Chapter 13 Culture & Etnicity

culture of north American health-care system

beilief in biomedical system value technology desire to conquer disease

cultural awareness

refers to an appreciation of the external signs of diversity,

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● 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. ● 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 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

Catholicism

-Fasting during lent -Baptism of stillborn infants

minority groups

Minority groups are also made up of individuals who share race, religion, or ethnic heritage; however, a minor-ity group has fewer members than the majority group.

cultural specifics that affect Health health cont.

-biological variations Biological variations include ways in which people are different genetically and physiologically. They create sus-ceptibility to certain diseases and injuries. Biological vari-ations include body build and structure, skin color, vital signs, enzymatic and genetic variations, and drug me-tabolism -religion and philosophy A person's religion may deter-mine what healthcare is acceptable to him. -politics, law Governmental policies affect healthcare. They determine what practitioners will be available and what programs will be funded; -economy -The condition of the economy directly affects the availability of funds for publicly funded services. -education Education influences the perception of wellness and illness and the knowledge of options that are available for healthcare.

Yin Foods

-eat when the body needs to be cooled alfalfa sprouts apple apricot Asian pear asparagus bamboo bamboo shoots barley, pearl bok choy broccoli burdock root carrot cauliflower celery

traditional and alternative healing

-folk medicine -Folk medicine is defined as the beliefs and practices that the members of a cultural group follow when they are ill, as opposed to more conventional (i.e., biomedi-cal or professional) standards -complementary medicine -Complementary medicine is the use of rigorously tested therapies to complement those of conventional medicine (Andrews & Boyle, 2007). Examples include chiroprac-tic care, biofeedback, and the use of certain supple-ments. -alternative medicine-alternative medicine is defined as therapies used instead of conventional (i.e., biomedical) medicine, and whose reliability has not been validated through clinical testing in the United States.

Barriers to Culturally Competent Care

-lack of knowledge -emotional responses -ethnocentrism -cultural stereotypes-cultural stereotype is the unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain respects. -prejudice -Prejudice refers to negative attitudes to-ward other people based on faulty and rigid stereotypes about race, gender, sexual orientation, and so on.

Health and illness beliefs and practices

-scientific -biomedical health system -magico-religious "alternative " (voodoo) -holistic-can be similar to magico-religious, but it focuses more on the need for harmony and balance of the body with nature

cultural archetype

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 usually not negative

Cultural Stereotype

A cultural stereotype is a widely held but oversim-plified and unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain re-spects. Stereotypes Copyright | F. A. Davis | Fundamentals of Nursing Volume 1 Theory, Concepts, and Applications | [email protected] | Printed from www.chegg.com

dominant culture

A dominant culture is the group that has the most authority or power to con-trol values and reward or punish behaviors. It is usually, but not always, the largest group. Copyright | F. A. Davis | Fundamentals of Nursing Volume 1 Theory, Concepts, and Applications | [email protected] | Printed from www.chegg.com

acculturation

A person who is acculturated accepts both his own and the new culture, adopting elements of each. Acculturation is the outgrowth of the minority group's need to survive and flourish in the new culture.

multicultural

A perspective recognizing the cultural diversity of the United States and promoting equal standing for all cultural traditions

Ethnocentrism

A tendency to view one's own culture and group as superior to others and to view behaviors and beliefs that differ greatly from your own as somehow wrong, strange, or unenlightened

concepts related to culture

Acculturation Cultural assimilation Cultural conflict Cultural shock Ethnicity Race Religion Socialization

Specific Cultures African American

African-Americans Health belief system Highly diverse; biomedical and folk health Language English; Black English dialect Communication Personal space comfort area tends to be close. Eye contact may be uncomfortable. Family roles Women are primary decision makers. Extended family plays an important role

specific cultures African American cont.

