Chapter 15

multicultural example

a hospital caregivers are from different groups

bicultural

a person who identifies with two cultures and integrates some of the values and lifestyle of each into his life ex: a jewish man who marries an italian catholic woman

personal values

a principle or standard that has meaning or worth to an individual

key point

remember that individuals within an ethnocultural group vary widely and that learning commonalities is no substitute for careful assessment of each person

Germans : personal space

require a great deal of space, and consider even looking into a room an invasion of privacy.

professional healthcare system

run by professional healthcare providers who have been formally educated and trained for their appropriate roles and responsibilities.

magico religious system ex

voodoo, which is practiced in somedeveloping nations in Africa, Latin America, and the Caribbean, and which considers the lion a spiritual symbol

Biological variations

ways in which people are different genetically and physio-logically. body build and structure, skin color,vital signs, enzymatic and genetic variations, and drug metabolism

key point

we all tend to group and categorize data to make it meaningful and useful, but we must be careful to avoid using these categories as the basis for interacting with people or providing care

culture

what people in a group have in common, but it changes over time

Rosanna throws away the prescription given by doctor for her son

Some people of Mexican heritage believe that illness is caused by the body's imbalance of "hot" and "cold" (not re-lated to temperature)

Economy

condition of the economy directly affects the availability of funds for publicly funded services. It also affects the individual's ability to pay for healthcare.

multicultural

region is populated by individuals many different cultural groups.

cultural assimilation

results in varying degrees of affiliation with the dominant culture when the new members gradually learn and take the essential values, beliefs, and behaviors of the dominant culture

Arabs and others from the Middle East : personal space

stand quite close when talking

examples of subculutres

street gangs , physicians, nurses, women, older adults, persons with disabilities, gays and lesbians, people of appalachian heritage, rural midwesterners, and people who abuse certain drugs

latino

strictly speaking , refers only to people from central or south america

dominant g group in north america

white anglo-saxon christian of european descent

cultural stereotype

widely held but oversimplified & unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain aspects

gender ex

us and canada view caring and nurturing as a women thing 9 % of men nurses

Complementary medicine

use of rigorously tested therapies to complement those of conventional medicine

practice ex

" i always wash my hands before preparing food

belief ex

" i believe that germs cause disease

magico-religious system,

"alternative" or "indigenous" in the UnitedStates.

nurses realize

"knowledge work"

Religion and Philosophy

A person's religion may deter-mine what healthcare is acceptable to him (e.g., blood trans-fusions, abortion).

environmental control ex

For example, if a person does not believe he can do anything to "change things," how would this attitude affect his decision to seek medical care? To take medications?To exercise and eat properly? Perception and tolerance of pain are examples of the effect of environmental control. Some people, especially Asian Americans, tend to accept pain stoically, and not demand relief. They do not view cir-cumstances as something to be "controlled." Think again about Mr. Chan (Meet Your Patients). Why do you think he just shakes his head and looks away when asked to rate his pain?

The social organization of your clients' cultures can provide cluesas to how they will act during life events

For example, imagine a patient who must depend on Medicaid to pay for her health-care, but who does not trust large institutions or government agencies. She is likely to use home remedies and to delay seeing a conventional medical provider.

culture specific ex 2

Greece amulets ( objects or charms worn as protection against evil spirits ) placed on baby

A close social organization can be found in all cultures; however,the specifics vary.

