1. Chapter 5 Culture and Ethnicity

2. 5-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Culture  Knowledge, beliefs, behaviors, ideas, attitudes, values, habits, customs, languages, symbols, rituals, ceremonies, and practices that are unique to a particular group of people.

3. 5-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Concepts of Culture  Each individual is culturally unique.  Behavior, self-perception, and judgment of others is dependent upon one’s cultural perspective.  Differences within cultural groups result from individual perspectives and practices.

4. 5-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Cultural knowledge is transmitted from one generation to another.  The sharing of common cultural practices provides a group with part of its cultural identity.  Culture is social in nature.  Culture is dynamic, adaptive, and ever-changing. Characteristics of Culture

5. 5-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Ethnicity and Race  Ethnicity A cultural group’s perception of themselves (group identity)  Race A grouping of people based on blood group, facial features, color of skin, hair, eyes

6. 5-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Ethnicity and Race  The similarities of people in racial and ethnic groups reinforce a sense of commonality and cohesiveness.  Problems arise when differences across and within cultural groups are misunderstood.

7. 5-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Stereotyping An expectation that all people within the same racial, ethnic, or cultural group act alike and share the same beliefs and attitudes.  Stereotyping results in labeling people according to cultural preconceptions. Labeling and Stereotyping

8. 5-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Labeling and Stereotyping  Ethnocentrism The belief that one’s own culture is superior to all others.  Oppression Occurs when the rules, modes, and ideals of one group are imposed on another group.

9. 5-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Racism  Racism is a form of oppression.  Racism is discrimination directed toward individuals who are perceived to be inferior due to biological differences.

10. 5-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Dominant Values in the U.S.  A dominant culture is the group whose values prevail within a society.  A subculture is a group of people who have experiences different from those of the dominant culture.

11. 5-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Competition, achievement success  Individualism, independence, self-reliance  Activity, work, ownership  Efficiency, practicality, reliance on technology  Material comfort  Youth and beauty Dominant Values in the U.S.

12. 5-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Multiculturalism in the U.S.  At present, the dominant culture of the U.S. is composed of white, middle-class Protestants of European ancestry.  The U.S. is becoming increasingly multicultural and multilingual.  White Americans will decline from 75% to under 50% of the total population by the year 2050.

13. 5-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Dominant values may conflict with the values of minority groups.  Minority groups can be composed of an ethnic, racial, or religious group that constitutes less than a numerical majority of the population.  Minority groups are considered to hold less power than the dominant group. Dominant Values in the U.S.

14. 5-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Dominant Values in the U.S.  Acculturation is the process of learning norms, beliefs, and behavioral expectations of a group.  People assume the characteristics of the dominant culture through acculturation.

15. 5-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Assimilation is cultural and structural blending into a dominant entity.  Cultural assimilation occurs when individuals from a minority group are absorbed by the dominant culture and take on its characteristics. Dominant Values in the U.S.

16. 5-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Cultural diversity refers to differences between people based on their cultural variables that result in a shared ideology and way of life.  New ideas and increased tolerance of other viewpoints are outcomes of a diverse population. Value of Diversity

17. 5-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Organizing Phenomena of Culture  Communication  Space  Orientation to Time  Social Organization  Environmental Control  Biological Variations

18. 5-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Communication  Communication refers to words, facial expressions, posture, and gestures that have different meanings to different people in varying cultures.

19. 5-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Space  Personal space includes one’s body and the surrounding environment.  Space, distance, and use of touch are viewed in the context of personal space.  Touch may be perceived as invasive by clients from some cultures.

20. 5-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Orientation to Time  Orientation to time includes concepts of past, present, and future.  Different cultures place different values on the ideas of tardiness, quickness, and efficiency.

21. 5-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Organization  Social organization refers to the ways in which groups determine rules of acceptable behavior and roles.  Social organizations include family, religious groups, and ethnic groups.

22. 5-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Organization  Family Types of family structures include nuclear, extended, attenuated, incipient, and blended. Family patterns include linear, collateral, and individualist.

23. 5-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Organization  There are diverse family structures and types as shown in these photographs.

24. 5-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Organization  There are diverse family structures and types as shown in these photographs.

25. 5-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Organization  There are diverse family structures and types as shown in these photographs.

26. 5-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Organization  Gender Roles Vary according to cultural context. In families with a patriarchal structure, the man is the chief authority figure. In a matriarchal structure, the woman is the chief authority figure.

27. 5-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Organization  Examples of alternative lifestyles in the United States include homosexual couples, single parent families, and communal groups.

