Chapter 15: Culture & Ethnicity

Samoan

Other Reported Entries American Samoan or Western Samoan

What Are the Main Points in This Chapter?

-The cultural and ethnic composition of North America has changed dramatically over the past several decades, making it essential that nurses understand the healthcare beliefs and practices of diverse populations. -Culture includes shared values, beliefs, norms, and practices that guide a particular group's thinking, decision making, and actions in a patterned way. -Through acculturation, most ethnic and cultural groups modify some of their traditional cultural characteristics, values, beliefs, and practices. -You should be familiar with the common characteristics of different cultural groups in your community. -The U.S. Census Bureau has identified the following racial categories on the 2010 Census questionnaire: White Black, African American, or Negro American Indian or Alaska Native Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander (specify, e.g., Tongan) -The Census Bureau (2010) categories for ethnicity (or "origin") are: (1) Hispanic, Latino, or Spanish and (2) Not Hispanic, Latino, or Spanish. Subcategories under Hispanic origin are Mexican, Mexican American, Chicano; Puerto Rican; Cuban; and Another Hispanic, Latino, or Spanish origin. -Culture universals (commonalities) are the values, beliefs, and practices that people from all cultures share. Culture specifics (diversities) are those values, beliefs, and practices that are unique to a culture. -A cultural archetype, similar to a model, is an example of something that is recurrent and has its basis in facts. A cultural stereotype is a widely held but oversimplified and unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain respects. Six organizing phenomena of culture that influence health include communication patterns, space, social organization, time, environmental control, and biological variations. -Healthcare providers cannot understand the health beliefs and practices of diverse populations if they view them through the lens of the conventional (Western, U.S.) culture of healthcare. -A variety of "alternative" healing systems exists. Remedies have been passed down from generation to generation and include the use of herbs, customs, and rituals. -An understanding of cultural concepts, theories, and models can help you develop cultural competence. -Ethnocentrism, stereotyping, prejudice, and racism are barriers to culturally competent care. -When assessing a client and making nursing diagnoses, you must consider the client's cultural values, beliefs, and practices related to health and healthcare. -Culturally competent care requires a nonjudgmental attitude, self-awareness, sensitivity, respect for differences, theoretical knowledge, and the desire to be culturally competent.

Other Pacific Islander

Other Reported Entries Carolinian, Chuukese (Trukese), Fijian, Kosraean, Melanesian, Micronesian, Northern Mariana Islander, Palauan, Papua New Guinean, Pohnpeian, Polynesian, Solomon Islander, Tahitian, Tokelauan, Tongan, Yapese

Guamanian or Chamorro

Other Reported Entries Chamorro or Guam

Other Race

Other Reported Entries Multiracial; mixed; interracial, or a Hispanic, Latino, or Spanish group (e.g., Mexican, Puerto Rican, Cuban, or Spanish)

Why should nurses know more about the culture and ethnicity of clients?

Answer: Most nurses in North America are white. The nursing care appropriate for white Americans may be ineffective and inappropriate for people from different cultural and ethnic groups. No matter what the nurse's culture/ethnicity, at some time she is likely to be caring for clients of a different cultural or ethnic group. In addition, nurses need to delegate and supervise others in providing culturally appropriate and sensitive care, ensuring that all clients have equal access to such care. The nurse needs a good understanding of culture and ethnicity for providing direct care but also for teaching and role modeling culturally competent care to other care providers.

Refer to the Meet Your Patients feature (in Volume 1 of your textbook). Identify an efficacious practice.

Answer: One efficacious (helpful) practice might be the presence of Mr. Chan's family members. Restoring harmony might also be helpful, or at least neutral. Another efficacious practice is seeking treatment in the professional healthcare system.

What are some common folk medicine practices?

Answer: Some of the more common healthcare practices may include hot and cold therapies; use of medals, jewelry, and amulets; herbs and roots; massage; rituals; incantations and prayers; use of certain foods; acupuncture; and meditation.

What does the acronym "BALI" stand for?

Answer: -Be aware of your cultural heritage. -Appreciate that the client is unique: influenced, but not defined by his culture. -Learn about the client's cultural group. -Incorporate the client's cultural values/behaviors into the plan of care.

Give an example of each: ethnic group, race, religion.

