1. Copyright 2002, Delmar, A division of Thomson Learning
Chapter 5
Cultural Assessment
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2. Copyright 2002, Delmar, A division of Thomson Learning
Competencies
Assess own cultural values, beliefs, and behaviors.
Identify potential areas of cultural conflict between the values and customs of patients and their families and those of health care providers.
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Competencies
Identify increased health risks and genetic traits, and disorders prevalent in selected ethnic, racial, and population groups.
Conduct a comprehensive cultural assessment.
Describe the process for providing culturally competent nursing care.
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4. Racial, Ethnic, and Cultural Diversity in the United States
In 1999, the U.S. population was comprised of
69.2% Euro-Americans
35.8% members of ethnic and cultural minority groups
Fastest growing minority group in United States is Hispanics
(continues)
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5. Racial, Ethnic, and Cultural Diversity in the United States
Trend toward increased racial, ethnic, and cultural diversity is expected to continue into the 21st century
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6. Culturally Competent Nursing Care
Identify cultural values and beliefs of patients and families.
Recognize normal behaviors of different cultural groups and their response to health and illness.
(continues)
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7. Culturally Competent Nursing Care
Identify ethnic variations on racial growth patterns.
Use cultural relativism ethic to guide practice.
Ultimate goal is to plan and implement culturally sensitive nursing care.
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Key Terms: Culture
Cultural diversity
Acculturation
Cultural relativism
Ethnocentrism
(continues)
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9. Copyright 2002, Delmar, A division of Thomson Learning
Key Terms: Culture
Bilingualism
Multiculturalism
Culture identity
Culture shock
Enculturated
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10. Culturally Competent Assessments
Culture
Subculture
Racial group
Race
Ethnic group
Ethnic identity
(continues)
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11. Culturally Competent Assessments
Minority group
Cultural values
Cultural norms
Value orientations
Time
Human nature
Activity
Relational
People to nature
(continues)
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12. Culturally Competent Assessments
Beliefs
Cultural beliefs
Folk illness
Scientific illness
Personalistic illness
Self-care practices
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13. Copyright 2002, Delmar, A division of Thomson Learning
Evaluating the Potential Physical or Psychological Harm from a Health Practice
A practice would not be considered harmful if the following conditions are met:
Practice is sanctioned by that culture.
Practice is within the limits of deviations that are acceptable in that culture.
(continues)
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Evaluating the Potential Physical or Psychological Harm from a Health Practice
Practice is important for the acceptance of the patient as a member of the culture.
The patient perceives that the practice is appropriate in this situation.
(continues)
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Evaluating the Potential Physical or Psychological Harm from a Health Practice
The intent of the health care provider is consistent with the cultural rules that govern the practice.
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16. Copyright 2002, Delmar, A division of Thomson Learning
Customs and Rituals
Difference between customs and cultural rituals
Communication patterns
Cultural meaning of symptoms
Language barriers
Family and kinship relations
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17. Tips for Overcoming Language Barriers
Speak slowly and distinctly
Use gestures or pictures
Avoid clichés, jargon, and value-laden terms
Avoid defensive or offensive body language
(continues)
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18. Tips for Overcoming Language Barriers
Obtain feedback to confirm accurate understanding
Provide reading material written in the appropriate language
Use an interpreter
Speak to the patient, rather than the interpreter
Use the same interpreter for each interaction (if possible)
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19. Cultural Characteristics and Health Care Beliefs and Practices
Asian American: Chinese
Communication styles
Self-expression is repressed
Value silence
Hesitant to ask questions
May smile when does not understand
Touching limited
(continues)
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20. Cultural Characteristics: Chinese
Family, social, work relationships
Hierarchical
Defer to elderly and authority figures
Value hard work and giving to society
Preserve family’s honor, save face
(continues)
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21. Cultural Characteristics: Chinese
Health values and beliefs
Health is the result of balance between yin and yang
Respect body, believe body must remain intact
Health customs and practices
Combine Western and traditional Chinese medicine
(continues)
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22. Cultural Characteristics: Chinese
