cultural diversity

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  1. cultural diversity
    includes, but is not limited to, people of varying cultures, racial and ethnic origin, religion, language, physical size, gender, sexual orientation, age, disability, socioeconomic status, occupational status, and geographic location. The essential knowledge and skills of understanding cultural diversity and providing culturally competent care have become essential components of nursing practice. Cultural diversity, including culture, ethnicity, and race, is an integral component of both health and illness because of the cultural values and beliefs we learn in our families and communities, as well as the need to know physiological characteristics common to certain populations that influence health. To be able to provide culturally competent care to people from diverse backgrounds, nurses must be sensitive to these factors. It is also vital to remember that each individual may be a member of multiple cultural, ethnic, and racial groups at one time. Therefore, different cultural values may guide an individual in different situations based on what is most important to them at the time.
  2. Culture
    may be defined as a shared system of beliefs, values, and behavioral expectations that provides social structure for daily living. Culture defines roles and interactions with others as well as within families and communities, and is apparent in the attitudes and institutions unique to particular groups.
  3. The characteristics of culture include the following:
    • • Culture guides what is acceptable behavior for people in a specific group. It is shared by, and provides an identity for, all members of the same cultural group.
    • • Culture is learned by each new generation through both formal and informal life experiences. Language is the primary means of transmitting culture.
    • • The practices of a particular culture often arise because of the group’s social and physical environment.
    • • Cultural practices and beliefs may evolve over time, but they mainly remain constant as long as they satisfy a group’s needs.
    • • Culture influences the way people of a group view themselves, have expectations, and behave in response to certain situations. Because a culture is made up of individuals, there are differences both within cultures and among cultures.
  4. subcultures
    A subculture is a large group of people who are members of an even larger cultural group, but who have certain ethnic, occupational, or physical characteristics that are not common to the larger culture. For example, nursing is a subculture of the larger healthcare system culture, and teenagers and older adults are often regarded as subcultures of the general population in the United States.
  5. Societies include both dominant culture groups and minority culture groups.
    A dominant group is the group that has the most ability to control the values and sanctions of the society. It usually is (but does not have to be) the largest group in a society. Minority groups usually have some physical or cultural characteristic (such as race, religious beliefs, or occupation) that identifies the people within it as different from the dominant group.
  6. cultural assimilation or acculturation
    When a minority group lives within a dominant group, many of their members may lose the cultural characteristics that once made them different, and their values may be replaced by the values of the dominant culture. For example, when people immigrate and encounter a new dominant culture, as they go to work, go to school, and learn the dominant language, they often move closer to the dominant culture. The process and the rate of assimilation are individualized. Mutual cultural assimilation also does occur, with somecharacteristics of both groups being traded. For example, many Hispanic immigrants to the United States learn to speak English, and many Americans learn to cook and enjoy traditional Hispanic foods. In this way, we gain from the many cultures with which we live. Although we seldom think about it, the clothes we wear, the foods we eat, the music we enjoy, many of the words we use, and the leisure activities we practice are all characteristics in which we have become acculturated.
  7. culture shock
    the feelings a person experiences when placed in a different culture perceived as strange. Culture shock may result in psychological discomfort or disturbances, as the patterns of behavior a person found acceptable and effective in his or her own culture may not be adequate or even acceptable in the new one. The person may then feel foolish, fearful, incompetent, inadequate, or humiliated. These feelings eventually can lead to frustration, anxiety, and loss of self-esteem.
  8. Ethnicity
    is 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 through adoption of characteristics of that group. People within an ethnic group generally share unique cultural and social beliefs and behavior patterns, including language and dialect, religious practices, literature, folklore, music, political interests, food preferences, and employment patterns. Ethnicity largely develops through day-to-day life with family and friends within the community.
  9. race
