1. Cultural Aspects of Health and Illness
Chapter 4
Cultural Aspects of Health and Illness

2. Transcultural Nursing
Focuses on care, health, illness patterns of people with similarities and differences in cultural belief, values, practices

3. Culture Not restricted to race, ethnicity
Refers to integrated patterns of behavior acquired over time (e.g., beliefs, values, customs, norms, habits, language, thoughts)
Learned within family unit, generation, and/or other social organizations

4. Cultural Diversity Differences among people; may or may not be visible
Race – visible physical characteristics (e.g., skin tone, head shape, hair texture)
Ethnicity –common group social customs, values, beliefs
A child from Nepal living in the United States. The child has a black dot on her forehead to protect her from the “evil eye.”

5. Cultural Competence
Respecting all differences; not letting one’s own biases influence others
Understanding/responding effectively to cultural and linguistic needs of patients
Joint Commission and NPSGs require cultural differences be respected

6. Cultural Sensitivity
Aware of, respects; appreciation of cultural differences
Avoid biased/offensive language and actions when interacting with diverse cultures
Avoid stereotyping

7. Health Care Disparities
Differences in incidence of health care problems among minority racial/ethnic groups when compared with white majority
Contributing factors – socioeconomic status, individual discrimination, access to care, language barriers

8. Healthy People 2020
Health promotion initiatives reflect assessments of major risks to health and wellness
Changing public priorities
Emerging issues related to U.S. health preparedness and prevention

9. Purnell’s Domains of Culture
Culture overview and communication
Homelessness
Family and workplace issues
Lesbian, gay, bisexual, transgender health
Biologic ecology
Nutrition
Spirituality

10. Homeless Most avoid health care
Prone to CV disease, hypertension, diabetes mellitus, high cholesterol, infections
Compensate for limited time
Limit number of visits needed

11. Communication
Language is largest barrier for non-English-speaking patients
Interpreters must be available in health care facilities
Determine which forms of patient communication are acceptable

12. Family & Workplace Issues
Family and gender roles influence plan of care
Assess who makes decisions in the family
Include questions about sexual identity/activity in health assessment

13. LGBT Health Many fear prejudice; hesitant to seek medical care
Establish patient’s gender identity; do not make assumption based on appearance
Ask questions about sexual identity

14. Biological Ecology
Biologic variations, health disparities, drug metabolism differences
Common biological variation relates to adult body size and type (e.g., dwarfism)

15. Dwarfism Height below 4’ 10” Disproportionate or proportionate
Results from genetic mutation, hormone imbalance

16. Ethnopharmacology
Study of effect of ethnicity on how drugs work in the body
Absorption
Distribution
Metabolism
Excretion

17. Nutrition Part of comprehensive health assessment
Respect patient’s food preferences/beliefs
Assess rituals and customs

18. Spirituality
Involves behaviors that give purpose to life, provide individual strength
Joint Commission requires all health care facilities to address patients’ spiritual needs
Chaplain is part of health care team

19. Health Care Practices and Practitioners
Assess patient’s health promotion and maintenance practices
Determine whether patient is able to afford health care
Use of alternative health care systems and healers
Folk health beliefs

20. Health Care Obstacles Transportation difficulties High cost of care
Fear and distrust of health care workers
Poor communication between patients and professionals

21. Folk Health
Left: “Hand of God” amulet to protect the wearer from the “evil eye.”
Right: Within the Mexican-American folk medicine system, the curandero is the folk healer.

22. Audience Response System Questions
Chapter 4
Audience Response System Questions 22

23. Question 1
What nursing priority ensures that culturally competent care is provided to a homeless patient admitted for an infected foot?
Contact the case manager to secure a shelter bed upon discharge.
Provide education regarding foot care to prevent re-infection.
Help the patient choose a diet high in protein.
Provide empathetic and clear communication when assessing the patient’s needs.
Answer: D
Rationale: The primary approach to caring for a homeless patient is to establish trust. Many of these patients have experienced discrimination and therefore do not trust nurses or other health care professionals. When talking with a homeless patient, avoid discriminatory language and do not make assumptions. Take time to communicate, empathize, and show concern to build trust and assess the patient’s needs (Billings & Kowalski, 2008; Jones et al., 2009).

24. Question 2
What is the fastest growing ethnic group in the United States?
Asian Americans
African Americans
Hispanic/Latino Americans
American Indian
Answer A
Rationale: In 2008, the number of minority populations in the United States accounted for 31% of the total population; Hispanic/Latinos are the largest minority group at over 15%; the African-American population represents about 12%. Asian Americans are currently the fastest growing group at 5% of the U.S. population (

25. Question 3
Which question illustrates the first step of becoming culturally competent?
“Do I have the skill to conduct a cultural assessment?”
“How many face-to-face encounters have I had with patients from diverse cultural backgrounds?”
“Do I have knowledge of my patient’s world view?”
“Am I aware of my own personal biases and prejudices toward cultures that are different from my own?”
Answer: D
Rationale: Becoming culturally competent first requires you to examine your feelings and experiences regarding diversity, starting with an understanding of your own heritage. Then, you will need to learn more about specific cultural differences so you can develop an appreciation for the values and beliefs of both patients and staff co-workers. According to the Campinha-Bacote ASKED Model for Cultural Competence, the first step in becoming culturally competent is being aware of one’s own personal biases and prejudices toward cultures that are different from one’s own.