Unit 1C: The Client in Context: Culture, Spirituality & Family

Main Topics: (1) Culture (2) Spirituality (3) Family

whole

Health assessment involves assessment of the individual as a ___.

1. Cultural Context

2. Family Context

3. Spiritual Context

4. Community Context

What 4 contexts is an individual part of, which affects their health status?

Culture

Totality of socially transmissible behavioral patterns, arts, beliefs, values, customs, lifeways, and all other products of human work and thought characteristic of a population or people that guide their worldview and decision making (Purnell & Paulanka, 2003)

Subculture

Composed of people who have a distinct identity and yet are related to a larger cultural group

Race

The classification of people according to shared biologic characteristics, genetic markers, or features

Acculturation

The process where people adapt to or borrow traits from another culture

Culture Shock

A disorder that occurs in response to transition from one cultural setting to another

Stereotyping

Assuming all members of a culture or ethnic group are alike

Ethnocentrism

The tendency to view your own way of culture as the most desireable, acceptable, or best, and to act in a superior manner toward other cultures

Cultural Imposition

The tendency to impose your beliefs, values, and patterns of behavior on individuals from another culture

SAUL

Acronym for the 4 Characteristics of Culture

1. Shared

2. Adapted

3. Universal

4. Learned

4 Characteristics of Culture

Shared

One of the 4 Characteristics of Culture

__ by all members of the group

Adapted

One of the 4 Characteristics of Culture

As environmental circumstances change, the group changes to improve its ability to survive

Universal

One of the 4 Characteristics of Culture

All humans have culture

Learned

One of the 4 Characteristics of Culture

Transmitted from generation to generation; learned through life experiences within one’s culture group

Culture-Bound Syndromes

Culturally-defined conditions which may have no equivalent from a biomedical/scientific perspective

Panuhot

Example of a Culture Bound Syndrome of Cebuanos

Empacho

Example of a Culture Bound Syndrome of Hispanic Americans

1. Eye contact may be considered disrespectful

2. Hesitant to ask questions; nodding may not mean agreement

3. Respect elders and authority figures

4. The word “no” may be interpreted as disrespect for others

5. Touching unacceptable with members of opposite sex

6. Female clients usually prefer a female care provider

7. Family involvement in care is preferred

8. Health beliefs: illness is an imbalance between yin and yang

9. Yin foods are cold and yang foods are hot

10. Other health practices: Acupuncture, Medicinal herbs, Ventosa, Acupressure/Massage

10 Chinese Cultural and Health Beliefs/Practices

Chinese

Major Cultural Group in which eye contact may be considered disrespectful

Chinese

Major Cultural Group in which they are hesitant to ask questions; nodding may not mean agreement

Chinese

Major Cultural Group in which they have respect for elders and authority figures

Chinese

Major Cultural Group in which the word "no" may be interpreted as disrespect for others

Chinese

Major Cultural Group in which touching unacceptable with members of opposite sex

Chinese

Major Cultural Group in which female clients usually prefer a female care provider

Chinese

Major Cultural Group in which family involvement in care is preferred

yin and yang

Chinese health belief: illness is an imbalance between __ __ __

cold; hot

Yin foods are ___ and yang foods are ___

1. Acupuncture

2. Medicinal Herbs

3. Ventosa

4. Acupressure/Massage

4 Health Practices of the Chinese

1. Similar cultural characteristics with the Chinese

2. Touching someone’s head isn considered disrespectful

3. CBS: “hwa-byung” (a mental illness common in married, middle-aged women; triggered by life crisis.)

3 Korean Cultural and Health Beliefs/Practices

Korean

Major Cultural Group that has similar cultural characteristics with the Chinese

Korean

Major Cultural Group in which touching someone's head is considered disrespectful

Hwa-Byung

Korean culture-bound syndrome

A mental illness common in married, middle-aged women; triggered by life crises

1. Men and women do not shake hands, touch each other or go together in public, unless they are married or belong to same immediate family

2. Physically robust person considered healthy

3. Culture is male-dominated

4. HC provider would only be of the same sex

5. Culture is highly influenced by Islamic religion

6. CBS: “Zar” (apathy and withdrawal believed to be caused by spirit possession)

7. They pray facing Mecca or at the East

8. Burial is immediate, one day after death

8 Middle Eastern Cultural and Health Beliefs/Practices

Middle Eastern

Major cultural group in which men & women do not shake hands, touch each other or go together in public, unless they are married or belong to the same immediate family

