Culture ***Review key terms, LGBT, Multiple choice on videos in class

Multiculturalism: many subcultures coexisting within a given society in which no

one culture dominates. Each family or group of immigrants brings its own culture,
adding to what has been described as the melting pot which implies the
assimilation of multiple ethnic groups and their cultural practices into a single
national identity with national allegiance and values.
U.S census Bureau identifies these races:
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Self-awareness must be possess and is critical to developing sensitivity to
differences while supporting a sense of cultural humility
Cultural humility occurs when a healthcare provider recognizes that her personal
cultural values are not superior over the cultural values of others, preventing the
provider from taking an authoritative stance or engaging in abuse of power.
Concepts Related to Culture and Diversity
Communication: clients use language differently, speak different languages, and
recognize nonverbal cues differently. Therapeutic communication, interpreters,
shared languages, and awareness of nonverbal cues can help nurses communicate
more effectively.
Using an interpreter: avoid using family and children, use an interpreter of same
gender, address your questions to the client, avoid using metaphors, medical
jargon, observe nonverbal communication, plan what to say, use short questions,
speak slowly but no loudly, and provide written material in their language.
Healthcare systems: availability of healthcare for vulnerable populations may be
difficult. Clients who live in poverty or are homeless may need referrals. Nurses
must advocate for services such as interpreters or mental health resources. Refer
clients to social services or nonprofit service agencies for additional resources.
Pain: May differ across cultural groups and gender roles (verbalization of pain and
preferred comfort for example) Clients reaction can be stoicism or hysterics. Nurses
must assess and accept a variety of client responses
Professional behaviors: Self-awareness of cultural competence. Cultural competence
is the ability to apply knowledge and skills to provide high quality care to clients of
diverse backgrounds.

Sexuality: Sexual orientation, homophobia, heterosexism. Assist in advocating for

LGBT healthcare needs and access. Recognize same sex partners as family and
client support.
Spirituality: Recognize religious beliefs related to dietary regimen or times of
fasting. Be non-judgmental and support religious practices.
Evaluating how successfully the client is able to follow the treatment regimen
whole observing cultural practices and rituals is essential to determining client
outcomes but also provides a way for nurses to evaluate whether or not they
provided culturally competent care that promoted improved client outcomes.
Cultural differences can present barriers to necessary care, areas include:

Lack of importance for family members in managing illness and disease

Lack of trust in the healthcare system
Belief that illness is not linked to scientific pathophysiology
Refusing to believe the mind-body connection
Fear or denial of death or life after death
Cultural assumptions about disease and illness that may influence the
presentation of symptoms or the response to treatments
Cultural beliefs that discussing prognosis and risks with client can increase
outcomes or be dangerous

Cultural values describe preferred ways of behaving or thinking that are sustained
over time and used to govern a cultural groups actions and decisions.
Diversity
Belief systems: influence decisions and actions regarding healthcare
Differ in every culture
Passed on from generation
May be rooted in religious faith or practices
Can affect the course and outcome of illness
Can present barriers to necessary care
Vulnerable populations: groups of people in our culture at great risk for diseases and
reduced life span.
Older in age
Living in poverty
Homeless
Abusive relationships (Women)
Mentally ill
Chronically ill
Children (Foster)
Immigration status
These groups face multiple challenges statistically poorer outcomes and shorter life
spans and can be from any culture, ethnicity, age, or gender (more likely women).

Assessment of a client from a vulnerable population requires investigation of

all systems, determine stressors and coping mechanisms, and help the client
identify potential resources.
Other factors influencing healthcare if transportation and accessibility.

Social Differences:
Jewish kosher diet, circumcision on the eighth day, death ritual
Asian: Direct eye contact may be sign of disrespect
Islamic: females with female providers, birth ritual, death ritual, dietary rules (no
pork), talking to the same sex could be disrespectful, male figure may make all the
decisions
Remember: Always ask the patient What are your values and beliefs about
healthcare?
What are some things I can do to make you
comfortable?
Be adaptable and provide complimentary therapy (any diverse array of practices,
therapies, and supplements that are not considered part of conventional or
traditional medicine that are used in addition to conventional treatments).
Note any practices that are contraindicated
Ethnocentrism is bad because its the belief that your culture is dominant than all
others.
Social justice: a framework to explore the complexities surrounding the variety of
factors that impact diverse and vulnerable populations. Allow to follow code of
ethics to promote equitable distribution of resources.
In summary: To overcome barriers to multiculturalism, a RN must have a deep
understanding of vulnerable clients who are impacted by racism, sexism, classism,
and heterosexism.
Sources of Diversity (Practice issues):
Gender: Male, Female, intersex, transgender/transsexual
Issues: stereotyping, gender roles, gender inequities, understanding the differences
in responses between genders, sexism (gender bias)
Race: Very complex, defined by physical attributes linked to continents of origin like
Asia, Europe, Africa.
Issues: Racism which is the oppression of a group of people based on perceived
race, in policy it could reflect rules that benefit one racial group over another.
Age: Children and older adults which they have to depend on other people for
nutrition, health care, transportation and personal safety.
Issues: Ageism which is discrimination against older adults, Older adults are less
likely to be fluent in the latest technologies.

Disability: mental deficiency, mental retardation, mental handicap, and learning

disability
Issues: families experience poorer health care compared with the general
population, can lead to economic hardship and family conflict.
Sexual Orientation: prefer someone of opposite sex or someone of same sex
Issues: Homophobia is fear, hatred, or mistrust of in lesbians or homosexuals by
displays of discrimination. Often bias toward homosexuals which create obstacles to
achieving full equality.