1. Cultural Diversity in Health Care

2. Introduction: Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Every aspect of a person’s life is influenced by that person’s culture. Because nurses provide health care to culturally diverse client populations in various settings, knowledge of culturally relevant information is essential for delivery of competent nursing care.

3. CULTURE: Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.3 This structure provides the group of people with a general design for living. Shared system of beliefs, values, and behavioral expectations An integrated, dynamic structure of knowledge, attitudes, behaviors, beliefs, ideas, habits, customs, languages, values, symbols, rituals, and ceremonies unique to a particular group of people.

4. Culture (cont.)  Provides social structure for daily living  Defines roles and interactions with others and in families and communities  Apparent in the attitudes and institutions unique to the culture Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.4

5. ETHNICITY AND RACE  Ethnicity–a cultural group’s perception of itself, or a group identity.  Race–a group of people with biological similarities. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.5

6. Typically based on specific characteristics :  Skin pigmentation, body stature, facial features, hair texture  Five major categories:  American Indian or Alaska Native »Asian »Black or African American »Native Hawaiian or Other Pacific Islander »White Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.6

7. CULTURAL DIVERSITY ALSO INCLUDES :  Ethnocentrism–the assumption of cultural superiority and inability to accept another culture’s ways.  Oppression–when the rules, values and ideals of one group are imposed on another group. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.7

8. Cultural Diversity also Includes (cont.)  Stereotyping–belief that people in same ethnic, racial, or cultural group act the same way, share same beliefs, attitudes.  Dominant culture–the group whose values prevail within a given society.  Minority group–constituting less than a numerical majority of the population.  Acculturation–the process of learning beliefs, norms, and behavioral expectations of a group  Cultural assimilation–members of a minority group are absorbed by the dominant culture, taking on the characteristics of the dominant culture. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.8

9. Which of the following occurs when a minority group, living with a dominant group, begins to blend in and lose the characteristics that made them distinct? A. Cultural imposition B. Cultural conflict C. Cultural assimilation D. Cultural shock Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9

10. CULTURE’S COMPONENTS  Perception of self and the individual: refers to personal identity, respect for individuals, and value.  Motivation–explains the methods and value of achievement.  Activity–identifies the ways people organize and value work.  Social relations–explains the structure and importance of friendships, gender roles, and class.  Perception of the world–indicates the explanation of religious beliefs and life events Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.10

11. CULTURE’S CHARACTERISTICS:  Culture is not inherited or innate, rather, it is integrated throughout all the interrelated components, motivations, activities, world views, relationships, and individuality are affected by consistent patterns of behavior and form a cohesive whole.  Culture is learned.  Culture is shared.  Culture is dynamic (constantly changing).  Culture is tacit (unspoken). Everyone in the cultural group understands acceptable behavior Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.11

12. INFLUENCES ON HEALTH CARE BELIEFS AND PRACTICES:  Cultural values define human responses to illness and will determine whether an individual seeks professional care when ill and complies with prescribed treatment.  Clients tend to define wellness and illness in the context of their own culture. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.12

13. PRACTITIONERS AND REMEDIES:  Variety in health/illness care providers is a natural extension of: –Culturally diverse concepts of etiology. –Definitions of health and illness.  Nurses must be able to: –Relate care and treatment to the client’s cultural context. –Incorporate informal caregivers, healers, and other members of the client’s support system as allies in treatment Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.13

14. BELIEFS OF SELECT CULTURAL GROUPS:  European Americans  African Americans  Hispanic Americans  Asian Americans  Native Americans Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.14

15. EUROPEAN AMERICANS:  Traditional healers: nurse, physician.  Healing practices: exercise, medications, modified diets, amulets, religious healing rituals. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.15

16. AFRICAN AMERICANS:  Traditional healers: elderly women healers, “community mother” or “granny,” “root doctor,” voodoo healer, spiritualist.  Healing practices: herbs, roots, oils, poultices, rituals, talismans Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.16

17. HISPANIC AMERICANS:  Traditional healers: curandero, espiritualista, yerbero, brujo, sobadora, santiguadora.  Healing practices: hot and cold foods, herbal teas, prayers and religious medals, massage, azabache, “three baths” ritual. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.17

18. NATIVE AMERICANS:  Traditional healers: shaman, medicine man/woman.  Healing practices: plants and herbs, medicine bundle or bag, sweet grass burned to purify the ill person, estafiate (dried leaves) tea, the Blessingway ceremony, sand paintings Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.18

19. CULTURAL AND RACIAL INFLUENCES ON CLIENT CARE:  Can be viewed through:  Communication  Orientation to space and time  Social organization  Biological variations Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.19

20. COMMUNICATION:  Not everyone shares the same language.  This can lead to misunderstanding and frustration.  Alternative methods include gestures and flash cards.  Family members may be able to assist.  Interpreters may be used. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.20

21. ORIENTATION TO TIME AND SPACE:  The distance that a person prefers to maintain from another is determined by one’s culture.  Individual’s orientation to time may affect: –Promptness, attendance at appointments. –Compliance with self-medication schedules.  Reporting the onset of illness Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.21

22. SOCIAL ORGANIZATION:  Refers to the ways that cultural groups determine rules of acceptable behavior and roles of individual members and includes:  Family structure.  Gender roles.  Religion Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.22

23. BIOLOGICAL VARIATION:  Distinguishes one racial or cultural group from another.  Includes variations in hair texture, eye shape, skin color, thickness of lips, and body structure.  Also includes enzymatic differences and susceptibility to disease. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.23

24. CULTURAL ASPECTS OF NURSING PROCESS–ASSESSMENT:  Culturally sensitive nursing care begins with examination of own culture, beliefs.  It is followed by an assessment of the client’s cultural beliefs and background.  Even if we cannot understand or accept particular cultural practices, it is important to show respect for them. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.24

25. CULTURALLY APPROPRIATE CARE  Respect clients for their beliefs.  Be sensitive to behaviors and practices different from your own.  Accommodate differences if they are not detrimental to the client’s health.  Listen for cues from client that relay unique ethnic beliefs about disease. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.25