CULTURE

CULTURE
refers to knowledge, beliefs, behaviors, ideas, attitudes, values, habits, customs, languages, symbols, rituals, ceremonies, and practices that are unique to a particular group of people.

CULTURE Culture is not static nor is it uniform among all members within cultural groups. Culture represents adaptive dynamic processes learned through life experiences

CHARACTERISTICS OF CULTURE

Culture is learned and taught

Cultural knowledge is transmitted from one generation to another. A person is not born with cultural concepts but instead learns them through socialization.

Culture is shared The sharing of common practices provides a group with part of its cultural identity.

Culture is social in nature

Culture develops in and is communicated by groups of people

Culture is dynamic, adaptive, and everchanging Adaptation allows cultural groups to adjust to meet environmental changes.

Cultural change occurs slowly and in response to the needs of the group. This dynamic and adaptable nature allows a culture to survive.

ETHNICITY AND RACE

Ethnicity
is a cultural groups perception themselves (group identity). of

This self-perception influences how the groups members are perceived by others. sense of belongingness and a common social heritage that is passed from one generation to the next.

Race
refers to a grouping of people based on biological similarities. Members of a racial group have similar physical characteristics such as blood group, facial features, and color of skin, hair, and eyes.

LABELING AND STEREOTYPING

Ethnocentrism

is

the belief that ones own culture is superior to all others. belief is common to all cultural

This

groups, all groups regard their own culture as not only the best but also the correct, moral, and only way of life

Oppression
Occurs when the rules, modes, and ideals of one group are imposed on another group. Oppression is based on cultural biases, which stem from values, beliefs, tradition, and cultural expectations

Racism

form of oppression, is defined as discrimination directed toward individuals who are misperceived to be inferior due to biologic differences.

Stereotyping
is an expectation that all people within the same racial, ethnic, or cultural group act alike and share the same beliefs and attitudes. Stereotyping results in labeling people according to cultural preconceptions; therefore, an individuals unique identity is often ignored.

Cultural diversity
Cultural diversity refers to the differences between people based on a shared ideology and value set of beliefs, norms, customs, and meanings evidenced in a way of life

Organizing factors of culture

ORGANIZING PHENOMENA OF CULTURE

Communication
the vehicle for preserving culture. transmitting and

To share complete and accurate information, nurses must be aware of the cultural variances related to communication

Communication
When the nurse assumes that the client understands the intended message and fails to confirm client understanding, cultural blindness can hamper the communication process

Space
An individuals personal space includes ones body, the surrounding environment, and objects and people within that environment. Culture determines the amount of social distance tolerated by a person.

Space
Nurses must be aware of the clients degree of comfort with closeness since diverse groups have varying norms for the use of touch.

Orientation to Time
Time orientation (being focused on the past, the present, or the future) varies according to cultural group When caring for clients of diverse cultures, be sensitive to the fact that they may view time differently.

Avoid jumping to conclusions that the client who is late for an appointment is lazy or inconsiderate.

Social Organization
Social organization refers to the ways in which groups determine rules of acceptable behavior and roles of individual members. Examples of social organizations include family and other kinship ties, religious groups, and ethnic groups.

Social Organization
Family Gender Lifestyle Religion

Family
If an event affects one family member, all the other members will be affected in one way or another

It is vital for the nurse to know who will be involved in making decisions related to health care
In many cultures, the family assumes greater importance than the individual

TYPES OF FAMILY STRUCTURES

Nuclear Extended Parents and children Parents, children, and other relatives (such as grandparents, cousins) Single parent with children Married couple with no children

Attenuated Incipient

Blended

Married couple and their children from previous unions; may indicate stepparents, step-siblings, half siblings.

Attributes necessary for nurses in order to collaborate with families:

Nonjudgmental attitude (i.e., do not expect all families to be alike and behave similar to ones own) Self-awareness of own about family members preconceptions

Respect for others beliefs and values

Attributes necessary for nurses in order to collaborate with families:

Recognition of families as significant providers of support
Value the participation of families in caregiving

Gender
Gender roles vary according to cultural context

Lifestyle
lifestyles are also becoming more diverse. Some examples of alternative lifestyles are homosexual couples, single parent families, and communal groups.

Religion
Religious beliefs influence a persons response to major life events such as birth, illness, and death. Religious practices are often a source of comfort during stressful life events and provide support during the healing process.

