Chapter 15
multicultural example
a hospital caregivers are from different groups
bicultural
a person who identifies with two cultures and integrates some of the values and lifestyle of each into his life ex: a jewish man who marries an italian catholic woman
personal values
a principle or standard that has meaning or worth to an individual
key point
remember that individuals within an ethnocultural group vary widely and that learning commonalities is no substitute for careful assessment of each person
Germans : personal space
require a great deal of space, and consider even looking into a room an invasion of privacy.
professional healthcare system
run by professional healthcare providers who have been formally educated and trained for their appropriate roles and responsibilities.
magico religious system ex
voodoo, which is practiced in somedeveloping nations in Africa, Latin America, and the Caribbean, and which considers the lion a spiritual symbol
Biological variations
ways in which people are different genetically and physio-logically. body build and structure, skin color,vital signs, enzymatic and genetic variations, and drug metabolism
key point
we all tend to group and categorize data to make it meaningful and useful, but we must be careful to avoid using these categories as the basis for interacting with people or providing care
culture
what people in a group have in common, but it changes over time
Rosanna throws away the prescription given by doctor for her son
Some people of Mexican heritage believe that illness is caused by the body's imbalance of "hot" and "cold" (not re-lated to temperature)
Economy
condition of the economy directly affects the availability of funds for publicly funded services. It also affects the individual's ability to pay for healthcare.
multicultural
region is populated by individuals many different cultural groups.
cultural assimilation
results in varying degrees of affiliation with the dominant culture when the new members gradually learn and take the essential values, beliefs, and behaviors of the dominant culture
Arabs and others from the Middle East : personal space
stand quite close when talking
examples of subculutres
street gangs , physicians, nurses, women, older adults, persons with disabilities, gays and lesbians, people of appalachian heritage, rural midwesterners, and people who abuse certain drugs
latino
strictly speaking , refers only to people from central or south america
dominant g group in north america
white anglo-saxon christian of european descent
cultural stereotype
widely held but oversimplified & unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain aspects
gender ex
us and canada view caring and nurturing as a women thing 9 % of men nurses
Complementary medicine
use of rigorously tested therapies to complement those of conventional medicine
practice ex
" i always wash my hands before preparing food
belief ex
" i believe that germs cause disease
magico-religious system,
"alternative" or "indigenous" in the UnitedStates.
nurses realize
"knowledge work"
Religion and Philosophy
A person's religion may deter-mine what healthcare is acceptable to him (e.g., blood trans-fusions, abortion).
environmental control ex
For example, if a person does not believe he can do anything to "change things," how would this attitude affect his decision to seek medical care? To take medications?To exercise and eat properly? Perception and tolerance of pain are examples of the effect of environmental control. Some people, especially Asian Americans, tend to accept pain stoically, and not demand relief. They do not view cir-cumstances as something to be "controlled." Think again about Mr. Chan (Meet Your Patients). Why do you think he just shakes his head and looks away when asked to rate his pain?
The social organization of your clients' cultures can provide cluesas to how they will act during life events
For example, imagine a patient who must depend on Medicaid to pay for her health-care, but who does not trust large institutions or government agencies. She is likely to use home remedies and to delay seeing a conventional medical provider.
culture specific ex 2
Greece amulets ( objects or charms worn as protection against evil spirits ) placed on baby
A close social organization can be found in all cultures; however,the specifics vary.
