1. Caring in Nursing Practice, Culture and Ethnicity

2.  Values, beliefs, norms & practices of a particular group  Learned and shared  Guide thinking, decisions, & actions in a patterned way

3.  Culture – a set of values, beliefs & traditions that are held by a specific social group and handed down from generation to generation  Subculture – made up of people with a distinct identity, but who have certain ethnic, occupational or physical characteristics that are found in the larger culture  Dominant group – the group within the culture that has the authority to control the value system.  Minority group – usually has some physical or cultural characteristic that identifies the people within it as different

4. “Despite being technically competent, a nurse can be incompetent, formulating unworkable interventions because of an unwillingness or inability to understand the culturally different patient.” (West, 1994,.232)

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

6.  The sense of identification that a cultural group collectively has, largely based on the group’s common heritage.  Race – Subculture of people characterized by specific characteristics.

7.  Culture Assimilation  AKA acculturation  When minority groups living within the dominant group loose the cultural characteristics that make them different.  Stereotyping – involves assigning characteristics to a group of people without considering specific individuality.

8.  Cultural Imposition – the belief that everyone should conform to the majority belief system.  Cultural conflict – when one ridicules others beliefs and traditions in an effort to make his or her own values more secure

9.  Gender Roles – It is important to know who is the dominant figure in a family  Language and Communication – Some clients may not be able to speak the English Language  Orientation to Space and time – personal space  Food and Nutrition  Socioeconomic

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

11. Characteristics  Feelings of despair, resignation & fatalism  Day to day attitude toward life with no hope for the future  Unemployment and need for financial or government aid  Use of escape values such as alcohol and drugs  Unstable family structure with abusiveness and abandonment  Decline in self respect and retreat from community

12. Effects of Poverty on Health Care  Lack of affordable and adequate housing  Crowded living conditions  The sick usually experience more complication  Recovery time is longer  Less likely to regain their preillness level of functioning  Lack of access to health care insurance

13. Family Support  Some cultures have large extended families and are unable to share private information with anyone outside the family.  Some cultures have great respect for elderly and will not consider institutional care

18. Physical and Mental Health  Physiologic Characteristics  Keloid formation – overgrowth of connective tissue that occurs during healing process of injury, surgery—African heritage  Lactose intolerance - lack of lactase to break down lactose during digestion - Hispanic, African, Chinese, Thai.  Sickle Cell Anemia – sickle shaped red blood cells. Most common in African or Mediterranean ethnic background.

19. Continued… Tay Sacks Disease – a gene for a hereditary disorder – have very short life span – Eastern European, Jewish descent. G6PD deficiency – enzyme deficiency. Red blood cells have no cell membrane they are easily destroyed, which leads to anemia and increased billirubin levels. - 10% of African American population Thalassemia – genetic disorder effecting the Hgb in RBC function. Mediterranean, Asian, and African origin. Sarcoidosis – formation of multiple tubercles or nodules on various parts of the body - African American population. Gout – An increase of uric acid in the blood -males especially from Puerto Rican or Filipino descent.

20. Psychological Characteristics  In most situations an individual will relate the behavior of another person to the individual’s own familiar culture.  It is important to remember that what may seem perfectly reasonable & important to a client may seem ridiculous and irrelevant to a nurse. The reverse perception may also exist.

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

22. Cultural Imposition and Ethnocentrism  Cultural Imposition. – the tendency for health personnel to impose their beliefs practices and values of other cultures, because they believe that their ideas are superior.  Ethnocentrism – the belief that one’s own ideas, beliefs and practices are the best and superior.

23.  Major Theme – Focus on caring practices of various cultures  Nursing Role – Understand the client’s needs and to adapt care to meet those needs.

25. Cultural Assessment  Identify factors that effect behavior by cultural assessment  Values, religion, dietary practices, family lines of authority, family life patterns and beliefs and practices related to health and illness  See guidelines on pp 47 & 52  See table 3-1 on page 48-51

26. TRANSCULTURAL C.A.R.E. ASSOCIATES

27. Different Health Practices Folk Healers less expensive, more accessible and more understanding of cultural needs. Speak the client’s language Traditional Folk Medicine Herbs

29. Transcultural Nursing  Nursing care planned and implemented in a way that is sensitive to the needs of individuals, families, and groups representing diverse cultural populations.  The culture of health care: Assess:  the cultural background  expectations and beliefs about healthcare  Cultural context of the encounter  Degree of agreement between the 2 persons set of beliefs and values

36. MANY FACES: ADDRESSING DIVERSITY IN HEALTH CARE