African-Americans (continued) Birth rites There are many folk customs. Breastfeeding is not readily accepted. Death rites Extended family is very supportive. Some fear touching the body or being present. Dietary practices Lactose intolerance common Collard greens, leafy and yellow vegetables, legumes, beans, rice, and potatoes Southern African Americans - pork, fried foods

ethnicity

Ethnicity is 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 genera-tion. Copyright | F. A. Davis | Fundamentals of Nursing Volume 1 Theory, Concepts, and Applications | [email protected] | Printed from www.chegg.com

terminology

Bicultural Multicultural Ethnocentrism Dominant culture Subcultures Minority groups

cultural shock

Feelings of helplessness and discomfort and a state of disorientation experienced by an outsider attempting to comprehend or effectively adapt to a different cultural group because of differences in cultural practices, values, and beliefs.

Muslim Americans Cont

Communication Women do not usually shake hands with men. Women keep head, arms, and legs covered. Male staff members should avoid being in the room with a female Muslim. Family roles Decision-making unit is the family, not the individual. Husband will be consulted in any decisions about family.

Yin ( Cold)-Yang (hot)

Concept of a lot of cultures related to health care - Eastern religions, some Hispanic cultures Not hot or cold by temperature, but by the effect the food has on your body.) Off seat cold diseases by eating hot foods and hot diseases by eating cold foods Yin foods are foods that cool the body. Alcohol, sugars, coffee

culturally competent care

Cultural Competence : cultural competence: being able to use knowledge and sensitivity in practice. Purnell and Paulanka -stresses teamwork in providing culturally sensitive and competent care to improve outcomes for individuals, families, and communities. Purnell's model defines cultural competence as "having the knowledge, abilities, and skills to deliver care congruent with the client's cultural beliefs and practices." Leinger-The goal of her theory is to guide research that will as-sist nurses to provide culturally congruent care that would contribute to the health or well-being of people using her three modes of nursing care actions and decisions -Discovering cultural care and caring beliefs, values, and practices -Analyzing the similarities and differences of these beliefs among the Campinha- Bacote The culturally competent model of care views cultural competence as a process, not an end point. The nurse must see himself as becoming culturally competent, rather than being culturally competent. The model iden-tifies five components of cultural competence, using the mnemonic ASKED. a-awareness s-skill k-knowledge e-encounters d-desire

cultural assimilation

Cultural assimilation occurs when the new members gradually learn and take on the essential values, beliefs, and behaviors of the dominant culture. Assimilation is complete when the newcomer is fully merged into the dominant cultural group.

Nursing strategies for providing culturally competent care

Cultural care preservation/maintenance:which sus-tains clients' cultural lifestyles in meaningful ways. These are actions that help the client retain or pre-serve cultural values related to health. Example: Encouraging the family to bring ethnic foods that are appropriate for the client's prescribed diet. Cultural care accommodation/negotiation: which adapts clients' lifestyles or nurses' actions. The nurse supports and enables the client to adapt to therapies or to negotiate with professionals to achieve satisfy-ing health outcomes. Negotiation acknowledges the gap between the nurse's and client's perspectives. You must negotiate when folk or traditional practices might be harmful to the client. Cultural care repatterning/restructuring: which changes nurses' actions or clients' lifestyles into different pat-terns. The nurse supports and encourages the client to greatly modify his behaviors and to adopt new, differ-ent, and beneficial health behaviors, while still respect-ing the client's cultural values and beliefs.

cultural competence

Cultural competence is attained on a continuum ranging from cultural destructiveness (most negative) to cultural proficiency (most positive)

culture characteristics

Culture -what people in a group have in common but it changes over time or Culture-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 world view and decision making - culture is learned -taught -shared by its members -dynamic(active) and adaptive ( change over time) -complex

culture universals and specifics

Culture universals are values, beliefs, and practices that people from all cultures share.

Chinese Americans cont

Death rites There is an aversion to death and anything concerning death. Donation of body parts is encouraged. Eldest son is responsible for all arrangements. White, yellow, or black clothing is worn for mourning. Dietary practices Lactose intolerance common Diet low in fat and sugar; high in salt Rice, fish, pork, poultry, nuts, dried beans, and tofu

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Define cultural competence. Answer: Cultural competence is what we are all 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 enable us to provide such care. It includes developing an awareness of our own beliefs and those of others, accepting and respecting cultural differences, being open to cultural encounters, and adapting care so that it is congruent to those of other cultures. This attribute is conscious and nonlinear. While cultural competence can be considered to be a developmental process, healthcare providers must continue to work toward its achievement. Also refer to the models presented in this chapter of Volume 1. ● 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 to clients and families by interfering with perceptions and communication.

