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Definition
| “a set of behaviors, attitudes, and policies that enable a system, agency, and/or individuals to function effectively with culturally diverse clients and communities.” |
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Term
| 6 Reasons defined by National Center of Cultural Competence |
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Definition
To respond to current and projected demographic changes in the United States:
To eliminate long-standing disparities in health status of people of diverse racial, ethnic and cultural background
To improve the quality of services and health outcomes
To meet legislative, regulatory and accreditation mandates
To gain a competitive edge in the market place
To decrease the likelihood of liability/malpractice claims |
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Definition
| – respect for cultural behaviors based on an understanding |
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Term
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Definition
| – the bewilderment one experiences when exposed to behavior which is atypical for their culture |
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Term
| Aculturation or Cultural Assimilation |
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Definition
| the process of replacing or giving up values, beliefs, and practices for those of another culture |
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Definition
| – how a person acts in certain situations (socially acquired) |
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Definition
| – Groups whose members share a common social and cultural heritage that is passed on to successive generations (feel sense of identity) |
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Definition
Degree of ethnicity is measured by actions that represent the norm:
* ethnic names
* clothing
* music, dance, art, and folklore
* native foods
* language and dialect
* religious practices
* political interests |
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Term
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Definition
| – patterned behavioral response that develops over time through social and religious customs and intellectual and artistic activities |
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Definition
| – members of a group share distinguishing physical features such as skin color or bone structure |
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Term
| 3 Major Racial Classifications |
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Definition
1. Caucasian (primarily from Europe)
2. Negroid (primarily from Africa)
3. Mongoloid (primarily from Asia)
SKIN COLOR IS THE CHIEF AND MOST IMPRECISE CATEGORIZATION
DO NOT EQUATE SKIN COLOR WITH CULTURE!!! |
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Term
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Definition
| – assumption that all people in a similar cultural, racial, ethnic group are alike and share same values and beliefs |
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Definition
| – belief that everyone should conform to the majority belief system |
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Term
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Definition
| – occurs when one ignores differences and proceeds as though they do not exist |
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Term
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Definition
| – occurs when people become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of others to make themselves feel more secure about their own values |
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Term
| Characteristics of a Culture |
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Definition
1. Learned behavior: process of passing down information
* primary means of transferring is through = language
2. Shared beliefs: arise from the social and physical environment
3. Symbols: based on beliefs |
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Term
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Definition
Impaired Verbal Communication r/t inability to speak English & interpreter unavailable
Impaired Parenting r/t use of culturally based discipline considered inappropriate or abusive by current country of residence
Ineffective Management of Therapeutic Regimen r/t mistrust of traditional healthcare personnel |
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Term
Cultural Factors that Affect Nursing Care White Middle Class:
Family:
Folk & Traditional Healthcare:
Values & Beliefs:
Common Health Problems
Nursing Considerations:* |
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Definition
Nuclear family is highly valued
Elder family members may live in NH when no longer able to care for themselves
Self-diagnosis of illnesses
Use of OTC drugs
Dieting (Fad diets)
Extensive use of exercise
Youth valued over age
Attractiveness
Punctuality
Cardiovascular diseases
Gastrointestinal diseases
Motor vehicle accidents
Mental illness
*Careful assessment of OTC medications
Nutritional assessment of dietary habits |
