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Culture NC-3


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culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people
division of mankind possessing traits that are transmissable by descent and that are sufficient to characterize it as a distinct human type
classification of any of the basic groups of mankind distinctly different by customs, characteristics and language.
the process which society imparts its competencies, values and expectations to children
material covert/manifest culture; nonmaterial covert culture
those aspects that cannot be observed directly, such as the ideas, beliefs, customs and feelings of the culture
Cultural creations, culture determining the behavior of individuals in social potitions
having identity of it's own, some deviation from the core culture
Primary Group
close intimate contact, behaviors directed through this relationship eg. family and peer group influence
Secondary group
Influence minimal, limited contact eg, professional organizations- church
Ethnic differences
family structure, language, food preferences, moral codes and expression of emotion
belief that your own ethnic group is superior to others
Ethnic stereotyping
All individuals from a particular ethnic background are labeled to be a certain way and inferior by ethnocentrics
visible and invisible impoverishment
the ability to efficiently bridge the gap between and individual's culture and the dominant culture
Hispanic and Oriental cultures with scolding
Are taught to look away when scolded
melting pot
cultural diversity
differences that exist among various groups of people
cultural/ethnic blending that occurs from migration
culture shock
feelings of helplessness and discomfort and a state of disorientation experienced by an outsider attempting to comprehend or effectively adapt to a different cultural group because of differences in cultural practices, values, and beliefs
cultural sensitivity
an awareness of cultural similarities and differences
Arab culture and the role of the male/female in decision making
men make the decisions and women are expected to support these decisions
variations in newborn are often related to racial or ethnic origin
eg. newborn infants of Asian and Afirca-American parents are smaller than infants of Caucasian parent and mongolian spots are common in Asian, African-American, Native American and Mexican American infants
cultural relativity
the concept that any behavior must be judged first in relation to the context of the culture in which it occurs
Culture and gender in the Arabic, Asian, Jewish, Italian, Greek and Indian
The male child is held in higher esteem than the female child. They may receive better health care & more food because this is the child that will take care of his parents in their old age
African American cultures and time
A-Americans are more flexible with time, they may be late or miss an appointment because something else was much more important. This is not communicated to the health care worker
Hispanics and time orientation
Very relaxed view of time, time walks for them (instead of time flies)
Japanese and Time
Japanese believe time is very precious, must be used wisely
Vietnamese and time
Relaxed with time, value property more than time, spend time with people more important
Head of household in the Vietnamese family
The Vietnamese father is the head of the household, they communicate to healthcare provider, they interact with anyone outside the family unit
Hispanics and head of household
A Hispanic father is the head of the household, makes decisions regarding illness and treatment of family members
Grandmothers role in the Hispanic family
The grandmother in the extended hispanic family is consulted regarding child care
Arab families and the extended family
They rely on the extended family regarding illness and crisis
Navajo Indians and strangers
Navajo Indians do not like strangers near to their infant child, they believe the stranger will bewitch them
Latino and attention to their newborn
If a stranger, particularly a woman lavishes attention on the child but does not touch them, they believe the child will develop symptoms of the "evil eye"
Vietnamese and Korean re attention to their child
Vietnamese and Korean become upset if a newborn is admired at length for fear the the evil spirit will overhear and desire the infant
Hospitalization and and infant of Amish decent
Amish consider a child's admission to the hospital a family affair, with all members gathering
Samoan decent and hopitalization
They are willing to relinquish the child to the hospital
Native American Indians & communication
They emphasize periods of silence to formulate thoughts for speech. interruption, interjection, or haste to arrive
Level of comfort with space and hispanics
body space or distance, Hispanics tend to be closer
Level of comfort with space and Asians
Asians prefer a greater distance
