Cultural Exam 1

religious groups nursing care for Jehovah Witness- holding knowledge

-*Belief that no human should sustain life by taking blood. -Will likely refuse transfusions. -Will not eat food in which blood has been added - such as sausages and lunch meats. -Do not observe any national holidays - do not try to engage them with holiday celebrations.* notes: -a lot of test questions from the religious groups section -very likely to refuse blood-- can draw blood, can take their blood but will not take other's blood. -won't eat food that blood is added -don't observe any holidays, don't engage them in holiday celebrations -*2 TEST QUESTIONS*

Religious groups Nursing care for seventh-day adventists

-*Body is their "temple". Strive to keep it pure and healthy. -May refuse what they interpret as "unclean" foods such as certain types of fish and certain meats. -Prefer soybeans as protein source. -Do not use caffeine or alcohol. -May refuse medical treatments on Friday night and Saturday morning and afternoon and into the evening (Sabbath)- interferes with religious doctrine* notes: -*THREE TEST QUESTIONS* -*soybeans as a proteins source* -no alcohol and caffeine

ethnicity

-*Frequently and perhaps erroneously used to mean "race," but the term ethnicity includes more than the biological identification.* -Broadest sense - refers to groups whose members share a common social and cultural heritage passed on to each successive generation. -Most important characteristic of ethnicity is that members of an ethnic group feel a sense of identity.

role of gender and cultural significance

-*Holding Knowledge: Chinese culture - distinct role between men and women. Yin - yang (female/male). -For some traditional Chinese Americans, the yin represents the dark, cold, wet, passive, weak, feminine aspect of humankind. In stark contrast, the yang represents the bright, hot, dry, active, strong, masculine aspect of humankind. -In some cultures it is preferable to assign nurses of the same gender as care providers. If the nurse is female and the client is male and is from a cultural group where touch is permitted only between members of the same sex and where direct eye contact is avoided, special modifications in care may be needed.* notes: -in Chinese medicine- everything is feminine and masculine. Yin is the soft feminine, yang in the male

nursing implications

-*If you suspect that a patient has non-traditional health beliefs - Always ask client - "Are there any family remedies you are using to treat your illness?" This statement will open lines of communication and give the patient an opportunity to tell you what they might be using to treat their condition. Do not use phases that "assume" they are using a certain remedy that you might tend to associate with their culture* -Ask patient what they have been using or doing to treat their symptoms. This is a great way to gather information about the use of alternative therapies and/or folk medicine -Understand locus of control and how this may impact an patient's believes/motivation to change certain behaviors notes: -Don't stereotype, don't make the assumption that because of their culture they are doing a specific remedy. -Understand locus of control-- if a person has a very strong external locus of control that is harder to manage than internal --They may believe that God has a plan and it does not matter whether or not they complete their treatment or take their medication

Religious groups Islam: the religion

-*Islam - means "peace, submission, and obedience". -Islam should solely indicate religion or acts of faith in the name of the religion, but not to pinpoint someone who practices the religion. -Muslim is commonly brought up where a person is being distinguished. -"I am a Muslim, my religion is Islam". - CORRECT -"People practice the Muslim religion." - INCORRECT -5 pillars - declaration of faith. Daily prayers. Fasting during 9th lunar month. Helping the poor. Pilgrimage to Mecca. -Muslims - do not eat pork. -Women cover face, arms, and hair - "hijab" (pronounced HID-JUB). -Will likely refuse care involving personal contact from opposite gender.* notes: -muslims do not eat pork -same gender care

culture defined

-*a patterned behavioral response that develops over time as a result of imprinting the mind through social and religious structures and intellectual and artistic manifestations -guides thinking, doing, and being -becomes expressions of who we are -passed down from one generation to the next* -*culture affects how people value, evaluate, and categorize life experiences -the members of a cultural group share values and ways of thinking and acting -these values and ways of thinking and acting are different from those of people who are outside the group* notes: -hard word to define, memorize the definition on slide! -cultural icons, churches, religious structures, places of worship, homes, social behaviors, patterns passed on for generations --guides our thinking, doing, and being. Becomes expressions of who we are, and are passed down from one generation to the next -culture as a nursing student: there is no other major that is up at 5:30 in the morning out of their dorm and on a unit by 7 am-- unexplainable, others do not get it. They don't understand the HESI and what it is and what is required of it. We know it because we are experiencing it together and it is a bond that holds us together.

cultural competence

-*cultural competence best defined as "the ability to respond to patients from cultures with interpersonal awareness, knowledge, skill, and sensitivity" -cultural competence is the act whereby a health care professional develops an awareness of one's existence, sensations, thoughts, and environment without letting these factors have an undue effect on those for whom care is provided. Cultural competence is the adaptation of care in a manner that is congruent with the client's culture* notes: NEED TO KNOW DEFINITION -being asked to pray with a patient that is a different religion, and you pray. Does not mean that you believe everything about their religion (you could or couldn't-- it doesn't matter). Part of spiritual nursing care! If you do not believe in god, it does not mean you do if you simply pray with a patient and their family

Dimensions of biological variations

-A direct relationship exists between race and body structure, skin color, other visible physical characteristics, enzymatic and genetic variations, electrocardiographic patterns, susceptibility to disease, nutritional preferences and deficiencies, and psychological characteristics

voice quality and intonation

-A softer volume of speech may be interpreted by the nurse as shyness. On the other hand, the nurse's behavior may be viewed as loud and boisterous if the volume is loud and if there is a deliberate attempt to accent particular words - soft voice and volume of speech more common in Asian-American or American-Indian (holding knowledge) -When the nurse cannot hear what the client is saying, there is a tendency for the nurse to speak louder -Amplifying the volume does not necessarily equate with being understood or understanding -The nurse can recognize this behavior by listening to tone of voice, quality of voice, and non word vocalizations, such as sobbing, laughing, and grunting notes: -what do we do when people don't understand? Usually speak louder-- shout-- amplifying doesn't really do anything

example, the word "pig"

-Americans are likely to share the same general denotative meaning for the word pig, depending on the occupation and cultural perception of the person -Connotation may be entirely different and precipitate completely different reactions -For an Orthodox Jew, the word pig is synonymous with the word unclean or unholy and thus should be avoided -For a pig farmer the word pig implies a clean, wholesome means of making a living

alternative therapies

-Approximately 61 million people, used one or more non-medical forms of therapy to treat illness -Mind and the body are seen as a whole -Acupuncture, holistic healing, therapeutic touch, aromatic therapy, meditation, guided imagery, and a variety of other techniques -Practitioners of alternative therapies include therapeutic touch experts, homeopaths, naturopaths, massage therapists, and reflexologists -There is a psychological component that allows the client to have a sense of control. For this reason, nurses should be well informed about nontraditional methods notes: -meditation, tapping, therapeutic touch, aromatherapy-- a lot of good evidence to suggest that these work and can be used in addition to medication alone. -Psychological component which allows the patient to feel as though they have a sense of control -breathing (slows down sympathetic nervous system, heart rate, helps you to relax)-mind body experience

culture-bound

-As children grow and learn a specific culture, they are to some extent imprisoned without knowing it. -Some anthropologists have referred to this existence as "culture-bound." In this context the term culture-bound describes a person living within a certain reality that is considered "the reality." -Most people have learned ways to interpret their world based on enculturation. Thus, although certain interpretations are understandable and persuasive to persons brought up to share the same frame of reference, other people may not share these interpretations and therefore may make little sense out of the context. notes: -we have learned way to interpret our world based on enculturation

implications for nursing care

-Assess the patient's time orientation - try to put aside own beliefs about time -Grouping clients/patients according to diagnosis - saves time -Organizing supplies and being prepared to assist with procedures -Recognize that words such as "now" and "later" have different meanings to different people - based on time orientation -Avoid fixed times for procedures - bathing, eating, medications (as much as possible) notes: -Assess the patient's time orientation, put away beliefs, be flexible about attidues *on test*** -Avoid fixed times for procedures -If a patient wants to sleep, let them sleep-- be flexible with what you need to do with them when you can!

