Unit 2: Caring Throughout the Life Span / Chapter 9: Culture and Ethnicity

Explain the following components of a cultural assessment. Ethnic heritage and ethnohistory:

Ethnic heritage and ethnohistory are the knowledge of a patient's country of origin and its history and ecological contexts.

A female Jamaican immigrant has been late to her last two clinic visits, which in turn had to be rescheduled. The best action that the nurse could take to prevent the patient from being late to her next appointment is: 1. Give her a copy of the city bus schedule. 2. Call her the day before her appointment as a reminder to be on time. 3. Explore what has prevented her from being at the clinic in time for her appointment. 4. Refer her to a clinic that is closer to her home.

Explore what has prevented her from being at the clinic in time for her appointment

Which of the following is not included in evaluating the degree of heritage consistency in a patient? 1. Gender 2. Culture 3. Ethnicity 4. Religion

Gender Rationale: Involves racial, ethnic, religious, and social groups

Culture

integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups

Bilineal

is limited to the side of either father (patrilineal) or mother (matrilineal)

Patrilineal

kinship that is limited to only the father's side

Matrilineal

kinship that is limited to only the mother's side

Fictive

nonblood kin; considered family in some collective cultures

Etic worldview

outsider's perspective

Cultural competence

process in which the health care professional continually strives to achieve the ability and availability to work effectively with individuals, families, and communities

Acculturation

process of adapting to and adopting a new culture

Cultural care preservation or maintenance

retaining and/or preserving relevant care values so patients are able to maintain their well-being, recover from illness, or face handicaps and/or death

Ethnicity

shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics

Ethnohistory

significant historical experiences of a particular group

Rites of passage

social rituals that mark the transition between developmental stages, especially between childhood and adulthood

Ethnocentrism

tendency to hold one's own way of life as superior to that of others

Enculturation

the social process by which culture is learned and transmitted across generations

Assimilation

to become absorbed into another culture and adopt its characteristics

Study of cultures to understand the similarities and differences across human groups

transcultural nursing

Cultural imposition

using one's own values and customs as an absolute guide in interpreting behaviors

Subcultures

various ethnic, religious, and other groups with distinct characteristics from the dominant culture

Key Points:

• Culture is the context for interpreting human experiences such as health and illness and provides direction to decisions and actions. • Culturally congruent care is meaningful, supportive, and facilitative because it fits valued life patterns of patients. • Nurses achieve culturally congruent care through cultural assessment and the application of cultural preservation, accommodation, and repatterning. • Culturally competent care requires knowledge, attitudes, and skills supportive of implementation of culturally congruent care. • Cultural assessment requires a comprehensive and thorough investigation of a patient's cultural values, beliefs, and practices. • Transcultural nursing is a comparative study and understanding of cultures to identify specific and universal caring constructs across cultures. • Impression management facilitates culturally congruent communication and intercultural relationships.

A registered nurse is admitting a patient of French heritage to the hospital. Which question asked by the nurse indicates that the nurse is stereotyping the patient? 1. "What are your dietary preferences?" 2. "What time do you typically go to bed?" 3. "Do you bathe and use deodorant more than one time a week?" 4. "Do you have any health issues that we should know about?"

"Do you bathe and use deodorant more than one time a week?"

Biculturalism

(sometimes known as multiculturalism) occurs when an individual identifies equally with two or more cultures

Which of the following best represents the dominant values in American society on individual autonomy and self-determination? 1. Physician orders 2. Advance directive 3. Durable power of attorney 4. Court-appointed guardian

Advance directive

When interviewing a Native American patient on admission to the hospital emergency department, which questions are appropriate for the nurse to ask? (Select all that apply.) 1. Do you use any folk remedies? 2. Do you have a family physician? 3. Do you use a Shaman? 4. Does your family have a history of alcohol abuse?

1. Do you use any folk remedies? 2. Do you have a family physician? 3. Do you use a Shaman?

A nursing student is taking postoperative vital signs in the postanesthesia care unit. She knows that some ethnic groups are more prone to genetic disorders. Which of the following patients is most at risk for developing malignant hypertension? 1. Ashkenazi Jew 2. Chinese American 3. African American 4. Filipino

African American

Old lady "granny midwife" as their healer

African Americans

Explain the following components of a cultural assessment. Time orientation:

All cultures have past, present, and future time dimensions. This information is useful in planning a day of care, setting up appointments for procedures, and helping a patient plan self care activities in the home.

