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.





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A handy reference guide!

CULTURAL SENSITIVITY:
A Guidebook for Health Care Professionals
, 2nd edition


NEW EDITION!

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, published by Joint Commission Resources, has been updated and expanded.

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Online Tutorial on Culture and Health

Developed by Geri-Ann Galanti

Designed for medical students and residents, but can be used by any interested healthcare professionals. Looks at Stereotypes vs. Generalizations; Dimensions of Culture; the 4 C's of Culture; Time Orientation; Removing Life Support; and Revealing a Fatal Diagnosis. Developed as part of a grant through the UC Schools of Medicine entitled "Statewide Initiative to Disseminate an End-of-Life Curriculum" funded through the National Cancer Institute. Each segment is 3-15 minutes long.

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E-Learning Course
on
Culture and Healthcare
9 units of CME
Offered through PerforMax3


Developed by Geri-Ann Galanti

Designed for any professional who cares for patients- physicians, nurses, assistants, pharmacists, physical therapists, etc.

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Orienting Foreign-Born
Nurses to Work Effectively in American Hospitals:
A Training Manual for Health Educators
NEW!

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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The 4 C's of Culture: A Mnemonic for Healthcare Professionals

A simple way for healthcare professionals to remember the questions to ask to get at the patient's perspective. They are a key to providing culturally responsive, patient-centered care.

The 4 C's of Culture:
Spanish Version

Un modelo para la entrevista clínica culturalmente competente:
“ The 4 C´s of Culture / PCCP”

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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. They also have handbooks on Individuals with Disabilities and Women's Health. They focus 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 free (other than shipping & handling) copies, use the online form.

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 CRM learning. Or call 1-800-421-0833.

Note: I served as a consultant on the film and wrote the Leader's Guide.

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 order form

 

Multicultural Health Series
10 vignettes, 6-11 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.

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 order form


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.


Silent Beats

A short (5:41), powerful video about stereotyping, posted on YouTube. NEW

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).

Pediatrics

Nursing

General Medicine

Slides for presentation on Racial and Cultural Disparities in Healthcare (PDF file only)

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.

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