Culture and EthnicityCulture and Ethnicity

CultureCulture

Values, beliefs, norms & practices of a Values, beliefs, norms & practices of a particular groupparticular group

Learned and sharedLearned and shared

Guide thinking, decisions, & actions in a Guide thinking, decisions, & actions in a patterned waypatterned way

Concepts of Culture and EthnicityConcepts of Culture and Ethnicity Culture – a set of values, beliefs & traditions that are held Culture – a set of values, beliefs & traditions that are held

by a specific social group and handed down from by a specific social group and handed down from generation to generationgeneration to generation

Subculture – made up of people with a distinct identity, but Subculture – made up of people with a distinct identity, but who have certain ethnic, occupational or physical who have certain ethnic, occupational or physical characteristics that are found in the larger culturecharacteristics that are found in the larger culture

Dominant group – the group within the culture that has the Dominant group – the group within the culture that has the authority to control the value system.authority to control the value system.

Minority group – usually has some physical or cultural Minority group – usually has some physical or cultural characteristic that identifies the people within it as differentcharacteristic that identifies the people within it as different

““Despite being technically Despite being technically competent, a nurse can be competent, a nurse can be incompetent, formulating incompetent, formulating

unworkable interventions because unworkable interventions because of an unwillingness or inability to of an unwillingness or inability to understand the culturally different understand the culturally different

patient.” (West, 1994, .232)patient.” (West, 1994, .232)

““Having knowledge of a culture before trying Having knowledge of a culture before trying to help a client and family is analogous to a to help a client and family is analogous to a nurse or a physician having basic nurse or a physician having basic knowledge of anatomy and physiology knowledge of anatomy and physiology before doing physical assessment or before doing physical assessment or attempting to meet a patient’s attempting to meet a patient’s

physical needs.” Madeleine Leiningerphysical needs.” Madeleine Leininger

EthnicityEthnicity

The sense of The sense of identification that a identification that a cultural group cultural group collectively has, largely collectively has, largely based on the group’s based on the group’s common heritage. common heritage.

Race – Subculture of Race – Subculture of people characterized people characterized by specific by specific characteristics. characteristics.

CultureCulture

Culture AssimilationCulture Assimilation– AKA acculturationAKA acculturation– When minority groups living within the dominant When minority groups living within the dominant

group loose the cultural characteristics that group loose the cultural characteristics that make them different.make them different.

– Stereotyping – involves assigning Stereotyping – involves assigning characteristics to a group of people without characteristics to a group of people without considering specific individuality. considering specific individuality.

CultureCulture

Cultural Imposition – the belief that Cultural Imposition – the belief that everyone should conform to the majority everyone should conform to the majority belief system.belief system.

Cultural conflict – when one ridicules others Cultural conflict – when one ridicules others beliefs and traditions in an effort to make his beliefs and traditions in an effort to make his or her own values more secureor her own values more secure

Cultural and Ethnic Influences on Cultural and Ethnic Influences on Health CareHealth Care

Gender Roles – It is important to Gender Roles – It is important to know who is the dominant figure know who is the dominant figure in a familyin a family

Language and Communication Language and Communication – Some clients may not be able – Some clients may not be able to speak the English Languageto speak the English Language

Orientation to Space and time – Orientation to Space and time – personal spacepersonal space

Food and NutritionFood and Nutrition SocioeconomicSocioeconomic

PovertyPoverty

The culture of poverty- The culture of poverty- the highest risk the highest risk families are headed by families are headed by one income single one income single females, fixed income females, fixed income elderly and future elderly and future generations of those generations of those living in povertyliving in poverty

CharacteristicsCharacteristics

Feelings of despair, resignation Feelings of despair, resignation & fatalism& fatalism

Day to day attitude toward life Day to day attitude toward life with no hope for the futurewith no hope for the future

Unemployment and need for Unemployment and need for financial or government aidfinancial or government aid

Use of escape values such as Use of escape values such as alcohol and drugsalcohol and drugs

Unstable family structure with Unstable family structure with abusiveness and abandonmentabusiveness and abandonment

Decline in self respect and Decline in self respect and retreat from communityretreat from community

Effects of Poverty on Health CareEffects of Poverty on Health Care

Lack of affordable and adequate housingLack of affordable and adequate housing Crowded living conditionsCrowded living conditions The sick usually experience more The sick usually experience more

complicationcomplication Recovery time is longerRecovery time is longer Less likely to regain their preillness level of Less likely to regain their preillness level of

functioningfunctioning Lack of access to health care insuranceLack of access to health care insurance

Family SupportFamily Support

Some cultures have large extended families Some cultures have large extended families and are unable to share private information and are unable to share private information with anyone outside the family.with anyone outside the family.