Middle Eastern

Major cultural group in which a physically robust person considered healthy

Middle Eastern

Major cultural group that is male-dominated

Middle Eastern

Major cultural group in which health care provider should ONLY be of the same sex

Middle Eastern

Major cultural group whose culture is highly influenced by Islam

Zar

Middle Eastern Culture Bound Syndrome

Apathy & withdrawal believed to be caused by spirit possession

1. Tend to be verbally expressive, yet values confidentiality (sensitive to open discussions regarding sex)

2. Believes illness to be causes either by the supernatural, as a punishment from God or as an imbalances between the caliente and frio forces

3. Health Practices:

   1. When ill, first seek advice from older women in family

   2. Then goes to either and “Jerbero” (specialized in the use of herbs) or “Curandero/curandera” (holisitc healer)

   3. If no relief, may go to a physician

4. CBS’s:

   1. Mal ojo (“evil eye”)

   2. Empacho (“ball of food”)

   3. Susto (“soul loss” following extreme fright)

   4. Caida dela mollera (“depressed fontanelle” due to improper handling of infant)

4 Hispanic American Cultural and Health Beliefs/Practices

Hispanic American

Major cultural group that tend to be verbally expressive, yet values confidentiality (sensitive to open discussions regarding sex)

supernatural;

caliente; frio

Hispanic Americans believe illness to be caused either by…

1. the ___, as a punishment from God, OR

2. an imbalance between the ___ and ___ forces

older women;

jerbero; curandero/curandera;

physician

In Hispanic American culture, when one is ill

1. First seeks advice from ___ ___ in the family

2. Then goes to either an ___ or ___

3. If no relief, may go to a ___

Jerbero

In Hispanic American culture, a healer that specializes in the use of herbs

Curandero/Curandera

In Hispanic American culture, a holistic healer

Mal Ojo

Hispanic Culture-Bound Syndrome

Evil Eye

Empacho

Hispanic Culture-Bound Syndrome

Ball of Food

Susto

Hispanic Culture-Bound Syndrome

“Soul Loss” following extreme fright

Caida dela mollera

Hispanic Culture-Bound Syndrome

“Depressed fontanelle” due to improper handling of infant

1. Menstruation is believed to rid the body of dirty and excess blood

2. Have a rich tradition of herbal remedies

3. CBS’s:

   1. Voodoo Illness (as a result of witchcraft)

   2. Falling Out (sudden collapse, fainting or blacking out; normal reaction)

3 African American Cultural and Health Beliefs/Practices

African American

Major cultural group that believes menstruation is believed to rid the body of dirty and excess blood

African-American

Major cultural group that has rich tradition of herbal remedies

Voodoo Illness

African-American Culture Bound Syndrome

Result of witchcraft

Falling Out

African-American Culture Bound Syndrome

Sudden collapse, fainting or blacking out; normal reaction

1. Need to engage “small talk” before discussing more serious matters

2. Respect the elderly and people older than you

3. Sex and socioeconomic status too personal to discuss

4. Expressing pain or crying is a sign of weakness (esp. among males)

5. Culture beliefs:

   1. Believes that illness may be caused by evil spirits; may see folk/faith healers

6. Health practices:

   1. Flushing (stimulating perspiration),

   2. Protection (use of amulets, religious medals, pictures, statues)

7. CBS’s:

   1. “panuhot”

   2. “nabuyagan”

   3. “pasmo”

   4. “kabuhi”

   5. “barang”

7 Filipino Cultural and Health Beliefs/Practices

Filipino

Major cultural group that needs to engage in "small talk” before discussing more serious matters

Filipino

Major cultural group in which one needs to respect the elderly & people older than you

Filipino

Major cultural group in which sex and socioeconomic status is too personal to discuss

Filipino

Major cultural group in which expressing pain or crying is a sign of weakness, especially among males

evil spirits; folk/faith healers

Filipino cultural beliefs: believes that illness may be caused by ___ ___; so may see ___ ___

