CHAPTER 3: Cultural Diversity cultural assimilation cultural blindness cultural diversity process that occurs when a minority group,

, living as part of a dominant group within a culture, loses the cultural characteristics that made it different the process of ignoring differences in people and proceeding as though the differences do not exist diverse groups in society, with varying racial classification and national origin, religious affiliation, languages, physical size, gender, sexual orientation, age, disability, socio economic status, occupational status, and geographic location tendency of some to impose their beliefs, practices, and values on another culture because they believe that their ideas are superior to those of another person or group sum total of human behavior or social characteristics peculiar to a specific group and passed from generation to generation or from one to another within the group those feelings, usually negative, a person experiences when placed in a different culture sense of identification that a cultural group collectively has; the sharing of common and unique cultural and social beliefs and behavior patterns, including language and dialect, religious practices, literature, folklore, music, political interests, food preferences, and employment patterns judgment of other people based on the standards and practices of one's own culture external environment surrounding a person that is regarded as being part of that person division of human beings based on distinct physical characteristics assigning characteristics to a group of people without considering specific individuality

cultural imposition culture culture conflict culture shock ethnicity

ethnocentrism personal space race stereotyping

1. Nurses provide care to culturally diverse people, and must develop the knowledge and practice the skills necessary for culturally competent care. CONCEPTS OF CULTURAL DIVERSITY 2. Cultural diversity is an integral component of both health and illness because of genetic characteristics and the cultural values and beliefs we learn in our families and communities. 3. To be able to provide culturally competent care to people from diverse backgrounds, nurses must be sensitive to culturally diverse needs, characteristics, and values of individuals, families, and groups. CULTURE

4. Culture may be defined as a shared system of beliefs, values, and behavioral

expectations that provide social structure for daily living. 5. Culture includes the beliefs, habits, likes and dislikes, and customs and rituals learned from one's family; the characteristics of culture include the following: a. Culture guides behavior into acceptable ways for people in a specific group. It is shared by, and provides an identity for, all members of the same cultural group. b. Culture is learned by each new generation through both formal and informal life experiences. Language is the primary means of transmitting culture. c. The practices of a particular culture often arise because of the group's social and physical environment. d. Cultural practices and beliefs may evolve over time, but they mainly remain constant as long as they satisfy a group's needs. e. Culture influences the way people of a group view themselves, have expectations, and behave in response to certain situations. Because a culture is made up of individuals, there are differences both within cultures and among cultures. 6. A subculture is a large group of people who are members of a larger cultural group 7. Cultures include both dominant groups and minority groups. A dominant group is the group within a country or society that has the most authority to control values and sanctions of the society. 8. A minority group usually has some physical or cultural characteristic (such as race, religious beliefs, or occupation) that identifies the people within it as different. 9. When minority groups live within a dominant group, many of their members lose the cultural characteristics that once made them different.

a. This process is called cultural assimilation or acculturation. Assimilation

occurs when one's values are replaced by the values of the dominant culture. 10. Mutual cultural assimilation does occur, with some characteristics of both groups being traded.

11.

Culture shock, or the feelings a person experiences when placed in a different culture that the person perceives as strange, may result in psychological discomfort or disturbances

ETHNICITY 12. Ethnicity is the sense of identification with a collective cultural group, largely based on the group's common heritage. RACE 13. Racial categories are typically based on specific physical characteristics, such

as skin pigmentation, body stature, facial features, and hair texture. Although there has been a blending of physical characteristics through the centuries, the three major race classifications are Caucasian, Negroid, and Mongoloid. FACTORS AFFECTING CULTURAL SENSITIVITY

14. 15. 16.

When one assumes that all members of a culture or ethnic group act alike, stereotyping is at work. Cultural imposition is the belief that everyone should conform to the majority belief system. Cultural blindness occurs when one ignores differences and proceeds as though they do not exist. a. This has been true of the healthcare system, especially in regard to what are considered nontraditional methods of care.

17.

