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“THE EFFECTIVE HEALTH CARE DELIVERY OF HEALTH CARE PROVIDER

TOWARDS SOCIO-CULTURAL DIVERSITY AMONG PATIENTS IN TAGUM


DOCTOR’S HOSPITAL”

____________________
A Thesis Presented to the Faculty
Tagum Doctor’s College, Inc,
Tagum City, Philippines
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In Partial Fulfilment of the Requirements for the Degree


Bachelor of Science in Nursing
____________________

By

Cliff Mark S. Babalcon


Mark Janrel G. Genito
Eddie King B. Manguilimotan
Sheguila V. Milan

April 13, 2019


Chapter 1

THE PROBLEM AND ITS SETTING

The make-up of the world population is changing as a result of people’s


movement across borders. This movement is giving rise to ethnically, culturally,
and linguistically diverse populations residing in many parts of the world. The
impact of this diversity presents unique challenges to the practice of medicine.
What happens when individual providers and health care organizations fail to
address possible differences in the perceptions, occurrence, management, and
outcomes of health problems among different cultural groups? The result may be
miscommunication and reciprocal frustration ultimately leading to misdiagnosis
and mistreatment (Ahmed, 2017).

The growing ethnic minority population groups will bring unique needs to
health care interactions that may result from cultural differences between care
provider and receiver (Berger, 1998; Betancourt, 2003, 2014). Differences in
cultural values and beliefs between the health care provider and the receiver
account for many misunderstandings in health interactions (Cline & McKenzie,
2018). When such differences are not accommodated, poor health outcomes arise.
For instance, Fadiman (2017) described the culture clash between the Merced
Community Medical Center in California and a refugee family from Laos over the
care of Lia Lee, a Hmong child diagnosed with epilepsy. Fadiman explained how
the fundamentally different notions of disease that divided the Hmong sense of
health and disease from the views of American scientific medicine eventually cost
the life of Lia Lee. Although Lia’s health was in the best interest of both her parents
and her doctors, miscommunication between the two cultures led to a tragedy and
brings to attention the issues of medical ethics and cultural differences.

The Department of Health of the Philippines 2017 fines that Filipinos are
considered fatalistic in that they tend to accept fate easily, especially when they
feel they cannot change a situation. Moreover, the acceptance of fate or destiny
comes from their close relationship and health respect to nature. The acceptance
of events they cannot change is tied to their cultural religious faith. A common
expression uttered by Filipinos is “bahala na”, originating from “bathala na” (it is up
to God) (Enriquez, 2014).

In Tagum Doctors Hospital encounter patients refuses to not to apply certain


medication to their patients like hot and cold compression of the injured parts of
the body because they are believing that it can worsen the problem of their patient
as what they practice and observed in their culture in highland where they came
from.

Ideally, health care provider seeks to address all necessary preparations in


order to provide good expectations of their clients. The above mentioned problems
of socio-cultural differences of patients serves as the basis of the researchers to
conduct the study about the effective health care delivery of health care provider
towards socio-cultural differences of patients. This seeks to find if there is a
significant relationship between effective health care delivery and socio-cultural
differences of patients.

Review of Related Literature

This section contains related materials from books, journals and


internet articles that would give strength and support to the findings of this
research.

Socio-cultural Diversity

Cline and McKenzie (1998) states that Socoi-cultural attributes that place
health care providers and receivers on two different ends of the health care
spectrum. Giving rise to ethnically, culturally, and linguistically diverse populations.
The impact of this diversity presents unique challenges to the practice of medicine.

Ethnical Diversity. As stated on the journal of Immigrant Minority Health


(2014) Ethnical Diversity is also emerging as a highly charged health care issue.
Ethnic and its counterpart’s xenophobia, prejudice and discrimination are being
increasingly implicated in racial and ethnic disparities in health and health care
and in disparities in the safety and quality of health care of ethnic minority
groups.

In addition (Equity, 2015) states that Irrespective of whether it is direct or


indirect, intended or unintended, Ethnical differences harms people in enduring
ways. In order to better understand the harms of Ethnical differences, an
examination of the notion of ‘harm’ itself is required.

Ethical analysis cannot be done in the abstract because moral meanings of


health care goods are rooted in history and culture, and they can be transformed
or rendered obsolete by scientific and technological advances as well as changes
in economic and other social and institutional circumstances. Hence, we need to
understand some of this history.

Cultural Diversity. (Kockrow, 2018) A lack of knowledge about cultural


norms for subpopulations within any given racial groups can be associated with
both a deficiency in cultural learning and limited exposure to others from different
cultural heritages.