Middle Eastern and Latino cultures, the man is likely to be the dominant family member and the woman the homemaker But many African American families are matriarchal; that is, the decision maker and family leader is a woman.

awareness

Take an honest look at your personal biases and prejudices toward cultural groups other than your own.

cultural awareness

appreciation external signs of diversity,

campinha- bacote

asked mnemonic

folk medicine

beliefs and practices that the members of a cultural group follow when they are ill, as opposed to more conventional (i.e., biomedical or professional) standards

complex

cultural assumptions and habits are unconscious and thus may be difficult for members of the culture to explain to others or to identify as different from another culture.

dynamic and adaptive

cultural customs, beliefs, and practices change over time and at different rates . Cultural change occurs with adaptation in response to the environment

learned and taught

cultural values, beliefs , and traditions are passed down from generation to generation.

all-encompassing

culture can influence everything its members think and do

culture exists at many levels

culture exists in both the material ( art, writings, dress, or artifacts) and the nonmaterial ( customs , traditions, language, beliefs, and practices

vulnerable population as subcultures

develop health problems & experience poorer outcomes b/c limited access to care , high risk behaviors, multiple / cumulative stressors

professional healthcare system ex

diet therapy, mind-body control methods, therapeutic touch, acupressure, reflexology, naturopathy, kinesiology, and chiropractic.

key point 3

each person must be seen as unique - as influenced by his heritage, but not defined by it

communication

exchange of information, ideas, and feelings verbal & nonverbal spoken language,gestures, silences

social organization

family unit (e.g., nuclear, single-parent, or extended family)and the broader groups (e.g., community, religious, ethnic)with which the individual or family identifies (

indigenous healthcare system

folk medicine and traditional healing methods,which may also include over-the-counter (OTC) and self-treatment remedies.

dominant culture

is the group that has the most authority or power to control values and reward or punish behaviors

Americans, Canadians of Northern European ancestry, and the British : personal space

keep at least 18 inches of space between themselves and the person with whom they are conversing.

cultural sensitivity

more to do with personal attitudes and being careful not to sayor do something that might be offensive to someone from a dif-ferent culture

cultures consist of common beliefs and practices

most members of culture share the same beliefs, traditions, customs, and practices as long as they continue to be adaptive and satisfy the members needs. Some members of the group may deviate from cultural norms, but for a norm to be considered cultural, many members must follow it

holistic belief system

need for harmony and balance of the body with nature.

immigrants

new members of a group or country

belief

one accepts as true

knowledge

patient's view of the world is in order to understand it and work competently with the patient.

acculturation

the process of adapting to and adopting a new culture experts theorize it takes 3 generations for acculturation

ethnocentrism

the tendency to think that your own group ( cultural,professional,ethnic, or social ) is superior to others and to view behaviors and beliefs that differ greatly from your own as somehow wrong, strange, or unenlightened

ayurveda,

the traditional healthcare system of India.

alternative medicine

therapies used instead of conventional(i.e., biomedical) medicine, and whose reliability has not been validated through clinical testing in the United States.

Environmental control

to a person's perception of his ability to plan activities that control nature or direct environmental factors

ethnicity

to groups whose members share a common social and cultural heritage that is passed down from generation to generation

race

to the group of people based on biological similarities such as skin color, blood type, or bone structure

Healthy people 2020 overarching goal

To eliminate disparities among racial and ethnic groups and improve the health of all groups

For example in nursing homes

Use of restraints is higher among Hispanics and asian/pacific islanders than it is among non hispanic white

ethnic group example

french canadians, roman catholics, hmongs, and latinos

quality & safety education for nurses

(1) pro-vide patient-centered care with sensitivity and respect for the diversity of human experience; (2) seek learning opportunities with patients who represent all aspects of human diversity;and (3) recognize personally held attitudes about working with patients from different ethnic, cultural, and social back-grounds (

ethnicity two categories

1. hispanic, latino, or spanish 2. not hispanic , latino or spanish

biological variations

African Americans metabolize antihypertensives differently from EuropeanAmericans ■African American and Caucasian men are on average about3.5 inches taller than Asian American men, and 2 inches taller than Mexican American men.■African Americans have a higher incidence of hypertension and sickle cell anemia.■Asian Americans tend to experience more gastrointestinal side effects from opiates, even though the analgesic effect is less.

culture specifics ex

Belize a baby is christened before visitors are allowed to see her, to prevent evil eye ( bad spell cast by others)

