Ch. 11 Assessing Culture

sickness

"patients' roles"

A nursing instructor is teaching about cultural awareness and sensitivity in client care. The student demonstrates understanding of the above when making which of the following statements?

*"Cultural awareness happens first when the nurse obtains culturally specific information from the client's health history."* Cultural awareness/sensitivity occur when the nurse takes a health history and asks specific questions about the client's culture. It does not happen when the client first arrives to the floor or when the nurse enters the room. It is a conscious and deliberate process in which the health care provider becomes appreciative and sensitive to the values, beliefs, life ways, practices, and problem-solving techniques of a client's culture. These questions are answered when doing the health history and interview

The nurse is conducting a cultural assessment with a client who recently immigrated to the United States. Which interview question is of most importance when addressing family history as it impacts the client's care?

*"Who is primarily responsible for making family decisions since arriving in the United States?"* Family is important in all cultures, but definitions of family and who is included in the family may vary among cultures. In the history, the nurse should note the family structure and who the decision makers are for the family, especially for health care issues. While the remaining options are appropriate questions, they are not as important to a hospitalized client's care as identifying who is going to be making health decisions.

From a critical cultural perspective, culture refers to which of the following?

*A dynamic process enacted between people and their families* A critical perspective of culture is based on understanding it as a dynamic, shifting process in which we all engage. Rather than seeing values and beliefs as determining people's behaviors and circumstances, a critical perspective sees them as being part of systems of meaning upon which people draw. It is not dependent on genetic or ethnic similarities.

A client comes into the clinic accompanied by her son. He explains that his mother has "not been feeling well". The nurse observes scars that resemble cigarette burns. What is the nurses best intervention for this assessment finding?

*Ask the client if she has had moxibustion.* Moxibustion is the attachment of smoldering herbs to the end of acupuncture needles or placing herbs on the skin; this causes scars that look like cigarette burns. It is used to strengthen one's blood and flow of energy, and to maintain good health.

When caring for a client from a culturally different background, what is the goal for incorporating the client's health beliefs and practices into the nursing plan of care?

*Improvement of the client's health outcomes* Consideration of clients' cultural background and incorporating health beliefs and practices in care plans contribute to enhanced client experiences with health care and improve health outcomes. Incorporating the client's health beliefs and practices will not enhance this client's social system or cultural connectiveness, nor will it improve communication with the family.

Which of the following statements is true of cultural groups and magico-religious beliefs in their health belief systems?

*No culture is without an element of magico-religious beliefs.* In the magico-religious belief system, the entire universe is seen to have supernatural forces at work, which affect all humans as well as the world in general. Spirits and various other entities are thought to affect the status of both physical and mental health.

When the nurse asks a client of African origin for the reason for coming to the health clinic, the client responds by saying, "Bad blood." The nurse recognizes that the client is most likely referring to which of the following?

*STIs* For some people of African origin, "bad blood" refers to contamination of the blood, especially by a sexually transmitted infection. "Low blood" may refer to having not enough blood or weak blood due to diet. "High blood" can refer to high blood pressure but also to thick or excessive blood. A sudden collapse preceded by dizziness or a spinning sensation may be referred to as "falling out" or "blacking out.

What must occur before a client will be willing to teach the nurse about her culture?

*The nurse needs to establish rapport and trust* If the nurse has established rapport and trust, clients will be willing to teach about their cultures.

Which of the following statements is true of sickle cell disease and other hemoglobinopathies?

*They are associated with high-malaria environments.* Hemoglobinopathies are biochemical variations that involve abnormal production or structure of the hemoglobin molecule. These conditions assist in the survival of malaria and are associated with populations living in or originating from geographic areas in which malaria is endemic, including much of Africa, the Mediterranean and Middle East, Asia, and Latin America.

The nurse knows that she will be caring for a client from Southern Korea who has been visiting with a family member. The nurse obtains some information about the Korean culture so that she will be able to meet the clients needs. What is the nurse demonstrating?

*cultural knowledge* Cultural knowledge is the process of seeking and obtaining a sound educational foundation concerning the various world views of different cultures. The nurse has sought information in order to provide culturally competent care by seeking knowledge of the client's culture.

A new graduate is caring for a client of Mexican descent and is overheard telling a coworker that she does not like caring for that particular client because she is so different. She further states that the client believes "crazy" things, eats "weird" things and dresses "funny." The nurse is exhibiting which of the following?

