NURS 330: Culture & Diversity (Giddens)

Concept of Culture

  • Culture is a constructed reality that helps humans create meaning from their experiences.
  • While often identified by visible factors (e.g., food, holidays, countries), culture includes deep-seated beliefs and worldviews affecting individual behavior, particularly in healthcare.

Definition of Culture

  • Culture: Defined as a pattern of shared attitudes, beliefs, self-definitions, norms, roles, and values within a specific language group or geographical area.
    • Guides areas such as social relationships, emotional expression, morality, religion, and technology.

Subconcepts of Culture

  1. Enculturation:

    • The process of learning the norms and values of one’s own culture.

  2. Acculturation:

    • The adoption of new cultural traits due to contact with another culture, leading to mutual change.

  3. Assimilation:

    • A process whereby individuals lose their original cultural identity to adopt the dominant culture, often imposed without choice.

  4. Biculturalism:

    • Individuals maintain dual cultural identities, selecting aspects of both cultures to adopt and retain.

  5. Ethnicity:

    • Common ancestry leading to shared values and beliefs, handed down through generations.
    • Ethnic Identity: The identity one has from their ethnicity.

  6. Race:

    • Often misinterpreted biologically but lacks genetic basis. Genetic variability is greater within labeled racial groups than between them.

Scope of Culture

  • Culture influences beliefs, values, and behaviors impacting:
    • Interpersonal relationships
    • Family dynamics
    • Childrearing practices
    • Dietary preferences
    • Communication styles
    • Dress and religious practices
  • Significantly influences healthcare decisions, trust in treatments, and perceptions of illness due to differing cultural norms:
    • Example: Western biomedical model focuses strictly on physiological causes of disease, while traditional beliefs may consider mind-body-spirit-social connections in illness recognition.

Causal Beliefs About Illness

  • Cultural explanations for illness vary:
    • Non-Western Explanatory Models:
    • Natural causes (e.g., biological, environmental)
    • Social causes (e.g., punishment for behavior)
    • Supernatural causes (e.g., spirits)
    • Western Models:
    • Primarily benefit from biomedical causation theories.

Symptoms and Expression of Illness

  • Illness manifestations can be unique across cultures:
    • Culture-bound Syndromes: Specific illnesses recognized within a culture but not necessarily accepted in others.
    • مثال:
      • Ataque de Nervios: In Latino-Caribbean culture, linked to stress, includes symptoms like dissociation, crying, and spasms.
      • Shenjing shuairuo: In Chinese culture, linked to decreased vital energy, symptoms include fatigue and memory loss.
      • Neurasthenia: Common in Asia, is an acceptable label compared to Western depression.
  • Cultural Risks: Instances such as anorexia nervosa or bulimia may be influenced by sociocultural norms and media pressure in Westernized countries.

Taboos in Health Behavior

  • Certain illnesses and behaviors may be stigmatized, causing patients to conceal symptoms or avoid treatment.
    • Examples include mental illnesses (schizophrenia, depression), STIs (herpes, syphilis), and severe illnesses (Ebola, AIDS).
    • In various cultures, social stigma can legally prohibit or shame individuals (e.g., suicide in Malaysia, Ghana).

Attributes and Criteria of Culture

  • Learned: Culture is acquired through family and peers, evolving into subcultures (racial, ethnic, occupational, etc.).
  • Changeable and Adaptive: Cultures evolve under influence from migration, environment, technology, and globalization.
  • Shared: Cultural beliefs, values, and behaviors are collective experiences within any group.

Individualism vs. Collectivism

  • Individualism: Values independence and self-reliance (common in Western cultures).
  • Collectivism: Values interdependence and community relationships (often seen in Asian or African cultures).

Power Distance

  • Power Distance: Refers to how cultures perceive and accept unequal power distribution. High power distance cultures expect hierarchy and authority, affecting communication styles, especially in health contexts.

Masculinity vs. Femininity

  • Refers to attitudes towards gender roles, with some societies favoring competitive masculine traits over cooperative feminine traits, influencing caregiver roles.

Long-term vs. Short-term Orientation

  • Cultures with a long-term orientation (e.g., China) prioritize future and perseverance, while short-term oriented cultures (e.g., U.S.) focus on immediate results and traditions.

Religiosity

  • Religiosity: Varies in personal influence; offers coping mechanisms and potentially significant health impacts, although perceptions and practices change with societal evolution.
  • Long-standing theories of human behavior have originated from the assumption of genetic uniformity leading to universal behavior.
  • Recent perspectives highlight the cultural determination of emotions and behaviors, influenced by social environments.

Leininger's Theory

  • Emphasizes understanding behavior in a cultural context through both emic and etic perspectives.
  • Emic: Understanding culture from within.
  • Etic: External analysis applying universal constructs.

Interprofessional Theory of Social Suffering

  • Illnesses are seen as social suffering shaped by cultural experiences, addressing broader issues like poverty and political inequities that underpin health disparities.

Context to Nursing and Health Care

  • Increasing U.S. diversity necessitates cultural understanding in healthcare for quality patient care.
    • By 2050, minorities are projected to comprise half of the U.S. population.
  • Health Disparities: Focus on achieving health equity outlined in Healthy People 2030 goals, addressing culturally competent care.
  • Cultural Competency in Nursing:
    • Involves understanding and accepting patient beliefs while promoting informed decision-making and self-efficacy in care.

Developing Cultural Competence

  • Involves four constructs: Cultural Desire, Self-Awareness, Cultural Knowledge, Cultural Skill.
  • Address innate biases and foster patient-centered care through understanding individual identities and social histories.

Conducting a Cultural Assessment

  • Efficient nursing requires cultural assessments to gather comprehensive patient perspectives and tailoring of care approaches.
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  • Data to Collect: Includes origins, communication preferences, healthcare beliefs, rituals, daily practices, and concerns regarding health and treatment.

Interrelated Concepts

  • Health Disparities: Systematic obstacles to health outcomes across identity groups.
  • Family Dynamics: Cultural influences shape care, information sharing, and parenting practices.
  • Ethics: Cultural contexts influence interpretations of ethical practices.
  • Spirituality: Personal connections with the transcendent; interlinked with cultural identities.
  • Communication: Cultural norms determine interpersonal dynamics, influencing healthcare interactions.
  • Stress and Coping: Cultural belief systems frame coping strategies and responses to distress.