Culture

Basic characteristics of culture

-Dynamic and ever-changing -Shared by all members of the same cultural group -Adapted to specific conditions such as environmental factors -Learned through oral and written histories, as well as socialization

Dimensions of cultural attributes: Shared beliefs, values and behaviors

-Individualism versus collectivism (individualism is independent practices, separate "self" from "non self" or the environment and social worlds; collectivism is interdependent self concept; rely on others for support/advice in health, considered self worth in the context of others (Japan) -Power distance (the acceptance of an unequal distribution of power as legitimate or fair versus illegitimate from the point of view of the less powerful -Masculinity versus femininity (how gender roles are distributed and how greatly they differ: masculine is greater value in western cultures, achievement, recognition; feminine is care taking and modesty) -Long-term versus short term orientation (orientation is the degree of which the culture is oriented towards the future long-term: favor thrift, perseverance, adapt to change; short-term: present or past orientation, emphasize quick results, favor tradition, leisure is important -Religiosity (how much religion is in day to day existence; what degree religious practices can be separated from nonreligious practices)

Culture vs. ethnicity

-an ethnic group could be people who are in the Olympics, experience 9/11, people in rapid who experienced the flood of, HIV/AIDS group, etc... -culture: set of beliefs ex: Omish, (see above)

Common attributes of culture include:

-culture is learned -culture is changing and adapting -values, beliefs, and behaviors are shared by members of the cultural group

Cultural competence in nursing

-expected component of professional nursing practice -requires underlying acceptance of patient's health beliefs -requires adapting care to meet unique needs and perspectives of individual

Factors and conditions leading to health disparities

-race -ethnicity -culture -georgraphic location -income, education, occupation -gender -age -health care attitude

Kleinman's inter professional theory of social suffering

-relationships and social interactions shape our illness experiences and collective perceptions of existential experiences of suffering -all illness are a form of social suffering, mediated by cultural and political institutions -emphases on the belief of the importance of understanding an individual's cultural interpretation of illness and suffering ex: TB, depression, STIs, substance abuse, domestic violence, PTSD & AIDS (seen as reflection of social structure and inequities)

Theoretic links to culture:

-there are multiple theories related to culture -two are presented in the text (Leininger's theory of cultural care diversity and universality & Interprofessional theory of social suffering) -Purnell model

Cultures occurs among?

-those who speak a particular language -those who live in a defined geographic region

collectivism

...the practice or principle of giving a group priority over each individual in it. the theory and practice of the ownership of land and the means of production by the people or the state.

Purnell model

12 domains 1. overview/heritage 2. communication 3. family roles & organization 4. workforce issues 5. biocultural ecology 6. high-risk behaviors 7. nutrition 8. pregnancy 9. death rituals 10. spirituality 11. health care practices 12. health care practitioners

The nurse at an outpatient clinic asks a patient who is Chinese American with newly diagnosed hypertension if he is limiting his sodium intake as directed. The patient does not make eye contact with the nurse but nods his head. What should the nurse do next? A. Ask the patient how much salt he is consuming each day B. Discuss the health implications of sodium and hypertension C. Remind the patient that many foods such as soy sauce contain "hidden" sodium D. Suggest some low-sodium dietary alternatives

A Rationale In an Asian culture spoken messages often have little to do with their meanings. It is important for the nurse to clarify how much salt the patient is consuming in his diet.

A community health nurse is making a healthy baby visit to a new mother who recently emigrated to the United States from Ghana. When discussing contraceptives with the new mom, the mother states that she won't have to worry about getting pregnant for the time being. The nurse understands that the mom most likely made this statement because: A. She won't resume sexual relations until her baby is weaned. B. She is taking the medroxyprogesterone (Depo-Provera) shot. C. Her husband was recently deployed to Afghanistan. D. She has access to free condoms from the clinic.

A Rationale In some African cultures such as in Ghana and Sierra Leone some women will not resume sexual relations with their husbands until the baby is weaned.

When action is taken on one's prejudices: A. Discrimination occurs. B. Delivery of culturally congruent care is ensured. C. Effective intercultural communication develops. D. Sufficient comparative knowledge of diverse groups is obtained.

