Ch 6 CULTURAL AND ETHNIC CONSIDERATIONS

CULTURE

A set of learned values, beliefs, customs, and practices taught that are shared by a group and passed from one generation to another

Which actions would the nurse take to help a patient prepare for a respiratory procedure?

Explain the need to sign a consent form before the procedure.

Review potential effects of the procedure on the patient's lifestyle

Ensure the patient understands the procedure's benefits and risks.

Which religious faith prohibits autopsy to determine cause of death, unless required by law?

Islam and Judaism prohibit autopsy,

three levels of health promotion ?

Primary Prevention

Secondary Prevention

Tertiary Prevention

primary prevention

avoid disease states through wellness activities----preemptive screening programs such as mammograms, colonoscopies, and glucose screening

secondary prevention

presence of disease----but seeks to reduce the impact of the condition by encouraging behaviors

example----dietary teaching to a patient with diabetes with the intention to reduce episodes of hyperglycemia

tertiary prevention

management, serious health problems --- seek to improve the quality of life and reduce further loss of function.

example---screening of patients with diabetes for diabetic retinopathy to prevent BLINDNESS

WELLNESS-ILLNESS CONTINUUM

means: range of a person's total health.

end of the spectrum is wellness----Illness, at the opposite end of the spectrum, represents a diminished or impaired state of health

LANGUAGE SPOKEN

is the most important area to consider when assessing a patient from a different culture,

You are caring for a Muslim patient and know that they pray several times a day. Which intervention is most appropriate in caring for this patient?

Schedule patient care around these prayer times.

A female Muslim patient has been assigned to a male nurse. As the nurse enters the room, the patient becomes very upset. Based on religious beliefs of Muslim, you know she is upset because:

She prefers to be taken care of by a female.

Which of the following Nursing Diagnoses is appropriate for a 35-year-old Hispanic patient who does not speak English?

Impaired verbal communication

A Hispanic-American child is brought to the clinic by her mother to be examined by the physician. Which of the following interventions is important when gathering data about the child?

Be sure to touch the child during the exam.

The nurse is doing discharge teaching with an African-American regarding nutrition intake. When developing this plan the nurse is aware that the common practice of African-American is to eat:

Fried foods

Which of the following are common characteristics seen among different cultures? Select all that apply.

-Culture is learned from birth through language and socialization.

Culture is dynamic and ever-changing, but it remains stable.

All member of the same cultural group share the paterns that are present in every culture. These include communication, means of economic and physical survival, transportation system, family systems, social customs and mores, and religious systems (mores are accepted traditional customs, moral attitudes, or manners of a particular social group)

Culture is an adaptation to specific conditions in a specific location.

All members of a culture will not have the same behavior. These variations are based on individual differences. INTERVENTIONS that would address these differences include :

Schedule patient care around prayer time.

Provide teaching in the language spoken.

Encourage family to participate in patient care.

SOCIETY

is a nation, community, or broad group of people who establish particular aims, beliefs, or standards or living and conduct.

SUBCULTURE

shares many characteristics with the primary culture but has characteristic patterns of behavior and ideals that distinguish it from the rest of a cultural group

NO ALL MEMBERS OF A CULTURE NOT HAVE THE SAME BEHAVIOR. SOME DIFFERENCES ARE:

Age

Religion

Dialect/language spoken

Gender identity and roles

Socioeconomic background

Geographic location of country of origin or current

Amount and type of interaction between younger and older generations

Degree of adoption of values in current country

the nurse must not stereotype

members of any culture group

STEREOTYPE

a GENERALIZATION about a form of behavior, and individual, or a group

ETHNIC STEREOTYPE

a FIXED concept of how all members of an ethnic group act or think

TRANSCULTURAL NURSING

understanding and integrating the many variables in cultural and subcultural practices into all aspects of nursing care.

different cultures have a variety of practices relate to:

Health care and treatment methods

Responses to illness and death

Childbirth

Care of people of different age groups

Diet and nutrition

CULTURAL COMPETENCE

the awareness of one's own cultural beliefs and practices and their relation to those of others, which may be different.

