ch 13 culture pt 2 (for kaplan)

communication

The means by which *culture is shared* Verbal and nonverbal Variations Significant problem (Extra notes) - Cross-cultural variations in verbal style can range from pronunciation, word meaning, voice quality, and humor, to nonverbal communication with eye contact, gesture, touch, body posture, facial expression, and silence. - *Most significant problem in working with cross-cultural groups. Mis-communication*

Intersex

a broad term used to describe people born with multiple or ambiguous sex characteristics.

Transgender

a broad term used to describe people whose sex assigned at birth does not match their gender identify

Cisgender

a broad term used to describe people whose sex assigned at birth matches their gender identity

Sexual orientation

a legal term used to describe the sexual, emotional, romantic and/or physical attraction to other people.

gender identity

a legal term used to described one's sense of their gender

Gay

a man who is sexually, emotionally, romantically and/or physically attracted to other men. Gay is also sometimes used as an umbrella term for all LGBT people.

Asexual

a person who is not sexually, emotionally, romantically and/or physically attracted to other people.

Bisexual

a person who is sexually, emotionally, romantically and/or physically attracted to people of any gender. Some people prefer the term Pansexual instead of bisexual.

Gender non-conforming

a term to describe people who don't fit into the gender binary (also gender expansive, non-binary, genderqueer, or genderfluid)

Lesbian

a woman who is sexually, emotionally, romantically and/or physically attracted to other women.

spirituality

is born out of the individual's unique life experience and personal effort to find purpose and meaning in life.

Culturological Assessment

refers to a systematic appraisal or examination of individuals, groups, and communities regarding their cultural beliefs, values, and practices to determine explicit nursing needs and intervention practices within the cultural context of the people being evaluated. A descriptive reference Assessments broad and comprehensive (extra notes) The culturological is a description reference to cultural phenomena in their broadest sense. broad and comprehensive because they deal with cultural values, beliefs, systems and ways of living now and in the recent past. In conducting one, the CHN should be involved in determining and appraising the traits, characteristics, or smallest units of cultural behavior as a guide to nursing care.

Gender binary

socially constructed dichotomy of male or female

cultural sensitivity

suggests that the nurse has basic knowledge of the client's culture but does not use the information to devise a plan of care that reflects the client's total cultural needs.

Sex assigned a birth

the marker of male or female on a person's birth certificate and is not the same as gender.

handshake

•In Western culture, we often judge people by their handshakes. •In the Philippines and in many European countries (such as Germany, Poland, and the Czech Republic), it's polite for a man to wait for a woman to extend her hand for a handshake. •Muslim and Hindu men typically do not shake hands with women. •The firmness of the grip also has cultural implications. For example, the Chinese and Japanese use a softer and longer handshake. The gentleness of the handshake does not indicate a lack of assertiveness within these cultural groups.

Eye to Eye

•In the *U.S.*, it's polite to look someone in the eye. This demonstrates openness, sincerity, trustworthiness, and confidence •In many *Asian* countries, looking away is a sign of respect •*Mexico:* Continued, intense eye contact is considered aggressive and threatening. •*Japan:* Prolonged eye contact is not the norm. Looking people directly in the eyes invades their privacy. •*France:* Don't be surprised if you may be looked at more intensely than you expect. This can be intimidating for some Asians and North Americans. •*Great Britain*: Often, the British do not look a person directly in the eye or don't maintain eye contact when talking. Don't be offended.

amish

•Practice vary across communities •Minor injuries •Heroic interventions • Unorthodox medical treatments •Cultural Factors •Medical cost coverage •Primary Language- Deitsch-PA Dutch Communication for follow-up •Health care practices vary considerably across Amish communities and from family to family. Many Amish use modern medical services, but others turn to alternative forms of treatment. They do not cite biblical injunctions against modern health care or the latest medicines, but they do believe that God is the ultimate healer. •Amish people are less likely to seek medical attention for minor aches or illnesses and more apt to use folk remedies and drink herbal teas. •Although they do not object to surgery or other forms of high-tech treatment, they are less inclined to use heroic life-saving interventions, and are reticent to intervene when their elderly face terminal illness. They are, in short, more willing to yield to the mysteries of divine providence. •In addition to home remedies, members often seek other forms of unorthodox medical treatment. Their search for natural healing often leads them to vitamins, homeopathic remedies, health foods, reflexologists, and chiropractors. •Amish health habits are shaped by many cultural factors—conservative rural values, a preference for natural antidotes, a lack of information, a sense of awkwardness in high-tech settings, difficulties accessing health care, as well as a willingness to suffer and lean on the providence of God. •The Amish (who do not carry commercial health insurance) cover medical expenses in various forms, often by contributions from the community, or through limited community-administered plans. •Healthcare providers will need to plan how they will contact Amish patients for follow-up. Although some Amish families may have mobile phones or computers that operate via generators or solar power, this is generally rare.7Healthcare providers should always ask patients how to best communicate with them. For instance, handwritten letters may be the best way to communicate the results of lab work or the need to make a follow-up appointment. •Healthcare providers must develop a trusting and respectful relationship with their Amish patients for the care to be effective.5 Ways to develop that relationship include taking time and slowing the pace of patient encounters, because the Amish tend to perceive the usual brusque pace of efficient clinical practices as rude and uncaring. •Usually only educated until the 8th grade.