summary

-Be aware of your own communication style and how it may differ from patient -Understand differences between high and low context cultures -Use appropriate communication techniques, approaches, and interventions notes: -Pay attention to your own communication and how it differs from your patient -High context and low context culture --Low context- more formal, focus on the subject matter more than who they are communicating with, emphasis on words, detailed contract, --High context - focus is on people involved, relationships are keep part, people remain flexible and change can happen at any time, problems are put aside and dealt with only when absolutely necessary

types and types of feedback in communication

-Before the assimilation of the Alaskan Eskimo into the American culture, the Alaskan Eskimo would indicate that a message was received by blinking rather than by making a verbal response (holding knowledge) -Nonverbal responses are also found in the Asian culture - may smile, but the smile may not indicate understanding (holding knowledge) -Asian patient may say yes simply to avoid confrontation or out of a desire to please - or may cover up disturbed feelings (holding knowledge) -Nodding, which nurses commonly interpret as understanding, may, for a Asian individual, simply indicate respect for the person talking (holding knowledge)

efficacious cultural health practices

-Beneficial to health status, although they can differ vastly from modern scientific practices -Efficacious health practices can facilitate effective nursing care, thus, nurses need to actively encourage these practices among and across cultural groups -Keep in mind that a treatment strategy that is consistent with the client's beliefs may have a better chance of being successful -Example: theory of hot and cold used by some Mexican Americans, may benefit from this belief - may avoid hot foods in the presence of stomach ailments such as ulcers - a practice consistent with the bland diet used in a medical regimen for the treatment of ulcers -Scientific health care practices may be blended with efficacious cultural health practices notes *-Efficacious: whatever the person is doing is beneficial to their health status ---Facilitate effective nursing care and nurses need to actively encourage these practices among and across cultural groups ---Keep in mind that a treatment strategy that is more aligned with the patient's belief might be more successful ---If it makes sense, allow them to continue those alternative treatments ---Ex. mexican americans-- hot and cold theory If someone has an ulcer, avoid hot food and drink because ulcers are a "hot" disease ---This is approved and found beneficial by the US-- it is right in alignment with western culture-- EFFICACIOUS health practice! ---These are blended with western medicine! ---we want them to do this! *

example, the word "compromise"

-Britain, the word compromise is a good word, and one may speak approvingly of any arrangement that has been a compromise, very often including one in which the other side has gained more than 50% of the points at issue - compromise means to work out a good solution -Traditional U.S. culture - it usually means to work out a bad one, a solution in which all the points of importance are lost

minority

-Can consist of a particular racial, religious, or occupational group that constitutes less than a numerical majority of the population. -Often a group is designated minority because of its lack of power, assumed inferior traits, or supposedly undesirable characteristics. -In any society, cultural groups can be arranged in a hierarchical power structure. Dominant groups are considered to be powerful, whereas those in minority groups are considered inferior and lacking in power. -Minority is not synonymous with numbers. In the United States, people of color (African-Americans, Latin Americans, Asian Americans) are considered minorities. However, when the population of the world is considered in its aggregate, it is obvious that people of color are in the majority. -Gender - females in the United States are a larger numerical percentage (50.9%) than males (49.1%) but are considered to be in the minority because of their underrepresentation in high-level managerial positions in the workplace. notes: -not always synonymous with numbers --what is minority in one place might not be minority in the world

census bureau

-Census Bureau re-categorized racial categories to include, for the first time in 2000, five suggested categories, including White, Black/African American, American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander. -Sixth category added "some other race." -Native Hawaiian/other Pacific Islander category was separated from the Asian category for the first time. Respondents able to choose more than one racial category.

age and time

-Children have higher metabolic rate - makes it appear that time moves slower for children -Older adults - perception that time moves quickly -No such thing as a lack of time; regardless of the way individuals spend time, it goes at the same pace - everyone has 168 hours to live per week, no more and no less notes: -Children -- time goes so slow, seems so far away until you are going to be an adult When you are older, you start to feel like time is starting to run out -There is no such thing as a lack of time, it is how we spend our time-- everyone has the same amount of time each week as everyone else

Who uses EFT?

-Cleveland Clinic - offered to all patients; classes offered to individuals to help manage stress associated with chronic disease -July 31, 2017 - approved by Veteran's Administration for therapists to use for treatment of PTSD, anxiety, depression -Schools - Teachers -Duke Medical Center -Psychologists, Social Workers, First Responders, Nurses -Athletes - Olympian Bralon Taplin used the EFT tapping technique as part of his race preparations for the Men's 400m Sprint event.

Individualism vs. Collectivism

-Collectivism vs Individualism: *there will be a question!* -Individualism: "every man or woman for themselves" -The focus is on the person, and by the individual succeeding it makes it better for all of society -Competition of jobs-- employee of the month United States -Collectivism: less emphasis on individual, but it is more about what is best for the group -Group rights take precedence -If it's not good for the whole group, it is probably not the right thing to do -Asian Countries --In terms of a patient who is sick... it is not the individual's issue, the health problem is the family's problem!

Folk Medicine

-Commonly referred to as "Third World beliefs and practices" -Often called strange or weird by nurses and other health professionals -Whether or not something seems "strange or weird" depends on familiarity with the beliefs -In most instances folk medicine practices do not seem strange or weird once health care providers become familiar with them -Becoming familiar with something does not imply acceptance -The folk medicine system classifies illnesses or diseases as natural or unnatural. This division of illnesses or diseases into natural and unnatural phenomena is common among Haitians, persons from Trinidad, Mexicans and Mexican Canadians, African Canadians, and some Southern White Americans notes: -Don't have to accept! Just become aware-- like when we practiced tapping in class.