In addition (McFarland, 2016) said that cultural characteristics of a group


may differ from the predominant group in any particular geographical space. Each
group has its own distinctive features but is also a part of a larger cultural group.
The racial or ethnic designation of Latino, for example, contains smaller
subpopulation groups that include Mexicans, Puerto Ricans, Cubans,
Guatemalans, and others. While those subgroups are part of the larger Hispanic
population, each of those groups have their own individual group values and
beliefs that make providing treatment in a health care setting challenging if the
health care staff lacks the cultural competency, or the cultural knowledge of that
subpopulation’s health care beliefs.

Linguistic Diversity. (L. J. Kirmayer, 2015) Linguistic barriers in health


practitioner-client communication are one of the most important contributors to
health disparities, and can lead to inappropriate medical diagnoses, higher rates
of treatment dropout, recurrent hospitalizations and longer stays, poor adherence
to medication and treatment recommendations, lower client satisfaction, and
greater risk of medical errors with more serious consequences.

Another concept by (Brisset et.al, 2014) states that lack of linguistic


resources and training, and a lack of clarity about the roles interpreters can play.
The results highlight the need for better organization of institutional services, and
for the development of specific training for professionals in working with
interpreters in the field of mental health. This training would include practical
information on available linguistic resources, and the implications of different
modes of working with an interpreter

Social-Economic Status. (Van Manen, 2016) states that Barriers have


been identified among those in the lower social economic status (SES). These
barriers impede health care utilization and negatively afreet health status.
However, studies show that among some African Americans when health care is
affordable and available, the utilization of health care systems is not maximized.
This suggests there are noneconomic barriers impeding access to and the
utilization of health care systems for some African Americans.

Supported by (Gomick et al., 1996; Powell, 2017) Barriers have been


identified which impede the utilization of health care systems. These barriers are
both economic and noneconomic. Economic barriers are caused by lack of
financial resources. Less is known about noneconomic barriers which exist at
income levels where insurance or other means of financing health care are
available.

Health Care Delivery

According to the biomedical model (Fuller, 2013), health constitutes the


freedom from disease, pain, or defect, making the normal human condition
"healthy." The model's focus on the physical processes; pathology, biochemistry
and physiology of a diseases that take into account the role of social factors or
individual subjectivity.
Pathology of a disease. (WILLIAM SHIEL JR., te al 2015) Pathology has
been defined as that branch of medicine which treats of the essential nature of
disease. A medical doctor that specializes in pathology is called a pathologist.
Pathologists are experts at interpreting microscopic views of body tissues.

The American Society for Investigative Pathology (ASIP) organized a


workshop for graduate program directors and other faculty interested in pathology
graduate education to be held in conjunction with the Experimental Biology 2003
conference. Workshop participants are listed in the appendix of this review article.
Specific goals of the half-day workshop were to establish networking among the
program directors and collectively brainstorm in several specific areas, including
defining the structure and diversity of various pathology training programs and
defining strategies to teach pathology to PhD candidates. Each topic is further
discussed in this article. All participants agreed that PhD training in pathology
includes a multidisciplinary approach to address questions relating to the
pathobiology of disease states.

Biochemistry of a disease. Abnormal liver biochemistries are most


commonly transient, thought to be related to the activity of IBD, and are believed
to have no impact on long-term prognosis. PSC is the most firmly established
hepatobiliary complication associated with IBD. Available data suggest that PSC
is the most common chronic liver disease in patients with IBD, although some
autopsy-based series published over 30 yr ago reported a prevalence of fatty liver
of up to 80% of cases.

Another by Kelleher, 2017 reveals that bringing new insights into our
understanding of hepatobiliary diseases in patients with IBD. Here we report the
prevalence of abnormal hepatic biochemistries and chronic liver disease in a large
cohort of patients with IBD. Contrary to current thinking, our data did not support
an association between IBD activity and abnormal hepatic biochemistries. In our
study, the presence of abnormal liver biochemistries, generally thought to be
without consequences, appeared to have a negative impact on the long-term
prognosis of these patients.
Physiology of a disease. Farlex, Inc, 2016 Pathophysiology (a.k.a.
physiopathology) a convergence of pathology with physiology is the study of the
disordered physiological processes that cause, result from, or are otherwise
associated with a disease or injury. Pathology is the medical discipline that
describes conditions typically observed during a disease state, whereas
physiology is the biological discipline that describes processes or mechanisms
operating within an organism. Pathology describes the abnormal or undesired
condition, whereas pathophysiology seeks to explain the functional changes that
are occurring within an individual due to a disease or pathologic state.