Immunizations acceptable
May be skeptical of multiple diagnostic tests
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23. Cultural Characteristics: Japanese
Communication styles
Listen emphatically
Touching is limited
Direct eye contact is considered disrespectful
Stoic, suppress overt emotion
Value self-control, politeness, and personal restraint
(continues)
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24. Cultural Characteristics: Japanese
Family, social, work relationships
Close families, interdependent, intergenerational
Family’s needs greater than individual needs
Obligation to kin and work group
Education highly valued
(continues)
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25. Cultural Characteristics: Japanese
Health values and beliefs
Illness caused by
Contact with polluting agent
Social or family disharmony
Imbalance from poor health habits
Cleanliness valued
(continues)
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26. Cultural Characteristics: Japanese
Health customs and practices
Utilization of Western medicine
Oldest child cares for elderly
Family cares for disabled
May not express pain, due to stoic expression
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27. Cultural Characteristics: Vietnamese
Communication styles
Value respect and harmony
Disrespectful to question authority
Avoid direct eye contact
Modest speech and actions
Relaxed concept of time
Avoid asking direct questions
(continues)
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28. Cultural Characteristics: Vietnamese
Family, social, work relationships
Close family, multigenerational
Patriarchical decision making
Family needs greater than individual’s needs
Education highly valued
Individual behavior reflects on total family
(continues)
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29. Cultural Characteristics: Vietnamese
Health values and beliefs
Illness caused by
Naturalistic forces
Supernaturalistic forces
Metaphysical forces
Or from contamination by germs
(continues)
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30. Cultural Characteristics: Vietnamese
Health customs and practices
Western and folk medicine
Use of herbs, therapeutic diets
Family responsible for health care
May consult priest, astrologer, shaman, or fortune teller for guidance about health
Restore balance using hot or cold foods
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31. Cultural Characteristics: Filipinos
Communication styles
Eye contact is avoided
Sex, financial status are too personal to discuss
Engage in small talk before discussing serious matters
Values personal dignity and preserving self-esteem
(continues)
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32. Cultural Characteristics: Filipinos
Family, social, work relationships
Strong family ties
Multigenerational
Family interests stronger than individual needs
Defer to elderly for guidance
Individual behavior reflects on family
(continues)
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33. Cultural Characteristics: Filipinos
Health values and beliefs
Illness related to
Natural forces
Supernatural forces
Metaphysical forces
Fatalistic view
Health customs and practices
Uses folk and scientific medicine
Stoic expression; pain is God’s will
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34. Cultural Characteristics: African Americans
Communication styles
May distrust majority group
Expressive use of nonverbal behavior and speech
May use black English
Values direct eye contact
Values congruence between verbal and nonverbal behavior
(continues)
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35. Cultural Characteristics: African Americans
Family, social, work relationships
Strong family ties
50% patriarchical, 50% matriarchical
High level of respect for elderly
Large social network
(continues)
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36. Cultural Characteristics: African Americans
Health values and beliefs
Illness is a collective event
Illness disrupts the entire family system
Illness is a natural event resulting from
Conflict or disharmony in one’s life
Failure to protect oneself
Sent by God as a punishment
(continues)
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37. Cultural Characteristics: African Americans
Health customs and practices
Health maintained by diet, rest, clean environment
Self-care and folk medicine may be used
May use home remedies first before seeking medical care
Prayer is used for prevention and treatment
(continues)
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38. Cultural Characteristics: African Americans
Family minister may visit when ill or hospitalized to help patient cope with illness or suffering
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39. Cultural Characteristics: Hispanic Americans—Mexicans
Communication styles
May be bilingual, may use nonstandard English
Introductory embrace common
May revert to native language in times of stress
Value direct eye contact
(continues)
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40. Cultural Characteristics: Mexicans
Prolonged eye contact is disrespectful
Appreciate small talk before conversation
Responds best to open-ended questions
May be hesitant to discuss sex
Family, social, work relationships
Strong family bonds
Respect wisdom of elders
(continues)
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41. Cultural Characteristics: Mexicans
