Culture and Diversity & Working with LGBTQ Population PDF

**Public Sector Equality Duty** Section 149 of the Equality Act 2010 outlines the Public Sector Equality Duty, which requires public authorities and those exercising public functions to consider equality in their day-to-day operations. **Key Requirements:** - Public authorities and those exerci...

**Public Sector Equality Duty** Section 149 of the Equality Act 2010 outlines the Public Sector Equality Duty, which requires public authorities and those exercising public functions to consider equality in their day-to-day operations. **Key Requirements:** - Public authorities and those exercising public functions must have due regard to: 1. Eliminating discrimination, harassment, victimisation, and other prohibited conduct 2. Advancing equality of opportunity between those who share a protected characteristic and those who do not 3. Fostering good relations between those who share a protected characteristic and those who do not **Advancing Equality of Opportunity:** - Remove or minimise disadvantages related to protected characteristics - Take steps to meet the needs of people with protected characteristics - Encourage participation in public life where it\'s disproportionately low **Fostering Good Relations:** - Tackle prejudice - Promote understanding **Protected Characteristics** The relevant protected characteristics are: - Age - Disability - Gender reassignment - Pregnancy and maternity - Race - Religion or belief - Sex - Sexual orientation **Additional Notes** - Compliance may involve treating some persons more favourably, but this doesn\'t permit otherwise prohibited conduct - For disabled persons, steps must be taken to account for their disabilities - The duty applies to both direct exercise of functions and outsourced services This duty requires active consideration of equality issues in developing policies and making decisions, not just avoiding discrimination. **Guidelines for Implementing Culturally Competent Nursing Care** [Guidelines for Implementing Culturally Competent Nursing Care - Marilyn K. Douglas, Marlene Rosenkoetter, Dula F. Pacquiao, Lynn Clark Callister, Marianne Hattar-Pollara, Jana Lauderdale, Jeri Milstead, Deena Nardi, Larry Purnell, 2014 (sagepub.com)](https://journals.sagepub.com/doi/abs/10.1177/1043659614520998?casa_token=rm0GGARfw1UAAAAA%3A_VYhvLAK0_wsrKnKHkA9-dD9hn_so8Qx3kdRi4rrZyOahIYIltQoqoUZNe_-_q1cSY3k6xG40Vgq&journalCode=tcna) This study focuses on the experiences of Korean immigrant women in the United States who are caring for their elderly parents-in-law. The research employs a qualitative descriptive approach to explore the cultural aspects of this caregiving experience. **Key Findings** **Cultural Expectations**: Korean immigrant women often face significant pressure to care for their parents-in-law due to traditional cultural norms and expectations. **Challenges**: The caregivers encounter various difficulties, including: - Language barriers - Unfamiliarity with the U.S. healthcare system - Balancing work and family responsibilities - Managing relationships with other family members **Coping Strategies**: The women develop various methods to cope with their caregiving duties, such as: - Seeking support from family and friends - Utilizing community resources - Adapting to new cultural contexts **Implications** The study highlights the need for culturally sensitive support services for Korean immigrant caregivers. Healthcare providers and policymakers should consider the unique cultural context and challenges faced by this group when developing interventions and support programs. **Methodology** The research utilized in-depth interviews with Korean immigrant women who were primary caregivers for their parents-in-law. This approach allowed for a detailed exploration of their experiences and perspectives. This study provides valuable insights into the intersection of cultural expectations, immigration, and caregiving responsibilities among Korean immigrant women in the United States. **Key Components of Cultural Competence** Cultural competence in nursing consists of four main components: 1. Awareness of one\'s own cultural worldview 2. Attitudes toward cultural differences 3. Knowledge of different cultural practices and worldviews 4. Cross-cultural skills **Strategies for Developing Cultural Competence** **Self-reflection**: Nurses should engage in self-reflection to identify their own biases, assumptions, and cultural beliefs. **Ongoing education**: Seek cultural education and training opportunities, such as workshops, seminars, and courses on cultural competence and diversity. **Building cultural knowledge**: Educate oneself about the cultural backgrounds, traditions, beliefs, and healthcare practices of served populations. **Effective communication**: Develop cross-cultural communication skills, including active listening, using interpreters when needed, and being mindful of nonverbal cues. **Implementing Culturally Competent Care** - Use