Florida National University HSA-3412 Cultural Diversity in Health Care: Week 2 Chapters 4 & 5 Objective: To judgmentally reproduce your understanding of the readings and your skill to apply them to your Health care Setting. ASSIGNMENT GUIDELINES (10%): Students will critically inspect the readings from Chapter 4 & 5 in your textbook. This assignment is intended to help you assessment, examination, and apply the readings to your Health Care setting as well as become the foundation for all of your outstanding assignments. You are requirement to read the PowerPoint Presentation assigned for week 2 and develop a 2-3page paper reproducing your understanding and capacity to apply the readings to your Health Care Setting. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA format when referring to the selected articles and include a reference page. EACH PAPER SHOULD INCLUDE THE FOLLOWING: 1. Introduction (25%) Arrange for a brief summary of the meaning (not a description) of each Chapter and articles you read, in your own words. 2. Your Critique (50%) a. Answer Review: Questions 1 to 4 in your textbook page 129 b. Answer Review: Questions 1 to 4 in your textbook page 154 Please you must submit your answers in the document. 3. Conclusion (15%) Briefly recapitulate your thoughts & deduction to your assessment of the PowerPoint Presentations and Chapter you read. How did these PPP and Chapters influence your thoughts on Diversity within the United States and Cultural Adaptation? Evaluation will be based on how clearly you respond to the above, in particular: a) The clarity with which you critique the articles; b) The depth, scope, and organization of your paper; and, c) Your conclusions, including a description of the impact of these articles and Chapters on any Health Care Setting. ASSIGNMENT DUE DATE: The assignment is to be electronically posted in the Assignments Link on Blackboard no later than noon on Sunday, May 15, 2016. ASSIGNMENT RUBRICS Assignments Guidelines Introduction Your Answers Review Conclusion Total 10 Points 25 Points 50 Points 15 Points 100 points ASSIGNMENT GRADING SYSTEM A B+ B C+ C D F Dr. Gisela LLamas 90% - 100% 85% - 89% 80% - 84% 75% - 79% 70% - 74% 60% - 69% 50% - 59% Or less. 10% 25% 50% 15% 100% Chapter 4 Religion, Rituals, and Health Overview of Chapter Topics Introduction: Religion, spirituality, and ritual Religion in the U.S. Religion and health behaviors - Effect of religion on health-related behaviors - Religion and health outcomes - Religion and medical decisions Rituals in relation to health practices Case Study: Cystic fibrosis in a Hasidic Jewish patient Religion, Spirituality, and Ritual There is considerable overlap between religion and spirituality. Religion: a belief in and respect for a supernatural power or powers, which is regarded as creator and governor of the universe, and a personal or institutionalized system grounded in such a belief or worship Spirituality: the life force within each of us, and it refers to an individual's attempt to find meaning and purpose in life Religion, Spirituality, and Ritual Religion is more associated with behaviors that can be quantified than the more inchoate term, spirituality. Religion can be categorized by denomination, so there is more agreement about the meaning of the term, and it can be more easily quantified (i.e., place of worship) Similar overlap exists between religion and ritual. - Religion may include established rituals, but not all rituals are associated with a specific religion. - Consequently, this chapter examines the relationship between ritual and health separately from the relationship between religion and health. Religion in the U.S. In 1999, 95% of population in U.S. reported a belief in God or higher power. In a 2005 study, 57% of those queried stated that religion is very important in their lives, while some 28% stated that it is fairly important. Since 1992, studies have found consistent rates of attendance at religious places of worship. Religion and ethnicity may be loosely linked, but a person's religious affiliation should not be assumed based on his/her ethnicity. Religion and Health Behaviors Lifestyle is single most prominent influence over health today. People with religious ties have been shown to follow healthier behavioral patterns than the nonreligious related to - Wider networks of social support than does a strictly secular life - Social networks are often key to coping with life stress so improved coping mechanisms - Proscribed behaviors (i.e., no alcohol consumption or premarital sex) Religion and Health Behaviors Dietary practices with possible effects on health - Prohibition or restriction of consumption of animal products and beverages - Fasting - Prohibition or restriction of use of stimulants and depressants because of addictive properties Some religions incorporate the use of stimulants or depressants into their ceremonies Religious practice may correlate with positive health behaviors generally, as well as with reduced rates of depression and higher rates of marital stability Religion and Health Behaviors Religion thought to correlate to positive outcomes with respect to: - - - - - - - - - - - Hypertension Mortality/longevity