1. Cultural Considerations
UNIT 13 Chapter 11
Cultural Considerations
UNIT 13 Chapter 11
Cultural Considerations

2. Introduction
Every aspect of person’s life influenced by that person’s culture
Since nurses provide health care to culturally diverse populations in various settings, knowledge of culturally relevant information essential for competent care
Introduction: Every aspect of person’s life influenced by that person’s culture
Since nurses provide health care to culturally diverse populations in various settings, knowledge of culturally relevant information essential for competent care

3. Culture
Integrated, dynamic structure of knowledge, attitudes, behaviors, beliefs, ideas, habits, customs, languages, values, symbols, rituals, and ceremonies unique to particular group of people
Provides group of people with general design for living
Culture encompasses the dynamic and integrated structures that are unique to a particular group of people: knowledge, beliefs, behaviors, ideas, attitudes, values, habits, customs, languages, symbols, rituals, ceremonies, and practices. These structures provide general guidelines for the people who belong to a particular culture. People who belong to a cultural group acquire the group’s beliefs as they grow and mature by observing the group’s traditions, accepted patterns of thought, and behavior and by interacting with others. Culture represents adaptive dynamic processes learned through life experiences; it is not static or uniform among all members of the group. The diversity within and among cultural groups results from individual perspectives and practices.

4. Ethnicity and Race Ethnicity Race
Cultural group’s perception of itself
Group identity
Race
Group of people with biological similarities
Similarities of racial and ethnic group members reinforce sense of identity and cohesiveness
Ethnicity, a cultural group’s perception or identity, reflects a common social heritage passed from generation to generation. This shared identity is evident in common customs and traits. A race, a group of people who share biologic similarities, shares similar physical characteristics such as skin color, hair color or texture, and facial features. Ethnicity and race often overlap because the cultural and biologic commonalities support each other, reinforcing a sense of cohesiveness
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5. Cultural Diversity
Differences among people resulting from ethnic, racial, and cultural variations
Provides varied ideas, viewpoints, and problem-solving approaches
Includes:
Ethnocentrism
Oppression
Stereotyping
Dominant culture
Differences among people resulting from ethnic, racial, and cultural variations
Provides varied ideas, viewpoints, and problem-solving approaches
The term cultural diversity refers to differences among people resulting from racial, ethnic, and cultural variables. In countries like the United States, a wide variety of cultural groups have contributed to society in many ways. When there are differences among and between cultural groups in a country, this diversity can contribute to social problems because of misunderstanding and unfamiliarity with different cultures. Some of these social problems result from bias or prejudice of individuals or groups toward other groups.
The assumption that one cultural group is superior to others is known as ethnocentrism and can result in oppression of other groups.
Stereotyping, the belief that all people within a particular racial, ethnic, or cultural group will act alike and share the same beliefs and attitudes, results in applying labels that overlook people’s individuality.
The cultural group whose values predominate in a given society is called the dominant culture
Includes:
Ethnocentrism
Assumption of cultural superiority and inability to accept another culture’s ways
Oppression
When rules, values, and ideals of one group are imposed on another group
Stereotyping
Belief that people in same ethnic, racial, or cultural group act same way and share same beliefs or attitudes
Dominant culture
Group whose values prevail within given society
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6. Cultural Diversity Includes: Minority group Acculturation
Constituting less than numerical majority of population
Acculturation
Process of learning beliefs, norms, and behavioral expectations of group
Cultural assimilation
Members of minority group absorbed by dominant culture
Take on characteristics of dominant culture
Cultural Diversity Includes:
Minority group
Constituting less than numerical majority of population
Acculturation
Process of learning beliefs, norms, and behavioral expectations of group
Cultural assimilation
Members of minority group absorbed by dominant culture
Take on characteristics of dominant culture
; a minority group is a group that does not constitute the largest numerical portion of a given population. Characteristics of the dominant culture, including its norms, beliefs, and behavioral expectations, are assumed by individuals and groups through the process of acculturation. When minorities are absorbed by the dominant culture and take on the dominant culture’s characteristics, the process is known as cultural assimilation.
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7. Culture’s Components Perception of self and individual Motivation
Activity
Social relations
Perception of world
Cultural Components
Perception of self and individual
Includes personal identity, respect for individuals, and values
Motivation
Explains methods and value of achievement
Activity
Identifies ways people organize and value work
Social relations
Explains structure and importance of friendships, gender roles, and class
Perception of world
Indicates explanation of religious beliefs and life events
The components of culture that organize the way people think about life include activity, how people organize and value work; social relations, the importance and structure of friendships, gender roles, and class; motivation, the value and methods of achievement; perception of the world, the interpretation of life events and religious beliefs; and perception of self and the individual, personal identity, value, and respect for individuals.
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8. Culture’s Characteristics
Learned behavior
Reflects shared beliefs
Defines acceptable behavior
Is dynamic
Observes traditions
Characteristics Learned behavior
Reflects shared beliefs
Defines acceptable behavior
Is dynamic
Observes traditions
Characteristics that are shared by all cultures include the following: culture is learned as children imitate adults in the group and integrated throughout all interrelated components; culture is shared by everyone belonging to a cultural group; culture is tacit because acceptable behavior is understood by everyone in the cultural group; and culture is dynamic, in a constant state of change.
It is important for nurses to understand the terminology, components, and characteristics of culture for several reasons. The United States continues to be a culturally diverse country; nurses will interact on a regular basis, in both health care and personal settings, with people whose cultural background may differ from their own. For nursing care to individuals and groups to be effective, it must be culturally competent in every aspect of the process, from assessment through evaluation. Culture plays a profound role in individuals’ perceptions of and beliefs about health and illness, and nurses must understand and respect the cultural values and beliefs of individuals for whom they will be providing care. Although knowledge of cultural concepts and beliefs is important for a nurse, the nurse must always remember that each client is an individual, regardless of his or her cultural background.

