Ch. 15: Culture and Ethnicity

Communication

an exchange of information, ideas, and feelings. It includes verbal and nonverbal language.

Male chauvinism

assumption of male superiority

Space

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

Cultural archetype

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

Sexism

the assumption that members of one sex are superior to those of the other sex.

Ayurveda

traditional healthcare system of India.

Complementary medicine

use of rigorously tested therapies to complement those of conventional medicine

Cultural stereotype

widely held but oversimplified and unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain respects.

Jargon

words or expressions used by subcultures

How does U.S. Census Bureau categorize ethnicity?

(1) Hispanic, Latino, or Spanish (2) Not Hispanic, Latino, or Spanish

The nurse is caring for a patient whose primary language is Vietnamese. When working with the interpreter, the nurse should do which of the following? Select all that apply. 1) Make eye contact with the interpreter. 2) Speak a little more loudly than usual. 3) Use an interpreter who is socially compatible with the patient. 4) Try to find a family member to help interpret.

1) Make eye contact with the interpreter. 3) Use an interpreter who is socially compatible with the patient.

What are minority groups?

Minority groups are made up of individuals who share race, religion, or ethnic heritage; Term is sometimes used to refer to a group of people who receive different and unequal treatment from others in society.

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 foods from home he typically eats. 4) Sit with the patient while he eats to make sure he consumes the prescribed diet.

2) Arrange for meals that accommodate his cultural dietary practices and specified diet.

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

2) Desire

When taking a cultural history, all of the following are important. Which one is most important in order 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.

3) Ask about use of alternative medicine and folk remedies.

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

4) Planning how to incorporate traditional practices and beliefs through discussion with the patient

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

4) Prejudice

Explain the difference between an archetype and a stereotype.

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 it 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).

What is the dominant culture?

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

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

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.

Environmental control

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

Practice

A set of behaviors a person follows.

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

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

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

A. Acculturation

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

A. Inaccurate assessments and inappropriate interventions

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.

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 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.

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 your textbook) as needed.

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

Cultural awareness

An appreciation of the external signs of diversity

Give an example of acculturation.

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.

Cultural sensitivity

More to do with personal attitudes and being careful not to say or do something that might be offensive to someone from a different culture

Territorialiy

Behavior and attitude that people exhibit about the area around them that they have claimed.

What is bicultural?

Bicultural describes a person who identifies with identifies with two cultures and integrates some of the values and lifestyle of each into his life. A bicultural person may experience divided loyalties.

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

C. Hospital interpreter

Biomedical healthcare system

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

Indigenous healthcare system

Consists of Folk medicine and traditional healing methods, which may also include OTC and self-treatment remedies.

What are some characteristics of culture?

Cultural beliefs provide identity and a sense of belonging as long as they don't conflict with the dominant culture and continue to satisfy its members. Cultures consist of common beliefs and practices, for a norm to be considered cultural, many members must follow it. Culture exists at many levels (material and the nonmaterial) Learned and taught. (cultural values, beliefs, and traditions are passed down from generation to generation.) Dynamic and adaptive. (cultural customs, beliefs, and practices change over time and at different rates) Complex. (Cultural assumptions and habits are unconscious) Diverse. All-encompassing.(culture can influence everything its members think and do)

Identify at least six culture specifics affecting health.

Cultural specifics include communication, space, time orientation, social organization, environmental control, and biological variations. Another is response to drugs.

Define culture.

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.

What is culture?

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

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

D. Black

What do recent demographic trends in North America indicate?

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.

How can nurses achieve Leininger's theory goal?

Discovering cultural care and caring beliefs, values, and practices Analyzing the similarities and differences of these beliefs among the different cultures

List five factors to consider when communicating with a client using an interpreter.

Factors to consider include the following: Always address questions to the client, not the interpreter. Ask the interpreter to translate the words used by the healthcare provider as closely as possible, unless he believes they would be offensive or misunderstood. Avoid asking family members, if possible, especially a child or spouse, to act as an interpreter because of confidentiality issues. Avoid using an interpreter who is socially or politically incompatible with the client. Be aware of gender and age differences (preferable to have the same gender). Do not use metaphors (pain stabbing like a knife) or medical jargon. Observe nonverbal communication (body language) when the client is listening and talking to the interpreter. Speak slowly and distinctly while facing the client.

List five factors to consider when communicating with clients from different cultures.

Factors to consider include the following: Physical and emotional well-being Situation under discussion Distractions Subject matter Communication skill Attitudes Personal needs and interests Background Sensory function Personal tendency to make judgments Environment Past experiences

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

False

What does the mnemonic ASKED stand for/ mean?

Five components of cultural competence. Awareness-similar to cultural sensitivity (look at biases and prejudices) Skills-your ability to conduct with sensitivity a cultural assessment and a culturally based physical assessment. Knowledge- the information that you have about cultural worldviews and theories. Encounters-takes practice to become culturally competent. Desire- must want to be culturally competent

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

Folk healers are sought out for a number of reasons, including access to care, lack of money and trust in the traditional healthcare system, and familiarity with the folk healer who knows and understands the culture, speaks the language, and makes house calls.

Racism

Form of prejudice and discrimination based on the belief that rave is the principal determining factor of human traits and capabilities, and that racial differences produce an inherent superiority (or inferiority).

What is the goal of Madeline Leininger's theory?

Goal of her theory is to guide research that will assist nurses to provide culturally congruent care using her three modes of nursing care actions and decisions

What does Race refer to?

