Quiz 3 Study Guide (With African Americans)

🌎 I. Transcultural Nursing and Cultural Competence

A. Foundational Concepts of Culture

• Culture is defined as both internal (implicit) and external (explicit).

• Culture is primarily learned and transmitted within a family, starting right after birth, which is known as Enculturation.

• It is a shared system of beliefs, values, and behavioral expectations that provides a social structure for daily living and is generally unconscious.

• Culture has a powerful influence on health and illness.

B. Cultural Dynamics and Attitudes

• Cultural Diversity is the coexistence of different groups (ethnic, racial, socioeconomic) within one social unit, encompassing variations in religion, language, sexual orientation, disability, and geographical location.

• Dominant Group is usually the largest group and possesses the most authority to control the values and sanctions of society.

• Minority Group is identified by a physical or cultural characteristic that differentiates them from the dominant group.

• Subculture is a large group within a broader culture that develops its own norms and values (e.g., nursing, "Swifties," bikers, yogis).

• Ethnocentrism is the belief that one’s own ideas, beliefs, and practices are the best or superior and should be followed by everyone else.

• Cultural Humility is the recognition of diversity and power imbalances, requiring the nurse to be open, self-aware, egoless, and flexible. Key principles include avoiding assumptions, being curious, waiting for answers, learning, and dismantling power dynamics in conversation.

• Acculturation involves two cultures exchanging ideas and adapting new values, but it does not require the rejection of the original home culture. Acculturation over a long period generally leads to assimilation.

• Cultural Assimilation is the process where a minority group absorbs the dominant culture’s values, behaviors, or beliefs, and meshes into one.

• Individualism encourages self-expression and values autonomy, where the most important person in society is the self. Collectivism prioritizes the larger group and is bound by loyalty.

C. Implicit Bias and Healthcare Disparities

• Implicit Bias is pervasive, meaning people are often unaware of their biases, yet these biases predict behavior.

• Implicit bias affects the equity in care and leads to failures in patient-centered care, interpersonal treatment, and communication.

• Examples of implicit bias include: Non-white patients receiving fewer cardiovascular interventions and renal transplants; Black women being more likely to die after a breast cancer diagnosis; and non-white patients being less likely to be prescribed pain medications (narcotic and non-narcotic).

D. Cultural Models in Nursing

• Lininger’s Sunrise Model: Provides a holistic view, showing how socio-cultural factors (technology, religion, values, politics, economics, education, kinship) influence a person's culture and health outcomes.

• Purnell Model for Cultural Competence: A systematic framework linking the individual, family, community, and global society. It is organized into 12 domains of culture: Overview/Heritage, Communication, Family roles and organization, Workforce issues, Biocultural ecology, High-risk behaviors, Nutrition, Pregnancy and childbearing practices, Death rituals, Spirituality, Health care practices, and Health care professionals.

• RESPECT Model (Cross-Cultural Communication): Rapport, Empathy, Support, Partnership (patient autonomy), Explanations (using Teach Back), Cultural Competence, T**rust.

E. Spiritual and Religious Needs in Healthcare

• Spirituality is a relationship with something non-material (God, nature, etc.). Religion is an organized system of beliefs.

• Spiritual needs include: the need for meaning and purpose, the need for love and relatedness, and the need for forgiveness.

• Nurses meet spiritual needs by offering compassionate presence, helping patients find meaning in their illness or death, fostering nurturing relationships, and facilitating religious beliefs (e.g., calling religious leaders, providing kosher meal trays, or turning a patient’s bed to face East for prayer for Muslim people).

• Agnostic refers to one who holds that nothing can be known about the existence of a higher power. Atheist denies the existence of a higher power.

F. Cultural Influences on Health and Illness

• Culture strongly influences reactions to pain and the choice of pharmacological vs. non-pharmacological interventions.

• Mental health disorders may carry a strong stigma in certain cultures.

• Food and nutrition are highly culturally influenced, especially around holidays.

• Communication requires assessing the need for a translator, and understanding appropriate non-verbal cues and eye contact.

G. Black/African American Cultural Considerations

• Historical events (Tuskegee Syphilis Study, Henrietta Lack/HeLa cells) have contributed to a mistrust of healthcare.

• Communication Style: Value oral communication (storytelling and humor). May refer to non-blood relatives as family.

• Physiological Assessment: When assessing darker pigmented skin, nurses must look for pallor (absence of underlying red tones), erythema (inflammation detected by palpation), cyanosis (ashen gray lips and tongue, palms, and soles of feet), and jaundice (yellowing sclera, palms, and soles of feet).

• Health Risks: Increased risk for Heart disease, HTN (may be resistant to Antihypertensives), CVA, Cancer, DM, and Sickle Cell Anemia. Approximately 75% of the population is lactose intolerant.

• Death Rituals: Are variable, but families are often oriented to staying at the bedside; there may be decreased use of hospice services and less likelihood of organ donation.

✡ II. Jewish Heritage and Orthodox/Hasidic Practices

A. Identity, Values, and Community

• Judaism is considered both a culture and a religion. The official language is Hebrew (used in prayer and the Torah).

• The spiritual and religious leader is the Rabbi. The House of Worship is the Synagogue (Shul or Temple).

• The greatest priority and source of strength is the preservation of life.

• Jewish people value education and are often called "People of the Book".

