culture

CULTURE AND ETHNICITY IN NURSING

PROVIDING CULTURALLY COMPETENT NURSING CARE

  • Definition of Culture:
    • Culture refers to “socially transmitted behavior patterns, arts, beliefs, values, customs, lifeways, and human works characteristic of a people that guides their worldview and decision making.”
    • It encompasses what a group shares in common and evolves over time.
    • Functions of Culture:
    • Provides identity and a sense of belonging.
    • Establishes common beliefs and practices.
    • Exists in various domains, including arts, writings, food, and dress.
    • Is learned and taught, including through assimilation.
    • Is complex and diverse within any group.
    • Is all-encompassing, influencing various aspects of life.

CULTURAL OPENNESS

  • Definition:
    • Cultural openness denotes an ongoing commitment to cultural self-awareness and the continuous development of transcultural skills.
  • Importance in Nursing:
    • Essential for providing culturally appropriate care, particularly when interacting with diverse patient populations.
  • Components of Cultural Openness:
    • Receptiveness to learning about different cultural perspectives.
    • Acknowledgment of one’s own cultural biases.

CULTURAL RELATIVENESS

  • Definition:
    • Cultural relativity is the recognition that individuals from different cultural backgrounds perceive and understand situations through their cultural frameworks.
  • Key Aspects:
    • Recognizes the existence of multiple valid viewpoints.
    • Accepts that culture shapes interpretations of various situations.
    • Does not require the adoption of others' beliefs.
    • Respects the uniqueness of each culture.
    • Avoids using one's cultural standards to judge other cultures.

ETHNOCENTRIC JUDGMENTS

  • Definition:
    • Ethnocentric judgments occur when individuals evaluate or assess other cultures through the lens of their own cultural standards and values as the only legitimate measure.
  • Consequences:
    • View one's healthcare practices as superior to those of other cultures.
    • Dismiss traditional healing methods as inferior.
    • Label patient behaviors as 'inappropriate' when they do not conform to Western medical approaches.
    • Make misguided assumptions about patients based on cultural stereotypes.
    • Impose one's cultural beliefs onto patients without considering their cultural context.

CULTURAL DIVERSITY – FACTORS INFLUENCING DIVERSITY

  • Elements of Cultural Diversity:
    • Varying cultures.
    • Racial and ethnic origins.
    • Religion.
    • Physical attributes like size and age, and gender.
    • Sexual orientation.
    • Disability.
    • Socioeconomic and occupational statuses.
    • Geographical locations.

KEY TERMS

  • Ethnicity:
    • A group characterized by shared traits such as race, ancestry, and physical characteristics.
    • Examples include Hispanic, Latino, Spanish, Mexican American, and Colombian American.
  • Race:
    • Closely related to biology and physical features, including skin color and blood type.
    • U.S. Census race categories include White American, Black/African American, Native American, Alaska Native, Asian American, and Native Hawaiian or other Pacific Islander.
  • Religion:
    • An ordered system of beliefs that may overlap with ethnicity as many within an ethnic group may share the same religion.
    • Awareness that race and ethnicity can influence health issues and genetics; nurses need to be aware of health problems prevalent in specific populations.

CULTURAL UNIVERSALITIES AND STEREOTYPES

  • Cultural Universals:
    • Values, beliefs, and practices shared across all cultures, including:
    • Celebrations of birth.
    • Marriage rituals.
    • Death rituals.
    • Use of common language.
  • Cultural Stereotype:
    • A widely held, oversimplified belief about a group that can be both negative and positive.
    • Importance for nurses to recognize patient uniqueness, being aware of personal biases (e.g., the stereotype that "All Asians are exceptionally good at math and science").

NORTH AMERICAN HEALTHCARE NORMS

  • Core Practices:
    • Reliance on a biomedical system.
    • Emphasis on preventive medicine.
    • Importance of habits such as hand washing, effective problem solving, and documentation.
    • Value placed on punctuality and neatness.
    • Focus on procedures and respect for the professional hierarchy (i.e., respect for physicians).
    • Adherence to ethical standards.

CULTURALLY COMPETENT RESPONSE TO PAIN

  • Understanding Pain:
    • Recognize that individual beliefs about pain vary; pain is defined by the patient.
    • Respect patients' rights to respond to pain as they choose.
    • Avoid stereotypical assumptions about pain responses based on culture.
    • Be observant of nonverbal cues of discomfort, such as clutching the painful area or avoiding exacerbating activities.

