Copyright 2002, Delmar, A division of Thomson Learning Chapter 5 Cultural Assessment

Copyright 2002, Delmar, A division of Thomson Learning

Chapter 5

Cultural Assessment


Competencies Assess own cultural values, beliefs,

and behaviors. Identify potential areas of cultural

conflict between the values and customs of patients and their families and those of health care providers.


Competencies Identify increased health risks and

genetic traits, and disorders prevalent in selected ethnic, racial, and population groups.

Conduct a comprehensive cultural assessment.

Describe the process for providing culturally competent nursing care.


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Racial, Ethnic, and Cultural Diversity in the United States In 1999, the U.S. population was

comprised of 69.2% Euro-Americans 35.8% members of ethnic and cultural

minority groups Fastest growing minority group in

United States is Hispanics


Racial, Ethnic, and Cultural Diversity in the United States Trend toward increased racial,

ethnic, and cultural diversity is expected to continue into the 21st century


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Culturally Competent Nursing Care Identify cultural values and beliefs

of patients and families. Recognize normal behaviors of

different cultural groups and their response to health and illness.


Culturally Competent Nursing Care Identify ethnic variations on racial

growth patterns. Use cultural relativism ethic to

guide practice. Ultimate goal is to plan and

implement culturally sensitive nursing care.


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Key Terms: Culture Cultural diversity Acculturation Cultural relativism Ethnocentrism


Key Terms: Culture Bilingualism Multiculturalism Culture identity Culture shock Enculturated


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Culturally Competent Assessments Culture Subculture Racial group

Race Ethnic group

Ethnic identity


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Culturally Competent Assessments Minority group Cultural values Cultural norms Value orientations

Time Human nature Activity Relational People to nature


Culturally Competent Assessments Beliefs Cultural beliefs

Folk illness Scientific illness Personalistic illness Self-care practices


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Evaluating the Potential Physical or Psychological Harm from a Health Practice A practice would not be considered

harmful if the following conditions are met: Practice is sanctioned by that culture. Practice is within the limits of

deviations that are acceptable in that culture.


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Evaluating the Potential Physical or Psychological Harm from a Health Practice

Practice is important for the acceptance of the patient as a member of the culture.

The patient perceives that the practice is appropriate in this situation.


Evaluating the Potential Physical or Psychological Harm from a Health Practice

The intent of the health care provider is consistent with the cultural rules that govern the practice.


Customs and Rituals Difference between customs and

cultural rituals Communication patterns Cultural meaning of symptoms Language barriers Family and kinship relations


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Tips for Overcoming Language Barriers Speak slowly and distinctly Use gestures or pictures Avoid clichés, jargon, and value-

laden terms Avoid defensive or offensive body

language


Tips for Overcoming Language Barriers Obtain feedback to confirm accurate

understanding Provide reading material written in the

appropriate language Use an interpreter Speak to the patient, rather than the

interpreter Use the same interpreter for each

interaction (if possible)


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Cultural Characteristics and Health Care Beliefs and Practices Asian American: Chinese Communication styles

Self-expression is repressed Value silence Hesitant to ask questions May smile when does not understand Touching limited


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Cultural Characteristics: Chinese Family, social, work relationships

Hierarchical Defer to elderly and authority figures Value hard work and giving to society Preserve family’s honor, save face


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Cultural Characteristics: Chinese Health values and beliefs

Health is the result of balance between yin and yang

Respect body, believe body must remain intact

Health customs and practices Combine Western and traditional

Chinese medicine


Cultural Characteristics: Chinese

Immunizations acceptable May be skeptical of multiple

diagnostic tests


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Cultural Characteristics: Japanese Communication styles

Listen emphatically Touching is limited Direct eye contact is considered

disrespectful Stoic, suppress overt emotion Value self-control, politeness, and

personal restraint


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Cultural Characteristics: Japanese Family, social, work relationships

Close families, interdependent, intergenerational

Family’s needs greater than individual needs

Obligation to kin and work group Education highly valued


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Cultural Characteristics: Japanese Health values and beliefs

Illness caused by Contact with polluting agent Social or family disharmony Imbalance from poor health habits

Cleanliness valued


Cultural Characteristics: Japanese Health customs and practices

Utilization of Western medicine Oldest child cares for elderly Family cares for disabled May not express pain, due to stoic

expression


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Cultural Characteristics: Vietnamese Communication styles

Value respect and harmony Disrespectful to question authority Avoid direct eye contact Modest speech and actions Relaxed concept of time Avoid asking direct questions


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Cultural Characteristics: Vietnamese Family, social, work relationships

Close family, multigenerational Patriarchical decision making Family needs greater than individual’s

needs Education highly valued Individual behavior reflects on total

family


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Cultural Characteristics: Vietnamese Health values and beliefs

Illness caused by Naturalistic forces Supernaturalistic forces Metaphysical forces Or from contamination by germs


Cultural Characteristics: Vietnamese Health customs and practices

Western and folk medicine Use of herbs, therapeutic diets Family responsible for health care May consult priest, astrologer, shaman,

or fortune teller for guidance about health

Restore balance using hot or cold foods


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Cultural Characteristics: Filipinos Communication styles

Eye contact is avoided Sex, financial status are too personal to

discuss Engage in small talk before discussing

serious matters Values personal dignity and preserving

self-esteem


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Cultural Characteristics: Filipinos Family, social, work relationships

