CULTURAL CARE

• Culturally responsive nursing care


  Care that is centered on the client's cultural point of view and integrates the client's values and beliefs into the plan of care
• Nursing care


  • Holistic and encompasses the client's perspectives on health, which are greatly influenced by the client's culture
  • Each person is born into a culture influenced by the place of birth and the family of origin
• Culturally responsive care


  Care that is centered on the client's cultural point of view and integrates the client's values and beliefs into the plan of care
• To deliver culturally responsive care

  1. Nurse must first develop self-awareness of his or her own culture, attitudes, and beliefs, and examine the biases and assumptions he or she holds about different cultures

  2. Nurse needs to gain the necessary knowledge and skills to create an environment where trust can be developed with the client
• Culture


  Thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups
• Subculture


  Usually composed of people who have a distinct identity and yet are related to a larger cultural group
• Examples of cultural subgroups


  • Occupational groups (e.g., nurses)
  • Societal groups (e.g., feminists)
  • Ethnic groups (e.g., Cajuns)
• Multicultural


  Used to describe a person who has multiple patterns of identification or crosses several cultures, lifestyles, and sets of values
• Diversity


  The fact or state of being different
• Factors accounting for diversity

  • Sex
  • Age
  • Culture
  • Ethnicity
  • Socioeconomic status
  • Educational attainment
  • Religious affiliation
• Race


  A term with many definitions, often used interchangeably with the terms ethnicity and culture
• Ethnicity


  A term often interchangeably used with race. Ethnicity may be viewed as a relationship among individuals who believe that they have distinctive characteristics that make them a group
• Nationality


  Sometimes used interchangeably with ethnicity or citizenship. Generally refers to the sovereign state or country where an individual has membership, which may be through birth, through inheritance (parents), or through naturalization
• Religion


  A system of beliefs, practices, and ethical values about divine or superhuman power worshipped as the creator(s) and ruler(s) of the universe
• Ethnocentrism


  The belief in the superiority of one's own culture and lifestyle. Other viewpoints are not only considered different, but also wrong or of lesser importance
• Xenophobia


  The fear or dislike of people different from one's self
• Prejudice


  A preconceived notion or judgment that is not based on sufficient knowledge; it may be favorable or unfavorable
• Racism


  Assumptions held about racial groups, including the belief that races are biologically discrete and exclusive groups that are inherently unequal and ranked hierarchically
• Institutional racism or institutional discrimination


  The denial of opportunities and equal rights based on race
• Discrimination


  The negative treatment of individuals or groups on the basis of their race, ethnicity, gender, or other group membership
• Generalizations


  Statements about common cultural patterns that may not hold true at the individual level and should serve only as openings for individuals to better understand each other
• Stereotyping


  Making the assumption that an individual reflects all characteristics associated with being a member of a group
• Health disparities


  Differences in care experienced by one population compared with another population
• Determinants of health


  • Social determinants (e.g., gender, socioeconomic status, employment status, educational attainment, food security status, availability of housing and transportation, racism, health system access and quality)
  • Behavioral determinants (e.g., patterns of overweight and obesity, exercise norms, use of illicit drugs, tobacco, or alcohol)
  • Environmental determinants (e.g., lead exposure, asthma triggers, workplace safety factors, unsafe or polluted living conditions)
  • Biological and genetic determinants (e.g., family history of heart disease, inherited conditions such as hemophilia and cystic fibrosis)
• Cultural models of nursing care


  The responsibility of supporting cultural competence is shared among individual nurses, employers, educators, professional associations, regulatory bodies, unions, accreditation organizations, government and the public
• Transcultural nursing


  Focuses on providing care within the differences and similarities of the beliefs, values, and patterns of cultures
• Cultural competence


  The ongoing process in which the health care professional continuously strives to achieve the ability and availability to work effectively within the cultural context of the patient (individual, family, community)
• Constructs of cultural competence