28. 5-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Organization  Religion Religious practices influence a person’s response to major life events such as birth, illness, and death. Illness and treatments are often the catalyst for increased spiritual needs.

29. 5-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cultural Disparities in Health and Health Care Delivery  Disparities in Health Minorities experience some diseases at a much higher rate than white Americans.  Disparities in Health Care Delivery Cultural insensitivity can create barriers to health care and inequities in services.

30. 5-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Biological Variations  Biological variations that distinguish one cultural group from another include: Enzymatic differences Susceptibility to disease

31. 5-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  The Poor  The Homeless  Migrant Workers  Abused Individuals  The Elderly  Pregnant Adolescents Vulnerable Populations

32. 5-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Vulnerable Populations  The poor have more complex health problems.  The poor have higher incidences of chronic illnesses.  Childhood poverty has long-lasting negative effects on health.

33. 5-33 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Vulnerable Populations  The Homeless Lack of affordable housing Increasingly stringent criteria for public assistance Decreased availability of social services Lack of employment History of psychosocial trauma Lack of mental health facilities

34. 5-34 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Vulnerable Populations  The homeless are at greater risk for diabetes, AIDS, respiratory diseases, cardiovascular diseases and parasitic infestations, mental illness, and substance abuse.

35. 5-35 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cultural Disparities in Health and Health Care Delivery  Environmental Control Relationships between people and nature One’s perceived ability to control activities of nature Beliefs about causation of disease may influence the type of treatment sought

36. 5-36 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Folk Medicine (Alternative Medicine)  Most cultures have preferences for their own caregivers.  Caregivers Folk healers, root doctor, granny, voodoo healer, spiritualist, herbalist, shaman

37. 5-37 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cultural Disparities in Health and Health Care Delivery  Biological variations that distinguish one cultural group from another include: Enzymatic differences Susceptibility to disease

38. 5-38 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Transcultural Nursing  Health behavior is culturally determined.  A thorough understanding of culturally relevant information is essential for delivery of competent nursing care.

39. 5-39 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Transcultural Nursing  Leininger’s transcultural nursing theory is the conceptual framework for understanding cultural diversity and providing culturally competent care.

40. 5-40 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Transcultural Nursing Theory  Every culture has some kind of system for health care based on values and behaviors.  Cultures have certain methods for providing health care, often unknown to nurses from other cultures.

41. 5-41 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cultural Competence  Cultural competence is the process through which the nurse provides care that is appropriate to the client’s cultural context.  Culturally competent nurses demonstrate knowledge and respect for cultural values related to health and illness.

42. 5-42 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Five Elements of Cultural Competence Cultural Awareness Cultural Knowledge Cultural Skill Cultural Encounters Cultural Desire Cultural Competence

43. 5-43 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cultural Competence and the Nursing Process  Assessment The nurse must acknowledge the importance of validating the meaning of and interpreting the intended verbal or nonverbal message.

44. 5-44 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cultural Assessment Factors  Client’s Ethnic Heritage  Family Role and Function  Religious Practices  Food Preferences  Native Language

45. 5-45 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cultural Assessment Factors  Social Networks  Health Care Beliefs  Family Patterns of Health Care  Educational Experiences (both formal and informal)

46. 5-46 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cultural Assessment Interview  Click the link below to view the Cultural Assessment Interview Guide Cultural Assessment Interview Guide

47. 5-47 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Noncompliance  Impaired Verbal Communication  Impaired Social Interaction  Deficient Knowledge  Disturbed Thought Processes  Powerlessness Culturally-Based Nursing Diagnoses

48. 5-48 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Planning and Outcome Identification  When planning culturally competent care, the nurse views the client as a partner of the health care team.

49. 5-49 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Cultural factors that may impact the plan of care: Perspectives on health, life, and death Perspectives on causes of illness, and maintenance of wellness Perceptions about the significance of symptoms Treatment approaches Planning and Outcome Identification

50. 5-50 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Caring for culturally diverse clients requires three major nursing interventions: Self-Awareness Nonjudgmental Approach Client Education

51. 5-51 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Client Education  Through self-awareness, the nurse recognizes the influence that one’s cultural background may have on the delivery of care.  A nonjudgmental approach is one that avoids using stereotypical, judgmental words.

52. 5-52 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Observe the interaction between the client and family to determine family roles and authority figures.  Use language easily understood by the client.  Clarify your verbal and nonverbal messages with the client.  Have the client repeat the information taught. Client Education

53. 5-53 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Determines client achievement of expected outcomes.  Determines efficacy of culturally sensitive nursing care to achieve client outcomes. It is important to demonstrate caring behaviors rather than just tolerate cultural variations. Evaluation