9. Influences on Health Care Beliefs and Practices
Cultural values define human responses to illness
Determine whether person seeks professional care when ill and complies with prescribed treatment
Clients tend to define wellness and illness in context of own culture
Cultural values define human responses to illness
Determine whether person seeks professional care when ill and complies with prescribed treatment
Clients tend to define wellness and illness in context of own culture
Each cultural group has a body of knowledge and beliefs about health and disease, and cultural practices can have a positive or negative impact on the health of group members. Examine some of the important beliefs and patterns of behavior that cultural groups hold about the definition of health, health promotion and protection practices, and health practitioners and remedies. How do these beliefs influence both individuals in the group and health care providers?
Discussion/Lecture
Health is defined by the World Health Organization (WHO) as complete physical, mental, and social wellness, not just the absence of disease; this concept of health is widely accepted around the world. However, the concepts of physical, mental, and social wellness are all culturally defined and are not viewed in the same way by different cultural groups. Deviations from what one cultural group defines as “normal health” are considered to be illness in that culture, but perhaps not in another. The origin or etiology of disease can be described as being supernatural (the result of metaphysical forces such as voodoo or evil spirits); nonsupernatural (the result of a cause-and-effect relationship); immediate (the result of known pathogenic agents, such as the tubercle bacillus); or ultimate (the result of some determinant, such as the relationship of smoking to lung cancer). Most cultural groups offer multiple explanations of disease etiology, borrowing from several of the preceding origins. Cultural groups also value differing practices and beliefs to achieve health protection and to promote health. For instance, a cultural group that values health practices such as regular exercise and immunizations to promote and protect health may have difficulty understanding another cultural group that values prayer and meditation to achieve the same outcome.

