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Chapter 9 Cultural Awareness

Terms in this set (34)

African-Americans have the highest mortality rate of any racial and ethnic group for all cancers combined, contributing in part to a lower life expectancy for both African-American men and women. Asian Americans generally have lower cancer rates than the non-Hispanic white population, but they also have the highest incidence rates of liver cancer for both sexes compared with Hispanic, non-Hispanic Whites, or non-Hispanic Blacks. Hispanic youths ages 2 to 19 are more likely to be overweight or obese than the non-Hispanic White or Black youths of the same age, which places them at a greater risk of developing a number of chronic diseases such as type 2 diabetes, high blood pressure, and asthma. Gay, lesbian, and bisexual young people have a significantly increased risk for depression, anxiety, and substance use disorders and are four times as likely as their straight peers to make suicide attempts that require medical attention. Transgender individuals are more likely to postpone medical care because of lack of insurance and encounters with discrimination than people who do not identify as transgender. In American Indian and Alaska Native populations, the infant mortality rate is 60% higher than in non-Hispanic Whites. In 2008 the infant mortality rate for African-American infants was more than twice the rate for non-Hispanic white infants. The infant mortality rate among children born to college-educated African-American women is significantly higher than among babies born to white women who are similarly educated.
Culture is associated with norms, values, and traditions passed down through generations. A more contemporary view of culture acknowledges its many other facets such as gender, sexual orientation, location, class, and immigration status. This more dynamic perspective recognizes that we all belong simultaneously to multiple social groups within changing social and political contexts, a framework often referred to as intersectionality. Oppression is a formal and informal system of advantages and disadvantages tied to our membership in social groups, such as those at work, at school, and in families. To better understand this more dynamic and complex way of thinking about culture, consider this example. As a nurse think about how a 27-year-old homeless woman with diabetes, an 85-year-old African-American retired nurse from rural Alabama, a 32-year-old Latina lesbian executive in San Francisco who is Catholic, and an undocumented immigrant woman from Eastern Europe who has a 3-year-old child with a developmental disability experience their womanhood. How may their experiences compare to the experiences of others as they live in America? How do their experiences compare with regard to using a health care system, managing their diabetes, or perceiving the presence or absence of opportunities to live a happy, safe, and productive life? How could age affect their perspective? How would these answers change if one looked at their lives 15 or 35 years ago? How would the experiences change if these individuals were men or transgender? Understanding culture requires you to adopt an intersectional perspective like the one in the example.
Historical and social realities shape an individual's or group's world view, which determines how people perceive others, how they interact and relate to reality, and how they process information. World view refers to "the way people tend to look out upon the world or their universe to form a picture or value stance about life or the world around them". When you assess a patient's cultural background and needs, you take into account each patient's world view, then you plan and provide nursing care in partnership with each patient. In any intercultural encounter there is an insider perspective (emic world view) and an outsider perspective (etic world view). For example, a Korean woman requests seaweed soup for her first meal after giving birth. Avoid stereotypes or unwarranted generalizations about any particular group that prevents an accurate assessment of an individual's unique characteristics and world view. Instead approach each person individually and ask questions to gain a better understanding of his or her perspective and needs. Most health care providers educated in Western traditions are immersed in the culture of science and biomedicine through their course work and professional experience. Consequently they often have a world view that differs from that of their patients. When patients access the health care system, they want to: (1) see their health care provider, and (2) feel better. In return the health care providers expect patients to: (1) make and keep appointments; (2) give a medication history; (3) give informed consent; (4) follow (discharge) instructions; (5) read, understand, and use health education materials; (6) correctly complete insurance forms; (7) pay their bills; and (8) go home and manage their care by taking their medication the right way, eating the right foods, and stopping/starting/changing a variety of behaviors. This list shows how complex each patient interaction is even before the interaction begins.