Communication and Culture

-Communication and culture closely intertwined -Culture influences how feelings are expressed and what verbal and nonverbal expressions are appropriate -Americans may be more likely to conceal feelings, and the United States is generally considered a low-touch culture -Eastern culture may be open and loud with expressions of grief, anger, or joy and may use touch more notes: -cultural assessment is one of the first things you should do with your patients (even though in the hospital that is never the first thing that happens) -can explain a lot about the patient, why are they irritable? Why they may not come back for follow up appointment? -in general, the US we tend to conceal feelings-- considered a low touch culture --in some eastern cultures, they are more open to loud expressions of grief, anger, and joy--- and they may use touch more

process of communication

-Communication may be conceptualized as a process that includes a sender, a transmitting device, signals, a receiver, and feedback -A sender attempts to relay a message, an idea, or information to another person or group through the use of signals or symbols -Many factors influence how the message is given and how it is received (as shown on next slide) -The receiver then interprets the message -Feedback is given to the sender about the message, and more communication may occur. If no feedback is given, there may be no reciprocal interaction notes: -communication is a process- there needs to be a receiver and feedback is given to the sender about the message and more communication occurs.

what is social organization?

-Cultural behavior, or how one acts in certain situations, is socially acquired, not genetically inherited - involves acquiring knowledge and internalizing values. -Patterns of cultural behavior are important - provide explanations for behavior related to life events - birth, death, puberty, childbearing, childrearing, illness, and disease. -Children learn certain beliefs, values, and attitudes about these life events, and the learned behavior that results persists throughout the entire life span unless necessity or forced adaptation compels them to learn different ways. -Patterns of cultural behavior are also apparent in rituals - weddings, funerals, and special holiday meals. notes: -patterns of behavior can be seen in rituals --weddings, funerals, special holiday meals

creating sacred/respected spaces

-Designate area -Use pictures symbols -Use color or pictures -Candle -Objects of importance in your life -Alter -For patient - use family pictures and other small objects, drawings, candle with battery notes: -try to create a sacred space for the patient- a blessed mother statue, a picture of their kids,

What is EFT?

-EFT has it's origins way back over 5000 years ago, in the Ancient Chinese Shaolin and Taoist monasteries, where the subtle energies and meridians that travel throughout the body were first mapped. -EFT is a meridian energy therapy - just like acupuncture, it works directly on the meridian system in the body. But instead of needles, you stimulate the major meridian lines by tapping on them. -By analogy, think of the meridians as rivers. Upsets in emotional or physical health lead to the equivalent of blockages or overflows in the rivers. -EFT is a mind/body healing technique because it combines the physical effects of meridian treatments with the mental effects of focusing on the pain or problem at the same time. -Tapping on the meridian points sends kinetic energy down the energy system clearing the blockages allowing the energy to flow freely again.

day of the year, time of the year

-Earth spins one time around on axis - one day -Passage of seasons - one year - earth moves one revolution around the sun - just under 365.25 days -Calendars created to first organize days first then years -Early civilization - middle of the day - sun directly above - at highest point - noon (12pm) -12 pm in one place - 12 am (midnight) in the direct opposite place

objects in the environment

-Easily movable chairs in a waiting room or office can be pulled together to provide physical closeness or separated to provide distance. -Positioning chairs at a 90-degree angle can communicate a cooperative stance, whereas a side-by-side arrangement of chairs can decrease communication. -Discomfort and, consequently, emotional distance can be created by uncomfortable furniture. -The nurse's position during the conversation (such as sitting behind a desk or leaning against the corner of the desk while looking down on the client seated at a lower level) can also promote the perception of psychological distance. notes: -get at the patient's level -Try to give people their own space -Side by side arrangement does not promote communication, but is preferred in some asian cultures *Not on test*

race

-Efforts to precisely delineate the term race have been made by many scientists. -Anthropologists suggests that race, in a pure sense of genetically homogeneous populations, does not exist in any human species today. -Members of a particular race share distinguishing physical features, such as skin color, bone structure, or blood group. -Very few races that still mate largely within the group, but some pure-blooded lineages are found in certain parts of the world, such as some of the descendants of West Africans who live along the Georgia and South Carolina seacoasts in the United States.

Folk medicine cont..

-Good versus evil and natural versus unnatural, is the belief held by some folk medicine systems that everything has an exact opposite -Examples - African Canadians who subscribe to a folk medicine system believe that for every birth there must be a death, for every marriage there must be a divorce, and for every person with good health there must be someone with bad health (holding knowledge) -Examples: Every illness has a cure, every poison has an antidote, every herb has a healing purpose, and so forth notes: -African Canadians think the opposite! --for every birth there is a death --for every marriage there is a divorce -examples: every illness has a cure, every poison has an antidote

Dysfunctional Cultural Health Practices

-Harmful -Example: United States - excessive use of such items as over refined flour and sugar -The nurse must be aware of practices that are dysfunctional and should work to establish educational training programs that help individuals identify dysfunctional health practices and develop beneficial practices notes: *-Harmful-not in alignment with western medicine --The nurse needs to intervene and try to change the patient's views-- this is the hard part of nursing! --You can't expect them to change their way of life quickly-- try to negotiate and take small steps to minimize their intake*

neutral cultural health practices

-Have no effect on the health status of an individual -Some consider neutral health practices irrelevant, however these practices may be extremely important - might be linked to beliefs that are closely integrated with an individual's behavior -Example: Many Southeast Asian women believe that sitting in a door frame or on a step while they are pregnant will complicate labor and deliver (holding knowledge) -Good health charms or religious items used to maintain or achieve good health -These practices require no planned nursing interventions - however the nurse must recognize their significance and respect the client's right to subscribe to and practice such beliefs notes: *-Neutral: no effect on the health status of the individual -Some find them irrelevant- not enough science to prove if they work or don't work -Southeast asian women- sitting on a doorstep while pregnant can cause complications -She is not hurting anyone by believing that -- it is neutral-- it is not helping nor hurting, so let her believe it. -No clinical significance, but supporting this shows support and acceptance towards their culture*

Concepts of time

-How do we learn about time? -Humans learn that time is associated with speed and velocity- we teach children how to read/tell time, learn that life is governed by the clock. -Also associated with philosophy and religion - children will ask "What did God do before he created the world", "Where will I go after I die?" - "Where was I before I was born?" -Time is thought of to be something external - we have no control over time - "Can't change the hands of time". notes: -fun fact, a pregnancy is 10 lunar months

distinction between illness and disease

-Illness: an individual's perception of being sick -Disease: Diagnosed when the condition is a deviation from clearly established norms based on Western biomedical science -How one experiences and copes with disease is based on the individual's explanation of sickness notes: -Illness is a person's perception of being sick A cough and sniffle might be "very sick" to someone and not sick to someone else -Disease is when you meet enough established criteria for a health care provider to diagnose you

natural medicines

-In 2007, the number of what is now termed "natural medicines" in some circles had increased again dramatically. -Natural medicines include vitamins, dietary supplements, and alternative medicines. -Use of dietary supplements and alternative medicines continues to gain popularity among health-seeking consumers -More than 40% of all U.S. residents have tried some type of alternative medication, whereas 50% of U.S. residents 35 to 49 years of age have tried alternative medicines -Reported that in the United States: ••106 million people use vitamins and minerals ••44.6 million people use herbal remedies ••24.2 million people use specialty dietary supplements notes: ^old statistics -when you think about natural medicines, that is a vitamin or supplement or dietary supplements or herbal tea--- over half of the US population has tried this --if not reported to health care provider, can be medication interactions

example

-In a classic study, Sidney Jourard (1972) reported that when touch between pairs of people in coffee shops around the world was studied, touch occurred more in certain cities. For example, touch occurred as frequently as 180 times an hour between couples in San Juan, Puerto Rico, and 110 times an hour in Paris, France. In other cities there was less touch; specifically, touch occurred twice an hour between couples in Gainesville, Florida, and zero times an hour in London, England.