ASSESSING A PATIENT’S CULTURAL BELIEFS

  • Important Assessment Questions:
    • Questions should be focused on understanding the patient’s cultural beliefs and values.
  • Interventions:
    • Implement the teach-back method to ensure patient comprehension of instructions.
    • Use printed materials in the patient's native language.
    • Ensure interpreters are well-trained in medical terminology.

BARRIERS TO CULTURALLY COMPETENT CARE

  • Types of Barriers:
    • Bias: The tendency to be impartial.
    • Ethnocentrism: The inclination to favor one's own culture.
    • Cultural Stereotyping: Generalizing members of an ethnic group based on perceived similar qualities.
    • Prejudices: Negative attitudes toward others shaped by stereotypes about race, gender, age, or sexual orientation.
    • Discrimination: Behavioral actions stemming from prejudice.
    • Racism: Discrimination primarily based on race.

SPACE AND PERSONAL DISTANCE IN CULTURES

  • Cultural Norms in Personal Space:
    • Americans, Canadians, and British prefer approximately 18 inches of personal space.
    • Middle Eastern cultures often favor close standing proximity with steady eye contact.
  • Nursing Practice:
    • Rationale for asking patients for permission before personal contact and explaining intentions.

FACTORS INFLUENCING CARE

  • Health Disparities:
    • Defined as health differences closely tied to social, economic, and/or environmental disadvantages (USDHHS, 2015).
  • Marginalized Groups:
    • Populations that are underrepresented and disadvantaged.
  • Social Determinants of Health:
    • Conditions influencing life experiences: born, grow up, live, work, and age, shaped by the distribution of wealth, power, and resources (WHO, 2013).
    • Standards to Address Health Disparities:
    • Emphasize cultural competency, health literacy, and patient and family-centered care.
    • Acknowledge that treating each patient's unique needs enhances overall care quality and safety, thereby reducing health disparities.

BECOMING A CULTURALLY COMPETENT NURSE

  • Steps to Cultivate Cultural Competence:
    • Developing self-awareness by assessing and acknowledging personal biases.
    • Gaining knowledge and understanding of patients' cultural contexts.
    • Accepting and respecting variations in cultural beliefs.
    • Avoiding assumptions that healthcare providers' beliefs mirror those of clients.
    • Transcending judgmental attitudes suggesting that "different is not as good."
    • Being open to cultural encounters and taking responsibility for one's cultural competency.

TRANSCULTURAL CONSIDERATIONS (HESI TOPIC)

  • Focus of Transcultural Nursing:
    • Providing culturally appropriate healthcare by understanding and respecting cultural differences and commonalities.
  • Goals:
    • Deliver culturally congruent care.
    • Provide knowledgeable, competent, and safe care to diverse populations.
    • Assist healthcare systems in serving various communities effectively.
  • Important Concepts:
    • Emic Perspective: Perception from the patient’s cultural viewpoint (patient’s lens).
    • Etic Perspective: Observation from an outsider’s perspective.
    • Cultural Openness: Commitment to self-awareness regarding cultural biases.
    • Cultural Relativism: Understanding differing cultural clarity as relative rather than absolute.
  • Clinical Significance:
    • Essential for modern healthcare as society diversifies.
    • Helps mitigate cultural misunderstandings and enhances patient outcomes.
    • Supported by standards from the American Nurses Association (ANA), which necessitates a skill set sensitive to patients' cultural backgrounds, beliefs, and practices.

EXAMPLES OF CULTURAL COMPETENCE IN NURSING PRACTICE

  • Scenario Analysis:
    • A nurse attends to a patient who avoids eye contact and communicates only with female staff, indicating potential ties to cultural beliefs.
    • Culturally Competent Response:
    • (C) Viewing the behavior from the patient’s cultural framework (emic perspective) is the appropriate choice.
  • Cultural Competency Training Implementation:
    • A nurse manager develops a cultural competency training program emphasizing the importance of cultural openness (B).
  • Correct Response to Patient Using Traditional Remedies:
    • A nurse discovers that an Asian patient is using traditional herbal remedies while taking prescribed medications.
    • The inappropriate response is immediately advising the patient to stop use due to safety concerns; this reaction is wrong because it disregards the patient's cultural practices and beliefs regarding health.
    • Correct Nursing Approach:
    • Engage with the patient about the remedies, discuss safety, and incorporate respectful dialogue surrounding the patient’s cultural practices to ensure comprehensive care.