Education

Education influences the perception of wellness and illness, the knowledge and understanding of options that are available for healthcare, and the person's expectations for care.

time orientation ex

European Americans: future oriented Native Americans and Latinos: more present oriented; may not show up on late or not show up for follow up appointment

complementary medicine ex

Examples include chiropractic care, biofeedback,and the use of certain supplements.

alternative medicine ex

Examples of alternative therapies include iridology, aromatherapy, andmagnet therapy

Disparities of minorities

Experience higher rates of illness and death and in general poorer health status compared with white ( non Hispanic)

communication ex

For example, Arabs tend to keep steady eyecontact when talking, but not between men and women;Asians and Native Americans usually do not make eye contact

Politics and the Law

Governmental policies affect health-care. They determine what practitioners will be available and what programs will be funded. For example, the federal government helps fund Medicare, which provides basic medical insurance for people age 65 and older, but Medicare limits the frequency and types of treatment for which it will pay. The legal system defines roles, functions, and standards of health professionals.

Kinship and social ties also determine who receives healthcare, and in what priority.

In the United States, for example, someone of high status (e.g., a celebrity or political figure) is likely to receive better care than a poor person who is unknown in the community. In some cultures, men receive care before women and children.

american nurses association

Nursing: Scope andStandards of Practice(2010) states that the registered nurse should provide holistic care that addresses the needs of diverse populations.

nursing values ex

Silent suffering as a response to pain■Objective reporting and description of pain, but not an emotional response■Use of the nursing process■Nursing autonomy■Caring

Time orientation

Some persons tend to be present or future oriented, whereas others are more rooted in the past.

Technology

The availability of supplies and equipment de-termines what is used in the healthcare setting and whatcomes to be culturally expected. Nurses in most of NorthAmerica, for example, assume they will have bed linens,water, electricity, necessary medications, electrocardiogra-phy, and x-ray imaging. In many parts of the world, how-ever, these items are not available

biomedical healthcare system

Western biomedical beliefs with traditional North American values of self-reliance, individualism, and aggressive action.This system is also known as Western medicine and allopathic medicine.

skills

ability to conduct with sensitivity a cul-tural assessment and a culturally based physical assessment

Cultural competence

achieved on a continuum ranging from incompetent to competent "having the knowledge, abilities, andskills to deliver care congruent with the client's cultural beliefs and practices

hispanic

americans are people who originally came from any spanish-speaking country ( mexico, spain) More than 60 % are from mexican origin

cultural beliefs provide identity and a sense of belonging

for a culture's members as long as they do not conflict with the dominant culture and continue to satisfy its members

subcultures

groups within a larger culture or social system that have some characteristics ( values, behaviors, ancestry,ways of living ) that are different from those of the dominant culture

ethnic group

have some characteristics in common ( race, ancestry, physical characteristics, geographic region, lifestyle, religion) that are not shared or understood by outsiders

vulnerable group : Native alaskans, american indians

higher incidence of early onset diabetes

vulnerable population ex

homeless, mentally ill , poor , physical disabilities , very young , old

spanish

implies origin in spain

space

individual's personal space, or how the person relates toward the space around him.

Minority groups

individuals who share race, religion or ethnic hertiage; fewer members

culture of nursing

learned and transmitted life ways, values, symbols, patterns, and normative practices of members of the nursing profession that are not the same as those of the mainstream culture.

assimilation example

learning to speak the dominant language, marrying a member from the new ( host) culture, making close, personal relationships with members of the new group

encounters

many face-to-face encounters as possible with patients from diverse cultural backgrounds.

socialization

process of learning to become a member of a society or a group

practice

set of behaviors that one follows

cultural archetype

similar to a model, a person or thing -something that is recurrent - and it has its basis in facts

gender as a subculture

some behaviors considered acceptable for men and not for women

culture universals

values, beliefs, practice that people from all cultures share

culture specifics

values, beliefs, practices, that are special or unique to a culture