Theoretical and Conceptual Framework

This study is anchored on the theory of Cline and McKenzie (1998) moved
beyond overt cultural categorization to also include covert Socoi-cultural attributes
that place health care providers and receivers on two different ends of the health
care spectrum. Giving rise to ethnically, culturally, and linguistically diverse
populations. The impact of this diversity presents unique challenges to the practice
of medicine.

In addition, according to the biomedical model (Fuller, 2013), health


constitutes the freedom from disease, pain, or defect, making the normal human
condition "healthy." The model's focus on the physical processes; pathology,
biochemistry and physiology of a diseases that take into account the role of social
factors or individual subjectivity.

Moreover, (Cline & McKenzie, 1998)., “patient’s dissimilarity with their


physicians begins with the ‘patient role’ and the ‘physician role,’ roles so different
from that of physician that the two might be said to be from different cultures”.
These cultural differences emerge from an asymmetrical relationship between the
physician and the patient that allows physicians to dominate the interaction.
Differences in cultural values and beliefs between the health care provider and the
receiver account for many misunderstandings in health interactions.
Figure 1 presents the schematic diagram of the variables of this study. The
independent variable is the Socio-cultural Diversity with its indicators ethnical,
cultural, linguistic, social-economic status. The dependent variable is the Health
Care Delivery with its indicators Pathology of a disease, Biochemistry of a disease
and Physiology of a disease

Independent Variable Dependent Variable

Health Care Delivery


Socio-cultural Diversity
 Pathology of a disease
 Ethnical  Biochemistry of a
 Cultural disease
 Linguistic  physiology of a
 Social-Economic disease
Status

Figure 1
Statement of the Problem

This study will be conducted to determine the relationship between


the health care delivery of health care provider and socio-cultural diversity among
patients in Tagum doctor’s hospital, Tagum City, Davao del Norte. The specific
sub-problems of the study are as follows:

1. What is the extent of employment of health care delivery of health


care provider in terms of:

1.1 Pathology of a disease


1.2 Biochemistry of a disease; and
1.3 physiology of a disease?

2. What is the extent of Socio-cultural Diversity of patients in terms of:

2.1 Ethnical Diversity;

2.2 Cultural Diversity;

2.3 Linguistic Diversity; and

2.4 Social-economic status?

3. Is there a significant relationship between the Health Care Delivery


of Health Care provider and Socio-cultural Diversity among patients
in Tagum doctor’s hospital, Tagum City, Davao del Norte?

Hypothesis

1. There is no significant relationship between Health Care Delivery of


Health Care provider and Socio-cultural Diversity among patients in Tagum
doctor’s hospital, Tagum City, Davao del Norte.
Significance of the Study

This study will significant for the Department of Health Officials, Hospital
personnel, School administrators, Clinical Instructors and other researchers of
nursing professionals as they focused on addressing medical assistance and
complete nursing care delivery of patients.
Department of Health Officials. This is important in the Department of Health
as a whole since it provides sufficient bases of health care delivery of health care
provider towards socio-cultural diversity particularly patients in the Province of
Davao del Norte.
Hospital personnel. This study will provide the awareness and aid of the
hospital personnel problem in promoting quality medication needs of patients.
School administrators. This study will provide the awareness and aid of the
administration to their clinical teachers as part of developmental education and
additional information.
Clinical Instructors. This will help them to determine Health Care Delivery
of Health Care provider has the positive implication to the Socio-cultural Diversity
among patients in Tagum doctor’s hospital, Tagum City, Province of Davao del
Norte.
Students. This study will benefit the students since they are the recipients
of the knowledge will be acquired. Thus, give them an avenue for an informative
factors.
Other researchers. This study will serve as a guide or reference in making
their own research which are beneficial to professionals, non-professionals and
institutions.

Definition of Terms

The following are the terms being defined conceptually and operationally.

Socio-cultural Diversity. Defines that Socoi-cultural attributes that place


health care providers and receivers on two different ends of the health care
spectrum. Giving rise to ethnically, culturally, and linguistically diverse populations.
The impact of this diversity presents unique challenges to the practice of medicine.

Ethnical. Defines that Ethical analysis cannot be done in the abstract


because moral meanings of health care goods are rooted in history and culture,
and they can be transformed or rendered obsolete by scientific and technological
advances as well as changes in economic and other social and institutional
circumstances.

Cultural.

Linguistic.

Social-Economic Status.

Pathology of a disease.

Biochemistry of a disease.