• Ancestry: Ashkenazi Jews originate from Eastern Europe and Russia. Sephardic Jews originate from Spain, Portugal, and the Middle East. Yiddish is a combination of Hebrew and German, used in Ashkenazi communities and the first language of many ultra-orthodox.

• Jewish people tend to live in tight-knit communities. An Eruv is a physical boundary that allows observant Jews to carry needed things (and push strollers) in public on Shabbat.

B. Preservation of Life (Pikuach Nefesh)

• Pikuach Nefesh states that rules are created to be lived by, not die by; therefore, many rules can be broken if it is life-saving.

• Examples include: Using phones on Shabbat/holidays to call 911; paramedics driving to the hospital; diabetics using medical technology; and eating non-kosher food if the only alternative is starvation. One can also eat on a fast day (like Yom Kippur) if medically necessary (e.g., pregnant women or those requiring medication with food).

C. Religious Observances

• Shabbat (Sabbath): Begins 18 minutes before sunset on Friday and ends 42 minutes after sunset on Saturday. Observant Jews do no work. Prohibitions include answering phones, driving, handling money, operating electrical devices (including ovens/stoves without pre-settings), or operating a call bell in the hospital.

• Jewish Day/Holidays: The Jewish day starts at sunset. All holidays start at sunset the night before.

  • Rosh Hashana (Jewish New Year) is when God opens the Books of Life and Death.

  • Yom Kippur (Day of Atonement) is a fast day 10 days after Rosh Hashana, when the Books are sealed.

  • Passover is 8 days long, commemorating the Exodus from Egypt. No unleavened (yeasted) bread is eaten; matzah is eaten instead.

• Kosher (Kashrut): Means "fit to eat".

  • Requires avoiding mixing milk and meat (e.g., cheeseburgers, lasagna). Separate utensils, plates, and preparation areas are used.

  • Must avoid pork and pork products and shellfish/non-scaled fish (fish must have fins and scales).

  • Meat must come from animals that chew cud and have split hooves and must be slaughtered in a particular, humane, and blessed way that drains the blood.

  • Kosher foods may be marked with a 'K' or 'U' with a circle.

D. Orthodox/Hasidic Practices in Healthcare

• Negiach Touch: Hasidic/Orthodox men are not permitted to touch women other than their wives and immediate family. They may keep hands in pockets to avoid accidental touch and should not be looked directly in the eye by women.

  • Therapeutic touch is NOT appropriate. Healthcare providers should only touch Hasidic men when providing direct care.

• Childbearing: Baby showers and naming the baby are considered bad luck before the baby’s arrival.

• Delivery: A Hasidic husband may not touch his wife during delivery and may choose not to attend, as she is considered "dirty" due to bleeding. He is not supposed to view his wife’s genitals (requires draping the patient).

• Circumcision/Naming: Male infants are circumcised and named at 8 days old by a mohel (usually a trained rabbi or OBGYN) at home, not in the hospital. Female infants are also named at 8 days.

E. Health Conditions and Death Rituals

• Genetic Conditions: Greater incidence of Tay-Sachs Disease (usually short life expectancy), Gaucher’s Disease (most prevalent), and Torsion Dystonia (rapid loss of motor function). One out of 50 carry the BRCA1 & 2 genes. Some Orthodox rabbis do not support genetic testing.

• Death Rituals:

  • The body is traditionally never left alone between death and burial.

  • Bodies are not refrigerated or embalmed.

  • Burial typically happens quickly (within 48 hours).

  • Shiva, or 7 days of mourning, is held following the funeral.

  • Mirrors in the house are covered during Shiva as a time to reflect and not worry about oneself.

  • A Minion (evening service) requires 10 adult men to officially take place.

🩸 III. Jehovah's Witness (JW)

A. Core Beliefs and Practices

• Deity/Jesus: God’s name is Jehovah. They view Jesus as the son of Jehovah, a Savior, and Son of God, but do not adhere to the Holy Trinity doctrine.

• Organization: The place of prayer is the Kingdom Hall. Religious leaders are Elders, who are unsalaried and not considered clergy.

• Afterlife: They believe God created the earth to be mankind’s eternal home. People who die pass out of existence and do not suffer in a fiery hell; billions will be brought back via resurrection.

• Marriage: Sexual immorality (cheating) is the only valid basis for divorce.

• Refusal of Celebrations: Jehovah's Witnesses do not celebrate holidays. This includes birthdays (as only sinners' birthdays are mentioned in the Bible) and Christian or secular holidays (seen as immortalizing people above God or based on Pagan traditions).

B. Absolute Refusal of Blood Transfusions

• Jehovah's Witnesses will not receive any blood products.

• This is based on the belief that God views blood as representing life, and the Bible states to abstain from blood. Avoiding blood shows respect to God as the Giver of Life.

• Nurses must respect this religious belief and patient autonomy. In critical situations (like labor and delivery), patients may be required to sign a blood refusal consent form, verifying they refuse blood even if it means they may die.

I. Transcultural Nursing: Models and Dynamics

Chart 1: Transcultural Nursing Models and Frameworks

Chart 2: Cultural Dynamics, Bias, and Attitudes

II. Judaism (Orthodox/Hasidic) Specifics

Chart 3: Judaism Key Practices and Healthcare Implications

III. Jehovah's Witness (JW) Specifics

Chart 4: Jehovah's Witness Core Beliefs and Restrictions

IV. Black/African American Cultural and Health Considerations

Chart 5: Historical Context, Assessment, and Health Risks