1. Chapter 6 Cultural and Ethnic Considerations All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

2. Overview United States described as “melting pot” from many different countries According to 2010 census, 34.6% of population is of African, Asian, Hispanic, American Indian, or some other ancestry (U. S. Census Bureau, 2010) All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 2

3. Culture Defined Set of learned values, beliefs, customs, and practices that are shared by a group and passed from one generation to another Subculture ◦Share characteristics with primary culture ◦Has characteristic patterns of behavior and ideals that distinguish it from the rest of cultural group All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 3

4. Culture Defined cont’d Characteristics Differences Age Religion Dialect or language spoken Gender identity and roles Socioeconomic background Geographic location of country of origin or current residence Amount and type of interaction between younger and older generations ◦Degree to which values in current country are adopted All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 4

5. Culture Defined cont’d Nurses need to deliver culturally competent care and avoid stereotyping Stereotype ◦Generalized expectation about forms of behavior, an individual, or a group Ethnic stereotype ◦Fixed concept of how all members of an ethnic group act or think All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 5

6. Culture Defined cont’d Transcultural nursing ◦Understanding and integrating variables into all aspects of nursing care ◦Nursing areas influenced by culture  Treatment methods  Responses to illness and death  Childbirth  Diet and nutrition All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 6

7. Culture Defined cont’d Race and ethnicity ◦Race  Group of people who share biologic physical characteristics and hereditary factors ◦Ethnicity  Group of people who share a common social and cultural heritage based on shared traditions, national origin, and physical and biologic characteristics All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 7

8. Culture Defined cont’d Ethnic and racial groups in the United States ◦Many cultures  Belong to one or more subculture Important not to make assumptions about a patient’s belief or practice based on name, skin color, or language All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 8

9. Question 1 Culture is defined as a: 1.set of learned values, beliefs, customs, and practices that are shared by a group and passed from one generation to another. 2.set of values that has been passed on from one generation to another. 3.group that shares biologic physical characteristics. All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 9

10. Cultural-Related Assessment Communication ◦Nurse and patient must understand each other ◦Do not assume patient/family understand ◦Keep questions brief and simple ◦Nurse is responsible for providing information to patient ◦Different cultural groups interpret different meanings for same words All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 10

11. Cultural-Related Assessment cont’d Communication ◦Silence—May indicate lack of understanding, stubbornness, apprehension, discomfort, agreement, disagreement, respect, or disdain  In American Indian, Chinese, and Japanese cultures, silence allows listener to consider what speaker has said  For Russians, French, and Spanish, silence indicates consensus among parties  In Asian cultures, silence is a sign of respect  In Mexican culture, silence may indicate disagreement with person of authority All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 11

12. Cultural-Related Assessment cont’d Communication ◦Nonverbal  Some cultures more comfortable with touching or maintaining eye contact  Touch is culturally related  Eye contact has significant cultural interpretations All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 12

13. Cultural-Related Assessment cont’d Communication ◦Nonverbal  In United States, maintaining eye contact indicates openness, interest in others, attentiveness, and honesty. Lack of eye contact—sign of shyness, humility, guilt, embarrassment, rudeness, thoughtlessness, or dishonesty  Asians and American Indians: sustained eye contact—impoliteness or invasion of privacy  East Indian cultures: avoid with people of lower or higher socioeconomic classes  Appalachian: sustained eye contact—hostility or aggressiveness All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 13

14. Cultural-Related Assessment cont’d Space ◦Different comfort areas for personal space  Western culture: more comfortable when maintaining 3-6 feet during conversation  Body movements are culturally related All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 14

15. Cultural-Related Assessment cont’d Time ◦Different meanings in various cultures  Northern European and United States give high priority to being on time  Eastern cultures more flexible  Asians spend time getting to know someone and view abrupt endings as rude  Mexican-Americans focus on current activity rather than previously planned activities All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 15

16. Cultural-Related Assessment cont’d Social organization ◦Socially acquired, not genetically inherited  Patriarchal: men (often oldest) make most decisions  Matriarchal: women make decisions about health care, provide care, and discipline  Knowing family structure assists in understanding the patient All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 16

17. Cultural-Related Assessment cont’d Religious beliefs and health care ◦Entwined with cultural beliefs ◦Some expect members to adhere to religion ◦Nursing care affected by religious beliefs and practices ◦Be aware of such beliefs to ensure care provided is sensitive to patient’s needs All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 17

18. Cultural-Related Assessment cont’d Health practices ◦Biomedical health belief system ◦Folk health belief system ◦Holistic health belief system ◦Alternative or complementary belief system All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 18

19. Cultural-Related Assessment cont’d Biological variations ◦Cultural groups are identified in various ways  Characteristics ◦ Body structure ◦ Skin color ◦ Hair color and texture ◦ Family history of disease ◦ Dietary practices All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 19

20. Question 2 Today you are caring for an American Indian patient. During your communication, you maintain eye contact, which is perceived by this population as being: 1.impolite or invading privacy. 2.interested. 3.attentive. 4.honest. All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 20

21. Nursing Process and Cultural Factors Nurse develops a care plan based on cultural background after assessing patient North American Nursing Diagnosis Association (NANDA) nursing diagnoses may not apply to culturally diverse patients To provide care and lessen limitations of the NANDA nursing diagnoses, the nurse must evaluate behavior of the prospective patient’s culture The nurse, health care system, or both may be required to change in order to accommodate, maintain, or reinforce patients’ health beliefs and practices All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 21

22. Cultural Practices of Specific Groups See Table 6-4 in Foundations text Mexican Americans ◦Health belief system ◦Language ◦Communication ◦Family roles All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 22

23. Cultural Practices of Specific Groups cont’d Mexican Americans ◦Birth rites ◦Death rites ◦Dietary practices All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 23

24. Cultural Practices of Specific Groups cont’d African Americans ◦Health belief system ◦Language ◦Communication ◦Family roles All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 24

25. Cultural Practices of Specific Groups cont’d African-Americans ◦Birth rites ◦Death rites ◦Dietary practices All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 25

26. Cultural Practices of Specific Groups cont’d Chinese Americans ◦Health belief system ◦Language ◦Communication All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 26

27. Cultural Practices of Specific Groups cont’d Chinese Americans ◦Family roles ◦Birth rites ◦Death rites ◦Dietary practices All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 27

28. Cultural Practices of Specific Groups cont’d Muslim Americans ◦Health belief system ◦Language ◦Communication All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 28

29. Cultural Practices of Specific Groups cont’d Muslim Americans ◦Family roles ◦Birth rites ◦Death rites ◦Dietary practices All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 29

30. Cultural Practices of Specific Groups cont’d American Indians ◦Health belief system ◦Language ◦Communication All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 30

31. Cultural Practices of Specific Groups cont’d American Indians ◦Family roles ◦Birth rites ◦Death rites ◦Dietary practices All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 31

32. Question 3 Which culture allows fathers in labor and delivery? 1.Chinese 2.American Indian 3.Mexican Americans 4.Muslim All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 32