Grouping of people based on biological similarities, such as skin color, blood type, or bone structure.

What are vulnerable populations?

Groups that are more likely to develop health problems and experience poorer outcomes because of limited access to care, high-risk behaviors, and/or multiple and cumulative stressors. Examples are the homeless, poor, and mentally ill, people with physical disabilities, the young and old, American Indians, Native Alaskans.

Cultural competence

Having the knowledge, abilities, and skills to deliver care congruent with the client's cultural beliefs and practices Achieved on a continuum ranging from incompetent to competent. It is a developmental process

List five factors to consider when communicating with a client who does not speak your language, when an interpreter is not available.

In addition to the appropriate strategies previously listed, consider the following factors: Greet the client with respect. Identify the client's primary language and use any words that you are familiar with in his language to show that you are trying to communicate. If appropriate, use a third language that is spoken by both of you (e.g., French is spoken by some Vietnamese). Speak slowly and clearly using simple sentences to talk about one problem or need at a time, using gestures. Restate in different words, if needed. Use pictures or diagrams. Be aware that some clients may answer "yes" even if they do not understand what you said.

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

It is well known that cultural specifics influence health. Knowing these specifics can help one better understand client behavior, making one more aware of why clients from different cultures have certain expectations of healthcare. Knowing tendencies for certain problems can guide you in planning assessments.

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

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 whose group/heritage is different from hers. 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.

What is multicultural?

Multicultural refers to many cultures and is used to describe groups rather than individuals.

Prejudice

Negative attitudes toward other people based on faulty and rigid stereotypes about race, gender, sexual orientation, and so on.

When does cultural assimilation occur?

Occurs when the new members gradually learn and take on the essential values, beliefs, and behaviors of the dominant culture.

What is Spanish?

Origin in Spain.

What are some common folk medicine practices?

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 is Hispanic Americans?

People who originally came from any Spanish-speaking country. More than 60% of Hispanic population in U.S. are of Mexican origin.

Personal value

Principle or standard that has meaning or worth to an individual.

What is acculturation?

Process of accepting both his own and the new culture, adopting elements of each. (Immigrants assume the characteristics of the new culture through this learning process)

What is culture defined?

Purell and Paulanka define culture as the totality of socially transmitted behavior patterns, arts, beliefs, values, customs, lifeways, and all other products of human work and thought characteristics of a population of people that guides their worldview and decision making.

According to U.S. Census Bureau, how is race determined?

Race is socially determined, rather than biologically determined.

What is Latino?

Refers only to people from Central or South America.

What does Religion refer to?

Religion refers to an ordered system of beliefs regarding the cause, nature, and purpose of the universe, especially the beliefs related to the worship of a God or gods.

Biological variations

Ways in which people are different genetically and physiologically Create susceptibility to certain diseases and injuries

Professional healthcare system

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

What are the three major health beliefs?

Scientific-also called biomedical health system Magico-religious system- considered alternative or indigenous Holistic belief system- similar to magico-religious system but it focuses more on the need for harmony and balance of the body with nature

How are Ethnicity and culture similar?

Similar to culture in that it refers to groups whose members share a common social and cultural heritage that is passed down from generation to generation.

How is ethnicity similar to subculture?

Similar to subculture, in that the members of an ethnic group have some characteristics in common that are not shared or understood by outsiders.

What is socialization and how does a person become socialized?

Socialization is the process of learning to become a member of a society or a group. A person becomes socialized by learning social rules and roles; by learning behaviors, norms, and values; and by perceptions of others in the same group or role.

Belief

Something one accepts as true.

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

Such barriers can impede the nurse's ability to provide culturally competent care to clients and families by interfering with perceptions and communication.

What is ethnocentrism?

Tendency to think that your own group is superior to others and to view behaviors and beliefs that differ greatly from your own as somehow wrong, strange, or unenlightened. Exists in all groups.

What health disparities exist among racial and ethnic groups?

That minority groups experience higher rates of illness and death and, in general, poorer health status compared with the white, non-Hispanic population.

Discrimination

The behavior manifestations of that prejudice.

Folk medicine

The beliefs and practices that the members of a cultural group follow when they are ill, as opposed to more conventional standards.

Culture of nursing

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

List the six cultural specifics affecting health.

The six cultural specifics affecting health are as follows: Communication Space Social organization Time orientation Environmental control Biologic variations

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

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 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?

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.

Culture universals

The values, beliefs, and practices that people from all cultures share.

How can I become culturally competent?

Theoretical knowledge can increase your awareness and appreciation of cultural differences.

Alternative medicine

Therapies used instead of conventional medicine, and whose reliability has not been validated through clinical testing in the United States.

What do the CLAS guidelines require?

They require healthcare organizations receiving federal funding to provide language assistance services, including bilingual staff and interpreter services, at no cost to the patient.

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

True

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

True

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

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

Culture Specifics

Values, beliefs, and practices that are special or unique to a culture.

What are racial categories does the U.S. Census Bureau ?

White Black, African American, or Negro American Indian or Alaska Native Asian Categories Native Hawaiian Pacific Islander Categories Hispanic/Latino/Spanish NOT included

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

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.

How do you recognize subcultures?

You may be able to recognize subcultures by their speech patterns, dress, gestures, eating habits, lifestyles, and so on.

What are subcultures?

groups within a larger culture or social system that have some characteristics that are different from those of the dominant culture.

Bias

one-sidedness; a tendency to lean a certain way, a lack of impartiality

Time orientation

present, past, or future thinking.