1. Chapter 5 Cultural Influences in Nursing in Community Health
Cynthia E. Degazon
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Introduction United States population is becoming increasingly diverse
Nurse and client often come from different cultural backgrounds and may not recognize or understand their differences
Nurses must be able to provide culturally competent care
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

3. Immigrant Health Issues
Recent changes in immigration laws have increased migration to the U.S.
1965 amendment of the Immigration and Nationality Act
Refugee Act of 1980
1986 Immigration Reform and Control
National debate about immigration policy has intensified since terrorist attacks of September 11, 2001
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

4. Immigrant Health Issues (cont’d)
Immigrants add about $10 billion to the economy annually; in their lifetime in the U.S., an immigrant family will pay $80,000 more in taxes than they consume in services (Immigrants’ Health Care Coverage and Access Fact Sheet, 2001)
This poses a dilemma for communities since the taxes are paid to the federal government, whereas immigrants use services provided and paid for by states and localities
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

5. Immigrant Categories
Legal immigrant: not a citizen but allowed to both live and work in the U.S.; also known as lawful permanent resident
Trend toward more immigrants being low-skill workers, and they compete with native low -skill workers for jobs
Refugees and people seeking asylum: admitted outside the usual quota restrictions based on fear of persecution due to their race, religion, nationality, social group, or political views
Nonimmigrants: admitted to the United States for a limited duration and specific purpose (i.e. students, tourists)
Unauthorized immigrant: either crossed border illegally or legal permission expired; eligible only for emergency medical services
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6. Providing Health Care for Immigrants: Factors to Consider
Financial constraints
Language barriers
Differences in social, religious, and cultural backgrounds between the immigrant and the health care provider
Providers’ lack of knowledge about high-risk diseases in the specific immigrant groups for whom they care
Immigrants may rely on traditional healing or folk health care practices unfamiliar to U.S. health care providers
When working with immigrant populations, consider how your own background, beliefs, and knowledge may be significantly different from those of the people receiving care
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Culture, Race, and Ethnicity
Culture: a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted across generations
Race: a biological designation whereby group members share features (e.g., skin color, bone structure, genetic traits such as blood groupings)
Ethnicity: shared feeling of peoplehood among a group of individuals
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

8. Cultural Competence
A combination of culturally congruent behaviors, practice attitudes, and policies that allow nurses to work effectively in cross-cultural situations
Four principles
Care is designed for the specific client
Care is based on the uniqueness of the person’s culture and includes cultural norms and values
Care includes self-employment strategies to facilitate client decision making to health behavior
Care is provided with sensitivity and is based on the cultural uniqueness of clients
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

9. Key Reasons Nurses Must Be Culturally Competent
The nurse’s culture often differs from that of the client, leading to different understandings of communication, behaviors, and plans for care
Care that is not culturally competent may increase the cost of health care and decrease the opportunity for positive client outcomes
To meet some of the objectives for persons of different cultures as outlined in Healthy People 2010, the client’s lifestyle and personal choices must also be considered
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

10. Developing Cultural Competence
Two principles: (1) maintain a broad, objective, and open attitude toward individuals and their cultures; (2) avoid seeing all individuals as alike
Cultural awareness
Cultural knowledge
Cultural skill
Cultural encounter
Cultural desire
Cultural preservation
Cultural accommodation
Cultural repatterning
Cultural brokering
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Inhibitors to Developing Cultural Competence
Nurses that do not understand transcultural nursing
Supervisors pressuring nurses to increase productivity by increasing their case load
Nurses feeling pressured by colleagues who are not knowledgeable about other cultures and who are offended when others use cultural competence concepts
Above inhibitors may result in stereotyping, prejudice, racism, ethnocentrism, cultural blindness, cultural imposition, cultural conflict, and culture shock
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Cultural Nursing Assessment
Systematic identification and documentation of the culture care beliefs, meanings, values, symbols, and practice of individuals or groups using a holistic perspective
During initial contact with a client, the nurse asks about the following issues:
Ethnic background
Religious preference
Family patterns
Food patterns
Health practices
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

13. Two Phases of an In-Depth Cultural Assessment
Data-collecting phase
The nurse collects self-identifying data similar to that collected in the brief assessment
The nurse raises a variety of questions that seek information on clients’ perception of what brings them to the health care system, the illness, and previous and anticipated treatments
After the nursing diagnosis is made, the nurse identifies cultural factors that may influence the effectiveness of nursing care actions
Organizing phase
Data related to the client’s and family’s views on optimal treatment choices are routinely examined, and areas of difference between the client’s cultural needs and the goals of Western medicine are identified
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14. Conducting Cultural Assessment
Be aware of the environment
Know about community social organizations
Know the specific areas that you want to focus on
Select a strategy to help gather cultural data
Identify a confidante
Know the appropriate questions to ask
Interview other nurses or health care professionals
Talk with formal and informal cultural leaders
Be aware that all information contains both subjective and objective data
Avoid pitfalls
Be sincere, open, and honest
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15. Using an Interpreter
Communication with the client or family is required for a cultural assessment
When nurses do not speak or understand the client’s language, they should obtain an interpreter
Depending on the volume of clients who cannot speak English, agencies may be required to have all of their written materials translated and regularly use interpreters or only portions of the materials translated
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16. Using an Interpreter (cont’d)
Using translators and interpreters is not without risk
They may not understand all terms
They may also reply for the patient instead of working toward greater understanding of all participants
Interpreters may emphasize their personal preferences by influencing both nurses’ and clients’ decisions to select and participate in treatment modalities
Nurses may minimize these potential risks by learning basic words and sentences of the most commonly spoken languages in the community and by having key written materials translated into the language of sizable client populations
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17. Cultural Groups’ Differences
Although all cultures are not the same, all cultures have the same basic organizing factors:
Communication (verbal and nonverbal)
Space
Social organization
Time perception
Environmental control
Biological variations
Culture and nutrition
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18. Culture and Socioeconomic Status
Members of minority groups are overrepresented on the lower tiers of the socioeconomic ladder
Poor economic achievement is common among populations at risk, such as those in poverty, the homeless, migrant workers, and refugees
Nurses should be able to distinguish between cultural and socioeconomic class issues and not interpret behavior as having a cultural origin when in fact it is based on socioeconomic class
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.