The nurse at an outpatient clinic asks a patient who is Chinese American with newly diagnosed hypertension if he is limiting his sodium intake as directed. The patient does not make eye contact with the nurse but nods his head. What should the nurse do next? 1. Ask the patient how much salt he is consuming each day 2. Discuss the health implications of sodium and hypertension 3. Remind the patient that many foods such as soy sauce contain "hidden" sodium 4. Suggest some low-sodium dietary alternatives

Ask the patient how much salt he is consuming each day

Cultural assessment is:

Cultural assessment is a systematic and comprehensive examination of the cultural care values, beliefs, and practices of individuals, families, and communities.

Which of the following is required in the delivery of culturally congruent care? 1. Learning about vast cultures 2. Motivation and commitment to caring 3. Influencing treatment and care of patients 4. Acquiring specific knowledge, skills, and attitudes

Acquiring specific knowledge, skills, and attitudes

A 46-year-old woman from Bosnia came to the United States 6 years ago. Although she did not celebrate Christmas when she lived in Bosnia, she celebrates Christmas with her family now. This woman has experienced assimilation into the culture of the United States because she: 1. Chose to be bicultural. 2. Adapted to and adopted the American culture. 3. Had an extremely negative experience with the American culture. 4. Gave up part of her ethnic identity in favor of the American culture.

Adapted to and adopted the American culture

Explain the following components of a cultural assessment. Caring beliefs and practices:

Allowing the patient to describe the meanings of care and identify caring behaviors is fundamental to culturally congruent care.

Explain the following components of a cultural assessment. Social organization:

Although different configurations of a family exist, the most common is the nuclear household made up of parents and their young children. Collectivistic groups often regard members of their ethnic groups as closest kin and want to consult them. Social hierarchy and roles are further defined by the culture.

Naturalistic therapies to prevent and treat illness

Asian Indians

To enhance their cultural awareness, nursing students need to make an in-depth self-examination of their own: 1. Motivation and commitment to caring. 2. Social, cultural, and biophysical factors. 3. Engagement in cross-cultural interactions. 4. Background, recognizing personal biases and prejudices.

Background, recognizing personal biases and prejudices

To be effective in meeting various ethnic needs, the nurse should: 1. Treat all patients alike. 2. Be aware of patients' cultural differences. 3. Act as if he or she is comfortable with the patient's behavior. 4. Avoid asking questions about the patient's cultural background.

Be aware of patients' cultural differences. Rationale: Caused by the changing demographic profile of the United States in relation to immigration and significant culturally diverse populations

Use of products that restore the balance based on yin/yang concepts

Chinese and Southeast Asians

The most important factor in providing nursing care to patients in a specific ethnic group is: 1. Communication 2. Time orientation 3. Biological variation 4. Environmental control

Communication Rationale: Because different cultural groups have distinct linguistic and communication patterns

During their clinical postconference meeting, several nursing students were discussing their patients with their instructor. One student from a middle-class family shared that her patient was homeless. This is an example of caring for a patient from a different: 1. Ethnicity. 2. Culture. 3. Heritage. 4. Religion.

Culture

Explain what a cultural-bound syndrome is and give an example.

Culture-bound syndromes are illnesses specific to one culture, explaining social reactions of the culture's members. An example is "going postal," which is extreme and uncontrollable anger in the workplace that results in shooting people.

A 6-month-old child from Guatemala was adopted by an American family in Indiana. The child's socialization into the American midwestern culture is best described as: 1. Assimilation. 2. Acculturation. 3. Biculturalism. 4. Enculturation.

Enculturation

Explain the following components of a cultural assessment. Communication patterns:

Different cultural groups have distinct linguistic and communication patterns that reflect core cultural values.

When action is taken on one's prejudices: 1. Discrimination occurs. 2. Delivery of culturally congruent care is ensured. 3. Effective intercultural communication develops. 4. Sufficient comparative knowledge of diverse groups is obtained.

Discrimination occurs

When providing care to patients with varied cultural backgrounds, it is imperative for the nurse to recognize that: 1. Cultural considerations must be put aside if basic needs are in jeopardy. 2. Generalizations about the behavior of a particular group may be inaccurate. 3. Current health standards should determine the acceptability of cultural practices. 4. Similar reactions to stress will occur when individuals have the same cultural background.

Generalizations about the behavior of a particular group may be inaccurate. Rationale: Nurses need to determine how much an individual's life patterns are consistent with his or her heritage.

Curandero as their healer

Hispanics

A nursing student is doing a community health rotation in an inner-city public health department. The student investigates sociodemographic and health data of the people served by the health department, and detects disparities in health outcomes between the rich and poor. This is an example of a(n): 1. Illness attributed to natural and biological forces. 2. Creation of the student's interpretation and descriptions of the data. 3. Influence of socioeconomic factors in morbidity and mortality. 4. Combination of naturalistic, religious, and supernatural modalities.