  • Cultural desire (motivation to engage in the process of becoming culturally aware, knowledgeable, skillful, and seeking cultural encounters)
  • Cultural awareness (self-examination of one's own prejudices and biases toward other cultures, and in-depth exploration of one's own cultural/ethnic background)
  • Cultural knowledge (obtaining a sound educational foundation concerning the various worldviews of different cultures)
  • Cultural skills (ability to collect culturally relevant data regarding the client's health in a culturally sensitive manner)
  • Cultural encounters (engaging in face-to-face cultural interactions with persons from diverse backgrounds, and learning to modify one's existing beliefs and prevent possible stereotyping)
• Health traditions model


  Predicated on the concept of holistic health and describes what people do from a traditional perspective to maintain, protect, and restore health
• Facets of the health traditions model


  • Traditional methods of maintaining health (physical, mental, and spiritual)
  • Traditional methods of protecting health (physical, mental, and spiritual)
  • Traditional methods of restoring health (physical, mental, and spiritual)
• Symbolic examples


  • Thousand-year-old eggs represent traditional foods that may be eaten daily to maintain physical health (China)
  • The enjoyment of nature, the natural environment, may be a universal way of maintaining mental health
  • The Islamic prayer represents a way of maintaining spiritual health (East Jerusalem)
  • Red string may be worn to protect physical health (Tomb of Rachel in Bethlehem, Israel)
  • The eye represents the plethora of eye-related objects that may be worn or hung in the home to protect the mental health of people by shielding them from the envy and bad wishes of others (Cuba)
  • The thunderbird may be worn for spiritual protection and good luck (Hopi Nation)
  • The herbal remedy represents aromatic plants that may be used by people from all ethnocultural traditional backgrounds as one method of restoring health
• Symbolic examples of traditional methods of restoring health


  • Thousand-year-old eggs represent traditional foods that may be eaten daily to maintain physical health (China)
  • Enjoyment of nature, the natural environment, may be a universal way of maintaining mental health
  • Islamic prayer represents a way of maintaining spiritual health (East Jerusalem)
  • Red string may be worn to protect physical health (Tomb of Rachel in Bethlehem, Israel)
  • Eye represents the plethora of eye-related objects that may be worn or hung in the home to protect the mental health of people by shielding them from the envy and bad wishes of others (Cuba)
  • Thunderbird may be worn for spiritual protection and good luck (Hopi Nation)
  • Herbal remedy represents aromatic plants that may be used by people from all ethnocultural traditional backgrounds as one method of restoring physical health (Africa)
  • Tiger balm represents substances that are used in massage therapy as a way of restoring mental health (Singapore)
  • Rosary beads symbolize prayer and meditation methods used in the spiritual restoration of health (Italy)
• Magico-religious health belief


  Health and illness are controlled by supernatural forces. The client may believe that illness is the result of "being bad" or opposing the creator(s)' will.
• Scientific or biomedical health belief

  Life is controlled by physical and biochemical processes that can be manipulated by humans. The client with this view will believe that illness is caused by germs, viruses, bacteria, or a breakdown of the body.
• Holistic health belief


  The forces of nature must be maintained in balance or harmony. Human life is one aspect of nature that must be in harmony with the rest of nature. When the natural balance or harmony is disturbed, illness results.
• Sociocultural forces, such as politics, economics, geography, religion, and the predominant health care system, influence the client's health status and health care behavior.
• Folk medicine


  Beliefs and practices relating to illness prevention and healing that derive from cultural traditions rather than from modern medicine's scientific base.
• Family


  • The basic unit of society; however, the concept of family is complex and influenced by personal and social values. There is no agreed-on definition of family and there is great diversity in family types and structures.
• Communication and culture


  Closely interconnected. Through communication, the culture is transmitted from one generation to the next, and knowledge about the culture is transmitted within the group and to those outside the group.
• Culturally responsive nursing care


  Care that is centered on the client's cultural point of view and integrates the client's values and beliefs into the plan of care