    Although the term ethnicity often is used interchangeably with race, these terms are not the same. Racial categories are typically based on specific physical characteristics such as skin pigmentation, body stature, facial features, and hair texture. Because of the significant blending of physical characteristics through the centuries, however, race is becoming harder to define using the simple classifications once used, and physical characteristics are not considered a reliable way to determine an individual’s race. Federal standards for race classification provide five categories including American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White, and provide the opportunity for an individual to identify themselves in multiple categories.
  10. stereotyping
    When one assumes that all members of a culture, ethnic group, or race act alike. Stereotyping may be positive or negative. Negative stereotyping includes racism, ageism, and sexism. These are beliefs that certain races, an age group, or one gender is inherently superior to others, leading to discrimination against those considered inferior.
  11. cultural imposition
    is the belief that everyone should conform to your own belief system
  12. cultural blindness
    occurs when one ignores differences and proceeds as though they do not exist. This has been true of the healthcare system, especially in regard to what are considered nontraditional methods of care.
  13. Culture conflict
    occurs when 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.
  14. a hereditary disorder, Tay-Sachs disease, is associated with individuals of Eastern European Jewish descent. Although the incidence of this disorder has declined over the years due to improved and earlier testing, it is still a concern. Use knowledge of these individualized risk factors when interviewing a patient to complete a health history.
  15. common health problems in American Indians and Alaska Natives
    • Heart disease
    • Cirrhosis of the liver
    • Diabetes mellitus
    • Fetal alcohol syndrome
  16. common health problems in African Americans
    • Hypertension
    • Stroke
    • Sickle cell anemia
    • Lactose intolerance
    • Keloids
  17. common health problems in Asian/Pacific Islanders
    • Hypertension
    • Cancer of the liver
    • Lactose intolerance
    • Thalassemia
  18. common health problems in Hispanics
    • Diabetes mellitus
    • Lactose intolerance
  19. common health problems in Whites
    • Breast cancer
    • Heart disease
    • Hypertension
    • Diabetes mellitus
    • Obesity
  20. Nursing care for the patient in pain is always individualized, but important culture-sensitive considerations include the following:
    • • Recognize that culture is an important component of individuality and that each person holds (and has the right to hold) various beliefs about pain.
    • • Respect the patient’s right to respond to pain in whatever manner is culturally and individually appropriate.
    • • Never stereotype a patient’s perceptions or responses to pain based on the person’s culture.
  21. ataques
    In times of high stress or anxiety, some Puerto Ricans may demonstrate a hyperkinetic seizure activity known as ataques. This behavior is a culturally accepted reaction. Be aware of these variations and accept them as culturally appropriate.
  22. How do hispanics deal with mental illness?
    many Hispanic people deal with problems within the family and would view it as inappropriate to tell problems to a stranger.
  23. How do Traditional Chinese people view mental illness?
    Traditional Chinese people often consider mental illness a stigma; therefore, seeking psychiatric help would be a disgrace to the family.
  24. In many cultures, the man is the dominant figure and generally makes decisions for all family members. On the other hand, in many African American and Caucasian families, the woman is often dominant. Knowing who is the dominant member of the family is important when planning nursing care.
  25. direct eye contact may be considered impolite or aggressive by:
    Asians, Native Americans, Indochinese, Arabs, and Appalachians; these groups of people tend to avert their eyes while speaking with another. Hispanics may look downward in deference to age, gender, social position, economic status, and authority. Muslim–Arab women indicate modesty by avoiding eye contact with men, and Hasidic Jewish men tend to avoid direct eye contact with women.
  26. Personal space
    the area around a person regarded as part of the person. This area, individualized to each person and to different cultures and ethnic groups, is the area into which others should not intrude during personal interactions. If others do not consider a person’s personal space, that person may become uncomfortable or even angry. When providing nursing care that involves physical contact, you should know the patient’s cultural personal space preferences. For example, people of Arabic and African origin commonly sit and stand close to one another when talking, whereas people of Asian and European descent are more comfortable with some distance between themselves and others.
  27. in some South Asian cultures, being late is considered a sign of respect. In addition, while some cultures are future-oriented (including activities that promote future good health), other cultures are more concerned with the present or the past. Understanding the patient’s orientation to time is important as you communicate, for example, the need to be on time for appointments for healthcare procedures and when taking medications.
  28. CULTURALLY SENSITIVE NUTRITION ASSESSMENT
    • 1. Which foods are considered edible and which are not?
    • • In France, corn is considered an animal feed, whereas corn is a commonly eaten vegetable in the United States.
    • • Religious beliefs prohibit some Jewish, Muslim, and Seventh-Day Adventist patients from eating pork.
    • • Patients who follow a vegetarian diet do not eat pork, beef, or chicken.