CULTURAL DISPARITIES IN HEALTH AND HEALTH CARE DELIVERY

Researchers suggest that cultural insensitivity can create more than mere discomfort. It can create real barriers to accessing health care (Lester, 1998, p. 28)

VULNERABLE POPULATION
Groups that are especially susceptible for health-related problems include the poor, the homeless, migrant workers, abused individuals, the elderly, pregnant adolescents, and people with sexually transmitted diseases such as acquired immunodeficiency syndrome (AIDS).

The Poor
increase in either income or education increases the likelihood of good health status. This relationship between socioeconomic status and health was observed for persons in every race and ethnic group examined

The Poor
Childhood poverty has long-lasting negative effects on ones health. Childre in low-income families fare less well than children in more affluent families.

health risk factors that are related to lower income:

Higher prevalence of cigarette smoking Elevated blood pressure Sedentary lifestyle Less likely to be covered by health insurance Less likely to receive preventive health care services

Folk Medicine
Folk healers are knowledgable about cultural norms and are usually familiar to the one seeking care (Edelman & Mandle, 1997)

The patient-centered orientation of nursing makes it imperative that nurses be able to respond to the unique cultural needs of different people. Nurses are challenged to provide effective caring and curing in varied cultural contexts

The Homeless
Those who are homeless are at greater risk for illness and injuries (Edelman & Mandle, 1997).

Hatton (1997) identified the following as major health care needs of homeless women: mental health, sexually transmitted diseases, and substance abuse.

Societal factors that contribute to homelessness are: Lack of affordable housing Decreased availability of social services Inadequate or lack of employment A history of psychosocial trauma Deinstitutionalization of clients from mental health facilities without adequate community support (such as half-way houses and group homes)

COMMON HEALTH PROBLEMS EXPERIENCED BY THE HOMELESS

Diabetes
Lack of regularly scheduled nutritious meals Inadequate rest Insufficient exercise

AIDS Higher rate of sexual assault Intravenous drug use Lack of treatment or inadequate follow-up

Respiratory diseases
Crowded living conditions Inadequate nutrition Limited or no access to treatment facilities

CARDIOVASCULAR DISEASE
Impaired peripheral circulation as a result of extended time of walking on the streets and/or sleeping in upright, seated position

Food served in many shelters has a high sodium content Consumption of alcohol and tobacco products

Parasitic infestations
Shared personal items (clothing, bedding, hairbrushes) Close physical contact (as in shelters) Lack of facilities for bath, showers Inability to treat all those in contact with the affected person

The American Nurses Association (1994) states that culture is a central concept of nursing.

TRANSCULTURAL NURSING

TRANSCULTURAL NURSING
a term sometimes used interchangeably with cross-cultural, intercultural, or multicultural nursing, refer to a formal area of study and practice that focuses on the cultural care (caring) values, beliefs, and practices of individuals and groups from a particular culture (Giger & Davidhizar, 1999).

TRANSCULTURAL NURSING
Every culture has some kind of system for health care that is based on values and behaviors. Cultures have certain methods for providing health care. These methods of care are often unknown to nurses from other cultures (Leininger, 1978).

TRANSCULTURAL NURSING
In 1978, Dr. Madeleine Leininger, the originator of the concept of transcultural nursing, stated that nursing is caring, and the core of transcultural nursing is caring for people from diverse cultural contexts.

Culture care accommodation

refers to those professional actions and decisions that a nurse makes in his or her care to help people of a designated culture achieve a beneficial or satisfying health outcome.

Culture care restructuring or repatterning

refers to those professional actions and decisions that help patients reorder, change, or modify their lifestyles toward new, different, or more beneficial health care patterns. At the same time, the patients cultural values and beliefs are respected, and a better or healthier lifestyle is provided.

Acculturation the process by which members of a cultural group adapt to or learn how to take on the behaviors of another group.

Cultural blindness
the inability of a person to recognize his or her own values, beliefs, and practices and those of others because of strong ethnocentric tendencies (the tendency to view ones own culture as superior to others).

Cultural imposition
the tendency to impose ones cultural beliefs, values, and patterns of behavior on a person or persons from a different culture.

Cultural taboos
activities governed by rules of behavior that are avoided, forbidden, or prohibited by a particular cultural group.

CULTURAL COMPETENCE
Cultural competence is the process through which the nurse provides care that is appropriate to the clients cultural context. Culturally competent nurses are those who demonstrate knowledge and understanding of the client culture; accept and respect cultural differences; and adapt care to be congruent with the clients culture (Purnell & Paulanka, 1998).