*ethnocentrism* Nurses who look at people of other cultures as different, show no interest in learning about them, perceive that their own worldviews are the only acceptable truths, and hold their values and behaviors as superior are practicing ethnocentrism. Stereotyping involves not recognizing the great variations that occur within a cultural group. Racism is considering people based on only their looks and culture. Bias means making judgments based on preconceived opinions.

A nurse is assessing a Navajo client, who has presented to the health clinic with complaints of feeling endangered, confusion, bad dreams, and hallucinations. Which culture-bound syndrome should the nurse suspect in this client?

*ghost sickness*

The nurse desires to learn more about a population of clients from a non-English speaking culture. Which action should the nurse perform as a first step to becoming more culturally aware?

*perform self-reflection* The first step to becoming more culturally aware is to engage in self-reflection. Reading about health care practices, talking with people, and analyzing the difference in behaviors may all contribute to cultural awareness however the nurse needs to look within first.

A nurse provides care for a client who experiences anxiety, gastrointestinal complaints, and a fear of being poisoned or killed. The nurse recognizes this as which culture-bound syndrome?

*rootwork*

When performing a cultural assessment, an important point to remember would be

*that definitions of family differ*

questions to ask yourself: ASKED

-Awareness: How aware are you of your own biases and prejudices toward people different from you? -Skill: Can you complete a cultural assessment while being sensitive to cultural differences and sensitivities? -Knowledge: How much do you know about different cultures and ethnic groups, about their beliefs, customs, and biologic variations? -Encounters: What level of interest do you have in interacting with people from different cultures or ethnicities? -Desire: Do you really have an interest in becoming culturally competent?

naturalistic (holistic) belief systems

-focus is on keeping harmony or natural balance in cosmic natural order, in which human life is only one aspect -yin/yang theory of China -hot/cold theory: based on concept of whole person vs. sum of the parts, and seeks balance of all aspects of a person; balance maintained by adding or subtracting substances that regulate body's temp, moisture, and dryness -cold: cancer, PNA -hot: DM, HTN, sore throat, infection, pregnancy (should not eat iron-containing foods because those are hot) -perceived to be 4 humors of the body (blood, phlegm, black bile, yellow bile) that work together

African Americans

-look away when being talked to but maintain very high level of eye contact when speaking -have fewer external iliac veins but have many more valves in lower legs than do whites--> lower prevalence of varicose veins -ahead of other American groups in motor development -have better response to diuretics than Whites -vascular diseases more common

Japanese

-may avoid saying "no" in order to prevent offending or embarrassing anyone -fewer words or silence better than too many words -allow silence between conversation -do not place as much value on frankness and clarity as Westerners -more personal space -nod to indicate they are listening -do not use direct eye contact -losing face: admitting failure or error causes this; hesitate to admit that they don't understand -perceive truth to be relative, depends on circumstances and obligations they have to others -give answers they think other person wants to hear -give very little explanation as to what they mean, vague answers

race

-not a physical characteristic but a socially constructed concept; based on human physical variation, which is genetically based -person's self identification with one or more social groups

culture

-the totality of socially transmitted behavioral patterns, arts, beliefs, values, customs, lifeways, and all other products of human work and thought characteristic of a population or people that guide their world-view and decision making -defines *values* (learned behaviors about what is held to be good or bad) and *norms* (learned behaviors that are perceived to be appropriate or inappropriate)

Asians

-use cupping -coining: rubbing ointment into skin with spoon or coin; used for "wild illness"--> fear of being cold or of wind, fever, headache -moxibustion: attachment of smoldering herbs to end of acupuncture needles or placement of herbs on skin (strengthens blood and flow of energy) -counseling not accepted -osteoporosis more common

cultural diversity

AKA cultural pluralism; coexistence of a difference in behavior, traditions, and customs

During a client interview, the nurse is focusing on cultural influences particularly when assessing: (Select all that apply.)

Health care beliefs and practices Nutrition High-risk behaviors Aspects of culture that are relevant to the health assessment include health care beliefs and practices, nutrition, and high-risk behaviors. Aspects of culture that are not necessary relevant to the health assessment include the cardiovascular status and employment history.

When culture is defined as a system, what components would be included? (Mark all that apply.)

