Culture and Ethnicity Chapter 6 By Heba Sadaka, BSN, RN Objectives: By the end of this lecture students should be able to : Differentiate culture, race, and ethnicity. Discuss two factors that interfere with perceiving others as individuals. Explain why U.S. culture is described as being anglicized. List at least five characteristics of Anglo-American culture. Define the term subculture and list four major subcultures in the United States. 1
Objectives Continue: List five ways in which people from subcultural groups differ from Anglo-Americans. Describe four characteristics of culturally sensitive care. List at least five ways to demonstrate cultural sensitivity List the national standards on Culturally and Linguistically Appropriate Services (CLAS) Culture Culture is: values, beliefs, and practices of a particular group Learned from birth Shared by members of a group Influenced by environment, technology, and available resources. Dynamic and ever changing. Race: Is a term used to categorize people with genetically shared physical characteristics such as skin color, eye shape, and hair texture. Cultural Aspects Minority- Groups of people who differ from the dominant group in terms of cultural characteristics such as language, physical characteristics, and/or both. Ethnicity is the bond or kinship a person feels with his or her country of birth or place of ancestral origin. http://www.mtsu.edu/~cdinit/photoalbum.htm 2
Cultural Aspects Stereotyping: Fixed attitudes about all people who share a common characteristic. Generalizing: Supposition that a person shares cultural characteristics with others of a similar background. Ethnocentrism The belief that one s own ethnicity is superior to all others. It is manifested by treating everyone different as deviant and undesirable. Anglo-American Culture and U.S. Subcultures Subcultures Unique cultural groups that coexist within the dominant culture Four major subcultures exist in the United States in addition to Anglo-American African Americans Asian Americans Latinos Native Americans http://www.mtsu.edu/~cdinit/photoalbum.htm Transcultural Nursing Providing nursing care within the context of another s culture. It includes the following aspects: Assessment of a cultural nature Acceptance of each client as an individual. Knowledge of health problems that affect particular cultural groups. Planning of care within the client s health belief system to achieve the best health outcomes 3
Language and communication style Hygiene practices, feelings about modesty Clothing or ornamentation Religion and religious practices Rituals surrounding illness, death and birth Family and gender roles Food habits and dietary restrictions Methods of making decisions Health beliefs and medical practices Proper form of greeting and showing respect http://www.mtsu.edu/~cdinit/photoalbum.htm Language and communication During stress and illness people prefer to use their primary language Native Americans: Tend to be private and hesitate to share personal information. The nurse need to allow the client some time to respond and listen only during the interview then write down the information later if possible 4
African Americans: Address client by their last name Ask open ended questions Follow up thoroughly with questions and provide respect and privacy Latinos Comfortable sitting close to interviewers Speak slowly Latino men are protective and authoritarian regarding women and children Asian Respond briefly and value simplicity and meditation May not openly disagree with authority (Dr. or Nurse) Eye Contact Anglo-American maintain eye contact throughout communication Asian and Native Americans consider lingering eye contact invasion of privacy and disrespect Arabs may consider direct eye contact sexually suggestive Space and Distance Asian Americans feel comfortable if you stand at more than an arm s length away Communicate with your client explain procedures before getting close to your client Touch Native Americans may interpret strong handshake as offensive Explain procedures and ask permission before you touch the client Emotional Expression Anglo Americans express their positive and negative feelings freely Asian tend to control their emotions Latino men may not discuss their symptoms as they may interpret it as less manly 5
Dietary Customs and Restrictions Food choices are dictated by cultural practices. Client teaching should include cultural and religious food preferences within the medically prescribed therapeutic diet. Religious practices may impose rules and restrictions in regard to fasting and food preferences. Time Punctuality is often less important to people from other cultures than it is to Anglo-Americans http://www.mtsu.edu/~cdinit/photoalbum.htm Beliefs Concerning Illness Biomedical or scientific perspective-base beliefs about health and disease on research findings. Naturalistic or holistic perspective-humans and nature must be in harmony to remain healthy (Native Americans) Hot/cold theory: Illness is an imbalance between hot and cold attributes (Latinos) Magico-Religious perspective-cultural belief that supernatural forces contribute to disease or health Yin Yang theory: the belief that balanced forces promote health (Asian Americans) 6
Biologic and Physiologic Variations Skin Characteristics: All skin regardless of a person s ethnic origin contains an underlying red tone. When assessing the skin in dark-skinned client use: the palms of the hand, the feet, and the abdomen (this areas contain less pigmentation) pallor The conjunctiva and oral mucous membranes cyanosis The sclera and hard palate jaundice Skin Characteristics Keloids: Irregular elevated thick scars are common among dark skinned Skin Characteristics Vitiligo: Irregular white patches on the skin as a result of an absence of melanin http://www.patient.co.uk/images/vitiligo78d.jpg 7
Skin Characteristics Mongolian spots: Dark blue area in the darkly pigmented infant and children It tend to fade by the time a child is 5 years old http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/17262.jpg Biologic and Physiologic Variations Hair Characteristics-Hair color and texture are also biologic variants. Enzymatic Variations-Lactase Deficiency, G-6-PD Deficiency, ADH Deficiency Lactase deficiency: it is a digestive enzyme that convert the sugar in milk into glucose and galactose Signs and symptoms intolerance to dairy product including cramps, intestinal gas, and diarrhea approximately 30 min after ingestion of milk or dairy product Biologic and Physiologic Variations G-6-PD: Is an enzyme that helps red blood cells to metabolize glucose Lack of this enzyme is common among African Americans and Mediterranean people. The disease is sex linked manifest males but females can be a carrier S & S of G-6PD deficiency During stress more red blood cell destroyed causing anemia Some drugs that inhibit red blood cell production 8
Biologic and Physiologic Variations ADH Deficiency It affect Native Americans and Asian American. It cause rapid vascular effect causing flushing, rapid heart rate and toxic effect causing organ damage Disease Prevalence-The incidence of chronic disease may be related to social factors Health beliefs and practices: Anglo-Americans belief illness results from infectious organisms, organ degeneration, and unhealthy lifestyle Consult with Dr. for diagnosis and treatment African Americans belief illness caused by supernatural cause and influence recovery They use individual and group prayer to speed recovery Health beliefs and practices: Asian Americans illness occur from imbalance between yin and yang energy Acupuncture, food and herbs used to restore balance Latinos Illness and misfortune are punishment from God result from an imbalance of hot or cold forces within the body Prayer used and lay practitioners who possess spiritual healing power are used Food that are hot or cold are consumed to restore balance 9
Health beliefs and practices: Native Americans Illness occur when harmony of nature disturbed A shaman or medicine man who has spiritual and healing power is consulted to restore harmony Culturally Sensitive Nursing Speak a second language Use culturally sensitive techniques Be familiar with physical differences Utilize accurate physical assessment techniques Learn cultural beliefs and be culturally sensitive Facilitate cultural rituals in the provision of care Advocate routine screening for diseases for which the client are genetically or culturally prone Apologize if cultural traditions or beliefs are violated Culturally Sensitive Nursing Consult the client in ways to solve health problems Never verbally or nonverbally ridicule a cultural belief or practice Integrate helpful or harmless cultural practices within the plan of care Modify or gradually change unsafe practices Avoid removing religious medals or clothes that hold symbolic meaning for the client Provide customarily eaten food 10
The National Standards on Culturally and Linguistically Appropriate Services (CLAS) Visit the website of The Office of Minority Health @ www.omhrc.gov Under culture competency you will find the 14 national standard on culture and linguistically appropriate services Please print them and bring them with you to lecture on Thursday. 11