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Cultural Care

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Title: Cultural Care


1
Cultural Care
2
HISTORICAL PERSPECTIVES
  • Transcultural nursing is a body of knowledge
    tandem practice for caring for persons from
    other cultures
  • Cultural awareness can they appreciate and are
    sensitive to the values, beliefs, Iifeways,
    practices, and problem-solving methods of a
    client s culture.
  • Cultural blindness occurs when the nurse does not
    recognize his or her own beliefs and practices,
    nor the beliefs and practices of others.
    Ethnocentrism refers to the idea that one's own
    ways are the only way or the best way to behave,
    believe, or do things.

3
  • Cultural Knowledge encompasses the familiarity of
    the worldview, believes practices,
    problem-solving strategies of groups that are
    ethnically or culturally diverse.
  • Community-based nursing practices require that
    the nurse have cultural knowledge of the
    community. This knowledge allows the nurse to use
    a preventive approach and facilitate self-care
    according to the client's particular culture.
    Collaboration and continuity in which he or she
    is working with the client.

4
  • Lack of cultural knowledge stands in the cultural
    competence. Nurses can have wonderful intentions
    and be sensitive caring, but if there is a lack
    of specific knowledge about the client's
    cultures, these mistakes are bound to be made.

1/30/2015
4
5
THE MEANING OF CULTURE
6
  • Culture refers to the beliefs, values, and
    behavior that are shared by members of a society
    and provide a design or map for living. It is
    culture that tells people what is acceptable or
    unacceptable in a given situation. It is culture
    that dictates what to do, say, or believe.
    Culture is learned.
  • Cultural diversity (also called cultural
    plurality) means that a variety of cultural
    patterns coexist within a designated geographic
    area.
  • Ethnocentrism is the belief and feeling that
    ones own culture is best. It reflects our
    tendency to judge other peoples beliefs and
    behavior using values of our own native culture

7
  • Discrimination Differential treatment of an
    individual due to minority status actual and
    perceived e.g., "we just aren't equipped to
    serve people like that."
  • Cultural imposition Belief that everyone should
    conform to the majority e.g., "we know what's
    best for you, if you don't like it you can go
    elsewhere."

8
CHARACTERISTICS OF CULTURE
  • Anthropologists sociologists have made
    significant contributions to the field of
    community health.
  • Their findings shed light on why and how culture
    influences behavior.
  • Five characteristics shared by all cultures are
    especially pertinent to nursing efforts to
    improve community health (1) culture is learned,
    (2) integrated, (3) it is shared, (4) it is
    tacit, (5) it is dynamic.

9
Culture Is Learned
  • Patterns of cultural behavior are acquired, not
    inherited. Rather than being genetically
    determined, the way people dress, what they eat,
    and how they talk are all learned.
  • At the moment of birth, we lack a culture. We
    dont yet have a system of beliefs, knowledge,
    patterns of customary behavior. But from that
    moment until we die, each of us participates in a
    kind of universal schooling that teaches us our
    native culture.
  • Laughing and smiling are genetic responses, but
    as infants we soon learn when to smile, when to
    laugh, and even how to laugh. We also inherit the
    potential to cry, but we must learn our cultural
    rules for when crying is appropriate.

10
Culture Is Integrated
  • Rather than being merely an assortment of various
    customs and traits, a culture is a functional,
    integrated whole. As in any system, all parts of
    a culture are interrelated interdependent.
  • The various components of a culture, such as its
    social mores or religious beliefs, perform
    separate functions but come into relative harmony
    with each other to form an operating and cohesive
    whole. In other words, to understand culture,
    single traits should not be described
    independently.
  • Each part must be viewed in terms of its
    relationship to other parts and to the whole. In
    some cultural groups (eg, Muslims), modesty for
    women may make it uncomfortable and perhaps
    traumatic to be examined by a person of the
    opposite sex.

