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Nursing 250 Cultural Diversity
Terms in this set (59)
The United States has become increasingly diverse over the last 20 years.
Other trends include, multigenerational families under the same roof, more same sex couples, and more suburban.
US Population Trends
-By 2050, the white population will actually be a minority group, constituting 48.9% of the total population of the United States.
-In some states, the white population will be a minority much sooner.
-A group's acceptance of a set of attitudes, ideologies, values, beliefs, and behaviors
-These influence the way that the members of the group express themselves
-Values and ways of thinking/acting are different from those outside the group.
-Learning starts at birth and continues throughout life
-Behaviors, beliefs, and attitudes are transmitted generation to generation
-Expressions of culture - unconscious
-Major effect on an individual's interactions/response to the health-care system.
Works of art
Response to illness, pain, stress
Concepts of Culture
-Culture is not a monolithic
-Often belong to several subcultures
-Develop when members accept outside values in addition to those of dominant culture
-Variations may exist within a given culture
Primary characteristics -
Diversity (pt 2)
Secondary characteristics - harder to identify:
Length of time away from the country of origin
Melting pot VS Salad Bowl
Melting pot: cultures try to "fit in" to the dominant culture: rid the trappings of native culture (acculturation)
Salad bowl: cultures cling to their traditional practices and languages in a minimal attempt to "fit in" (multi-culturalism
-Cultural relativism - members of a strong cultural group understand their culture/group members from their own viewpoint rather than from that of the larger culture.
-They do not try to understand its unique characteristics, values, and beliefs.
-Blending of melting pot and salad bowl together
-Outwardly, they appear acculturated to the dominant culture.
-At home or with their traditional culture, they speak their native language, wear their traditional clothes, eat ethnically correct meals, and generally follow their native customs.
Developing Cultural Awareness
-Awareness begins at home
-Nurses develop cultural awareness when can recognize and value all aspects of a client's culture: beliefs, customs, responses, methods of expression, language, social structure
-Merely learning about another person's culture does not guarantee that the nurse will have cultural awareness.
Developing Cultural Awareness (pt 2)
-If unfamiliar with a culture, many of the health-care practices may appear meaningless, strange, or dangerous.
-Beliefs about health care are based on:
-Related to religious beliefs
-Ideals/concepts that give meaning to an individual's life
-Most people resist changing values
-Not necessarily right or wrong
-Expectations or judgments based on attitude and verified by experiences
Cultural belief System
-They are highly complex
-Beliefs/practices kept as closely guarded secrets
-Possible sanction or punishment for members who reveal the belief
-They develop over time through trial-and-error
Cultural values: sources
Changing the clients health care views
-Recognize that the nurse comes from a particular culture that has its own set of health-care values.
-Identify the culture of the client and recognize specific health-care practices.
-Work with the client's beliefs and cultural values to make changes that will improve health.
-A systematic, comprehensive examination of the cultural care values, beliefs, and practices (individuals, families, and communities)
-Gathers information to enable nurse to implement culturally competent and safe patient care
-Ask the patient how they wish to be treated based upon their values and beliefs
Cultural Assessment( questions ok to ask)
-Why do you think you are ill? What caused the illness?
-What was going on at the time the illness started?
-How does the illness affect your body and health?
-Do you consider this to be a serious illness?
Physical variations during assessment
-The nurse must know the basic biological and physical variations among ethnic groups.
-Findings may be affected by ethnic variations in anatomical structure or characteristics.
-Changes in skin color may affect the interpretation of assessment findings.
What inhibits sensitivity to diversity
-Occurs when one assumes that all members of a culture, ethnic group, or race act alike. (Make generalizations)
-Can be positive or negative
-Typically based on a limited amount of information
-How could this affect how a nurse provides care?
Cultural Imposition/Cultural Blindness
-Imposition: Belief that everyone else should conform to your own belief system.
-Imposing values or patterns of behavior onto others.
-Blindness: Occurs when one ignores differences and proceeds as if they do not exist.
-People become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of others to make themselves feel more secure about their own values.
Affect on healthcare
-Physiologic variations: cultural groups more likely to be affected by a certain condition or respond differently to a particular med
-Pain: Some stoic, some very verbal
-Language: Consider how difficult it would be to be a patient who has a language barrier with their caregivers
-Nurses need to be aware and if they live in a geographic area that speaks a language other than English, they should learn key words and phrases.
Aids to communication
-Language access services
-All health care organizations are required to offer free language assistance, including bilingual staff or interpreter services to each patient with limited English proficiency. These services must be offered in a timely manner at all hours of operation, at all points of contact.
Aids to communication (pt 2)
Patients must be informed, in their preferred language, of their right to receive language assistance services both verbally and in written form.
The Joint Commission requires informed consent materials be in the patient's language whenever possible and that an interpreter be available when discussing informed consent.
Aids to communication (older adult)
-Ask older adults how they like to be addressed. If in doubt, address them formally (e.g., Mr. Lin).
-Determine the patient's preferences for touch
-Investigate the patient's preferences for silence
-Be aware of the patient's beliefs about eye contact during conversation
Other ways culture affects healthcare
Food and nutrition
Availability/Accessibility of care
Right to know
-The custom in many cultures, including Mexican, Filipino, Chinese, and Iranian, is for a patient's family to be the first to hear about a poor prognosis, after which the family decides whether and how much to tell the patient.
