The Cultural Aspects of Community Nursing Practice

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The Cultural Aspects of Community Nursing Practice

• By Nataliya Haliyash,
• MD, BSN
• TSMU, International Nursing School

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Lecture objectives

• Define and explain the concept of culture.
• Discuss the meaning of cultural diversity and its
  significance for community health nursing.
• Discuss the importance of cultural competence to
  community health nursing.
• Discuss barriers to developing cultural
  competence.

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• " Community health nurses must assist ill persons
  from various cultures - over time- to adjust to
  alterations in health states, adopt individual
  and family behaviors to improve health status and
  develop health promoting patterns."

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CULTURE

• SOME DEFINITIONS
• Culture refers to the cumulative deposit of
  knowledge, experience, beliefs, values,
  attitudes, meanings, hierarchies, religion,
  notions of time, roles, spatial relations,
  concepts of the universe, and material objects
  and possessions acquired by a group of people in
  the course of generations through individual and
  group striving.
• Culture is the systems of knowledge shared by a
  relatively large group of people.
• Culture is communication, communication is
  culture.
• Culture in its broadest sense is cultivated
  behavior that is the totality of a person's
  learned, accumulated experience which is socially
  transmitted, or more briefly, behavior through
  social learning.
• A culture is a way of life of a group of
  people--the behaviors, beliefs, values, and
  symbols that they accept, generally without
  thinking about them, and that are passed along by
  communication and imitation from one generation
  to the next.
• Culture is symbolic communication. Some of its
  symbols include a group's skills, knowledge,
  attitudes, values, and motives. The meanings of
  the symbols are learned and deliberately
  perpetuated in a society through its institutions.

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THEORY OF CULTURAL DETERMINISM

• The position that the ideas, meanings, beliefs
  and values people learn as members of society
  determines human nature. People are what they
  learn. Optimistic version of cultural determinism
  place no limits on the abilities of human beings
  to do or to be whatever they want. Some
  anthropologists suggest that there is no
  universal "right way" of being human. "Right way"
  is almost always "our way" that "our way" in one
  society almost never corresponds to "our way" in
  any other society. Proper attitude of an informed
  human being could only be that of tolerance.
• The optimistic version of this theory postulates
  that human nature being infinitely malleable,
  human being can choose the ways of life they
  prefer.
• The pessimistic version maintains that people are
  what they are conditioned to be this is
  something over which they have no control. Human
  beings are passive creatures and do whatever
  their culture tells them to do. This explanation
  leads to behaviorism that locates the causes of
  human behavior in a realm that is totally beyond
  human control.

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CULTURAL RELATIVISM

• Different cultural groups think, feel, and act
  differently. There is no scientific standards for
  considering one group as intrinsically superior
  or inferior to another. Studying differences in
  culture among groups and societies presupposes a
  position of cultural relativism. It does not
  imply normalcy for oneself, nor for one's
  society. It, however, calls for judgment when
  dealing with groups or societies different from
  one's own. Information about the nature of
  cultural differences between societies, their
  roots, and their consequences should precede
  judgment and action. Negotiation is more likely
  to succeed when the parties concerned understand
  the reasons for the differences in viewpoints.

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CULTURAL ETHNOCENTRISM

• Ethnocentrism is the belief that one's own
  culture is superior to that of other cultures. It
  is a form of reductionism that reduces the "other
  way" of life to a distorted version of one's own.
  This is particularly important in case of global
  dealings when a company or an individual is
  imbued with the idea that methods, materials, or
  ideas that worked in the home country will also
  work abroad. Environmental differences are,
  therefore, ignored. Ethnocentrism, in relation to
  global dealings, can be categorized as follows
• Important factors in business are overlooked
  because of the obsession with certain
  cause-effect relationships in one's own country.
  It is always a good idea to refer to checklists
  of human variables in order to be assured that
  all major factors have been at least considered
  while working abroad.