A Rationale Prejudices associate negative permanent characteristics with people who are different from the valued group. When a person acts on these prejudices, discrimination occurs.

When interviewing a Native American patient on admission to the hospital emergency department, which questions are appropriate for the nurse to ask? (Select all that apply.) A. Do you use any folk remedies? B. Do you have a family physician? C. Do you use a Shaman? D. Does your family have a history of alcohol abuse?

A, B, C Rationale Obtain information about folk remedies and cultural healers that the patient uses. Assessment data yield information about the patient's beliefs about the illness and the meaning of the signs and symptoms.

A 46-year-old woman from Bosnia came to the United States 6 years ago. Although she did not celebrate Christmas when she lived in Bosnia, she celebrates Christmas with her family now. This woman has experienced assimilation into the culture of the United States because she: A. Chose to be bicultural. B. Adapted to and adopted the American culture. C. Had an extremely negative experience with the American culture. D. Gave up part of her ethnic identity in favor of the American culture.

B Rationale Assimilation results when an individual gradually adopts and incorporates the characteristics of the dominant culture.

During their clinical post-conference meeting, several nursing students were discussing their patients with their instructor. One student from a middle-class family shared that her patient was homeless. This is an example of caring for a patient from a different: A. Ethnicity. B. Culture. C. Heritage. D. Religion.

B Rationale Culture is the context in which groups of people interpret and define their experiences relevant to life transitions. This includes events such as birth, illness, and dying. It is the system of meanings by which people make sense of their experiences.

9. Which of the following best represents the dominant values in American society on individual autonomy and self-determination? A. Physician orders B. Advance directive C. Durable power of attorney D. Court-appointed guardian

B Rationale Informed consent and advance directives protect the right of the individual to know and make decisions ensuring continuity of individual autonomy and self-determination.

You are working with a patient who has undergone transgender transformation to become a male. Western cultural masculine attributes to emphasize include A. Harmonious relationships, modesty, and caretaking. B. Achievement, material success, and recognition. C. Fitness, fidelity, and stamina. D. Generosity, sportsmanship, and leadership.

B Rationale Masculinity versus femininity describes how gender roles are distributed and how greatly male and female roles differ. Some societies, such as Western societies, place a greater value on masculine attributes such as achievement, material success, and recognition than on more feminine attributes such as harmonious relationships, modesty, and taking care of others. Fitness, fidelity, stamina, generosity, sportsmanship, and leadership are not Western cultural masculine attributes that would be emphasized.

A female Jamaican immigrant has been late to her last two clinic visits, which in turn had to be rescheduled. The best action that the nurse could take to prevent the patient from being late to her next appointment is: A. Give her a copy of the city bus schedule. B. Call her the day before her appointment as a reminder to be on time. C. Explore what has prevented her from being at the clinic in time for her appointment. D. Refer her to a clinic that is closer to her home.

C Rationale Present-time orientation is in conflict with the dominant organizational norm in health care that emphasizes punctuality and adherence to appointments. Nurses need to expect conflicts and make adjustments when caring for ethnic groups.

To enhance their cultural awareness, nursing students need to make an in-depth self-examination of their own: A. Motivation and commitment to caring. B. Social, cultural, and biophysical factors. C. Engagement in cross-cultural interactions. D. Background, recognizing her biases and prejudices.

D Rationale Cultural awareness is an in-depth self-examination of one's own background, recognizing biases and prejudices and assumptions about other people.

A powerful determinant of one's identity is A. Biculturalism. B. Race. C. Assimilation. D. Ethnicity.

D Rationale Ethnicity refers to a common ancestry that leads to shared values and beliefs. It is transmitted over generations by one's family and community. Ethnicity is a powerful determinant of one's identity or ethnic identity. Biculturalism, race, and assimilation are not determinants of one's ethnicity.

Culture strongly influences pain expression and need for pain medication. However, cultural pain is: A. Not expressed verbally or physically. B. Expressed only to others from a similar culture. C. Usually more intense than physical pain. D. Suffered by a patient whose valued way of life is disregarded by practitioners.

