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Lecture Notes

Culture and Ethnicity 

  1. Culture
    1. "The totality of socially transmitted behavioral patterns, arts, beliefs, values, customs, lifeways, and all other products of human work and thought characteristics of a population of people that guide their worldview and decision-making"
  2. Six characteristics of culture
    1. culture is learned
      1. not instinctive
      2. not innate
    2. culture is taught
      1. transmitted from parents to children over successive generations
      2. only humans can pass along culture
      3. transmitted by verbal/nonverbal communication
    3. culture is social
      1. originates and develops through the interactions of people
        1. e.g., families, groups, communities
    4. culture is adaptive
      1. customs, beliefs, and practices change slowly, but they can adapt to the social environments and to the biologic and psychologic needs of people
    5. culture is ideational
      1. group habits that are part of culture are, to a considerable extent, ideal norms or patterns of behavior
    6. culture is satisfying
      1. cultural habits persist only as long as they satisfy needs
  3. Demographics important to culture
    1. United States population characteristics by race (US Census 2000)
      1. White
        1. 1990 75.6%
        2. 2000 69.1%
        3. - 6.5% change
      2. Black
        1. 1990 11.7%
        2. 2000 12.1%
        3. + 0.4%change
      3. Native American
        1. 1990 0.7%
        2. 2000 0.9%
        3. + 0.2% change
      4. Asian/Pacific Islander
        1. 1990 2.8%
        2. 2000 3.7%
        3. + 0.9% change
      5. Hispanic/Spanish (of any race)
        1. 1990 9.0%
        2. 2000 12.5%
        3. + 3.5% change
    2. United States population characteristics by race and age (US Census 2000)
      1. White
        1. < 18 years of age = 23.5%
        2. 18-64 years of age = 62.2%
        3. > 65 years of age = 14.4%
      2. Black
        1. < 18 years of age = 31.4%
        2. 18-64 years of age = 60.4.7%
        3. > 65 years of age = 8.1%
      3. Native American
        1. < 18 years of age = 33.9%
        2. 18-64 years of age = 60.5%
        3. > 65 years of age = 5.6%
      4. Asian
        1. < 18 years of age = 24.1%
        2. 18-64 years of age = 68.1
        3. > 65 years of age = 7.8
      5. Pacific Islander
        1. < 18 years of age = 31.9%
        2. 18-64 years of age = 62.9%
        3. > 65 years of age = 5.2%
      6. Hispanic/Spanish (of any race)
        1. < 18 years of age = 35%
        2. 18-64 years of age = 60.1%
        3. > 65 years of age = 4.9%
    3. United States population characteristics by race and youth (ages 0-17) in 1990 and projections for 2010
      1. total youth
        1. 1990 64.4%
        2. 2010 64.9%
        3. +0.5%
      2. White youth
        1. 1990 45.2%
        2. 2010 41.4%
        3. -3.8%
      3. Hispanic/Spanish youth (of any race)
        1. 1990 7.2%
        2. 2010 9.8%
        3. +2.6%
      4. Black youth
        1. 1990 10.2%
        2. 2010 11.4%
        3. +1.2%
      5. Other races 2.2% (Asian/Pacific Islanders and Native Americans)
        1. 1990 2.2%
        2. 2010 2.8%
        3. +0.6%
    4. demographic trends relating to culture
      1. the white majority is older and shrinking
      2. the collective minorities (Black, Native American, Asian/Pacific Islander, Hispanic/Spanish) are younger and enlarging
      3. the collective minorities will become the majority in the 21st century
  4. Definition of terms important to the discussion of ethnicity and culture
    1. acculturation
      1. to modify the culture of a group or individual as a result of contact with another group or individual
    2. assimilation
      1. to gradually adopt and incorporate the characteristics of the majority group
    3. bicultural
      1. a person who crosses two cultures
    4. culture shock
      1. the state of being disoriented or unable to respond to a different cultural environment because of its sudden strangeness, unfamiliarity, and incompatibility to the stranger’s perceptions and expectations
    5. culture-specifics
      1. those values, norms of behavior, and life patterns that tend to be unique to a designated culture
    6. culture-universals
      1. those values, norms of behavior, and life patterns that are similar among different cultures
    7. discrimination
      1. differential treatment of members of a certain ethnicity, culture, or race
    8. ethnicity
      1. classification of people according to a shared common social and cultural heritage that is passed on to successive generations
    9. ethnocentrism
      1. the belief that one's own culture is superior to all others
    10. ethnoscience
      1. the systematic study of a designated cultural group
    11. majority group
      1. the group within a culture that has the authority to control the value system and determine the rewards of the system (usually, but not always, the largest group in the culture)
    12. material culture
      1. the sum of the tangible products (e.g., dresses, art, religious artifacts, eating utensils) produced and used by a culture
    13. minority group
      1. a group characterized by its religious, political, racial, or other characteristics from the majority group of which it forms a part
    14. nonmaterial culture