11
Culture Is Shared
  • Culture is the product of aggregate behavior, not
    individual habit. Certainly, individuals practice
    a culture, but customs are phenomena shared by
    all members of the group.
  • Culture does not depend on individuals. An
    ordinary habit dies with its possessor, but a
    group habit lives on in the survivors and is
    transmitted from generation to generation.
  • Moreover, the individual is not a free agent with
    respect to culture. He is born and reared in a
    certain cultural environment, which impinges on
    him at every moment of his life.
  • From earliest childhood his behavior is
    conditioned by the habits of those around him. He
    has no choice but to conform to the folkways
    current in his group.

12
Culture Is Mostly Tacit
  • Culture provides a guide for human interaction
    that is tacit that is, mostly unexpressed at
    the unconscious level. Members of a cultural
    group, without the need for discussion, know how
    to act what to expect from one another.
  • Culture provides an implicit set of cues for
    behavior, not a written set of rules. Because
    culture is mostly tacit, realizing which of ones
    own behaviors may be offensive to people from
    other groups is difficult. It also is difficult
    to know the meaning and significance of other
    cultural practices.

13
Culture Is Mostly Tacit
  • In some groups, such as Islamic women, silence is
    valued and expected but may make others
    uncomfortable. Offering food to a guest in many
    cultures is not merely a social gesture but an
    important symbol of hospitality and acceptance
    to refuse it, for any reason, may be an insult
    and a rejection.
  • Touching or calling someone by their first name
    may be viewed as a demonstration of caring by
    some groups but is seen as disrespectful
    offensive by others.

14
Culture Is Dynamic
  • Every culture undergoes change none is entirely
    static. Within every cultural group, some
    individuals generate innovations. More important,
    some members see advantages in doing things
    differently and are willing to adopt new
    practices.
  • Each culture, including our own, is an
    amalgamation of ideas, values, and practices from
    a variety of sources. This process depends on the
    extent of exposure to other groups.
  • Nonetheless, every culture is in a dynamic state
    of adding or deleting components. Functional
    aspects are retained less functional ones are
    eliminated.

15
Transcultural Assessment Model
16
The leininger Sunrise Model
  • A culture is made up of educational, economic,
    political, legal, kinship, religious,
    philosophical, technological systems. Each of
    this identified system affects health.
  • Health needs are biological psychosocial and
    cultural and are met within a combination of
    two subsystems a folk health system (primarily
    rented to religious beliefs and practices) and
    the professional health system.
  • Leininger (1991) points out that the greater the
    differences between folk and professional care
    practices the greater the need for nursing care
    accommodations.

17
The folk health system
  • The traditional or indigenous health care beliefs
    and practices These are per- formed by local
    practitioners, are well known to the culture,
    and have special meanings and uses to heal or
    assist people to regain well-being or health or
    to face unfavorable circumstances.
  • Professional health system refers to those
    cognitively learned practiced modes of
    assisting others that are obtained through formal
    professional schools of learning.

18
Cont
  • Folk medicine systems vary, but they often
    explain illness in terms of balances between the
    individual the physical, social, spiritual
    worlds focus on personal relationships, perhaps
    involving many persons.
  • Folk medicine classifies illness and disease as
    natural or unnatural. Natural illnesses are based
    on logical cause- -effect relationships.
    Unnatural events are believed to occur when the
    harmony of nature is upset. They are
    unpredictable may be considered a result of
    evil forces.

19
Complementary Therapies and Self-Care Practices
20
  • Complementary therapies (also called alternative
    medicine or alternative therapies) are practices
    that are used to complement contemporary Western
    medical and nursing care and are designed to
    promote comfort, health and well-being. The range
    of complementary therapies is broad and includes
  • Diet therapies (cancer diets, juice diets,
    fasting)
  • GI treatments (coffee enemas, high colonic
    enemas)
  • Balance and exercise activities (yoga)
  • Sensory exposure (aromatherapy, music therapy,
    light therapy)
  • Therapeutic manipulation (acupuncture,
    acupressure) client based on cultural group norms.

