chapter 6 cultural and ethnic considerations all items and derived items © 2015, 2011, 2006 by...

Chapter 6Chapter 6

Cultural and Ethnic Considerations

All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

OverviewOverview

United States described as “melting pot” from many different countries

According to 2010 census, 34.6% of population is of African, Asian, Hispanic, American Indian, or some other ancestry (U. S. Census Bureau, 2010)

All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 2

Culture DefinedCulture Defined

Set of learned values, beliefs, customs, and practices that are shared by a group and passed from one generation to another

Subculture◦Share characteristics with primary culture◦Has characteristic patterns of behavior and

ideals that distinguish it from the rest of cultural group


Culture Defined cont’dCulture Defined cont’d

Characteristics Differences Age Religion Dialect or language spoken Gender identity and roles Socioeconomic background Geographic location of country of origin or current

residence Amount and type of interaction between younger and older

generations◦ Degree to which values in current country are adopted



Nurses need to deliver culturally competent care and avoid stereotyping

Stereotype◦Generalized expectation about forms of

behavior, an individual, or a groupEthnic stereotype

◦Fixed concept of how all members of an ethnic group act or think



Transcultural nursing◦Understanding and integrating variables into all

aspects of nursing care◦Nursing areas influenced by culture

Treatment methods Responses to illness and death Childbirth Diet and nutrition



Race and ethnicity◦Race

Group of people who share biologic physical characteristics and hereditary factors

◦Ethnicity Group of people who share a common social and

cultural heritage based on shared traditions, national origin, and physical and biologic characteristics



Ethnic and racial groups in the United States◦Many cultures

Belong to one or more subcultureImportant not to make assumptions about

a patient’s belief or practice based on name, skin color, or language


Question 1Question 1

Culture is defined as a:1. set of learned values, beliefs, customs, and

practices that are shared by a group and passed from one generation to another.

2. set of values that has been passed on from one generation to another.

3. group that shares biologic physical characteristics.


Cultural-Related Assessment Cultural-Related Assessment

Communication◦Nurse and patient must understand each other◦Do not assume patient/family understand◦Keep questions brief and simple◦Nurse is responsible for providing information

to patient◦Different cultural groups interpret different

meanings for same words


Cultural-Related Assessment Cultural-Related Assessment cont’dcont’d

Communication◦Silence—May indicate lack of understanding,

stubbornness, apprehension, discomfort, agreement, disagreement, respect, or disdain In American Indian, Chinese, and Japanese cultures,

silence allows listener to consider what speaker has said

For Russians, French, and Spanish, silence indicates consensus among parties

In Asian cultures, silence is a sign of respect In Mexican culture, silence may indicate

disagreement with person of authority



Communication◦Nonverbal

Some cultures more comfortable with touching or maintaining eye contact

Touch is culturally related Eye contact has significant cultural interpretations



Communication◦Nonverbal

In United States, maintaining eye contact indicates openness, interest in others, attentiveness, and honesty. Lack of eye contact—sign of shyness, humility, guilt, embarrassment, rudeness, thoughtlessness, or dishonesty

Asians and American Indians: sustained eye contact—impoliteness or invasion of privacy

East Indian cultures: avoid with people of lower or higher socioeconomic classes

Appalachian: sustained eye contact—hostility or aggressiveness All items and derived items © 2015,

2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 13


Space◦Different comfort areas for personal space

Western culture: more comfortable when maintaining 3-6 feet during conversation

Body movements are culturally related



Time◦Different meanings in various cultures

Northern European and United States give high priority to being on time

Eastern cultures more flexible Asians spend time getting to know someone and

view abrupt endings as rude Mexican-Americans focus on current activity

rather than previously planned activities



Social organization◦Socially acquired, not genetically inherited

Patriarchal: men (often oldest) make most decisions

Matriarchal: women make decisions about health care, provide care, and discipline

Knowing family structure assists in understanding the patient



Religious beliefs and health care◦Entwined with cultural beliefs◦Some expect members to adhere to religion◦Nursing care affected by religious beliefs and

practices◦Be aware of such beliefs to ensure care

provided is sensitive to patient’s needs



Health practices◦Biomedical health belief system◦Folk health belief system◦Holistic health belief system◦Alternative or complementary belief system



Biological variations◦Cultural groups are identified in various ways

Characteristics◦Body structure◦Skin color◦ Hair color and texture◦ Family history of disease◦ Dietary practices



Today you are caring for an American Indian patient. During your communication, you maintain eye contact, which is perceived by this population as being:

1. impolite or invading privacy.2. interested.3. attentive.4. honest.


Nursing Process and Nursing Process and Cultural FactorsCultural Factors

Nurse develops a care plan based on cultural background after assessing patient

North American Nursing Diagnosis Association (NANDA) nursing diagnoses may not apply to culturally diverse patients

To provide care and lessen limitations of the NANDA nursing diagnoses, the nurse must evaluate behavior of the prospective patient’s culture

The nurse, health care system, or both may be required to change in order to accommodate, maintain, or reinforce patients’ health beliefs and practices


Cultural Practices of Cultural Practices of Specific GroupsSpecific Groups

See Table 6-4 in Foundations text

Mexican Americans◦Health belief system◦Language◦Communication◦Family roles


Cultural Practices of Specific Cultural Practices of Specific Groups cont’dGroups cont’d

Mexican Americans◦Birth rites◦Death rites ◦Dietary practices



African Americans◦Health belief system◦Language◦Communication◦Family roles



African-Americans◦Birth rites◦Death rites◦Dietary practices



Chinese Americans◦Health belief system◦Language◦Communication



Chinese Americans◦Family roles◦Birth rites◦Death rites◦Dietary practices



Muslim Americans◦Health belief system◦Language◦Communication



Muslim Americans◦Family roles◦Birth rites◦Death rites◦Dietary practices



American Indians◦Health belief system◦Language◦Communication



American Indians◦Family roles◦Birth rites◦Death rites◦Dietary practices



Which culture allows fathers in labor and delivery?

1. Chinese2. American Indian3. Mexican Americans4. Muslim


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