Cultural Care

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Cultural Care
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HISTORICAL PERSPECTIVES

• Transcultural nursing is a body of knowledge
  tandem practice for caring for persons from
  other cultures
• Cultural awareness can they appreciate and are
  sensitive to the values, beliefs, Iifeways,
  practices, and problem-solving methods of a
  client s culture.
• Cultural blindness occurs when the nurse does not
  recognize his or her own beliefs and practices,
  nor the beliefs and practices of others.
  Ethnocentrism refers to the idea that one's own
  ways are the only way or the best way to behave,
  believe, or do things.

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• Cultural Knowledge encompasses the familiarity of
  the worldview, believes practices,
  problem-solving strategies of groups that are
  ethnically or culturally diverse.
• Community-based nursing practices require that
  the nurse have cultural knowledge of the
  community. This knowledge allows the nurse to use
  a preventive approach and facilitate self-care
  according to the client's particular culture.
  Collaboration and continuity in which he or she
  is working with the client.

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• Lack of cultural knowledge stands in the cultural
  competence. Nurses can have wonderful intentions
  and be sensitive caring, but if there is a lack
  of specific knowledge about the client's
  cultures, these mistakes are bound to be made.

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THE MEANING OF CULTURE
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• Culture refers to the beliefs, values, and
  behavior that are shared by members of a society
  and provide a design or map for living. It is
  culture that tells people what is acceptable or
  unacceptable in a given situation. It is culture
  that dictates what to do, say, or believe.
  Culture is learned.
• Cultural diversity (also called cultural
  plurality) means that a variety of cultural
  patterns coexist within a designated geographic
  area.
• Ethnocentrism is the belief and feeling that
  ones own culture is best. It reflects our
  tendency to judge other peoples beliefs and
  behavior using values of our own native culture

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• Discrimination Differential treatment of an
  individual due to minority status actual and
  perceived e.g., "we just aren't equipped to
  serve people like that."
• Cultural imposition Belief that everyone should
  conform to the majority e.g., "we know what's
  best for you, if you don't like it you can go
  elsewhere."

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CHARACTERISTICS OF CULTURE

• Anthropologists sociologists have made
  significant contributions to the field of
  community health.
• Their findings shed light on why and how culture
  influences behavior.
• Five characteristics shared by all cultures are
  especially pertinent to nursing efforts to
  improve community health (1) culture is learned,
  (2) integrated, (3) it is shared, (4) it is
  tacit, (5) it is dynamic.

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Culture Is Learned

• Patterns of cultural behavior are acquired, not
  inherited. Rather than being genetically
  determined, the way people dress, what they eat,
  and how they talk are all learned.
• At the moment of birth, we lack a culture. We
  dont yet have a system of beliefs, knowledge,
  patterns of customary behavior. But from that
  moment until we die, each of us participates in a
  kind of universal schooling that teaches us our
  native culture.
• Laughing and smiling are genetic responses, but
  as infants we soon learn when to smile, when to
  laugh, and even how to laugh. We also inherit the
  potential to cry, but we must learn our cultural
  rules for when crying is appropriate.

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Culture Is Integrated

• Rather than being merely an assortment of various
  customs and traits, a culture is a functional,
  integrated whole. As in any system, all parts of
  a culture are interrelated interdependent.
• The various components of a culture, such as its
  social mores or religious beliefs, perform
  separate functions but come into relative harmony
  with each other to form an operating and cohesive
  whole. In other words, to understand culture,
  single traits should not be described
  independently.
• Each part must be viewed in terms of its
  relationship to other parts and to the whole. In
  some cultural groups (eg, Muslims), modesty for
  women may make it uncomfortable and perhaps
  traumatic to be examined by a person of the
  opposite sex.

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Culture Is Shared

• Culture is the product of aggregate behavior, not
  individual habit. Certainly, individuals practice
  a culture, but customs are phenomena shared by
  all members of the group.
• Culture does not depend on individuals. An
  ordinary habit dies with its possessor, but a
  group habit lives on in the survivors and is
  transmitted from generation to generation.
• Moreover, the individual is not a free agent with
  respect to culture. He is born and reared in a
  certain cultural environment, which impinges on
  him at every moment of his life.
• From earliest childhood his behavior is
  conditioned by the habits of those around him. He
  has no choice but to conform to the folkways
  current in his group.