Culture of north American health-care system cont

Definition of health as absence or minimization of disease Adherence to a set of ethical standards or minimization of disease

Barriers to Culturally competent care cont.

Discrimination-refers to the behavioral manifestations of that prejudice. Racism-is a form of prejudice and discrimination based on the belief that race is the principal determining factor of human traits and capabilities and that racial differences produce an inherent superiority (or inferiority). Sexism- widespread throughout history, is the assump-tion that members of one sex are superior to those of the other sex. Language barrier Street talk, slang, jargon

Yin-Yang

Diseases which are being exposed to cold surrounding became worst are cold diseases. They are Yin diseases. Diseases which are being exposed to hot surrounding became worst are hot diseases. They are Yang diseases. When a person has high fever, then that person should eat more Yin foods. And if a person is shivering with cold, then that person should eat more Yang foods.

Muslim Americans

Health belief system Holistic belief Modesty and privacy must be preserved. Same-sex health care providers are used if at all possible. Patient may wish to have physician consult with imam. Language Varies with country of origin

Chinese American

Health belief system Holistic belief; will accept biomedical interventions Language May continue to speak native language even after many years in the United States Communication Eye contact may be considered ill mannered. Face-to-face contact is uncomfortable. Touching is regarded as disrespectful or impolite

13-5

How do the cultural norms of the North American healthcare system differ from those of other cultural groups? Refer to ESG Table 13-2 (in this study guide) and Table 13-3 (in Volume 1) 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") ● The surgical procedure ● Dislike for tardiness or disorganization ● Handwashing

Specific Cultures : Mexican Americans

Mexican-Americans (continued) Birth rites It is inappropriate for the husband to be present at a birth. Female family members may be present at a birth. Death rites Small children are shielded from the dying. Families take turns staying around the clock. Dietary practices Lactose intolerance is common. Rice, corn, beans, beef, pork, poultry, and goat.

culture of health care: indigenous health care, professional health care , biomedical health care , alternative health care .

Indigenous health-care system The indigenous healthcare system consists of folk medicine and traditional healing methods, which may also include over-the-counter (OTC) and self-treatment remedies. Professional health-care system the professional healthcare system is run by a set of professional healthcare providers who have been formally educated and trained for their appropriate roles and responsibilities. Biomedical health-care system You are probably familiar with the scientific or biomedical health system. Alternative health care--Belief in supernatural (mystical) forces dominates the magicoreligious system, which is considered "alternative" or "indigenous" in the United States and Canada. (voodoo)

cult. characteristics

Is diverse (variety) Exists at many levels Has common beliefs and practices Is all-encompassing(cultures can influence everything its members think and do) Provides identity(and also a sense of belonging)

Ethnicity

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

13-4

Knowledge Check 13-4 ● 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. ● What are magicoreligious belief systems? Answer: The magicoreligious 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. ● 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. ● Refer to the "Meet Your Patient" feature in Volume 1. 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.

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Knowledge Check 13-9 ● List five factors to consider when communicating with clients from different cultures. Answer: 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 ● List five factors to consider when communicating with a client using an interpreter. Answer: 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 a client who does not speak your language, when an interpreter is not available. Answer: 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 don't understand what you have said.

Becoming culturally competent live and learn model

L-like I-Inquire V-Visit E-Experience L-listen E-evaluate A-acknowledge R-recommend N-negotiate

Specific Cultures Mexican Americans

Mexican-Americans Health belief system Biomedical mixed with folk practices Language Spanish mixed with English Communication Avoid eye contact Family roles Families may expect to help care for the patient. Male members are usually consulted for health care decisions.

Muslim Americans Continued

Muslim Americans (continued) Birth rites Men are not present during labor and delivery; some husbands may choose to be present during birth. Women will seek a female physician. Pregnant women are exempt from fasting during Ramadan.

Muslim Americans continue.

