. Discuss influence of demographics on health care
4. Describe the role of medicine as an institution of social control
5 Describe barriers to health care
6. Identify barriers to healthcare related to the health care providers, including the status of the providers
7. Identify strengths and barriers for selected cultural groups in relation to health care
8. Considering class readings and class discussions determine if health care is a right or privilege.
Text: Spector Chapters 3 & 7
Class #6 Feb. 21 Presentations on non-ethnic culture

 
Class #7
Exam #1 Exams are taken in HTC-1 Rm. 142 Computer Room
 
Class #8

Healing: Natural traditions
1. Define healing.
2. Identify and describe modern healing practices.
3. Identify and describe traditional healing practices derived from one’s heritage.
4. Compare and contrast modern healing practices and traditional healing practices.
5. Discuss and describe common health beliefs and practices prior to World War II.
6. Define and give an example of homeopathic medicine.
7. Define and give an example of osteopathic medicine.
8. Define and give an example of chiropractic healing.
9. Define and give an example of eclectic medicine, hydrotherapy, mesmerism, hypnotism, mind cure, and Christian Science.
10. Determine the role of natural remedies and alternative health care in today’s health care arena.
11. Explain how natural healing is associated with nursing.
Video and/or Guest Lecturer

Text: Spector, Chapter 5
Class #9

Healing: Magicoreligious traditions
1. Distinguish between spiritual and religion
2. Describe rituals which were used by ancient human beings
3. Describe the extension of ancient rituals to today's health practices
4. Describe objects and substances that are used to protect health
5. Describe religious practices that are used to protect health
6. Describe the following forms of healing: herbalists, bone setters, midwives, leeching, witchcraft, religious beliefs, prayers, incantations
7. Identify healing practices that persist today.
8. Compare and contrast the following types of healing: spiritual healing, inner healing, physical healing, deliverance or exorcism, auric healing, pilgrimages.
Video and/or Guest Lecturer

Text: Spector, Chapter 6

1. Bring a magico-religious item to class (1% of course grade)

Class #10

Cultural relativism
1. Define cultural relativism and cultural imposition
2. Distinguish between cultural relativism and ethnocentrism
3. Describe examples of situations in which cultural relativism may become an issue for health care providers.

Discuss ethnic group projects; select groups

 
 
Class #11
April 4 Groupwork on Ethnic Presentations
 
Class #12

African (Black) Americans
1. Explain why socio-economic status may influence the culture of African (Black) Americans.
2. Describe the role of historic problems on the African (Black) community.
3. Define African (Black) American's traditional definitions of health and illness, including how they view death.
4. Define and describe traditional methods of healing among African (Black) Americans--voodoo, healers, eating of starch or clay, religious beliefs and other methods of healing.
5. Define and give examples of current health practices employed by Black Americans to prevent illness by maintaining and protecting health.
6. Define and give examples of current health practices by Black Americans that focus on treating illness and restoring health.
7. List the leading causes of death of African (Black) Americans.
8. Compare current health-care problems of African (Black) Americans with White Americans, conclude why there are differences.
9. Describe African (Black) American health statistics.
10. List and describe physiological problems, skin problems, and hair-care needs that need to be considered when assessing an African (Black) American.
11. Choose appropriate guidelines that can be followed in caring for African (Black) Americans.
12. Explain why an appreciation of African (Black) American culture perception and meaning of health and illness are needed by the nurse.
13. Explain why there is a low number of African (Black) Americans enrolled in health programs or practicing in the health care field. Text: Spector, Chapter 10; Purnell & Paulanka Chapter 3

American Indian, Aleut and Eskimo
1. Describe traditional American Indian definitions of health and illness
2. Describe traditional American Indian beliefs about health, wellness and death.
3. Describe various healing techniques used by traditional American Indian healers.
4. Discuss issues related to morbidity and mortality in the American Indian population.
5. Describe the role of Indian Health Service.
6. Describe American Indian health statistics.
7. Describe cultural and communication issues that may be problematic in health care interactions
8. Discuss issues related to the number of American Indian health care providers.

