Chapter 13 Culture Flashcards
Meaningful knowledge about an individual cannot be gained by __________________
simply identifying the groups to which that person belongs.
3 Things that present significant challenges to fairness & tolerance in Canada
- Colonial history
- Ever-changing imm policies
- Inequities that structure relationships among diverse groups of ppl in Can.
Colonization and Colonialism
• Process by which a pop is taken over and governed by a nation-state such that power and authority are exercised in ways that consciously/unconsciously subordinate that pop
Neocolonialism
new, evolving, ongoing colonial policies & practices that continue to govern, oppress, and subordinate certain groups
- Indirect control thru econ/cult dep.—no dev of infrastructure
Diaspora; negative affects on African pop.
- Migration and dispersion of ppl from countries of origin and to the intricate ties that migrant communities maintain w/ their homeland
- African— incidence of circ. Disease, diabetes, psych disorder—can’t be explained by factors except oppression and discrim
With respect to multiculturalism, what is the Canadian federal government’s official policy and how is it supported?
Respect for diversity and multicul is official policy of the Can fed gov—supported by policies/laws incl. Canadian Multicul Act
Canadian Multicult. Act
Freedom—cultural heritage, participation, elimination of barriers
Barriers to participating in society fully:
o Employment
o Obtaining resources for safe shelter/adequate nutrition
o Civic engagement
o Playing role in shaping policies that affect them
o Voting
o Assessing HC
2 Examples of policies that undermine multiculturalism
- Laws structured to favour most highly educated and wealthy ppl from other countries—disadvantages women. 3 classes of immigrants: family, refugee, economic. Economic come w/ spouses who are bound to them—creates dynamic for intimate violence—no other financial means than partner
- Until 1960, Indian Act restricted ppl from voting or leaving reserves
What is Democratic Racism? Give and example.
Nott overt racial cats & ideas of racial/bio inf/superiority, uses cultl differences as euphemism for racial diffs to explain health, social and economic inequities—subtle.
Ex. Immig/minorities Pap smears—attribute it to different values/beliefs
Cultures are shaped by:
sociohistorical, political and economic contexts and by power dynamics within those contexts
Contemporary definition of culture
Process between ppl; continuously participate in & create it, constantly in flux
Why is using eth/cult/race as basis for practice problematic?
- Suggests ns can know another person’s cultural by determining which group the person belongs
- Overlooks complexity of individuals life, salient features of person’s experience and sets conditions for discrimination
Nursing requires complex understanding of culture in order to:
- uphold ethical obligations of nursing including: promoting fairness
- recognizing and addressing inequities
- practicing respectfully with all people
Explain how nurses focus on: Knowing Thinking Being Interacting and Understanding
Knowing—about various perspectives on culture—consider consequences for nursing of practice based on diff understandings
Thinking—considering your own culture/ differences/ reflection
- Being—working with pts form all backgrounds and across diffs
- Interacting and Understanding—skills required across differences
What is racialization? It can lead to negative impacts on which 3 areas? it is a form of what?
Process of categorizing ppl into racial categories that are
constructed as different and unequal
Lead to negative impacts that are:
• Social
• Economic
• Political
Form of othering
What is a visible minority?
- Why is it a racialization category?
People who are identified as being non white; except Aboriginal people
attempts to classify ppl by skin colour, etc
What are the three approaches to culture in nursing and HC? How do they differ?
Cultural Sensitivity, Cultural Safety, Cultural Competence
Differ by:
- Degree of attn. to analysis of power/structural conditions
- Sig of social and historical contexts
- Emphasis on individual vs collective responsibility
This approach to culture views it as a characteristic of people or something held by groups (belongs to them)
cultural sensitivity
Cultural Sensitivity
Culture is something that belongs to ppl or grps rather than something that happens between ppl / static, permanent, unchanging
Cultural Sensitivity Requires Nurses to:
- Find out what a person’s cultures is and to be sensitive to, & tolerant of, diffs from the presumed norm, with tolerance often implying a tolerating majority and a tolerated minority
- Help pt adapt/makes accoms regarding diffs
- *Not req for dom norms or practices to be adapted/changed
These tools are used to help understand cultural sensitivity
inventories/assessment tools
7 Limitations to these inventories for cultural sensitivity
o Diversity within groups > diversity between groups
o Ppl often disagree w/ assigned classifications
o Many claim membership in a grp but don’t subscribe to
all practices associated
o Can be stereotypical/ lead nurses to make erroneous
assumptions about indvs.
o Categorization by ethnicity offensive
o Focuses on indvs, overlooking broader context of lives
o Sensitivity often implies that:
(a) there is a preferred norm outside of which sensitivity
and tolerance are reqd
• (b) minorities are tolerated by a dom majority(superio.)
• (c) nurses only passive responsibility to be sensitive but
not necessarily engage in change
Sensitivity often implies that:
(a) there is a preferred norm outside of which sensitivity
and tolerance are reqd
(b) minorities are tolerated by a dom majority(superio.)
