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Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Larry Purnell PhD, RN,FAAN

European American Culture



European American Overview/Heritage The term European American culture refers to the middle-class

values of citizens of the mainland United States. This European American culture is a blended culture from

mostly European white groups who settled in the US making a new culture over time– the dominant American culture.

Today, the United States includes immigrants or descendents of immigrants from almost every nation and culture of the world.



European American Overview/Heritage

The word American used in this presentation refers to the United States of America.

Many emphasize material possessions and physical comfort.



European American Overview/Heritage

Americans value individualism, free speech, freedom of choice, independence, self-reliance, confidence, “doing” rather than “being,” egalitarian relationships, nonhierarchal status of individuals, achievement status over ascribed status, volunteerism, friendliness, openness, futuristic temporality, and the ability to control the environment.



European American Communication The dominant language in the US is English, but

accents vary throughout the United States and are usually understandable to all. Having well-developed verbal skills is considered important.

Voice volume is loud compared with many other cultures.

English is low contexted, requiring many words to express a thought.



European American Communication The rate of speech varies depending on

location within the United States. People from the South generally speak slower than people in the Northeast.

Many individuals readily disclose personal information about themselves. Personal sharing is encouraged in a wide variety of topics, but not religion.



European American Communication People of the same sex (especially men) or

opposite sex do not generally touch each other unless they are relatives or close friends.

Regardless of class or social standing of the conversants, Americans are expected to maintain direct eye contact without staring.



European American Communication Men and women extend the right hand when greeting

someone for the first time. Most Americans are future-oriented but try to balance

the past with the present. Punctuality is valued in both business and social

settings. Usual name format is given name, middle name

(optional), and family name. People usually refer to each other by the given name.



European American Family Roles and Organization

A value is placed on egalitarian relationships and decision-making, although great variations exist within families.

Women may have careers, and men often assist with child care, household chores, and cooking responsibilities.

Great value is placed on children, and many laws help protect children.




Autonomy is encouraged in children and teenagers. Children and teenagers are encouraged to have

friends of the same and opposite genders. Teenagers are expected to refrain from premarital

sex, smoking, recreational drug use, and alcohol use until they reach the age of 18 years or until they leave home.




Most teenagers move out of their parents’ home when their education is completed or when they turn age 18 years.

Social attitudes toward homosexual activity vary widely and sometimes carry a stigma.

Since the early 2000s, same gender relationships and marriages have become major topics for politicians and legislators.



European American Workforce Issues Americans are expected to be punctual on their job,

with formal meetings, and with appointments. If one is more than a minute or two late, an apology is expected.

The American workforce stresses efficiency (time is money), operational procedures on how to get things done, task accomplishment, and proactive problem solving.



European American Workforce Issues Most Americans place a high value on “fairness” and

rely heavily on procedures and policies in the decision-making process.

American values expect that the needs of individuals are subservient to the needs of the organization.

All professionals are expected to be assertive, a concept that is difficult for some non-Americans.



European American Workforce Issues Intuitive abilities and common sense are not usually

valued as much as technical abilities. The scientific method is valued, and everything has to

be proven. Americans want to know why, not what. Many are obsessed with collecting facts and figures

before they make decisions. Pragmatism is valued.



European American Workforce Issues When individuals speak in their native language at

work, it may become a source of contention for both clients and health-care personnel.

Four generations are in the workforce in the United States: (a) traditionalists, (b) baby boomers, (c) generation X, and (d) the millennials.

Each group brings a different worldview, different perspectives, and varied strengths to the workforce.



European American Biocultural Ecology The leading causes of death in Americans are heart

disease, cancer, chronic obstructive lung disease, unintentional injury, diabetes, and HIV.

Nearly 1 million people in the United States are HIV-positive or have AIDS with the highest concentrations in large urban areas.

Other common health conditions include obesity, cystic fibrosis, and multiple sclerosis.



European American Biocultural Ecology

Cigarette-smoking has been declining in the United States.

Higher socioeconomic groups are more likely to drink but are also more likely to drink without problems.

High-risk sexual behavior continues with the continuing incidence of STI and HIV infections.



European American Biocultural Ecology

Many traffic laws have been enacted, although they vary from state to state, requiring automobile seat belts, child restraints, and helmets for bicycle and motorcycle riders.

In many states, people still do not use helmets for motorcycle or bicycle riding.



