Transcript 07 Cultural Diversity and Community Oriented Nursing Practice

The Cultural Aspects of
Community Nursing Practice
By SYDORENKO OKSANA,
MD, PhD
Lecture objectives:
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Define and explain the concept of culture.
Discuss the meaning of cultural diversity and
its significance for community health nursing.
Discuss the importance of cultural
competence to community health nursing.
Discuss barriers to developing cultural
competence.
" Community health nurses must assist ill
persons from various cultures - over time- to
adjust to alterations in health states, adopt
individual and family behaviors to improve
health status and develop health promoting
patterns."
CULTURE
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SOME DEFINITIONS
 Culture refers to the cumulative deposit of knowledge, experience,
beliefs, values, attitudes, meanings, hierarchies, religion, notions of
time, roles, spatial relations, concepts of the universe, and material
objects and possessions acquired by a group of people in the
course of generations through individual and group striving.
 Culture is the systems of knowledge shared by a relatively large
group of people.
 Culture is communication, communication is culture.
 Culture in its broadest sense is cultivated behavior; that is the
totality of a person's learned, accumulated experience which is
socially transmitted, or more briefly, behavior through social
learning.
 A culture is a way of life of a group of people--the behaviors, beliefs,
values, and symbols that they accept, generally without thinking
about them, and that are passed along by communication and
imitation from one generation to the next.
 Culture is symbolic communication. Some of its symbols include a
group's skills, knowledge, attitudes, values, and motives. The
meanings of the symbols are learned and deliberately perpetuated
in a society through its institutions.
THEORY OF CULTURAL
DETERMINISM
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The position that the ideas, meanings, beliefs and values people learn
as members of society determines human nature. People are what they
learn. Optimistic version of cultural determinism place no limits on the
abilities of human beings to do or to be whatever they want. Some
anthropologists suggest that there is no universal "right way" of being
human. "Right way" is almost always "our way"; that "our way" in one
society almost never corresponds to "our way" in any other society.
Proper attitude of an informed human being could only be that of
tolerance.
The optimistic version of this theory postulates that human nature being
infinitely malleable, human being can choose the ways of life they
prefer.
The pessimistic version maintains that people are what they are
conditioned to be; this is something over which they have no control.
Human beings are passive creatures and do whatever their culture tells
them to do. This explanation leads to behaviorism that locates the
causes of human behavior in a realm that is totally beyond human
control.
CULTURAL RELATIVISM
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Different cultural groups think, feel, and act differently. There is
no scientific standards for considering one group as intrinsically
superior or inferior to another. Studying differences in culture
among groups and societies presupposes a position of cultural
relativism. It does not imply normalcy for oneself, nor for one's
society. It, however, calls for judgment when dealing with groups
or societies different from one's own. Information about the
nature of cultural differences between societies, their roots, and
their consequences should precede judgment and action.
Negotiation is more likely to succeed when the parties concerned
understand the reasons for the differences in viewpoints.
CULTURAL ETHNOCENTRISM
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Ethnocentrism is the belief that one's own culture is superior to that
of other cultures. It is a form of reductionism that reduces the
"other way" of life to a distorted version of one's own. This is
particularly important in case of global dealings when a company or
an individual is imbued with the idea that methods, materials, or
ideas that worked in the home country will also work abroad.
Environmental differences are, therefore, ignored. Ethnocentrism,
in relation to global dealings, can be categorized as follows:
Important factors in business are overlooked because of the
obsession with certain cause-effect relationships in one's own
country. It is always a good idea to refer to checklists of human
variables in order to be assured that all major factors have been at
least considered while working abroad.
CULTURAL ETHNOCENTRISM
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Even though one may recognize the environmental differences
and problems associated with change, but may focus only on
achieving objectives related to the home-country. This may result
in the loss of effectiveness of a company or an individual in terms
of international competitiveness. The objectives set for global
operations should also be global.
The differences are recognized, but it is assumed that associated
changes are so basic that they can be achieved effortlessly. It is
always a good idea to perform a cost-benefit analysis of the
changes proposed. Sometimes a change may upset important
values and thereby may face resistance from being implemented.
The cost of some changes may exceed the benefits derived from
the implementation of such changes.
MANIFESTATIONS OF CULTURE
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Cultural differences manifest themselves in different ways and
differing levels of depth. Symbols represent the most superficial
and values the deepest manifestations of culture, with heroes
and rituals in between.
 Symbols are words, gestures, pictures, or objects that carry a
particular meaning which is only recognized by those who share
a particular culture. New symbols easily develop, old ones
disappear. Symbols from one particular group are regularly
copied by others. This is why symbols represent the outermost
layer of a culture.
 Heroes are persons, past or present, real or fictitious, who
possess characteristics that are highly prized in a culture. They
also serve as models for behavior.
 Rituals are collective activities, sometimes superfluous in
reaching desired objectives, but are considered as socially
essential. They are therefore carried out most of the times for
their own sake (ways of greetings, paying respect to others,
religious and social ceremonies, etc.).
MANIFESTATIONS OF CULTURE
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The core of a culture is formed by values. They are
broad tendencies for preferences of certain state of
affairs to others (good-evil, right-wrong, naturalunnatural). Many values remain unconscious to
those who hold them. Therefore they often cannot
be discussed, nor they can be directly observed by
others. Values can only be inferred from the way
people act under different circumstances.
Symbols, heroes, and rituals are the tangible or
visual aspects of the practices of a culture. The true
cultural meaning of the practices is intangible; this is
revealed only when the practices are interpreted by
the insiders.