(c) nurses only passive responsibility to be sensitive but
not necessarily engage in change
Cultural Competence
- Developing competence in understanding different cultures (learning about others)
- Developing competence in learning about themselves (nurse) and about contexts that shape experiences
- Used in many diff ways—compatible with sensitivity and safety
Cultural Safety
Culture is something that happens between ppl and grps
Founded on critical understanding of culture that recog that cultures are dynamic and constantly shifting in relation to power dynamics in our society and historical, economic, political, and local trends
5 Central Ideas of Cultural Safety
- CS does not refer to cataloguing of culture-specific beleifs—rather it is how a grp is perceived and treated that is relevant rather than the different things its members think or do
- The social, economic, and political positions of grps within society influence health and health care
- Individual and institutional discrimination in HC creates risks for pts, including by ppl that hold power in HC contexts (HCPs)—Ex. Hypertension/heart disease in AAs, Aboriginal-diabetes and partner violence
- Critical reflexivity is essential to nursing practice-self-reflection
- Promoting Safety Requires Actions that:(a) Recognize, respect, and nurture the unique cult identities of all people/families
(b) Safely meet peoples’ needs, expectations, and rights given the unique contexts of their lives
Two Beginning Skills Toward Practicing in Culturally Safe Manner
1 SELF-REFLECTION—how our biases, assumps, norms and ways of beings influence viewpoints, interactions, and practices
2 being able to critically analyze culture of health
We are all culturally/ socially positioned by:
o Resources we have o Where we were born o Where we live o How we look o Abilities and opportunities we have
In Individualistic Western culture, social positioning is thought of as:
as personal accomplishments/failures (Ex. Education—think accomp as result of parent’s hard work not product of opp to have a job or consequence of family supports/public funding that enabled us to get an edu)
___________________is 1st step to looking @ how we may be diff from others, our assumps about those diff, & how diffs affect us all—and to work effectively as a nurse across those differences
Examining Social Position (advs/disadv)
It is useful to consider the factors that shape your social positioing such as:
historical, social, economic, political and cultural factors
Common example of how dominant values operate in nursing/ health-care
visiting hours—based on assump that families are avail to visit outside normal work hours and female fam members are available to provide care
White Dominance
Ethnic composition and dom values, beliefs, practices, norms
‘Acting white’ and ‘performing whiteness’ is necessary for survival within nursing establishment, regardless of colour
White ppl dominant in nursing vs nonprofessional jobs
Individualism
Individuals > collective—common in liberal democracies—operates w/ corporatism to hold indvs responsible for own economic well-being and health, regardless of life circums.
Corporatism
Business model in which dynamics of marketplace/ management/ organizational theories shape HC so that econ and political values dominate
Ethnicity
Most relevant grouping that defines a person’s culture
A group or community maintained by a shared o Heritage o Culture o Language o Religion
Ambiguous/dynamic concept that can encompass aspects like: o Race o Origin o Ancestry o Identity o Language o Nationality o Religion
Often used as a polite term for race
What is the most relevant grouping that defines a person’s culture?
ethinicity
Race
Socially constructed, used to classify according to common ancestry
Reliant of differentiation by physical characteristics like: o Colour of skin o Hair texture o Stature o Facial characteristics
No biological basis—socially constructed
Why is emphasis on ethnicity/race for understanding culture a problem?
Emphasis on ethnicity or race as basis for understanding culture leads to ppl applying assumps about grps to indvs—but culture is more complex
Biomedicine
o Application of natural sciences to understanding, treating and promoting health
o Insufficient to understanding/responding to issues because focus on microlevel, no examination of social/structural synamics that produce health/health inequalities
5 Things to Consider Practicing Reflexivity—Culturally Safe Care
Scrutiny of own/others’ knowledge claims, assumptions, practices
Dialogue is central process of reflexivity
Engaging in reflexive approaches requires:
—–Commitment to creating opps for reflection and dialogue to consider complexity and specificity of indvs, rels, and contexts
Develop tolerance for discomfort of not knowing how to act/say
Questions to ask yourself:
What am I assuming/why? What knowledge supports/contradicts/missing?
Why am I applying this ethnic cat to this pt? alternative ways to describe pt?
Basis for liking/disliking pt? Basis for app/disapp pts decisions?
When I think of something as cultural, what econ, poli, or other social influences might be operating?
Interacting with and understanding patients (applying cultural safety in practice)
Inquiry & active listening
Nonjudgemental acceptance
Anticipate where you will be most judgmental and what you will do in those circumstances
Pay attention to when ppl say they are being discriminated against
o Discrimination is what the pt says it is
Be honest when you don’t know what to say/do/did something wrong
Ensure ppl have opp to comm in language that they are able to speak and understand
Working With Language Interpreters
- Identify language spoken at home (may differ from public)
- Use trained medical interpreter, if possible
- Same gender pt and interpreter is ideal
- Permit sufficient time
- Ensure confidentiality/priv—avoid using visitors
