1. Community and family cultural assessment Lecture 2 1 1 Clinical Application for Community Health Nursing (NUR 417)

2. After reading this lecture, the students should be able to understand the following:  Explain the concept of culturally sensitive psychosocial nursing care.  Discuss factors to consider when assessing culture and ethnicity in patients and their families.  Consider treatment approaches to patients in various cultural and ethnic groups.. 2 2 Objectives

3.  Culture is defined as a configuration of learned behaviors and beliefs that are shared and transmitted in a society and by a particular group of people.  Culture is a system of beliefs, behaviors, and symbols that are learned, shared, and passed on through generations of a social group.  Culture influences what people perceive, it guides their interactions, and it can change over time.  Culture describes a particular society’s entire way of living. 3 3 Introduction

4. Culturally competent nursing care is defined  as being sensitive to issues related to culture, race, religion, gender, sexual orientation, and social or economic class.  Cultural competence implies not only awareness of cultural differences but also the ability to assess and intervene appropriately and effectively. 4 4 Definition

5. 1.Communication 2.Space 3.Social organization 4.Time 5.Environmental control 6.Biological variations 5 5 Cultures can be compared using six phenomena that vary with application and use, yet are seen across all cultural groups:

6. 1. Communication This refers to all verbal and nonverbal behavior in the presence of another. Communication has its roots in culture. Cultural mores, norms, ideas, and customs are all expressed through communication. The nurse who cares for diverse patients must have an understanding of the client’s needs and expectations as expressed through their communication and culture. 6 6

7.  This element of culture refers to territoriality, density, and distance. It relates to how space is controlled, used, and defended.  Three interpersonal dimensions of space in Western culture have been identified:  the intimate zone (0–18 inches) (0-45cm)  the personal zone (18–36 inches ) (45-90cm)  the social zone (3–6 feet) (90-180cm) 7 7 2. Space:

8. Cultural behaviors are acquired through social interactions in groups such as families, religious groups, and ethnic groups. This process of learning cultural values is called acculturation. 8 8 3. Social organization

9. 4. Time : Awareness of time is learned gradually. Some cultures place great importance on punctuality and efficiency, whereas others ignore the clock. 9 9

10.  This element has to do with the degree to which individuals perceive they have control over their environment.  Persons from various cultures have different beliefs about how much they can influence events in their lives.  To provide culturally appropriate care, nurses should respect the individual’s unique beliefs while understanding how these beliefs can be used to promote health in the patient’s environment. 10 5. Environmental control

11. This element refers to biological differences in people from various racial and ethnic groups, such as body size and shape, skin and hair color, physiologic responses to medications, susceptibility to disease, and nutritional preferences. A new field called ethnopharmacology is addressing different responses to medications. 11 6. Biological variations:

12.  A cultural assessment helps the nurse gather and use other information related to culture that is vital in providing culturally sensitive care.  The nurse must be aware that beliefs about health and the causes of illness, appropriate care, and who should provide that care, can differ among cultures. 12 CULTURAL ASSESSMENT

13.  Cultural assessment may take several hours. The list of questions (in the next 2 slides) can provide a brief but helpful focus for a relevant cultural assessment. Answers to these questions do not guarantee culturally competent care, but nevertheless good care cannot be provided without specific cultural and ethnic information  When patient and health-care professionals are from different cultures, questions must be asked that respectfully acknowledge differences and build trust 13 CULTURAL ASSESSMENT

14. Where was the patient born? If an immigrant, how long in this country? What is the patient’s ethnic affiliation, how strong is the ethnic identity? Who are the patient’s major support people? Does patient live in an ethnic community? Who in the family takes responsibility for health concerns and decisions? Any activities in which the client may decline to participate because of culture, religious taboos? 14 Cultural Assessment—Questions to Ask

15. Any special food preferences, food refusals because of culture, religion? What are the primary and secondary languages, speaking and reading abilities? What is patient’s religion, its importance in daily life, current practices? What is the patient’s economic situation, is income adequate for needs? What are the patient’s health beliefs and practices? What are patient’s perceptions of health problem and expectations of health care? 15 Cultural Assessment—Questions to Ask

16.  Ethnocentrism is defined as the belief that one’s own cultural beliefs and health-care practices are superior to those of other cultures.  To provide quality care to all individuals, nurses must be sensitive to patients’ cultural differences and as aware as possible of their own cultural beliefs and behaviors 16

17.  Culture often influences what a patient believes about his or her illness, its causes, and when and from whom to seek care.  Although you may not be able to be aware of the specific beliefs of every culture, having some general information about the culture and ethnicity of patients for whom you frequently care for is important. 17

18. 18 Enhancing Cultural Sensitivity Be aware of your own ethnocentrism. Be aware of your own prejudices that may influence your assessment. Maintain an open mind and seek out more information about your patient’s culture, beliefs, and values. Communicate your interest about the patient’s beliefs and values. Approach each patient as an individual. Avoid assuming people from one cultural background all hold the same beliefs.

19. Respect the role of the family in the patient’s treatment. In some cultures, the family is responsible for protecting the patient, especially when the patient is the parent. In their role, family members may want to protect the patient from bad news. This may be contrary to your own belief in patient autonomy and, therefore, may lead to conflicts between the health-care providers and the family. 19

20. CULTURAL AND ETHNIC INFLUENCE ON COMMUNICATION Verbal and nonverbal communication patterns are closely tied to cultural beliefs and practices. Eye contact, hand gestures, facial expressions, and personal space, as well as how words or slang are used and what can be discussed, are defined by our culture and environment. For many people, eye contact indicates honesty, openness, and alertness. However, people in some cultures do not value eye contact and, in fact, even avoid it.

21. Some nonverbal behaviors such as facial expressions, hand gestures, and social distance vary among cultures. Also, some patients may be extremely uncomfortable when asked intimate, very personal questions, no matter how accepting and professional the nurse may be. If this information is vital to patient care, efforts need to be made to explain how the information will be used