    • 2. What times and types of food are considered meals?
    • • Anglo-Americans typically eat three meals a day, with foods such as bacon and eggs or cereal for breakfast, sandwiches and soup for lunch, and meat with potatoes and vegetables for dinner.
    • • Vietnamese may eat soup for every meal.
    • • Beans are a staple for meals among Mexican people.
    • • People from Middle Eastern countries often eat cheese and olives for breakfast.
    • • Native American and Latin American people usually eat two meals a day.
    • • Rural southern African Americans may eat large amounts of food on weekends and less food at meals during the week.
    • • Holy days or religious holidays influence food choices for almost all cultures.
  29. A report from the U.S. Census Bureau (2008) noted that an estimated 13% of the U.S. population had income below the poverty threshold. Of that population, the lowest income was found in African Americans, American Indians, and Alaska Natives.
  30. poverty
    There has been much debate about how to define poverty. In terms of economics, a person or family whose income falls below the poverty line is considered poor. The U.S. Census Bureau defines poverty by using a set of money/income guidelines that vary by family size and composition. If the family’s total income is less than that family’s threshold, all members of the family are considered poor. Others have stated that poverty is a relative term that reflects a judgment on the basis of community standards. Such standards vary at different times and in different places; what is judged poverty in one community might be regarded as wealth in another. No matter how poverty is defined, it is an increasingly devastating epidemic, fueled by real estate foreclosures and credit debt that has evolved into a culture of its own. At highest risk are children, older people, families headed by single mothers, and future generations of those now living in poverty. The amount of money a person or family has affects how they meet their basic needs and maintain their health. Poverty leads to other problems such as lack of health insurance, care of infants and children, and homelessness. All these areas are of concern to nursing. The feminization of poverty threatens to increase the number of people who are living at poverty level. The number of female-headed households is increasing as a result of divorce, abandonment, unmarried motherhood, and changes in abortion laws. Because it is now common in many households that two incomes are required for economic survival, a single woman supporting a household is at a financial disadvantage. The number of single-parent families headed by women is associated closely with the increasing number of children living in poverty and the number of homeless families with children. The increasing population of older people has also raised problems associated with poverty. Many older people live on fixed incomes that often do not keep up with inflation, and many (particularly widows) are on the borderline of poverty or have already slipped below the poverty level. Socioeconomic status often differs by the cultural group of the older adult. For example, Pacific/Asian, African American, Native American, and Hispanic elders generally have lower incomes than do elders in the Anglo-American majority population. The work history of the cultural group, especially those who have worked all their lives as agricultural workers, often means an individual has no Social Security or Medicare benefits. In some cases, the culture of poverty is passed from generation to generation. This appears to be especially true in such groups as migrant farm workers, families living on welfare, and people who live in isolated areas of Appalachia. Poverty has long been a barrier to adequate healthcare. It prevents many people from consistently meeting their basic human needs. The lack of affordable or adequate housing is a problem experienced frequently by poor people. When low-income housing is available, it sometimes lacks such necessities as running water, heat, and electricity. To stretch their available money and to pool resources, many poor people live in crowded conditions, with several families living together in one household. Research has demonstrated that crowded living conditions foster depersonalization, correlate with higher crime rates, and lead to psychological problems such as schizophrenia, alienation, and feelings of worthlessness. Such conditions also contribute to an increased incidence of disease and illness because of the proximity of people, the sharing of utensils and belongings, poor sanitation, and poor health habits. The health effects of such conditions include a higher incidence and severity of illness in poor people than in people of higher income groups. Accessing healthcare facilities frequently requires transportation, which many times is neither affordable nor available to poor people. Their access to health insurance also is frequently limited, and they often must choose between purchasing food and purchasing healthcare. Those in upper income groups tend to live longer and to experience less disability than those in lower-income groups. Other barriers to healthcare include isolation, language or communication difficulties, seasonal occupations, migration patterns, depersonalization, and institutional prejudice.
  31. Poverty cultures have the following characteristics:
    • • Feelings of despair, resignation, and fatalism
    • • Day-to-day attitude toward life, with no hope for the future
    • • Unemployment and need for financial or government aid
    • • Unstable family structure, possibly characterized by abusiveness and abandonment
    • • Decline in self-respect and retreat from community involvement
  32. in some groups, illnesses are classified as natural or unnatural
    “Natural illnesses” are caused by dangerous agents, such as cold air or impurities in the air, water, or food. “Unnatural illnesses” are punishments for failing to follow God’s rules, resulting in evil forces or witchcraft causing physical or mental health problems.
  33. Therapeutic Touch
    is an intentional act that involves an energy transfer from the healer to the patient to stimulate the patient’s own healing potential.
  34. Acupuncture
    long used in China, is a method of preventing, diagnosing, and treating pain and disease by inserting special needles into the body at specified locations.
  35. acupressure
    involves a deep-pressure massage of appropriate points of the body
  36. When a nurse with a particular set of cultural values about health interacts with a patient who has his or her own set of cultural values about health, the following factors affect this interaction:
    • • The cultural background of each participant
    • • The expectations and beliefs of each about healthcare
    • • The cultural context of the encounter (e.g., hospital, clinic, home)
    • • The degree of agreement between the two persons’ sets of beliefs and values
  37. The following nursing diagnoses are examples of those that might be appropriate for providing culturally competent care:
    • • Impaired Verbal Communication related to inability to speak English and interpreter unavailable
    • • Social Isolation related to recent move away from neighborhood and friends of same ethnic group
    • • Impaired Parenting related to use of culturally based discipline considered inappropriate or abusive by current country of residence
    • • Spiritual Distress related to inability to take part insignificant culturally based rituals regularly
    • • Readiness for Enhanced Family Process related to request for information about child care
    • • Ineffective Management of Therapeutic Regimen (Individual) related to mistrust of traditional healthcare personnel
    • • Situational Low Self-Esteem related to language difficulties and inability to secure employment
    • • Powerlessness related to inability to make healthcare providers understand the importance of dietary and social values and beliefs
  38. Cultural imposition in healthcare
    is the tendency for health personnel to impose their beliefs, practices, and values on people of other cultures.
  39. ethnocentrism
    Closely related to cultural imposition, the belief that one’s own ideas, beliefs, and practices are the best, are superior, or are most preferred to those of others. When health professionals assume that they have the right to make choices and decisions for patients, patients may respond in the same way that minority cultures often respond to such an attitude by the dominant culture: by becoming passive, resistive, angry, or resistant to treatment.
  40. CULTURAL NORMS OF THE HEALTHCARE SYSTEM
    • Beliefs
    • • Standardized definitions of health and illness
    • • Omnipotence of technology