RACE

A group of people who share BIOLOGICAL PHYSICAL CHARACTERISTICS

ETHNICITY

A group of people who share a common social and cultural heritage based on shared traditions, national origin, and physical and biological characteristics.

the nurse should not make assumptions about a patient's beliefs or practices based on the person's

name, skin color, or language

it is important for the nurse to

recognize personal cultural beliefs when caring for others

ETHNOCENTRISM

a person believes that the beliefs and practices of his or her particular culture are best.

nurses must learn to

value the beliefs and practices of others and realize that practices of other cultures can be valuable in health care

SILENCE

may indicate a lack of understanding. stubbornness, apprehension, or discomfort

silence among American Indian, Chinese, and Japanese cultures

it may allow the nurse to consider what the speaker has said before continuing

silence among Russian, French and Spanish cultures

it may be used to indicate agreement between parties

silence among Asian cultures

it may indicate a sign of respect.

silence among Mexicans

it may indicate that they disagree with a person of authority

NONVERBAL COMMUNICATION

some groups are more comfortable when touching or maintaining eye contact than are others

touch is especially culturally related

eye contact also has significant cultural interpretations

Eye contact in the United States indicates

Openness, interest, attentiveness, and honesty. lack of eye contact may be perceive as shyness, humility, guilt, embarrassment, rudeness, thoughtlessness, or dishonesty

some Asians or American Indians relate eye contact to

impoliteness or view it as an invasion of privacy.

certain East Indian cultures avoid eye contact with

people of lower or higher socioeconomic classes

among some Appalachian people, maintaining eye contact

may indicate hostility or aggressiveness

the nurse needs to respond appropriately for

each culture

SPACE

cultures may have different comfort areas of personal space

Western cultures (space)

people in a casual or public setting are most comfortable when they can maintain 3 to 6 feet between them

another aspect of personal space may be

a desire to use a certain space- sitting in a particular chair or a specific area of the room

body movements may be culturally related (space)

some gestures that are commonly used may offend someone from another culture

TIME

the measurement of time can have different meanings in various cultures

The United States and many northern European cultures

generally regard being on time as a high priority

Mexican-Americans are more concerned with a current activity than

in going to a previously planned meeting

SOCIAL ORGANIZATION

cultural behavior is socially acquired, not genetically inherited

withing a culture, there are varying social structures

Patriarchal

matriarchal

PATRIARCHAL

men make most of the decisions

MATRIARCHAL

women make most of the decisions

knowing the family structure will help the

nurse better understand the patient

RELIGIOUS BELIEFS AND HEALTH CARE

religious beliefs are frequently entwined with cultural beliefs

some cultures expect all members to adhere

to a particular religion

as people from varying cultures intermarry, religious practices also

vary

nursing care is

clearly affected by patients' religious beliefs and practices, it is important for nurses to be aware of the wide range of such beliefs to ensure that the care given is sensitive to the needs of individual patients

THREE BASIC CONCEPTS OF HEALTH BELIEFS

Biomedical health belief system

Folk health belief system

Holistic health belief system

BIOMEDICAL HEALTH BELIEF SYSTEM

western cultures have almost universally used the biomedical method of treating illness and maintaining health.

FOLK HEALTH BELIEF SYSTEM

folk medicine encompasses many different traditions in cultures around the world. it often includes native healers who use a variety of methods in treating disorders

HOLISTIC HEALTH BELIEF SYSTEM

this system operates on the premise that natural forces govern everything in the universe, including human beings and their illnesses. methods are used to manipulate the environment to improve health

Biological Variations

cultural groups are identified in a variety of way they may share strong biological characteristics.

obvious characteristics (biological variations)

body structure

skin color

hair color and texture

family history of diseases that are common within the ethnic group

cultural dietary practices

DEATH RITE OF AMERICAN INDIANS

assistance with ceremonies, particularly those associated with death, is shared and has great importance.

people of this culture have a taboo against touching a dead person or any article associated with the deceased individual. taboos associated with death in a hogan include the need to seal the entry and warn others to stay awake; frequently the need to abandon or burn the hogan is observed.

