Chapter 15 Culture and Ethnicity

okay so divided this up into three different Zoom recordings just because of is twoh hour lecture which is lot to listen to all at once so we're going to start with chapter 15 which is your culture and ethn toity these are learning outcomes that you can find in your book these are the ke terms I'll use most of these in our lecture but some of them you might need to look up in your book as well so we're going to start off with culture and ethnicity so what is culture culture is defined as socially transmitted shared behaviors patterns beliefs values customs lifeways arts and all other products of human work and thought characteristics of population of people that guide their world view and decision making then we have ethnicity so ethnicity is person's identification with or membership in particular race National or cultural group and observations of group's Customs beliefs and language the United States is considered Multicultural Society we continue to see trend of increasing immigrants some projections indicate that the United States soon the United States will soon become majority minority and what this means is that we're going to have so many different cultures that we're not going to have just one majority culture as nurses we need to understand our patients cultural values so that we can provide them with good care we also need to be aware because of we're going to need to understand their cultures so we can do teaching supervising and role modeling culturally competent care for them as well as other people that we might work alongside of so the benefits to having culturally competent care is that it's going to increase your patients safety and satisfactions and it's going to reduce Health Care disparities when we talk about health care disparities Health Care disparities are preventable differences and the burden of disease injury violence or opportunities to achieve Optimal Health that are experienced by socially disadvantaged populations healthc care disparities include mortality and life expectancy the burden of disease many of which are listed here also mental health uninsured or underinsured lack of access to Care Health disparities can result from multiple of factors it can be due to Poverty environmental threats inadequate Access to Health Care indiv individual and behavioral factors and educational inequalities when we talk about the burden of disease some of this is related to systemic inequities based on race or ethnicity and some are genetically predisposed we can also look at things like dietary practices and other cultural values that can impact somebody's Health page 298 to 299 and your book kind of touches on the lockdown so when we talk about what's Me by culture it's important for us to know that we're not going to be able to learn every cultural practice of every group but it is important for us to learn about the cultures that we're going to most often encounter what's culture so culture is what people in group have in common it can change slowly or can change rapidly it's going to be learned through life experiences and it can be taught through values beliefs and traditions that are past down from generation to generation this can be formally so in schools or informally through family some generations will totally adopt the values and beliefs and traditions of their Elders some might adopt them partially and some might completely move away from the teachings entirely culture is shared by its member culture Norms are shared through teachings and social interactions they can be dynamic and active meaning Dynamic and adaptive culture customs beliefs practices are not static they're going to change over time and at different rates cultural change occurs typically as an adaptation and response to the outside environment and they're complex our cultural assumptions and habits are typically unconscious and therefore it's difficult for members of culture to EXP explain to others or to identify as different from another culture so our cultural characteristics are going to be able to provide the members with sense of identity and sense of bonging it's going to be Universal which everybody is included in that culture and it's going to be dynamic meaning that they're going to share their Customs beliefs and practices and those practices and and shared beliefs are going to change over time when we say that it exists at many levels we're meaning that it can be at the material Level so it's going to be Arts writing dresses and artifacts that the culture produces and then non materials are going to be those Customs Traditions language beliefs and practices the values beliefs and traditions again are going to be passed down from generation to generation those assumptions and habits are going to be unconscious to those that are in it and the culture is going to be diverse so it's going to demonstrate the variety that exists among groups and among members of the particular culture so now we can get into ethnicity race and religion so ethnicity is similar to culture in that it refers to groups whose members share common social and cultural heritage that's passed down from generation to generation ethnicity is also similar to subculture and that the members of the ethnic group have some characteristics in common that are not shared or understood by Outsiders authenticity may include race but it's not the same as race race refers to the grouping of people based on biological similarities such as skin color blood type or bone structure then we can talk about religion religion refers to an order system of beliefs regarding the cause nature and the purpose of the universe especially the beliefs related to worship of God gods or higher entity our concepts related to culture the first one that we can talk about is ethnocentrism and what this is is that we believe that our culture is the superior culture and we're going to use it as criteria to judge other cultures with then we have socialization socialization is learning the culture by immersing ourselves into it and therefore by this immersion process we learn social rules and roles we learn the behaviors the norms and values and the perceptions of others in that culture some common locations where we can accomplish soci civilization would be famili schools churches and peers in class used an example that if you had strong Hispanic culture in your development and they were throwing large together if you went and socialized there and started learning their behaviors storms and values you would be practicing