21
C u l t u r a l / i d e o l o g i c a l L e v e l
  • Culture consists of a societys framework of
    knowledge and beliefs, the content of its books
    and mass media, its technology, the determination
    of how social roles are to be fulfilled, which
    behaviors are normal and which unacceptable and
    which are its morals and value systems. It is
    culture that ranks the importance of families
    versus individuals, of industriousness versus
    leisure.
  • It is culture that determines the relative value
    of competitiveness, equity among people,
    benevolence, valuation of health, and ultimate
    goals. A communitys infrastructure its roads,
    bridges, water, electricity, buildings, and
    medical technology might be viewed as part of
    the physical environment, but it all has been
    created or borrowed by the culture.
  • Culture is the way of life of a people. Like
    health and disease, culture is transmitted from
    group to group, from generation to generation.
    Witness the power of television to transmit the
    culture of high-technology nationsboth the
    useful and the destructive aspectsto every
    corner of the world. Raising the hopes for a
    healthier, happier life has been useful, but
    marketing materialism, consumerism, aggression,
    violence has been harmful.

22
C u l t u r a l / i d e o l o g i c a l L e v e l
  • A communitys ideology is part of its overall
    culture, and is often inferred, rather than seen.
    Ideology is the world of ideas, beliefs, and
    values in which the members of a society live.
  • What people say is important to them is not
    always reflected in their behavior, however, and
    the written plan for many institutions is often
    not the real way they operate. In health
    planning, it is critical to understand this
    paradox.
  • Culture tells its possessor what is important. It
    may value fame, sports skills, or conforming to
    friends. Or, it may tell who is important and who
    can be left outperhaps women, ethnic minorities,
    the poor, and the powerless, who are often
    neglected.

23
C u l t u r a l / i d e o l o g i c a l L e v e l
  • The stream of illness generated in these
    subgroups by lack of resources, lack of knowledge
    and skills, and lack of a way out, is forced
    under the surface in many communities. But
    illness filters upwards to and through the roots
    of the upper and powerful classes, and the garden
    at the top soon ceases to flourish.
  • Culture also tells us what is possible and what
    is not. For example, villagers in Surinames
    interior had known malaria as far back as their
    spoken history could trace. And, they used the
    statistically powerful persistency forecastthe
    best predictor of the future is what has always
    happened in the pastto accept that malaria would
    always be a part of their lives.
  • By developing trust in health workers, however,
    who themselves had seen malaria eradicated in
    their own communities, Surinamese villagers were
    able to change their perception of what is
    possible, and so release hope and energy to
    eradicate the malaria scourge in their own
    communities

24
Generic Professional Knowledge
  • Emic refers to the local or insider's views and
    values about a phenomenon.
  • Etic is the professional or outsider s views and
    values about a phenomenon.
  • The community-based nurse uses both these types
    of care knowledge and verified with the client
    and family those areas that are meaningful and
    acceptable to them. Discovering how generic
    (Emic) and professional (Etic) systems are alike
    or different assists the nurse in providing
    culturally congruent care to individuals or
    groups

25
Component of Cultural Assessment
26
Six phenomena of cultural assessment
  • Communication. A continuous process by which one
    person may affect another through written or oral
    language, gestures, facial expressions
  • Space- The area around a person's body that
    includes the individual, surrounding environment
    and object within that environment.
  • Social organization. The family and other groups
    within a society that dictate culturally accepted
    role behaviors of different member of the society

27
  • Time. The meaning influence of time from a
    cultural perspective. Time orientation refers to
    an individual's focus on the past, the present or
    the future.
  • Environmental control The ability or perceived
    ability of an individual or persons from a
    particular cultural group to plan activities that
    control nature such as illness causation
    treatment
  • Biologic variation. The biologic differences
    among racial and ethnic groups. It can include
    physical characteristics, such as skill color
    physiology

28
Communication
  • Because the community-based nurse spends much of
    his or her time teaching, communicating roles,
    knowledge of communication styles and meanings is
    essential.
  • Verbal and nonverbal behavior, space between
    persons talking, family number roles, eye contact
    salutations integrate communication patterns

29
Space and Physical Contact
  • The concept of space is another important
    dimension of cultural knowledge.
  • How close people stand by each other in
    conversation, overt expressions of affection or
    caring with touch, and rules relating to personal
    space and privacy vary greatly among cultures

30
Time
  • Because the concept of time has such different
    meanings in various cultures it is important
  • for the nurse to know of this dimension within
    the cultural group receding care

31
Social Organization
  • A The community-based nurse must understand the
    family patterns of the groups within the
    community being served the family is the basic
    unit of society

32
Biologic Variations
  • To perform a thorough assessment and provide
    culturally congruent care, the community-based
    nurse who bows biologic variations specific to
    his or her clients will be most effective.
  • Although some biologic variations are obvious
    e.g., skin color, hair texture, facial features,
    stature, and body markings), others require
    knowledge based on medical information and
    research.

