Are you interested in learning more about cultural diversity in health care?
If so, I suggest you read my book. I focus on case studies of actual cultural conflicts with explanations of why they occurred and what could be done to achieve cultural competency. Click on the links near the top of the page to go directly to a specific section.
4th edition available August 30, 2008
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A handy reference guide!
CULTURAL SENSITIVITY:
A Guidebook for Health Care Professionals
(Click on link, then type "Cultural Sensitivity" in the Product Search box.)
UPDATED!
Written by Geri-Ann Galanti
A handy pocket reference guide to the important principles underlying culturally competent health care. Provides easy access to potential patient behaviors and beliefs that impact your success in providing care.
This guidebook has been updated and expanded. It is now being published by Joint Commission Resources.
**********************************************E-Learning Course
on
Culture and Healthcare
3 units of CME
Developed by Geri-Ann GalantiDesigned for any professional who cares for patients- physicians, nurses, assistants, pharmacists, physical therapists, etc.
Written by Geri-Ann Galanti
A user-friendly training manual which provides everything you need to help foreign-born nurses make a successful transition to an American health care environment. It
covers four major areas:
• The Role of the Registered Nurse
• Improving Cultural Communication
• Working with Patients
• Working with Multicultural Staff
Each section integrates information with an array of exercises and activities, such as case studies and role-plays to help with application.
Also included is a set of 119 PowerPoint slides to accompany your presentation.
To see more, download this pdf sample.
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65 Tips for Foreign-Born Nurses Working in American Hospitals
Written by Geri-Ann Galanti
This short booklet was designed to enable nurses to get useful information easily and quickly in order to successfully adapt to their environment. It is divided into seven categories: Physician/Nurse Relationships, Nurse/Nurse Relationships, Nurse and Patient, Role of the Nurse, American Culture and Values, Understanding (Anglo) American Families, American Communication Patterns and Pain Management. There is also a list of resources in the back of the booklet to support a nurse’s ongoing education.
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Other Recommended Readings
General
Andrews, M.M. and J.S. Boyle, eds. (1999) Transcultural Concepts in Nursing Care, 3rd edition. New York: Lippincott.
Gardenswartz, L. and A. Rowe (1998) Managing Diversity in Health Care. San Francisco: Jossey-Bass Publishers.
Giger, J.N. and R.E. Davidhizar, eds. (1999) Transcultural Nursing: Assessment and Intervention. St. Louis: Mosby.
Gropper, R.C. (1996) Culture and the Clinical Encounter. Yarmouth, ME: Intercultural Press, Inc.
Lipson, J.G. and
S.L. Dibble, eds. (2005) Culture
and Clinical Care. San Francisco: UCSF Nursing Press.
Salimbene,
S. (2005) What Language
Does Your Patient Hurt In? A Practical Guide to Culturally Competent
Patient Care. Amherst, MA: Diversity Resources,
Inc.
Spector, R. (2000) Cultural Diversity in Health and Illness, 5th edition. Upper Saddle River, NJ: Prentice Hall.
The Western Journal of Medicine (December, 1983) Volume 139, No. 6. Special Issue: Cross-Cultural Medicine.
The Western Journal of Medicine (September, 1992) Volume 157, No. 3. Special Issue: Cross-Cultural Medicine--A Decade Later.
Specific Ethnic Groups
Fadiman, A. (1997) The Spirit Catches You and You Fall Down. New York: Farrar, Straus and Giroux. (Hmong)
Hammerschlag, C.A. (1988) The Dancing Healers: A Doctor's Journey of Healing with Native Americans. San Francisco: Harper & Row.
Ohnuki-Tierney, E. (1984) Illness and Culture in Contemporary Japan. Cambridge: Cambridge University Press.
Payer, L. (1996) Medicine and Culture: Varieties of Treatment in the United States, England, West Germany, and France. New York: Henry Holt & Co.
Sheikh, A. and A.R. Gatrad, eds. (2000) Caring for Muslim Patients. Oxford: Radcliffe Medical Press. [See review I wrote for BMJ]
Snow, L.F. (1993) Walkin' Over Medicine. Boulder, CO: Westview Press. (African Americans)
Kaiser Handbooks
Provider's Handbook Series on Culturally Competent Care provides an
overview of cultural
and epidemiological characteristics of the following groups: Latino;
African American; Asian and Pacific
Islander; and Lesbian, Gay, Bisexual and
Transgendered. It focuses on
general aspects of each group that affect health care utilization,
presenting background information and health care statistics that can
help providers become even more sensitive, responsive and knowledgeable
about diverse population. To obtain
copy, contact the National Diversity Hotline at 510-271-6663.
Or write to:
Kaiser Permanente, National Diversity Department, One Kaiser Plaza, 22 Lakeside, Oakland, CA 94612.
Other excellent books
These books do not have a cultural focus, but are related to competent
and compassionate health care delivery. They are books I would recommend
that all health care professionals read.
Callanan, M. and P.Kelley
(1992) Final
Gifts: Understanding the Special Awareness, Needs,
and Communications of the Dying. New York: Bantam.