      1. the sum of the intangible products (e.g., religion, legal systems, beliefs, customs, languages, social institutions) of a culture
    15. race
      1. classification of people according to shared biologic characteristics and physical features (e.g., skin color, bone structure, facial features, hair textures, blood type)
    16. racism
      1. the belief that one's own race is superior to all others
    17. racial prejudice
      1. covertly or overtly denying members of a race equal access to opportunities to achieve economic success
    18. refugee
      1. a person fleeing from another country because of religious, political, or other ideologic reasons
    19. sojourner
      1. someone who relocates with the intention of remaining only a short time and then returning home
    20. stereotyping
      1. assuming that all members of a certain ethnicity, culture, or race are alike
    21. subculture
      1. a smaller cultural group within a larger culture which has a distinct identity and yet is also related to the larger cultural group
  5. Transcultural nursing
    1. the study of different cultures and subcultures with respect to nursing and health-illness caring practices, beliefs, and values
    2. the goal of transcultural nursing is to develop the following:
      1. cultural awareness
        1. conscious and informed recognition of the differences and similarities between different cultural or ethnic groups
      2. cultural sensitivity
        1. respect and appreciation for cultural behaviors based in an understanding of the other person's perspective
      3. cultural competence
        1. knowing, utilizing, and appreciating the culture of another in assisting with the resolution of a problem
        2. continuum of cultural competence
          1. unconscious incompetence
            1. not being aware that one is lacking knowledge about a patient's culture
          2. conscious incompetence
            1. being aware that one is lacking knowledge about a patient's culture
          3. conscious competence
            1. learning about a patient's culture
            2. verifying generalizations about a patient's culture
            3. providing culturally specific interventions for a patient
          4. unconscious competence
            1. automatically providing culturally congruent care to a patient from a diverse culture
  6. Macroaspects of Purnell's model for cultural competence
    1. global society
      1. seeing the world as one large community of multicultural people
    2. community
      1. a group or class of people having a common interest or identity living in a specified locality
    3. family
      1. two or more persons who are emotionally involved with each other who may, but not necessarily, live in close proximity to each other
    4. person
      1. a biopsychosociocultural human being who is constantly adapting to his/her environment biologically, psychologically, and socially
    5. conscious competence
      1. knowing, utilizing, and appreciating the culture of another in assisting with the resolution of a problem
    6. health
      1. a state of wellness as defined by an ethnocultural group and generally including physical, mental, and spiritual states as they interact with the family, community, and global society
  7. Microaspects of Purnell's model for cultural competence
    1. overview, inhabited localities, and topography
      1. overview, inhabited localities, and topography
        1. identify the part of the world from which the cultural or ethnic group originates and describe the climate and topography of the country
      2. heritage and residence
        1. identify where this group predominantly resides and include approximate numbers
      3. reasons for migration and associated economic factors
        1. identify major factors that motivated this group to emigrate
        2. explore economic or political factors that have influenced this group's acculturation and professional development in America
      4. educational status and occupations
        1. assess the educational attainment and value placed on education by this ethnic group
        2. identify occupations that individuals in this group seek on immigration
    2. communications
      1. dominant language and dialects
        1. identify the dominant language of this group
        2. identify dialects that may interfere with communication
        3. explore contextual speech patterns of this group. What is the usual volume and tone of speech?
      2. cultural communication patterns
        1. explore the willingness of individuals to share thoughts, feelings, and ideas
        2. explore the practice and meaning of touch in their society: within the family, between friends, with strangers, with members of the same sex, with members of the opposite sex, with health-care providers
        3. identify spatial and distancing characteristics when communicating on a one-to-one basis. Explore how distancing changes with friends versus strangers
          1. the intimate zone (0 to 18 inches)
          2. the personal zone (18 inches to four feet)
          3. the social zone (four feet to 12 feet)
          4. the public zone (12 feet and beyond)
        4. explore the use of eye contact within this group. Does avoidance of eye contact have special meanings? How does eye contact vary among family, friends, and strangers? Does eye contact change among socioeconomic groups?
