fundamentals- chapter 14

Question 1

transcultural care

Answer 1

• culture and spirituality have a major effect on how people manage their heath and use health care resources
• nursing care based on patients’ unique cultural and spiritual needs greatly improves patient outcomes and quality of care

Question 2

transcultural nursing

Answer 2

nursing care that recognizes cultural diversity and is sensitive to the cultural needs of the patient and the family

Question 3

culture

Answer 3

• collection of beliefs, values, and assumptions about life that is shared and maintained by a group of people (intergenerational)
• includes attitudes, roles, behaviors, and religious or spiritual practices

Question 4

culture

Answer 4

distinguishing features:
- learned and acquired in a social context
- shared by a group
- incorporated into an individual’s identity
- dynamic and changes under the influence of shared experience

Question 5

poverty as a subculture

Answer 5

• shared beliefs
• day-to-day survival
• family dynamics may be altered
• malnutrition
• poor health

Question 6

understanding spirituality

Answer 6

• religion and spirituality are different
• religion is a formalized system of belief and worship; have rituals related to health, illness, birth, death, and behavior
• spirituality concerns the spirit or soul and is an element of religion

Question 7

major religions in the US and Canada

Answer 7

1. Christianity
2. Islam
3. Judaism
4. Eastern religions (Hinduism, Buddhism, and Taoism)

Question 8

Christianity

Answer 8

• largest religion in the world
• 3 main divisions (Roman Catholic, Eastern Orthodox, and Protestant)
• believe in eternal life
• death is viewed as a transition to life with God
• a priest or a religious leader should be called if the patient desires a sacrament
• main religious activities of Protestants: reading of scripture and devotionals, and attendance at church services

Question 9

Catholic beliefs

Answer 9

• birth: infants should be baptized soon after birth
• Holy Communion (must not eat or drink anything 15 mins prior)
• sacrament of the sick: administered by priest to patients who are ill and conscious
• death: must receive sacrament of the sick and make a confession. all body parts must be cremated or buried

Question 10

Catholic beliefs

Answer 10

• birth control: do not believe in contraceptives. only natural family planning. sterilization is forbidden unless for medical reasons
• organ donation: transplants are acceptable. can receive but cannot give/donate organs
• religious articles: rosary beads, medals, and other objects should be kept visible and secure

Question 11

Eastern Orthodox

Answer 11

• birth: babies must be baptized within 40 days by a deacon or priest
• Holy Communion: the priest should be called if the patient wants to receive communion
• sacrament of the sick: priest does this at bedside
• diet:
• holidays:
• death:

Question 12

Christian Science

Answer 12

• do not normally seek traditional health care
• believe that sickness, evil, and sin are not from God but of the mind. Illness and sin can be changed by altering the thoughts rather than by medical intervention
• do not take medications

Question 13

Jehovah’s Witness

Answer 13

• abortion is forbidden
• taking blood into the body is prohibited
• transfusion is not permitted
• organ transplant may be accepted, but organ must be cleansed with non-blood solution before transplantation
• only meat that is drained of blood may be eaten
• the body must be buried with all its parts, which prevents organ donation

Question 14

Church of Jesus Christ of Latter-day Saints (Mormons)

Answer 14

• a church elder must be notified in the event of a death
• natural means of birth control are recommended
• cleanliness is vital. a sacred undergarment may be worn that should be removed only in an emergency

Question 15

Seventh-Day Adventist

Answer 15

• the Sabbath is observed on Saturday
• many are vegetarians
• most avoid eating pork

Question 16

Unitarian Universalist Association

Answer 16

• strong belief in woman’s right of choice regarding abortion
• advocate donation of organs for transplant and research

Question 17

Mennonite

Answer 17

women may wish to wear head covering while hospitalized

Question 18

Islam

Answer 18

• one of the fastest growing religions in the world
• emphasizes equality of the races and social classes and attempts to promote brotherhood for all
• some women may not be allowed to make decisions about their health
• sometimes the woman’s husband or father must be present to give consent for treatment

Question 19

Muslim beliefs

Answer 19

• birth: baby is bathed immediately and given to mother. circumcision is performed before puberty. a preemie born at at least 130 days gestation is treated the same as a full-term infant
• diet: no pork or alcoholic beverages allowed. all meat must be killed and blessed in a special way. may not eat traditional african-american foods such as cornbread or collard greens

Question 20

Muslim beliefs

Answer 20

• death: patients must face Mecca and confess sins and beg forgiveness of the family. If family is unavailable, any practicing Muslim can provide this support. after death the body must not be touched until the family has washed it, prepared it, and positioned it facing Mecca. burial is performed as soon as possible. cremation is forbidden. autopsy is forbidden except for legal reasons. organ donation is not permitted.