10. Definition of Health Developed by World Health Organization
Health is not only absence of disease, but also complete physical, mental, and social wellness
Developed by World Health Organization
Health is not only absence of disease, but also complete physical, mental, and social wellness

11. Etiology Peter Morley presents four views of origin of disease:
Supernatural (Due to metaphysical forces)
Non-supernatural
Immediate (Traces diseases to known pathogenic agents)
Ultimate (Describes determinates for diseases)
Each cultural group has a body of knowledge and beliefs about health and disease, and cultural practices can have a positive or negative impact on the health of group members. Examine some of the important beliefs and patterns of behavior that cultural groups hold about the definition of health, health promotion and protection practices, and health practitioners and remedies. How do these beliefs influence both individuals in the group and health care providers?
Discussion/Lecture
Health is defined by the World Health Organization (WHO) as complete physical, mental, and social wellness, not just the absence of disease; this concept of health is widely accepted around the world. However, the concepts of physical, mental, and social wellness are all culturally defined and are not viewed in the same way by different cultural groups. Deviations from what one cultural group defines as “normal health” are considered to be illness in that culture, but perhaps not in another. The origin or etiology of disease can be described as being supernatural (the result of metaphysical forces such as voodoo or evil spirits); nonsupernatural (the result of a cause-and-effect relationship); immediate (the result of known pathogenic agents, such as the tubercle bacillus); or ultimate (the result of some determinant, such as the relationship of smoking to lung cancer). Most cultural groups offer multiple explanations of disease etiology, borrowing from several of the preceding origins. Cultural groups also value differing practices and beliefs to achieve health protection and to promote health. For instance, a cultural group that values health practices such as regular exercise and immunizations to promote and protect health may have difficulty understanding another cultural group that values prayer and meditation to achieve the same outcome. Cultural groups also prefer certain types of health care practitioners, those who most closely relate to their concept of etiology and definitions of health and illness. For example, for a cultural group that does not accept a scientific rationale for the etiology of a health problem, standard treatments (i.e., traditional Western medical practices) are not acceptable and alternative remedies and practitioners are sought. Cultural groups that ascribe etiology of disease to supernatural causes are likely to seek treatment from spiritual leaders. In folk medicine (i.e., alternative medicine), the classification of illness as either natural or supernatural determines the type of treatment and healer chosen. Unless traditional health care providers base their therapeutic regimens on culturally accepted remedies, members of any cultural group are unlikely to comply with them. Nurses who provide care to clients from different cultural groups must be aware of groups’ basic beliefs about illness, factors contributing to illness, and home remedies.
Most cultures support multi-etiologic origin
Three or four explanations as to why and how diseases occur
Peter Morley presents four views of origin of disease:
Supernatural
Due to metaphysical forces
E.g., witchcraft, etc.
Non-supernatural
Accepted cause and effect
Even though it may lack scientific rationale
Immediate
Traces diseases to known pathogenic agents
Ultimate
Describes determinates for diseases
Health Promotion and Protection
Strategies for achieving and maintaining good health vary by cultural group
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12. Practitioners and Remedies
Variety in health/illness care providers is natural extension of:
Culturally diverse concepts of etiology
Definitions of health and illness
Nurses must be able to:
Relate care and treatment to client’s cultural context
Incorporate informal caregivers, healers, and other members of client’s support system as allies in treatment
Variety in health/illness care providers is natural extension of:
Culturally diverse concepts of etiology
Definitions of health and illness
Nurses must be able to:
Relate care and treatment to client’s cultural context
Incorporate informal caregivers, healers, and other members of client’s support system as allies in treatment
Cultural groups also prefer certain types of health care practitioners, those who most closely relate to their concept of etiology and definitions of health and illness. For example, for a cultural group that does not accept a scientific rationale for the etiology of a health problem, standard treatments (i.e., traditional Western medical practices) are not acceptable and alternative remedies and practitioners are sought. Cultural groups that ascribe etiology of disease to supernatural causes are likely to seek treatment from spiritual leaders. In folk medicine (i.e., alternative medicine), the classification of illness as either natural or supernatural determines the type of treatment and healer chosen. Unless traditional health care providers base their therapeutic regimens on culturally accepted remedies, members of any cultural group are unlikely to comply with them. Nurses who provide care to clients from different cultural groups must be aware of groups’ basic beliefs about illness, factors contributing to illness, and home remedies.
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13. Beliefs of Select Cultural Groups
European Americans
African Americans
Hispanic Americans
Asian Americans
Native Americans
Summarize the health beliefs associated with major cultural groups in the United States. See p 233 Table 11-1
The cultural groups most frequently encountered in the United States are European Americans, African Americans, Hispanic Americans, Asian Americans, and Native Americans.
European Americans comprise the largest cultural group in the United States. The group’s predominant values include independence, individuality, wealth, comfort, cleanliness, achievement, punctuality, hard work, aggression, assertiveness, rationality, orientation toward the future, and the concept of being masters of individual fate. People from this background tend to be individualistic and competitive. They also value the nuclear family and its traditions.
African Americans currently represent the largest minority group in the United States. They came to this country either as slaves or as free immigrants from various African countries and the Caribbean islands, representing different educational levels, income levels, occupations, and religious beliefs; these factors account for the variety of cultural practices among African Americans. Their beliefs about health and illness are linked to a supernatural or nonsupernatural view of disease. Among those coming from traditional African societies, disease is viewed as the result of disharmony in relationships; healing occurs when harmony is restored. Disease may also be viewed as a punishment from God or another higher power, or as the result of evil forces.
Hispanic Americans are presently the second largest minority group in the United States; the majority have come from Mexico, Puerto Rico, and Cuba. People from these countries have different cultural patterns but generally share the large extended family system in which females are subservient to males yet have a major role in family cohesiveness. Religion is a strong influence on Hispanic culture, with the Roman Catholic faith as a foundation. Illness is considered to be the result of a natural cause, witchcraft, a curse, or punishment for sin. Diseases are perceived to be an imbalance between “wet and dry” or “hot and cold” forces; treatment depends on the identified cause. While Western medicine may be seen as appropriate for some diseases, the native healer (curandero or curandera) is appropriate for diseases with supernatural causes.
Asian Americans come from countries such as Korea, Vietnam, Laos, the Philippines, Cambodia, China, and Japan. Despite the cultural diversity among people of these countries, they share similarities such as being patrilineal (family relations are traced through males), with males being the heads of households; they also share respect for elders. Among Asian Americans, the etiology of disease is attributed to the opposing forces of yin (cold) and yang (hot); when these forces are balanced, the person is healthy. Foods considered either “hot” or “cold” are used to treat illnesses. Illness may also be seen as the result of supernatural powers; in this case, a traditional healer may be consulted or healing may occur through prayer. Practices such as acupuncture, cupping and burning, and herbal remedies are also used.
Native Americans, representing over 200 different tribes, are another diverse group. Many Native Americans have adopted Western health practices, but others believe health results only from a harmonious relationship with nature and the universe. Illness is viewed as supernatural in origin, as discord in the forces of nature, or as the result of witchcraft; treatment may require exorcism of evil spirits. Methods of prevention include prayer, charms, and fetishes (objects having power to protect or assist the owner). Medicine men and women are viewed as possessing supernatural healing powers.
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14. Cultural Considerations
UNIT 14 Chapter 11
Cultural Considerations
UNIT 14 Chapter 11
Cultural Considerations

