NURS 330: Culture & Diversity (Treas)

Culture in Healthcare

• Traditional healthcare culture responds to illness with specific therapies aimed at treating biophysical disorders.
• Nursing, as part of the culture of holism, addresses the physical, emotional, mental, and spiritual dimensions of illness.
• Culture acts as a social determinant of individual and family health.

Influence of Culture on Health and Illness

• Cultural influence affects health decisions, behaviors, perceptions, and the self-view as either well or ill.

Examples of Cultural Influence:

1. Health-promoting Values:

   • Cultural groups promote values like nutritious diets and regular physical activity.

2. Responses to Illness:

   • Some religious views interpret illness as divine punishment, leading individuals to hide symptoms as a form of penance.

   • Alternatively, others see illness as a personal lesson for spiritual growth.

What is Culture?

• Culture is a complex and dynamic concept encompassing social norms, behaviors, and beliefs shared by groups over time.
• It is dynamic as it evolves through interactions with different groups, expanding knowledge and customs.

Definitions of Culture:

1. Spector (2017):

   • Culture as "luggage" carried through life, including beliefs, habits, and practices learned from families.

2. Leininger and McFarland (2002):

   • Culture is the learned, shared, transmitted knowledge influencing thoughts, decisions, and actions in specific patterns.

3. Office of Minority Health (2013):

   • Culture is an integrated pattern of thoughts, communications, actions, customs, beliefs, values, and institutions associated with different groups.

Characteristics of Culture

• Culture provides identity and fosters a sense of belonging when it satisfies members and does not conflict with the dominant culture.
• Members share common beliefs, traditions, and practices.
• Culture is both universal (shared by all) and dynamic (changes over time).
• Exists at various levels: material (art, artifacts) and nonmaterial (customs, language, beliefs).
• Cultural values, beliefs, and traditions are passed down generationally through life experiences.
• Cultural assumptions can often be unconscious and challenging to articulate.
• Culture is diverse, showcasing the variety among groups and individuals.

Ethnicity, Race, and Religion

Distinctions among Culture, Ethnicity, Race, and Religion:

• These terms often overlap, but:

1. Subculture of Nursing:

   • Practices a specific set of beliefs and values.

2. Ethnic Group:

   • Example groups include Portuguese Americans from the Azores.

   • Ethnicity shares a common social and cultural heritage.

3. Racial Group:

   • Identified by phenotypic traits such as skin color or blood type.

4. Religion:

   • Refers to an ordered system of beliefs about the universe.

Key Definitions

Ethnicity

• Similar to culture; refers to groups with common social and cultural heritage passed through generations.

• Includes characteristics like race, ancestry, lifestyle, and religion.

Race

• Identifies individuals by physical traits like skin color.

• Race and ethnicity overlap; the U.S. Census lists separate categories for each.

Key Concepts

Bicultural and Multicultural

• Bicultural: Identifies with two cultures, integrating values and lifestyles from both.

• Multicultural: A setting with individuals from various cultural groups, like a hospital staff.

Socialization, Acculturation, and Assimilation

Socialization

• The process of learning to become a member of a society, including social roles and expectations.

Acculturation

• Learning process immigrants undergo to adopt characteristics of a new culture.

Assimilation

• Involves the gradual adoption of the dominant culture’s values and behaviors.

Dominant vs. Subcultures

Dominant Culture

• Group with the most authority and power; often defines what is considered the norm.

Subcultures

• Groups within a larger culture with unique characteristics that differ from the mainstream.

Underrepresented (Minority) Groups

• Composed of individuals sharing common racial, ethnic or religious characteristics, often receiving unequal treatment in society.

Vulnerable Populations as Subcultures

• Vulnerable populations face health problems due to limited access to care and high-risk behaviors.

• Ex: People facing homelessness, economic instability, or mental illness.

Public Health Framework

• The Healthy People 2030 initiative focuses on health equity, reducing disparities, and promoting health literacy.

Gender and Age as Subcultures

• Gender: Definitions and roles are evolving, challenging traditional male and female binaries.
• Old Age: Older adults, especially the very old, face unique vulnerabilities and potential for abuse.