ORTHODOX JEWS BIRTH/NAMING

for observant Jews, babies are named by the father. male children are named 8 days after birth, when ritual circumcision is done. A mohel performs the circumcision is often postponed if the infant is in poor health. female babies are usually named during the reading of the holy Torah.

nurses need to be sensitive to the wishes of the parents when caring for babies who have not yet been named.

ORTHODOX JEWS' HOLY BOOK IS THE

Torah

DEATH FOR ORTHODOX JEWS

Judaism defines death as occurring when respiration and circulation are irreversibly stopped and no movement is apparent.

1 Euthanasia is strictly forbidden by Orthodox

2 Before death, Jewish faith indicates that visiting of the person by family and friends is a religious duty. the Torah and Psalms are often read and prayers recited. a witness needs to be present when a person prays for health so that if death occurs God will protect the family and the spirit will be committed to God. Extraneous talking and conversation about death are not encouraged unless initiated by the patient or visitors. In Judaism, the belief is that people should have someone with them when the soul leaves the body; so allow family and friends to stay with patients. after death, the body is not to be left alone until burial, usually within 24 hours.

3 When death occurs, the body is to remain untouched for 8 to 30 minutes. medical personnel are not to touch or wash the body; only an Orthodox person or the Jewish Burial Society is permitted to care for the body.

handling of a corpse on the Sabbath is forbidden to Jewish persons. if need be, the nursing staff is permitted to provide routine care of the body, wearing gloves. water receptacles in the room have to be emptied, and the family often request that mirrors be covered to symbolize that a death has occurred.

4 Orthodox Jews and some conservative Jews do not approve of autopsies. if an autopsy is necessary, all body parts are required to remain with the body.

5 For Orthodox Jews, the body is required to be buried within 24 hours. No flowers are permitted. a Fetus is required to be buried.

6 A 7-day mourning period is required by the immediate family. they stay at home except for Sabbath worship.

7 Make sure that organs or other body parts such a amputated limbs are made available for burial for Orthodox Jews because they believe that all of the body must be returned to the earth.

ORTHODOX JEWS DIETARY RULES

kosher dietary laws include the following:

no mixing of milk and meat at a meal; no consumption of food or any derivative thereof from animals not slaughtered in accordance with Jewish law; use or separate cooking utensils

for milk and meat products; IF FOR MEDICAL REASONS A PATIENT REQUIRES MILK AND MEAT PRODUCTS FOR A MEAL, THE DAIRY FOODS SHOULD BE SERVED FIRST, FOLLOW LATER BY THE MEAT.

DURING Yom Kippur (day of the Atonement), a 24-hour- fast is required; but exceptions are made for those who cannot fast because of medical reasons or age.

during pass-over, no leavened products are eaten.

Observant Jewish patients often with to say prayers over the bread and wine before meals. time and quiet environment, should be provided for this

ROMAN CATHOLIC BIRTH CONTROL

Prohibited except for abstinence or natural family planning methods. referral to a priest for questions about this is often of great help. Nurses teach the techniques of natural family planning if they are familiar with them; make referral to the physician or to a support group of the church that instructs couples in this method of birth control. STERILIZATION is prohibited unless there is an overriding medical reason.

LATTER-DAY SAINTS DIETARY HABITS

abstinence from the use of tobacco; beverages with caffeine such as cola, coffee, and tea; alcohol and other substances considered injurious. Mormons eat meat but encourage the intake of fruits, grains, and herbs.

LATTER-DAY SAINTS PERSONAL CARE

cleanliness is very important to Mormons. a sacred undergarment may be worn at all times by Mormons and is removed only in emergency situations

LATTER-DAY SAINTS (OTHER ACTIVITIES)

allowing quiet time for prayer and the reading of the sacred writings is important. the church maintains a welfare system to assist those in need. families are of great importance, so visiting is important to encourage.

