SCHOOL OF NURSING RN-BSN PROGRAM

COLLEGE  OF  HEALTH  AND URBAN AFFAIRS

COURSE DESCRIPTION

GENERAL INFO REQUIREMENTS

SCHEDULE DUE DATES

RN-BSN MAIN PAGE

Transition to Professional Nursing
CULTURE AND CULTURAL COMPETENCE  

To e-mail the instructor  phillips@fiu.edu

CLASS HANDOUT  

DEFINITIONS
Culture is the learned, shared and transmitted values, beliefs, norms, and lifeway practices of a particular group that guide thinking, decisions, and actions in patterned ways.

• Cultural identity—the sense of being part of an ethnic group or culture.

• Culture-universals—commonalities of values, norms of behavior, and life patterns that are similar among different cultures.  

• Culture-specifics—values, beliefs, and patterns of behavior that tend to be unique to a designated culture.   
  

• Material culture—refers to objects (dress, art, religious artifacts)

• Non-material culture—refers to beliefs, customs, languages, social institutions.  
  

• Subculture—composed of people who have a distinct identity but are related to a larger cultural group. 

• Bicultural—a person who crosses two cultures, lifestyles, and sets of values.  
  

• Diversity—refers to the fact or state of being different.  Diversity can occur between cultures and within a cultural group.

• Acculturation—individuals who have taken on, usually observable, features of another culture.  People of a minority group tend to assume the attitudes, values, beliefs, and practices of the dominant society resulting in a blended cultural pattern.   

• Cultural shock—the state of being disoriented or unable to respond to a different cultural environment because of its sudden strangeness, unfamiliarity, and incompatibility to the stranger’s perceptions and expectations.
  

• Ethnic—refers to a group of people who share a common and distinctive culture and who are members of a specific group.

• Ethnicity—a consciousness of belonging to a group that is differentiated from others by symbolic markers (culture, biology, territory, religion).

• Ethnic groups share a common social and cultural heritage that is passed on to successive generations. 

• Ethnic identity—refers to a subjective perspective of the person’s heritage and to a sense of belonging to a group that is distinguishable from other groups. 

• Race—the classification of people according to shared biologic characteristics, genetic markers, or features.   Not all people of the same race have the same culture.  

CHARACTERISTICS OF CULTURE

• Culture is learned.

• Culture is taught.

• Culture is social.

• Culture is adaptive.

• Culture is satisfying.

• Culture is difficult to articulate.

• Culture exists at many levels.

COMPONENTS OF CULTURE

• Language.

• Art and music.

• Values systems (beliefs, morals, rules).

• Religion, influencing dietary restrictions, contraception, blood transfusions, death-related practices (autopsy, organ donation, cremation, prolonging life).

• Philosophy.

• Family interactions and patterns.

• Communication styles.

• Patterns of behavior.

• Prenatal care, childbirth and childrearing practices.

• Rituals or ceremonies.

• Recreation and leisure activities.

• Festivals and holidays.

• Nutrition and food preferences.

• Health and illness practices.

• Attitudes about touch, territory and privacy.

• Time and space orientation.

• Pain responses.

• Role of men and women.

CULTURE AND NURSING
Transcultural nursing—the study of different cultures and subcultures with respect to nursing and health-illness caring practices, beliefs, and values. 

Cultural awareness—the conscious and informed recognition of the differences and similarities between different cultural and ethnic groups.

Cultural sensitivity—the respect and appreciation for cultural behaviors based on an understanding of the other person’s perspective.

Cultural competence—is the knowing, utilizing and appreciating the culture of another in assisting with the resolution of a problem.  Nurses who are culturally competent:

• Work within the cultural belief system of the client to resolve health problems.

•  Gather data about the client’s personal and cultural views regarding health and illness.

• Avoid stereotyping clients by cultural norms.

• Consider the client’s world and experiences when developing care plans.

Ethnorelativity—ability to appreciate and respect viewpoints different from one’s own.