    • Practices
    • • Maintenance of health and prevention of illness
    • • Annual physical examinations and 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
  41. ASSURING CULTURAL COMPETENCE IN HEALTHCARE
    • • Ensure that all patients/consumers receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.
    • • Implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.
    • • Ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.
    • • Offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.
    • • Make available easily understood patient-related materials and post signs in the language of the commonly encountered groups and/or groups represented in the service area.
    • • Ensure that data on the individual patient’s/consumer’s race, ethnicity, and spoken and written language are collected in health records, integrated into the organization’s management information systems,and periodically updated.
    • • Maintain a current demographic, cultural, and epidemiological profile of the community, as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area.
  42. TRANSCULTURAL ASSESSMENT: HEALTH-RELATED BELIEFS AND PRACTICES
    • 1. To what cause(s) does the patient attribute illness and disease (e.g., divine wrath, imbalance in hot/cold or yin/yang, punishment for moral transgressions, hex, soul loss, pathogenic organism)?
    • 2. What are the patient’s cultural beliefs about the ideal body size and shape? What is the patient’s self-image compared to the ideal?
    • 3. What name does the patient give to his or her health related condition?
    • 4. What does the patient believe promotes health (eating certain foods; wearing amulets to bring good luck; sleep; rest; good nutrition; reducing stress; exercise; prayer; rituals to ancestors, saints, or intermediate deities)?
    • 5. What is the patient’s religious affiliation (e.g., Judaism, Islam, Pentecostalism, West African voodooism, Seventh-Day Adventism, Catholicism, Mormonism)? How actively involved in the practice of this religion is the patient?
    • 6. Does the patient rely on cultural healers (e.g., curandero, shaman, spiritualist, priest, minister, monk)? Who determines when the patient is sick and when the patient is healthy? Who influences the choice/type of healer and treatment that should be sought?7. In what types of cultural healing practices does the patient engage (use of herbal remedies, potions, massage; wearing of talismans, copper bracelets, or charms to discourage evil spirits; healing rituals, incantations, prayers)?
    • 8. How are biomedical/scientific healthcare providers perceived? How does the patient and his or her family perceive nurses? What are the expectations of nurses and nursing care?
    • 9. What comprises appropriate “sick role” behavior? Who determines what symptoms constitute disease/illness? Who decides when the patient is no longer sick? Who cares for the patient at home?
    • 10. How does the patient’s cultural group view mental disorders? Are there differences in acceptable behaviors for physical versus psychological illnesses?
  43. Transcultural nursing care
    has been both developed as a specialty and established as a formal area of practice as the result of theory development by Dr. Madeleine M. Leininger, a nurse–anthropologist. Her Theory of Cultural Care Diversity and Universality provides the foundation for providing culturally competent care for patients of all ages, as well as to families, groups, and communities. A nurse who is culturally competent has the knowledge and skills to adapt nursing care to cultural similarities and differences. Cultural competence takes time. It involves developing awareness, acquiring knowledge, and practicing skills.
  44. Nurses must incorporate knowledge of the health-related effects of the practice of Islam on Arab Muslims in health promotion activities. Selected examples include:
    • • The Islamic religion does not allow the use of healthcare professionals of the opposite gender unless it is impossible to locate one of the same gender.
    • • Some Muslims might not participate in health promotion activities because they believe God has preordained their life.
    • • Issues such as safe sex and family planning cannot be discussed with Arab teenagers because no sexual relations are accepted before marriage.
    • • Abortion is prohibited, unless the mother’s life is threatened by the pregnancy.
    • • Giving intravenous fluids leads Muslims to break their fast.
    • • Organ transplantation is allowed only in the case of saving a patient’s life.