Culturally competent care
Care, that is planned and implemented in a way that is sensitive to the needs of individuals, families, and groups from diverse populations within society.
Cultural Context of health and caring
Health, illness, and caring have meanings that are unique to the culture
Every culture provides a context for which groups interpret and define experiences relevant to birth, illness, and death
Alternative/Integrative Health Practices
Outside of conventional, science-based western medicine/not sanctioned by the official health-care system.
Not taught widely in medical schools
Not generally used in hospitals
Not usually reimbursed by insurance
Alternative practice pt 2
-Widely used by a large percentage of the population
-Use continues to increase in popularity
-Nurses need to have a good understanding of integrative practices to insure their clients' safety and well-being and to be supportive of their practices.
Based on the belief that clients, after an illness or injury, have the capability to regain their overall health and maintain wellness during their life spans
Integrative Health (con't)
The practitioner using integrative health practices is to:
-Become familiar with each client's particular health needs.
-Personalize their care using the full range of elements that affect health, including physical, mental, spiritual, social and environmental factors
-Therapies and practices are called alternative when they are used in place of conventional therapies.
-Therapies are called integrative or complementary when they are used with conventional therapies.
-The term healing is preferred to medicine because alternative and complementary modalities typically are based in holistic philosophies.
Integrative/ Alternative health
Primary users are
-Ages 35 to 49
-People with higher educational levels (some graduate education)
-Those with annual incomes of more than $50,000
-Ethnic groups with traditional practices
Why their use has increased
-Dissatisfaction with conventional health care
-Desire for greater control over one's health
-Desire for cultural and philosophical congruence with personal beliefs about health and illness
-Belief in the effectiveness of alternative therapies
-Individual's health status
-Rising cost of conventional health care
-Focuses on physical
-Reduces humans to simple beings who are all anatomically and physiologically similar
-Emphasis is placed on diagnosis and cure based on physical symptoms
-Takes a holistic "multibody" approach
-Takes into consideration the complexity of each person
-Includes both the material and nonmaterial aspects of the individual and self-healing forces
Conventional: usually considered adjuncts to biomedical treatment.
Integrative: commonly seen as a way of life and a method of preventing illness.
Benefits of natural foods:
-Integrative modalities recommend only foods produced in a natural manner and in their natural environment
-Some rationales include:
-Concerns about food production/processing
-Belief that the person-body, is designed to live in a natural environment
-Belief that what is eaten directly affects health
Regulation of supplements:
-Nutritional supplements are not regulated by the FDA.
-If manufacturers make no claims that they are effective against a disease, they do not need to be tested for safety and effectiveness before they are sold to the public.
-There has been a gradual increase in the regulation of these products.
Plants as medicine
Plants as medicine
Both integrative and conventional health care use plants as medicines.
Herbs may be angiosperms (flowering plants, trees, or shrubs), algae, moss, fungus, seaweed, lichen, or ferns.
Herbs used as medicines come from some part of the plant (leaf, root, flower, fruit, stem, bark, or seed or its syrup-like exudates).
-Electrical-chemical reactions are produced in the nervous system and help regulate other body systems.
-Electrical impulses trigger heartbeats.
-Electrical currents regulate the production of hormones.
-Blood is composed of iron; therefore, magnetic forces exist in all parts of the body.
Conventional use of energy
Magnetic resonance imaging
X-rays and radiation treatments for cancer
Low-voltage electric current to stimulate growth of bone cells (osteoblasts) to accelerate healing of fractures
Electric shock for cardiac arrest and dysrhythmia
Uses external energy sources to stimulate tissue regeneration or improve the immune system response
Sound and light therapy
In many integrative models, illness reflects blockage, loss, or imbalance of body energy or vital essence.
Disturbance of internal body energy can result from external or internal factors.
The treatment is aimed at removing the blockage of energy flow
External energy forces
-May be actual energy treatments
-Mobilizing the healing energy of
-Faith, spirituality, and prayer
-Therapeutic and healing touch
Gain knowledge and understanding about folk remedies used by patients to prevent cultural imposition.
Many groups use techniques such as coining, cupping, pinching and burning.
use of integrative health practices
Nurses feel uncomfortable with the use of herbal products and integrative therapies because of:
-Unclear definitions of practices
-Lack of foundation in the biomedical sciences
-Basis in concepts of holism, self-care, and theoretical constructs that come from beliefs different from those of biomedicine and the science
-Few standards or regulations for practitioners
Challenge to nurses
Challenges to nurses
Professional accountability: staying current
Client's right to self-determination
Keeping an open mind
Assessment of use of integrative practices and nutritional supplements
right of passage
significant social markers of changes in a person's life.
Grief and Loss
Be aware of religious and cultural preferences when helping clients and families prepare for death
Ask about rituals and ceremonies used
Allow clients and families the ability to participate in the planning
Be sensitive to cultural perceptions
Need for transcultural nursing
The percentage of minority nurses does not reflect the national population trends.
Minority nurses have remained constant at approximately10% of RNs.
The number of minority students enrolled in basic nursing programs remains at about 15%.
Need to develop in order to provide culturally competent care.
Examine your own beliefs, values, practices, and family experiences.
Identify your biases
How do they affect how you feel about others? How will they affect the nursing care you provide?
Learn as much about the belief system and practices in your community where you work.
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
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