nursing interventions, tips, and approaches

-In order to communicate effectively, the nurse should do the following: -Use hand gestures along with words -Repeat the message with different words if needed -Speak slowly and distinctly -Ask patient to demonstrate all health care teaching instructions - for example, if teaching how to use an inhaler for asthma, make sure the patient can demonstrate how to use it - this assures that the patient comprehends instructions -Avoid asking questions with a yes or no response - this does not assure that the patient understands -Avoid the use of medical terms notes: *many test questions* -Use a lot of hand gestures along with your your words to explain --"Mrs smith would you like more water" while making a pouring water movement -Repeat the message, with different words --"Would you like a blanket" "would you like a cover" -Speak slowly and distinctly -If you're trying to teach any patient with limited english vocabulary-- how do we know that they understand our instructions? HAVE THEM DEMONSTRATE -Assures that the patient comprehends the instructions -Avoid questions that require a yes or no response -Ask questions a different way "tell me about your pain, did it get better or worse during the night" -Avoid medical terms -Not everyone understands those terms

Health and Balance

-In the broadest sense, health may be viewed as a balance between the individual and the environment -Health practices (eating nutritiously, subscribing to preventive health services available in the community, and installing hazard- and pollution-control devices) are all believed to have a positive effect on the individual, who in turn can positively affect the environment notes: -Being healthy means different things to different people --If someone has a chronic illness- their view on health is not the same as someone who doesn't have a disease! --Health is reciprocal relationship with the person's environment

use of nursing diagnosis in transcultural nursing

-Issues r/t NANDA -"Impaired verbal communication" connotes that the client's verbal communication and ability to understand and use language are impaired in some way. -Diagnosis does not consider the causative factors creating the impairment -Individuals who speak a language different from that used by health care providers or nurses may be very capable of both use and comprehension of a specific language when interacting with persons fluent in that language -If the patient has "impaired communication" then isn't the nurse is equally impaired? -Nursing diagnoses related to "social isolation" and "noncompliance" need further defining characteristics for use with culturally diverse populations -The term "non-adherence" May remove the stigma of guilt experienced by the health care recipient who is inappropriately labeled noncompliant -be careful and sensitive to what terminology you use --impaired verbal communication-- if they don't speak English, it does not mean they have impaired communication, they just speak a different language --social isolation and non adherence rather than noncompliance-- they are not adhering to the plan we are offering them

An old myth!

-Julius Caesar - decreed that months should have 30 or 31 days except for February which was then the last month of the Roman calendar -Historians believe Caesar named the fifth month in his own honor (Julius/July) -Augustus named his month right after Caesar - August - but he soon realized his month was shorter than Julius's and took a day from February and added it onto his month - hence readjusting the rest of the year - 3 long months in a row - June July August

box 2-2 verbal and nonverbal communication

-Language or Verbal Communication Vocabulary Grammatical structure Voice qualities Intonation Rhythm Speed Pronunciation Silence -Nonverbal Communication Touch Facial expression Eye movement Body posture -Communications that Combine Verbal and Nonverbal Elements Warmth Humor notes: -some communications involve verbal, nonverbal, both! --both: humor-- laughing releases endorphins -nonverbal: asian and alaskan eskimo --asian: smile and nod might just be out of respect not out of understanding

nursing models for transcultural care

-Leininger's Sunrise Model -Symbolizes the rising of the sun (care). -The model depicts a full sun with four levels of foci -Within the circle in the upper portion of the model are components of the social structure and worldview factors that influence care and health through language and environment. -These factors influence the folk, professional, and nursing systems or subsystems located in the lower half of the model. -Various cultural phenomena are studied from the micro, middle, and macro perspectives

silence

-Meaning varies among cultural groups -Silences may be thoughtful, or they may be blank and empty when the individual has nothing to say -May also indicate stubbornness and resistance, apprehension, or discomfort -Patients from some cultures believe silence is needed for reflection. When one of these persons is speaking and suddenly stops......might mean the person wants the nurse to consider the content of what has been said before continuing (common in Navajo and Asian culture - holding knowledge) -Russian, French, and Spanish persons may use silence to indicate agreement between parties (holding knowledge) Asian - silence as respect toward elders (holding knowledge) notes: -silence has different meanings among different cultures-- some need silence in order to understand and communicate

polychromic vs monochronic

-Monochronic - cultures that prefer to do one thing at a time-prefer orderliness and believe there is a time and place for everything. US, Canada, Northern Europe -Polychronic - cultures that prefer to do multiple things at the same time. Latin America, Africa, Arab parts of the Middle East notes: -Monochronic: one thing at a time, orderly-ness, time and place for everything --US, canada -Polychronic: many things at once --Arab, latin america, africa

culture as a totality

-Most anthropologists believe that to understand culture and the meaning assigned to culture-specific behavior, one must view culture in the total social context. -Concept of holism requires that human behavior not be isolated from the context in which it occurs.- culture must be viewed and analyzed as a totality—a functional, integrated whole whose parts are interrelated and yet interdependent. -Components of culture, such as politics, economics, religion, kinship, and health systems, perform separate functions but nevertheless mesh to form an operating whole. -Culture is more than the sum of its parts. notes: -remember that culture is more than the sum of it's parts

individuals with future-oriented perceptions

-Most middle-class Americans, regardless of ethnic or cultural heritage, tend to be future oriented -Some middle-class Americans tend to defer gratification of personal pleasure until some future objective has been met, such as advanced education - delay starting families, purchasing homes, buying an expensive car, or investing money until they have prepared for a profession through advanced education -Dominant American culture structure time rigidly - adhere to a time-structured schedule is a way of life, regardless of whether the schedule involves work or leisure -Nurse who works with future-oriented individuals - important to talk about events in relation to the future - adhere to the schedule for planned events in a timely/precise manner

