Ch 2 - Culture

Folkways

- How we greet each other in our culture - not formally written laws, but if not done, may offend the other person in same culture

Most common diseases affecting AFRICAN AMERICANS

- Hypertension - Cancer - Stroke - Diabetes - Kidney/Liver disease

European Americans

- LARGEST cultural group in US - speech may be loud, eye contact ESSENTIAL - TOUCH accepted - can be matriarchal or patriarchal - elders live outside of family - individual responsible for their OWN HEALTH - prayer, religious symbols can prevent illness

Most common diseases affecting ASIAN AMERICANS

- Lactose intolerance - Hypertension - Liver/Stomach cancers

Characteristics of culture

- Learned - Shared - Integrative/patterned - Adaptive - Symbolic

Asian Americans

- includes Korea, Japan, Philippines, China - TABOO to openly express emotions - PATRIARCHAL - extended families in same house common - elders protected - health is balance between YIN/YANG, good/evil - good health a gift from ANCESTORS - CLEANLINESS prevents illness - Eastern medicine, i.e., acupuncture, herbs, meditation

Patients who use spiritual or religious expressions benefit with

- increased life span - healthy self-concept - improved mental health

Hispanics believe illness is caused by

- internal/external imbalances between HOT and COLD temperatures - natural causes - punishment from God

Cultural barriers to health care

- language - lack of health insurance - knowledge deficit - reluctance to question health provider - adherence to old cultural practices

Hispanics generally share similar

- language - religion - values

The nurse is correct when completing a physical assessment on a newly admitted patient if he or she includes these elements of the client's culture

- meaning of gender roles - use of touch - use of eye contact (NOT - pt connection to supreme being or how pt derives meaning/purpose from life)

Presently, ______________ of the US population speaks a language other than English.

1/5

Religion and spirituality are used interchangeably, but are NOT

THE SAME

Direct eye contact with a Hispanic may be interpreted as

"the evil eye"

Characteristics of Culture - INTEGRATED/PATTERNED

- Based on economics, social patterns, work ethics, individualism - all aspects integrated to form a whole culture - people work together cognitively and emotionally to help in adaptation Examples: Child-rearing practices Expectations of children Hopes for offspring

The elements that make up ALL cultures are

- Beliefs - Values - Norms - Folkways - Laws - Mores - Sanctions - Race - Ethniticites

Most common diseases affecting EUROPEAN AMERICANS

- Breast cancer - Leukemia

Religious groups in America

- Christianity (largest overall group) - Protestants (largest in Christianity) - Catholics (second largest) - other faiths; Judaism, Buddhism, Islam

Culturally competent care requires an understanding of

- Culture - Race - Ethnicity - Diversity IN MINORITY GROUPS

Characteristics of Culture - ADAPTIVE

- Culture constantly adapting response to environment and biological demands - Methods: Diffusion, Acculturation, Technological innovation, Globalization - manipulate environment to resolve problems of survival/reproduction - as new rules created, old rules are dropped Examples: Feminist movement/women in workforce

Values

- Deeply embedded feelings that determine good or bad, right or wrong Examples Child taught not to hit another when angry

Most common diseases affecting HISPANICS

- Diabetes - Hypertension - Obesity - AIDs - Alcoholism - Lactose intolerance

Common CULTURAL BARRIERS to health care

- Difficulties with English - Lack of health insurance - Knowledge deficit - Reluctance to question health provider - Adherence to old cultural practices

Native Americans

- FOURTH largest ethnic group in US - more than 200 tribes - each tribe has its own LANGUAGE - generally MATRIARCHAL - elders highly respected - Health is harmony between nature, the universe - life lived based on native teachings handed down by the creator - illness prevented using charms, prayers - evil spirits exorcised - use herbal remedies - use doctors, medical treatments, medicine men

Asian Americans and DEATH

- God determines who dies - grief period can extend beyond 30 days - okay for women to grieve; NOT OKAY for men to - may have burial rituals, may cremate

