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Taylor Fundamentals of Nursing Chapter 5: Cultural Diversity

Terms in this set (38)

Culture
- A shared system of beliefs, values + behavioral expectations that provides social structure for daily living
- Helps shape what is acceptable behavior + shapes identity for members
- Learned by each new generation though both formal + informal life experiences. Language is the PRIMARY means of transmitting culture
- The practices often arise because of the group's social + physical environment
- May evolve over time but remain constant as long as they satisfy a group's needs
- Influences the way people of a group view themselves, have expectations + behave in response to certain situations
Cultural Assimilation
- Also called acculturation
- When many members LOSE the cultural characteristics that once made them different
Subcultures
- Are a subgroup within a culture
- A large group of people who are members of the larger cultural group byt who have a certain ethnic, occupational or physical characteristics that are not common to the larger culture.

Ex. Nursing is a subculture of the larger culture
Ethnicity + 2 Categories on U.S. System
- A sense of identification with a collective cultural group, largely based on the group's common heritage
- One belongs to a specific ethnic group or groups either through birth or though adoption of characteristics of that group
- Generally share unique cultural + social beliefs + behavior patterns, language/dialect, religious practices, literature, folklore, music, political interests, food + employment
- Largely develops though day-to-day life wiht family + friends within the community

2 Categories on U.S. Census:

1.) Hispanic or Latino
2.) Not Hispanic or Latino
Race + 5 Categories
- Typically based on specific physical characteristics such as skin pigmentation, body stature, facial features + hair texture

Federal standards for race classification include 5 categories:

1.) African American/Black
2.) Native Hawaiian/Other Pacific Islander
3.) White
4.) American Indian/Alaska Native
5.) Asian
Stereotyping
When one assumes that ALL members of a culture, ethnic group or race act alike
Cultural Imposition
The belief that everyone else should conform to your own belief system
Cultural Blindness
Occurs when one ignores the differences + proceeds as though they do not exist
Culture Conflict
Occurs when people become aware of cultural differences, feel threatened + respond by ridiculing the beliefs + traditions of to others to make themselves feel more secure about their own values.
Cultural Influences on Health Care
1.) Physiologic Variations
2.) Reactions to pain
3.) Mental health
4.) Gender roles
5.) Language (linguistics) + communication
6.) Orientation to space + time
7.) Food + nutrition
8.) Family support
9.) Socioeconomic factors
10.) Health disparities
NATIVE AMERICANS: Common Health Problems
- Heart disease
- Cirrhosis of the liver
- Diabetes mellitus
- Fetal alcohol syndrome
AFRICAN AMERICANS: Common Health Problems
- Hypertension
- Stroke
- Sickle cell anemia
- Lactose intolerence
- Keloids
ASIANS: Common Health Problems
- Hypertension
- Cancer of the liver
- Lactose intolerance
- Thalassemia
HISPANICS: Common Health Problems
- Diabetes mellitus
- Lactose intolerance
WHITES: Common Health Problems
- Breast cancer
- Heart disease
- Hypertension
- Diabetes mellitus
- Obesity
What culture is less likely to have lactose intolerence?
Native Americans
Linguistic Competence
Refers to the ability of caregivers + organizations to understand and effectively respond to the linguistic needs of patients and their families in a healthcare encounter.
5 Cultures where Direct Eye Contact is Considered Rude or Offensive
1.) Asians
2.) Native Americans
3.) Indochinease
4.) Arabs
5.) Appalachian Americans
2 Cultures that value CLOSE personal space when speaking
1.) Arabs
2.) African Americans
2 Cultures that value LOTS OF personal space when speaking
1.) Asians
2.) Europeans
Characteristics of a POVERTY CULTURE
- Feelings of despair, resignation + fatalism
- Day-to-day attitude toward life, with no hope for the future
- Unemployment + need for financial or government aid
- Unstable family structure, possibly characterized by abusiveness + abandonment
- Decline in self respect + retreat from community involvement
"Natural Illnesses"
Caused by dangerous agents, such as cold air or impurities in the air, water or food.
"Unnatural illnesses"
Punishments for failing to follow God's rules, resulting in evil forces or witchcraft causing physical or mental health problems.
7 Elements of CULTURAL COMPETENCE
Note: Becoming culturally competent is a lifelong challenge