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Term
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Definition
Second largest minority group in US
10% of total US population
Reflect cultural roots that include elements of African healing & medicine
Diverse communities: recent arrival of people from Haiti, Caribbean, & Africa |
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Term
Cultural Factors that Affect Nursing Care African American:
Family:
Folk & Traditional Healthcare: |
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Definition
Close & supportive extended-family relationships
Family unity, loyalty & cooperation important
Usually matriarchal
Varies extensively, may include spiritualists, herb doctors, skilled elder family members, voodoo and faith healing
Events (including illnesses) attributed to phenomena that are either “natural” or “unnatural”
Folk & Traditional Healthcare:
NATURAL – result of phenomena, operating according to God’s plan, that maintain the balance or harmony of nature
UNNATURAL – result of phenomena, wrought by the devil, that upset or unbalance the harmony of nature – outside the realm of nature – successful treatment requires the intervention of a specialist who commands supernatural powers |
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Term
Cultural Factors that Affect Nursing Care African American:
Folk & Traditional Healthcare:
HUMORAL theory |
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Definition
– Focuses on regulation of body by four humors (major body fluids)
BLOOD
PHLEGM
BLACK BILE
YELLOW BILE
HUMORAL theory –
basis for treatment of humoral imbalance was that each humor had two of four characteristics
BLOOD – hot & moist
PHLEGM – cold & moist
BLACK BILE – cold & dry
YELLOW BILE – hot & dry |
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Term
Cultural Factors that Affect Nursing Care African American:
Values & Beliefs:
**Common Health Problems: |
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Definition
Present oriented
Religion important
Close contact
**Hypertension morbidity & mortality 3-5 times than Whites (70% higher than among white Americans)
Diabetes 33% more prevalent than in Whites
rate of Coronary Artery Disease
Infant mortality rates are twice as high for African Americans as for white Americans
AIDS affects 3 times more than non-African Americans
Sickle cell anemia genetically inherited disorder found almost exclusively |
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Term
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Definition
sickle shaped RBC’s that are very fragile and rupture easily, this prevents the blood from flowing easily through the small vessels of the body
Only 50% of children born with Sickle Cell Anemia live to adulthood; others die before age 20
Can be diagnosed during first trimester of pregnancy by DNA analysis |
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Term
African American:
Nursing Considerations: |
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Definition
Skin assessment best done in indirect sunlight
Pallor identified by absence of underlying red tones
Brown skin tends to be yellow-brown
Black skin tends to appear ashen
Erythema detected only by palpation
Skin warm, tight, & edematous in inflamed area
Cyanosis observed in facial skin, earlobes, nail beds & around mouth
Jaundice can be seen in generalized yellowing of sclera
(Normal yellow pigmentation found in dark-skinned people tend to be concentrated in inner & outer canthi of eyes) |
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Term
African American:
Keloid formation – |
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Definition
Irregular scar tissue, which sometimes forms after a person has suffered a small cut or a scratch in the skin
Cause of keloids is genetic
Most often, keloids are found in people of African descent
Also seen in Indians and Chinese, and more rarely in Whites |
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Term
| 5 major Asian populations in US |
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Definition
(Taiwan, Hong Kong, & mainland China)
Korean
Japanese
Filipino
Southeast Asian (Laos, Cambodia, Vietnam, & Thailand) |
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Term
Cultural Factors that Affect Nursing Care Asian:
#Family: |
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Definition
Diverse culture, language, etiquette, & rules for interaction
Common thread of Confucian, Buddhist, & Taoist thought links health care beliefs & practices
Fastest growing group in US (0.7% of US population)
#Avoid conflict
Personal distance important
Respect for elders & authority
Brief eye contact
Brief factual answers
Strong emphasis on harmony |
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Term
Asian:
Folk & Traditional Health Care: |
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Definition
Health defined as the harmonious balance between the forces of Yin cold and Yang hot
The terms refer NOT to temperatures but to attributes and/or conditions
EXAMPLE:
Linden tea, served hot, is a “cold” herb and used to treat “hot” ailments
