Effect of culture in community health Dr {Naiema Gaber }

 Define culture, race, and ethnicity and cultures competency  Analyze the effect of culture on nursing practice.  Describe major barriers to developing cultural competence.  Compare and contrast the effects of cultural organizational factors on health and illness among culturally diverse groups in a community  Develop culturally competent nursing interventions to promote positive health outcomes for clients.

 Is a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted intergenerationally.  Culture is a dynamic process that develops over tome and resistant to change.  Culture provides tested solutions to life’s problems.

 Parents and family transfer of traditions, and teach both explicit and implicit behaviors of culture.  Explicit behaviors as language, interpersonal distance and the accepted behavior in public. It can be observed and allow the individual to identify the self with other persons  The implicit behaviors are less visible and include the way individuals perceive health and illness, body language, difference in language expressions and the use of titles. They are very much a part of the culture. For example; the value related to older adult.

 It is primarily a social classification that relies on physical markers such as skin color to identify group membership.  Individuals may be of the same race but of different cultures. For example: the black individuals have the same physical markers either in the USA or Africa or Asia.

 It is the shared feeling of people hood among a group of individuals.  It reflects cultural membership and is based on individuals sharing similar cultural patterns such as beliefs, values, customs, behaviors and traditions.  Ethnicity represents the identifying characteristics of culture as race, religion or national origin. It is influenced by education, income level, geographical location and association with individuals from ethnic groups other than one’s own.

 Cultural competence in nursing is a combination of culturally congruent behaviours, practice attitudes and politics that allows nurses to work effectively in cross-cultural situations.  Cultural competence in nurse function effectively when caring for clients of other cultures.  Cultural competence reflects a higher level of knowledge than cultural Sensitivity.

 1- care is designed for the specific client  2- Care is based on the Uniqueness of the patient’s culture  3-Care includes self-empowerment strategic to facilitate client decision making in his health behavior  4- care is provided with sensitivity and based on cultural uniqueness of clients

 1-The nurse’s culture often differs from that of the client.  2-Care that is not culturally competent may further increase the cost of health care, increase delays in client’s health, cereate obstacles to obtain information to make appropriate nursing diagnosis and develop effective treatment. More over, inhibit effective communication with the clients. The end result is decrease in the quality of nursing care.

 3- Specific objectives for persons of different culture need to be outlined in Healthy People 2010.

 Developing cultural competence is an ongoing process that involves every aspect of client care.  Nurses should maintain a broad objective and open attitude toward individuals and their cultures.  Avoid seeing all individuals as alike.  The key elements of developing cultural competence is promoting mutual respect for differences.

 1- culturally incompetence destructive  2- culturally sensitive Neutral  3-culturally competence constructive Each stage has three dimensions *cognitive (thinking) * affective (feeling) *psychomotor (doing) All together have an overall effect on nursing care

 1-cultural Awareness  2-cutural knowledge  3-cultural skill  4- cultural encounter (communication, language)  5- cultural desire (nurse’s intrinsic motivation)

 Prejudice: is the emotional manifestation of deeply beliefs about a group. It refers to a negative feelings.  Racism: is a form of prejudice that occurs through the exercise of power by individuals and institutions against people of other skin colors who are judged to be inferior.

 Ethnocentrism: is the belief that one’s own culture group determines the standards by which another group’s behavior is judged.  Cultural imposition : is the act of imposing one’s culture beliefs, values and practices on individuals from an other culture. NB. Culture relativism: recognizing that clients have different approaches to health care and that each culture should be respected.

 It is a systemic identification and documentation of culture care beliefs, meaning, values, symbols and practice of individuals or groups.  Culture assessment should focus on those aspects relevant to presenting problem, necessary intervention and education.  Anon judgmental approach toward the client’s culture is helped.  During initial contacts with clients, nurses should perform a general cultural assessment to obtain an overview of the client’ characteristics.

 In-depth cultural assessment should be conducted in two phases  I- data collection phase  II-organization phase I-Data collection phase 1- nurse collect self-identifying data 2-nurse raise a variety of questions on client’s perception of illness and treatment 3-identifying cultural factors that may influence the effectiveness of nursing care actions after formulating nursing diagnosis.

 II-organization phase  Data related to the client’s and family’s views on optimal treatment choices are examined and areas of difference between the client’s cultural needs and goals of medicine are identified  The key to successful cultural assessmentlies in nurses being aware of their own culture

 Always be aware of the environment  Know about community social organizations as schools hospitals  Know the specific areas to focus on before cultural assessment  Select a strategy for gathering cultural data  Identify a confidante who will help between culture  Know the appropriate questions to ask without offending the client

 Interview other nurses or health professionals who worked with the specific client to get their input  Talk with formal and informal community leaders to gain understanding about significant aspects of community life.  Be aware that all information has both subjective and objective aspects and verify the collected data before working on it.  Avoid pitfalls in making premature generalizations.  Be sincere open and honest with yourself and the clients

 Communication verbal and nonverbal  Space =personal distance  Time value (past, present and future)  Environmental control  Biological variations (physical and physiological)  Family organization (role function)  Nutrition  Socioeconomic status All theses factors should be explored in a cultural assessment because of their potential for highlighting differences between groups

 Communication  Space  Social organization  Time  Environmental control  Biological variation  Child rearing practices  Religious practices  Family structure It is important that the nurses know the idiomatic expression unique to each language.

 Age, religion, language spoken, gender, socioeconomic background, geographic location, history of sub-cultural group,

 1- A 60 year-old white woman refused to have nursing care provided by an African nurse. This is a-prejudice b-racism c-ethnocentrism d imposition (a)

 2-The belief in one’s own superiority may lead to a- ethnocentrism b-conflict c-imposition D-racism (A)

 3- In depth cultural assessment should be conducted in how many phases a- two b-three c-four d-five (a)

 4- One of the keys to a successful cultural assessment is a-using pitfall in making generalization b-talk only with formal community leaders C-focus on general areas during assessment d-identify a confidante who will help between cultures (d)