terms patients can understand - Ensure medical interpreters are present for patients who speak other languages - Respect patients\' cultural and religious beliefs that may conflict with treatment plans - Recruit healthcare professionals from diverse backgrounds - Analyze patient demographics to identify underserved populations - Form committees to promote and coordinate cultural awareness measures **Organizational Support** Healthcare organizations can support culturally competent care by: 1. Providing cultural competence training programs 2. Allocating resources for interpreters and culturally appropriate materials 3. Creating a diverse workforce 4. Establishing supportive policies and procedures 5. Offering ongoing education and professional development opportunities By implementing these strategies, healthcare providers can enhance patient outcomes, build trust with diverse populations, and promote health equity. **Notes:** ***Culture and Diversity - Christiana Joseph*** Learning objectives: - Explore the concept of culture and diversity. - Establish implications for health care; legal, ethical and clinical - Explore our own attitudes and perceptions (including personal biases) of different groups within society and how these might influence our interactions with individuals or members of that group. - Understand the impact of working with different cultures and diverse individual **Culture** - A shared system of meaning, it derives from common rituals, values and laws, and provides a common lens for perceiving and structuring reality for its members (**Veroff  and Golderberg1995**). - The total of non-biologically inherited patterns of shared experience and behaviour through which personal identity and social structures are attained in each generation in a particular society, whether ethnic group or a nation (Littlewood 1990) Characteristic's of Culture - Culture is neither a static or monolithic phenomenon; that is there may be considerable variation within cultural groups, this variation being affected by variables such as social class, geographic location, or generational status - Culture operates at an unconscious level-unconscious bias - It constructs us and we construct it- it is dynamic - It constructs many of our basic notions; such as self, body, emotions and ideas about health and illness **Malik 2000** Diversity - Diversity is present when there is a mixture of differences in age, religion, culture, gender, ethnicity, education and more amongst a group of people within the same environment. Pros: - Can learn from each others cultures - Reduces ignorance towards other cultures Cons: - Lead to ingroup favouritism which can cause conflict - Can cause conflict due to differing opinions Protected Characteristics - What do you understand by the term 'Protected Characteristics' and what legislation(s) underpins this protection? - Thinking about cultural values, how may this be linked with 'protected characteristics? - Originally came about because of the diversity and to counter conflict that came from this. List has increased over time. - Religious groups discriminating in regards to gender orientation. Legal: Equality Act 2010 [Equality and Human Rights Commission - Protected characteristics](https://www.equalityhumanrights.com/en/equality-act/protected-characteristics) An individual or organisation that provides services to the public must not treat someone worse just because of one or more protected characteristic; - Age - Disability - Gender reassignment - Pregnancy and maternity (which includes breastfeeding) - Race - Religion and belief - Marriage and civil partnership - Sex - Sexual orientation Ethics and Morals - Is there a difference between Ethics and Morals? - Morals is what you believe is right and wrong, whereas ethics are the general agreed beliefs about what is right. 4 Universal Principles - Ethical *Beauchamp, T. L. and Childress, J. F (2001)* - Respect for autonomy - The healthcare provider: assumes the patient has capacity to make rational, informed and voluntary decisions & basis for practice of "informed consent". - Beneficence - The healthcare provider: has an obligation to convey benefits and to help patients to further their legitimate interests. - Non-Maleficence - The healthcare provider: does not intentionally create a harm or injury to the patient, either through acts of commission or omission. - Justice - The healthcare provider: allocates (scarce) resources in a fair way. **Bias** 'Bias is a prejudice in favour of or against one thing, person, or group compared with another usually in a way that's considered to be unfair. Biases may be held by an individual, group, or institution and can have negative or positive consequences.' (*Office of Diversity and Outreach, University of California, 2021*). - Kahneman (2011) distinguishes between two types of thinking i.e. system 1 and system 2. - Unconscious Bias ( Implicit ) -- System 1 type of thinking which we are not aware of (*Greenwald & Krieger, 2006*) - Conscious Bias ( Explicit ) -- System 2 type Unconscious Bias *Why is a conscious appreciation for culture and diversity important?