Nurse 104 Cultural and Ethnic Considerations

Folk Health Belief System

-Traditions - if you don't take this then you will be sick -encompasses many different traditions in cultures around the world -often includes native healers who use a variety of methods in treating disorders -incorporates religious practices and magic -methods are used to manipulate the environment to improve health

Elasticity

-Implies that it's possible to recover future activities but not present ones -Focus more on a current activity and are less concerned about a previously planned meeting

Alternative or Complimentary Belief System

-Need to know what they are taking because it could contradict with their care -non-medical forms of therapy to treat an illness. -acupuncture, aromatic therapy, mediation, therapeutic touch, and a variety of other techniques prevail as feasible alternative therapies -most of the individuals using an alternative therapy did so without informing their health care provider -alternative therapies address the whole patient by viewing symptoms as the tip of the iceberg and as the body's means for communicating to the mind that something needs to be changed, removed or added to one's life. -the mind and body are seen as a whole unit

Culture-Related Assessment--Communication --Body language

-Nonverbal communication is expressed through body language, some groups are more comfortable when touching or maintaining eye contact, touch is especially culturally related -Ask first! Can I hold your hand? Do you need a hug? 1. US - consider casual touching inappropriate except among intimates 2. England & Germany - less likely to touch each other in public, or allow casual touching by strangers 3. Spanish, French, Italian, Jewish, S.American - are likely to be much more comfortable about touching each other and being touched.

Culture-Related Assessment--Communication

-Nurse and patient must understand each other -Do not assume patient/family understand -Keep questions brief and simple -Nurse is responsible for providing information to patient -Different cultural groups interpret different meanings for same words

Culture-Related Assessment--Communication Body Movements

-Some commonly used gestures have the potential to offend someone from another culture 1. Italian or Jewish people use more body movements to illustrate or emphasize what they are communicate than people from Asia

Biomedical Health Belief System

-Western culture (science) -life is regulated by biomedical & physical processes -life processes can be manipulated by human beings using mechanical interventions -health is the absence of disease or sighs and symptoms of disease -disease is an alteration of the structure and function of the body -disease has a specific cause, onset, course, and treatment. It is caused by trauma, pathogens, chemical imbalance, or failure of body parts.

Holistic Health Belief System

-Whole - includes alternative means of treatment -religious experiences are based on cultural beliefs and may include such things as blessings from spiritual leader, apparitions of dead relative, and even miracle cures -healing powers may also be ascribed to animate and on inanimate objects. -religion dictates social, moral, and dietary practices designed to assists and individual in maintaining a health balance and playing a vital role in illness prevention -treatment is designed to restore balance with physical, social and metaphysical worlds. It may extend beyond treating the person to treating the environment to decrease pollution or prevent hunger, homelessness, etc...

Perception of time or time orientation

1. Future-oriented (e.g.US) 2. Present-oriented (e.g.Black, Hispanic, American Indian)

Culture-Related Assessment--Communication --Silence

1. May indicate a lack of understanding, stubbornness, discomfort, disagreement, disdain vs. agreement, respect, apprehension 2. American Indian, Chinese, Japanese culture - silence may be used to allow the nurse to consider what the speaker has said before continuing 3. Russian, French, and Spanish cultures - silence indicates agreement (consensus) among parties. 4. Asian cultures - silence is a sign of respect 5. Mexican - silence may indicate disagreement with person of authority

Culture-Related Assessment--Space

1. Western - more comfortable maintaining 3-6 ft between them during a conversation. Close contact is reserved for more intimate relationships 2. Members of some cultures are accustomed to more close contact and sometimes inadvertently invade the space of a person form a Western culture -The need for personal space also manifests itself in a desire to use a certain space (for example, sitting in a particular chair each day for meals)

According to 2010 census

34.6% of population is of African, Asian, Hispanic, American Indian, or some other ancestry.

Mohel

A Jewish person who is trained to do circumcisions.

Melting pot

A concept implies that people are so completely blended together that everyone shares the same values, beliefs, health practices, communication styles, and religion

Ethnic stereotype

A fixed concept of how all members of an ethnic group act or think.

Stereotype

A generalized expectation about forms of behavior, an individual, or a group.

Society

A nation, community, or broad group of people who establish particular claims, beliefs, or standards of living and conduct. A community of people who share a common culture

Ethnocentrism

A perception that the practices and beliefs of one's own culture are superior to those of other cultures. Belief in the superiority of one's own ethnic group.

Curandero

A traditional Native Healer or Shaman in Mexico.

What are four ethnic social groups

Folklore Language Food preference Day to day living

Health belief system

All cultures have a system of belief that explains what causes illness, how it is cured and treated and what is involved in those treatments.

All members of a culture do not exhibit the same behaviors. These variations within a cultural group occur because of individual differences. These are:

Age Religion Dialect or language spoken Gender identity and roles Socioeconomic background Geographic location of country of origin or current residence Amount and type of interaction between younger and older generations Degree to which values in current country are adopted

Culturally-Related Assessment

Areas you need to explore when assessing the patients are: -communication -space -time -social organization -religious beliefs -health practices -biologic variations

biomedical health belief system

Based on the belief that life is controlled by physical and biochemical processes that can be manipulated by humans

Cultural Nursing

Be aware of religious and cultural preferences when helping patients and families prepare for death Ask families about the rituals and ceremonies they used 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 done at the patient's bedside. Be sensitive to cultural perceptions regarding organ donation, viewing the body, and preparing for burial

Folk health belief system

Belief that health and illness are controlled by supernatural forces. May use native healers, plants, religious rituals, and prayers

Cultural-Related Assessment Health Practices Four basic concepts of health beliefs

Biomedical Health Belief System, Folk Health Belief System,Holistic Health Belief System, Alternative or Complimentary Belief System

Culturally Competent Nursing Care

Care must be sensitive to needs - Family and cultural needs The healthcare system is a culture Nursing -The largest culture that can make a difference

Three major races

Caucasian Negroid Mongoloid

Name four common characteristics of all cultures

Culture is learned Culture is taught Culture is social Culture is an adaptation Culture is learned from birth through language and socialization; culture is dynamic and ever-changing, but it remains stable. All members of the same cultural group share the patterns that are present in every culture, and culture is an adaptation to specific conditions in a specific location.