15. Cultural and Racial Influences on Client Care
Can be viewed through:
Communication
Orientation to space and time
Social organization
Biological variation
Cultural and Racial Influences on Client Care: The need to communicate is universal, but cultural differences in language can cause misunderstanding and frustration for both clients and nurses. When language differences impede communication, alternative methods of communication—such as gestures, pictures, or flash cards—can be useful tools. Members of a client’s family may also be able to bridge the communication gap between nurse or health provider and client. If family members are unable to assist, an interpreter may be required. Communication
Not everyone shares same language
Can lead to misunderstanding and frustration
Alternative methods include gestures and flash cards
May have family members assist
May use interpreters
A client’s cultural orientation to space and time also affects his or her attitude toward care. Clients may believe that certain spaces or objects belong to them, and the distance people prefer to maintain from others is culturally determined; this idea is known as territoriality (interpretation of personal space). It is important for a nurse to know what personal space is acceptable for members of different cultural groups. Orientation to time also varies by culture. For instance, European Americans are generally future oriented and are cognizant of the time at which certain things begin or end, while Asian Americans are oriented to the past, and Native Americans and African Americans are oriented to the present. These cultural differences in time orientation can affect such aspects as taking medications on a prescribed schedule or keeping follow-up appointments with health care providers. Orientation to Time and Space
Distance person prefers to maintain from another person determined by one’s culture
Individual’s orientation to time may affect:
Promptness and attendance at appointments
Compliance with self-medication schedules
Reporting onset of illness
Social organization encompasses the ways cultural groups determine rules of acceptable behavior and roles of individual members, including family structure, gender roles, and religion. There is no family structure that predominates in American society today; family refers to the members of a shared household who have similar values and participate in shared goals, rather than a strict biologic relationship. Families vary in structure from the traditional two-parent nuclear arrangement to single-parent households or extended family groupings. Social Organization: Ways cultural groups determine rules of acceptable behavior and roles of individual members, including:
Family structure
Gender roles
Religion
Gender roles are culturally determined and vary by family organization. For example, in Hispanic, Latino, and traditional Muslim families, the patriarchal (male head of household) structure is predominant; the husband/father is the authority figure and decision maker while the wife is responsible for household maintenance and child care. Religious beliefs influence clients’ lifestyles, attitudes, and feelings about life, pain, and death; they may also determine dietary choices, acceptability of birth control, and appropriate medical care. To provide holistic care, nurses must recognize the spiritual dimension of every client and help the client to meet spiritual needs (the desire to find meaning and purpose in life, pain, and death). Spiritual care of clients (recognition of spiritual needs and assistance given in meeting them) is important for nurses to consider as they enable clients to identify and use their spiritual beliefs to cope with health crises. The nurse can also call on a client’s religious support system, such as rabbis, clergy, or lay persons, to provide spiritual care. Nurses must also recognize and respect that some people do not believe in a higher being or practice a specific religion.
Biologic variation refers to the ways in which one cultural or racial group differs from another. Skin color, eye shape, and body structure are among the obvious variations. Susceptibility to disease and enzymatic differences are among the less obvious variations. Biological Variations
Distinguishes one racial or cultural group from another
Includes variations in hair texture, eye shape, skin color, thickness of lips, and body structure
Also includes enzymatic differences and susceptibility to disease