Children are highly desired and valued
Homes may be decorated with religious articles
Relaxed concept of time
Health values and beliefs
Illness can be prevented by
Being good
Eating proper foods
Working proper amount of time
(continues)
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42. Cultural Characteristics: Mexicans
Illness may also be prevented through prayer or wearing of religious medals or amulets
Illness may be caused by
A body imbalance between hot and cold, wet and dry
Dislocation of body parts
Magic or supernatural forces
Punishment from god
(continues)
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43. Cultural Characteristics: Mexicans
Present oriented, not future oriented
Hospital may be viewed as place to die
Health customs and practices
May use special holistic healers
Prevent and treat illness with hot and cold food prescriptions and prohibitions
(continues)
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44. Cultural Characteristics: Mexicans
May use religious rituals (prayer) and scientific medicine to treat severe illness
Extremely modest
May be stoic in expression of pain
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45. Cultural Characteristics: Native Americans
Communication styles
May speak their tribal language and English
Nonverbal communication important
Unwavering eye gaze is insulting
Hesitant to discuss personal affairs until trust is developed
Hesitant to discuss sex
(continues)
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46. Cultural Characteristics: Native Americans
Family, social, work relationships
Strong extended family
Family members are responsible for one another
Elders are respected
Children are valued
Respect for traditions and to honor wisdom
(continues)
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47. Cultural Characteristics: Native Americans
Health values and beliefs
Medicine and religion strongly interwoven
Health results from being in harmony with nature and universe
Do not believe in the germ theory
Illness and pain are caused by something that occurred in the past or will happen in the future
(continues)
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48. Cultural Characteristics: Native Americans
May use objects to guard against witchcraft
Health customs and practices
May use traditional healers, ceremonies, herbs to treat illness
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49. Cultural Characteristics: Middle Eastern
Communication styles
Men and women do not shake hands or touch each other in any manner outside immediate family or marital relationships
Touching or embracing on arrival or departure are common among same sex
Use silence to show respect for another
(continues)
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50. Cultural Characteristics: Middle Eastern
Family, social, work relationships
Male-dominated society
Eldest male is the decision maker
Male children valued more than female children
Adult male may not be alone with any female except his wife
(continues)
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51. Cultural Characteristics: Middle Eastern
Health values and beliefs
Magico-religious
Will of Allah
Illness may be caused by hot and cold or evil eye
Expect immediate pain relief from health professionals
“Heart disease” may mean emotional distress
(continues)
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52. Cultural Characteristics: Middle Eastern
Obligation to visit and care for the sick and ill
Health customs and practices
Use magico-religious, folk, self-care, and medical science
Use of amulets, religious charms
Same sex health care provider may be required to examine or care for same sex patient
(continues)
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53. Cultural Characteristics: Middle Eastern
Male health professionals may not be able to examine female patients; female health professionals may not be able to care for male patients
Dead must be buried with the body intact
Female circumsion may be performed
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54. Cultural Characteristics: Euro-Americans
Communication styles
Nod to denote understanding
Neutral facial expressions in public
Hugs and embraces among close friends are appropriate
Pat on shoulder shows camaraderie
Own personal space
Firm handshake symbolic of goodwill
Smile, speak pleasantly to others
(continues)
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55. Cultural Characteristics: Euro-Americans
Family, social, work relationships
Nuclear family
Encourage and nurture each individual
Healthy, autonomous children
Egalitarian decision making
Future oriented
Generous in times of crisis
Value education and knowledge
Competitive and achievement oriented
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(continues)

56. Cultural Characteristics: Euro-Americans
Health values and beliefs
Future oriented
Control internal and external environments
Use of modern medicine and technology
Illness result of injury or pathology
Good health is a personal responsibility
(continues)
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57. Cultural Characteristics: Euro-Americans
Health customs and practices
Self-care practices
Balance between diet, rest, activity, work, and leisure
Intolerant of delays in health care services
Active participant in decisions regarding health care
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