Foundations: Potter and Perry Ch. 9 Culture and Ethnicity

Ethnocentrism pg. 103

A tendency to hold one's own way of life as superior to others. It is the cause of biases and prejudices that associate negative permanent characteristics with people who are different form the valued group.

Table 9-2 Cultural Healers Ayurvedic Practitioner

Asian Indians Combination of dietary, herbal and other naturalistic therapies to prevent and treat illness

Transcultural Nursing pg. 103

Defines as a comparative study of cultures to understand similarities (culture universal) and differences (culture-specific) across human groups. The goal is culturally congruent care.

Cultural Encounters

Engaging in cross-cultural interactions that provide learning of other cultures and opportunities for effective intercultural communication development

Enculturation pg. 103

Facilitates cultural learning. Socialization into one's primary culture as a child is known as_____.

Patrilineal pg. 111

Kinship on the father's side

Matrilineal pg. 111

Kinship on the mother's side

Bilineal pg. 111

Kniship extends to both the mother and father sides

Assimilation pg. 103

Members of an ethnocultural community are absorbed into another community and lose their unique characteristics such as language, customs, and ethnicity. It may be spontaneous, which is usually the case with immigrants, or forced, as is often the case of ethnic minority communities.

Table 9-2 Cultural Healers Shaman

Native Americans Combination of prayers, chanting and herbs to treat illnesses caused by supernatural, psychological, and physical factors

Fictive pg. 111

Nonblood kin

Box 9-4 Rules of Impression Management

1. Greet patients and their visitors in their own language if possible. 2. Introduce yourself. Tell patients what to call you. 3. Welcome visitors and request them to introduce themselves and explain how they are related to the patient. 4. Than the visitors for coming. 5. Ask to talk with the patient in private and offer to accompany visitors to the waiting room. 6. Inform visitors that you will call them when you finish with the patient. 7. Tell the patient your purpose. 8. Clarify if the patient wants someone else such as a family member to be present. 9. Avoid asking the patient questions in front of the family or spouse that will put him or her at risk with this group. 10. It the patient needs an interpreter: A. Introduce yourself to the interpreter B. Determine the qualifications of the interpreter. a. Make sure that the interpreter can speak the dialect of the patient. b. Ensure gender, age, and ethnic compatibility of the interpreter with the patient's preference and topic of discussion. c. Watch for differences in educational and socioeconomic status between the patient and interpreter. d. Orient the interpreter to your purpose and expectation (e.g. assessment of the patient's level of pain, intent to explain procedure to the patient) C. Clarify you questions about the interpreter's training, compatibility with the patient, and the interpreter's understanding of your expectations beforehand. D. Introduce the interpreter to the patient. E. Pace your speech slowly and allow time for back translation. F. Direct your questions to the patient. G. Request the interpreter to ask the patient for feedback and clarification at regular intervals. H. Observe the patient's nonverbal and verbal behaviors. I. Thank both the patient and interpreter. 11. Ask the patient with whom you will need to consult for major decisions and how to contact this person. 12. Observe nonverbal behavior and match the degree of distance exhibited by the patient.

Box 9-5 Language Access Services

>All health care organizations are required to offer free language assistance, including bilingual staff or interpreter services to each patient with limited English proficiency. These services must be offered in a timely manner at all hours of operation at all points of contact. >Patients must be informed, in their preferred language, of their right to receive language assistance services both verbally and in written form. >The competence of bilingual staff and interpreters providing language assistance must be ensured by the health care organization. >Unless requested by the patient, family and friends should not be used to provide interpretation services. >Interpreters are more effective when they have knowledge of the culture of the patient. >Patient-related information and signage must be posted in the service area of the health care organization in the languages of the groups who are commonly served.

Box 9-7 Focus of Older Adults: Culturally Sensitive communication

>Ask older adults how they like to be addressed. If in doubt, address them formally >Determine patient's preferences for touch. for example, in the United States Americans often greet each other with a firm handshake. However, many Native Americans see this as a sign of aggression, and touch outside of marriage is sometimes forbidden in older adults form the Middle East. >Investigate the patient's preferences for silence. Generally Eastern cultures value silence, whereas Western cultures are uncomfortable with it. >Be aware of the patient's beliefs about eye contact during conversation. In European American cultures direct eye contact is a sign of honesty and truthfulness. However, eye contact with other groups such as older Native Americans is not allowed. Older Asian adults sometimes avoid eye contact with authority figures because it is considered disrespectful, and direct eye contact between genders in Middle Eastern cultures is sometimes forbidden except between spouses.

Box 9-1 Evidence-Based Practice: Cultural Beliefs and Rituals Surrounding Death. Application to Nursing

>Be aware of religious and cultural preferences when helping patients and families prepare for death. >Ask families about the rituals and ceremonies they use to help them cope with the death of a loved one. >Allow patients and families the ability to participate in planning which rituals will be performed at the patient's bedside. >Be sensitive to cultural perceptions regarding organ donation, viewing the body, and preparing for burial.