Answer: -Ethnic group. Latino or Hispanic, Greek Orthodox, Bosnian Serbs -Race. White or Caucasian, black or African American, Asian, American Indian, Alaska Natives, Native Hawaiian or Other Pacific Islander -Religion. Catholic, Greek Orthodox, Baptist, Buddhist, Hindu

A patient reports experiencing gas, abdominal bloating, and diarrhea after consuming milk or cheese. Lactose intolerance might immediately be suspected if the patient is of which heritage? 1) African American 2) Mexican American 3) European American 4) Arab American

Answer: 1) African American Rationale: Lactose intolerance, caused by a deficiency of the enzyme lactase, is more commonly seen in African Americans than in the other cultural groups listed. Of course, one would assume lactose etiology as the cause of the patient's symptoms, but it would be important to rule it out.

A patient who came from Central America is admitted with diabetes mellitus. The nurse is collecting biographical information. Which information provided by the patient represents his ethnicity? 1) Latino 2) Catholic 3) White 4) Teacher

Answer: 1) Latino Rationale: Ethnicity refers to groups whose members share a common cultural heritage. This patient came from a Spanish-speaking country in Central America; therefore, his ethnicity is considered Latino. Catholic is his religion, white is his race, and teacher is his occupation.

A Hispanic patient is frustrated because the healthcare team does not understand the importance of hot and cold therapies. Which nursing diagnosis is most appropriate for this patient? 1) Powerlessness 2) Impaired Verbal Communication 3) Spiritual Distress 4) Risk for Noncompliance

Answer: 1) Powerlessness Rationale: Powerlessness is the best nursing diagnosis for the patient who is unable to make healthcare personnel understand the importance of his cultural beliefs. Impaired verbal communication can be used for patients who do not speak or understand the healthcare personnel's language. Spiritual Distress might occur because a treatment is not in agreement with the patient's religious beliefs. Risk for Noncompliance can be identified when a patient fails to follow a health-promoting or therapeutic plan the healthcare provider believes they agreed to.

How do the barriers of ethnocentrism and language impede nursing care of diverse populations?

Answer: Such barriers can impede the nurse's ability to provide culturally competent care by failing to incorporate and view as important the client and family values, beliefs and practices. Language barriers prevent an adequate and comprehensive assessment upon which to plan, implement, and evaluate care.

A patient is prescribed a low-sodium, low-fat diet. How can the nurse best ensure that the patient follows the prescribed diet during hospitalization? 1) Make sure dietary services sends a low-sodium, low-fat meal tray. 2) Arrange for meals that accommodate his cultural dietary practices and specified diet. 3) Ask the patient's family to bring in from home the foods he typically eats. 4) Sit with the patient while he eats to make sure he consumes the prescribed diet.

Answer: 2) Arrange for meals that accommodate his cultural dietary practices and specified diet. Rationale: The nurse can help ensure that the patient consumes the prescribed diet by requesting a culturally appropriate meal tray for the patient. Patients are more likely to follow the prescribed diet when it contains foods that they prefer. Simply providing a tray that is low in fat and sodium does not take into consideration his cultural preferences. The family can provide foods for the patient after they have been instructed about the diet. Sitting with the patient while he eats does not ensure that the patient will follow the diet, and it fosters dependence.

A long-term care facility has started a program to increase the cultural competence of its employees. When notified of this, a nurse thinks to himself, "I don't have time for this nonsense. I already know all I need to about culture, and I don't really like taking care of so many different kinds of people anyway." This most clearly illustrates the nurse's lack of cultural: 1) Awareness 2) Desire 3) Exposure 4) Knowledge

Answer: 2) Desire Rationale: Cultural desire is the wish to be culturally competent. This nurse clearly does not want to improve in that area. He seems to be aware of his personal biases ("I don't like taking care of different kinds of people . . ."). Exposure refers to the actual face-to-face encounters with patients from diverse cultural backgrounds. This scenario does not state clearly whether this nurse has had many encounters, but nothing in the scenario indicates that he is lacking in encounters. Apparently he has had enough encounters to develop a negative bias. Cultural knowledge refers to principles and theories. There is nothing in this scenario to indicate that the nurse lacks cultural knowledge, although it is not beyond the realm of possibility. The question asks, though, not what is possible, but what the nurse's thinking "most clearly illustrates."

