Chapter 15: Culture & Ethnicity

communication

an exchange of information, ideas, & feelings - includes verbal & nonverbal language *i.e., spoken language, gestures, eye contact, silence*

stereotype

are widely held but oversimplified beliefs that have no basis in fact - can be negative but not always ex. natural atheletic

culture provides identity & a sense of belonging for its members

as long as they do not conflict w/ dominant culture & continue to satisfy its members

the united states is a multicultural society with an increase in

asian and spanish speaking nation

sexism

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

discrimination

behavior manifestations of prejudice

magico-religious

belief is supernatural (mystical) forces - Voodoo

folk medicine

beliefs & practices that the members of a cultural group follow when they are ill, as opposed to more conventional (i.e., biomedical, professional) standards - knowledge is passed down from generation to generation by oral, sometimes written, tradition - self-treatment & use of folk healers

scientific

biomedical belief system

language barrier

can involve foreign languages, dialects, regionalisms (words or pronunciation particular to a specific region), street talk, jargon

biomedical healthcare system

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

economy

condition of the economy directly affects the availability of funds for publicly funded services & also affects the individual's ability to pay for healthcare

indigenous healthcare system

consists of folk medicine & traditional healing methods, which may include OTC & self-treatment remedies

culture is complex

cultural assumptions & habits are unconscious & may be difficult for members of culture to explain to others or to identify as different from another culture

culture is all-encompassing

culture can influence everything its members think & do

culture is diverse

culture demonstrates the variety that exists among groups & among members of a particular group

culture is shares by its members

culture norms are shared through teaching and social interactions

ethnicity

refer to group whose members share a common social & cultural heritage that is passed down from generation

environmental control

refers to a person's perception of his ability to plan activities that control nature or direct environmental factors - person's health & illness are directly related to this concept

space

refers to a person's personal space, or boundary lines that determine how close another person can come - person's comfort level is related to space

religion

refers to an ordered system of beliefs regarding the cause, nature & purpose of the universe, especially related to God or gods

multicultural

refers to many cultures & is used to describe *groups* rather than individuals Ex) US is multicultural - hospital is a multicultural group - nurses are a subculture

race

refers to the grouping of people based on biological similarities, such as skin color, blood type, or bone structure - strictly related to biology

professional healthcare system

run by a set of professional healthcare providers who have been formally educated for their appropriate roles & responsibilities

ethnicity

similar to culture, refers to groups whose members share a common social & cultural heritage passed down from generation to generation - may include race & origin

holistic

similar to magics-religious, but it focuses more on the need for harmony & balance of the body w/ nature

cultural archetype

something that is recurrent based on facts - usually not negative

purnell & paulanka

stresses teamwork to provide culturally sensitive & competent care to improve outcomes for individuals, families, & communities

cultural care preservation/maintenance

sustains clients cultural lifestyles in meaningful ways - actions that help the client retain or preserve cultural values related to health

european americans

tend to be future-oriented

far east

tend to be past-oriented & value traditions & relationships over time & deadlines

ethnocentrism

tendency to think that your own group (cultural, professional, ethnic, or social) *is superior* to others & to view others behaviors & beliefs that differ greatly from your own somehow wrong, strange, or unenlightened

biological variations

the ways in which people are different genetically & physiologically - body build & structure, skin color, vital signs, enzymatic & genetic variations, & drug metabolism

alternative medicine

therapies used instead of conventional (biomedical) medicine & whose reliability has not been validated through clinical testing in US - iridology, aromatherapy, magnetic therapy

culture specifics

those values, beliefs, & practices that are special or unique to a culture ex. jewish baby boys get circ on the 8th day of birth

complementary medicine

use of rigorously tested therapies that are outside of the mainstream medical or nursing care to complement those of conventional medicine - chiropractic care, biofeedback, use of certain supplements

culture universals

values, beliefs, & practices that people from ALL cultures share ex. all cultures celebrate birth of a new baby someway

time orientation

varies among people of different cultures; some persons tend to be past-, present-, or future-oriented

campinha-bacote

views cultural competence as a process, not an end point - nurse must see himself as becoming culturally competent rather than be culturally competent - A-S-K-E-D - Awareness - Skills - Knowledge - Encounters - Desire

cultural competencies

"having the knowledge, abilities, & skills to deliver care congruent w/ the client's cultural beliefs & practices"