Eye contact and different cultures
Anglos- direct eye contact, vietnamese-look away as a sign of respect, Native Americans-eye contact initially (unwavering eye contact as sign of disrespect and insulting), Asians-eye contact hostility
Hand shakes and cultures
Native Americans consider handshaking a sign of aggression, Anglos-a sign of good will
Cultures and questioning health care professionals
Asian cultures consider a sign of disrespect to question those who are viewed as persons of authority. Japanese family waits patiently rather than ask question, Criticisms can cause Asians to "lose face" feel ashamed
Expression of emotion in cultures
Hispanic and Jewish emotions are expressed openly, Nordic and Asian groups are more restrained
Use of hand outs in cultures
Use of handouts and booklets are uncommon in most cultures. It is considered inappropriate and taboo in Native American cultures
Health practicies in different cultures
curandero/curandera-Mexican-American (special healing powers), Asians-herbalist, acupuncturist, accupressure, moxibustion; Native Americans- Healers with specific skills, Native Hawaiians-kahunas (heal imbalance or disputes)
Hatian folk medicine and meconium
they believe it is essential to rid the body of meconium, a first food is prepared called lok, mixture of castor oil, grated nutmeg, sour orange juice, garlic, unrefined sugar and water. Given till stool changes from black to yellow
Purness model for cultural competence
provides essential information in the context of ethnic, racial and cultural responses to medication and compliance
Responses to medication by culture
Asian-Americans have increased sensitivity to beta blockers, African-Americans respond well to monotherapy for hypertension than do European-American
Not all languages have the future verb tense eg
Finnish and Chinese only have the present tense. One must interpret in the context, Instructions must be simple do not use you will/you should. eg take one pill at bedtime
Languages that convey thought in their words
American Indian dialect, Chinese and Vietnamese. Silence is considered important. Hasty response is considered rude
Volume of voices in culture
A-American, Euro-Americans, and Arabs speak in voice volume that may carry to those nearby
Tone of voice in culture
Because clients speak in loud voices do not mean they are angry, nor does speaking in a soft voice tone indicate that the person is not interested in the discussion
eye contact
Because many Asians/Pacific Islanders do not maintain eye contact with people does not mean that they are not interested or not listening to the conversation, they are demonstating respect for the person's status
Spatial distancing in cultures
Euro-Americans=maintain Approx. 18 to 24 inches; Germans may see this as a violation of personal space; Arabs and Hispanics stand very close to each other. Those who like space may withdraw if the nurse is too close, explain the reason for being so close
the quality or state of being connected with time or the world
Present oriented cultures
Portuguese, Haitians, Hispanics
Present oriented cultures and medications
the nurse may need to take extra time and stress the importance of taking the medication (future -oriented individuals are more likely to comply with prescription regimens)
Mexican-Americans and Brazilians re: time
Very relaxed, apts are flexible, expect to be seen if late, unstable with med. regimen
maintaining, relating to, or based on a belief that all people are, in principle, equal and should enjoy equal social, political, and economic rights and opportunities (a US value)
Assessessment in dark skinned people for oxygenation , cyanosis and jaundice
oxygenation: sclera, conjuntiva, bucal mucosa, tongue, lips, nail beds, palms and soles of the feet rather than relying on the skin tone; jaundice- examining the sclera for a yellow pigmentation
Greetings by cultures
Asians, Hispanics, Germans prefer to be addressed formally, the nurse should greet the client formally until told otherwise
cultures with extended family names
Hispanics and Koreans eg Including families last name in their name or not taking on the last name of the husband
1. increase effectiveness of: to improve the effectiveness of a drug or treatment, especially by adding another drug or agent
2. make something powerful: to make something potent or powerful
Hispanic and Arabic cultures and the sick role
Any reason is acceptable for being ill and the person is relieved of normal responsibilities
Germans and Polish people in the sick role
The are expected to carry out their obligations unless they are severely ill
Asian/Pacific Islanders and pain
Reluctant to express pain because they believe it is God's will or a punishment for past sins
Arabs and pain
openly expresses pain, expect to be relieved preferably by injectable or IV medications
Islamic women and health care providers
prefer health care providers of the same gender and may refuse tx from male