Muslim Americans (continued) Death rites Any intervention to hasten death is forbidden. Autopsy is acceptable. Organ donations are permitted. Dietary practices Fasting during daylight hours is practiced during Ramadan. Pregnant women/children are exempt. Medical condition may exempt person from fasting. Alcohol and drugs are forbidden. Food should not include any pork products.

Nursing as a subculture

Nursing is largest subculture in health-care culture. culture of nursing is defined as the learning and transmitted life-ways,values, symbols, patterns and nonnormative practices of members of the nursing profession that are not the same as those of the mainstream culture Nursing values -Silent suffering as a response to pain -Objective reporting and description of pain -Use of nursing process -Nursing autonomy -Caring -Knowledge -Critical thinking

religion

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 Copyright | F. A. Davis | Fundamentals of Nursing Volume 1 Theory, Concepts, and Applications | [email protected] | Printed from www.chegg.com

seventh-day Adventist

Saturday is Sabbath no alcohol, pork , fish without scales many are vegetarians

Orthodox Judaism

Saturday is Sabbath (sundown Friday to sundown Saturday) No pork No meat or milk on same tray Burial next day after death - no autopsy, no embalming

socialization

Socialization is the process of learning to become a member of a society or a group.

subcultures

Subcultures are groups within a larger culture or so-cial system that have some characteristics (e.g., values, behaviors, ancestry, ways of living) that are different from those of the dominant culture. People in subcul-tures have had different experiences from those in the dominant group because of status, residence, gender, sexual orientation, ethnic background, education, or other factors that unify the group Copyright | F. A. Davis | Fundamentals of Nursing Volume 1 Theory, Concepts, and Applications | [email protected] | Printed from www.chegg.com

Importance

The United States and Canada are multicultural societies You will care for clients who are not from your culture

religion, culture, ethnicity, race

These distinctions between culture, ethnicity, race, and religion might seem confusing, but think of it this way: You are a member of the subculture of nursing, but you are also a member of an ethnic group (e.g., Portuguese Americans from the Azores), a racial group (e.g., white), and a religion (e.g., Roman Catholicism), each with its own sets of beliefs and values. So, your culture is a blend of all of those.

cultural conflict

This occurs when people become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of other to make themselves feel more secure about their own values, When two or more groups start disputing because of their cultural differences

Vulnerable Populations as subcultures

Vulnerable Populations as Subcultures Vulnerable populations are groups who 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. Homeless Poor Mentally ill People with physical disabilities Young Elderly Some ethnic and racial minority groups

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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. ● 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. ● 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 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 hous

yang foods

Yang foods. The most yang foods are salt, meat, eggs, poultry, fish and cooked root vegetables. Plants that grow beneath the ground are more yang, while those that grow up in the air such as most fruit, are more yin. Cooked grains, cooked beans and cooked vegetables are in the middle

culture specifics that affect health

culture specifics (culture diversities in Leininger's theory) are those values, beliefs, and prac-tices that are special or unique to a culture. -communication (different languages ) -space (between one another) or their space around them -time orientation ( some persons tend to be present-or future-oriented, where as others are more rooted in the past -social organizationSocial organization includes the family unit (e.g., nuclear, single-parent, or extended family) and the wider organizations (e.g., community, religious, ethnic) with which the individual or family identifies -Environmental control- refers to a person's perception of his ability to plan activities that control nature or direct environmental factors

bicultural

describes a person who identifies with two cultures and integrates some of the values and lifestyles of each into his life.

cultural sensitivity

has 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

Jehovah's witnesses

no blood transfusion

race

race is strictly related to biology. Race refers to the grouping of people based on biological simi-larities, such as skin color, blood type, or bone structure Copyright | F. A. Davis | Fundamentals of Nursing Volume 1 Theory, Concepts, and Applications | [email protected] | Printed from www.chegg.com

13-1

nowledge Check 13-1 ● 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 the United States. ● 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 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 providers13

13-2

nowledge Check 13-2 ● 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. ● 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 ● 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. ● 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, Englis

13-3

nowledge Check 13-3 ● 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 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). ● 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 responses to drugs. ● 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 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