Texts: Spector, Chapter 8; Purnell & Paulanka Chapter 17
Class #13

Asian
1. Describe the historical aspects of the Chinese-American experience.
2. Describe the concepts of Taoism, the five elements, the holistic concept, and yin and yang, and explain how they relate to the Chinese philosophy of health and illness.
3. Compare the Asian religious teachings of Buddhism, Confucianism, Taoism and Shamanism, and describe how these cultural values may affect the health care experience.
4. Describe traditional methods of prevention and health maintenance.
5. Describe traditional methods of healing and health restoration, including traditional healers, pediatrics, acupuncture, Moxibustion, and herbal remedies.
6. Identify the major health problems of the Asian/Pacific Islander American population in the United States.
7. Describe Asian/Pacific Islander American health statistics.
8. Discuss issues related to the number of Asian/Pacific Islander American health care providers.
9. Explain why environmental conditions may affect the health of a person migrating or immigrating to the United States from Asian countries.
European
1. Describe the demographics of the European American population in the United States.
2. Describe the history of migration for Italian Americans
3. Identify traditional beliefs of Italian Americans related to health and illness.
4. Identify the two genetic diseases commonly seen in Italian Americans.
5. Describe the potential effects of communication and time in the health care environment.
6. Compare and contrast the health and illness beliefs of the German and Polish Americans.
7. Explain why environmental conditions may affect the health of a person migrating or immigrating to the United States from European countries.

Texts: Spector Chapter 9; Purnell & Paulanka Chapters 7, 18
Class #14 Hispanic
1. Define the term Hispanic Americans.
2. Define Chicanos.
3. Define Chicanos traditional definitions of health and illness.
4. Identify and explain the five major categories of the causes of illness among Chicanos.
5. Describe the role religious rituals and folk healers play in the health of Chicanos.
6. Compare and contrast a curandero and physician.
7. Distinguish differences and similarities between factors explaining the continuing belief in curanderismos and your personal health beliefs.
8. Compare and contrast Chicano and Puerto Ricans perceptions of health and illness and use of folk healers and remedies.
9. Explain why environmental conditions may affect the health of a person migrating or immigrating to the United States from Puerto Rico, Cuba or Mexico.
10. Compare and contrast similarities and differences between a Puerto Rican's general progression of seeking health care and your personal progression of seeking health care.
11. Identify barriers experienced by Hispanics seeking health care and develop solutions to minimize these barriers.
12. Describe Hispanic American health statistics.
13. Explain why there is a low number of Americans of Hispanic origin enrolled in health programs or practicing in the health care field.
14. Explain why an appreciation of Americans of Hispanic origin perception and meaning of health and illness is needed by the nurse.
15. Discuss the pros and cons of the use of a midwife.
16. Explain the paradoxical view the medical and public health professions take of the practicing lay midwife.
Texts: Spector Chapter 11;
Purnell & Paulanka: Chapter 16
Class #15 Role of culture with health care providers
1. Identify strategies for delivery of culture-specific care.
MULTI-CULTURAL FEAST
Course wrap-up and evaluations
 
Class #16 May 9 FINAL EXAM HTC1 RM 143
 

SUCCESSES AND DIFFICULTIES ENCOUNTERED: TOP
Instruction: The major difficulty encountered was that I did not have the time over the past two semester to really infuse the course with all of the new ideas I had in mind. For example, one thing I wanted to get going, at least during spring semester, was to have a type of chat room identified so the students could discuss with other pre-nursing students around the world what their experiences were as students and in their respective cultures. In addition, I wanted to have a large number of web sites available for students to use to research international aspects of health and illness.

My suggestions to future applicants is to make your manageable, realistic, and be very clear and specific about your objectives.

STUDENT EVALUATION OF COURSE INFUSED WITH DIVERSITY: TOP
: The standard evaluation form for the course was used. Written responses were as follows:

  • The class was fun and very informative. The class should have a review for the exams.
  • The class is great, a wonderful learning tool for my future, not only in healthcare, but in general. Deanette
    is a fantastic teacher who really enjoys what she does.
  • This comes out in her teaching which makes students. enjoy the class even more. One thing to consider would be to offering the class at different times instead of just one evening class.
  • We never went over anything that we were tested on.
  • Just always doing things that I feel that didn’t pertain to class.
  • Just wish went over material being tested onI could have done the class via internet.
  • Deanette, I really enjoyed this class. Most of all I enjoyed your enthusiasm for teaching. Thanks for a
    great semester.
  • The class was very interesting. I am glad I was able to learn about other ethnic groups
  • .I enjoyed the class because it gave me the opportunity to learn about my own culture (I wasn’t aware I had
    one) as well as other cultures.

RECOMMENDED RESOURCES:TOP

Participant SupportMaricopa Community College Logo For additional information about the Diversity Infusion Program, please contact the Executive Director, Dr. Bonnie A. Gray.  
This site was updated on June 27, 2009.
Feedback regarding this site can be directed to Mary E. Gibbons.
Note disclaimer: The Maricopa County Community College District is an EEO/AA Institution

Link to Diversity Helpline email