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Culture Is Mostly Tacit

• Culture provides a guide for human interaction
  that is tacit that is, mostly unexpressed at
  the unconscious level. Members of a cultural
  group, without the need for discussion, know how
  to act what to expect from one another.
• Culture provides an implicit set of cues for
  behavior, not a written set of rules. Because
  culture is mostly tacit, realizing which of ones
  own behaviors may be offensive to people from
  other groups is difficult. It also is difficult
  to know the meaning and significance of other
  cultural practices.

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Culture Is Mostly Tacit

• In some groups, such as Islamic women, silence is
  valued and expected but may make others
  uncomfortable. Offering food to a guest in many
  cultures is not merely a social gesture but an
  important symbol of hospitality and acceptance
  to refuse it, for any reason, may be an insult
  and a rejection.
• Touching or calling someone by their first name
  may be viewed as a demonstration of caring by
  some groups but is seen as disrespectful
  offensive by others.

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Culture Is Dynamic

• Every culture undergoes change none is entirely
  static. Within every cultural group, some
  individuals generate innovations. More important,
  some members see advantages in doing things
  differently and are willing to adopt new
  practices.
• Each culture, including our own, is an
  amalgamation of ideas, values, and practices from
  a variety of sources. This process depends on the
  extent of exposure to other groups.
• Nonetheless, every culture is in a dynamic state
  of adding or deleting components. Functional
  aspects are retained less functional ones are
  eliminated.

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Transcultural Assessment Model
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The leininger Sunrise Model

• A culture is made up of educational, economic,
  political, legal, kinship, religious,
  philosophical, technological systems. Each of
  this identified system affects health.
• Health needs are biological psychosocial and
  cultural and are met within a combination of
  two subsystems a folk health system (primarily
  rented to religious beliefs and practices) and
  the professional health system.
• Leininger (1991) points out that the greater the
  differences between folk and professional care
  practices the greater the need for nursing care
  accommodations.

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The folk health system

• The traditional or indigenous health care beliefs
  and practices These are per- formed by local
  practitioners, are well known to the culture,
  and have special meanings and uses to heal or
  assist people to regain well-being or health or
  to face unfavorable circumstances.
• Professional health system refers to those
  cognitively learned practiced modes of
  assisting others that are obtained through formal
  professional schools of learning.

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Cont

• Folk medicine systems vary, but they often
  explain illness in terms of balances between the
  individual the physical, social, spiritual
  worlds focus on personal relationships, perhaps
  involving many persons.
• Folk medicine classifies illness and disease as
  natural or unnatural. Natural illnesses are based
  on logical cause- -effect relationships.
  Unnatural events are believed to occur when the
  harmony of nature is upset. They are
  unpredictable may be considered a result of
  evil forces.

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Complementary Therapies and Self-Care Practices
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• Complementary therapies (also called alternative
  medicine or alternative therapies) are practices
  that are used to complement contemporary Western
  medical and nursing care and are designed to
  promote comfort, health and well-being. The range
  of complementary therapies is broad and includes
• Diet therapies (cancer diets, juice diets,
  fasting)
• GI treatments (coffee enemas, high colonic
  enemas)
• Balance and exercise activities (yoga)
• Sensory exposure (aromatherapy, music therapy,
  light therapy)
• Therapeutic manipulation (acupuncture,
  acupressure) client based on cultural group norms.