Culture conflict occurs when people become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of others to make themselves feel more secure about their own values CULTURAL INFLUENCES ON HEALTHCARE

PHYSIOLOGIC CHARACTERISTICS 18. cultural groups adapted slowly to their environment. 19. From a scientific and anthropologic point of view, these adaptations were natural changes that helped improve the lives and well-being of human beings. Some of these biologic variations were effective adaptations for a particular period or for living in a certain environment. 20. When a person no longer is in the environment that encouraged the biologic variation, the variation might then have a detrimental effect on the person's health and well-being. 21. Three examples of these conditions, which may result from environmental factors or through inheritance, include: a. Keloids: result from an overgrowth of connective tissue during the healing process that forms a scar after an injury, surgery, or burn i. People with dark skin are much more likely to develop keloids. b. Lactase deficiency and lactose intolerance: The enzyme lactase must be present in the body to break down lactose during digestion. Without lactase, the lactose ferments in the intestines, resulting in gas (flatus), diarrhea, and abdominal bloating and cramping. Lactase deficiency and lactose intolerance are more common in Hispanic women and in both men and women of African, Chinese, and Thai ancestry c. Sickle cell anemia: The sickle shape also prevents the RBCs from moving easily through the smaller blood vessels in the body. This factor can lead to these blood vessels being clogged by RBCs, which can cause many potentially serious problems. Sickle cell anemia is most common in people of African or Mediterranean origin.

PSYCHOLOGICAL CHARACTERISTICS 22. a person interprets the behaviors of another person in terms of her or his own familiar culture.

23.

in a healthcare setting, the patient evaluates the attitudes and actions of the healthcare provider at the same time the healthcare provider interprets the behavior of the patient.

REACTIONS TO PAIN 24. expressions and behaviors exhibited by people in pain are culturally prescribed

a. Some cultures allow and even encourage the open expression of

emotions experienced by a person in pain, whereas other cultures frown on the open and free expression of emotions. 25. Nurses often assume that a patient who does not complain of pain is not having pain. a. A patient who deals with pain quietly and stoically may have painreduction needs ignored by nurses. b. Nurses should be sensitive to other signals of discomfort, such as holding or applying pressure to the painful area, self-restriction of activities that intensify the pain, and uncontrollable, spontaneous expressions of discomfort, such as facial grimacing and moaning. MENTAL HEALTH 26. Most mental health norms are based on research and observations made of white, middle-class people. 27. Many ethnic groups have their own norms or acceptable patterns of behavior for psychological well-being and normal psychological reactions to certain situations. GENDER ROLES 28. In many cultures, the man is the dominant figure and generally makes decisions for all family members. 29. In male-dominant cultures, women are usually passive. 30. On the other hand, in many African American and Caucasian families, the woman is often dominant. LANGUAGE COMMUNICATION 31. Language acquisition is tied to necessity and assimilation rather than to degree of difficulty. 32. Nurses who work in a geographic area with a high population of residents who speak a language other than English should learn pertinent words and phrases in that language. 33. Sometimes a family member or friend can translate for the nurse, but such a person may be protective and not the most reliable means of transferring information. 34. Eye contact, as a nonverbal communication behavior, is one of the most culturally variable forms of communication.

ORIENTATION TO SPACE AND TIME

35.

Personal space is the area around a person regarded as part of the person. This area, individualized to each person and to different cultures and ethnic groups, is the area into which others should not intrude during personal interactions.

FOOD AND NUTRITION 36. Food preferences and how foods are prepared often are related culturally. 37. Certain food groups serve as staples of the diet based on culture and remain so even when members of that culture are living in a different country. FAMILY SUPPORT

38.

In m any cultural and ethnic groups, people have large, extended families and consider the needs of any family member to be equal to or greater than their own. a. They may be unwilling to share private information about family members with those outside the family (including healthcare providers). b. Other cultural groups have great respect for the elders in the family and would never consider institutional care for them. c. Including the family in planning care for any patient is a major component in nursing care to meet individualized needs.