        5. explore the meaning of various facial expressions. Do specific facial expressions have special meanings? Do persons tend to smile a lot? How are emotions displayed or not displayed in facial expressions?
        6. are there acceptable ways of standing and greeting outsiders?
      3. temporal relationships
        1. explore temporal relationships in this group. Are individuals primarily past-, present-, or future-oriented? How do individuals see the context of past, present, and future?
        2. identify how differences in the interpretations of social time versus clock time are perceived
        3. explore how time factors are interpreted by this group. Are individuals expected to be punctual in terms of jobs, appointments, and social engagements?
      4. format for names
        1. explore the format for a person's names
        2. how does one expect to be greeted by strangers and health-care practitioners?
    3. family roles and organization
      1. head of household and gender roles
        1. identify the perceived head of the household. How does this change during different developmental aspects of life?
        2. describe gender-related roles of men and women in the family system
      2. prescriptive, restrictive, and taboo behaviors for children
        1. identify prescriptive, restrictive, and taboo behaviors for children
        2. identify prescriptive, restrictive, and taboo behaviors for adolescents
      3. family roles and priorities
        1. describe family goals and priorities emphasized by this culture
        2. explore developmental tasks in this group
        3. explore the status and role of the aged in the family
        4. explore the roles and importance of extended family members
        5. describe how one gains social status in this cultural system. Is there a caste system?
      4. alternative lifestyles
        1. describe how alternative lifestyles and nontraditional families such as single parents, blended families, communal families, same-sex families, and so forth, are viewed by this society
    4. workforce issues
      1. culture in the workplace
        1. identify specific workforce issues affected by immigration, e.g., education
        2. describe specific multicultural considerations when working with this culturally diverse individual or group in the workforce
        3. explore factors influencing patterns of acculturation of this cultural group
        4. explore native health-care practices and their influence in the workforce
      2. issues related to autonomy
        1. identify cultural issues related to professional autonomy, superior or subordinate control, religious issues, and gender in the workforce
        2. identify language barriers with concrete interpretations of the language
    5. biocultural ecology
      1. skin color and biologic variations
        1. identify the skin color and physical variations for this group
        2. explore any special problems or concerns the skin color may pose for health-care practitioners
        3. identify biologic variations in body habitus and structure
      2. diseases and health conditions
        1. identify specific risk factors for individuals related to the topography or climate
        2. identify any hereditary or genetic diseases or conditions that are common with this group
        3. identify any endemic diseases specific to this cultural or ethnic group
        4. identify any diseases or health conditions for which this group has increased susceptibility
      3. variations in drug metabolism
        1. identify specific variations in drug metabolism, drug interactions, and related side effects
    6. high-risk behaviors
      1. high-risk behaviors
        1. identify specific high-risk behaviors common among this group
        2. explore behaviors related to the use of alcohol, tobacco, and recreational drugs and other substances among this group
      2. health-care practices
        1. identify the typical health-seeking behaviors of this group
        2. assess the level of physical activity in their lifestyle
        3. assess the use of safety measures such as seat belts and helmets
    7. nutrition
      1. meaning of food
        1. explore the meaning of food to this group
      2. common foods and food rituals
        1. identify foods, preparation practices, and major ingredients commonly used by this group
        2. identify specific food rituals
      3. dietary practices for health promotion
        1. identify dietary practices used to promote health or to treat illness in this cultural group
      4. nutritional deficiencies and food limitations
        1. identify enzyme deficiencies or food intolerances commonly experienced by this group
        2. identify large-scale or significant nutritional deficiencies experienced by this group
        3. identify native food limitations in America that may cause special health difficulties
    8. pregnancy and childbearing practices
      1. fertility practices and views toward pregnancy
        1. explore cultural views and practices related to fertility control
        2. identify cultural views and practices toward pregnancy
      2. prescriptive, restrictive, and taboo practices in the childbearing family
        1. identify prescriptive, restrictive, and taboo practices related to pregnancy, such as foods, exercise, intercourse, and avoidance of weather-related conditions
        2. identify prescriptive, restrictive, and taboo practices related to the birthing process, such as reactions during labor, presence of men, position for delivery, preferred types of health practitioners, or place of delivery
        3. identify prescriptive, restrictive, and taboo practices related to the postpartum period, such as bathing, cord care, exercise, foods, and roles of men
    9. death rituals
      1. death rituals and expectations
        1. identify culturally specific death rituals and expectations
        2. explain the purpose of death rituals and mourning practices
        3. what are specific burial practices, such as cremation?