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C u l t u r a l / i d e o l o g i c a l L e v e l

• Culture consists of a societys framework of
  knowledge and beliefs, the content of its books
  and mass media, its technology, the determination
  of how social roles are to be fulfilled, which
  behaviors are normal and which unacceptable and
  which are its morals and value systems. It is
  culture that ranks the importance of families
  versus individuals, of industriousness versus
  leisure.
• It is culture that determines the relative value
  of competitiveness, equity among people,
  benevolence, valuation of health, and ultimate
  goals. A communitys infrastructure its roads,
  bridges, water, electricity, buildings, and
  medical technology might be viewed as part of
  the physical environment, but it all has been
  created or borrowed by the culture.
• Culture is the way of life of a people. Like
  health and disease, culture is transmitted from
  group to group, from generation to generation.
  Witness the power of television to transmit the
  culture of high-technology nationsboth the
  useful and the destructive aspectsto every
  corner of the world. Raising the hopes for a
  healthier, happier life has been useful, but
  marketing materialism, consumerism, aggression,
  violence has been harmful.

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C u l t u r a l / i d e o l o g i c a l L e v e l

• A communitys ideology is part of its overall
  culture, and is often inferred, rather than seen.
  Ideology is the world of ideas, beliefs, and
  values in which the members of a society live.
• What people say is important to them is not
  always reflected in their behavior, however, and
  the written plan for many institutions is often
  not the real way they operate. In health
  planning, it is critical to understand this
  paradox.
• Culture tells its possessor what is important. It
  may value fame, sports skills, or conforming to
  friends. Or, it may tell who is important and who
  can be left outperhaps women, ethnic minorities,
  the poor, and the powerless, who are often
  neglected.

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C u l t u r a l / i d e o l o g i c a l L e v e l

• The stream of illness generated in these
  subgroups by lack of resources, lack of knowledge
  and skills, and lack of a way out, is forced
  under the surface in many communities. But
  illness filters upwards to and through the roots
  of the upper and powerful classes, and the garden
  at the top soon ceases to flourish.
• Culture also tells us what is possible and what
  is not. For example, villagers in Surinames
  interior had known malaria as far back as their
  spoken history could trace. And, they used the
  statistically powerful persistency forecastthe
  best predictor of the future is what has always
  happened in the pastto accept that malaria would
  always be a part of their lives.
• By developing trust in health workers, however,
  who themselves had seen malaria eradicated in
  their own communities, Surinamese villagers were
  able to change their perception of what is
  possible, and so release hope and energy to
  eradicate the malaria scourge in their own
  communities

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Generic Professional Knowledge

• Emic refers to the local or insider's views and
  values about a phenomenon.
• Etic is the professional or outsider s views and
  values about a phenomenon.
• The community-based nurse uses both these types
  of care knowledge and verified with the client
  and family those areas that are meaningful and
  acceptable to them. Discovering how generic
  (Emic) and professional (Etic) systems are alike
  or different assists the nurse in providing
  culturally congruent care to individuals or
  groups

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Component of Cultural Assessment
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Six phenomena of cultural assessment

• Communication. A continuous process by which one
  person may affect another through written or oral
  language, gestures, facial expressions
• Space- The area around a person's body that
  includes the individual, surrounding environment
  and object within that environment.
• Social organization. The family and other groups
  within a society that dictate culturally accepted
  role behaviors of different member of the society

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• Time. The meaning influence of time from a
  cultural perspective. Time orientation refers to
  an individual's focus on the past, the present or
  the future.
• Environmental control The ability or perceived
  ability of an individual or persons from a
  particular cultural group to plan activities that
  control nature such as illness causation
  treatment
• Biologic variation. The biologic differences
  among racial and ethnic groups. It can include
  physical characteristics, such as skill color
  physiology

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Communication

• Because the community-based nurse spends much of
  his or her time teaching, communicating roles,
  knowledge of communication styles and meanings is
  essential.
• Verbal and nonverbal behavior, space between
  persons talking, family number roles, eye contact
  salutations integrate communication patterns

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Space and Physical Contact

• The concept of space is another important
  dimension of cultural knowledge.
• How close people stand by each other in
  conversation, overt expressions of affection or
  caring with touch, and rules relating to personal
  space and privacy vary greatly among cultures

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Time

• Because the concept of time has such different
  meanings in various cultures it is important
• for the nurse to know of this dimension within
  the cultural group receding care

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Social Organization

• A The community-based nurse must understand the
  family patterns of the groups within the
  community being served the family is the basic
  unit of society

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Biologic Variations

• To perform a thorough assessment and provide
  culturally congruent care, the community-based
  nurse who bows biologic variations specific to
  his or her clients will be most effective.
• Although some biologic variations are obvious
  e.g., skin color, hair texture, facial features,
  stature, and body markings), others require
  knowledge based on medical information and
  research.

