1. Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 9 Culture and Ethnicity Denise Coffey MSN, RN

2. 2 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Population Diversity  The United States is becoming more diverse.  Health disparities among ethnic and racial minorities continue to increase.  Racial and ethnic minorities often experience poor access to care.

3. 3 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Understanding Cultural Concepts CultureSubculturesEthnicity Emic worldview Etic worldview Enculturation AcculturationAssimilationBiculturalism

4. 4 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Cultural Concepts  Culturally congruent care  Fits the person’s valued life patterns and set of meanings  Requires specific knowledge, skills, and attitudes in the delivery of culturally congruent care  Cultural conflicts  Ethnocentrism  Cultural imposition

5. 5 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Cultural Context of Health and Caring  Health, illness, and caring have meanings that are unique to each culture.  Every culture provides a context according to which groups interpret and define experiences relevant to birth, illness, and death.

6. 6 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Cultural Healing Modalities and Healers  Chinese and Southeast Asians  Herbalist, acupuncturist, fortune teller, shaman  Asian Indians  Ayurvedic practitioner  Native Americans  Shaman

7. 7 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Healers  African American  “Granny midwife,” spiritualist, voodoo practitioner, hougan (male), mambo (female)  Hispanics  Cuarandero/a, yerbero, sabador, espiritsta, santero/a

8. 8 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Culture and Life Transitions  Rights of passage  Pregnancy  Childbirth  Newborn  Postpartum period  Grief and loss

9. 9 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Cultural Assessment  A systematic and comprehensive examination of the cultural care values, beliefs, and practices of individuals, families, and communities  Gathers information that will enable the nurse to provide culturally competent care

10. 10 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Selected Components of Cultural Assessment Ethnic heritage and ethnohistory Biocultural history Social organization Religious and spiritual beliefs Communication patterns Time orientation Caring beliefs and practices Experiences with professional health care

11. 11 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Decisions  Action modes of professional decisions or actions:  Cultural care preservation or maintenance  Cultural care accommodation or negotiation  Cultural care repatterning or restructuring

12. 12 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Knowledge check The role of the nurse in planning care for a culturally diverse population can best be described as: A. Focusing only on the needs of the client, ignoring the nurse's beliefs and practices B. Including care that is culturally congruent with the nursing staff based on predetermined criteria C. Providing care while remaining aware of one's own bias and focusing on the client's individual needs rather than the staff's practices D. Blending the values of the nurse that are for the good of the client and minimizing the client's individual values and beliefs during care D. Blending the values of the nurse that are for the good of the client and minimizing the client's individual values and beliefs during care

13. 13 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Knowledge check According to the Nurse Practice Act (NPA), how are cultural needs addressed? A. There are no references to culture or ethnicity of clients in the NPA. B. Knowledge of cultural aspects is to be incorporated into the plan of care to meet each client's unique needs. C. Cultural needs can be ignored when the client is very ill and about to die, because physical needs are more important at this time. D. Only scientifically based methods of treatment are to be used in nursing; use of other methods or therapies is not the role of the nurse.