      2. responses to death and grief
        1. identify cultural expectations or responses to death and grief
        2. explore the meaning of death, dying, and the afterlife
    10. spirituality
      1. religious practices and use of prayer
        1. identify the influence of the dominant religion of this group on health-care practices
        2. explore the use of prayer, meditation, and other activities or symbols that help individuals reach fulfillment
      2. meaning of life and individual source of strength
        1. explore what gives meaning to life for individuals
        2. identify the individual's sources of strength
      3. spiritual beliefs and health-care practices
        1. explore the relationship between spiritual beliefs and health practices
    11. health-care practices
      1. health-seeking beliefs and behaviors
        1. identify predominant beliefs that influence health-care practices
        2. describe the influences of health promotion and prevention practices
      2. responsibility for health care
        1. describe the focus of acute-care practice (curative or fatalistic)
        2. explore who assumes responsibility for health care in this culture
        3. describe the role of health insurance in this culture
        4. explore behaviors associated with the use of over-the-counter medications
      3. folklore practices
        1. explore the combinations of magicoreligious beliefs, folklore, and traditional beliefs that influence health-care behaviors
      4. barriers to health care
        1. identify barriers to health care, such as language, economics, and geography for this group
      5. cultural responses to health and illness
        1. explore cultural beliefs and responses to pain that influence interventions. Does pain have a special meaning?
        2. describe beliefs and views about mental illness in this culture
        3. differentiate between the perceptions of mentally and physically handicapped in this culture
        4. describe cultural beliefs and practices related to chronicity and rehabilitation
        5. identify cultural perceptions of the sick role of this group
      6. blood transfusion and organ donation
        1. describe the acceptance of blood transfusions, organ donation, and organ transplantation among this group
    12. health-care practitioners
      1. traditional versus biomedical care
        1. explore the roles of traditional, folklore, and magicoreligious practitioners and their influence on health practitioners
        2. describe the acceptance of health-care practitioners in providing care to each gender. Does the age of the practitioner make a difference?
      2. status of health-care providers
        1. explore the perceptions of health-care practitioners with this group
        2. identify the status of health-care providers in this society
        3. describe how different health-care practitioners view each other
  8. Applying the nursing process
    1. assessing
      1. how your own cultural values, beliefs, behaviors, and attitudes relate to your own nursing practice
      2. collect cultural data about the patient as part of the health assessment
    2. diagnosing
      1. no specific nursing diagnoses that relate to problems of ethnicity and culture
      2. when making related nursing diagnoses, be aware of cultural values, beliefs, behaviors, and attitudes that may influence the patient's situation
    3. planning and implementing
      1. consider the cultural context of the patient and family
      2. use culturally sensitive nursing strategies (interventions)
      3. honor cultural food practices and preferences
      4. when communicating with patients who speak a different language attempt to:
        1. avoid using slang words, medical terminology, and abbreviations
        2. augment verbal communication with gestures or pictures
        3. speak slowly, in a respectful manner, in a normal voice
        4. validate the patient's understanding of verbal communication
      5. utilize interpreters correctly, e.g.:
        1. use interpreters rather than translators
        2. use dialect-specific interpreters whenever possible
        3. use interpreters trained in the health-care field
        4. give the interpreter time alone with the patient
        5. provide time for translation and interpretation
        6. be aware that interpreters may affect the reporting of symptoms, insert their own ideas, or omit information
        7. avoid the use of relatives who may distort information or not be objective
        8. avoid using children as interpreters, especially with sensitive topics
        9. use same-age, same-gender, same-social class interpreters whenever possible
        10. maintain eye contact with both the patient and interpreter to elicit feedback and read nonverbal cues
        11. remember that patients can usually understand more than they can express; thus, they need time to think in their own language
        12. speak slowly without exaggerated mouthing, allow time for translation, use active rather than passive tense, wait for feedback, and restate the message
        13. use as many words as possible in the patient's language and nonverbal communication when unable to understand the language
        14. if an interpreter is unavailable, the use of a translator is acceptable
      6. identify and utilize cultural community resources
      7. translate written materials into a patient's language of origin
      8. explain to the patient the need to violate their intimate and personal spaces
      9. if the patient desires, arrange for treatment of an illness by both folk and biomedical methods
      10. be aware that patients who speak English as a second language may revert to their primary language under stress, such as an illness
    4. evaluating
      1. compare the patient's current status with pre-determined or evaluation criteria

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This page was last modified on 6/1/03