    Muslims believe that God created humans and gave them their bodies as gifts to be cared for through general hygiene, diet, and exercise. However, there are also Islam tenets that might hinder health promotion, including the reluctance of Muslim women to expose their bodies or reveal their health problems to male healthcare providers. In addition, the American healthcare system is more complex than those in Arab countries, and language barriers, cultural misconceptions, and perceptions of disrespect toward Arabs are other examples of obstacles in seeking care. As a result, although the Arab Muslim population is at increased risk for heart disease, diabetes, and cancer, they may lack the knowledge or skills to prevent, detect, and treat these diseases.
  45. White Middle Class cultural factors that affect nursing care
    • Family
    • • Nuclear family is highly valued.
    • • Elderly family members may live in a nursing home when they can no longer care for themselves.

    • Folk and Traditional Healthcare
    • • Self-diagnosis of illnesses
    • • Use of over-the-counter drugs (especially vitamins and analgesics)
    • • Dieting (especially fad diets)
    • • Extensive use of exercise and exercise facilities

    • Values and Beliefs
    • • Youth is valued over age
    • • Cleanliness
    • • Orderliness
    • • Attractiveness
    • • Individualism
    • • Achievement
    • • Punctuality

    • Nursing Considerations
    • • Careful assessment of client’s use of over-the-counter medications (observe for signs and symptoms of toxic medication levels, especially fat-soluble vitamins)
    • • Nutritional assessments of dietary habits
  46. African American's cultural factors that may affect nursing care
    • Family
    • • Close and supportive extended-family relationships
    • • Strong kinship ties with nonblood relatives from church ororganizational and social groups
    • • Family unity, loyalty, and cooperation are important.
    • • Usually matriarchal