16. Cultural Aspects of Nursing Process:
Assessment-Culturally sensitive nursing care begins with examination of own culture and beliefs
Important to show respect for cultural practices
Even if not understood or accepted
Diagnosis-Any nursing diagnosis may be appropriate for client of any cultural group
Cultural Aspects of Nursing Process: Assessment
Culturally sensitive nursing care begins with examination of own culture and beliefs
Followed by assessment of client’s cultural beliefs and background
Important to show respect for cultural practices
Even if not understood or accepted

17. Cultural Aspects of Nursing Process
Planning and Outcome Identification
Must consider cultural variables when establishing goals and planning interventions
Implementation
Interventions should be carried out in manner that respects client’s preferences and desires
When client does not speak or understand native language well, nurse should arrange to have interpreter explain procedures and tests
Cultural Aspects of Nursing Process: Planning and Outcome Identification
Must consider cultural variables when establishing goals and planning interventions
Care most effective when:
Client and family active participants in planning
Cultural preferences respected
Implementation
Interventions should be carried out in manner that respects client’s preferences and desires
As much as possible
When client does not speak or understand native language well, nurse should arrange to have interpreter explain procedures and tests

18. Cultural Aspects of Nursing Process
Evaluation
Should include feedback from client and family to determine reactions to interventions
Culturally competent nurses perform self-evaluations to identify their attitudes toward caring for clients from diverse cultures
Evaluation
Should include feedback from client and family to determine reactions to interventions
Culturally competent nurses perform self-evaluations to identify their attitudes toward caring for clients from diverse cultures

19. Culturally Appropriate Care
Respect clients beliefs
Be sensitive to behaviors and practices different from own
Accommodate differences if not detrimental to client’s health
Listen for cues from client that relay unique ethnic beliefs about disease
Teach positive health habits
Culturally Appropriate Care
Respect clients beliefs
Be sensitive to behaviors and practices different from own
Accommodate differences if not detrimental to client’s health
Listen for cues from client that relay unique ethnic beliefs about disease
Teach positive health habits
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