Question 21

Muslim beliefs

Answer 21

• birth control: many believe that artificial birth control interferes with God’s will. others believe that the woman should have only as many children as the husband can afford, and contraception is permitted.
• abortion: prohibited

Question 22

Muslim practices

Answer 22

• other practices: washing is required at prayer time. privacy must be provided for prayer. the Koran should not be touched by anyone ritually unclean, and nothing must be placed on top of it. Muslim women usually wear clothing that covers the entire body

Question 23

Judaism

Answer 23

• Orthodox, Conservative, Reform, and Reconstructionist
• Strict rules regarding hygiene, diet, sexual mores, and religious ceremony
• Food prepared according to Jewish dietary laws during slaughter, processing, and packaging and is then labeled “kosher”
• Important to consult with the patient to be sure that nursing care does not cause spiritual distress
• There are rituals regarding care of a dead body and burial. a rabbi should be consulted

Question 24

Jewish beliefs

Answer 24

• Birth: Babies are named by the father. Children are named 8 days after being born, when circumcision is performed. Female babies are named during the reading of the Torah.
• Care of women: The woman is thought to be unclean during her menses or after the birth of a child until she has bathed in a pool called a mikvah. The Orthodox Jewish man cannot help the woman with her care.

Question 25

Jewish beliefs

Answer 25

• Diet: Kosher rules include no mixing of milk and meat and using separate utensils for milk and meat. Only animals slaughtered according to Jewish law may be eaten.
• Sabbath: From sunset Friday to sunset Saturday, Jews may not ride in cars; smoke; or use lights, money, or television. Surgery or medical treatments or care are avoided until a later time if possible.

Question 26

Jewish beliefs

Answer 26

• Death: when there are no respirations and no circulation, and this cannot be corrected
• Orthodox Jews forbid assisted death
• Nurses must allow family to be with the patient when he or she dies and when the soul leaves the body. The body must be buried within 24 hours. The body may not be touched for 8 to 30 minutes and then only by an Orthodox person.
• On the Sabbath, a body must not be handled
• All body parts removed during autopsy must be buried with the body

Question 27

Jewish beliefs

Answer 27

• Birth control: birth control is discouraged and vasectomies are forbidden; abortion is allowed only to save the mother’s life
• Organ transplant: may be allowed with a rabbi’s approval
• Shaving: no blade must touch the skin; scissors or electric razor may be used

Question 28

Jewish beliefs

Answer 28

• Hats: orthodox men may wear skull caps (yarmulkes) all the time and women cover their hair after marriage
• Prayer: Prayer to God is required. Nurses need to allow a quiet environment for prayer.

Question 29

Reformed Judaism

Answer 29

• Birth: Orthodox practices may or may not be observed; circumcision may be practiced
• Care of women: beliefs do not follow the rules about touching women
• Diet: kosher diets are usually not observed
• Sabbath: there is worship in temples on Friday but no other rules
• Death: beliefs allow life support but no heroic measures; cremation is allowed

Question 30

Reformed Judaism

Answer 30

• Organ transplant: allowed with the rabbi’s approval
• Hats: praying is usually done without yarmulkes

Question 31

Hinduism

Answer 31

• Many are vegetarians. most believe that eating meat involves harming a living creature
• Illness or disease is seen as the result of the misuse of the body or a consequence of sin committed in a previous life
• Eldest woman is the authority on health and healing matters
• Ayurvedic medicine follows principles of “hot” and “cold” to balance the diet as needed for the season and the disease state

Question 32

Buddhism

Answer 32

• Do not believe in healing through faith
• Believe spiritual peace and liberation from anxiety through following Buddha’s teachings are important in promoting health and recovery

Question 33

Taoism

Answer 33

Believe that illness or disease is due to an imbalance in yin and yang

Question 34

barriers to cultural competence

Answer 34

6 major barriers:

• Stereotyping
• Prejudice and racism
• Ethnocentrism (superiority)
• Cultural imposition (forcing your beliefs)
• Cultural conflict (perceived threat)
• Cultural shock (discomfort)

Question 35

cultural awareness

Answer 35

• know a people’s history/ancestry and an appreciation for their artistic expressions, foods, and celebrations
• understanding that health is expressed differently across cultures and that culture influences an individual’s response to health, illness, disease, and death