    • Folk and Traditional Healthcare
    • • Varies extensively and may include spiritualists, herb doctors, root doctors, conjurers, skilled elder family members, voodoo, faith healing

    • Values and Beliefs
    • • Present oriented
    • • Members of the African American clergy are highly respected in the black community.
    • • Frequently highly religious

    • Nursing Considerations
    • • Many African American families may still use various folk healing practices and home remedies for treating particular illnesses.
    • • Special care may be necessary for the hair and skin.
    • • Special consideration should be given to the sometimes extensive and frequently informal support networks of patients (i.e., religious and community group members who offer assistance in a time of need).
  47. Asian cultural factors that may affect nursing care
    (Beliefs and practices vary, but most Asian cultures share some characteristics.)

    • Family
    • • Welfare of the family is valued above the person.
    • • Extended families are common.
    • • A person’s lineage (ancestors) is respected.
    • • Sharing among family members is expected.

    • Folk and Traditional Healthcare
    • • Theoretical basis is in Taoism, which seeks a balance in all things.
    • • Good health is achieved through 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 (e.g., treat a cold disease with hot foods).
    • • Many Asian healthcare systems use herbs, diet, and the application of hot or cold therapy. Also, many Asians believe that there are points on the body that are located on the meridians or energy pathways. If the energy flow is out of balance, treatment of the pathways may be necessary to restore the energy equilibrium.
    • Acumassage—Technique of manipulating points along the energy pathways
    • Acupressure—Technique for compressing the energy pathway points
    • Acupuncture—Technique by which fine needles are inserted into the body at energy pathway points

    • Values and Beliefs
    • • Strong sense of self-respect and 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
    • • Some members of Asian cultures 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 members believe that it is best to die with the body intact, so they may refuse surgery except in dire circumstances.
    • • Members of many Asian cultures seldom complain about what is bothering them. Therefore, the nurse must carefully assess the patient for pain or discomfort by observing for nonverbal signs of discomfort, such as facial grimacing or wincing and holding of the painful area.
    • • Some Asians consider it polite to give a person the responses the person is expecting. Therefore, misinformation may be transmitted to the questioner in an effort, on the client’s part, to be respectful.
    • • Some members may move from physician to physician in an attempt to be cured of an illness, but to avoid insulting or embarrassing a physician, they will not inform him or her that they are going to another physician. This can result in confusion, inaccuracies, and overmedication.
    • • Some Asians may refuse to have diagnostic studies done because they believe that a skilled and competent physician can diagnose an illness solely through a physical examination.
    • • Some members may have a difficult time understanding the importance of taking a regimen of medications because many of their folk treatments involve the ingestion of one dose of herbal mixtures.
    • • Dietary counseling may be necessary if the patient is on a salt-restricted diet because many Asian foods have a high salt content related to the use of soy sauce.
  48. Hispanic cultural factors that affect nursing care
    • Family
    • • Familial role is important.
    • • Compadrazgo: special bond between a child’s parents and his or her grandparents
    • • Family is the primary unit of society.

    • Folk and Traditional Healthcare
    • • Curanderas(os): folk healers who base treatments on humoral pathology—basic functions of the body are controlled by four body fluids or “humors”:
    • Blood—hot and wet
    • Yellow bile—hot and dry
    • Black bile—cold and dry
    • Phlegm—cold and wet
    • • The secret of good health is to balance hot and cold within the body; therefore, most foods, beverages, herbs, and medications are classified as hot (caliente) or cold (fresco, frio) (a cold disease will be cured with a hot treatment).

    • Values and Beliefs
    • • Respect is given according to age (older) and sex (male).
    • • Roman Catholic Church may be very influential.
    • • God gives health and allows illness for a reason; therefore, may perceive illness as a punishment from God. An illness of this type can be cured through atonement and forgiveness.

    • Nursing Considerations
    • • It may be difficult to convince an asymptomatic patient that he or she is ill.
    • • Special diet considerations are necessary if the patient believes in the hot/cold theory of treating illnesses.
    • • Diet counseling may be necessary at times, because many members have a normal diet that is high in starch.
  49. Puerto Rican cultural factors that affect nursing care
    (Since the Jones Act of 1917, all Puerto Ricans are American citizens.)