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CULTURAL ETHNOCENTRISM

• Even though one may recognize the environmental
  differences and problems associated with change,
  but may focus only on achieving objectives
  related to the home-country. This may result in
  the loss of effectiveness of a company or an
  individual in terms of international
  competitiveness. The objectives set for global
  operations should also be global.
• The differences are recognized, but it is assumed
  that associated changes are so basic that they
  can be achieved effortlessly. It is always a good
  idea to perform a cost-benefit analysis of the
  changes proposed. Sometimes a change may upset
  important values and thereby may face resistance
  from being implemented. The cost of some changes
  may exceed the benefits derived from the
  implementation of such changes.

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MANIFESTATIONS OF CULTURE

• Cultural differences manifest themselves in
  different ways and differing levels of depth.
  Symbols represent the most superficial and values
  the deepest manifestations of culture, with
  heroes and rituals in between.
• Symbols are words, gestures, pictures, or objects
  that carry a particular meaning which is only
  recognized by those who share a particular
  culture. New symbols easily develop, old ones
  disappear. Symbols from one particular group are
  regularly copied by others. This is why symbols
  represent the outermost layer of a culture.
• Heroes are persons, past or present, real or
  fictitious, who possess characteristics that are
  highly prized in a culture. They also serve as
  models for behavior.
• Rituals are collective activities, sometimes
  superfluous in reaching desired objectives, but
  are considered as socially essential. They are
  therefore carried out most of the times for their
  own sake (ways of greetings, paying respect to
  others, religious and social ceremonies, etc.).

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MANIFESTATIONS OF CULTURE

• The core of a culture is formed by values. They
  are broad tendencies for preferences of certain
  state of affairs to others (good-evil,
  right-wrong, natural-unnatural). Many values
  remain unconscious to those who hold them.
  Therefore they often cannot be discussed, nor
  they can be directly observed by others. Values
  can only be inferred from the way people act
  under different circumstances.
• Symbols, heroes, and rituals are the tangible or
  visual aspects of the practices of a culture. The
  true cultural meaning of the practices is
  intangible this is revealed only when the
  practices are interpreted by the insiders.

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Manifestation of Culture at Different Levels of
Depth
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• Cultural groups may have unique
• 1) family structure
• 2) values and attitudes,
• 3) language,
• 4) arts,
• 5) child-rearing, and
• 6) religion and traditions.

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Cultural Groups

• Traditional cultural groups that have more
  economic difficulties, poorer health, and less
  accessibility to health care than other groups
  include
• African Americans
• Asians
• Hispanics
• Native Americans
• Migrant Workers
• Refugees

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A Value

• What is a value?
• "A culturally prescribed criterion by which
  individuals evaluate persons, behaviors, objects,
  and ideas as to their relative morality,
  desirability, merit, or correctness."
• "conceptions of what is desirable . . . the
  underlying assumptions by which individual and
  social goals are chosen."

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Dominant Values

• The beliefs and sanctions of the dominant or
  majority culture are called dominant values.
• In the United States, the majority culture is
  made up largely of Anglo-Saxons whose dominant
  values include
• the work ethic,
• thrift,
• success,
• independence,
• initiative,
• respect for others,
• privacy,
• cleanliness,
• youthfulness,
• attractive appearance, and
• a focus on the future.

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• Americans once expected parents to raise their
  children in accordance with the dominant cultural
  messages. Today they are expected to raise their
  children in opposition to them. Once the chorus
  of cultural values was full of ministers,
  teachers, neighbors, leaders. They demanded more
  conformity, but offered more support. Now the
  messengers are violent cartoon characters,
  rappers and celebrities selling sneakers. Parents
  are considered responsible only if they are
  successful in their resistance. Thats what makes
  child-raising harder. Its not just that American
  families have less time with their kids its
  that we have to spend more of this time doing
  battle with our own culture.
• Ellen Goodman