Question 36

cultural sensitivity

Answer 36

• refrain from using offensive language, respect patterns of communication, and refrain from speaking in ways that are disrespectful of a person’s cultural beliefs
• ability to engage and communicate with an individual from another culture in a respectful manner

Question 37

cultural competence

Answer 37

• know yourself; examine your own values, attitudes, beliefs, and prejudices
• keep an open mind

Question 38

communication

Answer 38

• obvious cultural difference is language
• dialects can differ
• opinions on personal space and eye contact differ
• learning key phrases in other languages is helpful
• most health agencies have an interpreter available

Question 39

view of time

Answer 39

• orientation to time and perception of timeliness varies
• cultures may be more focused on the past, present, or future
• it is important to know the patient’s view of time

Question 40

organization of the family

Question 41

nutrition

Question 42

death and dying

Question 43

health care beliefs

Question 44

Asian/Pacific Islander Americans

Answer 44

• Value self-control, age, authority, and harmony
• Maintain a holistic view of health and illness, in which nature is a dominant force
• Yin (negative, dark, cold, feminine)
• Yang (positive, light, warm, masculine)
• Acupressure, acupuncture, acumassage
• May believe that misdeeds lead to illness
• Consider it disrespectful to disagree with those in authority
• Reluctant to express emotions to others
• Tend to be stoic about pain
• May be overly agreeable to maintain harmony
• Buddhism, Taoism, Hinduism, and Christianity are the prominent faiths

Question 45

Hispanic Americans

Answer 45

• Family is valued over the individual
• Family system is patriarchal
• Health is seen as a gift from God
• Equilibrium achieved through prayer, religious objects, rituals, use of herbs and spices, and by treating others fairly and with respect
• Often seek help within the family first or may see a curandero
• May believe in the use of “hot” and “cold” foods to restore equilibrium
• May be superstitious (e.g., mal de ojo)
• May wear religious objects or bring them in from home
• It is acceptable to be vocal about illness or pain
• Touch is comforting and promotes rapport
• Health requires being in harmony with God

Question 46

African Americans

Answer 46

• Health and illness may be intertwined with religion and good and bad forces
• Families often multigenerational, and members of the church may be considered family
• Family is often matriarchal
• African Americans may believe that illness is preventable if they are attentive to their relationship with God and other people

Question 47

Native Americans

Answer 47

• Believe in keeping harmony between humans and the universe
• Majority of tribes share a present orientation, a respect for the aged, and an inclination to work cooperatively with avoidance of individual pain
• Believe each individual has a physical and spiritual dimension, each governed by different set of laws
• Treatment of illness includes herbal medicines, rituals, fasting, massage, and consultation with the shaman

Question 48

European Americans

Answer 48

• Value youth, attractiveness, cleanliness, order, punctuality, individualism, education, and hard work.
• Value self-care and self-improvement and use preventive health practices.
• Maintain scientific view of health and illness in which life is controlled by physical and biochemical processes that can be altered by human intervention.
• Often use home remedies before seeking professional health care.
• Use medical technology and health care professionals to diagnose and treat illness.

Question 49

Arab Americans

Answer 49

• Value family and affiliation with others; may have daily gatherings of extended family.
• Food plays a central role in life. Caring is shown by offering food. Muslims do not eat pork nor do they drink alcohol.
• Common bonds of group are the Arabic language and the Islamic religion, although many Arab Americans are Christian.

Question 50

susceptibility to disease

Answer 50

• Certain diseases are passed from parent to child through the genes that determine a person’s characteristics
• Be alert for signs of disorders that are common to a particular culture or race
• Learn about disorders that are predominant in a particular group

Question 51

susceptibility to disease

Answer 51

• African or Mediterranean ancestry: sickle cell anemia
• Eastern European and Jewish ancestry: Tay-Sachs disease, lactose deficiency
• Hispanic, American Indian ancestry: hypertension, diabetes

Question 52

assessment in transcultural nursing

Answer 52

• Consider the general aspects of the patient’s culture and spiritual orientation before beginning the assessment
• Begin the introduction in English unless you speak the patient’s language
• Obtain an interpreter if needed
• Every patient should receive a spiritual assessment by a nurse

Question 53

nursing diagnosis in transcultural nursing

Question 54

planning in transcultural nursing

Question 55

implementation in transcultural nursing

Question 56

culturally sensitive nursing interventions

Question 57

evaluation in transcultural nursing