33
Environmental Control
  • There are three predominant views on the
    relationship between the environment health
    magic religious, biomedical, humeral.
  • The magic religious view sees illness as a having
    a supernatural force that is, malevolent or evil
    spirits cause disease, or illness is a punishment
    from God.

34
Acculturation and Assimilation
  • Acculturation may occur as they learn the ways
    to exist in a new culture. This may include
    learning to drive going to schools negotiating
    public transportation getting a job and
    interacting in an environmental unlike that of
    the home country

35
  • Assimilation, takes place when individuals or
    groups identify more strongly with the dominant
    culture in values activities and daily living.
  • Cultural Skills as the ability to collect
    relevant cultural data regarding the client's
    health history.

36
  • A culturologic assessment as a systematic
    identification documentation of culture care,
    beliefs, meaning, values, symbols practices of
    individuals or groups with a holistic
    perspective.
  • It gives the nurse good information with cultural
    implications to use as a basis for planning
    teaching and treatment plans.
  • All clients have a right to have their values
    beliefs practices considered, respected
    incorporated into the plan of care

37
Cultural Care Preservation
  • The first of the modalities is cultural care
    preservation /or maintenance. After careful
    assessment observation, the nurse identifies
    those cultural care practices that are helpful to
    the client.
  • The nurse then assists, supports, facilitates, or
    enables the client family to preserve those
    actions or behaviors.
  • The nurse working in this community encourages
    supports ways to enlist the help of the extended
    community facilitates ways to let the care
    needs be known

38
Cultural Care Accommodation
  • The second mode of cultural care accommodation or
    negotiation refers to those nursing actions
    decisions that assist or enable the client arid
    family to continuity with practices that are
    meaningful to them but may be altered due to
    circumstances.
  • For example the nurse in the community may be
    setting up a referral for a client to be seen in
    a clinic for follow-up care. The client is Muslim
    and must adhere to the practice of praying five
    times a day.

39
  • The nurse will negotiate with the client as to
    times of day that would provide enough time
    between prayers for an appointment or assist in
    helping the client find a place within or near
    the clinics where these prayers may be said.

40
Cultural Care Repatterning
  • The third way in which nurses make decisions or
    intervene is cultural care Repatterning or
    restructuring.
  • When the nurse assesses the client, family, and
    communities and finds practices that may be
    detrimental to health and well-being, he or she
    will work with the client to change behaviors
    that are harmful. .

41
Develop Cultural Self-Awareness
  • The first transcultural nursing principle focuses
    on the nurses own culture. Self-awareness is
    crucial for the nurse working with people from
    other cultures.
  • Nurses must remember that their culture often is
    sharply different from the culture of their
    clients.

42
  • Cultural self-awareness means recognizing the
    values, beliefs, and practices that make up ones
    own culture.
  • It also means becoming sensitive to the impact of
    ones culturally based responses. In terms of her
    own culture, this nurses behavior was intended
    to reassure clients and meet their needs.
  • Unaware of the negative consequences of her
    behavior, the nurse caused damage rather than
    meeting needs

43
  • Cultural self-assessment
  • Ethnic and racial background influences
  • Typical verbal nonverbal communication patterns
  • Cultural values and norms, or expected cultural
    practices or behaviors
  • Religious beliefs and practices
  • Health beliefs and practices

44
Concepts Related to Bridging Cultural Differences
(ETHNIC)
E Everyone has a culture.
T Take time to collect relevant cultural information.
H Hold all judgments ie. be careful about interpreting the culturally different student's behavior, especially if unfamiliar with the culture.
N Notice and negotiate differences in understanding of teaching and learning
I Involve cultural resources as appropriate.
C Collaborate to develop objectives and educational strategies.
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