Race

Features A group of people that share biologic physical characteristics and hereditary factors

Third-world belief system

Folk health belief system is often referred to as "third-world" belief system

Third-World Belief System

Folk health belief system is often referred to as "third-world" beliefs and practices If is often called strange or weird by nurses and other health professionals who are unfamiliar with folk medicine beliefs. Once care providers become familiar with the practices, they no longer seem strange or weird.

Imam

Islamic leadership position. Religious leader.

When a patient has a poor grasp of English, what must a nurse do to encourage communication

Keep the questions or directions brief and simple; sometimes the patient can read written English better; if possible, find an interpreter or other family members to translate.

Culture-Related Assessment--Communication Eye contact

Maintaining eye contact also has significant cultural interpretations 1. US - indicate maintaining of eye contact as openness, interest in others, attentiveness, and honesty vs. lac of eye contact as shyness, humility, guilt, embarrassment, rudeness, thoughtlessness, or dishonesty 2. Asian & American Indian - relate sustained eye contact to impoliteness or invasion of privacy 3. East Indian - avoid eye contact with people of lower or higher socioeconomic classes 4. Appalachian - sustained eye contact indicates hostility, aggressiveness

Culture-Related Assessment--Time

Measurement of time and the rhythms of people's activities and interactions often have different meanings in various cultures 1. US & Northern European - give a high priority to being on time for appointments, they expect others to follow this pattern (time is money) 2. Eastern culture - schedules and time are much more flexible 3. Asians - spend a lot of time getting to know someone and will view abrupt endings as rude 4. Mexican Americans - (may be late for appointment because they) focus more on a current activity and are less concerned about a previously planned meeting 5. Japanese American - prompt and adhere to fixed schedules, especially when meeting with people they regard highly *(nursing practice emphasizes providing medications and treatments on rigid schedule)

Cultural assimilation (acculturation)

Minorities living within a dominant culture start to lose their own culture

Culture-Related Assessment--Religious Beliefs and Health Care

On admission - as what religion the patient is -Entwined with cultural beliefs -Some cultures expect all members to adhere to a particular religion; religious and cultural beliefs are difficult to separate in these societies -Religious practices become more varied as people form varying cultures intermarry -Nursing care is affected boy patients' religious beliefs and practices -Be aware of such beliefs to ensure care provided is sensitive to patient's needs

What is the difference between race and ethnicity

Race refers to a group of people who share biologic physical characteristics. Ethnicity refers to a group of people who share a common social and cultural heritage based on traditions, national origin, and physical and biologic characteristics.

Culture

Set of learned values, beliefs, customs, and practices that are shared by a group and passed from on generation to another. Set of values that has been passes on from one generation to another. Group that shares biologic physical characteristics. -is a groups "total way of life" -components: 1.symbols 2.language 3.values & beliefs 4.norms Beliefs, customs, and traditions of a specific group of people.

Subculture

Share characteristics with primary culture Has characteristic patterns of behavior and ideals that distinguish it from the rest of cultural group (example: Asian bowing). A group within society that is differentiated by its distinctive values, norms, and lifestyle.

Race is based on these specific characteristics

Skin pigmentation Body stature Facial features Hair texture

Ethnicity

Social group one identifies with Group of people who share a common social and cultural heritage based on shared traditions, national origin, and physical and biological characteristics A social division based on national origin, religion, language, and often race.

Culture-Related Assessment--Social Organization

Socially acquired not genetically inherited. Knowing family structure assists in understanding the patient. Impact on how individuals and families function -patriarchal vs. matriarchial -description of family structure may base on biological relationships -some are based on meeting basic needs for family by forming a group among unrelated individuals Interventions -it is important to know who the patient depends on for comfort and decision making and how the patient describes the family.

What are the factors that have directed the changes of thinking from modern biomedical health care to alternative therapies

Some of the long-established methods have become less effective, a number of folk remedies have been shown to be effective in treating certain diseases, more physicians with varied beliefs about health and illness now practice in the United States, and new groups of people from other cultures arrive and bring with them a variety of methods to deal with health issues.

Cultural Competence

The awareness of one's own cultural beliefs and practices and their relation to those of others, which may be different. An understanding of how a patient's cultural background shapes his beliefs, values, and expectations for therapy.

Culture shock

The feelings a person experiences when placed in a different culture. -For the patient, fear sometimes prevents from receiving the best care

Holistic health belief system

The forces of nature must be maintained in balance or harmony.

Patriarchal

The men (often the oldest) make most of the decision. Sometimes delay any decision making regarding health care for one of the family members until the oldest man in the family is consulted

Define transcultural nursing

Understanding and integrating the knowledge of providing culturally appropriate nursing care in all aspects of nursing care. -To help the culture we have to accommodate the culture we are caring for (blending). -An understanding that certain things can wait while activities of another cultures are taking place. Nursing areas influenced by culture: -treatment methods -responses to illness and death -childbirth -diet and nutrition Transcultural nursing is practiced when the nurse consistently attempts to apply knowledge about culture to all aspects of care.

Matriarchal

Women make most decisions about health care, provide the care, and discipline. Will expect the women to give care to a family member in the hospital.