North American healthcare culture typically reflects which culture? 1) Asian 2) European American 3) Latino 4) African American

Answer: 2) European American Rationale: Although the demographics are changing in this recent decade with increasing Hispanic and Asian inhabitants, North American healthcare culture typically reflects the dominant (European American) culture because most healthcare providers belong to that culture.

The nurse is caring for a 42-year-old, Chinese American patient who underwent emergency coronary artery bypass graft surgery. He is self-employed and has no health insurance. Each day members of his family spend hours at his bedside. Which is the most important factor for the nurse to focus on when planning the patient's discharge? 1) Ethnic background 2) Family support 3) Employment status 4) Healthcare coverage

Answer: 2) Family Support Rationale: The nurse should focus on the patient's strengths and resources for health restoration and self-care. In this case, that is the patient's family. His family can be a great support for him when he is discharged (e.g., preparing healthy meals, helping him manage exercise and treatment regimens). Although the patient's ethnic background is very important to his care, discharge planning should revolve around his available resources. Insurance should not be the focus at this time, although at some point the nurse has probably obtained data about these topics.

The nurse preparing a Latino patient for a diagnostic procedure states, "After the cardiac catherization, you will need to be supine. We will also assess you for a thrombus." Which statement below is true? 1) The statements are appropriate to teach the patient about the procedure. 2) The nurse is using healthcare jargon in her explanation to the patient. 3) The nurse should use an interpreter to explain the procedure to the patient. 4) The information will have to be repeated to a family member, when he/she arrives.

Answer: 2) The nurse is using healthcare jargon in her explanation to the patient. Rationale: The nurse is using nursing/medical words to explain the procedure, such as supine and thrombus. Words or expressions used by a subculture are known as jargon. A more appropriate explanation would use flat instead of supine and blood clot instead of thrombus. There is no information in the scenario that would indicate an interpreter is needed or that the patient does not understand English.

A patient who moved to the United States from Italy comes to the clinic for medical care. The patient has been in this country for several years and has adopted some elements of her new country. Yet, she still retains some customs from her homeland. This patient is experiencing: 1) Assimilation. 2) Socialization. 3) Acculturation. 4) Immigration.

Answer: 3) Acculturation Rationale: This patient is experiencing acculturation; she has accepted both her own and the new culture and has incorporated elements of both into her life. Socialization is the process of learning to become a member of society or group. Cultural assimilation occurs when the new member gradually learns and takes on, to a great extent, the dominant culture's values, beliefs, and behaviors. Immigration is the act of moving to a new country.

When taking a cultural history, all of the following are important. Which one is most important to later plan for patient safety? 1) Obtain data directly from the patient. 2) Show empathy and respect; build rapport. 3) Ask about use of alternative medicine and folk remedies. 4) Ask open-ended questions when beginning the assessment.

Answer: 3) Ask about use of alternative medicine and folk remedies. Rationale: Always ask patients about their use of alternative medicine and folk remedies so that their effects on traditional biomedical medications and treatments can be evaluated. Some remedies may interfere with traditional treatments; others can be dangerous. Many people use folk remedies, but they may be reluctant to tell you because they fear ridicule or at least disapproval. It is best to obtain data directly from the client, but this includes all data, not just that contributing to safety. Empathy and respect help to build trust and encourage the patient to provide data; but this includes all kinds of data. Asking open-ended questions encourages patients to talk and therefore supply more of all types of data.

What is folk medicine?

Answer: The folk health system or folk medicine is a set of beliefs and practices that are followed by a cultural group that reflects what the people do when they are ill rather than following the conventional standards of healthcare. Rosanna, the young mother in the Meet Your Patients scenario (in Volume 1 of your textbook), had used the folk health system by going to her curandero and dressing her son in heavy clothing to counter a "cold" illness.