Woods, Michael S. (2004) Healing
Words: The Power of Apology in Medicine.
Oak Park, IL: Doctors in Touch.
Recommended
Films
Patient
Diversity: Beyond the Vital Signs
This comprehensive training program from CRM Learning features a 20-minute
video and a Leader's Guide with exercises and role-plays for 2-4 hours
worth of training on the topic of cultural diversity in healthcare. The
patients include:
A Mexican man whose
loud post-operative suffering is not taken seriously by the nurse,
who stereotypes him as a typical "expressive" Mexican. His pain, however,
is real, and due to internal hemorrhaging. It serves as a reminder not to stereotype patients.
A Cambodian boy is brought in covered with welts;
a traditional
healing remedy (coining) is mistakenly thought to be child
abuse.
An Hispanic woman brings in
her infant because she believes one of the nurses gave her baby the “evil
eye.”
An African American woman refuses treatment because she believes God is
punishing her for a past transgression. A culturally compentent nurse
succeeds in changing her mind by communicating though the patient's belief
system.
An elderly Chinese patient's wife rejects the hospital food because it is the wrong balance of yin and yang.
For more information, go to www.crmlearning.com. Or call 1-800-421-0833.
Note:
I served as a consultant on the film and wrote the Leader's Guide.
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Kaiser Films
Kaiser Permanente's award winning cultural issues videos were produced by Kaiser Permanente's MultiMedia Communications and the Educational Theatre Program's CareActors, M. Jean Gilbert, Project Director, Jo Ann Lesser, Producer. The project was jointly funded by Kaiser Permanente and The California Endowment. Now available in both video and DVD format.
Cultural
Issues in the Clinical Setting-Series A and B
The brief but dramatic vignettes are each
accompanied by support materials for facilitators and participants which
will be sent electronically and are included in the nominal price. The
vignettes raise numerous issues around differing health beliefs and practices,
conflicting values, stereotyping, overt and covert prejudices, and language
barriers. The video is 70 minutes long and contains 10 vignettes.
Series
A:
Diabetic Compliance: Latino. Two versions of an interview with a
non-English-speaking, non-compliant diabetic Hispanic woman. The
first uses a family member
as the interpreter and is an example of how not to handle an encounter.
The second uses a professional interpreter and goes much better. It’s
a good example of why professional interpreters are important.
Sickle-Cell Case in the E.R. An African American adolescent is in crisis
and needs pain medication; the E.R. staff is not so sure. A good example
of stereotyping.
Pediatric Asthma: A Middle-Eastern doctor and an aggressive mother tangle
over the care of a young girl...a values clash. The second part of the
segment is a good example of how foreign physicians’ presentation
of self may be misinterpreted by Americans.
A Somatic Complaint: Long buried painful memories of an Asian woman manifest
in diffuse symptoms that are not well understood by this physician. A
good example of how Asians may somaticize psychological problems into
physical complaints.
A Gay Adolescent: An adolescent football player comes out to his family
doctor. The doctor deals with the situation both knowledgeably and sensitively.
Series B: Birthing Issues
Goes through a day in the life of a young OB/Gyn physician coping with
a diverse group of patients. Good advice from another, more experienced
physician is at first spurned then sought as the doctor is confronted
by special needs and circumstances.
Lesbian Parents: The physician is caught off-guard when she learns that
the two women before her are both the prospective parents and have some
special concerns.
The Hmong Way: The physician is startled when young woman's mother wishes to
incorporate unusual birthing practices in the birthing care of her pregnant daughter,
including keeping the placenta.
A Middle Eastern Dilemma: A conversation between the more experienced physician
and one of her Middle Eastern patients reveals conflicts and familial concerns
around acculturation in an immigrant family.
A Big Baby is Coming: A non-English speaking woman from Mexico is delivering
a very large baby with macrosomia. She is diabetic and has lost several babies
at birth. Her husband is very uncomfortable in the labor room and a nurse reveals
her tendency to stereotype through prejudicial remarks.
A Circumcised Somali Mother in Labor: A by now tired and concerned
physician discovers that the woman presenting for childbirth, having had no prenatal
care,
must have her vaginal opening enlarged in the presence of thick scar tissue or
have
a C-section.
Download video
order form
Download
DVD order form NEW!
Multicultural
Health Series 2
Four vignettes, 8-1/2 to 10 minutes each
Walking in Beauty:
Navaho beliefs about illness & curing.
The case focuses on a Navaho man with cancer. It emphasizes both aspects of communication
and of world view. His understanding of the cause of his disease and how it should
be treated are very different from those of biomedicine.
Day of Rest: The Jewish Sabbath
An orthodox Jewish man brings his wife into the hospital to deliver a baby on
the Sabbath. The segment focuses on the conflicts he has with the nurses due
to his religious beliefs.
Changes:
Foreign Physicians
An older, Anglo American man comes into the clinic for a check-up. He’s
not happy to find that a young, female, East Indian physician with a rather
heavy accent has replaced his regular doctor of 20 years. It is a good example
for foreign-born physicians of how to deal with prejudice on the part of patients.