How we view the world How we behave in relation to other people Shared ideas, rules, and meanings

where are the largest portions of immigrants from?

Mexico

lactose intolerance

North and Central European ancestry; high prevalence in South America, Africa, Asia

US census categories

White, Black or AA, American Indian or Alaska Native, Asian, Native Hawaiian, and other Pacific Islanders

cultural humility

a dynamic and lifelong process focusing on self-reflection and personal critique

ethnicity

a socially, culturally, and politically constructed group that holds in common a set of characteristics not shared by others with whom members of the group come into contact; determines whether a person is of Hispanic origin or not

acculturative stress

adaptation to a new cultural environment

stereotyping

an oversimplified conception, opinion, or belief about an aspect of an individual or group

cultural relativism

belief that the behaviors and practices of people should be judged only from the context of their cultural system (basically, you are only your culture)

asian traditions- traditional healers

chinese medical practitioners, herbalists

national standards for care- standards 5-8

communication and language assistance

national standards for care- standard 15

concerns organization's progress in implementing and sustaining other standards

culture-bound syndromes

conditions perceived to exist in various cultures and occur as a combination of psychiatric or psychological and physical s/s

disease

deviations from a biomedical norm

westerners

do not use silence

national standards for care- standards 9-14

engagement, continuous improvement, accountability

hispanic traditions- traditional healers

folk healers (witches, midwife)

national standards for care- standards 2, 3, 4

governance, leadership, work force

assimilation

gradual adoption and incorporation of characteristics of prevailing culture

subculture

group of people with a culture that differentiates them from the larger culture of which they are a part

Eskimos, Native Americans, Hispanics

have increased risks of peripheral neuropathy with isoniazid

hispanic traditions- preventative and healing practices

hot/cold balance for diet, herbs, amulets, prayers to Gods and saints, spiritual reparations for sins, avoiding "evil eye" caused by jealousy and envy

Latins

indicate height for humans by bending their fingers up and putting back of hand at height level; American gesture of indicating height is insult to Latins; interrupt one another

cultural imposition

intrusive application of the majority group's cultural view upon individuals and families

illness

lived experience of culturally constructed categories

Eastern countries and Native Americans

look down to show respect to person talking; pause after each person speaks before the other does to show respect

african traditions- preventative and healing practices

magical and herbal mix of herbs, roots, and rituals, talismans, or amulets

african traditions- traditional healers

magicoherbalist, hoodoo (AKA conjurers), or other traditional healers known as "Old Lady, "granny", or lay midwife

native american/alaska native traditions- traditional healers

medicine men or shamans

Chinese

more sensitive to cardiovascular effects of some drugs; increased absorption of antipsychotics, narcotics

enculturation

natural conscious and unconscious conditioning process of learning accepted cultural norms, values, and roles in society and achieving competence in one's culture through socialization

navajo

not buying baby clothes before birth

Belize and Panama

not permitting father to see mother or baby until baby is cleaned

asian traditions- preventative and healing practices

prevent or rebalance yin/yang, hot/cold foods and conditions, wear amulets, acupuncture, cupping, moxibustion

national standards for care- principal standard (1)

provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultures

biocultural ecology

refers to client's physical, biologic, and physiologic variations, such as variations in drug metabolism, disease, and health conditions

2 types of silence

remaining silent for long periods; used to space talking between 2 people carrying a conversation

native american/alaska native traditions- preventative and healing practices

respect for nature and avoid evil spirits, use masks, herbs, sand paintings, amulets

magicoreligious belief system

spirits and other entities affect status of both physical and mental health

worldview

the way individuals or groups of people look at the universe to form basic assumptions and values about their lives and world around them

2 major hand gestures

those for indicating height and those for indicating "okay"

nonimmigrants

those in the US for a specific purpose, with permanent residence in another country

asylees or refugees

those who have a well-founded fear of persecution should they return to their country of nationality

A nursing instructor asks students to list culturally based characteristics. The students should include which of the following? (Select all that apply.)

touch eye contact time diet

ethnocentrism

universal tendency of humans to think their ways of thinking, acting, and believing are the only right, proper, and natural ways

biomedical model

used by western healthcare and medicine as basis for defining illness and treatments; based on what science can investigate and conclude and assumes that all disease or illness has a cause-effect that can be studied