Strong family ties Multigenerational Family interests stronger than

individual needs Defer to elderly for guidance Individual behavior reflects on family


Cultural Characteristics: Filipinos Health values and beliefs

Illness related to Natural forces Supernatural forces Metaphysical forces

Fatalistic view Health customs and practices

Uses folk and scientific medicine Stoic expression; pain is God’s will


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Cultural Characteristics: African Americans Communication styles

May distrust majority group Expressive use of nonverbal behavior

and speech May use black English Values direct eye contact Values congruence between verbal and

nonverbal behavior


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Cultural Characteristics: African Americans Family, social, work relationships

Strong family ties 50% patriarchical, 50% matriarchical High level of respect for elderly Large social network


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Cultural Characteristics: African Americans Health values and beliefs

Illness is a collective event Illness disrupts the entire family

system Illness is a natural event resulting from

Conflict or disharmony in one’s life Failure to protect oneself Sent by God as a punishment


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Cultural Characteristics: African Americans Health customs and practices

Health maintained by diet, rest, clean environment

Self-care and folk medicine may be used

May use home remedies first before seeking medical care

Prayer is used for prevention and treatment


Cultural Characteristics: African Americans

Family minister may visit when ill or hospitalized to help patient cope with illness or suffering


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Cultural Characteristics: Hispanic Americans—Mexicans Communication styles

May be bilingual, may use nonstandard English

Introductory embrace common May revert to native language in times

of stress Value direct eye contact


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Cultural Characteristics: Mexicans

Prolonged eye contact is disrespectful Appreciate small talk before

conversation Responds best to open-ended questions May be hesitant to discuss sex

Family, social, work relationships Strong family bonds Respect wisdom of elders

Copyright 2002, Delmar, A division of Thomson Learning(continues)


Children are highly desired and valued Homes may be decorated with religious

articles Relaxed concept of time

Health values and beliefs Illness can be prevented by

Being good Eating proper foods Working proper amount of time


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Illness may also be prevented through prayer or wearing of religious medals or amulets

Illness may be caused by A body imbalance between hot and cold,

wet and dry Dislocation of body parts Magic or supernatural forces Punishment from god


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Present oriented, not future oriented Hospital may be viewed as place to die

Health customs and practices May use special holistic healers Prevent and treat illness with hot and

cold food prescriptions and prohibitions



May use religious rituals (prayer) and scientific medicine to treat severe illness

Extremely modest May be stoic in expression of pain


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Cultural Characteristics: Native Americans Communication styles

May speak their tribal language and English

Nonverbal communication important Unwavering eye gaze is insulting Hesitant to discuss personal affairs

until trust is developed Hesitant to discuss sex


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Cultural Characteristics: Native Americans Family, social, work relationships

Strong extended family Family members are responsible for

one another Elders are respected Children are valued Respect for traditions and to honor

wisdom


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Cultural Characteristics: Native Americans Health values and beliefs

Medicine and religion strongly interwoven

Health results from being in harmony with nature and universe

Do not believe in the germ theory Illness and pain are caused by

something that occurred in the past or will happen in the future


Cultural Characteristics: Native Americans

May use objects to guard against witchcraft

Health customs and practices May use traditional healers,

ceremonies, herbs to treat illness


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Cultural Characteristics: Middle Eastern Communication styles

Men and women do not shake hands or touch each other in any manner outside immediate family or marital relationships

Touching or embracing on arrival or departure are common among same sex

Use silence to show respect for another


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Cultural Characteristics: Middle Eastern Family, social, work relationships

Male-dominated society Eldest male is the decision maker Male children valued more than female

children Adult male may not be alone with any

female except his wife


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Cultural Characteristics:Middle Eastern Health values and beliefs

Magico-religious Will of Allah Illness may be caused by hot and cold or

evil eye Expect immediate pain relief from health

professionals “Heart disease” may mean emotional

distress


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Cultural Characteristics:Middle Eastern

Obligation to visit and care for the sick and ill

Health customs and practices Use magico-religious, folk, self-care,

and medical science Use of amulets, religious charms Same sex health care provider may be

required to examine or care for same sex patient


Cultural Characteristics:Middle Eastern

Male health professionals may not be able to examine female patients; female health professionals may not be able to care for male patients

Dead must be buried with the body intact

Female circumsion may be performed

Copyright 2002, Delmar, A division of Thomson Learning(continues)

Cultural Characteristics: Euro-Americans Communication styles

Nod to denote understanding Neutral facial expressions in public Hugs and embraces among close friends

are appropriate Pat on shoulder shows camaraderie Own personal space Firm handshake symbolic of goodwill Smile, speak pleasantly to others

Copyright 2002, Delmar, A division of Thomson Learning (continues)

Cultural Characteristics: Euro-Americans Family, social, work relationships

Nuclear family Encourage and nurture each individual Healthy, autonomous children Egalitarian decision making Future oriented Generous in times of crisis Value education and knowledge Competitive and achievement oriented


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Cultural Characteristics: Euro-Americans Health values and beliefs

Future oriented Control internal and external

environments Use of modern medicine and technology Illness result of injury or pathology Good health is a personal responsibility


Cultural Characteristics: Euro-Americans Health customs and practices

Self-care practices Balance between diet, rest, activity,

work, and leisure Intolerant of delays in health care

services Active participant in decisions

regarding health care

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Copyright 2002, Delmar, A division of Thomson Learning Chapter 5 Cultural Assessment