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Environmental Control

• There are three predominant views on the
  relationship between the environment health
  magic religious, biomedical, humeral.
• The magic religious view sees illness as a having
  a supernatural force that is, malevolent or evil
  spirits cause disease, or illness is a punishment
  from God.

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Acculturation and Assimilation

• Acculturation may occur as they learn the ways
  to exist in a new culture. This may include
  learning to drive going to schools negotiating
  public transportation getting a job and
  interacting in an environmental unlike that of
  the home country

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• Assimilation, takes place when individuals or
  groups identify more strongly with the dominant
  culture in values activities and daily living.
• Cultural Skills as the ability to collect
  relevant cultural data regarding the client's
  health history.

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• A culturologic assessment as a systematic
  identification documentation of culture care,
  beliefs, meaning, values, symbols practices of
  individuals or groups with a holistic
  perspective.
• It gives the nurse good information with cultural
  implications to use as a basis for planning
  teaching and treatment plans.
• All clients have a right to have their values
  beliefs practices considered, respected
  incorporated into the plan of care

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Cultural Care Preservation

• The first of the modalities is cultural care
  preservation /or maintenance. After careful
  assessment observation, the nurse identifies
  those cultural care practices that are helpful to
  the client.
• The nurse then assists, supports, facilitates, or
  enables the client family to preserve those
  actions or behaviors.
• The nurse working in this community encourages
  supports ways to enlist the help of the extended
  community facilitates ways to let the care
  needs be known

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Cultural Care Accommodation

• The second mode of cultural care accommodation or
  negotiation refers to those nursing actions
  decisions that assist or enable the client arid
  family to continuity with practices that are
  meaningful to them but may be altered due to
  circumstances.
• For example the nurse in the community may be
  setting up a referral for a client to be seen in
  a clinic for follow-up care. The client is Muslim
  and must adhere to the practice of praying five
  times a day.

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• The nurse will negotiate with the client as to
  times of day that would provide enough time
  between prayers for an appointment or assist in
  helping the client find a place within or near
  the clinics where these prayers may be said.

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Cultural Care Repatterning

• The third way in which nurses make decisions or
  intervene is cultural care Repatterning or
  restructuring.
• When the nurse assesses the client, family, and
  communities and finds practices that may be
  detrimental to health and well-being, he or she
  will work with the client to change behaviors
  that are harmful. .

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Develop Cultural Self-Awareness

• The first transcultural nursing principle focuses
  on the nurses own culture. Self-awareness is
  crucial for the nurse working with people from
  other cultures.
• Nurses must remember that their culture often is
  sharply different from the culture of their
  clients.

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• Cultural self-awareness means recognizing the
  values, beliefs, and practices that make up ones
  own culture.
• It also means becoming sensitive to the impact of
  ones culturally based responses. In terms of her
  own culture, this nurses behavior was intended
  to reassure clients and meet their needs.
• Unaware of the negative consequences of her
  behavior, the nurse caused damage rather than
  meeting needs

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• Cultural self-assessment
• Ethnic and racial background influences
• Typical verbal nonverbal communication patterns
• Cultural values and norms, or expected cultural
  practices or behaviors
• Religious beliefs and practices
• Health beliefs and practices

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Concepts Related to Bridging Cultural Differences
(ETHNIC)
E Everyone has a culture.
T Take time to collect relevant cultural information.
H Hold all judgments ie. be careful about interpreting the culturally different student's behavior, especially if unfamiliar with the culture.
N Notice and negotiate differences in understanding of teaching and learning
I Involve cultural resources as appropriate.
C Collaborate to develop objectives and educational strategies.
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