    • Family
    • • Compadrazgo—same as in Hispanic culture

    • Folk and Traditional Healthcare
    • • Similar to that of other Spanish-speaking cultures

    • Values and Beliefs
    • • Place a high value on safeguarding against group pressure to violate a person’s integrity (may be difficult for Puerto Ricans to accept teamwork)
    • • Close-mouthed about personal and family affairs (psychotherapy may be difficult to achieve at times because of this belief)
    • • Proper consideration should be given to cultural rituals, such as shaking hands and standing up to greet and say goodbye to people.
    • • Time is a relative phenomenon; little attention is given to the exact time of day.
    • • Ataques—culturally acceptable reaction to situations of extreme stress, characterized by hyperkinetic seizure activity

    • Nursing Considerations
    • • It may be difficult to teach Puerto Rican patients to follow time-oriented actions (e.g., taking medications, keeping appointments).
  50. Native American cultural factors that affect nursing care
    (Each tribe’s beliefs and practices vary to some degree.)

    • Family
    • • Families are large and extended.
    • • Grandparents are official and symbolic leaders and decision makers.
    • • A child’s namesake may become the same as another parent to the child.

    • Folk and Traditional Healthcare
    • • Medicine men (shaman) are heavily used.
    • • Heavy use of herbs and psychological treatments, ceremonies, fasting, meditation, heat, and massages

    • Values and Beliefs
    • • Present oriented. Taught to live in the present and not to be concerned about the future. This time consciousness emphasizes finishing current business before doing something else.
    • • High respect for age
    • • Great value is placed on working together and sharing resources.
    • • Failure to achieve a personal goal frequently is believed to be the result of competition.
    • • High respect is given to a person who gives to others. The accumulation of money and goods often is frowned on.
    • • Some Native Americans practice the Peyotist religion, in which the consumption of peyote, an intoxicating drug derived from mescal cacti, is part of the service. Peyote is legal if used for this purpose. It is classified as a hallucinogenic drug.

    • Nursing Considerations
    • • The family is expected to be part of the nursing care plan.
    • • Note taking often is taboo. It is considered an insult to the speaker because the listener is not paying full attention to the conversation. Good memory skills often are required by the nurse.
    • • Indirect eye contact is acceptable and sometimes preferred.
    • • It often is considered rude or impolite to indicate that a conversation has not been heard.
    • • A low tone of voice often is considered respectful.
    • • A Native American patient may expect the caregiver to deduce the problem through instinct and not through asking many questions and history taking. If this is the case, it may help to use declarative sentences rather than direct questioning.
  51. Hawaiian cultural factors that affect nursing care
    • Family
    • • Familial role is important.
    • • Ohana, or 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

    • Folk and Traditional Healthcare
    • • Kahuna La’au Lapa’nu is the ancient Hawaiian medical practitioner.
    • • View patient’s illness as part of the whole.
    • • Relationships among the physical, psychological, and spiritual
    • • Emphasis on preventive medicine
    • • Treatment uses more than 300 medicinal plants and minerals

    • Values and Beliefs
    • • Aloha: a deep love, respect, and affection between people and the land
    • • Christian God replaced the myriad of Hawaiian gods.
    • • Lifestyle more revered than compliance with healthcare issues
    • • Present oriented, less initiative and drive rather than direction and achievement
    • • Death seen as part of life and not feared

    • Nursing Considerations
    • • Many Hawaiians may still use folk healing practices and home remedies.
    • • Special consideration given to the extensive family network during hospitalization
    • • Acceptance from healthcare practitioners of current health practices and lifestyle
  52. Appalachian cultural factors that affect nursing care
    • Family
    • • Intense interpersonal relations
    • • Family is cohesive, and several generations often live close to you each other.
    • • Elderly are respected as providers.
    • • Tend to live in rural, isolated areas

    • Folk and Traditional Healthcare
    • • “Granny” woman, or folk healer, provides care and may be consulted even if receiving traditional care.
    • • Various herbs, such as foxglove and yellow root, are used for common illnesses such as malaise, chest discomfort, heart problems, and upper respiratory infections.
    • • Elderly may have had only limited contact with healthcare providers and be skeptical of modern healthcare.