1.) Developing an awareness of one's own existence, sensations, thoughts + environment to prevent them from having an undue influence on those from other backgrounds
2.) Demonstrating knowledge + understanding of the client's culture, health-related needs, and culturally specific meanings of health + illness
3.) Accepting and respecting cultural differences in a manner that facilitates the client's and family's abilities to make decisions to meet their needs and beliefs.
4.) Not assuming that the health care provider's beliefs and values are the same as the clients
5.) Resisting judgemental attitudes such as "different is not as good"
6.) Being open to and comfortable with cultural encounters.
7.) Accepting responsibility for one's own education in cultural competence by attending conferences, reading professional literature, and observing cultural practices.
Ethnocentrism
The belief that the ideas, beliefs and practices of one's own culture are superior to those of another's culture.
Transcultural Nursing Care
Both a specialty and a formal area of practice
- Resulted from the work of Dr. Madeline Leininger, a nurse-anthropologist
- Her Theory of Cultural Care Diversity + University (1991) provides the foundation for providing culturally competent care for patients of all ages, as well as families, groups and communities.
- A nurse who is culturally competent has the knowledge and skills to adapt nursing care to cultural similarities and differences
- Developing cultural competence takes time. It involves developing awareness, acquiring knowledge and practicing skills.
Cultural Norms of the Healthcare System
BELIEFS:
- Standardized definitions of health and illness
- Omnipotence of technology

PRACTICES:
- Maintence of health and prevention of illness
- Annual physical examinations + diagnostic procedures

HABITS:
- Documentation
- Frequent use of jargon
- Use of a systematic approach and problem solving methodology

LIKES:
- Promptness
- Neatness and organization
- Compliance

DISLIKES:
- Tardiness
- Disorderliness and disorganization

CUSTOMS:
- Professional deference and adherence to the pecking order found in autocratic and bureaucratic systems
- Use of certain procedures attending birth and death.
White
- Nuclear family is highly valued
- Elderly family members may live in a long term care facility when they can no longer care for themselves
- Self diagnosis of illnesses
- Use of over the counter drugs, especially vitamins and analgesics
- Dieting, especially fad diets
- Extensive use of exercise + exercise facilities

VALUES + BELIEFS:
- Youth is valued over age
- Cleanliness, orderliness
- Attractiveness
- Individualism
- Achievement
- Punctuality
African American
- Close and supportive extended family relationships
- Strong kinship ties with nonblood relatives from church or organizational and social groups
- Family unity, loyalty and cooperation are important
- Usually matriarchal
- May include spiritualists, herb doctors, root doctors, conjurers, skilled elder family members, voodoo, faith healing
- Special care may be necessary for the hair and skin

VALUES + BELIEFS:
- Present orientated
- Members of the African American clergy are highly respected
- Frequently highly religious
Asian
- Welfare of the family is valued above the person
- Extended families are common
- A person's lineage is respected
- Sharing among family members is expected
- Theoretical basis in Taoism, which seeks a balance in all things
- Good health is achieved though the proper balance of YIN (feminine, negative, dark, cold) and YANG (masculine, positive, light, warm).
- An imbalance in energy is caused by an improper diet or strong emotions
- Diseases and foods are classified as HOT or COLD and a proper balance between them will promote wellness (ex. treat a cold disease with hot foods)
- Use herbs diet + application of HOT and COLD therapy
- Accumassage, acupressure, acupuncture

VALUES + BELIEFS:
- Strong sense of self respect + self control
- High respect for age
- Respect for authority
- Respect for hard work
- Praise of self or others is considered poor manners
- Strong emphasis on harmony and the avoidance of conflict.
Nursing Considerations for ASIANS
- Some may be upset by the drawing of BLOOD for laboratory tests. They consider blood to be the body's life force, and some do not believe that it can be regenerated.
- Some believe that it is best to die with the body INTACT, so they may REFUSE SURGERY
- Some Asians consider it polite to give the person the responses the person is expecting.
- Some members may change physicians in an attempt to be cured of an illness, but to aboid insulting or embarrassing a physicain, they will not inform him or her that they are going to another practitioner. This can result in confusion, inaccuracies and overmedication
- Some REFUSE DIAGNOSTIC STUDIES because they believe that a skilled and competent physician can diagnose an illness solely though a physical examination
- Some may have a difficult time understanding the importance of medication because many folk treatment involve the ingestion of herbal mixtures
- Dietary counseling may be necessary as Asian foods have a high salt content
Hispanic
- Familial role is important
- Compadrazgo: special bond between a child's parents and the child's grandparents
- Curanderas: Folk healers who base treatments on humoral pathology- basic functions of the body are controlled by four body fluids or "humors":
BLOOD: hot + wet
YELLOW BILE: hot + dry
BLACK BILE: cold + dry
PHLEGM: cold + wet
- The secret to good health is to balance HOT and COLD within the body; therefore, most foods, beverages, herbs and medications are hot or cold. A cold disease will be cured with a hot treatment.