Folk Medicine- Natural and Unnatural Events

-Natural events have to do with the world as God made it and as God intended it to be -Natural laws allow a measure of predictability for daily life -Unnatural events can therefore be viewed as events that interrupt the plan intended by God - at their very worst represent the forces of evil and the work of the devil -Unnatural events are frightening because they have no predictability. They are outside the world of nature, and so when they do occur, they are beyond the control of ordinary mortals notes: -Natural: God's plans--- level of predictability for daily life -Unnatural: interrupt the plan created by god-- work of the devil and forces of evil --Scary, no predictability

time

-Observatory in London - 0 degrees longitude - 180 degrees east of Greenwich and 180 degrees west of Greenwich - all time is measured from this 0 degree point -Clocks -earliest clocks were sundials -Tropical Years (ephemeris time)- nothing to do with hot climate - 365,342199 solar days- 31,556,925.9747 seconds - hence the "leap year" -Solar time - measured by the sun - starting at noon - solar days vary in length due orbiting of earth around the sun - solar time has implications for those who live at north or south pole - sun up most of summer and down most of winter (northern Canada)

ethnic minority

-Often used because it is less offensive to people of color than other terms. -The term people of color might be the preferable option as opposed to ethnic minority, particularly in situations where sensitivity to racial preferences needs to be heightened. -Estimated that by the year 2050 about half of the total American population will be nonwhite, thus eliminating the meaning of the term ethnic minority. notes: -by 2050 half the total population will be of color and we won't have the term anymore

locus of control construct as a health care value

-Part of social learning theory - the locus of control construct can be applied to a variety of phenomena - weather, preventative health, curative health actions -Internal control - when a person perceives that their own behavior will influence an outcome - when the person believes that an outcome of an event has something to do with their own behavior - examples - "if I don't smoke cigarettes, I will live a long, healthy life" - "if I eat less carbs, I will lose weight and live longer" "if I take my chemotherapy, I will rid myself of cancer" -External control - result of luck, chance, fate - these individuals are less likely to take action to change the future -Nurse must be aware that individuals who believe in the external locus of control tend to be more fatalistic about nature, health, illness, death, and disease -Cultures known to have external locus of control - Hispanics, Appalachians, Puerto Ricans (holding knowledge) -European Americans, African Americans fall within both spectrums (holding knowledge) notes: *-When someone has an INTERNAL locus of control: perceive that their own behavior will influence the outcome of an event --If i don't smoke cigs i will live a long healthy life --If i take my chemo i will rid myself of cancer --If i don't eat carbs, i will lose weight and be healthy --strong internal: will come to follow up appointments, will be open to setting health goals, feel like they can control their health by taking certain actions, discharge planning and follow up will be easier -EXTERNAL: luck, chance, fate- less likely to take action to change the future --People with stronger external locus of control --"Whatever will be will be" "it is in God's hands" -****MORE FATALISTIC ABOUT NATURE, DEATH, HEALTH, and DISEASE****** -Most people have both-- usually in cultures one is more dominant than the other* A LOT OF QUESTIONS!!!

eye contact

-People use more eye contact while they are listening - may use glances of about 3 to 10 seconds - when glances are longer than this, anxiety is aroused. -Traditional U.S. culture - positive self-concept, openness, interest in others, attentiveness, and honesty -In U.S. culture, lack of eye contact - may be interpreted as a sign of shyness, lack of interest, subordination, humility, guilt, embarrassment, low self-esteem, rudeness, thoughtfulness, or dishonesty -Level of comfort with direct eye contact varies: Holding knowledge: Mexican and AA patients comfortable with eye contact Some cultures regard eye contact as disrespectful because it is believed that "looking in an individual's eyes" is "looking into an individual's soul" (Navajo) Some Asian Americans and Navajo relate eye contact to impoliteness and an invasion of privacy notes: -see above

more examples

-Person who was told he was going "to be discharged tomorrow" somehow interpreted this to mean that he was going to develop "a discharge from below." -For Hispanics, problems arise with cognates such as constipation because for Hispanics this term generally refers to nasal congestion rather than intestinal constipation (holding knowledge)

humor

-Powerful component of verbal and nonverbal communication -Create a bond of shared pleasure between people, decrease anxiety and tension, build relationships, promote problem solving and learning, provide motivation, and enable personal survival -Healthy and constructive coping mechanism - helps to reduce anxiety -Nurse must carefully assess the individual client and the situation to decide if humor is appropriate -May also affect the immune system by promoting the body's ability to combat such problems as cancer and diseases of the connective tissue, such as arthritis and lupus -Ability to laugh at oneself and with others can ease the anxiety that may be present in an intercultural situation

individuals with present-oriented perceptions

-Present-oriented individuals do not necessarily adhere strictly to a time-structured schedule - present takes precedence over the future and the past for these individuals - whatever is occurring at a precise moment may be more important than a future appointment -Tend to react to time in a linear fashion - perceive time as being on a straight plane - believe that a present moment spent on a particular task or with a particular individual cannot be regained: "We will never have this moment again" or "We must do it now because we'll pass this way only once." This idea is in contrast to the thoughts held by persons with future-time orientation, who say, "I'll get back with you" or "We can do it later." The implication of these latter statements is that both persons will be around and the essence of the moment can be relived -Present-oriented individuals are not likely to be involved in preventive care; however, they will seek out emergency care in acute care facilities. Holding knowledge: A common belief shared by some African-Americans and Mexican Americans is that time is flexible -Holding Knowledge - For older generations of African-Americans this belief has been translated through the years as a perception of time wherein lateness of 30 to 60 minutes is acceptable -Holding Knowledge - Navajos and Inuits believe that only what is needed for the day should be used and that nature will continue to provide for future needs - life is a spiritual experience for Indians - gifts of the Great Spirit should never be abused -Many Navajos and Inuits have been taught to live in the present and not be concerned with the future - therefore they share what they have today -Important for the nurse to remember - time perception may also be related to socioeconomic status. For example, although some African-Americans and Mexican Americans are sometimes stereotyped as present-oriented individuals, many have been assimilated into the dominant culture, are very time-conscious, and take pride in punctuality

proximately to others

-Proxemics is the term for the study of human use and perception of social and personal space. -Individuals tend to divide surrounding space into regions of front, back, right, and left -The front region is considered the most important, is the largest, is recalled with the greatest precision, and is described with the greatest detail. -Generally, in Western culture there are three primary dimensions of space: the intimate zone (0 to 18 inches), the personal zone (18 inches to 3 feet), and the social or public zone (3 to 6 feet). -Intimate zone - comforting, protecting, and counseling and is reserved for people who feel close. -Personal zone usually is maintained with friends or in some counseling interactions. -Touch can occur in the intimate and personal zones. -The social zone is usually used when impersonal business is conducted or with people who are working together. Sensory involvement and communication are often less intense in the social zone. -Wide variations to these general dimensions do occur and are often influenced by cultural background notes -We usually think about what is going on in front of us -Intimate zone: 0-18 inches -Personal zone (18 in to 3 feet) -Public zone (3 to 6 feet): stay here until you explain what you will be doing in intimate or personal zone -*before you enter someone's personal space, stand back a little bit and explain why you are going into their space-- provide a little explanation* --personal or intimate zone-- slightly uncomfortable, still close quarters

rhythm, speed, and pronunciation

-Rhythm also varies from culture to culture; some people have a melodic rhythm to their verbal communication, whereas others appear to lack rhythm -Rate and volume of speech frequently provide a clue to an individual's mood -Depressed talk slowly, aggressive person talks loudly

other practices

-Rural South - Old Farmer's Almanac -Astrology - individuals from diverse cultures believe there are certain times when surgery should be performed or avoided - no surgery during full moon -Dreams - some Haitians interpret dreams to predict health -Special healers - "curandero" - Hispanic/Latino healer who uses prayer -Shaman - derives power from the supernatural -Priest - learns a codified body of rituals from biblical laws -Chakra System - energy system used by many cultures - each chakra is associated with specific body system/s notes: -Old farmer's almanac: most accurate predicting the weather, moon cycles, different health practices --Used in the rural south to maintain health -astrology: Nancy Raegan used astrology to run the White House