    • Values and Beliefs
    • • Independence and self-determination
    • • Isolation is accepted as a way of life.
    • • Person oriented
    • • May be fatalistic about losses and death
    • • Belief in a divine existence rather than attending a particular church

    • Nursing Considerations
    • • Treat each person with regard for personal dignity.
    • • Allow family members to remain with patient as support system.
    • • Acceptance from healthcare providers of current health practices and lifestyle
    • • Allow patients to make decisions about care.
  53. Described below are different levels of response you might have toward a person.
    • Levels of Response
    • 1. Greet: I can greet this person warmly and welcome him or her sincerely.
    • 2. Accept: I can honestly accept this person as he or she is and be comfortable enough to listen to his or her problems.
    • 3. Help: I can genuinely try to help this person with his or her problems.
    • 4. Background: I have the background of knowledge and/or experience to be able to help this person.
    • 5. Advocate: I can honestly be an advocate for this person.
  54. respecting culturally based family roles
    Take into consideration the cultural role of the family member who makes most of the important decisions. In some cultures, it is the husband or father, whereas in others, it is the grandmother or another respected elder. To disregard this fact or to proceed with nursing care that is not approved by this person can result in conflict or in disregard for what has been taught. Be careful to involve this person in the nursing care planning.
  55. seeking cultural acceptance
    Seek assistance of a respected family member, member of the clergy, or traditional healer, as indicated, so that the patient is more likely to accept healthcare services. Acknowledging the role of the person’s traditional healer can be an important way of building trust. If invited, folk medicine practitioners can work closely with professional health practitioners in the interest of the patient and family. Such efforts promote mutual understanding, respect, and cooperation.
  56. Minority groups living within a dominant culture may lose the cultural characteristics that made them different. What is this process called?
    Cultural assimilation
  57. ethnocentrism
    occurs when one believes that one's own ideas and practices are superior to those of others.
  58. A Malaysian client is admitted to the health care facility with complaints of cramping pain in the abdomen and loose stools. Where should the nurse be seated when interviewing the client?
    At more than one arm's distance
  59. When providing nursing care to an African American individual, which of the following cultural factors should the nurse consider?
    Cultural factors that should be considered when providing care to the African American family include the recognition that the family is usually matriarchal, values and beliefs are present oriented, there is strong family unity and cooperation, and families are frequently highly religious and highly respect the African American clergy.
  60. Cultural blindness
    is characterized by ignoring cultural differences or considerations and proceeding as if they do not exist. This phenomenon may underlie the failure to incorporate cultural considerations into dietary choices.
  61. A client reports to the primary health care facility for routine physical examination after cardiac rehabilitation following myocardial infarction. Keeping in mind that the client is a Latino, how should the nurse conduct the interview?
    The nurse should avoid using medical terminology and make the examination as simple as possible. Many Latinos speak English as a second language and may not understand medical terminology. They may feel embarrassed to ask the nurse to repeat the information again. The nurse should avoid asking the client to express himself emotionally, as Latino men may have difficulty expressing themselves. It is not necessary to sit at a long distance and the questions may be either closed-ended or open-ended.
  62. Which definition of culture is most accurate?
    Culture is a belief system that the members of the culture hold, to varying degrees, consciously or unconsciously, as absolute truth. That belief system guides everyday behavior and makes it routine.
  63. When your patient, who is from a South Asian culture, arrives 25 minutes late to her appointment at your clinic, you recognize this as a sign of which of the following?
    respect
  64. The nurse is performing a nutrition assessment of a patient from the Middle East. What may the nurse expect as a traditional breakfast consumed by a patient from the Middle East?
    Cheese and olives
  65. How is the nursing profession becoming more culturally diverse?
    • • By the increased number of foreign-born nurses in the profession
    • • By the increased number of male nurses in the profession 
  66. In Seventh-Day Adventism, Judaism, and the Muslim religion, pork is prohibited. In Hinduism, all meat is prohibited. However, holy days or religious holidays influence food choices in almost all cultures and religions.

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