MUSLIM AMERICANS DIETARY PRACTICES

fasting during daylight hours is practiced during Ramadan. medical condition often exempts person from fasting. allow family to provide meals if allowed with treatment. alcohol and drugs are forbidden.

make sure no pork products are included in foods.

IMAM

Muslim prayer leader.

curandero

a folk healer within the Mexican-American folk medicine system

when communication, in what culture does silence indicate respect?

Asian

some Asian and Native American cultures believe eye contact implies

rudeness

this culture views time a "elastic," indication time is flexible

Hispanic

Western culture believes in this health of practice

biomedical medicine

Chinese American beliefs focus on this type of medicine

holistic

the religious holiday "Ramadan" is practiced by what culture?

Muslim

fasting during this religious holiday is a practice of the Jewish culture

Yom Kippur

BLACK AFRICAN AMERICANS (FAMILY ROLES)

women are primarily decision makers in family (MATRIARCHAL) and are frequently head of the household

extended family plays important role. even when no related by blood, close ties exist. May refer to these people as "Aunt," "Uncle," "Grandmother," and include them in family decisions.

CHRISTIANITY PRACTICES (WHEN THEY HAVE A CHILD WHAT DO THEY DO AND WHAT IS THAT CALLED)

BAPTISM

ELASTICITY (TIME)

implies that it is possible to recover future actuvities but not present ones

Which action would the nurse take when developing a care plan to ensure that it is culturally sensitive ?

Incorporate the cultural behaviors of the patient into the plan.

(pg. 108)

Which strategies will the nurse implement to enhance communication with patients from various cultures?

active listening; validating the patient's understanding; using appropriate gestures, touch, and eye contact; and using alternative communication methods

(pg. 99)

The health care provider suggests abortion as the treatment choice for an expectant mother. Which nursing action would be most appropriate?

Find out if the patient's religion allows abortion.

(pg. 99)

The nurse is caring for a female patient with ovarian cancer. The patient refuses to sign the informed consent for care and requests the nurse to wait for her spouse to arrive before getting the signature. To which community does the patient likely belong?

Islamic Community

(pg. 103)

A patient's husband insists that he must be the one who signs the patient's consent form. To which religious faith might the nurse consider that the patient and her spouse belong?

Islam

A male infant has been born. The family insists that circumcision be done on the eighth day of life. To which religion does the child likely belong?

Judaism

(pg. 104)

The nurse is doing discharge teaching with an African American patient regarding nutrition intake. Which food customs would the nurse consider when developing this educational plan?

Many meats & vegetables are fried in LARD

A patient from the Catholic faith is dying. The nurse calls the priest and requests which action to address the patient's needs at this time?

The "anointing of the sick" sacrament

(pg. 105)

((priest applies holy oil to the patient's forehead and hands.))

A Protestant patient is admitted to a health care facility. The nurse is asked to avoid pork in the patient's diet. To which Protestant denomination might the patient belong?

Seventh-Day Adventist

(pg. 106)

((usually vegetarians))

Which strategy does the nurse employ when examining an Asian patient with syphilis?

Assign a nurse of the same gender

(pg. 99)

While interacting with the parents of a child who was severely injured, the nurse notes that neither parent has the ability to read or write. Which strategy does the nurse adopt to ensure effective communication?

Provide instructional material supported by illustrations.

(pg. 98)

A young mother has decided to abort a fetus because of severe deformities. The nurse caring for her does not believe in abortions and refuses to provide care for the patient. Which action would demonstrate cultural competence by the nurse?

Examine personal feelings by performing a self-assessment.

(pg. 96)

Which dietary precaution would the nurse adopt while assisting in the care of a patient from the Islamic community?

Giving permissible meat

(pg. 103)

A Vietnamese patient brings a 7-year-old child for a clinic visit twice a week to assist with translation. The nurse is concerned that the child is missing too many days of school. Which action would demonstrate acting as an advocate for the family?

Making arrangements for a translator to be present on the visits.

(pg. 98)