Box 9-3 Nursing Assessment Questions Focused

>Did you have this problem before? >Is there someone you want us to talk to about you care?

Box 9-3 Nursing Assessment Questions contrast

>How different is this problem form the one you had previously? >What is the difference between what we are doing and what you think we should be doing for you?

Box 9-3 Nursing Assessment Questions Ethnohistory

>How long have you/your parents resided in this country? >What is your ethic background or ancestry? >How strongly does your culture influence you? >Tell me why you left your homeland.

Box 9-2 Cultural Aspects of Care: Understanding Cultural Safety. Nursing Implications

>Set culture care as a priority >Approach patients and families in a culturally sensitive manner. > Engage in negotiated partnerships with patients and families. >Enable the families and social networks of patients to serve as backup support.

Box 9-3 Nursing Assessment Questions Bicultural Ecology and Health Risks

>What caused your problem? >How does this problem affect or how has it affected your life and family? >How do you treat this problem at home? >What other problems do you have?

Box 9-3 Nursing Assessment Questions Socioeconomic Status

>What do you do for a living? >How different is your life here from back home?

Box 9-3 Nursing Assessment Questions Caring Beliefs and Practices

>What do you do to keep yourself well? >What do you do to show someone you care? >How do you take care of sick family members? >Which caregivers do you seek when you are sick? >How different is what we do from what your family does for you when you are sick?

Box 9-3 Nursing Assessment Questions Open-Ended

>What do you think caused your illness? >How do you want us to help you with your problems?

Box 9-3 Nursing Assessment Questions Language and Communication

>What language(s) do you speak at home? >What language(s) do you use to read and write? >How should we address you or what should we call you? >What kinds of communication upset or offend you?

Box 9-3 Nursing Assessment Questions Social Organization

>Who lives with you? >Whom do you consider members of your family? >Where do members of your family live? >Who makes the decisions for you or your family? >To whom do you go outside of your family for support? >What expectations do you have of your family members who are males, females, old, or young?

Cultural Care Accommodation of Negotiation pg. 113

Adapt or negotiate with others for a beneficial or satisfying health outcome.

Table 9-2 Cultural Healers Voodoo Practitioners Hougan (male) Mambo (female)

African American Combination of herbs, drumming and symbolic offerings to cure illness, remove curses, and protect a person

Table 9-2 Cultural Healers Granny Midwife

African American Consultation in diagnosing and treating common illnesses and care of women in childbirth and children

Table 9-2 Cultural Healers Spiritualis

African American Spiritual advising, counseling, and praying to treat illness or cope with personal and psychosocial problems

Cultural Awareness

An in-depth self-examination of one's own background, recognizing biases, prejudices, and assumptions about other people.

Naturalistic Practitioners pg. 104

Attribute illness to natural impersonal, and biological forces that cause alteration in the equilibrium of the human body. Healing emphasizes use of naturalistic modalities, including herbs, chemicals, heat, cold, massage, and surgery.

Cultural Skills

Being able to assess social, cultural, and biophysical factors influencing treatment and care of patients

Personalistic Practitioners pg. 104

Believe that an external agent, which can human (sorcerer) or nonhuman (ghosts, evil, or deity), causes health and illness. They emphasize the importance of humans' relationships with others, both living and deceased, and with their deities.

Culturally Congruent Care pg. 103

Care that fits the person's life patterns, values, and a set of meanings. Patterns and meanings are generated from people themselves rather than predetermined criteria. Sometimes this differs from the values and meanings of the professional health care system

Table 9-2 Cultural Healers Herbalist

Chines and Southeast Asians Combination of plant, animal, and mineral products in restoring balance based on yin/yang concepts

Table 9-2 Cultural Healers Shaman

Chines and Southeast Asians Combination of prayers, chanting and herbs to treat illness caused by supernatural, psychological, and physical factors

Table 9-2 Cultural Healers Fortune Teller

Chines and Southeast Asians Consultation to foretell outcomes of plans and seek spiritual advice to enhance good fortune and deal with misfortune

Table 9-2 Cultural Healers Acupuncturist

Chines and Southeast Asians Yin treatment using needles to restore balance and flow of qi; yang treatment using moxibustion or heat with acupuncture possibly indicated to restore yin/yang balance

Table 9-2 Cultural Healers Santero/a

Hispanic Combination of prayers, symbolic offerings, herbs, potions, and amulets against witchcraft and curses

Table 9-2 Cultural Healers Yerbero (Herbalist)

Hispanic Consultation for herbal treatment of traditional illnesses

Table 9-2 Cultural Healers Espiritista (Spiritualist)

Hispanic Foretelling of future and interpretation of dreams; combination of prayers, herbs, potions, amulets, and prayers for curing illnesses, including witchcraft

Table 9-2 Cultural Healers Sabador (Bonesetters)

Hispanic Massage and manipulation of bones and joints used to treat a variety of ailments, including musculoskeletal conditions

Table 9-2 Cultural Healers Parteras (Lay midwives)

Hispanic assistance for women in childbirth and newborn care

Table 9-2 Cultural Healers Curandero/a

Hispanic combination of prayers, herbs, and other rituals to treat traditional illnesses, especially in children

Culture-bound Syndrome pg. 104

Illness that are specific to one culture. They are used to explain personal and social reactions of the members of the culture. They occur in any society. In the United States "going postal" is an example. Hwa-byung is a Korean example.