VALUES + BELIEFS:
- Respect is given according to age (older) and sex (male)
- Roman Catholic Church may be influential
- God gives health + allows illness for a reason, therefore many see illness as a punishment from god that can be cured though atonement and forgivness.
- Ma be difficult to convince an asymptomatic patient that they are ill
- Diet counseling may be necessary at times because the usual diet is HIGH IN STARCH.
Compadrazgo
special bond between a child's parents and the child's grandparents
Curanderas
Folk healers who base treatments on humoral pathology- basic functions of the body are controlled by four body fluids or "humors":

BLOOD: hot + wet
YELLOW BILE: hot + dry
BLACK BILE: cold + dry
PHLEGM: cold + wet
Muslim
- The family forms the basic building block of Muslim society. The man is considered the head of the family.
- Marriage forms the sole basis for sexual relations and parenthood
- Islamic law generally discourages the use of contraceptives, extolling the virtues of large families but there seems to be a trend toward smaller families
- Restricted eating of pork and alcohol
- Muslims may perceive a sudden death or illness as a sign of punishment or a test from God
- Offer a HALAL diet free of alcohol or pork
- During RAMADAN muslims must fast from sunrise to sunset and includes abstaining form all substances including pharmacetuicals and IV drips, however illness is an exception.

VALUES + BELIEFS:
- There is no God but Allah and that Muhammad is his messenger
- Belief that god created humans and gave them their bodies as gifts to be cared for though general hygiene, diet and exercise
- Belief that Allah will determine when they will die, Death is an imporant part of the tradidional Islamic life cycle. They WASH the body of the deceased and bury as soon as possible. Cremation is not allow under Islamic law.
Native American
- Families are large and extended
- Grandparents are official and symbolic leaders and decision makers
- A child's namesake may become the equivalent to another parent to the child.
- Medicine men (shaman) are heavily used
- Use of herbs and psychological treatments, ceremonies, fasting, meditation, heat and massages.
- Present oriented. Taught to live in the prsent and not to be concerned about the future.Values finishing current business before doing something else
- Value is placed on working together and sharing resources
- Failure to achieve a personal goal is frequently believed to be the result of competition
-High respect is given to a person who gives to others. The accumulation of money and goods is frowned upon.
- The family is expected to be part of the nursing care plan.
- Note taking is TABOO.
- Indirect eye contact is acceptable
- A low tone of voice is considered respectful
- May expect the caregiver to deduce the problem though instinct instead of asking many questions and history taking.
- It may help to use declarative sentences rather than direct questioning
Hawaiian
- Familial role is important
- Chana (extended families) are jointly involved in childrearing
- Hierarchy of family structure- each gender and age have specific duties
- Closely knit families in small, isolated communities
- Kahuna La'au Lapa'au is the ancient Hawaiian medical practitioner
- Christian god replaced the myriad of Hawaiian gods
- Lifestyle more revered than compliance with health care issues
- Death seen as a part of life and is not feared
- Present oriented, less initative and drive rather than direction and achievement
Appalachian American
- Intense interpersonal relations
- Family is cohesive, and several generations often live close to each other
- Elderly are respected as providers
- Tend to live in rural, isolated areas
- "granny" woman or folk healer provides care and may be consulted even if receiving traditional care
- Various herbs are used
- Elderly may have had only limited contact with healthcare providers and may be skeptical of modern healthcare
- Independence and self determination
- Isolation is accepted as a way of life
- Person oriented
- May be fatalisitic about losses and death
- Belief in a divine existance rather then attending a particular church
- Treat each person with reguard for each person's dignaty
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