Middle Eastern and Latino cultures, the man is likely to be the dominant family member and the woman the homemaker But many African American families are matriarchal; that is, the decision maker and family leader is a woman.
awareness
Take an honest look at your personal biases and prejudices toward cultural groups other than your own.
cultural awareness
appreciation external signs of diversity,
campinha- bacote
asked mnemonic
folk medicine
beliefs and practices that the members of a cultural group follow when they are ill, as opposed to more conventional (i.e., biomedical or professional) standards
complex
cultural assumptions and habits are unconscious and thus may be difficult for members of the culture to explain to others or to identify as different from another culture.
dynamic and adaptive
cultural customs, beliefs, and practices change over time and at different rates . Cultural change occurs with adaptation in response to the environment
learned and taught
cultural values, beliefs , and traditions are passed down from generation to generation.
all-encompassing
culture can influence everything its members think and do
culture exists at many levels
culture exists in both the material ( art, writings, dress, or artifacts) and the nonmaterial ( customs , traditions, language, beliefs, and practices
vulnerable population as subcultures
develop health problems & experience poorer outcomes b/c limited access to care , high risk behaviors, multiple / cumulative stressors
professional healthcare system ex
diet therapy, mind-body control methods, therapeutic touch, acupressure, reflexology, naturopathy, kinesiology, and chiropractic.
key point 3
each person must be seen as unique - as influenced by his heritage, but not defined by it
communication
exchange of information, ideas, and feelings verbal & nonverbal spoken language,gestures, silences
social organization
family unit (e.g., nuclear, single-parent, or extended family)and the broader groups (e.g., community, religious, ethnic)with which the individual or family identifies (
indigenous healthcare system
folk medicine and traditional healing methods,which may also include over-the-counter (OTC) and self-treatment remedies.
dominant culture
is the group that has the most authority or power to control values and reward or punish behaviors
Americans, Canadians of Northern European ancestry, and the British : personal space
keep at least 18 inches of space between themselves and the person with whom they are conversing.
cultural sensitivity
more to do with personal attitudes and being careful not to sayor do something that might be offensive to someone from a dif-ferent culture
cultures consist of common beliefs and practices
most members of culture share the same beliefs, traditions, customs, and practices as long as they continue to be adaptive and satisfy the members needs. Some members of the group may deviate from cultural norms, but for a norm to be considered cultural, many members must follow it
holistic belief system
need for harmony and balance of the body with nature.
immigrants
new members of a group or country
belief
one accepts as true
knowledge
patient's view of the world is in order to understand it and work competently with the patient.
acculturation
the process of adapting to and adopting a new culture experts theorize it takes 3 generations for acculturation
ethnocentrism
the tendency to think that your own group ( cultural,professional,ethnic, or social ) is superior to others and to view behaviors and beliefs that differ greatly from your own as somehow wrong, strange, or unenlightened
ayurveda,
the traditional healthcare system of India.
alternative medicine
therapies used instead of conventional(i.e., biomedical) medicine, and whose reliability has not been validated through clinical testing in the United States.
Environmental control
to a person's perception of his ability to plan activities that control nature or direct environmental factors
ethnicity
to groups whose members share a common social and cultural heritage that is passed down from generation to generation
race
to the group of people based on biological similarities such as skin color, blood type, or bone structure
Healthy people 2020 overarching goal
To eliminate disparities among racial and ethnic groups and improve the health of all groups
For example in nursing homes
Use of restraints is higher among Hispanics and asian/pacific islanders than it is among non hispanic white
ethnic group example
french canadians, roman catholics, hmongs, and latinos
quality & safety education for nurses
(1) pro-vide patient-centered care with sensitivity and respect for the diversity of human experience; (2) seek learning opportunities with patients who represent all aspects of human diversity;and (3) recognize personally held attitudes about working with patients from different ethnic, cultural, and social back-grounds (
ethnicity two categories
1. hispanic, latino, or spanish 2. not hispanic , latino or spanish
biological variations
African Americans metabolize antihypertensives differently from EuropeanAmericans ■African American and Caucasian men are on average about3.5 inches taller than Asian American men, and 2 inches taller than Mexican American men.■African Americans have a higher incidence of hypertension and sickle cell anemia.■Asian Americans tend to experience more gastrointestinal side effects from opiates, even though the analgesic effect is less.
culture specifics ex
Belize a baby is christened before visitors are allowed to see her, to prevent evil eye ( bad spell cast by others)
Education
Education influences the perception of wellness and illness, the knowledge and understanding of options that are available for healthcare, and the person's expectations for care.