plant based remedy
Herbal monographs
therapeutic and qualitive
therapeutic monograph
contain info on use, dosage, side effects and contraindications
qualitative monographs
contains info on areas such as compliance with compounding guidelines and standards of purity
Aloe Vera
use to treat minor burns, insect bites, ans sunburn, treats dandruff, oily skin, and psoriasis. Also used as a laxative, can also cause increase in menstrual flow
popular tea for relief of degestive and GI complaints, irritable bowl syndrome, infant colic, allergic reaction can occur
Dong Qui
Woman's tonic, treats cramps and regulates mentrual cramps, Contains B12
Immune system enhancer, urinary and respiratory, flulike symptoms, not good for autoimmune problems
serotonin antagonist, a mediator of vascular headaches from platelets
lowers cholesterol, decrease blood pressure, reduces clotting capability, acts as an antibiotic, decrease triglyceride levels
boosts immune system, treats stomach ache and digestive disorders, including motion sickness, relieves pain,, swelling, stiffness of both osteorthritis and rheumatoid arhtritis
CNS effect, increasing both cerebral arterial dilation and uptake of oxygen and glucose, improves congnition
relieves stress, boost energy
treats congestion associated with common cold (can be toxic)
Kava Kava
promotes sleep and muscle relaxation
helps with chronic fatigue, ulcers, (side effects increase bp, headache, lethary, water retention, increase K+, rearely heart failure
Milk thistle
promotes liver function, treat hepatitis, cirrhosis and fatty liver associated with alcohol and drugs
reduces fever, clears congestion, restores energy
St John's Worts
Saw palmetto
treats for colds, asthma, bronchitis, thyroid dificiency
mild sedative and sleep inducing agent
Culture universals
commonalities of values, norms of behavior, and life patterns among different cultures
those values, beliefs and patterns of behavior that tend to be unique to a designated culture rather than share with members of other cultures
material culture
objects such as dress, art, religious artifacts or eating utensils and ways these are used
nonmaterial culture
beliefs, customs, languages and social institutions
a person who crosses two cultures, lifestyles and sets of values
fact or state of being different
ethnic group
shares a common social and cultural heritage that is passed on to successive generations
cultural identity/ethnicity
consciousness of belonging to a group the is differentiated from others by symbolic markers- eg culture
Health care practices and the elderly chinese
they prefer to use natural resources
diagreeing and the elderly chinese
the chinese elderly will not argue even if in disagreement to remain harmonious
Nurse role and the chinese elder in reference to heathcare
sensitivity and patience is important,allow them to express their thoughts, preserve harmony in the home by allowing the input of family members
Characteristics of culture
It is learned, taught, social, adaptive, satisfying, different to articulate and exists at many levels
culture than uses yin and yang
chinese (Holistic)
culture that uses hot and cold for illness
spanish (holistic)
stereotypical masculinity: an exaggerated sense or display of masculinity, emphasizing characteristics that are conventionally regarded as male, usually physical strength and courage, aggressiveness, and lack of emotional response
nonverbal communication
silence, touch, eye movement, facial expressions and body posture
Meaning of silence in culture
some cultures view silence as a sign of respect, others view silence as agreement. Nurse must be careful to distinguish which is appropriate for the culture being dealt with
Touching in cultures
Some cultures only certain elders are allowed to touch the head of an individual. Nurses should not touch someone's head without permission
Facial expression among cultures
Italian, Jewish, African American and Spanish-speaking persons- respond readily with a smile. English, Irish and Northern European tend to respond with less facial expression
a member of a people living in southern China and mainly remote areas of northern Laos, Thailand, and Vietnam
Getting pass spatial barrier in nursing
Explain procedure to patient carefully and then await permission
Death and dying practices with culture
a nurses role is to find out if there are special practices with certain cultures. eg gypsies if they are dying only members of that tribe can touch the body
Spiritual health or well being
feeling of being generally alive, purposeful and fulfilled
the denunciation or condemnation of something by religions eg diets by certain cultures, pork for instance with Jews and Muslims
Sacrament of the sick aka
Last Rites
Nursing Diagnosis for spirituality