A patient of Scandinavian heritage is admitted for observation after sustaining injuries in a motor vehicle accident. The nurse expects that he may endure pain stoically, without grimacing or vocalizing. The nurse's thinking is an example of a/an: 1) Archetype 2) Bias 3) Prejudice 4) Stereotype

Answer: 3) Prejudice Rationale: An archetype is an example of a person or thing—something that is recurrent—and it has its basis in facts. Therefore, it becomes a symbol for remembering some of the culture specifics and is usually not negative. A bias is the tendency to see only one side of an issue, a lack of impartiality. Prejudice refers to negative attitudes toward other people that are based on faulty and rigid stereotypes about race, gender, sexual orientation, and so on. A cultural stereotype is the unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain respects. Similar to biases, a stereotype may be positive or negative.

Which intervention by the nurse best indicates that she values a Native American patient's beliefs and indigenous healthcare system? 1) Incorporating Native American practices into care based on consultation with a cultural resource book 2) Explaining the values and beliefs of the traditional healthcare system to the patient so that the patient understands what is occurring 3) Contacting a Native American resource group for information about the culture 4) Planning how to incorporate traditional practices and beliefs through discussion with the patient

Answer: 4) Planning how to incorporate traditional practices and beliefs through discussion with the patient Rationale: "Planning how to incorporate traditional practices and beliefs . . ." is the only answer that indicates that the nurse has assessed to determine the patient's beliefs. When consulting a cultural resource book or a Native American resource group for information, the nurse would be assuming that the patient's wishes will conform to her cultural group. Differences among members can occur within a cultural group. By explaining the traditional healthcare system, the nurse is not attempting to deal with the patient's beliefs but is trying to convince the patient that the mainstream way is preferred.

While admitting a patient with a particular religious heritage, the nurse comments to another nurse, "This is going to be a pain. This kind of patient always has a million family members in and out, and they're always so noisy and demanding." This illustrates: 1) Discrimination 2) Sexism 3) Ethnocentrism 4) Prejudice

Answer: 4) Prejudice Rationale: Prejudice refers to negative attitudes toward other people, which are based on faulty and rigid stereotypes about race, gender, sexual orientation, and so on. Discrimination refers to behavioral manifestations of prejudice; the nurse is not discriminating because she has not yet taken any action. Sexism is the assumption that members of one sex are superior to those of the other sex; there is no mention of gender in the scenario. Ethnocentrism is a positive bias toward one's own culture, believing that that culture's beliefs and values are right and those of other cultures are wrong or at least bizarre. It is broader than prejudice and is not directed toward a specific cultural group.

Explain the difference between an archetype and a stereotype.

Answer: A cultural stereotype is a widely held but oversimplified and unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain respects. Stereotypes are not always negative. Someone may think, for example, that people of a particular heritage are "naturally intelligent" or "naturally athletic." A cultural archetype is similar to a model, which you learned about in Chapter 8. An archetype is an example of a person or thing—something that is recurrent—and has its basis in facts. Therefore, it becomes a symbol for remembering some of the culture specifics and is in no way negative (Campinha-Bacote, 2007).

As a nurse, in which of the following cultural health practices would you support your client: efficacious, neutral, dysfunctional, uncertain? Why?

Answer: A nurse should allow and even promote efficacious health practices because they are beneficial. Dysfunctional practices are harmful and should be discouraged. Neutral or uncertain practices can be allowed to continue if they are important to the client until a time they are considered to be harmful.

The process a person goes through to adapt to a new culture is referred to as which of the following? A. Acculturation B. Cultural competence C. Culture shock D. Phenomena of culture

Answer: A. Acculturation Rationale: Acculturation is a learning process in which an individual assumes the characteristics of the dominant culture, whereas cultural competence can be defined as a set of congruent behaviors, attitudes, and practices that enable us to provide such care. Culture shock is the experience of not comprehending the culture in which one is situated or living. The phenomena of culture are a set of organizing phenomena that influence health, including communication, space, time orientation, social organization, environmental control, and biological variations.

Stereotyping in nursing may result in which of the following? A. Inaccurate assessments and inappropriate interventions B. More frustration on the part of the nurse than the client C. Less frustration on the part of the nurse and the client D. Enhanced participation of family and patients

Answer: A. Inaccurate assessments and inappropriate interventions Rationale: Stereotyping is the preconceived and untested beliefs about people. This can lead to frustration for both patients and nurses and can inhibit cooperation and participation.

A nurse is preparing to care for her newly admitted patient. The person who accompanied the patient informs her that he is from the Middle East and speaks very little English. He is unsure of the patient's primary language. The hospital has no interpreters available who speak any Middle Eastern language. List at least four alternative interventions the nurse can use to communicate with the patient.