* - To allow and encourage professionals to treat people as individuals and understand their background without incorporating their own bias. Addressing Unconscious/Conscious Bias **A** - Acknowledge **C** - Challenge **T** -- Train ( **iHASCO   Unconscious Bias Training** ) **'P**ay attention to what's actually happening beneath the judgements and assessments **A**cknowledge your own reactions, interpretations, and judgements **U**nderstand the other reactions, interpretations, and judgements that may be possible **S**earch for the most empowering, productive way to deal with the situation **E**xecute your action plan' ( ***Ross, 2014*** ) Implications for mental health - We live in a multicultural society - People who experience discrimination in social or economic contexts have a higher risk of poor mental wellbeing and developing mental health problems; - People may experience inequality in access to, and experience of, and outcomes from services; and - Mental health problems result in a broad range of further inequalities. - Ethnic Minorities suffer poorer health, poorer access and poorer outcomes compared to their white counterparts - Black African women had a mortality rate four times higher than White women in the UK. - There is a significant disproportionate number of ethnic minorities detained under mental health legislation in hospitals in England and Wales -- Black African women were seven times more likely to be detained than White British women. - Gypsies, Travellers and Roma were found to suffer poorer mental health than the rest of the population in Britain. They were also more likely to suffer from anxiety and depression. Intersectionality - Intersectionality broadly derives from the premise that people have multiple, shifting and layered identities, - Recognising that when two or more elements of an individual's identity (including age, disability, gender and gender identity, race, religion or belief, and sexual orientation) simultaneously interact, - They become inseparable and this, coupled with social determinants, economic status and broader context, create a unique and distinct experience. \"Intersectionality is a framework for conceptualizing a person, group of people, or social problem as affected by a number of discriminations and disadvantages. It takes into account people's overlapping identities and experiences in order to understand the complexity of prejudices they face.\" - YW Boston E.g. Black African women were seven times for likely to be detained under mental health legislation than White British women. *What are the elements of intersectionality in this scenario?* Practitioners' Skills *(Cornah 2006)* - Listen to the person and engage in a dialogue - Self awareness - Be sensitive to religious issues - Avoid pathologising, dismissing or ignoring the religious or spiritual experiences of service users. - Explore the explanatory model of the patient and clinician - Take risks, don't be afraid to ask - Show a level of curiosity; "want to" not "have to" - Help service users identify those aspects of their lives that provide them with meaning, hope, value and purpose. - Provide good access to relevant and appropriate religious and spiritual leaders. - Need to be educated, use of "culture broker". - Read about culture. - Look for the difference that makes a difference - Take an intersectional approach Practitioners' Barriers *Cornah 2006* - Lack of time - Concern about stepping outside one's area of expertise - Discomfort with the subject - Worries about imposing beliefs on the service user - Lack of interest or awareness - Lack of training Service Users Barriers *Walls and Sashidharan (2003)* - Interest by Ethnic Minority communities - Availability of BAME staff within mental health services - Language difficulties - Racism of staff - Cultural awareness amongst staff - Lack of government interest Contributory Factors *Helman (2000) Islam et al 2015.* - Services are perceived as culturally insensitive and discriminatory. - Experience and expectation of racist mistreatment discouraging early access. - Mental health problems remains a taboo for a lot of BAME communities. - Health and illness belief models. ***Therapy with LGBTQ Populations - Dr Alexandra Pilman & Merle Schlief*** Session Overview: 1. Terminology 2. Sexuality and Gender Measures 3. LGBTQ+ People in the UK 4. Mental Health of LGBTQ+ People 5. Explanations of LGBTQ+ Mental Health Inequalities 6. Prevention of LGBTQ+ Mental Health Inequalities 7. Mental Health Care for LGBTQ+ People **Terminology** Gender/Sex Sex/Gender Assigned at birth - Based on biological markers at birth (chromosomes, hormones, reproductive anatomy) - E.g. female, male, intersex Gender (Identity) - Current gender e.g. female, male, non-binary, genderqueer - Pronouns (e.g. she/her, he/him, they/them, he/she/they) Gender Expression - Expression of gender through one's appearance (behaviour, clothing etc.) Gender Trans(gender) - Gender differs from sex/gender assigned at birth - E.g. trans women or men, non-binary or genderqueer (between, beyond, or without gender) Cis(gender) - Gender matches the sex/gender assigned at birth - Often binary: Cis women or cis men Transition Social transition: - Change of name, pronouns, gender expression Physical transition: - Hormone therapy - Surgical interventions *No transition is the same - a person's gender does not depend on their physical or social transition.