D Rationale Patients suffer cultural pain when health care providers disregard values or cultural beliefs

A 6-month-old child from Guatemala was adopted by an American family in Indiana. The child's socialization into the American midwestern culture is best described as: A. Assimilation. B. Acculturation. C. Biculturalism. D. Enculturation.

D Rationale Socialization into one's primary culture as a child is known as enculturation.

Which of the following is required in the delivery of culturally congruent care? A. Learning about vast cultures B. Motivation and commitment to caring C. Influencing treatment and care of patients D. Acquiring specific knowledge, skills, and attitudes

D Rationale Specific knowledge, skills, and attitudes are required in the delivery of culturally congruent care.

LECTURE

LECTURE

PRACTICE QS

PRACTICE QS

acculturation

Process of acquiring new attitudes, roles, customs or behaviors Ex: an immigrant from China develops a preference for Western foods and music (doesn't mean you give up your own culture values and adopt new ones but rather you pick up other culture norms such as going to another country and adopting culture norms while living there

Culture

a pattern of shared attitudes, beliefs, self-definitions, norms, roles and valeus

Taboo

a social or religious custom prohibiting or forbidding discussion of a particular person, place, or thing ex: sex was a taboo subject

Affective

apathetic (incompetent) sympathetic (sensitive) committed to change (competent)

Ethnicity

can be apart of a culture and vice versa -is influenced by culture and common ancestry

Stages of cultural competency

cognitive affective psychomotor (skills) overall effect

Cultural competence and interrelated constructs

cultural desire is related to self awareness, cultural skill and cultural knowledge *self-awareness is always #1; then you have the desire once you get some knowledge and skill

Leininger's sunrise model?

demonstrates how culture is inclusive of everyday life; factors which surround the individual or population are based upon the ethnohistory (the history of peoples and cultures; especially nonwestern ones)

Overall effect

destructive (incompetent) neutral (sensitive) constructive (competent)

Health care disparities

differences in incidence, prevalence, morbidity, burden of disease DUE TO: social, economic, environment

Biculturalism

dual pattern of identification Ex: a woman of Christian faith married to a Muslim adopts some muslim practices and also maintains some traditional Christian practices

Cognitive

oblivious (incompetent) aware (sensitive) knowledgable (competent)

Assimilation

process by which a person give up his original identity and develops a new cultural identity by becoming absorbed into the dominant cultural group Ex: a native american loses his native identity after living in Chicago for 10 years; adopting a child from a foreign country

enculturation

process by which a person learns norms, values and behaviors of another culture ex: a high school student form the US spends a summer abroad with a family in Switzerland

Cultural desire

provides means to overcoming one's biases and their effects on providing care

Define culture concept

refers to learned, shared, transmitted values, beliefs, norms and lifeways of a particular culture that guides thinking, decisions and actions in patterned ways

Interprofessional theory of social suffering (Kleinman)

takes in the human consequences of war, famine, depression, disease, torture—the whole assemblage of human problems that result from what political, economic, and institutional power does to people—and also human responses to social problems as they are influenced by those forms of power. In the same way that the notion of social suffering breaks down boundaries between specific scholarly disciplines, this cross-disciplinary investigation allows us to see the twentieth century in a new frame, with new emphases.

Race

the physical traits such as appearance that continues to the race (skin color, eyes, etc...) -is influenced by physical or biological characteristics

Psychomotor (skills)

unskilled (incompetent) lacking some skills (sensitive) highly skilled (competent)

Cultural imposition

using one's own values/lifestyles as an absolute guide in dealing with clients and interpreting their behavior

When providing nutritional education for a Mexican-American patient with newly diagnosed hypertension, the nurse notes that the patient is nodding "yes" to everything that is being said. With a better understanding of cultural interdependence, a nurse should immediately A. Write everything down for the patient to refer to later. B. Prompt the patient further to elicit additional questions or concerns. C. Call the recognized elder for this patient. D. Call the patient's oldest male relative for help with decision making.