Answer: Alternative interventions include the following: -Greet the client with respect, and be aware of nonverbal cues. -If you are able to identify one, use a third language or one that is similar to their spoken language (e.g. French is spoken by some Vietnamese). -Speak in English slowly and clearly, using simple sentences to talk about one problem or need at a time, using gestures. -Restate information in different words if it appears the client does not understand your initial attempts. -Use pictures or diagrams. -Use written language in short, simple sentences. -Use the Internet or computer software to translate words into the Middle -Eastern language. -Have the patient type information in his native language, using the Internet or computer software, and convert it into English.

What are magico-religious belief systems?

Answer: The magico-religious belief systems are alternative belief systems (different from conventional Western medicine) in which supernatural forces dominate and practices and rites such as voodoo are fairly common.

How do the cultural norms of the North American healthcare system differ from those of other cultural groups? Refer to Tables 15-2 and 15-3 (in Volume 1 of your textbook) as needed.

Answer: Although there may be some similarities, the major difference between the norms of the healthcare system and those of other cultural groups is that the professional healthcare system is run by a set of professionals who have been formally educated and trained for their roles and responsibilities. Other differences are linked to the influence of the dominant culture in U.S. society: that of white European American Protestant (and some would add, males). North American healthcare system values that may be different from some other cultures include the following: -Standardized definitions of health and illness -Significance of technology -Maintenance of health and prevention of disease through such practices as immunizations and avoidance of stress -Annual physical examinations and diagnostic tests -Punctuality -Neatness and organization -Compliance (e.g., with medical "orders") -Surgical procedure -Dislike for tardiness or disorganization -Handwashing

Give an example of acculturation.

Answer: An example of acculturation that many immigrants have to face is related to language. For example, a family moves to the United States from Mexico. To survive, they attempt to learn the language of the dominant culture, English.

You are assigned a patient who speaks Vietnamese. He is to begin chemotherapy in the morning. To explain his treatment to him, you will use which of the following people? A. Family member B. Asian staff member C. Hospital interpreter D. Friend of the patient

Answer: C. Hospital interpreter Rationale: The hospital interpreter can objectively assist you in explaining procedures or treatments to the patient in a linguistically appropriate manner. A friend or family member may not be able to adequately explain treatment or may be frightened or intimidated by the task. Choosing a staff member who may be of the same ethnic background does not mean that he can speak the same language.

Define cultural competence.

Answer: Cultural competence is what we are attempting to achieve in providing care to clients that is appropriate, congruent, and nonbiased. Cultural competence can be defined as a set of congruent behaviors, attitudes, and practices that enables us to provide such care appropriate to a group's cultural values and beliefs. It includes developing an awareness of our own beliefs and those of others, accepting and respecting cultural differences, engaging in cultural encounters, and adapting care so that it is congruent to those of other cultures. This attribute is conscious and nonlinear. Although cultural competence is a developmental process, healthcare providers must continue to work toward its achievement. Also refer to the models presented in Chapter 15 in your textbook.

Identify at least six culture specifics affecting health.

Answer: Cultural specifics include communication, space, time orientation, social organization, environmental control, and biological variations. Another is response to drugs used in the treatment of disorders, such as hypertension.

Define culture.

Answer: Culture is both universal and dynamic. Culture can be defined as the totality of socially transmitted behavior patterns, arts, beliefs, values, customs, and other products of human thought and work characteristics of a population of people, which can guide their worldview and decision making.

Of the following cultural groups, which is at high risk for sickle cell anemia? A. Alaskan Native B. Pacific Islander C. Hispanic D. African American

Answer: D. African American Rationale: Sickle cell anemia is hereditary and occurs primarily in people of African ancestry and occasionally in people of Mediterranean descent.

What do recent demographic trends in North America indicate?

Answer: Demographic trends in North America (particularly in the United States and Canada) indicate that recent immigration patterns have led to a multicultural society. There are an increased number of cultural and ethnic groups present nationally, regionally, and locally. The past decade has seen immigration increasing from Asian- and Spanish-speaking nations and a higher growth rate among African Americans. These minority groups collectively now constitute a majority in some areas of the United States.