skin membranes

-Skin is a major sense organ -Proprioceptors - nerves that keep us informed as to what is happening with our muscles. -Exteroceptors - located in the skin and convey the sensations of heat, cold, touch, and pain to the central nervous system. -Skin temp. gives important information about the patient to the nurse. -Fair -skinned - turn red and blush easily. Can see anger and/or embarrassment -Dark skinned individuals need further assessment to identify emotional state - swelling in the regions of the forehead. --May have to feel skin to assess for warmth. -English language - "hot under the collar", "cool stare", 'heated argument". *nothing on test*

visual and auditory perception among cultures

-Some Japanese - prefer to be presented with parts first, then the big picture. Very perceptive to visual stimuli rather than sound. Comfortable with paper thin walls. -Some Dutch and German - can not filter sound as easily. Prefer double doors, thick walls. notes: -holding knowledge: means it's not true for everyone

worldview of social time vs clock time

-Some cultures scornful of clock time - peasants in Algeria live with total indifference to the clock time - they have labeled the clock as "the devil's mill" -Amish have "slow time" - when those around them adjust to daylight savings time to standard time, they set clocks half hour ahead - may cause problems when scheduling medical appointments -French culture - studies reveal they do not perceive the concept of "wasting time" -African American culture - may show up late for appointment several hours late - not seen as wasting time - other things take priority -Asian culture - time is viewed as flexible - may feel offended if meeting is abruptly ended due to time

religious practices

-Some have elaborate rules about healthcare -Blessings, miracle cures, inanimate objects, burning candles, incense, prayers -Blessing of the throat on St. Blaine's Feast - prevents sore throats -Baptism - cleansing ritual -Circumcision - practice that prevents harm/illness -Amish - believe that although medications can help, it is God who heals - believe in a strong connection to earth, soil, animals, etc. (holding knowledge) notes: -Catholic: if you get your throat blessed you will not get sick-- a ritual, more of an external locus of control. -Rituals are important in health care --Example: prayer-- it is not hurting anything, we encourage this

bicultural

-Term used to describe a person who crosses two cultures, lifestyles, and sets of values. Some children of African -American, Hispanic, Asian, and American Indian heritage are socialized to be bicultural—that is, to acquire skills to function in both a minority and a majority culture.

Definitions- Environmental Control

-The ability of an individual or persons from a particular cultural group to plan activities that control nature -The individual's perception of ability to direct factors in the environment - implies that the concept of environment is broader than just the place where an individual resides or where treatment occurs. -In the most practical sense, the term environment encompasses relevant systems and processes that affect individuals

stereotyping

-The assumption that all people in a similar cultural, racial, or ethnic group are alike and share the same values and beliefs.

culture bound syndromes

-The nurse should appreciate that some illnesses are uniquely found in a given cultural group. Culture-bound syndromes is a term that refers to "diseases" that seem to be specific to a single culture or a group of related cultures. -Culture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for a pattern of sets of experiences. -In some cases the "illness" may be linked to a category in the Diagnostic and Statistical Manual of Mental Disorders (APA, 2000) but have symptoms, a course, and social responses that are influenced by local cultural factors. -Examples: amok, a mental or emotional affliction known in the Philippines that causes one to become a killer -Susto, an ailment widely associated with Spanish-speaking groups in which the soul is believed to leave the body as a result of a frightening event. notes: -*Perception: that one's own way (belief's, practices) is best*

ethnocentrism

-The perception that one's own way is best. Own beliefs and health practices are best. -In populations throughout the world, people are bound by common ties, elements, life patterns, and basic beliefs germane to their particular country of origin. -Medical paradigm used in Western culture views health, illness, and dying as biophysical realities. However, the meaning a nurse places on life can affect relationships with clients. -For example, a nurse's belief that there is no relationship between illness and evil may conflict with a client's belief that illness is a punishment from God or the work of spirits. -Holding knowledge: Some Puerto Ricans believe that sickness and suffering are a result of one's evil deeds. -Holding Knowledge: Many Ugandans believe that an infant's illness or death is the result of a neighbor's curse. -Some health practices difficult to understand - female genital cutting, which may range from a ceremonial pricking of the genitalia to the removal of the clitoris, occurs in 28 African countries with prevalence rates estimated at 50%.

personal boundaries

-The term used to describe the use of structural boundaries in the environment. -A boundary separates a person from others and helps define a person's space. -Fences, doors, curtains, walls, desks, chairs, and other objects may create boundaries between persons. -The use of restraints with agitated clients involves physical invasion of both intimate space and body boundaries. This personal invasion may cause patients to resist restraints and become aggressive and combative. -A hospitalized client needs not only a personal sleeping area but also a place to put and arrange personal belongings without fear that they will be disturbed by others. The nurse should respect patient privacy and knock before entering the room. -Nurses can create a healing environment by influencing a client's inner personal space as well as by creating a therapeutic outer space for the client to occupy. -Need for space serves four functions: security, privacy, autonomy, and self-identity. -If a client is in a place where a feeling of control is experienced, the client will feel safer, less threatened, and less anxious. -People generally tend to feel safer in their own territory because it is arranged and equipped in a familiar manner. -Reduce patient anxiety regarding special needs - provide explanations when performing tasks. -*Use neutral and acceptable position when talking to culturally diverse clients - feet on the floor, and upper body leaning slightly forward toward client - most acceptable to people of most cultures. ON TEST* -Assess boundaries of patients and families - some will be more open to support and to interventions. -Use appropriate zone of interpersonal space when working with patients - most prefer 3 to 6 feet. -Color is a phenomenon with cultural implications. In many North American cultures, warm colors such as yellow, red, and orange tend to stimulate creative and happy responses. -In some Asian countries, white is associated with a funeral. -In many African countries, red symbolize witchcraft and death. -In the dominant culture in the United States, good mental health is often associated with the ability to coordinate the color of one's wardrobe. In contrast, in some countries, including those in Africa, the Caribbean, and the South Pacific, bright, multiple colors are the accepted norm of dress. -In Western culture, cool colors such as blue, green, and gray tend to encourage meditation and deliberation and thus may have a dampening effect on communication. notes: -Fences: keep something in or keep something out -Helps to define our space --If two people share the same room with the same prognosis and diagnosis-- the person by the window has better outcomes. -Give people privacy, knock on doors -Let patients know what their space is: why it is emphasized to know where things are and how to work things (call light)-- put things in their reach. -People feel more secure when they know their territory -know what position is the most acceptable position when talking to culturally diverse patients -3-6 feet is preferred --Numbers won't be asked on the test -Chakra system: energy centers in our body that spin in a clockwise fashion-- some think there are many chakras, and most just believe in 7 chakras. --don't have to know for test

cultural perceptions of time

-Time orientation among certain groups in relation to future-time and present-time orientation - "holding knowledge" •Dominant American: future over present •African Black: present over future •Puerto Rican American: present over future •Mexican American: present •Chinese American: past over present •Navajo: present notes: -time orientation among certain groups in relation to future time and present time orientation -past over present: decisions are based on tradition more than anything