Arab Populations and Muslims

•Small group •Mental anguish and distress •Arabic •Muslim and Christian •This group in the U.S. is small in comparison to others discussed, but because of the terrorist attacks of 9/11 and ongoing terrorism, as well as the wars in the Middle East, increasing racial and religious animosity has been directed toward people from this part of the world. •A common language and Arabic and background unite them, yet only 18% of Muslims reside in Middle Eastern countries. •Arabs are largely Christian or Muslims. Most Muslims live in China, India, and South Asia.

cultural knowledge

*Educated understanding* Worldview from an emic (native) perspective Be aware of the culture that's prevalent in your area (extra notes) Although it is unrealistic to expect that nurses will have knowledge of all cultures, *they should know how and where to obtain information that impacts the individual with whom they have frequent interactions* Process of searching for and obtaining a sound *educated understanding* about culturally diverse groups Emphasis is on learning about the clients' worldview from an *emic (native) perspective*

cultural desire

*Intrinsic motivation* to engage in the four (previous) elements - Do so because they want to! *cannot be taught* in the classroom **** (extra notes) - Based on the humanistic value of caring for the individual - Nurses who wish to become culturally competent do so because they want to, rather than because they are directed to do so.

environmental control

*Person's relationship with nature* 3 views of nature & the role of environment in everyday life 1. Nature controls environment 2. They (nature + environment) work in harmony 3. Environment controls nature (extra notes) - refers to the person's relationship with nature and efforts to plan and direct factors in the environment that affect them. - In cultures that perceive individuals as having mastery over the environment, one can expect that a client with the diagnosis of cancer will be willing to engage in a rigorous treatment, include chemotherapy, radiation, and laser therapy to beat the disease. - Persons who value harmony with the environment (ex. African Americans, Asians, American Indians) may perceive cancer as disharmony with other forces and that medicine can only relieve the symptoms rather than cure the disease. They would look to the mind, body and spirit connection for healing comes from within, to find treatments for the malignancy. - Individuals from cultures that view the environment as dominant over nature (ex Hispanics) may believe that they have little or no control over the serious illness for which they have been diagnosed. These individuals are less likely to engage in illness management interventions that are harsh and that they cannot trust to yield a positive health outcome

perception of time

*Refers to past, present and future time* *& duration of and periods between events* Some cultures assign greater or lesser value to events that occur in past, present or future (extra notes) If *future oriented*... they often will delay immediate gratification until future goals are accomplished. Some *present oriented*... may place greater emphasis on the here and now and view information about their present set of circumstances as more important that what will happen in the future. Other cultures believe that their ancestral lineage determines their current health status. When nurses discuss health promotion and disease prevention strategies with persons who have a present orientation, they should focus on the immediate benefits these clients will gain rather than emphasizing future outcomes. In cultures that focus on *past orientation*, individuals may be less concerned about planning ahead and focus more on wishes and memories of their ancestors. Time is viewed as being more flexible than in present-oriented cultures. Individuals may not be offended by being late or early for appointments.

cultural awareness

*Self-examination* of own beliefs and values Culturally aware nurses - Conscious of culture - Understand own behavior - Recognize that health is expressed differently

nutrition

*Social activity* in many cultures. Religious Culture domain of nutrition Mutual goal setting Culturally oriented materials (extra notes) - For many cultures, the preparation and eating of food is a social activity and members of the group come together to celebrate life and comfort with one another. - Almost all family rituals, including births, baptisms, graduations, marriages, retirements and deaths, include food as part of the ceremony. - Many of these practices may have their origin in religious as well as cultural traditions. - The culture domain of nutrition includes much more than having adequate food to sustain dietary requirements. - Efforts to understand dietary patterns of clients should go beyond relying on membership in a defined group. Knowing the client's nutritional practices enables nurses to develop dietary regimens that do not conflict with their cultural food requirements. - When engaging in mutual goal setting with the client and a nutritionist need to change harmful dietary practices, the team might need to consult culturally oriented material before prescribing particular food items.