Manifestation of Culture at Different
Levels of Depth
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Cultural groups may have unique
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1) family structure
2) values and attitudes,
3) language,
4) arts,
5) child-rearing, and
6) religion and traditions.
Cultural Groups
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Traditional cultural groups that have more economic
difficulties, poorer health, and less accessibility to
health care than other groups include:
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African Americans
Asians
Hispanics
Native Americans
Migrant Workers
Refugees
A Value
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What is a value?
"A culturally prescribed criterion by which
individuals evaluate persons, behaviors,
objects, and ideas as to their relative
morality, desirability, merit, or correctness."
"conceptions of what is desirable; . . . the
underlying assumptions by which individual
and social goals are chosen."
Dominant Values
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The beliefs and sanctions of the dominant or majority
culture are called dominant values.
In the United States, the majority culture is made up
largely of Anglo-Saxons whose dominant values
include
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the work ethic,
thrift,
success,
independence,
initiative,
respect for others,
privacy,
cleanliness,
youthfulness,
attractive appearance, and
a focus on the future.
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Americans once expected
parents to raise their children in
accordance with the dominant
cultural messages. Today they
are expected to raise their
children in opposition to them.
Once the chorus of cultural
values was full of ministers,
teachers, neighbors, leaders.
They demanded more
conformity, but offered more
support. Now the messengers
are violent cartoon characters,
rappers and celebrities selling
sneakers. Parents are
considered “responsible” only if
they are successful in their
resistance. That’s what makes
child-raising harder. It’s not just
that American families have less
time with their kids; it’s that we
have to spend more of this time
doing battle with our own
culture.
Ellen Goodman
Dominant Values
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Dominant Values in American Society: An
Exploratory Analysis.
http://eric.ed.gov/ERICWebPortal/custom/port
lets/recordDetails/detailmini.jsp?_nfpb=true&
_&ERICExtSearch_SearchValue_0=ED1285
02&ERICExtSearch_SearchType_0=no&acc
no=ED128502
Dominant Values
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Dominant values are important to consider in the
practice of community health nursing because they
shape people’s thoughts and behaviors.
Why are some client behaviors acceptable to health
professionals and others not?
Why do nurses have such difficulty persuading
certain clients to accept new ways of thinking and
acting?
Explanations can be found by examining the
concept of culture, especially its influence on health
and on community health nursing practice.
Racial and Ethnic Health Disparities
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The Department of Health and Human
Services has an initiative to combat the health
care disparities based on race and ethnicity.
President Clinton asked for $400 million over
five years to support public-private
collaborative efforts, led by HHS, to close the
gaps between racial and ethnic populations
and white Americans in six health categories
where disparities are recognized.
Racial and Ethnic Health Disparities
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Those areas are
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infant mortality,
cancer screening and management,
cardiovascular disease,
diabetes,
HIV/AIDS infection rates, and
child and adult immunizations.
The Department of Health and Human
Resources has committed to eliminating the
gaps in theseareas by 2010 with interim
goals set for 2000.
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President Clinton's radio address to the
nation, February 21, 1998, in which he talks
about steps being taken to bridge the health
care disparity gap.
http://raceandhealth.hhs.gov/radio-ad.htm
Initiative to Eliminate Racial and Ethnic
Disparities in Health of HHS
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http://raceandhealth.hhs.gov/
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Other variations among cultural groups (as
far as organizational factors) include:
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Communication
Space
Social Organization
Time
Environment control
Biological variations
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Cultural competence in Nursing Care
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1) Care is designed for the specific client.
2) Care is based on uniqueness of the person's
culture (norms and values).
3) Care includes empowerment strategies fascilitates client decision making in health behavior.
4) Care is provided with sensitivity to cultural
uniqueness.
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In a brief cultural assessment nurses ask clients about their
ethnic background, religious preference, family patterns,
food patterns, and health practices.
ASSIGNMENT 1: Exploring Your Own
Cultural Background
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1. What ethnic group, socioeconomic class,
age group and community do you belong to?
2. What about your ethnic group,
socioeconomic class, religion, age or
community do you wish to change?
3. What experiences have you had with
people different from you?
4. What were those experiences like and how
did you feel about them?
ASSIGNMENT 1: Exploring Your Own
Cultural Background
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5. What is there about you that might cause
you to be rejected by members of other
cultures or ethnic groups?
6. Where and how was knowledge about your
heritage passed on to you?
7. Who are the persons in your network
responsible for influencing and shaping the
lives of young people?
ASSIGNMENT 2: Cultural Awareness and
Health Considerations
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To complete this assignment successfully,
you should:
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Study the assignment carefully
Remember back to your childhood and a
significant episode of being ill and answer
these questions:
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1. Who decided what was wrong with you?
ASSIGNMENT 2: Cultural Awareness and
Health Considerations
2. What were the interpretations of your symptoms?
3. Who made the decision about what to do for you?
4. Did the meanings of your symptoms and who was consulted have
anything to do with the selected treatments?
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Now, think about your parents or whomever raised
you. How would they respond if they were
diagnosed with cancer?
5. What would be the condition's influence on their ADL's including
work?
6. Would the person complain?
7. How would offers of help be received?
8. How would pain/discomfort be expressed?
9. What remedies would be used to alleviate pain or discomfort?
Nursing Participatory Paradigm: A Pine
Ridge Illustration
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http://www.youtube.com/watch?v=edtAQtxIB
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http://www.youtube.com/watch?v=_mShsTOv
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Essay Response to "A Pine Ridge
Illustration" Video: write a two-page essay on
your response to the video.
That’s all falks!