Depression Suicide Promiscuous sexual behavior Drug and alcohol use Delinquency General feelings of well-being Hope/purpose/meaning in life Self-esteem Educational attainment Religion and Health Outcomes Religion also can harm health - Sometimes used to justify hatred, aggression, and prejudice - Can be judgmental, alienating, exclusive - Can cause feeling of religious guilt or feeling of failure to meet religious expectations - May restrict health care services because belief that health is in God's hands Religion and Medical Decisions Beginning of life decisions - Abortion: Opposed or strictly limited by many religions (i.e., health of the mother is at risk if pregnancy continued; child would be born with a disability that will cause suffering; rape; incest) - Birth control usage: Varying methods approved or strongly opposed by certain religions; some religions permit hormonal methods but not the methods that block or destroy sperm Religion and Medical Decisions End of life decisions - Religious belief may influence decisions to accept/reject optional treatments to prolong life at the end i.e., respirators, organ transplants, feeding tubes Religion and Medical Decisions End of life decisions Organ donation: perspective is changing some now view it an act of compassion; related to belief in resurrection Euthanasia: the act or practice of ending life of someone who is suffering from a terminal illness or incurable condition by lethal injection or suspension of medical treatment - Opposed when viewed as murder or suicide or that it will damage karma (states that one must show respect for preservation of life) - Some see as an act of compassion and concern for dignity Religion and Medical Decisions End of life decisions Use of advance directives for end of life care Advanced directives are legal documents that enable a person to convey his or her decisions about care ahead of time Include information about use of life-sustaining equipment, artificial hydration and nutrition (tube feeding), resuscitation, organ donation, comfort care Concerns related to appointing one person as the decision maker in collectivists cultures, person undergoing needless suffering, and if you discuss it, it will happen Ritual in Relation to Health Practices Ritual: a set of actions that usually are very structured and have symbolic meaning or value May be performed on certain occasions, at regular intervals, or at discretion of individuals or communities; held in private or public Tied to numerous activities and events i.e., births, deaths, holidays, club meetings, etc. Many rituals in health care settings i.e., being on time for appointments, how people are addressed, where patient's sit Ritual in Relation to Health Practices Objects as rituals (i.e., amulets, bracelets, statues, crosses) Importance of shrines in ritual activities (many are for health and healing) Rituals involving animal sacrifice (done to build and maintain personal relationship with a spirit) Birth rituals (i.e., food restrictions, silent birth, how placenta is discarded) Death rituals (how and when the body is disposed of, prayer, dress, use of flowers) Summary Religion and spirituality play a major role in people's lives and in their health decisions and behaviors. It has been shown to improve health, but also can contribute to health problems Impacts medical decisions Many rituals are related to health and some are tied to specific religions . Chapter 5 Multicultural Health: Legal and Ethical Impacts Overview of Chapter Topics The health care-related-functions of government in the U.S. Laws affecting cultural practices and health Legal protections for ethnic minorities - General history - Recent developments targeting minority health care Ethics in relation to health care Case Study: The distraught family The health care-related-functions of government in the U.S. United States Constitution is the source for all law in the country - Describes structure and function of government and ensures that government does not intrude upon fundamental rights of U.S. citizens - Fundamental rights are in the first 10 amendments, collectively known as the Bill of Rights - Included are right to free speech, exercise of religion, and to privacy The health care-related-functions of government in the U.S. United States Constitution is the source for all law in the country - The fundamental right to engage in practices or rituals that arise from cultural or ethnic origins does not existmany are protected if they are considered religious or private To impose a fundamental right government must have compelling reason i.e., to protect welfare of citizens The government provides protection for cultural groups from discrimination on health care, and employment Laws affecting Cultural Practices and Health Many cultures have traditions and practices that involve health and healing Those practices may conflict with state or federal laws Unlicensed practicesunlawful to engage in the provision of health care services with a license; problematic when healers apply healing practices e.g. midwives, use of herbs, curanderos Use of ethnic remediesare subject to government oversight and regulation to ensure safety