time orientation ex
European Americans: future oriented Native Americans and Latinos: more present oriented; may not show up on late or not show up for follow up appointment
complementary medicine ex
Examples include chiropractic care, biofeedback,and the use of certain supplements.
alternative medicine ex
Examples of alternative therapies include iridology, aromatherapy, andmagnet therapy
Disparities of minorities
Experience higher rates of illness and death and in general poorer health status compared with white ( non Hispanic)
communication ex
For example, Arabs tend to keep steady eyecontact when talking, but not between men and women;Asians and Native Americans usually do not make eye contact
Politics and the Law
Governmental policies affect health-care. They determine what practitioners will be available and what programs will be funded. For example, the federal government helps fund Medicare, which provides basic medical insurance for people age 65 and older, but Medicare limits the frequency and types of treatment for which it will pay. The legal system defines roles, functions, and standards of health professionals.
Kinship and social ties also determine who receives healthcare, and in what priority.
In the United States, for example, someone of high status (e.g., a celebrity or political figure) is likely to receive better care than a poor person who is unknown in the community. In some cultures, men receive care before women and children.
american nurses association
Nursing: Scope andStandards of Practice(2010) states that the registered nurse should provide holistic care that addresses the needs of diverse populations.
nursing values ex
Silent suffering as a response to pain■Objective reporting and description of pain, but not an emotional response■Use of the nursing process■Nursing autonomy■Caring
Time orientation
Some persons tend to be present or future oriented, whereas others are more rooted in the past.
Technology
The availability of supplies and equipment de-termines what is used in the healthcare setting and whatcomes to be culturally expected. Nurses in most of NorthAmerica, for example, assume they will have bed linens,water, electricity, necessary medications, electrocardiogra-phy, and x-ray imaging. In many parts of the world, how-ever, these items are not available
biomedical healthcare system
Western biomedical beliefs with traditional North American values of self-reliance, individualism, and aggressive action.This system is also known as Western medicine and allopathic medicine.
skills
ability to conduct with sensitivity a cul-tural assessment and a culturally based physical assessment
Cultural competence
achieved on a continuum ranging from incompetent to competent "having the knowledge, abilities, andskills to deliver care congruent with the client's cultural beliefs and practices
hispanic
americans are people who originally came from any spanish-speaking country ( mexico, spain) More than 60 % are from mexican origin
cultural beliefs provide identity and a sense of belonging
for a culture's members as long as they do not conflict with the dominant culture and continue to satisfy its members
subcultures
groups within a larger culture or social system that have some characteristics ( values, behaviors, ancestry,ways of living ) that are different from those of the dominant culture
ethnic group
have some characteristics in common ( race, ancestry, physical characteristics, geographic region, lifestyle, religion) that are not shared or understood by outsiders
vulnerable group : Native alaskans, american indians
higher incidence of early onset diabetes
vulnerable population ex
homeless, mentally ill , poor , physical disabilities , very young , old
spanish
implies origin in spain
space
individual's personal space, or how the person relates toward the space around him.
Minority groups
individuals who share race, religion or ethnic hertiage; fewer members
culture of nursing
learned and transmitted life ways, values, symbols, patterns, and normative practices of members of the nursing profession that are not the same as those of the mainstream culture.
assimilation example
learning to speak the dominant language, marrying a member from the new ( host) culture, making close, personal relationships with members of the new group
encounters
many face-to-face encounters as possible with patients from diverse cultural backgrounds.
socialization
process of learning to become a member of a society or a group
practice
set of behaviors that one follows
cultural archetype
similar to a model, a person or thing -something that is recurrent - and it has its basis in facts
gender as a subculture
some behaviors considered acceptable for men and not for women
culture universals
values, beliefs, practice that people from all cultures share
culture specifics
values, beliefs, practices, that are special or unique to a culture