Hawaiian - values/beliefs

- aloha: deep love and respect & affection between people - lifestyle over compliance with healthcare issues - present orientated - death is part of life and not feared

african american - family

- close & extended family relationships - strong relationships with church or social group - usually matriarchal (older women is the power in the family)

culture is dynamic & adaptive

- culture customs, beliefs, & practices are not static - they change over time at different rates - culture change occurs with adaptation in response to environment

hispanic family

- familial role is important - family is the primary unit society

native american - family

- families are large and extended - grandparents are official and symbolic leaders - a child namesake may become the same as another parent to the child

native american - nursing considerations

- family is expected to be part of the nursing care plan - *note taking is often frowned up as it is considered an insult to the speaker bc the listener is not paying attention to the conversation* - *indirect eye contact is acceptable and sometimes preferred* - it is often considered rude or impolite to indicate that a conversation has not been heard - low tone of voice is considered respectful - the patient may expect the caregiver to deduce the problem through instinct and not asking many questions & history taking - it may help to declarative sentences instead of direct questionings

Hawaiian - family

- family is important - Ohana or extended family help childrearing - each gender and age have specific duties - closely knit in small, isolated communites

hispanic traditional healthcare

- folk healer based on body fluids - blood: hot & wet -yellow bile: hot & dry - black bile: cold & wet - phlegm: cold & wet *Must balance cold & hot within the body*

Hispanic Nursing Considerations

- it may difficult to convince an asymptomatic patient they are ill - special diet considerations due to hot/cold theory - normal site is high in stack - may need diet couseling

Hawaiian - traditional healthcare

- kahuna a'au lapa'nu is the ancient medical practitioner - patient's illness as part of the whole - there is a relationship between physical, psychological and spiritual - emphasis on preventive medicine - use over 300 medicinal plants and mineral

Hawaiian - nursing considerations

- many hawaiian's still use folk healing practice and home remedies - special consideration given to the extensive family network during hospitalization - acceptance from healthcare practitioners of current health practices and lifestyles

asian - nursing considerations

- may be upset by drawing blood, as that is considered a body's life force - some believe it is best to die with the body intact - they seldom complain about what is bothering them or if they are in pain - some consider it polite to give a person the response they are expecting (misinformation) - some may move from a physician to physician in attempt to be cured of an illness - some may refuse diagnostics because they believe a skilled physical should diagnosis an illness through physical exams - possible high use of herbs

native american - traditional healthcare

- medicine men or Shaman's are heavily used - heavy use of herbs or psychological treatments, ceremonies, dating, medications, heat and massages

african american - value/beliefs

- present orientated - clergy is highly respected in the community - frequently highly religious

hispanic values beliefs

- respect is given to adults & males - mainly roman catholic devoted - god gives health & illness for a reason

asian - values/beliefs

- strong sense of self-respect & self-control - big respect for age - respect for authority - respect for hard work - praise of self or others is considered poor manners - strong emphasis on harmony and avoidance of conflict

asian - traditional healthcare

- taoism - balance in all things - good health is a balance of yin (dark, cold, feminine, negative) & yang (light, positive, warm, masculine) - energy imbalance is due to improper diet or strong emotions - disease and food are classified as hot & cold and must be treated with a balance (a cold is treated with a hot food) - high use of herbs, diet & hot/cold therapy

african american - traditional healthcare

- varies - may include spiritualist, herb doctor, skilled elder family members - Voodoo or faith healing

asian - family

- welfare of the family is valued above the person - extended families are common - elders and ancestors are high respected

native american - values/beliefs

-presents orientated, but concerned about the future - high respect for age - great value is on working together and sharing resources - failure to achieve a personal goals frequently believed to be the result of competition - high respect is given to others - accumulation of money and goods is frowned upon - some practice peyote religion (combustion of a hallucinogenic drug)

socialization

process of learning to become a member of a society or group - learns social rules & roles, learning the behaviors, norms, values & perceptions of others in the same group or role

You are teaching a workshop on providing culturally competent care to a class of fellow nurses at your hospital. One nurse asks, "Why do we need to learn this?" Which of the following responses should you give? SELECT ALL THAT APPLY. 1) "Our population is diverse and becoming more so all the time." 2) "Minority groups experience higher rates of illness, and we need to be aware of that." 3) "Disparities in the quality of care among racial groups are common, and we need to work to eliminate them." 4) "Nursing care that is appropriate for the dominant cultural group may be ineffective and inappropriate for people of other cultures." 5) "Learning cultural competence will prevent discrimination lawsuits against the hospital." 6) "Many racial and ethnic groups lack sufficient access to preventive health care."