* Sexuality Sexual attraction - Attraction (or lack thereof) towards certain genders or regardless of gender Sexual behaviour - Based on the gender of a person's sexual partner(s) Sexual orientation - i.e. the sexuality someone identifies with - *Can* be based on sexual attraction and/or behaviour - Influenced by culture (religious or political) believes, personal or societal) experiences - Can match or differ from romantic orientation LGBT(QIA+) - i.e. Lesbian, gay, bisexual, trans, queer and/or questioning, intersex, asexual, and other sexual and gender identities - Different variations e.g. G as first letter SGM - i.e. sexual and gender minorities - Anyone who is not / does not identify as heterosexual and/or cis-gender Queer - Used as umbrella term and/or to avoid gender/sexuality categories - Term reclaimed by many in the community Caution 1. People within the LGBTQ+ community identify with different labels -- don't assume! 2. The labels (or lack thereof) that people identify with can change over time. 3. Many do not identify with the term "homosexual" -- more commonly used in medical settings. **Sexuality and Gender Measures** Gender/Sex *Only ask about sex/gender assigned at birth if necessary for your research.* Sexuality Measures tap into the 3 sexuality constructs: - Sexual behaviour - men who have sex with men (MSM) - Sexual attraction - Sexual identity Measures as categorical or continuous variables. Klein Sexual Orientation Grid (KSOG) (A) Sexual Attraction (B) Sexual Behaviour (C) Sexual Fantasies (D) Emotional Preference (E) Social Preference (F) Self-Identification (G) Heterosexual-/Gay Lifestyle **LGBTQ+ People in the UK** Sexual Minorities in the UK UK Census 2021 - 92.5% - 93.4% of UK population aged 16+ identified as heterosexual or straight (though decreases overtime). **Mental Health of LGBTQ+ People** Mental Disorders among Sexual Minorities Compared with heterosexual young people: - ↑ severe depressive symptoms (n=17) - ↑ severe anxiety symptoms (n=4) - ↑ severe oppositional defiant, conduct, and diagnosis of "borderline personality" disorder among SM girls (n=2) - Mixed evidence for alcohol use disorder symptoms Summary: - Evidence to support ↑ probability of: - Strong: Depressive and anxiety symptoms, self-harm, suicidal thoughts - Some: Psychotic-like experiences, conduct problems, and diagnosis of "personality disorders" - Mixed: Substance and alcohol use disorders and suicide attempts - Mental health inequalities present from age 10, increase during adolescence, and persist into adulthood - Need for early prevention and intervention! Mental Health of Gender Minorities - Some evidence to support ↑ probability of: - Depression - Anxiety - Suicidal thoughts, attempts, NSSH - Caution: - Small, convenience samples - Cross-sectional analyses - High-quality population-based research needed! **Explanations of LGBTQ+ Mental Health Inequalities** Minority Stress Theory Health Equity Promotion Model Intersectionality and Mental Health - Multiple, interdependent social identities linked to structural positions of power and oppression - Effect of intersecting identities on mental health beyond the sum of its parts *Need to jointly examine a person's intersecting identities to understand their experiences (of minority stressors) and the effects on mental health.* Explanations for Mental Health Inequalities Explanations for Trans Mental Health Inequalities Violence - 41% experienced hate crime because of their gender - 28% of those in a relationship experienced domestic abuse - 12% physically attacked at work - 36% of students had negative experiences at university - 79% didn't report hate crimes to the police Microaggression: **Prevention of LGBTQ+ Mental Health Inequalities** - Tackle systemic and societal stigma and discrimination - Universal interventions at schools, healthcare settings etc. targeting risk factors in the entire population School-based universal interventions - Inclusive policies - LGBTQ+ inclusive curricula - Teacher training - LGBTQ+ pride clubs - Workshops and multi-media **Mental Health Care for LGBTQ+ People** Facilitators of Positive Therapeutic Experience - Warmth, empathy, understanding, encouragement, non-judgemental, acknowledgment of sexual orientation - Avoid assumptions about sexuality - Avoid assumption that sexuality is the main or only issue for seeking help - Generally, experience of therapy appears to get better, even in public mental health services