Cultural Considerations lecture

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Information about Cultural Considerations lecture

Published on January 14, 2008

Author: Bianca



Cultural Considerations:  Cultural Considerations Jennifer Coleman Health Assessment Why Study Cultural Assessment?:  Why Study Cultural Assessment? What does this have to do with health assessment? Increase nurses sensitivity to sociocultural influences in health care. Improve ability to assess, intervene and evaluate health problems. The goal of the nurse is to provide care that will minimize cultural conflicts. Cultural Influences on Health Care:  Cultural Influences on Health Care To help understand ones own culture. To learn to accept the idea that cultural patterns are an integral part of safe, effective nursing care. To realize that our own nursing practice is scientifically based and often thought to be superior to other cultures. To understand and appreciate other culture’s norms and values as well as their effectiveness. Culture:  Culture Patterns of behavior (beliefs & practices) shared by a group of people performing essential tasks of daily living Meanings of Culture:  Meanings of Culture Beliefs and practices shared by a group. Specific, distinctive and encompassing of knowledge, customs and skills. A way of enabling us to interpret our surroundings and the actions of people around us and to behave appropriately. A set of rules that provides us with a means for behaving and interpreting the behavior of others. Characteristics of Culture:  Characteristics of Culture Culture is learned (language & socialization) Culture is social, shared with member (church) Culture is adaptive (stable but dynamic) Culture is integrative Culture is idealistic (norms in groups) Culture is satisfying Communication Governance Transfer of goals Artistic expression Social Characteristics of Culture:  Social Characteristics of Culture Male – Female roles Most cultures are patriarchal Native American and Hispanic – matriarchal Language and communication patterns Ethnic groups may have different language from the country Language barriers – Frustrating and anxiety producing Body language, eye contact, hand gestures Subculture:  Subculture Large aggregates of people who have shared characteristics that are not common to all members of the culture Religion Occupation Health related characteristics (blind, AIDS, cancer, hearing impaired) Age Gender Time Orientation:  Time Orientation Middle class in U.S. and Canada – orientated to future, present is for achieving long term goals, scheduled life Middle-Eastern – future orientation, present is for achieving goals, time should be spent productively Asian-American – past orientation Native American – present orientation, live day to day, often no clocks in the home Hispanic – focus on present with hope for the future More Social Characteristics :  More Social Characteristics Family Nuclear family Extended family – valued in Chinese, Native Americans, Hispanics 2nd family Nutritional practices Ethnic influences on diet (Judaism – Kosher) Relationships with Others:  Relationships with Others Lineal Heredity and kinship ties Ordered succession and have continuity Collateral Focus on group goals Family orientation is all important Individual Personal autonomy and independence Individual goal orientation Concepts Relevant to Culture:  Concepts Relevant to Culture Holism Cultural change Enculturation Culture bound Ethnocentrism Stereotypes Cultural Values – Beliefs Holism:  Holism Looking at human behavior within the context in which it occurs Holistic health is the consideration of the whole person Mind, body and spirit are interdependent Culture can be viewed and analyzed as a whole Components of a Culture:  Components of a Culture Health practices Habits Language Morals Art Religion Beliefs Rules Customs Patterns of behaviors Music Support Systems Diet Ways of life Philosophy of life Spirituality Cultural Change:  Cultural Change A change that results from contact between groups and of forces within a group. This is generally a positive change because the change creates new challenges and new problems. The health status of any society is related to its ability to change. Their change is influenced by the many components of culture. Example – acceptance of alternative medicine (chiropractic, osteopathic, homeopathic…) because of political, social and legal changes. Enculturation/Socialization:  Enculturation/Socialization Process of acquiring knowledge and internalizing values. Example: Children acquire their culture by watching adults and making inferences about the rules for behavior “cheating in games” “speeding” Cultural patterns provide explanations for life events (birth, death, puberty, illness, disease) Culture Bound:  Culture Bound Whenever people learn a culture, they are to some extent imprisoned by it – with limited exposure to other cultures or ways of thought, their culture can be the only reality. Culture-bound syndrome African-American “Blackout” collapse, dizzy Caucasian “Anorexia nervosa” “Bulimia” Ethnocentrism:  Ethnocentrism The belief that one’s own cultural viewpoint is the best. We need to be aware that people may live with different rules and priorities from those of us as health care providers. Stereotypes:  Stereotypes Exaggerated (generally negative) beliefs and images that are popular depictions of a group in the mass media and folklore “All African Americans have large families.” “All welfare recipients are minorities.” “All Asians excel in math and science.” “All American Indians are alcoholics.” Need to be extremely sensitive to the individual variation within every group Cultural Values and Beliefs:  Cultural Values and Beliefs Value – a type of belief on how one should or should not behave; provides powerful motivation and standards of care (public and personal values) Belief – statements that one holds as true The behavior of clients in regards to health and illness can be understood by knowing something about their values and beliefs. Influences the kind of health care a person considers acceptable/desirable. Cultural Differences:  Cultural Differences Communication patterns Ethnic collectivity Cultural shock Subculture Communication Patterns:  Communication Patterns Speaking different languages. Difficulty explaining things in simple language so that clients can understand. Facial expressions, posture, voice tone, body movement. Personal space and contact – an invisible, flexible boundary that surrounds the individual, provide a margin of safety and security. Territorial and personal space:  Territorial and personal space Territorial – pattern of behavior arising from an individuals feeling that certain spaces and objects belong to that person Personal space – distance a person prefers to maintain from others when interacting with them 0-18” Intimate 18”-4’ Personal 4’-12’ Social 12’ or up Public Unique Communication Examples:  Unique Communication Examples Eye contact Important, valued in Caucasian Americans Disrespectful/insulting with Native-Americans, Vietnamese (most Asian-Americans) Emotional expression Acceptable: African-Americans, Hispanic Unacceptable: Chinese, Japanese Ethnic Collectivity:  Ethnic Collectivity A group whose members share a common social and cultural heritage passed on to each successive generation Cultural Shock:  Cultural Shock The feelings of helplessness and discomfort and the state of disorientation experienced by an outsider attempting to comprehend a new reality Adapt to a different cultural group because of differences in practices, values and beliefs Unique Cultural Beliefs Related to Health Care:  Unique Cultural Beliefs Related to Health Care Chinese Healthy body is a gift from parents and ancestors and must be cared for Health is a balance of energy forces: Yin and yang (cold and hot) – Vietnamese also believe in this Chi – innate energy and blood is source of life, lack of chi results in fatigue, long illness Acupuncture & acupressure Common milk intolerance Cultural Beliefs:  Cultural Beliefs Native-American (~500 recognized tribes) Health is a state of harmony with nature and universe Disorders have aspects of supernatural Respect of body through proper management Will often consult a shaman (medicine person) Many fear witchcraft Theology and medicine are interwoven Cultural Beliefs:  Cultural Beliefs Hispanic-American Health associated with religion (good health may be good luck, reward for good behavior) Some believe in hot/cold imbalance (Puerto Rican, Filipino, Haitian) Health promotion – performing properly, eating proper foods, working proper amounts of time, praying, wearing religious medals/amulets, sleeping with relics in home May consult a curandero Cultural Beliefs:  Cultural Beliefs Caucasians Value the individual Illness has a cause & effect relationship Some religions believe illness is punishment for sins committed Hot and Cold:  Hot and Cold Hot Fever, diarrhea, rashes, sore throat, ulcers Chocolate, eggs, hard liquor, beef, goat’s milk PCN, tobacco, garlic, vitamins, aspirin, cinnamon Cold CA, pneumonia, menstrual pain, teething, colds, HA Fresh veggies, tropical fruits, dairy, fish, honey, goat Orange flower water, bicarb of soda, sage Pain Perception:  Pain Perception Highly personal experience, with a dependence on cultural learning and meaning of the situation. Silent suffering is often valued by health care providers. Expect variations in pain perception, tolerance and expression. Years of experience and clinical practice are unrelated to inferences of suffering. Spirituality and Religion:  Spirituality and Religion Spirituality – each person’s unique life experiences and personal effort at finding purpose and meaning in life, personal understanding and interpretation of existence Religion – organized system of beliefs concerning the cause, nature, and purpose of the universe (~1500 religions in US) Spirituality:  Spirituality Beliefs will influence client’s feelings about illness, lifestyle and behavior Religious beliefs often practiced during crisis and times of stress Some persons question faith in times of crisis Some persons see illness as punishment/trial for the soul (Hindu, Buddhist) Unique Religious Beliefs Concerning Medical Care:  Unique Religious Beliefs Concerning Medical Care Church of Christ Scientist (Christian Science) – See sickness & sin as errors of mind that can be altered by prayer, unlikely to donate organs Scientology - followers deny any psychiatric care their doctors may prescribe to the psychiatrist – the Scientology definition of a "psychiatrist" was officially declared by Hubbard to be "an anti-social enemy of the people" Unique Religious Beliefs Concerning Medical Care:  Unique Religious Beliefs Concerning Medical Care Jehovah’s Witness – Oppose blood transfusions Judaism – Resist surgical procedure on Sabbath Russian Orthodox – Cross necklace is important and should only be removed when necessary and replaced ASAP, opposed to autopsy, embalming or cremation Mennonites:  Mennonites Large and growing population in AR German and English language Illness and health seem to be centered around the ability to do work No health insurance Antibiotics, blood transfusions, psych meds, etc. all accepted Use of midwives is common Mennonites:  Mennonites Innate distrust of science and the medical system Often victims of odd remedies Keep explanations simple and basic Visitors are important – community based life Hat for women very important – start to wear ~12, prefer to die with it on No photos, prefer a private room Components in a cultural assessment:  Components in a cultural assessment A cultural assessment will indicate the health status of a group of people. Communication style Time Orientation Family relationships Health beliefs (i.e.-pica) Education Religion Self-Care:  Self-Care Self-care is valued in many cultures. Many health care professionals do value self-care. Can be more expensive and time-consuming than biomedical alternatives. Influenced by accessibility of OTC medications. Can be effective and does not necessarily delay more effective treatments. Health Problems Unique to Certain Groups/Cultures:  Health Problems Unique to Certain Groups/Cultures Sickle-cell – Mediterranean, African Genetically passed as a recessive gene Protection to malaria HTN – African-Americans, Japan, Taiwan Stress, obesity, salt intake influence rates Cystic fibrosis – Scots, English Genetically passed as a recessive gene Unique Health Problems:  Unique Health Problems Lactose Intolerance African-American Asian-American Diabetes African-American, Hispanic Diet, exercise, weight control, genetics Summary on Cultural Sensitivity:  Summary on Cultural Sensitivity Recognize cultural diversity exists Respect people as unique individuals Respect the unfamiliar Id & examine own beliefs & values Cultural groups have definitions & practices of health & illness that may differ from the nurse’s Be willing to modify health care delivery to accommodate client’s cultural background Summary Continues:  Summary Continues Recognize own stereotypes & expectations concerning client’s cultural background Appreciate that each client’s cultural values are ingrained & therefore very difficult to change

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