Exam 4 (Ch 13- Factors Affecting Health) Flashcards
Culture
What people in a group have in common, but it changes over time.
Purnell and Paulanka define culture as
“the totality of socially transmitted behavior patterns, arts, beliefs, values, customs, lifeways, and all other products of human work and thought characteristics of population of people that guides their worldview and decision making.”
Characteristics of culture:
Culture is learned It is taught It is shared by its members It is Dynamic and Adaptive It is complex It is diverse It exists at many levels It has common beliefs and practices It is all-encompassing It provides identity
Bicultural
Describes a person who identifies with two cultures and integrates some of the values and lifestyles of each into his life.
Multicultural
Refers to many cultures. Describes groups rather than individuals.
Socialization
The process of learning to become a member of a society or a group. A person becomes socialized by learning social rules and roles, by learning the behaviors, norms, values, and perceptions of others in the same group or role.
Immigrants
New members of a group or country
Acculturation
Assuming the characteristics of another culture\
Cultural assimilation
When the new members of a group or country gradually learn and take on the essential values, beliefs, and behaviors of the dominant culture.
A person becomes assimilated when they:
- Learn to speak the dominant language,
- Marry a member from the new culture,
- and make close, personal relationships with members of the new group.
Ethnocentrism
The tendency to think that your own group (cultural, professional, ethnic, or social) is superior to others and to view behaviors and beliefs that differ greatly from your own as somehow wrong, strange, or unenlightened.
Dominant culture
The group that has the most authority or power to control values and reward or punish behaviors. It is usually, but not always, the largest group.
Subcultures
groups within a larger culture or social system that have some characteristics (e.g. values, behaviors, ancestry, ways of living) that are different from those of the dominant culture.
Minority groups
Made up of individuals who share race, religion, or ethnic heritage; however, a minority group has fewer members than the majority group.
Sometimes used to refer to a group of people who receive different and unequal treatment from others in society. Some consider it an offensive term b/c it suggests inferiority and marginalization
Vulnerable Populations
Groups who are more likely to develop health problems and experience poorer outcomes because of limited access to care, high-risk behaviors, and/or multiple and cumulative stressors.
e.g. people who are homeless, poor, or mentally ill; people with physical disabilities; the very young; and older adults.
Healthy People 2020
Public health initiative. Addresses the care of vulnerable populations and includes as one of 4 broad goals, the elimination of health inequalities.
Ethnicity
Similar to culture in that it refers to groups whose members share a common social and cultural heritage that is passed down from generation to generation. Similar to subculture and race.
Ethnic group
Group that has some characteristics in common (e.g., race, ancestry, physical characteristics, geographic region, lifestyle, religion) that are no shared or understood by outsiders.
e.g. French Canadians, Roman Catholics, Hmongs,and Latinos
U.S. Census Bureau identifies two categories for ethnicity:
1) Hispanic, Latino, or Spanish and
2) Not Hispanic, Latino or Spanish.
Subcategories of 1: Mexican, Mexican American, Chicano, Puerto Rican, Cuban, and other Hispanic, Latino, or Spanish origin.
Latino
Refers only to people from Latin America (Central or South America)
Spanish origin:
Implies origin in Spain
Race
Strictly related to biology. It refers to the grouping of people based on biological similarities, such as skin color, blood type, or bone structure.
Religion
Refers to an ordered system of beliefs regarding the cause, nature, and purpose of the universe, especially the beliefs related to the worship of a God or gods.
May be confused with ethnicity (e.g., the Jewish culture overlaps with Jewish faith community).
Values
Help shape health related beliefs and practices.
Personal value
A principle or standard that has meaning or worth to an individual
e.g. cleanliness
Belief
Something that one accepts as true
e.g. “I believe that germs cause disease”
A practice
A set of behaviors that one follows
e.g. I always wash my hands before preparing food
Dominant U.S culture values
youth, beauty, success, independence, and material belongings
Culture universals (culture commonalities)
the values, beliefs, and practices that people from all cultures share
e.g. all cultures celebrate the birth of a new baby in some way
Culture Specifics (Culture diversities)
Those values, beliefs, and practices that are special or unique to a culture.
e.g. cultures celebrate “birth rites” in different ways
Cultural stereotype
A widely held but oversimplified and unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain respects.
Stereotypes are not always negative
Cultural archetype
An example of a person or thing–something that is recurrent–and it has its basis in facts; a symbol for remembering that is usually not negative
e.g. Mexican Americans having brown eyes or European Americans having light-colored skin.