personal space

*The physical distance maintained between individuals* 4 Zones - Intimate space (direct contact- 1.5 feet) - Personal distance (1.5-4 feet) - Social distance (4-12 feet) - Public distance (>12 feet) (extra notes) - amount of space varies among individuals and between cultures. - Cultural groups have spatial preference

African Americans

13.5% of the U.S. population Great disparities exist - Poverty - Inmates More than 28% of African Americans live in poverty, compared with 1% of Whites. Despite the population is made up of only 13.5% of the population, more than 50% of prison inmates are black

Native American Indians, Aleut, and Eskimo Communities

1st settlers of North America Alaska Natives- Eskimo communities residing in Alaska Form a larger cluster of tribal groups whose members are descendants of the original Native Americans who inhabited this country before White Europeans settled here. They have adopted many European American values and practices, yet they preserve many aspects of their own culture.

Campinha-Bacote model

5 elements of cultural competence 1.Cultural awareness 2.Cultural knowledge 3.Cultural skill 4.Cultural encounter 5.Cultural desire A *model that views cultural competence as the ongoing process in which the health care provider continuously strives to achieve the ability to effectively work within the cultural context of the client*

Asian Americans

5.5% of U.S. population Largest group Chinese and Filipinos Immigrants and refugees from various Pacific Rim countries, such as China, Korea, Japan, Thailand, Laos, the Phillippines, Vietnam, and Cambodia.

religion

Component of health and illness coping Spiritual assessment required by Joint Commission an organized system of beliefs concerning the cause, nature, and purpose of the universe, especially belief in or the worship of a god or gods. More than 1200 practiced in the United States. may influence decisions regarding prolongation of life, euthanasia, autopsy, donation of a body for research, disposal of a body or body parts including fetus, and type of burial.

cultural diversity

Biologic variations Personal space Perception of time Environmental control Social organization Communication Nutrition Religion (extra notes) = A multifaceted and complex concept that refers to the differences among people, especially those related to values, attitudes, beliefs, norms, behaviors, customs and ways of living refers to *the degrees of variation that is represented among populations based on lifestyle, ethnicity, race, interest, across place, and place of origin across time* - It includes other aspects of variation among people, such as... social class, gender identity, sexual orientation, physical abilities/disabilities, and care beyond multiculturalism. - also refers to *the changing populations of the world as it becomes more of a global village* It is about *understanding and embracing each other's differences and similarities*

Cupping/Coining

Cupping - a therapy in which heated glass cups are applied to the skin along the meridians of the body, creating suction as a way of stimulating the flow of energy. Coining - A traditional health practice in which a heated coin is placed or rubbed on the skin (to treat conditions such as asthma).

cultural encounter

Engage in cross-cultural interactions Two types: - Direct (face-to-face) - indirect (shared between one's own peers)

cultural skill

Effectively *integrate cultural awareness* (extra notes) The ability of nurses to effectively integrate cultural awareness and cultural knowledge when conducting a cultural assessment and to use the data to meet the specific client's needs Culturally skillful nurses elicit from patients their perception of the health problem, discuss treatment protocol, negotiate acceptable options, select interventions that incorporate alternative treatment plans, and collaborate with all stakeholders.

direct cultural encounter

Eg: when nurses learn directly from their Puerto Rican clients about spicy food that they avoid during periods of breastfeeding.

Cultural Self-Assessment

Identify health-related attitudes, values, beliefs Ethnocentric tendencies (extra notes) - CHN can engage in a cultural self-assessment. Though identification of health-related attitudes, values, beliefs, and practices that are part of the personal cultural meaning brought to the nurse-client interaction, the nurse can better understand the cultural aspects of health care from the perspective of the client, family, group or community. - Everyone has ethnocentric tendencies that must be brought to a level of conscious awareness so that efforts can be made to temper ethnocentrism and view reality from the perspective of the client.