European American Nutrition

The typical American diet is high in fats and cholesterol and low in fiber. Recent movements have had a major influence on promoting a healthier diet.

Given the varied topography of the United States, there are no food shortages for a healthy diet.



European American Nutrition Meal times and food choices vary according to ethnic

background, the region of the country, urban vs rural residents, and weekdays vs weekends.

Breakfast is usually consumed between 6:00 AM and 9:00 AM, depending on the person’s work schedule.

The noontime meal, typically consumed by 1:00 PM, is called “lunch” in urban areas and “dinner” in rural areas.

The evening meal, “dinner” in urban areas or “supper” in rural areas, is served between 6:00 PM and 9:00 PM and is usually the largest meal of the day.



European American Pregnancy & Childbearing Practices

Commonly used methods of fertility control include natural ovulation methods, birth control pills, foams, Norplant, the morning-after pill, intrauterine devices, condoms, abortion, and sterilization procedures such as vasectomy and tubal ligations.

Sterilization in the United States is strictly voluntary.




Pregnant women are expected to seek preventive care, eat a well-balanced diet, and get adequate rest in order to have a healthy pregnancy and baby.

Women are encouraged to breast-feed. Prospective fathers are encouraged to take prenatal

classes with expectant mothers and provide a supportive role in the delivery process.




Women are encouraged to not smoke or drink alcohol during their pregnancies.

Most employers give at least 6 weeks maternity leave for the mother.

Some give up to 3 to 6 months maternity leave. Men can also take maternity leave but few do.



European American Death Rituals Death and responses to death are difficult topics for

many Americans to verbalize. The dying person should not be left alone. Most people are buried or cremated within 3 days of

death; extenuating circumstances may lengthen this period to accommodate family and friends who must travel a long distance to attend a funeral or memorial service.



European American Death Rituals The family decides if the deceased will be cremated or

will have an open or closed casket. More people are choosing to remain at home and

participate in a hospice for end-of-life care to have their comfort needs met.

Although women may be more expressive than men, most Americans demonstrate their grief conservatively. Generally, tears are shed, but loud wailing and uncontrollable sobbing rarely occur.



European American Spirituality Dominant religions in the United States are those of

the Judeo-Christian faiths and include Catholicism, Protestantism, and Judaism.

However, there are many other recognized religions that are consistent with religious freedom, a reason that many people immigrated to the United States.

Although church and state are separate, many public events and ceremonies still open with a prayer.



European American Spirituality In times of illness, many people say prayers. A call for prayer for sick people may be made

in church congregations. Family remains an important part of

spirituality varying in degree and intensity.



European American Health-care Practices

The United States is undergoing a paradigm shift from curative and restorative medical practices and sophisticated technological care to health promotion and wellness; illness, disease, and injury prevention; and increased personal responsibility.

Most believe that individuals, families, and the community have the ability to influence health.




Many view good health as a divine gift from God. Advance directives are an important part of medical care,

which allows patients to specify their wishes concerning life and death decisions before entering an inpatient facility.

Directives designate the name of a family member or significant other to speak for the patient and make decisions when or if the patient is unable to do so.




Some patients have a living will that outlines their wishes in terms of life-sustaining procedures in the event of a terminal illness or a serious accident.

Even when a client is covered by health insurance, an insurance company representative may need to approve health visits and validate specific procedures, medicines, and treatments for which it will pay.




As an adjunct to biomedical treatments, many people use acupuncture, acupressure, acumasage, herbal therapies, massage therapy, aromatherapy, and other complementary and alternative treatments.

An awareness of combined practices when treating or providing health education to individuals and families helps ensure that therapies do not conflict with each other, intensify the treatment regimen, or cause an overdose.




Pain is the “fifth vital sign.” Patients should be made comfortable and not have to tolerate high levels of pain.

The Americans with Disabilities Act protects individuals with a handicap.

Rehabilitation and occupational health services focus on returning individuals with handicaps to productive lifestyles in society as soon as possible.




Most Americans favor organ donation and transplantation and receive blood or blood products transfusions.

Some may reject receiving blood or blood products based on religious or personal beliefs.



European American Health-care Practitioners

Most people combine biomedical health-care practices with traditional practices, folk healers, and magicoreligious healers.

The advanced practice role of registered nurses is gaining respect as their numbers increase and the public sees them as equal or preferable to physicians and physician assistants.

The public holds nurses in high regard. Gender and direct care are usually not a major concern.

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