List five factors to consider to help you develop strategies to become more culturally competent.

Answer: Factors to consider include the following: -Respect your client regardless of cultural background. -Advocate for all clients, including those who are not from the dominant culture. -Learn from the folk medicine practitioner to understand how to incorporate efficacious practices in the plan of care, when it is in the best interest of the client. -Identify alternatives to harmful practices. -Take the time to understand the individual's beliefs, practices and values. -Recognize that there are differences in and among individuals within cultural groups. -Use a qualified interpreter to overcome language barriers in communicating with your client.

A nurse and client of the same race who speak the same language will not experience problems in communication. True False

Answer: False Rationale: Often languages will have different dialects that evolve in different regions and increase communication problems. The nurse and client may also experience generational, values, religious, and/or differences in beliefs.

Why might members of some cultural groups seek out the local folk healer rather than the conventional healthcare provider?

Answer: Folk healers are sought out for a number of reasons, including easier access to care and familiarity with the folk healer who knows and understands the culture, speaks the language, and makes house calls. They may also not have the money to access and may distrust the professional healthcare system.

How could you use this information about cultural specifics to provide better care to your clients?

Answer: It is well known that cultural specifics influence health. Knowing these specifics can help you better understand client behavior and increase awareness of why clients from different cultures have certain expectations of healthcare. Also, knowing the tendencies for certain culturally common problems can guide you in the assessment of your clients.

List the six cultural specifics affecting health.

Answer: The six culture specifics affecting health are as follows: Communication Space Social organization Time orientation Environmental control Biological variations

How can nursing diagnoses cause bias in the planning of care for clients from different cultures?

Answer: The use of some nursing diagnoses and diagnostic labels can be biased because the implied assumption may be that the client is at fault (e.g., language barrier, knowledge deficit) rather than acknowledging that the healthcare provider has an inability to meet the needs of the client and/or family. The nurse may perceive a problem when the patient does not, and vice versa.

How does culture provide identity for an individual?

Answer: The values, beliefs, and practices of the culture provide identity for an individual. These can guide many, if not all, aspects of the individual's life. They may include, dress, food, dance, song, and even what one believes and does to keep well and fight diseases.

A stereotype is a preconceived and untested belief about people or groups of people. True False

Answer: True

Race is defined as the physical characteristics that are shared by a specific ethnic group. True False

Answer: True

List three types of alternative healthcare that are delivered by formally trained practitioners as a part of the professional healthcare system.

Answer: Types of alternative healthcare include diet therapy, mind-body control methods, therapeutic touch, acupressure, reflexology, naturopathy, kinesiology, and chiropractic therapy.

Describe, in general, how the nursing process can help you provide culturally competent care.

Answer: With every client, the nursing process is essential to the performance of a cultural assessment, the formulation of appropriate nursing diagnoses, the identification of expected client outcomes, the planning of nursing interventions, and the evaluation of the plan of care.

Other Asian

Bangladeshi, Bhutanese, Burmese, Cambodian, Hmong, Laotian, Indochinese, Indonesian, Iwo Jiman, Madagascar, Malaysian, Maldivian, Nepalese, Okinawan, Pakistani, Singaporean, Sri Lankan, Thai

American Indian or Alaska Native

Origins Any of the original peoples of North and South America (including Central America); has tribal affiliation or community attachment Other Reported Entries Navajo, Blackfeet, Inupiat, Yupik, Canadian Indian, French American Indian, or Spanish American Indian

Asian

Origins Any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent (e.g., Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam) Other Reported Entries Asian Indian (Bengalese, Bharat, Dravidian, East Indian, or Goanese) Chinese (Cantonese, Chinese American, or Taiwanese) Filipino (Philippino, Philippine, or Filipino American) Japanese (Nipponese or Japanese American) Korean (Korean American) Vietnamese (Vietnamese American)

Race White

Origins Europe, the Middle East, or North Africa Other Reported Entries Irish, German, Italian, Lebanese, Near Easterner, Arab, or Polish

Black, African American, or Negro

Origins Any of the black racial groups of Africa Other Reported Entries Afro-American, Kenyan, Nigerian, or Haitian

Native Hawaiian

Origins Pacific Other Reported Entries Part Hawaiian or Hawaiian.