6 culture specifics that influence health:
- Communication
- Space
- Time orientation
- Social organization
- Environmental Control
- Biological Variations
Communication
Verbal and nonverbal language
i.e spoken language, gestures, eye contact, and even silences
Space
Refers to a person’s personal space, or how the person relates toward the space around him.
Territoriality
The behavior and attitude that people exhibit about the area around them they have claimed.
Examples of attitudes towards personal space:
- Americans, Canadians of Northern European ancestry, and the British keep at least 18 in. of space b/t them and the person that they’re talking to
- Arabs and others from the Middle East typically stand quite close when talking
- Germans usually require a great deal of space, and consider looking into a room an invasion of privacy
Time orientation
Some persons tend to be present- or future-oriented, whereas others are more rooted in the past
e.g. clients who are present-oriented tend to show up late (or not at all) for appointments; written or telephone reminders should be provided
Social Organization
Includes the family unit (e.g., nuclear, single-parent, or extended family) and the wider organizations (e.g., community, religious, ethnic) with which the individual or family identifies.
e.g. in Middle Eastern and Latino cultures, the man is likely to be the dominant family member and the woman the homemaker.
Environmental Control
Refers to a person’s perception of his ability to plan activities that control nature or direct environmental factors.
e.g. Asian Americans tend to accept pain stoically, and not demand relief
Biological Variations
Ways in which people are different genetically and physiologically; they create susceptibility to certain diseases and injuries
*Body build and structure, skin color, vital signs, enzymatic and genetic variations, and drug metabolism
Other cultural specifics
- Religion and Philosophy
- Education
- Technology
- Politics and the Law
- Economy
Religion and Philosophy
A person’s religion may determine what healthcare is acceptable to him.
e.g. Jehovah’s Witnesses do not accept blood transfusions, and many religions forbid abortion
Education
Education influences the perception of wellness and illness and the knowledge of options that are available for healthcare.
Technology
Availability of supplies and equipment determines what is used in the healthcare setting and what comes to be culturally expected.
Politics and the Law
Governmental policies affect healthcare. They determine what practitioners will be available and what programs will be funded.
Economy
The condition of the economy directly affects the availability of funds for publicly funded services. It also affects the individual’s ability to pay for healthcare.
Indigenous Healthcare System
Consists of folk medicine and tradition healing methods, which may also include over the counter and self-treatment remedies.
Professional Healthcare System
Run by a set of professional healthcare providers who have been formally educated and trained for their appropriate roles and responsibilities.
Biomedical Healthcare System
Also known as Western medicine and allopathic medicine, combines Western biomedical beliefs with traditional North American values of self-reliance, individualism, and aggressive action.
Generally speaking, people follow one of 3 major health belief systems:
- Scientific,
- Magico-religious, or
- Holistic
Magico-Religious System
Belief in supernatural (mystical) forces.
e.g., voodoo which is practiced in some developing nation in Africa, Latin America, and the Caribbean and which considers the lion a spiritual symbol
Holistic Belief System
Can be similar to magico-religious, but it focuses more on the need for harmony and balance of the body with nature
Culture of the North American Healthcare System:
- Belief in and reliance on the biomedical system
- Valuing of technology
- Desire to conquer disease
- Definition of health as the absence or mineralization of disease
- Adherence to a set of ethical standards and codes of conduct
Largest subculture within the healthcare culture:
Nursing
Culture of nursing
The learned and transmitted lifeways, values, symbols, patterns, and normative practices of members of the nursing profession that are not the same as those of the mainstream culture.
Nursing values include:
- Silent suffering as a response to pain
- Objective reporting and description of pain, but not an emotional response
- Use of the nursing process
- Nursing autonomy
- Caring
- Knowledge
- Critical thinking
Traditional healing
refers to alternative beliefs, those that are not of the Western, North American, biomedical, or professional healthcare systems
Folk medicine
Defined as the beliefs and practices that the members of a cultural group follow when they are ill, as opposed to more conventional standards
Complementary medicine
The use of rigorously tested therapies to complement those of conventional medicine
e.g. chiropractic care, biofeedback, and the use of certain supplements
Alternative medicine
Defined as therapies used instead of conventional (i.e., biomedical) medicine, and whose reliability ahs not been validated through clinical testing in the United States
e.g., iridology, aromatherapy, and magnet therapy
TCM
Traditional Chinese Medicine
Ayurveda
the traditional healthcare system of India
Cultural awareness
Refers to an appreciation of the external signs of diversity
Cultural sensitivity
Refers to the personal attitudes and being careful not to say or do something that might be offensive to someone from a different culture
Cultural competence
Is attained on a continuum ranging from cultural destructiveness (most negative) to cultural proficiency (most positive). You become more aware of and sensitive to the needs of individuals from various ethnocultural groups over time.