socialization because you would be immersing yourself into that culture nursing in itself is culture which we'll talk about later on but as students you guys are now being socialized among nurses in their culture so that you have better understanding right so then we can talk about culturation so culturation is new member of group or country that assumes the characteristics of that culture through learning process called culturation person who is curated accepts both his own and the new culture adopting elements from each then we have assimilation so assimilation occurs when the new member gradually learns and takes on those essential values and beliefs and behaviors of the dominant culture assimilation is complete when the newcomer is fully merged into the dominant culture so what's dominant culture your dominant culture is group that has most Authority or power to control the values and reward or even punished behaviors it's usually but not always the largest grp group in particular area then we have subcultures so subcultures are groups within larger culture or social system excuse me so when we think about subcultures people and subcultures have different experience from those in the dominant group because of status residence gender sexual orientation ethnic background education or factors that unify the group so if we look at Southern Culture as dominant culture and then we look at Southern Culture people of higher economic status those in higher economic status would be subculture of the Southern Culture same thing if we look at people of different sexual orientation in the Southern Culture so it's just something that's still in the dominant culture however it's that smaller group and then we have the very small groups which is your minority group right and minority groups are made up of individuals who share race religion or an ethnic herriage they usually have fewer members than the majority and then we have rituals rituals are formal stylized repetitive actions performed in special places at special times these actions convey information about participants and are used to inform others about the beliefs and traditions of culture detrimental concepts are something that we nurses need to be aware of because we do not want to be implementing something that's going to be detrimental or negative to our patients so the first one we can talk about is generalization generalization is statement idea or principle that has very broad application generalizations typically infer or draw conclusions from many factors they can be positive and they can be negative we have stereotypes stereotypes is set of fixed ideas they are unfavorable and they're about members of group this is the thought process about the group then we have Prejudice Prejudice is the process of devaluing an entire group because of assumed behaviors values or attributes people demonstrate Prejudice when they apply group stereotypes to individuals and assume that the people within the group will be act in this predetermined manner Prejudice includes labeling groups or cultures so we can think of this is that prejudice is going to be the feeling that we assign to the thought of the stereotype so can assign lazy to all blondes that are stupid right or can assign hate discrimination refers to policies and practices that are harmful and we have health disparities which is discrimination of higher burden of illness injury or mortality and then we have Healthcare disparities which is an inequality related to the access use and quality of Health Care we'll go more into that in few slides and then we have racism so racism is an unfounded belief that race determines person's character or ability and that one race is superior inferior to another race again we discussed it few slides ago but refers to the group of people based on biological similarity such as Skin blood type or bone structure now we're going to move into to our vulnerable populations so we have some examples on the board of what vulnerable population is and these are groups that are more likely to develop health problems and experience poorer outcomes because of limited access to care highest behaviors and or multiple and cumulative stressors some ethnic and racial minority groups are also vulnerable an example is that among American Indians and Native alaskans there's higher incident of diabetes early in life with higher mortality rate so vulnerable populations can be considered subcultures of the majority culture group as the nurse you need to be aware when we're caring for patients of vulnerable population we need to help the patient identify their strengths and resources so that we can provide their care right if we don't know what their strengths and resources is not going to be able to help provide the best care for them so now we can talk about cultural universals in specifics your cultural universals are going to be values beliefs and practices that people from all cultur share whereas culture specifics are going to be values beliefs and practices that are special or unique to culture our archetypes are an example of person or thing something that's recurrent and it has its basis in facts therefore it becomes symbol for remembering some of the culture specifics and is usually not negative then we look at stereotypes again we know that stereotypes are widely held but they're very oversimplified and un unsubstantiated belief so it's not valid and people of certain race or ethnic group are alike in respects stereotypes are not always negative some may think for example that people of particular Heritage are naturally intelligent or naturally athletic and once we understand all of this then we can understand how culture specifically affects health care so these are next two slides are things of how culture specifically affects Healthcare first we want to talk about communication and we know that communication occurs both in verbal and nonverbal and it's very easy to understand when patient's not speaking the same language of you that we're going to have cultural communication barrier but we need to also remember that eye contact touch gesture posture physical distance all of that also plays into fact so although you and your patient might speak the same language cultural influences how feelings and thoughts are expressed and which verbal and nonverbal Expressions all play into patient feeling comfortable and you feeling comfortable with them and give the example of ey contact so in America when we make eye contact that shows trust if we're talking to patient and their eyes are darting