CULTURE AND HEALTH CARE
Types of health care systems

• Indigenous health care system—refers to the traditional folk health care methods.  Often viewed as 
  more humanistic than the professional health care system.

• Professional health care system—refers to a structured system maintained by individuals engaged in a 
  formal program of study.  Goal of health care is to use the best of both systems and that health professionals need to consider ways to interface with the two systems for the benefit of clients.

TYPES OF HEALTH CARE BELIEFS
Magico-religious health belief view

• Health and illness are controlled by supernatural forces.

• Getting well is dependent on a Supreme Being’s will.

• May view illness as possession of an evil spirit and require magical treatments to get well.

Biomedical health belief view

• Life processes are controlled by physical and biochemical processes that can be manipulated by humans.

• Illness is caused by viruses, bacteria, or a breakdown of the human machine, and a pill, treatment or surgery will cure the problem.

Holistic health belief view

• The forces of nature must be maintained in balance or harmony, and when the natural harmony or balance is disturbed, illness results.

• Native American, Chinese, and Spanish cultures all have beliefs related to balance or harmony (the Medicine Wheel, yin-yang, hot-cold).

MODEL OF TRANSCULTURAL HEALTH CARE
Sunrise Model (Leininger, 1991)
Emphasizes that health and care are influenced by elements of the cultural and social structural dimensions which are addressed within environmental contexts, language expressions, and ethnohistory:

• Technological factors  

• Religious and philosophical factors  

• Kinship and social factors  

• Cultural values and lifeways  

• Political and legal factors

• Economic factors  

• Educational factors  

• Health care expressions, patterns and practices are integral parts of the cultural and 
  social structure dimensions.

CULTURALLY SENSITIVE CARE
To become culturally sensitive, it is important to:

• Become aware of one’s own cultural heritage.

• Become aware of the client’s culture as described by the client.

• Become aware from the client of adaptations made to live in a North American culture.

• Form a nursing care plan with the client that incorporates his/her culture.

BARRIERS TO CULTURAL SENSITIVITY
Ethnocentrism

• Refers to an individual’s belief that his or her culture’s beliefs and values are superior to those of other cultures.

• In health care, ethnocentrism means that the only valid health care beliefs and practices are held by the health care culture.

Stereotyping

• Assuming that all members of a culture or ethnic group are alike.

• May be unrelated to reality and an outcome or racism or discrimination.

Prejudice

• A strongly held opinion (positive or negative) about some topic or group of people.

Discrimination

• The differential treatment of individuals or groups based on categories such as race, ethnicity, gender, social class, or exceptionality.

Racisim

• A form of discrimination related to ethnocentrisim where a person believes that race is the primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race.  
  

CONVEYING CULTURAL SENSITIVITY

• Always address clients by their last names unless given permission otherwise.

• When meeting for first time, introduce yourself by name and position.

• Be authentic.  Share your lack of knowledge about their culture. 

• Use language that is culturally sensitive.

• Find out what the client knows about his/her health problems and treatments, and whether this information is congruent with dominant or traditional health care systems. 

• Do not make assumptions; ask if you don’t know or understand.

• Respect the client’s values, beliefs and practices, even if different or you don’t agree.

• Show respect for the client’s support people; they may also make the decisions.

• Make a concerted effort to obtain the client’s trust; however, it may come slowly or not at all.

PROVIDING CULTURALLY COMPETENT CARE
Use:

• Cultural care preservation and/or maintenance.

• Cultural care accommodation and/or negotiation.

• Cultural care re-patterning or restructuring of nursing care.

Nurses should:

• Learn the rituals, customs and practices of the major cultural groups they care for, appreciate the richness of diversity, and view them as an asset rather than a hindrance to practice.

• Identify personal biases, attitudes, prejudices, and stereotypes.

• Incorporate cultural practices into care. 

• Recognize that cultural symbols and practices can often bring comfort.

• Include a cultural assessment of the client and family as part of the overall assessment.

• Recognize that is the client’s or family’s right to make their own health care choices.

• Provide the services of an interpreter if one is needed.

• Convey respect and cooperate with traditional healers and caregivers.