B Rationale The patient is nodding "yes" because it is a polite way of indicating that the power distance is too close for the patient. Acknowledging power distance is the way in which a less powerful member of an organization or institution (such as a family) accepts and indicates that power is being distributed unequally. Cultures that endorse a low power distance expect and accept power relations that are more consultative or democratic. People relate to one another more as equals, regardless of formal positions in the culture. Subordinates are more comfortable with and demand the right to contribute to and critique the decision making of those in power. In cultures that endorse a high power distance, less powerful persons accept power relations that are more autocratic and paternalistic. Subordinates acknowledge the power of others simply based on where they are situated in certain formal, hierarchical positions. When a nurse provides nutritional education for a patient who is from a culture that values a greater power distance, as does the Mexican-American culture, it might appear that the patient is willing to accept all that the nurse suggests; further prompting would elicit additional questions or concerns. A patient from a collectivist culture will usually consult family members about the best course of action. It is not acceptable for a nurse to take it upon herself or himself to call a recognized elder or oldest male relative for help with decision making. Although writing everything down may be acceptable in some cultures, with an Asian patient it may be best to prompt the patient further to elicit additional questions or concerns.

The nurse is triaging a hysterical patient in the emergency room. The patient is crying, has uncontrollable spasms, and is trembling and shouting. It is important to identify the manifestation of illness in order to effectively treat a patient. The nurse identifies this as a culture-bound syndrome called A. Shenjing shaijo. B. Loco de la cabeza. C. Ataque de nervios. D. Neurasthenia.

C Rationale Ataque de nervios is a Latin-Caribbean culture-bound syndrome that usually occurs in response to a specific stressor and is characterized by dissociation or trance-like states, crying, uncontrollable spasms, trembling, or shouting. Shenjing shaijo refers to "weakness of nerves" in Chinese culture; it is caused by a decrease in vital energy that reduces the function of the internal organ systems and lowers resistance to disease. Loco de la cabeza is a Spanish phrase meaning "crazy in the mind," a condition that is not necessarily manifested by physical symptoms. Neurasthenia is used in Asian cultures to describe extreme fatigue after mental effort and bodily weakness of persistent duration.

A nursing student is taking postoperative vital signs in the postanesthesia care unit. She knows that some ethnic groups are more prone to genetic disorders. Which of the following patients is most at risk for developing malignant hypertension? A. Ashkenazi Jew B. Chinese American C. African American D. Filipino

C Rationale Certain genetic disorders are linked with specific ethnic groups such as malignant hypertension among African Americans.

It is best for nurses to have a broad understanding of cultural influences on health care because of A. Disability entitlements. B. Requirements of the Health Insurance Portability and Accountability Act (HIPAA). C. Increasing global diversity. D. Litigious society.

C Rationale Culture is an essential aspect of health care because of increasing global diversity. Disability entitlements are defined benefits for eligible mental or physically disabled beneficiaries for housing, employment, and health care. HIPAA requirements are found in the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety. A litigious society is one that is excessively ready to "go to the law" (indicating a system of regulations to govern the conduct of the people of a community, society or nation, in response to the need for regularity, consistency and justice based upon collective human experience) or to initiate a lawsuit.

A nursing student is doing a community health rotation in an inner-city public health department. The student investigates sociodemographic and health data of the people served by the health department, and detects disparities in health outcomes between the rich and poor. This is an example of a(n): A. Illness attributed to natural and biological forces. B. Creation of the student's interpretation and descriptions of the data. C. Influence of socioeconomic factors in morbidity and mortality. D. Combination of naturalistic, religious, and supernatural modalities.

C Rationale Health disparity populations are populations that have a significant increased incidence or prevalence of disease or that have increased morbidity, mortality, or survival rates compared to the health status of the general population.

A registered nurse is admitting a patient of French heritage to the hospital. Which question asked by the nurse indicates that the nurse is stereotyping the patient? A. "What are your dietary preferences?" B. "What time do you typically go to bed?" C. "Do you bathe and use deodorant more than one time a week?" D. "Do you have any health issues that we should know about?"

C Rationale Nurses need to avoid stereotypes or unwarranted generalizations about any particular group that prevents further assessment of the individual's unique characteristics.