Penicillin, considered a “hot” treatment because it can produce diarrhea & rashes, which are “hot” symptoms
Water & fruit juice are “cold” substances & are to be avoided during illness & after childbirth (times that produce a “cold” condition) |
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Term
Asian:
Folk & Traditional Health Care: |
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Definition
Qi or Ch’i:
Generation & flow of blood through vessels
Flow of the energy force (Qi) through meridians or acupuncture points
Blood is believed to be ruled by heart, governed by spleen, & stored in liver
When flow of Qi is blocked by a broken bone or disease, acupuncture at the meridians permits the force to flow freely again
Acupuncture:
purpose is to treat an excess of YANG & restore balance between YIN & YANG
Treatments wrongly interpreted as abuse:
Coining & Pinching – metal coin in dipped in oil & rubbed briskly over skin until welts appear; welts can also be produced by pinching the skin between thumb & index finger; draw out fever & illness
Treatments wrongly interpreted as abuse:
Cupping – suction produced by heating & applying small tubes or hot cups to forehead or abdomen; cups produce negative pressure as they cool, resulting in circular ecchymosis
Moxibustion – treatment for excess YIN; pulverized wormwood heated & applied to torso, head, or neck to produce superficial burns; stimulate blood flow
Herbs:
In the form of a slush, tea, or other drink are important part of traditional medicine in Asian cultures
Home remedies:
Use of cooling/hot drinks & foods
Herbs & patent medicines (OTC), first recourse at initial sign of illness |
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Term
Asian:
Common Health Problems: |
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Definition
Tuberculosis
Communicable disease
Suicide
Mental Illness
Lactose Intolerance
Stomach Cancers |
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Term
Disorders
Lactose Intolerance: d/t lactace deficiency that causes sx like
Flatulence
* Culprit is milk and products
Bloating
Cramping *Asian (50%)
Diarrhea |
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Definition
Encourage foods high in calcium:
Canned salmon – 1 can=1 cup milk
(#7 of 15 best calcium sources)
Leafy green veg. (broccoli, spinach)
Soy & Tofu |
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Term
| Asian:Nursing Considerations: |
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Definition
Understand the importance of the “head”
Most sacred part of a human being
Never touch without obtaining permission
Blood is viewed as a vital element
In Asian traditional medicine blood is NOT drawn for medical purposes – upsets body’s natural balance
Harmony & “face” may mask noncompliance:
Suppress negative thoughts & emotions to keep harmony & accept tx. when they disagree
To maintain “face”, they may not admit when they don’t understand
Caregivers should observe indirect communication
Rather than asking “Do you understand?”, Ask pt to describe what he has been told to do or to describe condition in own words |
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Term
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Definition
Foods & Beverages classified as YIN & YANG
Believe that their cuisine naturally balances these forces-
EX.- Study of menopausal symptoms among women of Japan found fewer symptoms attributed to diet high in soybean, a substance that contains natural estrogen
Most Asians are Lactose Intolerant
Salads & raw vegetables might be strange to people who derive most of their vegetable nutrients from stir-frying
Asian “chicken soup” – rice soup with chicken is common “illness food”, thought to severity of scars from surgery
Beef & eggs – should not be served to those who are ill
After childbirth Asian women prefer to eat mostly fish & avoid deep-fried foods, meats in any form of sauce, & spicy foods |
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Term
Asian:
Religious Beliefs & Practices: |
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Definition
Confucianism – concentrates on interpersonal rules & proper way to conduct social interactions
Practice in moderation & avoid excess
Destined to fulfill their mission on earth & need to allow ming, or fate, to guide their lives
Pao, one should treat others as one wants to be treated
Chung, loyalty and respect for authority
Another Confucian belief that can have a profound effect on an Asian patient’s attitude toward surgery:
“ONLY THOSE SHALL BE TRULY REVERED WHO, AT THE END OF THEIR LIVES, WILL RETURN THEIR PHYSICAL BODIES WHOLE AND SOUND.”
Buddhism – shaped attitudes toward life and behavioral traits that may manifest themselves during healthcare interactions
Acceptance of fate & suffering
Stoicism
Behavioral reserve
Suppression of negative thoughts & complaints
Taoism – central belief involves finding the “way”, or tao
Achieved by “flowing in accordance with nature” & remaining in harmony with both the cosmological (yin/yang) and natural spheres
The reserve & stoicism displayed by Asians may be misunderstood by Westerners |
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