QSEN
Quality and Safety Education for Nurses
Purnell model for cultural competence stresses:
Teamwork in providing culturally sensitive and competent care to improve outcomes for individuals, families, and communities
Cultural competence
Defined as “having the knowledge, abilities, and skills to deliver care congruent with the client’s cultural beliefs and practices.”
Leininger’s theory
Goal is to guide research that will assist nurses to provide culturally congruent care that would contribute to the health or well-being of people using her three modes of nursing care actions and decisions.
ASKED
- Awareness: similar to cultural sensitivity in other models
- Skills: refers to your ability to conduct with sensitivity a cultural assessment and a culturally based physical assessment.
- Knowledge: the information you have about cultural worldviews and theories.
- Encounters: It takes practice to become culturally competent
- Desire: Suggests that you must want to be culturally competent
Bias
one-sidedness: a tendency to “lean” a certain way, a lack of impartiality
Cultural stereotype
The unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain respects. May be positive or negative
Prejudice
Refers to negative attitudes toward other people based on faulty and rigid stereotypes about race, gender, sexual orientation, etc.
Discrimination
Refers to the behavioral manifestations of prejudice.
e.g., before the 1960s many US hospitals refused treatment to African Americans
Racism
A form of prejudice and discrimination based on the belief that race is the principal determining factor of human traits and capabilities and that racial differences produce an inherent superiority (or inferiority).
Sexism
The assumption that members of one sex are superior to those of the other sex.
Male chauvinism
assumption of male superiority
Language barrier
affect your ability to communicate with clients. Involves foreign languages, dialects, regionalisms (word or pronunciation particular to a specific region), street talk, and jargon
Ebonics
Also called black Vernacular English or AAVE, is a type of English that has, in the past, been spoken primarily by blacks, but many white youth enamored with hip-hop culture now embrace Ebonics as a way to connect with the street culture.
Lipson and Meleis suggest that the following minimum information is important when taking a cultural assessment:
- Language(s) spoken; proficiency in language of the host
- Length of time client has been in the host country
- Where client was raised
- Ethnic affiliation and identity
- Usual religious practices
- Nonverbal communication style
- Family roles and primary decision-maker about the client’s healthcare
- Social support in the host country
Risk for imbalanced nutrition: Less than body requirements
might apply to a patient who is hospitalized and cannot obtain foods prepared in the traditional way of his ethnic group
Impaired Parenting
could occur if the patient’s traditional methods of discipline are not acceptable or appropriate in the dominant culture
Spiritual Distress
might occur because a necessary treatment is not congruent with a client’s religious beliefs
Powerlessness
might occur when the patient is unable to make healthcare personnel understand the importance of his religious and dietary beliefs
Impaired verbal communication
is sometimes used for patients who do not speak or understand the nurse’s language. Better use as the etiology of the diagnoses, such as Ineffective Therapeutic Regimen Management
Risk for Noncompliance
can be used for clients and/or caregivers who do not follow a health-promoting or therapeutic plan the healthcare provider believes they agreed to. (Nonadherence vs. noncompliance)
Leininger’s Modes:
- Cultural care preservation/maintenance: sustains clients’ cultural lifestyles in meaningful ways.
e. g. encouraging the family to bring ethnic foods that are appropriate for client’s prescribed diet - Cultural care accommodation/negotiation: adapts clients’ lifestyles or nurses’ actions.
e. g. negotiating with the client to continue seeing the curandero, but to come to the clinic every 6 wks to have his BP checked. - Cultural care repatterning/reconstructuring changes nurses’ action or clients’ lifestyles into different patters.
e. g. When p/t absolutely refuses to medication, the nurse uses massage, distraction, and other nonpharmacological techniques to help relieve his pain
CLAS
National Standards for Culturally and Linguistically Appropriate Services
CLAS Guidelines
require healthcare organizations receiving federal funding to provide language assistance services, including bilingual staff and interpreter services, at no cost to the patient.
Interpreter
Specially trained to provide the meaning behind the words
Translator
Restates the words from one language to another
“take a trip to BALI”
BE aware of your own cultural heritage
APPRECIATE that the client is unique: influenced, but not defined by his culture
LEARN about the client’s cultural group
INCORPORATE the client’s cultural values/Behaviors into the care plan
Unconscious Incompetence
Not being aware that you lack knowledge about another culture
Conscious Incompetence
Being aware that you lack knowledge about another culture
Conscious competence
learning about the client’s culture, verifying generalizations about the culture and providing culture specific interventions.
Unconscious competence
automatically providing culturally congruent care to clients of diverse cultures
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