Flushing

Filipino health practice

Stimulates perspiration

Protection

Filipino health practice

Use of amulets, religious medals, pictures, statues

1. Panuhot

2. Nabuyagan

3. Pasmo

4. Kabuhi

5. Barang

5 Filipino Culture-Bound Syndromes

Panuhot

(Syndrome mentioned in lecture but not defined)

Filipino Culture-Bound Syndrome

Caused by excessive air that is trapped in the stomach which then causes discomfort, pain, gripes or flatulence

Nabuyagan

(Syndrome mentioned in lecture but not defined)

Filipino Culture-Bound Syndrome

A stranger's greeting or evil eye can cause a child to become ill or develop a psychological disorder

Pasmo

(Syndrome mentioned in lecture but not defined)

Filipino Culture-Bound Syndrome

Illness believed to be caused by sudden temperature changes, such as going from hot to cold

Kabuhi

(Syndrome mentioned in lecture but not defined)

Filipino Culture-Bound Syndrome

Causes severe headaches, nausea, vomiting, shortness of breath, and epigastric pain. It's also characterized by frequent burping

Barang

(Syndrome mentioned in lecture but not defined)

Filipino Culture-Bound Syndrome

Caused by sorcery or witchcraft

Cultural Competence

An ability to interact effectively with people of different cultures

1. Become sensitive to nonverbal cues & communication

2. Engage in many direct cultural encounters

3. Appreciate differences, but build on similarities

3 DO’s for Cultural Encounters

1. Stereotyping

2. Personalizing all perceived negative communication

3. Judging others based on your personal values & rules

3 DON’T’s for Cultural Encounters

Spirituality

A search for meaning & purpose in life, which seeks to understand life's questions in relation to the sacred

Informal, non-organized, self-reflection & experienced

Spiritual Assessment

Will help the nurse address client's spiritual needs to maintain well-being

Spirituality

___ is…

1. informal

2. non-organized

3. self-reflection

4. experienced

Religion

Refers to rituals, practices & experiences involving a search for the sacred (God, Allah) that are shared within a group

Each ___ has different views on health & illness

Religion

___ is…

1. formal

2. organized

3. ritualistic

4. group-oriented

Buddhism

Major world religion in which prayer & meditation are used for cleansing & healing

Reincarnation

In Buddhism, this is the belief death is associated with rebirth into another form.

Buddhism

Major world religion in which many are strict vegetarians

No, the nurse’s response is inappropriate because the nurse fails to accommodate to the patient’s dietary restrictions and does not offer other nutritional alternatives (like beans, corn, potatoes) that are allowed in the patient’s vegan diet.

Hinduism

Major cultural belief that illness is a result of karma

Karma

Hindu belief that illness is a result of past and current life actions

Right

In Hinduism, the ___ hand is seen as holy, thus eating and interventions need to be done with this hand to promote clean healing

Hinduism

Major world religion in which many but not all are vegetarians, not allowed to eat beef

Beef

What food are all Hindus not allowed to consume?

1. Dawn/Sunrise

2. Noon

3. Afternoon

4. Sunset

5. Evening

In Islam, what periods of the day does prayer occur?

East

In Islam, prayers are done facing the ___ on a rug, which is preceded by washing hands and feet.

Islam

Major world religion in which ladies are not to view men other than their husbands naked

Allah

In Islam, it is believed all outcomes in life are seen as predetermined by ___

East

For dying patients that practice Islam, it is important that they face ___ and die facing ___

pork; alcohol

In Islam, consumption of ___ and ___ is proibited.

Ramadan

In Islam, this is the month of fasting where one should refrain from eating, drinking, having sex & indulging in anything in excess or ill-natured from dawn until sunset.

Jesus Christ; miracles

In Christianity, it is believed ___ ___ is the savior and ___ happen through prayers

unction

In Christianity, there is extreme ___ for the dying

emergency baptisms

In Christianity, there are ___ ___ for dying/dead newborns.

save a life

In Judaism, restrictions related to work on holy days are removed to ___ __ ___

Vidui

In Judaism, this is the last prayer of confession.

1. Arms should NOT be crossed

2. Clothing & bandages should be buried with them

In Judaism, what two things must be done for a client that has died?