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Dominant Values

• Dominant Values in American Society An
  Exploratory Analysis.
• http//eric.ed.gov/ERICWebPortal/custom/portlets/r
  ecordDetails/detailmini.jsp?_nfpbtrue_ERICExtSe
  arch_SearchValue_0ED128502ERICExtSearch_SearchTy
  pe_0noaccnoED128502

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Dominant Values

• Dominant values are important to consider in the
  practice of community health nursing because they
  shape peoples thoughts and behaviors.
• Why are some client behaviors acceptable to
  health professionals and others not?
• Why do nurses have such difficulty persuading
  certain clients to accept new ways of thinking
  and acting?
• Explanations can be found by examining the
  concept of culture, especially its influence on
  health and on community health nursing practice.

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Racial and Ethnic Health Disparities

• The Department of Health and Human Services has
  an initiative to combat the health care
  disparities based on race and ethnicity.
  President Clinton asked for 400 million over
  five years to support public-private
  collaborative efforts, led by HHS, to close the
  gaps between racial and ethnic populations and
  white Americans in six health categories where
  disparities are recognized.

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Racial and Ethnic Health Disparities

• Those areas are
• infant mortality,
• cancer screening and management,
• cardiovascular disease,
• diabetes,
• HIV/AIDS infection rates, and
• child and adult immunizations.
• The Department of Health and Human Resources has
  committed to eliminating the gaps in theseareas
  by 2010 with interim goals set for 2000.

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• President Clinton's radio address to the nation,
  February 21, 1998, in which he talks about steps
  being taken to bridge the health care disparity
  gap.
• http//raceandhealth.hhs.gov/radio-ad.htm

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Initiative to Eliminate Racial and Ethnic
Disparities in Health of HHS

• http//raceandhealth.hhs.gov/

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• Other variations among cultural groups (as far as
  organizational factors) include
• Communication
• Space
• Social Organization
• Time
• Environment control
• Biological variations

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Cultural competence in Nursing Care

• 1) Care is designed for the specific client.
• 2) Care is based on uniqueness of the person's
  culture (norms and values).
• 3) Care includes empowerment strategies -
  fascilitates client decision making in health
  behavior.
• 4) Care is provided with sensitivity to cultural
  uniqueness.
• In a brief cultural assessment nurses ask clients
  about their ethnic background, religious
  preference, family patterns, food patterns, and
  health practices.

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ASSIGNMENT 1 Exploring Your Own Cultural
Background

• 1. What ethnic group, socioeconomic class, age
  group and community do you belong to?
• 2. What about your ethnic group, socioeconomic
  class, religion, age or community do you wish to
  change?
• 3. What experiences have you had with people
  different from you?
• 4. What were those experiences like and how did
  you feel about them?

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ASSIGNMENT 1 Exploring Your Own Cultural
Background

• 5. What is there about you that might cause you
  to be rejected by members of other cultures or
  ethnic groups?
• 6. Where and how was knowledge about your
  heritage passed on to you?
• 7. Who are the persons in your network
  responsible for influencing and shaping the lives
  of young people?

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ASSIGNMENT 2 Cultural Awareness and Health
Considerations

• To complete this assignment successfully, you
  should
• Study the assignment carefully
• Remember back to your childhood and a significant
  episode of being ill and answer these questions
• 1. Who decided what was wrong with you?

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ASSIGNMENT 2 Cultural Awareness and Health
Considerations

• 2. What were the interpretations of your
  symptoms?
• 3. Who made the decision about what to do for
  you?
• 4. Did the meanings of your symptoms and who was
  consulted have anything to do with the selected
  treatments?
• Now, think about your parents or whomever raised
  you. How would they respond if they were
  diagnosed with cancer?
• 5. What would be the condition's influence on
  their ADL's including work?
• 6. Would the person complain?
• 7. How would offers of help be received?
• 8. How would pain/discomfort be expressed?
• 9. What remedies would be used to alleviate pain
  or discomfort?

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Thats all falks!

• Q A ?