Socio-Cultural Aspects of Healthcare in South Africa — Comprehensive Study Notes

Community and Culture

• Community (1.1)

  • Population attached to homes, workplaces, daily interaction sites (schools, markets, etc.).

  • Concrete examples: villages, towns, cities, neighbourhoods.

• Culture (1.2)

  • Total “synthetic environment” – both material & non-material products passed from generation to generation.

  • Classic definitions:

  • Tylor: Complex aggregate of knowledge, belief, art, morals, laws, customs, skills, habits acquired as a member of society.

  • Theodorson: Way of life + man-made environment transmitted inter-generationally.

  • Cuber: Changing patterns of acquired behaviour and products (attitudes, values, knowledge, objects) shared & transmitted.

  • Key idea: People acquire culture from community; it is not innate.

Subculture and Cultural Change

• Sub-culture (1.3)

  • Smaller social grouping within society not in conflict with dominant culture.

  • Shares core values of majority but adds unique values/habits → distinct identity (e.g., nursing profession inside wider hospital culture).

• Cultural Change (1.4, 16)

  • Repositioning/reconstruction of cultural concepts via globalization, inventions, legislation, discovery, diffusion, contact.

  • Always ongoing; modifies both material and non-material aspects.

Culture Shock and Transcultural Nursing

• Culture Shock (1.5)

  • Feeling of disorientation/confusion when facing unfamiliar cultural practices.

  • Wallace: “confusion & emotional turmoil” when confronted with totally different culture.

  • Nursing example: Student witnessing culturally driven birthing behaviours (crying, vocalization).

• Transcultural Nursing (1.6)

  • Formal field comparing holistic culture–care–health–illness patterns.

  • Goal: deliver culturally congruent, competent, compassionate care recognising similarities & differences in values, beliefs, lifeways.

Fundamental Characteristics of Culture

• 1. Exclusively Human Product

  • Humans create patterned behaviours → transmit.

  • Cognitive ability lets us alter environment & pursue goals beyond survival (e.g., \text{MRI}, sonar scanners in hospitals).

• 2. Acquired Behaviour

  • Not genetic; learned through socialisation (family → society).

  • Values become internal “road signs” for lifelong behaviour.

  • Large learning potential → continuous transmission.

• 3. Common Property of Group

  • Shared by members; interaction produces culture.

  • Example: hospital hierarchy (nurse manager → unit manager → staff) traces back to Florence Nightingale era.

• 4. Dynamic & Cumulative

  • Never stagnant; constant change despite resistance.

  • Mechanisms: diffusion, inventions, discoveries, outside contact.

  • Example: Pre-shift hymn-singing by Black nurses becomes wider habit adopted by others.

• 5. Universal Similarities

  • “Transcendental” elements in all cultures:

  • Language, marriage/family, governance, moral value system, health-care structure, economy, recreation, art, religion, age/sex role norms.

• 6. Inter-societal Differences

  • Non-material (values, norms, symbols) and material (technology) vary among societies.

  • Culture is learned, not inherited.

Norms, Sanctions, and Values

• Norms

  • Social rules guiding expected behaviour in specific contexts.

  • In nursing: protocols for both nurses & patients.

  • Types (Pg. 29-31):

  • Formal norms: written regulations (hospital policies, legal standards).

  • Informal norms: unwritten expectations (greetings, dress code nuances).

  • Taboos: strongly prohibited acts (e.g., breaching patient confidentiality).

• Sanctions (Pg. 32)

  • Mechanisms enforcing conformity.

  • Positive → rewards: smile, praise, medals/certificates.

  • Negative → punishments: disapproval, fines, imprisonment.

• Values (Pg. 33-34)

  • Abstract notions of desirable vs. undesirable.

  • Guide long-range choices; produce high standards (e.g., passion for patient care).

  • Internalised values: personally adopted, guide behaviour even when unobserved.

  • Institutionalised values: embedded in organisational structures/policies (e.g., patient autonomy).

  • Relationship: Child obeys rule (norm) due to sanction; later understands intrinsic value behind it.

Cultural Diversity, Universals, Relativity, Ethnocentrism

• Diversity

  • Variety in understandings, value systems, knowledge bases.

• Cultural Universals

  • Elements common worldwide: gender roles, rituals, marriage, dance, art, jokes, sports, healing.

• Cultural Relativity

  • Attitude of understanding/respecting cultural differences; ability to “distance” from own lens.

  • Essential for non-judgemental nursing assessment.

• Ethnocentrism

  • Belief one’s own culture is superior; judging others by home standards.

  • Can hinder therapeutic rapport; must be actively overcome.

Cultural Change, Contact, Competence, Awareness, Skills, Humility

• Cultural Contact

  • Interaction between people of different cultures → mutual change.

• Cultural Competence (Pg. 16-17)

  • Strategy to reduce health disparities.

  • Nurse actions:

  • Ask each client about cultural practices/preferences.

  • Integrate social, environmental, cultural needs into care plan.

  • Respect, appreciate, continuously expand knowledge & sensitivity.

• Cultural Awareness – affective: self-reflection on own norms & biases.

• Cultural Knowledge – cognitive: factual learning about other cultures.

• Cultural Skills – psychomotor: performing assessments/tests in culturally sensitive manner.

• Cultural Humility – culmination: lifelong commitment to self-evaluation & lens-shifting in practice.

Social Class, Stratification, and Health

• Social Class

  • Layer of people sharing similar prestige, occupation, education, income, etiquette.

• Social Stratification

  • Unequal distribution of wealth, power, status across classes.

  • Impacts access to resources, including health care.

• Class ↔ Health Brainstorm

  • Lifestyle: diet, exercise, substance use patterns differ.

  • Healthcare access & quality: private vs. public, insurance status.

  • Illness prevalence: infectious disease burden vs. chronic illnesses influenced by environment.

  • Violence: higher exposure in lower socio-economic contexts.

  • Chronic illness management: affordability of meds, follow-up capacity.

Religious Influences on Health, Illness, and Death (Self-study prompts)

• Domains to explore per tradition: dietary laws, transfusion/organ donation views, end-of-life rituals, prayer/healing beliefs, modesty norms.

  • 6.1 Christianity

  • 6.2 Jehovah’s Witnesses (e.g., refusal of blood products).

  • 6.3 Judaism

  • 6.4 Islam

  • 6.5 Hinduism

  • 6.6 Buddhism

  • 6.7 Traditional African worldview (ancestors, holistic balance).

Transcultural Nursing Care and Nurse-Client Relationship Principles

• Aim (Pg. 21-22): Deliver nursing measures harmonious with patient’s cultural beliefs, practices & values.

• Leininger’s Definition: Cognitively based, supportive, facilitative acts tailored to cultural lifeways → meaningful, beneficial, satisfying care.

• Guiding Principles for Nurse-Client Relationship (Pg. 47-48)

  • Maintain respect for cultural uniqueness.

  • Establish trust via culturally appropriate communication (language services, non-verbal cues).

  • Safeguard dignity, privacy aligned with cultural modesty norms.

  • Facilitate patient decision-making within cultural & family frameworks.

  • Collaborate with cultural mediators/faith leaders when helpful.

  • Ensure informed consent processes respect literacy & cultural nuances.

  • Reflect on personal biases; practice cultural humility continually.

These bullet-point study notes synthesise every major/minor idea from the transcript, contextualised for nursing students preparing for examinations on socio-cultural dimensions of healthcare in South Africa.