Hispanic Americans

Members 55 million Largest Ethnic group in the U.S. •Depending on the region of the country, socioeconomic status, immigration or citizenship status, or age, members of this large minority group refer to themselves as Mexican American, Spanish American, Chicano, Latin American, Latin, Latino or Mexican. Hispanic is used solely for convenience •Of the almost 55 million Hispanics, Mexicans are the largest percentage at 64.3%, Central and South Americans constitute almost 15%, Puerto Ricans 9.4%, and Cubans 3.7%.

acculturation

Merging with or adopting the traits of a different culture Eg: if you move to a new country - adapt by adopting that culture (language, schedules) (extra notes) - Acculturation is the process of merging with or adopting the traits of a different culture. - Adapting to a new culture requires changes in daily living practices. - These changes relate to language, education, work, recreation, social experiences, and the health care system.

biologic variations

Physical Biological Physiological *Distinguish one race from another* ** (extra notes) - the physical, biological, and physiological characteristics that exist between racial groups and distinguish one race from another. - These characteristics occur in areas of growth and development, skin color, enzymatic differences, susceptibility to disease, and laboratory test findings. - Racial categories originated from a shared genealogy due to geographic isolation. In today's global village, this isolation has been broken down and there are more mixed groups.

cultural competency

Respecting and understanding the values and beliefs of a certain cultural group so that one can function effectively in caring for members of that cultural group. Higher level of knowledge (extra notes) - reflects a higher level of knowledge than cultural sensitivity, which was once thought to be all that was needed for nurses to effectively care for their clients. - Cultural competent community health nursing requires that nurses understand the lifestyle, value system, and health and illness behaviors of diverse individuals, families, groups and communities.

Gender expression

how one celebrates or performs their gender

indirect cultural encounter

eg: When nurses share these assessment finding with other nurses to help them develop their knowledge to effectively care for other Puerto Rican clients who are breastfeeding.

Hand Gestures

•Thumbs up. This is considered crude throughout the Arab world. •The peace or "V sign" sign, the first and second fingers extended and the hand clenched, is rude in some cultures, such as in New Zealand. When this sign is made with the palm facing inward, it is offensive in Great Britain and Canada. •The "OK" sign, making a circle with the thumb and forefinger with the other fingers raised, is offensive or rude in many countries, such as Germany, Spain, Mexico, and Brazil. It means "money" in Japan and "worthless" in France. •Pointing at another person. This is impolite in Canada, Saudi Arabia, Belgium, and Portugal and insulting in the Philippines. •Placing your hands on your hips. This gesture suggests aggressiveness and can imply you are making a challenge in some countries, including Mexico and Argentina. •Winking at a person. This is inappropriate in many countries, including Australia and Taiwan. •Putting your hands in your pockets. This should be avoided in many countries, including Germany, Mexico, and Turkey. •Snapping your fingers. This is an obscene gesture in Belgium. •Waving your hand. This gesture is offensive in Greece. The Greek way of motioning "goodbye" is to lift the index finger while keeping the hand closed.

C

●A community-based hospice nurse has an Asian male client with terminal-stage ●cancer. The client complains that he is in continuous pain and receives no relief ●from the codeine prescribed by his primary care physician (PCP). Because this ●nurse is culturally competent with Asian clients; the nurse contacts the client's PCP to discuss replacing this medication with another pain-reducing drug. The nurse's action can best be described as an example of: ●a. cultural accommodation. ●b. cultural assessment. ●c. cultural brokering. ●d. cultural repatterning.

LGBTQ+

●LGBTQ+ is an acronym meant to encompass a whole bunch of diverse sexualities and genders. People will often refer to the Q, which stands for queer, as an umbrella term under which live a whole bunch of identities. ● It is important to use the term Queer only if the patient uses it for themselves or states it is okay to use. While Queer is a powerful identity marker used by many LGBT people to signify their political, social and/or sexual differences from the majority population and a term used by many to celebrate inclusion within the LGBT community, it is also a term historically used by anti-LGBT people to degrade and dehumanize LGBT people. Some members of this community may find the word offensive for this reason. ●Lesbian, Gay, Bisexual, Transgender, and Queer are all different labels, representing different identities. Some individuals identify with a couple of those labels (e.g., gay and transgender), or even several (e.g., lesbian, gay, queer, and transgender) ●LGB all represent sexual identities. And the T represents a gender identity ●The order of the letters do not matter- Most common is LGBT but other letters may be added and they may be in different order

A

●The nurse is educating her Nigerian client regarding the prenatal services ●available through the maternal-child health clinic. The client is interested in ●confirming her pregnancy at this visit but does not see the need for ongoing visits because childbirth is viewed as a natural process in her culture. The nurse negotiates with the client to structure a strategy to achieve a healthy pregnancy ●outcome that uses the clinic's resources in a manner that is satisfactory to the ●client. This is an example of: ●a. cultural accommodation. ●b. cultural brokering. ●c. cultural preservation. ●d. cultural repatterning.