1) "Our population is diverse and becoming more so all the time." 2) "Minority groups experience higher rates of illness, and we need to be aware of that." 3) "Disparities in the quality of care among racial groups are common, and we need to work to eliminate them." 4) "Nursing care that is appropriate for the dominant cultural group may be ineffective and inappropriate for people of other cultures." 6) "Many racial and ethnic groups lack sufficient access to preventive health care."

list concepts related to culture:

1. ethnicity 2. race 3. religion 4. socialization 5. acculturation 6. cultural assimilation 7. cultural conflict 8. cultural shock

You have just arranged a follow-up appointment for a patient who is from Nicaragua, Central America, for next Thursday at 8 a.m. Given what you know about the time orientation of this culture, which of the following should you expect? 1) The client will likely show up 15 minutes early to the appointment. 2) The client will likely show up right on time. 3) The client will likely call ahead of time to reschedule the appointment. 4) The client will likely show up as soon as he has finished a conversation he started with his neighbor.

4) The client will likely show up as soon as he has finished a conversation he started with his neighbor.

cultural care accommodation/negotiation

adapts clients' lifestyles or nurses' actions - nurse supports & enables client to adapt to therapies or to negotiate w/ professionals to achieve satisfying health outcomes

bicultural

a person who identifies w/ 2 cultures & integrates some of the values & lifestyles of each into his life *individual*

religion & philosophy

a person's religion may determine what healthcare is acceptable to him - Jehovah's Witnesses do not accept blood transfusions

culture is taught

culture values, beliefs, & traditions are passed down from generation to generation

alternative healthcare

diet therapy, mind-body control methods, therapeutic touch, acupressure, reflexology, naturopathy, kinesiology, and chiropractic

culture exists at many levels

exists as both material (art, writing, dress, or artifacts) & nonmaterial (customs, traditions, language, beliefs, & practice ) levels

racism

form of prejudice & discrimination based on the belief that (a) race is principal determining factor of human traits & capabilities and (b) that racial differences would produce an inherent superiority/inferiority

leininger

goal of this theory is to guide research that will assist nurses to provide culturally congruent care using her three modes of nursing care actions & decisions - discovering cultural care & caring beliefs, values, & practices - analyzing similarities & differences of these beliefs among the different cultures

politics & the law

government, policies affect healthcare; they determine what programs will be funded, reimbursement for providers, & acceptable functions & standards

dominant culture

group that has the *most authority/power to control* values & reward or punish behaviors Ex) government

vulnerable populations

groups that are more likely to develop health problems & experience poorer outcomes b/c of limited access to care, high-risk behaviors, and/or multiple & cumulative stressors - homeless, poor, mentally ill, people w/ disabilities, young, elderly, some racial/ethnic minority groups - *vulnerable population is a subculture of all major culture groups*

subcultures

groups w/in a larger culture or social system that have some characteristics (e.g., values, behaviors, ancestry, ways of living) that are different from those of the dominant culture - street gangs, physicians, nurses, women, older adults, persons w/ disabilities, gays & lesbians, people of Appalachian heritage, rural Midwesterners, people who abuse certain drugs

acculturation

immigrants (new members of a group or country) assume the characteristics of that culture through a learning process

social organization

includes the family unit (e.g., nuclear, single-parent, or extended family) & the wider organizations (e.g., community, religious, ethnic) w/ which the individual or family identifies

minority groups

individuals who share race, religion, or ethnic heritage - viewed as subordinate to & usually have fewer members than the minority group (ex. Jewish people of the US)

education

influences the perception of wellness & illness & the knowledge of options that are available for healthcare --> affect the person's expectations for care

by 2043, projections indicate that the united states will become a _______________ for the first time

majority-minority

african american - nursing considerations

many may still use varies fold healing practices - special care of hair & nails - give special consideration for extensive & frequent informal support networks (religious & community group)

latin americans & filipinos

more present-oriented & enjoy living in the moment

culture consist of common beliefs & practices

most members of a culture share the same beliefs, traditions, customs, & practices as long as they continue to be adaptive & satisfy the member's needs - some members of the group deviate from cultural norms, but for a norm to be considered cultural, many members must follow it

prejudices

negative attitudes toward other people based on faulty & rigid stereotypes about race, gender, sexual orientation, etc.

culture is learned

occurs through life experiences shared w/ other members of culture, formally (in schools) or informally (in families)

cultural assimilation

occurs when the new members gradually learn & take on the essential values, beliefs, & behaviors of the dominant culture - assimilation is complete when the newcomer is fully emerged into the dominant cultural group - learning to speak the dominant language, marrying a member from the new (host) culture

lack of knowledge/bias

one-sidedness: a tendency to "lean" a certain way, a lack of impartially - can be + or -