Impact of Culture on Health

Values, Beliefs, and Practices

1. Definition:

   • Values: Principles deemed important by an individual.

   • Beliefs: Something seen as true.

   • Practices: Behaviors followed in daily life.

2. Examples of Cultural Influence on Health:

   • Individuals may not share common beliefs or practices of the dominant culture.

3. Cultural Universals and Specifics:

   • Universals are shared values across cultures.

   • Specifics are unique practices of individual cultures, e.g., different birth rites.

Archetype vs. Stereotype

• Archetype: Non-negative, used to remember cultural specifics without assuming all individuals fit the mold.

• Stereotype: Negative assumptions that generalize certain traits to all members of a racial or ethnic group, which can lead to misassessments.

Culture Specifics Affecting Health

Communication

• Verbal and nonverbal exchanges can vary greatly across cultures, impacting health outcomes.

Space

• Personal space varies across cultures; understanding this helps improve interpersonal interactions.

Time Orientation

• Different cultures may prioritize past, present, or future, affecting patient adherence to health recommendations.

Social Organization

• Differences in family structures can impact health decisions and trust in healthcare systems.

Environmental Control

• Perception of health control affects treatment engagement; some may view illness as something beyond control.

Biological Variations

• Genetic and physiological differences may affect drug metabolism and disease susceptibility.

Other Cultural Specifics

• Religion: A significant factor influencing acceptance of treatments.

• Education: Affects health perceptions and knowledge of healthcare options.

• Politics and Law: Policies that affect healthcare access can vary across cultural lines.

• Economy: Economic conditions determine the availability of healthcare options.

Culture of Healthcare

Conventional Healthcare System

• Based on biomedical models with cultural norms such as reliance on technology and methods to minimize disease.

Indigenous Healthcare Systems

• Folk medicine and traditional healing coexist alongside conventional systems; conflicts can occur with conventional providers.

Health and Illness Belief Systems

1. Biomedical System: Western scientific approach focuses on pathology and symptoms.

2. Magico-religious System: Relies on supernatural beliefs; example: Voodoo.

3. Holistic System: Focuses on harmony between body and nature.

Cultural Competence in Nursing

Definitions

• Cultural Awareness: Appreciation of diversity's external signs.

• Cultural Sensitivity: Knowledge of uniqueness found in different cultures.

• Cultural Competence: Ability to incorporate culture respecting client preferences and empower health decisions.

American Nurses Association (ANA) Standards

• Promotes that nurses practice culturally congruent care and demonstrate respect towards diversity.

Barriers to Competent Care

• Bias, ethnocentrism, cultural stereotypes, prejudices, and discrimination can hinder nursing effectiveness.

Improving Patient Outcomes through Cultural Competence

• Culturally competent care promotes dignity and empowers patient involvement in care decisions.

• Features respectful, trusting relationships that contribute to better health outcomes.

Addressing Racism in Healthcare

• Awareness of systemic racism can lead to better advocacy and equitable treatment in healthcare settings.

Language Barriers

• Communication challenges arise from language differences; professional interpreters are essential for patient understanding, especially during consent.

Cultural Humility

• An emerging trend emphasizing self-reflection, learning from clients, and adapting care to fit patient needs.

Practical Applications

Assessment and Recognizing Cues

• Gather cultural data directly from clients, integrating it into health records.

Cultural Assessment Tools

• Models like Leininger's Sunrise Model and Spector's Heritage Assessment Tool help evaluate cultural specifics and heritage consistency.

Nursing Diagnoses

• Must consider cultural factors affecting health, ensuring sensitivity to patients' perspectives.

Planning Care

• Involves mutual goal-setting that respects cultural beliefs while promoting positive health outcomes.

Implementation Strategies

• Culturally competent interventions include individualizing education based on client needs and beliefs.

Communicating Across Languages

• Professional interpreters are crucial for accurate healthcare communication, especially in consent situations.

Strategies for Cultural Competence

• Reflect, keep learning, incorporate values into care, and respect cultural practices while negotiating compromises when necessary.