Elements of Cultural Competence

Cultural Skill The nurses ability to perform a culturally specific assessment (i.e., physical and psychosocial) A cognitive process in which the nurse becomes aware of and sensitive to the clients cultural values, beliefs, and practices

Cultural Awareness

Elements of Cultural Competence

Cultural Knowledge Cultural Encounters Cultural Desire The nurse seeks a sound educational base about different cultures. The nurse interacts with clients from diverse cultural backgrounds. The nurses motivation (want to) to become culturally competent

CUES THAT SIGNAL LACK OF EFFECTIVE COMMUNICATION

Efforts to change the subject

This could indicate that the patient does not understand what you are saying and is attempting to talk about something more familiar.

Absence of questions
Paradoxically, this often means that the listener is not grasping the message and therefore has difficulty formulating questions to ask

Inappropriate laughter
A self-conscious giggle may signal poor comprehension and may be an attempt to disguise embarrassment.

Nonverbal cues
Although a blank expression may signal poor understanding, among some Asian Americans it may reflect a desire to avoid overt expression of emotion. Similarly, avoidance of eye contact may be a cultural expression of respect for the speaker; some Native Americans and Asian Americans use this gesture.

COMPLEMENTARY AND ALTERNATIVE THERAPIES

Interventions for alterations in health and wellness vary among cultures.

Alternative medical systems

complete systems of theory and practice that are different from conventional medicine. EXAMPLES Acupuncture Herbal medicine Oriental massage Ayurveda, Indias alternative medicinek (including diet, exercise, meditation, herbal medicine, massage, exposure to sunlight, and controlled breathing to restore harmony of an individuals body, mind, and spirit)

Alternative medical systems

Homeopathic medicine (including herbal medicine and minerals) naturopathic medicine (including diet, acupuncture, herbal medicine, hydrotherapy, spinal and soft-tissue manipulation, electrical currents, ultrasound and light therapy, therapeutic counseling, and pharmacology)

Mindbody interventions
defined as techniques to facilitate the minds ability to affect symptoms and bodily functions.

Some examples are meditation, dance, music, art therapy, prayer, and mental healing.

Biologically based therapies

defined as natural and biologically based practices, interventions, and products. Example herbal therapies (an herb is a plant or plant part that produces and contains chemical substances thatact upon the body), special diet therapies (such as those of Drs. Atkins, Ornish, and Pritikin) orthomolecular therapies (magnesium, melatonin, megadoses of vitamins) biologic therapies (shark cartilage, bee pollen).

Manipulative and body-based methods

defined as interventions based on body movement. Examples: chiropracty (primarily manipulation of the spine) osteopathic manipulation massage therapy (soft tissue manipulation), and reflexology

Energy therapies
defined as interventions that focus on energy fields within the body (biofields) or externally (electromagnetic fields) EXAMPLES

Qi gong Reiki Therapeutic touch Pulse electromagnetic fields Magnetic fields Alternating electrical current direct electrical current.

CAUSES OF ILLNESS

BIOMEDICAL OR SCIENTIFIC
The basic assumptions underlying the biomedical perspective are that all events in life have a cause and effect, that the human body functions much like a machine, and that all of reality can be observed and measured

NATURALISTIC OR HOLISTIC
According to this view, the forces of nature must be kept in natural balance or harmony. The treatment of disease consists of adding or subtracting cold, heat, dryness, or wetness to restore the balance of these humors According to the naturalistic world view, breaking the laws of nature creates imbalances, chaos, and disease

MAGICO-RELIGIOUS
the world is an arena in which supernatural forces dominate and that the fate of the world and those in it depends on the action of supernatural forces for good or evil. Belief in spiritual power is also held by many nurses who credit supernatural forces with various unexplained phenomen related to patients health and illness states.

MAJOR NURSING

INTERVENTIONS WHEN CARING FOR CULTURALLY DIVERSE CLIENTS

Self-Awareness
Self-awareness can be used to help nurses recognize their own stereotypes, biases, and prejudgments about clients who are culturally different. Further experience introspection, and study empower nurses to appreciate their own cultures and the strengths of other cultures.

Nonjudgmental Approach
When caring in a manner sensitive to the clients cultural background, the nurse enables the client to offer open, honest feedback, to disagree, or to discuss real or perceived problems. A key component of successful interactions with culturally diverse patients is to avoid using stereotypical, judgmental words (Ward-Collins, 1998, p. 30).

Client Education
Education must be relevant not only to the clients needs but also must be provided in a culturally sensitive manner

you need to present the information in a way that the patient grabs onto what is important to her. We need to learn how to present teaching so that people can hear it. If people cant hear it, then we will not succeed in what we are trying to teach