Most common diseases affecting NATIVE AMERICANS

- Heart disease - Diabetes - Alcoholism - Accidents - Lactose intolerance

Bathing a Hispanic woman after birth may be delayed for

14 days

Being culturally sensitive

- Listen carefully, show sincere interest - Be nonjudgemental - Determine pt's level of understanding - Determine pt's health beliefs, practices - Identify beliefs about gender, age - Determine family roles/expectations - Use interpersonal space carefully - Determine how eye contact is interpreted - Use touch, tone, volume of voice carefully - Determine if pt prefers certain gender as caregiver - Identify predominant language - Determine food observances

Mores

- Moral beliefs strongly held by members of the culture - failure to abide bye mores may lead to ostracism from culture Examples: Incest Child abuse

Levels of culture

- National - International - Subcultures

Hispanics are made up of:

- Puerto Ricans - Mexicans - Dominicans - Cubans - South/Central American countries

Arab Americans

- Saudi Arabia, Egypt, Iran, Palestine, Turkey, Pakistan, Syria, etc. - talk in LOUD voices, CLOSE PROXIMITY, intense EYE CONTACT - touch ONLY with SAME SEX - women wear clothing to cover bodies from wrists to ankles, heads, faces - usually PATRIARCHAL - strict adherence to DIET, MEALTIMES, periods of fasting during RAMADAN - illness seen as PUNISHMENT for sin - usually seek health care provider of same sex

Sanctions

- Social remedies for violating any NORMS - may be positive or negative - positive sanctions reward or honor - negative sanctions voice disapproval for violating norm, may lead to imprisonment

Norms

- Socially accepted rules/practices that guide interactions within a culture - determine role of each family member by age, gender, or ranking - 4 methods: Folkways, Laws, Mores, Sanctions

Hispanic Americans

- Stand close, frequently touch within families - Constant environmental temp keeps away illness - Try not to be a burden to others when ill - May believe in home remedies/folk healing - May believe in herbal medicine - "hot" "cold" herbals and food - may wear religious items

Beliefs

- Truths held by a culture's people - influence our behavior/concepts about death, health, illness Examples Women's roles Child-rearing practices

Promoting Racial Sensitivity in Children

- Use positive role models - Answer questions factually - Have honest, open conversations - Do not deny differences in color of skin, hair type, shape of eyes - Do not make child feel ashamed when they question race/color - Foster positive feelings toward individual heritage - Expose children to people of other races/cultures - Select dolls from different cultural and ethnic groups - Read child stories depicting different cultural/ethnic groups - Good books: The Hundred Dresses The People Could Fly Black Is Brown Is Tan Children from Australia to Zimbabwe The Friendship

Laws

- Written policies supported and enforced by government - carries specific punishment

Religion can satisfy these basic needs

- answer the currently unanswerable questions in life - offers sense of hope - strength to endure difficult times - may guide individuals to be decent to themselves and others - reduce social isolation - provides support network - may have rules that might be followed about unhealthy behaviors such as caffeine, smoking, alcohol - may provide moral guidance, promote well being

Native Americans and DEATH

- body MUST REMAIN INTACT for afterlife - cleansing ceremony to touch dead

African Americans

- common race, specific cultural groups - more emphasis on NONVERBAL than verbal behavior - loud voice either JEST or ANGER - usually MATRIARCHAL - families may include strangers - health a gift from GOD - illness caused by cold, drafts, air, acts of God, witchcraft - length of life more important than quality of life - death not an end

Similarities of cultures

- communication - social controls - family - marriage - education - supernatural beliefs

Arab Americans and PREGNANCY

- cultural/religious practices continue during pregnancy including fasting to be blessed with son - mother-in-laws help new mother - only use female doctors/nurses - immediately after birth, FATHER reads from Koran to give thanks to Allah - breastfeeding preferred and may continue until child is 2 y/o

Arab Americans and DEATH

- death God's will - body must be specially prepared - bed should face MECCA

African Americans and DEATH

- death not an end, but passing to better life - intact body to bury preferred - wakes may go on several nights - after-burial celebrations w/singing religious songs - grief openly displayed/accepted

Documented benefits of spiritual and religious expressions include

- decreased stress - relief from illnesses such as hypertension, allergy, depression, nausea

Basic needs RELIGION serves

- defines spirituality - meaning to incomprehensible events - sense of hope - defines ritual/rites of passage - reduces social isolation - promotes healthy behavior - encourages family unit