Physiology of a disease.
Chapter 2

METHOD

This chapter presents the research design, research subjects, research


instruments, and data gathering procedure.

Research Design
The researcher will use the Quantitative non-experimental research design,
Descriptive Correlational method in conducting this study. This method is a design
which describes the nature of a situation as it exists at the time of the study and to
explore the course of a particular phenomenon. This investigates possible relations
with the use of questionnaire or instrument to be prepared by the researcher. It will
help to determine the relationship of Health Care Delivery of Health Care provider
and Socio-cultural Diversity among patients in Tagum doctor’s hospital, Tagum
City, Davao del Norte.

Research Subject
The respondents of this study are patient admited in Tagum doctor’s
hospital, Tagum City, Davao del Norte. The researchers will be using
Convenience sampling method to determine the sample and Convenience
sampling method is define as a non-probability sampling technique where subjects
are selected because of their convenient accessibility and proximity to the
researcher.

Research Instrument
The instrument to be used in gathering the data for this study will be
distributed to the respondents are a researcher-made questionnaire. The
researchers make use of two sets of questionnaires which suit to evaluate the
extent of employment Health Care Delivery of Health Care provider and Socio-
cultural Diversity among patients in Tagum doctor’s hospital with the following
indicators that corresponds to the two significant variables.
The questionnaires contain checklist using the Likert scale which consist of
five categories in numerical values that corresponds to the descriptive equivalents.
The rating scale to be used and the following scale and parameter limits will be
applied. The scale of 5 for always; 4 for often; 3 for sometimes; 2 for seldom; and
1 for never. Data will be interpreted and analyzed using the scale limits below the
descriptive rating equivalent.

Health Care Delivery of Health Care provider

Parameter Descriptive Description


Limits Equivalent

4.50-5.00 Always This means that the employment


Health Care Delivery of Health Care
provider is observed in all occasions.

3.50-4.49 Often This means that the employment


Health Care Delivery of Health Care
provider is observed in most
occasions.

2.50-3.49 Sometimes This means that the employment


Health Care Delivery of Health Care
provider is observed in some
occasions.

1.50-2.49 Seldom This means that the employment


Health Care Delivery of Health Care
provider is rarely observed.

1.00-1.49 Never This means that the employment


Health Care Delivery of Health Care
provider is not observed.
Socio-cultural Diversity among patients

Parameter Descriptive Description


Limits Equivalent

4.50-5.00 Always This means that the Socio-cultural


Diversity among patients is observed in
all occasions.

3.50-4.49 Often This means that the Socio-cultural


Diversity among patients is observed in
most occasions.

2.50-3.49 Sometimes This means that the Socio-cultural


Diversity among patients is observed in
some occasions.

1.50-2.49 Seldom This means that the Socio-cultural


Diversity among patients is rarely
observed.

1.00-1.49 Never This means that the Socio-cultural


Diversity among patients is not observed.

Data Gathering Procedure


The researcher will undertake the following procedures in order to gather
the data needed for the study:

Seeking Permission to Conduct the Study. The researcher will ask


permission and seek approval from the office of the Administrator of Tagum
Doctor’s College and to the CEO of Tagum Doctor’s Hospital to ask permission to
conduct the study about the employment Health Care Delivery of Health Care
provider and Socio-cultural Diversity among patients in Tagum doctor’s hospital.

Administration and Retrieval of Questionnaires. Upon the approval of


the Administrator of Tagum Doctor’s College and the CEO of Tagum Doctor’s
Hospital, the researcher will go to all the subject Hoptial to distribute the
questionnaires to the respondents. Retrieval of questionnaires will be done by the
researcher after the respondents thoroughly answered all the questionnaires.

Checking, Collating and Processing. Right after the retrieval of


questionnaires, the researcher will check, collate and tabulate all the responses
given by the respondents. Results of the tabulated data will be submitted to the
statistician to analyze statistically to answer the problems raised in the first chapter
of this research.

Statistical Treatment
The following statistical tools will be used in the computation of the as well
as in the testing of the hypothesis at a 0.05 level of significance.

Mean. It will be used to determine the extent of implementation of Health Care


Delivery of Health Care provider and Socio-cultural Diversity among patients in
Tagum doctor’s hospital. It will answer the first and second statement of the
problem.

Pearson r. It will be used to determine significant relationship between Health


Care Delivery of Health Care provider and Socio-cultural Diversity among patients
in Tagum doctor’s hospital. It will answer the third statement of the problem.

Linear Regression. It will be used to determine the degree of influence of


Thematic teaching strategy to the academic engagement of the students. It will
answer the fourth statement of the problem.