Spiritual distress, Potential for enhanced spiritual well-being, fear related to apprehension about soul's future after death and unpreparedness of death, self-esteem disturbance related to failure to live with the precepts of one's faith, sleep pattern disturbance related to spiritual distress, ineffective coping related to feeling abandonment by God and loss of religious faith, decisional conflict related to conflict between treament and plan and spiritual beliefs
family values
system of ideas, attitudes and beliefs about the worth of an entity or concept that consciously or unconsciously bind together the members of the family in a common culture
family power
the potential or actual ability to change the behavior of other family members
Korean culture family power rest's with an elder
the grandfather
Addressing families where family power is dominant
Nurses must be careful not to just address a child independently, they will be perceived as being put in superiority, must include other family members (this can occur when the child is the interpreter)
family roles commonly encountered
breadwinner, homemaker, nuturer, social planner, peacemaker
family assessment
collection of data regarding the family's current level of functioning, support systems, sociocultural information, environmental information, type of family, family structure, and needs
the gradual acceptance by a person or group of the standards and practices of another person or culture (culture is learned)
a change in the cultural behavior and thinking of a person or group of people through contact with another culture (adopt a new cultural norm)
Importance of male in chinese and middle eastern countries - child bearing woman
child bearing woman is held in a higher status when pregnant especially if the child is male
Procreation and Jewish culture
It is the man's responsibility to procreate, the woman is not obligated, the health of the woman comes first
superstition and south east Asian pregnant women
SE Asian women avoid sitting in doorways and steps for fear that they may have a complicated birth (they avoid areas near doors in waiting rooms and exam rooms)
superstition and Vietnamese pregnant women
lifting the arms above the head is prohibited to prevent increase risk of preterm birth, they do not lie or sit for prolonged periods this might cause an oversized baby, these women also avoid wind and drafts, by eating creamy oil and other heavy foods, go to sleep early and wake up early, they avoid stimulants and stress and hydrate well
superstition and Mexican American culture in child bearing women
bad air is related to evil spirits, this air may enter the body and cause illness. Windows are kept closed, or a heal covering is worn
Latinos and superstion in pregnancy or childbirth
Latinos may place a raisin on the cord stump of newborn to prevent drafts from entering the baby's body
Muslim taboo: naming the child
this is not done till after childbirth and to ensure the first word the baby hears is a word from God
Taboo in West Africa- ward off evil
mud is put on the face of a baby then they are called ugly names to ward off evil spirits, pregnant women are prohibited from participating in ceremonies
represents the female, passive principle - darkness, cold and wetness
is the masculine active principle- light heat and dryness
SE Asians and hot and cold
Women are encouraged to keep warm, because blood which is considered hot is lost, so becoming at risk for cold, cold drinks and food are avoided
Indegenious healers in Mexican American cultures
partera-midwifes are utilized during pregnancy and in labor
Cutural norms regarding feeding
Hispanic women believe newborns should have supplemental feeding, they refuse to nurse until milk is established
Hispanics and introduction of solids
Newborns as young as two weeks are introduced with solids in formula, the nipples are enlarged to accomodate this
Reasons why solids are added early in Hispanics
If young women do not follow the custom they may seem unfit mothers, these foods are also added to prepare them for these foods later, food is very important part of the culture, when there are celebrations q one is expected to participate and eat equally
content of health history
biographical data, chief complaint, present health concern/present illness, past history, family history, review of systems, patient profile
patient profile
past life events related to health, education and occupation, environment physical, spiritual, cultural, interpersonal) Lifestyle (patterns and habits), presence of physical or mental disability, self-concept, sexuality, risk for abuse, stress and coping response
past life events
early childhood of pt, where they live right now,(the interviewer is encouraging the person to make a quick review of his or her earlier life to share anything that is significant eg. cricis, abuse failure etc
Education and occupation
"tell me about your job", asking also, what educational req. were needed for the particular job, instead of asking did you graduate from high school is much more sensative.