A cultural assessment includes

- ethnic/racial origin - language used - decision-maker for family - preference of gender of health care workers - determine personal space/communication style - beliefs about medicine, pregnancy, healing - dietary laws/preferences

Spiritual distress in a patient may be identified as

- feelings of hopelessness - anger - depression - withdrawal

European Americans and PREGNANCY

- focuses on care during and after birth for mother and child - usually vaginal delivery, some c-sections

Hispanic women play actives roles in

- health - childbearing decisions

Native American DIET

- high in fats - lacks fruits

Culture determines

- how we view the world - how we practice religion - how we interact with each other - how members understand work roles, sexuality

African Americans and PREGNANCY

- natural, normal process - may have delayed prenatal care - pregnant women taught to avoid certain practices that are believed to lead to complications in pregnancy, i.e., reaching up, having picture taken - women, mother support during birth - postpartum concerns are exposure to cold, drafts - may delay showers/baths, washing hair after birth to avoid cold - may choose bottlefeeding over breastfeeding - solid foods introduced to infant at earlier age

Native Americans and PREGNANCY

- prenatal care usually delayed until advanced pregnancy - midwife preferred - husband, mother, father may support - postpartum bleeding prevented by herbs - breastfeeding after milk present for a few days after birth - babies are touched less frequently than other cultures

Transcultural nursing benefits the patient by

- promoting early recovery from disease - supporting a meaningful death experience - increasing patient satisfaction

Spiritual and religious assessment includes

- religious or spiritual preferences - practices - needs to practice their preference

Characteristics of Culture - SHARED

- share traditions, values, beliefs - gives culture stability/security - shared through interactions w/members of group or direct instruction - examples: Language Individualism in America

ethnicity

- stable cultural patterns shared by a group of families with the same historical roots - from same race, geographic area - share same language - share diet, customs, dance, music, family structure/roles, religious beliefs/practices - celebrate the diversity among racial groups, i.e., Caribbeans have heritage of African, Indian, French, Portuguese, English, Dutch ethnicities

SUBCULTURES

- subgroups within a dominant culture - share common beliefs/interests - i.e., health care workers as a group

A nurse can better understand patients' behavior and response to health care by understanding

- their histories - their beliefs

Asian Americans and PREGNANCY

- time of happiness, contentment - treatment for pregnancy discomfort is to OMIT MILK, maintain HIGH LEVEL OF ACTIVITY - birth support from mother, other women - may have no postpartum activity for 40-60 days; others help tend to house and baby - breastfeed, usually after 3 days

Culture decides

- what is - what can be - what one feels about it - what to do about it - how to go about doing it

Hispanics do not breastfeed until

3-4 days after birth when milk is considered READY

The first milk secreted by a Hispanic mother is felt to be

CONTAMINATED and may cause the baby to become ill

Knowing a person's _______________________ will help you understand his or her response to illness.

CULTURE

The majority of Hispanics practice what religion?

Catholic

The ultimate goal of transcultural nursing is

Culturally Congruent Care

Knowing a patient is Arabic and prefers same-sex caregivers and planning for that in the patient's care plan is an example of

Culturally Specific Care

Even between Native American friends, __________________ is unacceptable.

DIRECT EYE CONTACT

Asian Americans consider loud tones

DISRESPECTFUL

African Americans have a basic ____________ of the health care system.

DISTRUST

Asian Americans consider it disrespectful to look ____________ directly in the eye.

ELDERS

In this culture, open expression of grief is not accepted and men should not outwardly grieve or cry.

European American

How to get Cultural Assessment

Find out: - ethnic/racial origin - language - family roles - use of communication - beliefs about medicine, pregnancy, healing - dietary preferences

The largest minority group in America is

Hispanic Americans

The most rapidly growing ethnic group in America is

Hispanic Americans

With Native Americans, illness is the result of an

IMBALANCE between environment and supernatural forces

Behavior that is correct within a culture is called a

MORE

Characteristics of Culture - LEARNED

Learned from birth as behaviors, values, beliefs, traditions passed from one generation to the next through language - learned from parents, siblings, other children - through TV shows/computer games - enculturation - learning through observation/instruction - children learn mealtimes, bed times, types of foods, manner of dress

Native Americans may touch friends or family, but there is ___________ between strangers.