Voice Inside the Phone: Using the Interpreter Line
Vignette illustrates the use of the language line service for interpreting
in a medical setting. The physician is skeptical at first, but finds it very
easy and helpful in treating the young son of an Armenian woman.
Download
video order form
Download
DVD order form (contains Series 2 & 3) NEW!
Multicultural
Health Series 3
Six vignettes, 6-11 minutes each.
Rebirth:
End of Life.
Dr. Jerry Mitchell empathically assists an ethnic Chinese
family as
they come to terms with the unexpected
death of their 22 year-old daughter. He benefits from a “cultural consult” with
a Buddhist colleague.
Pocketful of Miracles: Alternative Medicine/Literacy Issues.
Dr. Funaki is surprised to learn that his patient from Colombia is using
alternative
medicines
along with her prescribed medication and also finds out that she can’t
read her prescription labels even though they are in Spanish.
Proof: Domestic Violence.
Nurse Singh brings suspicions
of domestic violence in a South Asian family to the attention of Physician
Assistant, Eliza Polanco.
Suspicions are confirmed when the patient finally whispers a request for
help.
Lupe's Dilemma: Sexually Transmitted Disease. Lupe Pena
is pregnant and infected for the second time with chlamydia. Physician Assistant
Ernie Walker
helps her come up with a safe, family-supported way to get her partner to
come in for treatment.
Lost Opportunities: Mistrust and Denial.
Roy Turner, an
African American patient who came to the emergency room with a heart attack,
is finally coming in
for a follow-up visit in cardiology. Dr. Ryan provides appropriate clinical
information
and education, but cultural and economic barriers are ignored; trust and
rapport are never achieved.
Between Two Worlds: Refugees Confronting the American Medical
System.
A care team comes to understand the unique concerns and sacrifices
made by the Rhamatis
in fleeing their native Afghanistan. The couple leaves this visit reassured
that they will receive ongoing care in a safe, confidential, and welcoming
environment.
Download video order
form
Download
DVD order form (contains Series 2 & 3) NEW!
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Worlds
Apart
A
Four-Part Series on Cross-Cultural Healthcare by Maren Grainger-Monsen,
MD, and Julia Haslett, Stanford University, Center for Biomedical
Ethics.
Contains 4 video documentaries, each highlighting a different ethnic
group, disease, and cultural issue. Comes with an excellent facilitator’s
guide. Videos range from 10-14 minutes each. Topics covered are:
• Mohammad: An Afghani Muslim man who refuses chemotherapy for
stomach cancer due to religious reasons. Addresses issues of language
barriers.
• Justine: A young Laotian girl with Atrial Septal
Defect whose grandmother fears that a scar left by surgery to close the
hole will
mark her in
successive
lifetimes. Addresses the issue of various explanatory models.
• Robert: An African American man with End Stage Renal Disease
who is awaiting a kidney transplant.
Addresses issues of racial/ethnic disparities
in medical care.
• Alicia: A Puerto Rican woman with diabetes, hypertension, and
asthma. Adresses issues of non-adherence to medical regimes and use of
traditional
remedies.
Available from Fanlight Productions.
PowerPoint Presentations
Below are PowerPoint presentations by M. Jean Gilbert and/or Geri-Ann Galanti, created for physicians as part of a pilot project entitled "Implementing CLAS Standards: Designing, Implementing & Evaluating 3-Tiered Cultural Competency Training." Project is funded by The California Endowment and headed by Miya Iwataki, Director, Office of Diversity Programs, LA County Department of Health Services.
OB-Gyn
There are QuickTime
videos embedded in this PowerPoint. The videos are from Kaiser Permanente's
Multicultural Health Series. They will not play when you download this
file. However, you can purchase them at minimal cost from Kaiser
(Cultural Issues in the Clinical Setting, Series B).
Other Resources
CHISPA
(Caring for HISpanic PAtients interactively)
A
technology based approach for the acquisition of cultural and linguistic
competencies for the multicultural workplace. It is designed to teach
Allied Health professionals how to approach Hispanic patients in a culturally
appropriate manner. CHISPA consists of three components: Interactive CD,
Website, Train the Trainer and Activities Manual. For further information,
go to http://itdc.lbcc.edu/chispa/about.html
Also see the Embanet
Success Letter and Nurse
Village for more information about the program.
Note:
I served as a consultant on the project and wrote the Trainer's Manual.
DIVERSOPHYTM
Interactive training game is designed for use in the continuing education of physicians, nurses, non-medical front-line support staff and administrators in healthcare organizations and for integration into the Nursing and Medical school curriculums. For more information and additional resources, contact:
Inter-Face International
tel. (815)282-2433
CLAStalk
An e-mail discussion group
sponsored by Resources for Cross Cultural Health Care and the DiversityRx
website (www.diversityRx.org). Participants
can raise issues, ask questions, share information and resources and
network with each other around topics related to the design, delivery
and evaluation of culturally and linguistically appropriate services
(CLAS) in health care.