physical- living (type of housing, neighborhood )spiritual-extent to which religion is part of life, interpersonal-ethnic background, (language spoken, family relationships, folk practices
provide info on health related behaviors
complete physical examination
skin, neck and head, thorax and lungs, breasts, cardiovascular system, abdomen, rectum, genitalia, neurologic system, musculoskeletal system
basic tools for physical exam
vision, hearing, touch and smell
4 fundamental techniques used in the physical exam
inspection, palpation, percussion and auscultation
Physical assessment
inspection-posture and stature, body movements, nutrition status -(obese, muscle wasting), speech-slurred, drooping etc, VS
abdominal assessment
when the abdomen is examined, auscultation is performed before palpation and percussion to prevent altering bowel sounds
sounds in the body
tympany, hyperresonance, resonance, dullness and flatness
drumlike sound produced by percussing the airfilled stomach
audible when one percusses over inflated lung tissue in someone with emphysema
sound elicited over air-filled lungs
percussion of the liver
percussion of the thigh
703x weight in pounds /height in inches(2) squared 703x205/67 (2)=32
biochemical assessment
reflects both the tissue level of a given nutrient and any abnormality of metabolism in the utilization of nutrients
serum needed for biochemical assessment
serum protein, serum albumin and globulin, transferrin, retinolobinding protein, hemoglobin, serum vitamin A, carotene, and vitamin C, and studies of urine (creatinine, thiamine, riboflavin, niacin, and iodine)
Low serum and albumin and transferrin levels
measures protein deficits, in adults and are expressed as percentages, they are only detected when there is severe malnutrition
Albumin synthesis depends on
normal liver function and adequate supply of amino acids,
Reasons for decreased albumin levels
overhydration, liver or renal disease, and excessive protein loss b/c/o burns, major surgery, infectiona and cancer
protein that binds and carries iron from the intestine through the serum
creatinine/height index
a 24hour urine sample is obtained, and the amt. of creatinine is measured and compared to normal ranges based on the pt's height and gender. Values less than normal may indicate loss of lean body mass and protein malnutrition.
Factors associated with potential nutrtional deficits
dental and oral problems, npo for diag. tests, prolonged use-glucose,saline IV fluids, N/V, stress of illness, wound drainage, pain, fever, GI intubation, Tube feedings, GI disease, ETOH, depression, eating disorders, medications, imobilization
group of people whose physical or cultural characteristics differ from the majority of people in a society.
transcultural nursing
a term used interchangeably with cross-cultural, or multicultural nursing, refers to a formal area of study and practice that focuses on the cultural care values, beliefs and practices of individuals and groups from a particular culture
culture care accomodations
refers to those professional actions and decisions that a nurse makes in his or her care to help people of a designated culture achieve a beneficail or satisfying health outcome.
culture care restructuring
(repatterning) refers to those professional actions and decisions that help patients reorder, change, or modify their lifestyles toward new, different, or more beneficial health care patterns.
cultural blindness
is the inability of a person to recognized his or her own values, beliefs and practices and those of others b/c/o strong ethnocentric tendencies
cultural competent nursing
refers to the complex integration of attitudes, knowldge, and skills (including assessments, decision making, judgements, critical thinking, and evaluation) that enables the nurse to provide care in a culturally sensitive and appropriate manner.
cross cultural communication- efforts to change the subject
This could indicate that the patient does not understand what you are saying and is attempting to talk about something more familiar
cross cultural communication-abscence of questions
paradoxically this often means that the listener is not grasping the message and therefore has difficulty formulating questions to ask
cross cultural communication-inappropriate laughter
a self-conscious giggle may signal poor comprehension and may be an attempt to disguise embarrassment
cross cultural communication-nonverbal cues
although a blank expression may signal poor understanding, among some Asian Americans it may reflect a desire to avoid overt expression of emotion. Similarly, avoidance of eye contact may be a cultural expression of respect for the speaker; some Native Americans and Asian Americans use this gesture
Native Americans and eye contact
Native A. stare at the floor during conversations, a cultural behavior conveying respect and indicating that the listener is paying close attention to the speaker

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