facial expression and eye movement

-Traditional U.S. culture - facial expression is used as a part of the communication message -Coldness - constant stare with immobile facial muscles indicates coldness -Fear - eyes open wide, the eyebrows rise, and the mouth becomes tense with the lips drawn back & eyebrows drawn down -Anger - lips are often tightly compressed. -Disapproval or tiredness - eyes rolled upward -Disgust - narrowed eyes, a curled upper lip, and a moving nose -Embarrassed or self-conscious - eyes turn away or down; have a flushed face; pretend to smile; rub the eyes, nose, or face; or twitch the hair, beard, or mustache -Direct gaze with raised eyebrows shows surprise -Some cultures such as Italian, Jewish, African-American, and -Hispanic persons may smile readily and use many facial expressions, along with gestures and words, to communicate feelings of happiness, pain, or displeasure (holding knowledge) -Irish, English, and northern European persons (in general) tend to have less facial expression and are generally less responsive, especially to strangers (holding knowledge) -Can also be used to convey an opposite meaning of the one that is felt; for example, in Asia negative emotions may be concealed with a smile (holding knowledge) notes: -some cultures think eye contact is a sign of respect and some think that it is a sign of disrespect

measurement of time

-Two distinct meanings: Duration - an "Interval of time" and "Points in time". -Point in time - the end of an interval that starts an arbitrary or fixed reference point - such as the birth of Christ. -Interval of time - if someone asks "what time is it?" Answer: -"10 o'clock". This is a given point in time but it is also an interval since it indicates a time from a certain reference point - which in this case is midnight.

olfactory perception

-U.S. - underdeveloped in the use of their olfactory functions - use of deodorant and suppression of odor in public places. -Smell evokes deep memories - more than site or sound. -Smell of holidays -Christmas- grandmother's perfume, etc.... -Some hospitals approve the use of essential oils - studies indicate lavender helps to reduce insomnia in hospital setting - more research needed. Hospitals using essential oils require nurses to take a certification course. notes: -US: suppressing odor -Middle eastern: think it is natural -Essential oils: lavender and peppermint in the hospital --Can be dangerous- always ask and educate yourself --Most oils require a carrier oil --Antidote: coffee beans *Not on the test*

death and dying and end of life decisions across cultures

-US Healthcare system - based on 3 values - life is sacred and should be preserved at all costs, autonomous decision-making should be maintained, no individual should suffer needlessly -Some cultures slow to accept Advanced Directives - African American culture has some distrust of healthcare system - may regard advanced directives as a way to neglect or deny treatment -Truth - telling about death and dying - family centered approach for Mexican Americans and Korean Americans - may seek to avoid unnecessary suffering of a loved one - some do not believe loved ones should be told of metastatic disease and should be protected from the prognosis -African Americans less likely to take pain medication to avoid suffering compared to Whites -Whites more likely than African Americans and Hispanics to refuse intubation notes: -Life is sacred, life should be preserved at all cost, no individuals should suffer needlessly -Not on test

The need for transcultural nursing knowledge

-United States is rapidly becoming a multicultural pluralistic society -In 2010, 72.4% of the population in the United States was White of European descent; 12.6%, African-American; 16.3%, Hispanic American; 4.8%, Asian American; and 0.9%, American Indian (U.S. Department of Commerce, Bureau of Census, 2010 Census Briefs, 2011). -By the year 2020, only 53% of the U.S. population will be White of European descent -By the year 2021, the number of Asian Americans and Hispanic Americans will triple, while the number of African-Americans will double (U.S. Department of Commerce, Bureau of the Census, American Community Survey, 2009). notes: -becoming more and more of a multicultural society -don't need to memorize anything or know, just statistics for help with understanding

Uncertain Cultural Health Practices

-Unknown effects - not enough scientific evidence to determine if the health practice is efficacious, neutral, or negative notes: -not enough to know if it's beneficial, neutral, or negative -ex. reiki-- not enough research to see that it is efficacious yet

individuals with Oriented perceptions notes

-We are in college, learning, and delaying starting a family/purchasing a home/investing money until we finish college-- future time orientation --Delaying future gratification --We are rigid, we structure our time very rigidly ---Most western culture, especially younger generation ---Talk about events in regard to the future, and follow through in a timely and precise manner -Present oriented: Linear fashion-- "we will never have this moment again" --This idea is in contrast to people with future time orientation "I'll get back to you" --Time is considered flexible-- older generations of african americans, lateness of 30-60 minutes is completely acceptable --Not as involved in preventive health care --If they get very sick-- they will go to the emergency room -Present time oriented- do not plan for the future --Sometimes is financial barrier, some only have enough money for the present --Preventative tools that you can give these people that have strong present time orientation-- they are more likely to do it! --Educate as much as possible, and try to work with them. --Always do that complete cultural assessment--

biracial

-When an individual crosses two racial groups -Problem associated with biracialism is the inability of the individual to identify or find acceptance in any one of the biologically related racial groups. It is the total exclusion and the sense of not belonging to either of the racial groups that often create the dilemma -Examples of biracial and bicultural -An African American grows up in a Mexican neighborhood participates in cultural events and celebrations - considers Mexican neighbors their family - still holds on to some traditions of AA culture but has adapted to the Mexican culture = BICULTURAL -Biracial - mother is Jewish. Father is American Eskimo. These are two distinct RACES -Key point - culture doesn't always or completely depend on race

vocabulary

-Words have both denotative and connotative meanings -Denotative meaning is one that is in general use by most persons who share a common language -Connotative meaning usually arises from a person's personal experience notes: -*When do you call an interpreter? Assess what cultural barriers exist, so you can assess the need for an interpreter*

cultural care concepts

-culturally congruent care --fits the person's valued life patterns and set of meanings --requires specific knowledge, skills, and attitudes in the delivery of care -culturally competent --is the process of acquiring specific knowledge, skills, and attitudes to provide culturally congruent care. pp: (-Culturally congruent care is meaningful, supportive, and facilitative because it fits valued life patterns of patients. -Our goal is to provide culturally congruent care. -The process of providing culturally competent care puts us on the path to providing culturally congruent care. -The process of providing culturally competent care requires seeking support from the patient's family. -It also requires seeking organizational support from inside the health care agency and from outside health care agencies. -Cultural conflicts can inhibit our learning and therefore inhibit our ability to provide culturally congruent care. -Cultural conflicts to avoid are ethnocentrism and cultural imposition. -Ethnocentrism occurs when people believe that their own way of life is superior to that of others. -Ethnocentrism causes bias and prejudice. -Cultural imposition can occur when people have cultural ignorance or cultural blindness about others. -Cultural imposition causes people to use their own values and lifestyle as the absolute guide in dealing with patients and interpreting their behavior. [You can use the example in the book about the Apostolic Pentecostal woman to initiate a discussion about visible and invisible cultural components and how the process of culturally competent care, leading to culturally congruent care, could be achieved.])