Some cultures have great respect for elderly Some cultures have great respect for elderly and will not consider institutional careand will not consider institutional care

Physical and Mental HealthPhysical and Mental Health

Physiologic CharacteristicsPhysiologic Characteristics– Keloid formation – overgrowth of connective Keloid formation – overgrowth of connective

tissue that occurs during healing process of tissue that occurs during healing process of injury, surgery—African heritageinjury, surgery—African heritage

– Lactose intolerance - lack of lactase to break Lactose intolerance - lack of lactase to break down lactose during digestion - Hispanic, down lactose during digestion - Hispanic, African, Chinese, Thai.African, Chinese, Thai.

– Sickle Cell Anemia – sickle shaped red blood Sickle Cell Anemia – sickle shaped red blood cells. Most common in African or cells. Most common in African or Mediterranean ethnic background.Mediterranean ethnic background.

Continued…Continued…

Tay Sacks Disease – a gene for a hereditary disorder – have Tay Sacks Disease – a gene for a hereditary disorder – have very short life span – Eastern European, Jewish descent.very short life span – Eastern European, Jewish descent.

G6PD deficiency – enzyme deficiency. Red blood cells have G6PD deficiency – enzyme deficiency. Red blood cells have no cell membrane they are easily destroyed , which leads no cell membrane they are easily destroyed , which leads to anemia and increased billirubin levels. - 10% of African to anemia and increased billirubin levels. - 10% of African American populationAmerican population

Thalassemia – genetic disorder effecting the Hgb in RBC Thalassemia – genetic disorder effecting the Hgb in RBC function. Mediterranean, Asian, and African origin.function. Mediterranean, Asian, and African origin.

Sarcoidosis – formation of multiple tubercles or nodules on Sarcoidosis – formation of multiple tubercles or nodules on various parts of the body - African American population.various parts of the body - African American population.

Gout – An increase of uric acid in the blood -males especially Gout – An increase of uric acid in the blood -males especially from Puerto Rican or Filipino descent. from Puerto Rican or Filipino descent.

Psychological CharacteristicsPsychological Characteristics

In most situations an In most situations an individual will relate the individual will relate the behavior of another person behavior of another person to the individual’s own to the individual’s own familiar culture.familiar culture.

It is important to remember It is important to remember that what may seem that what may seem perfectly reasonable & perfectly reasonable & important to a client may important to a client may seem ridiculous and seem ridiculous and irrelevant to a nurse. The irrelevant to a nurse. The reverse perception may reverse perception may also exist.also exist.

Culture ShockCulture Shock

Feelings an individual Feelings an individual experiences when experiences when placed in a different placed in a different and often strange and often strange culture and may result culture and may result in psychological in psychological discomfort or discomfort or disturbances.disturbances.

Cultural Imposition and Cultural Imposition and EthnocentrismEthnocentrism

Cultural Imposition. – the Cultural Imposition. – the tendency for health tendency for health personnel to impose their personnel to impose their beliefs practices and beliefs practices and values of other cultures, values of other cultures, because they believe that because they believe that their ideas are superior.their ideas are superior.

Ethnocentrism – the belief Ethnocentrism – the belief that one’s own ideas, that one’s own ideas, beliefs and practices are beliefs and practices are the best and superior. the best and superior.

Providing Transcultural CareProviding Transcultural Care

Major Theme – Focus Major Theme – Focus on caring practices of on caring practices of various culturesvarious cultures

Nursing Role – Nursing Role – Understand the client’s Understand the client’s needs and to adapt needs and to adapt care to meet those care to meet those needs.needs.

Cultural AssessmentCultural Assessment

Identify factors that effect behavior by Identify factors that effect behavior by cultural assessmentcultural assessment– Values, religion, dietary practices, family lines of Values, religion, dietary practices, family lines of

authority, family life patterns and beliefs and authority, family life patterns and beliefs and practices related to health and illnesspractices related to health and illness

– See guidelines on pp 47 & 52See guidelines on pp 47 & 52– See table 3-1 on page 48-51See table 3-1 on page 48-51

Reaction to PainReaction to Pain

Reactions are Reactions are culturally prescribedculturally prescribed

……………….... Let’s Let’s discussdiscuss

Different Health PracticesDifferent Health Practices

Folk HealersFolk Healers

less expensive, more less expensive, more accessible and more accessible and more understanding of understanding of cultural needs . Speak cultural needs . Speak the client’s languagethe client’s language

Traditional Folk MedicineTraditional Folk Medicine

HerbsHerbs

Transcultural NursingTranscultural Nursing

Nursing care planned and implemented in a way Nursing care planned and implemented in a way that is sensitive to the needs of individuals, that is sensitive to the needs of individuals, families, and groups representing diverse cultural families, and groups representing diverse cultural populations.populations.

The culture of health care: Assess:The culture of health care: Assess:– the cultural backgroundthe cultural background– expectations and beliefs about healthcareexpectations and beliefs about healthcare– Cultural context of the encounterCultural context of the encounter– Degree of agreement between the 2 persons set of Degree of agreement between the 2 persons set of

beliefs and valuesbeliefs and values