around the room and they're not making eye contact with us we might think that the patient being in distrust right but in Japan eye contact can be seen as sign of disrespect so that would just be something that we would need to take into consideration is this patient not making eye contact with me because it's cultural barrier don't just assume that it's because they're untrustworthy same thing with space right we like our personal space we feel protected we feel safe secure and less anxious and in control and and prior to covid where six feet of space became the new Norm preco studies shows that Americans like about three foot of space between them and stranger in Romania they like four and half feet of space and in Argentina they're okay with just one and half feet so think about if you were Romanian coming into America and the American nurse would kept getting in your personal space how would you feel just like if you went down to Argentina and the nurse has cut your personal space in half you're going to feel uncomfortable and we don't want our patients to feel anxious and uncomfortable around us the next thing is time orientation so we need to remember that some cultures tend to be present or future oriented where others tend to be more rooted in the past an example is European Americans tend to be future oriented in contrast the Native American and Latinos can be present oriented and they also have deep roots in their past as well and then we have our social organizations so what what does your what does your cultural patient include as their family are they looking at single parent family unit are they looking at nuclear family unit they looking at an extend family unit do they even have wider organization where their congregation is their family we need to identify this because that'll be who your support system is and then environmental control just refers to person's perception of his or her ability to plan activities that control nature or direct environmental Factor this includes the phenomenon our health and illness belief bels and practices so then we have our cultural specifics that affect healthc care more of them we have our biological variations so your biological variations is in which people are different genetically and physiologically and we just know that certain cultures are more likely to have susceptibility to certain diseases and certain injuries we have bi olical variations that include our bodybuild our structure our skin color our Vital Signs how we metabolize drugs and all of that will be introduced slowly throughout the program we also have religion and philosophy so person's religion May determine what health care is acceptable for them for example some religions like Jehovah's Witnesses do not accept blood transfusion and many religions forbid abortion we also have education so education influences the perception of wellness and illness and the knowledge of options that are available for Health Care these in turn affect the person's expectations for care and technology is also something that we come to expect from our health care setting so if you're somebody who's coming from city where there's High educations and lots of technology and you go someplace that's more rural where there's less education and less technology that's cultural adjustment that you have to make our politics so government policies like the Affordable Care Act affect Health Care by determining eligibility allocation of funds reimbursement for providers and what the acceptable standards are we also have the economy so the condition of the economy directly affects the availability of funds for publicly funded Services it also affects the individual's ability to pay for the healthcare they've receed so the culture of Health Care can be divided into indigenous Health Care system and the indigenous Health Care System consists of folk medicine and traditional healing medicines and can also include over-the-counter and self- treatment re remedies and then we have the Professional Health Care system and this is what all the nurses are in school for right this is run by set of Professional Health Care providers who have all been formally educated and trained so our health and illness beliefs we can have scientific belief right nursing is scientific belief we used our evidence-based scientific for our outcomes and our interventions we can have magico religious which is the belief of supernatural almost mystical forces dominates this which is considered sometimes alternative or indigenous in the United States and Canada one example is voodoo which is practiced in some developing nations in Africa Latin America and the Caribbean we can also have holistic which can be similar to magical religious but it is focused more on the need for Harmony and balance of the body with nature nursing as subculture so nursing is the largest subculture in the healthc care culture having beliefs and values that have been formed in part by Society at large these values are listed here of Silent suffering as response to pain caring nursing on top use of nursing practice knowledge and critical thinking all of these values are starting to shift as anying culture we still focus on much but silent and suffering is going away as nurses we need to examine and clarify our own attitudes and values to become more sensitive to others and this is something that as we talk about understanding the cultural values of your patients you also need to understand the cultural values of your colleagues so transcultural nursing transcultural nursing is profession this focuses on human caring associating differences and similarities among the beliefs values and patterns lifeways of culture to provide culturally congruent meaningful and beneficial Health Care with that trans cultural nurses provide knowledgeable competent and Safe Care to people of diverse cultures research in transcultural nursing focuses on discovering or explaining largely unknown and vaguely known cultural care and health concerns and they do this with two perspectives the first perspective is the emit perspective this focuses on local indigenous and Insider culture the edic perspective focuses on the outside World especially on professional views transcultural nurses are Specialists generalists and Consultants functioning in diverse clinical practice settings and sometimes in schools they'll assist others to become more sensitive to the knowledge about diverse cultures they may identify cultures that are neglected or misunderstood and may help Healthcare Systems assess how they