Goal of transcultural nursing knowledge

-deliver culturally competent care -deliver care free of inherent bias -to do this effectively... the nurse must be aware of his/her own stereotypes based on culture notes: -THE FIRST STEP TO BECOMING CULTURALLY COMPETENT, THE NURSE HAS TO BE AWARE AND MINIMIZE THEIR OWN STEREOTYPES --must also be aware of our language when talking about different cultures. "They are different than us"-- no that is wrong, can't say that because they are US!! -***ELIMINATE STEREOTYPE AND BIAS*** on test --you don't have to change your beliefs to meet the needs of the patient

Madelyn Leininger

-founder of transcultural nursing in mid 1960's -the transcultural nursing society, founded in 1974 notes: -founder of transcultural nursing ---*EXAM QUESTION: Who was the founder of transcultural nursing* -1974: transcultural nursing society was founded -Leininger passed away just a few years ago

cultural context of health, illness, and caring

-in every culture: --health, illness, and caring have meaning that are unique --groups interpret and define experiences relevant to birth, illness, and death through a certain context. notes: -birth, illness, and death-- a lot of cultural patterns come out -holding knowledge (patterns of behavior that appear to be true among groups of people) --asian mother-- very quiet, internal, silent culture. Most communication is done through silence, nonverbal, very quiet. Japanese for example, there is gammon-- which means they hold in pain ----if a kid falls and scrapes their knee and cries they might say, "no! Don't cry" ----hard to do a pain assessment on these patients ----may say yes when they mean no just to please you --African American culture- very comfortable with space- their comfort with being in close quarters is much different than someone from a traditional asian country ----communication is much more open ----praying, outward expression of pain, more comfortable with people in close contact ----easier to assess much more willing to express and communicate pain and needs --navajo ----taboo to touch a dead body ------family will not come and say goodbye and touch the body --jewish ----burial is supposed to occur within 24 hours of death ----in some cultures, the male is the primary decision maker about a woman's health -death and birth- where a lot of cultural patterns emerge

ethnicity defined

-members of an ethnic group feel a common sense of identity -ethnic identity is based on the language, geographic area, racial characteristics, and values of the group's heritage notes: -vocab is tricky nowadays. Race-- for example-- is defined by government structure. --ethnicity and race are different.

how can a nurse provide culturally congruent nursing care

-provide care in a sensitive manner -does not mean you have to change your own beliefs to meet patient's needs -Cultural care preservation or maintenance—Retain and/or preserve relevant care values so patients maintain their well-being, recover from illness, or face handicaps and/or death. -Cultural care accommodation or negotiation—Adapt or negotiate with others for a beneficial or satisfying health outcome. -Cultural care re-patterning or restructuring—Reorder, change, or greatly modify patients' lifestyles for a new, different, and beneficial health care pattern. "If nurses do not recognize that the intervention strategies planned for an African-American client with diabetes are uniquely different from those planned for a Vietnamese American, an Italian American, and so forth, they cannot possibly hope to change health-seeking behaviors or actively encourage the wellness behaviors of this client or any client." -when nurses consider race, ethnicity, culture, and cultural heritage, they become more sensitive to clients -however, there is NOT a cookbook approach to delivering care to clients by virtue of race, ethnicity or culture -nurses must realize there is as much variation with certain races, cultures, or ethnic group as there is across cultural groups notes: -when providing culturally congruent care you must accommodate and negotiate for negative behaviors --ex. diabetes- we know sugar causes diabetes. How do we get people to change though? That is where the work comes into transcultural nursing! You must learn how to negotiate. -the care you provide is different based on culture-- might need to change interventions and patient education to fit their needs better -don't stereotype-- no cookie cutter approach ---eliminate bias and stereotype and then do a cultural assessment (every patient is different)

Giger and Davidhizar's transcultural assessment model

-six cultural phenomena that vary with application and use yet are evident in all cultural groups -(1) communication, (2) space, (3) social organization, (4) time, (5) environment control, and (6) biological variations -has been applied to the care of clients in a variety of clinical specialties, including the maternity client -in 1993, the model was combined with the cultural heritage model. the combination of these two models which appears in Potter and Perry's fundamentals of nursing textbook, is unique because it provides a holistic method of providing cultural competent care implications for nursing practice -set culture care as a priority -approach patients and families in a culturally sensitive manner -engage in negotiated partnerships with patients and families -enable the families and social networks of patients to serve as backup support -Giger and Davidhizar's model and other frameworks are best continuously being refined through research and best practices. -care must ALWAYS be "PATIENT CENTERED." This can be achieved through knowing cultural self, recognizing cultural bias, and addressing client's healthcare needs within the context of patient's cultural norms notes: -We will use this all the way through the semester Just know that they exist, will talk about the next class -MANY QUESTIONS ON EXAM -**Always remember that transcultural care is CLIENT CENTERED AND RESEARCH FOCUSED*

cultural values

-unique expressions of a particular culture that have been accepted as appropriate over time -develop as direct result of an individual's desirable or preferred way of acting or knowing something that is often sustained by a culture over time and that governs actions or decisions. notes: -catholicism: blessed mother, rosary, etc. Anyone who is catholic, or other similar religions: Sunday you wake up, get dressed, go to church. When you come home, it is a family day. You may pray together before you eat-- cultural value that is accepted as NORMAL by you over time, helps to explain who you are as a person.

Emotional Freedom Technique (EFT)

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biological variations

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cultural applications- chapter 3 space

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social organization

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environment control

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Chapter 2

Communication

cultural health practices

Cultural health practices are categorized: -efficacious -neutral -dysfunctional -uncertain notes: *QUESTIONS ON TEST* -don't worry about uncertain but the other three are important!

cultural patterns of space

Examples •US cities - laid out along a grid or axis - north, south, east, west. •Paris, streets are laid out from the center with no grid system. •In France, desk of most important person in the office will be in the center of the room/area. •India, space (homes, cities, villages) divided into areas of superiority and inferiority. Men and woman separated. notes: -Space: united states cities are built on a grid city vs somewhere in Europe that is not on the grid system -Hindu caste systems-- if you are born into a cast, you must stay within that cast and marry within the cast--- can't switch casts unless you go to another life -Don't have to know for the test

response to touch-cultural implications

Holding Knowledge: -Some Asian cultures - women do not shake hands with each other or with men. -Handshakes among Latino men are often seen as cold - for some Latins, two men put arms around each other's shoulder's when greeting. -Japanese culture - touching man's shoulders is often seen as humiliating. -*Tai and Vietnamese cultures - head is sacred - known as the "seat of life" - spirit leaves through the head - therefore always ask parent's permission before touching the head.* notes: -always ask the patients permission before touching tai and Vietnamese heads

chapter 5

Time

spatial behavior

holding knowledge: -Group rights must be considered in relation to space. -In cultures where priority is given to the group over the ---individual (Asian cultures, many Latino and Mediterranean cultures, most Arab cultures, and cultures of Africa and the Middle East), group rights and shared space are important considerations. -In cultures where priority is given to the individual rather than the group (United States, Canada, cultures of North and West Europe, Australia, and New Zealand), privacy is more likely to be valued. -In a culture where priority is given to the individual, a person may choose to be alone when feeling ill or in pain notes: -in culture where priority is given to group instead of individual -What's best for group is more important, and individual rights are second --Individualistic culture- US -Remember the difference between collectivist and individualist