Cultural Imposition pg. 103

Nurses and other health care providers who have cultural ignorance or cultural blindness about differences generally resort to ______ _____ and use their own values and lifestyles as the absolute guide in dealing with patients and interpreting their behaviors. Thus a nurse who believes that people should bear pain quietly as a demonstration of strong moral character is annoyed when a patient insists on having pain medication and denies the patient's discomfort.

Box 9-6 Patient Teaching: Cultural Considerations in Healthy Food Choices

OBJECTIVE: Patient will verbalize healthy foods that are culturally appropriate. TEACHING STRATEGIES: >Refer patient to speak with a dietitian who is familiar with cultural food choices. >Develop a diet plan that includes patient's cultural diet preferences. >Provide culturally sensitive teaching brochures that describe healthy food choices. >Include people in family who help shop for and prepare food in the home. EVALUATION: >Ask patient to keep a food diary for 1 week and evaluate food choices. >Ask patient to describe how cultural food choices will fit within his or her prescribed diet.

Cultural Knowledge

Obtaining sufficient comparative knowledge of diverse groups, including their indigenous values, health beliefs, care practices, worldview, and bicultural ecology

Ethnicity pg 102

Refers to a shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics. Members feel a common sense of identity. Some examples are Irish, Vietnamese, or Brazilian. It is different from race, which is limited to the common biological attributes shared by a group such as skin color. Racial classification examples are Asian and Caucasian.

Ethnohistory pg. 107

Refers to significant historical experiences of a particular group

Cultural Care Repatterning or Restructuring pg. 113

Reorder, change, or greatly modify patients' lifestyles for a new, different, and beneficial health care pattern,

Cultural Care Preservation or Maintenance pg. 113

Retain and/or preserve relevant care values so patients maintain their wellbeing, recover form illness, or face handicaps and/or death.

Acculturation pg. 103

Secondary culture learning that occurs when the culture of a minority is gradually displaced by the culture of the dominant group in the process of assimilation.

Rites of Passage pg. 105

Significant social markers of changes in a person's life. Examining the practices surrounding these life events provides a view of the cultural meanings and expressions relevant to these transitions.

Biculturalism pg. 103

Sometimes referred to as multiculturalism; occurs when an individual identifies equally with two or more cultures.

Subcultures pg. 102

Such as the Appalachian and Amish cultures are examples of ethnic and religious groups with characteristics distinct form the dominant culture. Primary and secondary characteristics of culture are defined by the degree to which an individual identifies with his or her cultural group. PRIMARY characteristics include nationality, race, gender, age, and religious beliefs. SECONDARY characteristics include socioeconomic and immigration status, residential patterns, personal beliefs, and political orientation.

Emic Worldview pg. 102

The insider or native perspective.

Cultural Desire

The motivation and commitment to caring that moves an individual to learn from others, accept the role as learner, be open and accepting of cultural differences, and build on cultural similarities

Etic Worldview pg. 102

The outsider's perspective.

Cultural Competence pg. 103

The process of acquiring specific knowledge, skills and attitudes to ensure delivery of culturally congruent care. The process has five components 1. Cultural Awareness 2. Cultural Knowledge 3.Cultural Skills 4.Cultural Encounters 5. Cultural Desire

Culture pg. 102

The thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. It is a concept that applies to a group of people who's members share values and ways of thinking and acting that are different from those of people who are outside the group.

Comparative Cultural Contexts of Health and Illness Table 9-1 Method of Diagnosis

WESTERN: Scientific, high0tech, Specialty focused, Organ-specific manifestations NONWESTERN: Naturalistic, magico-religious, holistic, mixed, global (nonspecific symptomatology)

Comparative Cultural Contexts of Health and Illness Table 9-1 Caring Pattern

WESTERN: Self-care, self-determination NONWESTERN: Caring provided by others, group reliance and interdependence

Comparative Cultural Contexts of Health and Illness Table 9-1 Treatment

WESTERN: Specialty specific, pharmacological, surgery NONWESTERN: Holistic, mixed (magico-religious, supernatural herbal, biomedical)

Comparative Cultural Contexts of Health and Illness Table 9-1 Practitioners/ Healers

WESTERN: Uniform standards and qualifications for practice NONWESTERN: May be learned through apprenticeship, criteria for practice not uniform, reputation established in community

Comparative Cultural Contexts of Health and Illness Table 9-1 Cause of Illness

WESTERN: biomedical causes NONWESTERN: Imbalance between humans and nature, supernatural, Magico-religious

Cultural Pain pg. 107

When health care providers disregard values or cultural beliefs