Influence of socioeconomic factors in morbidity and mortality

Combination of prayers, chanting, and herbs to treat illness caused by supernatural factors

Native Americans

Patients suffer cultural pain when:

Patients experience cultural pain when health care providers disregard their values or cultural beliefs.

Explain the following components of a cultural assessment. Religious and spiritual beliefs:

Religious and spiritual beliefs are major influences on the patient's views about health, illness, pain and suffering, and life and death.

Cultural care repatterning or restructuring

Reordering, changing, or greatly modifying a patient's/family's customs for a new, different, and beneficial health care pattern

A community health nurse is making a healthy baby visit to a new mother who recently emigrated to the United States from Ghana. When discussing contraceptives with the new mom, the mother states that she won't have to worry about getting pregnant for the time being. The nurse understands that the mom most likely made this statement because: 1. She won't resume sexual relations until her baby is weaned. 2. She is taking the medroxyprogesterone (Depo-Provera) shot. 3. Her husband was recently deployed to Afghanistan. 4. She has access to free condoms from the clinic.

She won't resume sexual relations until her baby is weaned

Explain the following components of a cultural assessment. Biocultural history:

Some distinct health risks are attributable to the ecological context of the culture. Certain genetic disorders are also linked with specific ethnic groups.

Culture strongly influences pain expression and need for pain medication. However, cultural pain is: 1. Not expressed verbally or physically. 2. Expressed only to others from a similar culture. 3. Usually more intense than physical pain. 4. Suffered by a patient whose valued way of life is disregarded by practitioners.

Suffered by a patient whose valued way of life is disregarded by practitioners

The aim of asking questions in the cultural assessment is to:

The aim is to encourage patients to describe values, beliefs, and practices that are significant to their care that health care providers will take for granted unless otherwise uncovered.

Foster identified two distinct categories of cross-cultural healers. Explain each one. a. Naturalistic practitioners b. Personalistic practitioners

a. Naturalistic practitioners attribute illness to natural, impersonal, and biological forces that cause alteration in the equilibrium of the human body. b. Personalistic practitioners believe that an external agent, which can be human or nonhuman, causes health and illness.

National standards regarding language services include:

a. Provide language assistance services free of charge to all patients with limited English at all points of contact. b. Notify patients, both verbally and in writing, of their rights to receive language assistance services. c. Use interpreters for patients with limited English proficiency (unless the patient requests that their family or friends interpret for them).

Briefly explain the three nursing decision and action modes to achieve culturally congruent care. a. Cultural care preservation or maintenance: b. Cultural care accommodation or negotiation: c. Cultural care repatterning or restructuring:

a. Retains or preserves relevant care values b. Adapt or negotiate with others for satisfying health outcomes c. Reorder, change, or modify the patient's lifestyle

Adapting to and adopting a new culture

acculturation

Cultural care accommodation or negotiation

adapting or negotiating with the patient/ families to achieve beneficial or satisfying health outcomes

Naturalistic practitioners

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

Culture-bound syndrome

illnesses restricted to a particular culture or group because of its psychosocial characteristics

Personalistic practitioners

believe that an external agent, which can be human (i.e., sorcerer) or nonhuman (e.g., ghosts, evil, or deity), causes health and illness. Personalistic beliefs emphasize the importance of humans' relationships with others, both living and deceased, and with their deities

When an individual identifies equally with two or more cultures

bioculturalism

Culturally congruent care

care that fits people's valued life patterns and sets of meanings generated from the people themselves. Sometimes this differs from the professionals' perspective on care

Emic worldview

insider or native perspective

Self-examination of one's own background, recognizing bias and prejudices

cultural awareness

Motivation and commitment to caring that move an individual to learn about others

cultural desire

Engaging in cross-cultural interactions that provide learning of other cultures and opportunities

cultural encounters

Sufficient knowledge of diverse groups, including their values, beliefs, and care practices

cultural knowledge

Able to assess social, cultural, and biophysical factors influencing treatment

cultural skills

Concept that applies to a group of people whose members share values and ways of thinking and acting that are different from those of people who are outside the group

culture

Transcultural nursing

distinct discipline developed by Leininger that focuses on the comparative study of cultures to understand similarities and differences among groups of people.

Insider or native perspective

emic worldview

Socialization into one's own culture

enculturation

Shared identity related to social and cultural heritage

ethnicity

An outsider's perspective

etic worldview

Cultural pain

feeling that a patient has after a health care worker disregards the patient's valued way of life