Transcultural Healthcare Chapter 8: Transcultural Healthcare

Culture, Subculture, Race, Minorities, and Ethnicity *It is the accumulated learning for generational groups of individuals within structured or nonstructured societies. Subcultures These are groups within dominant cultures. They form because individuals share characteristics that belong to an identifiable group.

Culture, Subculture, Race, Minorities, and Ethnicity (cont.) Large groups of humankind that share common biologic and sociologic characteristics Racial blurring mixing has blurred the physical characteristics of individuals* Minority Global shifts of multiple groups of individuals who are continually revising cultures and subcultures Ethnicity Common heritage shared by a specific culture

Barriers to Culturally Competent Care Prejudice Belief based on preconceived notions about certain groups of people Ethnocentrism Belief that one’s own culture is the best and only acceptable culture Stereotyping Categorizing people and believing that all those belonging to a certain group are alike

Culturally Competent Nursing Care The Hispanic is the fastest growing population in the US* Cultural sensitivity Understanding and tolerance of all cultures and lifestyles 1. born natural citizens 2. health practices 3. effects the culture has on them Enables the nurse to Understand more accurately and to accept the behavior of others Provide better care by being sensitive to cultural factors involved in the client’s health or illness

Nursing Considerations/Cultural Assessment Note the effect of socioeconomics: a client may divide one prescription for use by several individuals who may have similar symptoms Ask the client if anyone else in the family needs to be aware of any healthcare situation: the client may or may not traditionally have a say in important decisions Understand that some family members like to assist with care of the client Educate the client and family caregivers whenever the opportunity arises

Box 8-3 Questions to ask: 1. what is the importance of religion, religious beliefs and religious practices 2. who makes the financial decisions? Healthcare decisions? 3. are you healthy? 4. does your heart condition affect your quality of life?

Values and Beliefs Beliefs May be based on fact, fiction, or a combination of both and can be difficult to change Values Shape how an individual perceives right or wrong and what is desirable or valuable Nurses must recognize that different beliefs and values exist and affect nursing.

Taboos and Rituals Taboos Members of the culture cannot violate taboos without discomfort and risk of separation from the group. Rituals Members are often required to practice rituals for comfort, acceptance, and inclusion. Often, taboos and rituals are associated with religious or spiritual services pertaining to healing, death, or dying.

Concepts of Health and Illness Culture greatly influences an individual’s concepts of health and illness. Each society has norms relating to the meaning of illness, how an ill person should behave, and what means should be used to assist him or her. These also transmit to treatment and healing beliefs and practices, and attitudes toward mental illness. Nurses must strive to accommodate clients’ healthcare beliefs and practices (as long as they are safe), even if they do not fully understand or agree with them.

Health and Illness Health belief systems: 1. magicoreligious-supernatural forces dominate Scientific/biomedical 2. holistic medicine-belief that the forces of nature must be kept balanced Yin/yang and hot/cold theories Attitude toward mental illness *belief that chemical changes in the brain can cause mental disorders is a relatively new concept for many cultures *mental illness may be seen as a disgrace to the family

Language and Communication The nurse and the clients may speak different languages. Facilitate communication: Professional interpreter Family as interpreter Nurse as interpreter Personal space and touching *Americans, Canadians, British have the largest personal space zone of all cultures they would need private rooms, require several feet for comfort* *Muslim-Arab woman may avoid eye contact especially with men (sign of modesty)

Diet and Nutrition Cultural eating rituals vary and some religions maintain strict dietary practices. The nurse should take into account each client’s nutrition and dietary customs as nutrition and diet constitute an important part of health and treatment of illness.

Elimination People of various cultures treat the elimination of bodily wastes differently. Many cultures consider elimination to be a private function. Nurse need to consider that some people are unable to void or to use a bedpan or commode unless they have complete privacy. *Arab cultures consider the left hand dirty and use it only to clean themselves after elimination

Death and Dying Each cultural group has an attitude or series of beliefs about death and dying. Nurses must respect the client’s beliefs even if they are different from their own beliefs. Many Asian cultures consider death to be preordained, believing that when a person’s time to die has come, nothing can stop it. Traditional Western culture tries to prevent death and to prolong life at all costs.

Religious and Spiritual Beliefs The interrelationship among cultures, religious beliefs, and healthcare is very strong. Each individual is unique and often has a mixture of belief systems, so it is important not to stereotype a client with any one religion. With knowledge of the individual’s belief system, the client and the client’s community of significant others will be more accepting of necessary medical interventions, lifestyle changes, dietary changes, and treatment regimens.

Judaism Reform, Orthodox, Conservative *KOSHER laws for food preparation Have family bring in food for client

Islamic (muslims) Teachings of the Koran Pork and alcohol prohibited Pray 5 times a day facing Mecca (east

Jehovah’s witnesses NO BLOOD PRODUCTS (except maybe autologous)