serve or fail to serve diverse cultures in in the community transcultural immerses are committed to cultural openness lifelong commitment that promotes cultural selfawareness and continuing development of transcultural skills traditional and alternative healing so if you have patient who practices folk medicine folk medicine is defined as the beliefs and practices that the members of cultural group follow when they're ill as opposed to more Convent conventional standards fol medicine includes both self treatment and the use of folk healer folk healer is not going to be the same as physician nurse practitioner or somebody like that your complimentary medicine is is the use of rigorously tested therapies to complement those of conventional medicine examples include chiropractor biof feedback certain supplements and acupuncture these are things that formally trained practitioner will do alternative medicine is defined as therapies used instead of conventional medicine and those reliably has not been validated through clinical testing in the United States examples of alternative therapies are Aroma theapy and magnet therapy so remember your alternative medicines of aroma therapy and magnet therapy you can buy it off Amazon it's not by train practitioner folk medicine is not trained practitioner your complimentary medicines are going to complement conventional and they're going to be by that trained practitioner so our culturally competent care we're going to look at two models the first model is going to be prell's model and in prell's model we have these we we can think about the meaning of the different levels so the first one is unconsciously incompetent and this is that you're not aware that you lack the knowledge about other cultures if you're consciously competent you're aware that you lack the knowledge and you're not doing anything about it the consciously competent you're learning about the client's culture you're verifying generalizations about the culture and you're providing cultural specific interventions and then you're unconsciously competent is you're fully aware you're automatically providing culturally congruent care to clients of diverse cultures you're increasing your consciousness of cultural diversity which is going to improve the possibility for healthare practitioners to provide culturally competent care so unconsciously competent would be the best one to be this is peral's model the pie-shaped wedges depict the issues all society and human share but there are expressed in ways specific to culture these domains provide organizing framework for the model the center of the model is empty and represents that which is Unknown about cultural group our next Theory is used to guide research that will assist nurses to provide culturally congruent care that would contribute to health or well-being of people using the three models of Nursing Care actions and decisions nurses can achieve this goal by discovering cultural care and caring beliefs values and practices anal ing the similarities and differences of these beliefs among the different cultures so what are going to be your barriers your barriers to providing cultural care are going to be your barriers as well as the barriers that the patients have so first we can have our biases and our biases are going to be lack of impartially one-sided and they can be positive or negative then we have our ether ISM that comes back and remember this is when our culture is going to be the best and we're going to judge other people against it our cultural stereotypes prejudices and discriminations that we already talked about our racism that we've already talked about can be barrier sexism which is the assumption that members of One sex are superior to those of another sex are language barriers and remember language barriers is not just spe is not just specific to foreign languages and dialects but we also need to take into account our street talk and our jargon so if your patient has foreign language barrier and you use your medical jargon it's actually two barriers coming into play out once and always talk about the jargon of like your NPO that's PRN does patient necessarily know that PRN means as needed do they understand that noo is nothing but mouth those two things patients very often do not understand but us nurses are so used to using that jargon amongst one another that sometimes when it comes down to the patient we forget they don't understand our jargon so we need to be conscious of that lack of knowledge about the culture and the ethnic values beliefs and behaviors of people within the community Is Not Unusual among Health Care Providers it can cause them to misinterpret client's behaviors emotional responses such as fear and distrust both of ours and our patients can arise anytime members of different cultural groups be if we're aware this may happen we may be able to avoid this barrier and communicate with our clients more effectively and then we have our self- knowledge so self- knowledge is essential in removing the barriers and it helps us to effectively communicate with our clients so now let's look at what that nursing process is going to be for cultural and ethnicity so there's going to be the assessment and our assessment begins with our health history we need to obtain at least the information from every patient about their language their ethnic affiliation and identity their religious practice their primary decision maker in their family and their social support and then once we have this information we might have to do more in-depth assessment with that information and when we get to religion if patient gives you specific religion you might have to very much get into their different practices in this assessment aspect and then our physical assessment so your physical assessment may reveal biocultural variations to assess and evaluate clients accurately you may need to know the normal physiological variations among Health members of the selected population and this could be that it's common for them to have an elevated blood pressure or this could be cultural practices that they normally do to one another and remember when we're getting this information right about you know the patients language their ethnical affiliations their religious practice their primary decision maker all of that we want to do on the initial right we don't want to wait for there to be problem to to ascertain this information we want to get it as soon as we can so when we talk about our diagnos our nursing diagnosis our nursing Concepts and we're starting