SOCIOECONOMIC FACTORS 39. Low income is a major problem in the United States, and is often described as having created a culture of poverty 40. Poverty leads to other problems, such as lack of health insurance, care of infants and children, and homelessness 41. The feminization of poverty threatens to increase the number of people who are living at poverty level. a. The number of female-headed households is increasing as a result of divorce, abandonment, unmarried motherhood, and changes in abortion laws. b. A single woman supporting a household is at a financial disadvantage. c. The number of single-parent families headed by women is associated closely with the increasing number of children living in poverty and the number of homeless families with children. 42. The expanding population of older people has also raised problems associated with poverty 43. Characteristics of Poverty: a. Feelings of despair, resignation, and fatalism b. Day-to-day attitude toward life, with no hope for the future c. Unemployment and need for financial or government aid d. Unstable family structure, possibly characterized by abusiveness and abandonment e. Decline in self-respect and retreat from community involvement 44. Poverty prevents many people from consistently meeting their basic human needs. CULTURAL INFLUENCES IN ILLNESS CARE 45. People's values and beliefs about health, illness, and care for an illness develop

as a direct result of cultural and ethnic influences. 46. In some groups, illnesses are classified as natural or unnatural. a. Dangerous agents, such as cold air or impurities in the air, water, or food, cause natural illnesses. b. Unnatural illnesses are punishments for failing to follow God's rules, resulting in evil forces or witchcraft causing physical or mental health problems. 47. Herbs are a common method of treatment in many cultures 48. Other types of traditional therapies include the use of cutaneous stimulation, Therapeutic Touch, acupuncture, and acupressure. a. Cutaneous stimulation by massage, vibration, heat, cold, or nerve stimulation reduces the intensity of the sensation of pain. b. Therapeutic Touch is an intentional act that involves an energy transfer from the healer to the patient to stimulate the patient's own healing potential. c. Acupuncture, long used in China, is a method of preventing, diagnosing, and treating pain and disease by inserting special needles into the body at specified locations. d. Acupressure involves a deep-pressure massage of appropriate points of the body. CULTURALLY COMPETENT NURSING CARE 49. The nurse who recognizes and respects cultural diversity has cultural sensitivity and provides nursing care that accepts the significance of cultural factors in health and illness. 50. The healthcare system is a culture with customs, rules, values, and a language of its own. 51. Nursing is the largest subculture of the healthcare system. Most nurses are members of, and have the same value systems as, the dominant middle class in the United States. 52. Cultural imposition is the tendency for health personnel to impose their beliefs, practices, and values on people of other cultures because they believe that their ideas are superior to those of another person or group. 53. ethnocentrism, the belief that one's own ideas, beliefs, and practices are the best, are superior, or are most preferred to those of others 54. T o avoid this practice, the nurse must carefully and critically examine his or her own values and beliefs and be willing to understand health and illness from the viewpoint of the patient receiving care. 55. A careful merging of modern and traditional cultural beliefs is a necessary prerequisite for safe, considerate, and successful nursing care of all patients. Cultural Assessment

56.

An effective way to identify specific factors that influence a patient's behavior is to perform a cultural assessment. a. Primary informant should be the patient

Guidelines for Nursing Care 57. A culturally competent nurse is able to adapt nursing care 58. Cultural competence takes time. It involves developing awareness, acquiring knowledge, and practicing skills. 59. Another important cultural guideline is to treat each person as an individual 60. Develop Cultural Self-Awareness: Become aware of the role of cultural influences in your own life.

61.

Develop Cultural Knowledge: Learn as much as possible about the belief system and practices of people in your community and of patients in the area in which you work. a. Practice techniques of observation and listening to acquire knowledge of the beliefs and values of patients for whom you are caring. 62. Accommodate Cultural practices in Healthcare: Incorporate factors from the patient's cultural background into healthcare whenever possible and when the practices are not considered harmful to health. 63. Respect Culturally Based Family roles: T ake into consideration the cultural role of the family member who makes most of the important decisions. In some cultures, it is the husband or father, whereas in others, it is the grandmother or another respected elder. 64. Avoid mandating Change: Keep in mind that health practices are part of the overall culture and that changing them may have widespread implications for the person. You need to provide the necessary support and reinforcement for the patient if a change in a health practice with a cultural basis is considered necessary. 65. Seek Cultural Assistance: Seek assistance of a respected family member, member of the clergy, or traditional healer, as indicated, so that the patient is more likely to accept healthcare services