NO TOUCHING

Transcultural nursing theory states

ONE WORLD, MANY CULTURES

Hispanic births mainly occur with midwives, also called

PARTERAS

Speaking loudly is considered ______________ by Native Americans.

RUDE

Purpose of transcultural nursing

To provide nurses with education missing in nursing practice to promote/maintain cultural care needs of an individual

Hispanic women must be kept _____________ after birth to regain their strength.

WARM

Characteristics of Culture - SYMBOLIC

We use symbols, language, gestures, pictures, for communication among cultural members - verbal and nonverbal - material or nonmaterial Examples Alphabet Clothing style Art Stop sign Body language

Does how an infant is treated after birth depend on the cultural background of his or her parents?

YES

Hispanics view life as

a gift from God

Hispanics believe in large, extended families headed by

a male

Hispanics view death as

a natural part of the life cycle

African Americans may view direct eye contact as

a sign of aggression

transcultural nursing

a way of viewing patients as belonging to one world with many cultures

culture

all learned patterns of behavior passed down through generations that influence our thinking, decisions, and actions

Hispanic children are cared for by

all people in their culture, elders included

Hispanics believe when they are ill, the should try not to

become a burden to others

ethnocentrism

belief that one's cultural values and patterns of behavior are superior

diffusion

borrowing cultural traits from another culture

culturally congruent care

care that incorporates key values and beliefs of a culture

globalization

change by a combination of diffusion, acculturation, migration patterns, and tourism

1/3 of Hispanic Americans are

children 15 or younger

Culture includes

customs

Nurses who respect the patient's cultural difference

deliver competent care

The ability to learn one's culture within the cultural group is an example of

enculturation

Transcultural Nursing

formal area of study/practice focused on comparative human care and understanding the differences and similarities in beliefs, values, and practices among people - uses HOLISTIC care approach

Race

group of people sharing certain similar physical characteristics including skin color, hair texture, facial shape, and/or body shape/size

spirituality

how an individual finds purpose and meaning to their life

Asian Americans only accept touch between

individuals of SAME SEX

Madeline Lenninger

introduced theory of TRANSCULTURAL NURSING in mid-1950s

The best way to provide culturally competent health care is to

involve patient and family in developing a plan of care

cultural relativism

learn and apply the other person's cultural standard to each situaiton

INTERNATIONAL culture

learned patterns of behavior across national borders because of migration and globalization

NATIONAL culture

learned patterns of behavior/values shared by a whole nation

cultural relativism is

learning and applying another person's cultural standard to each situation

Madeline Lenninger, introducer of transcultural nursing theory, believed

nurses must be prepared to care for anyone anywhere in the world

cultural competence

ongoing/continuous self-evaluation and development of cultural skills

Health indices are markedly _________________ for Hispanics than other ethnic groups.

poorer

Children are NOT born with

prejudice

cultural sensitivity

recognizes diversity exists and to respect a persons uniqueness - avoiding offending another's beliefs or practices

The expected patient outcome when the nurse is culturally sensitive is

recovery

A client expresses a cultural belief that prayer and faith heal better than any medicine. The nurse assigned to care for this client can provide culturally competent care by

respecting his belief

Race categorizes people _____________________ rather than biologically.

socially

technological innovation

solve problems in society - discovery of penicillin which saves lives all over the world

religion

specific system of beliefs and worship

ethnocentric

the belief that one's culture, or patterns of behavior are superior to another culture's

Culture is learned because of

traditions passed down from one generation to the next

cultural awareness

understanding of culture, race, and ethnicity of diverse minority groups as well as their values and beliefs, and how a patient solves problems in their culture. - knowing a patient's cultural expectations and needs from THEIR point of view

Culturally Specific Care

using knowledge specific to a patient's culture to determine the patient's values and needs to plan and deliver care for a more positive outcome

acculturation

values/beliefs are exchanged as a result of continuous, direct interactions between cultures - immigrant to America adopts freedom of expression