to do the plannings for our outcomes and evaluations there really are no diagnosis or concepts that specifically address culture however cultural factors can be the ideology of various problems any of the diagnostic labels or concepts can be used for patients and unning culture provided that the divining characteristics are present the outcomes we choose whether standardized or individualized will depend on the concept that we've identified if the diagnosis are culturally sensitives the outcome should be as well so then we move on to our possible effects patient's culture can have on their health practices right so the first one the efficacious this is helpful so their cultural Health practices are going to be help to their overall well-being so bringing ethnic foods that are appropriate for the client's prescribed diet encourage practices that will likely improve client health and help preserve cultural values related to health all of this is going to have positive helpful impact on their health then we have neutral so neutral is going to be it's not really going to be helpful but it's also not going to be harmful some people associate good health with eating properly or fasting to cure disease some treatment illnesses with prayers or simple Foods there should be no harm in allowing the patient to continue neutral Health practice you wouldn't want to interfere with these neutral Health practices and then we have our uncertain unknown so your uncertain unknown is that client who wants to do smoothie every day and that smoothie we're not really certain of what's in there but they're using it for good health well we may need to ascertain more information about what's going on so that we either will encourage it or discourage it right so we know that certain supplements certain spices Can interfere with you know blood thickness and squatting abilities and things like that so certain things we need to understand more and then we have dysfunctional so dysfunctional cultural practices are going to be harmful and client May refuse to give prescription medication to their child we want to discourage fault practices that may cause harm in such instances you should support and enable the patient to adapt to biomedical therapies and then we're going to be talking about negotiation and reping soon and use the example in class of the dysfunctional harm where there was patient whose family was collecting their urine and they gave their urine to treat things and when the child suffered significant injury the family wanted to bring the urine in and continue to use the urine as treatment and this was kind of folk practice that the family had had and the nursing staff were not able to obviously continue with that so with that we kind of go into our negotiation and our reping instruction so negotiation is going to be when we look at the client's perspective and it may different from ours but we can kind of negotiate and acknowledge the gaps we typically do this negotiation when it's going to be folk or odd traditional practices that may be harmful to our patient repatterning and restructuring occurs when you attempt to change the actions of your in patients entire lifestyle you would support and encourage the patient to greatly modify their behaviors and to adapt new different and beneficial Health behaviors while still respecting their cultural values and leaves rep pattering and restructuring most commonly can occur with dietary consumption if you have somebody who has diet and that diet is going to significantly impact their overall wellbeing they try to restructure and repattern so if you have somebody who is you know their culture is those home fried heavy greasy foods and you need them to go onto heart healthy diet that would be an example when we're pattering occurs so communication with clients of different language talking louder does not get the message through and very often we think that if we speak louder they'll understand but the end message here is that you need professional medical interpreter or translator it is legal we're we're Bound by law to do it Health Care Facilities must provide language assistance Services in order of preference so sometimes we have bilingual staff we can have face tace interpretation by trained professionals we can use telephone interpreters we need to make sure that whoever The Interpreter is that they can relay Health Care content so we have to be cautious of of family members or lay members that might be bilingual because they might not actually understand the complexity of medical treatment so your medical interpreters are going to understand that if you slip and say NPO they're not going to verbatim tell them NPO they're going to be able to tell them nothing by mouth or they're going to ask for clarification so that the patient understands developing strategies so how are you going to improve yourself right we're going to reflect we need to know ourself we need to understand our own cultural values and practices and appreciate how they may differ from those how by other people around us we need to consider how our own biases about people and groups may affect the care that we provide and we need to learn from our mistakes remember mistake twice is is the decision we want to keep learning we want to learn as much as we can about the cultural groups and the community and our work area we want to study nursing theories and principles pertaining to culture we want to take advantage of every opportunity to interact with persons of different cultures we want to learn to accommodate and negotiate when we are able to we want to collaborate with inter professionals and consider the cultural role of the family member who makes the primary decisions and we want to be respectful the acronym to help you remember all of this can be Bali so Bali the is for be aware of our own cultural heritage is appreciate that the client is unique we want to learn about the client's cultural group and we want to incorporate the culture when we can another one is the live learn so we want to like inquire visit and experience and we want to listen evaluate and knowledge recommend and negotiate your overall Concepts to your cultural care is knowing the patients individual culture will enable the best care possible we want to always use that certified interpreter we want to acknowledge the roles of cultures beliefs regarding their health and illness and we need to understand and find out what matters most to them about their illness and their treatments and that is the end of this lecture very much