i.e., herbs, botanicals, and other folk remedies are often not approved by FDA Legal Protections for Ethnic Minorities General history - Segregation and discrimination existed in health care i.e., minority physicians denied hospital privileges - Court rulings and Federal laws favoring \"separate but equal\" treatment for minorities (Plessy, 1896; Hill-Burton Act, 1946)separate hospital facilities could be made for certain populations - Outlawing of the separate-but-equal approach (Simkins decision, 1964) led to the elimination of segregated health care and made separate but equal hospitals illegal Legal Protections for Ethnic Minorities Federal law and court rulings focused on antidiscrimination in health care services - Title VI of Civil Rights Act of 1064, which: Banned discrimination in use of Federal funds Authorized Federal agencies to establish nondiscrimination standards Provided for enforcement by withholding funds or \"any other means authorized by law\" Legal Protections for Ethnic Minorities Title VI of Civil Rights Act of 1964, which: Precludes discrimination on race, color, or national origin Recipients of federal may not discriminate including - Denying services, financial aid, or other benefits - Providing a different service or other benefit - Segregate or separately treat individuals Legal Protections for Ethnic Minorities Establishment of Department of Health and Humans Services (DHHS) and its Office of Civil Rights (OCR), which is responsible for enforcement of the Civil Rights Act Legal Protections for Ethnic Minorities Federal law and court rulings focused on antidiscrimination in health care services - Supreme court decisions defining scope of antidiscrimination protections and limits of 1st Amendment protection of religious practices Goldman (1986) Al-Khazraji (1987) Legal Protections for Ethnic Minorities Federal law and court rulings focused on antidiscrimination in health care services - Recent amendment to the 1946 Hill-Burton Act Mandated nondiscriminatory care by recipients of Federal funds - Subsequently, new DHHS regulations were established to ensure compliance with new amendment. Legal Protections for Ethnic Minorities Federal law and court rulings focused on antidiscrimination in health care services - Executive order 16166 (2000), entitled \"Improving Access to Services for Persons with Limited English Proficiency\" Goal: To eliminate English competency as a barrier to use of Federally assisted programs and to improve access to care - Subsequently DHHS regulations Defined \"Limited English Proficiency\" (LEP) Required recipients of Federal funds to take reasonable actions to ensure that LEP individuals have access to Federally funded programs and services Legal Protections for Ethnic Minorities Federal law and court rulings focused on antidiscrimination in health care services - Promulgation by DHHS of national standards for Culturally and Linguistically Appropriate Services (CLAS) in health care - The 14 CLAS standards address culturally competent care, language access services, and organizational support for cultural competence - Federal and state governments have begun addressing the need for multiculturalism though other laws and standards Legal Protections for Ethnic Minorities JCAHO's 2007 addition of CLAS standards for the evaluation/accreditation of U.S. health care organizations New CLAS standards included: - Respecting individual values and beliefs - Providing appropriate communication, including interpretive services - Providing appropriate informed consent - Providing conducive end-of-life care - Ensuring equality in the standard of care and in staff competence Ethics in Relation to Health Care Ethical thinking - Ethics are concerned with moral conduct and judgment; it is a way of understanding morality - Morality involves traditions and beliefs about human conduct and right and wrong - Values are personal beliefs about what is true or appropriate behavior; not all values are moral - Can be used to mediate conflicts between purely personal values and wider considerations of morality - Can be used to mediate conflicts between moral considerations and legally mandated actions or standards Ethics in Relation to Health Care Basic ethical principles include: - Respect for the rights of others, regardless of cultural, gender, religious, or racial differences - Autonomy, embodying the right of selfdetermination Includes the right to choose or not to choose and the right to be informed or to choose not to be informed Ethics in Relation to Health Care Basic ethical principles include: - Veracity (truthfulness) and fidelity (faithfulness in fulfilling commitments) - Nonmaleficence, the principle that health practitioners should do no harm - Beneficence, the imperative to do good or to eliminate that which is harmful - Justice, the principle that all people should be treated fairly and with equal consideration All of these principles have crucial implications for health care in a multicultural setting Summary Many cultural practices are impacted by legal and ethical principles. Protection of ethnic minorities from discrimination in health care did not begin until 1960s. New laws continue to be developed i.e., LEP \f\f