Transcript (2) Community and family cultural assessment - Home

Clinical Application for Community Health Nursing (NUR 417)
Community and family
cultural assessment
Lecture 2
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Objectives
After reading this lecture, the students should
be able to understand the following:
 Explain the concept of culturally sensitive
psychosocial nursing care.
 Discuss factors to consider when assessing
culture and ethnicity in patients and their
families.
 Consider treatment approaches to patients in
various cultural and ethnic groups..
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Introduction
 Culture is defined as a configuration of learned behaviors
and beliefs that are shared and transmitted in a society
and by a particular group of people.
 Culture is a system of beliefs, behaviors, and symbols that
are learned, shared, and passed on through generations of
a social group.
 Culture influences what people perceive, it guides their
interactions, and it can change over time.
 Culture describes a particular society’s entire way of living.
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Definition
Culturally competent nursing care is defined
as being sensitive to issues related to culture, race,
religion, gender, sexual orientation, and social or
economic class.
Cultural competence implies not only awareness of
cultural differences but also the ability to assess and
intervene appropriately and effectively.
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Cultures can be compared using six phenomena that
vary with application and use, yet are seen across
all cultural groups:
1.
2.
3.
4.
5.
6.
Communication
Space
Social organization
Time
Environmental control
Biological variations
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1. Communication
This refers to all verbal and nonverbal behavior in the
presence of another. Communication has its roots in
culture. Cultural mores, norms, ideas, and customs are all
expressed through communication.
The nurse who cares for diverse patients must have an
understanding of the client’s needs and expectations as
expressed through their communication and culture.
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2. Space:
 This element of culture refers to territoriality,
density, and distance. It relates to how space is
controlled, used, and defended.
 Three interpersonal dimensions of space in
Western culture have been identified:
 the intimate zone (0–18 inches) (0-45cm)
 the personal zone (18–36 inches) (45-90cm)
 the social zone (3–6 feet) (90-180cm)
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3. Social organization
Cultural behaviors are acquired through
social interactions in groups such as
families, religious groups, and ethnic
groups. This process of learning cultural
values is called acculturation.
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4. Time :
Awareness of time is learned gradually. Some
cultures place great importance on
punctuality and efficiency, whereas others
ignore the clock.
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5. Environmental control
 This element has to do with the degree to which
individuals perceive they have control over their
environment.
 Persons from various cultures have different beliefs
about how much they can influence events in their
lives.
 To provide culturally appropriate care, nurses should
respect the individual’s unique beliefs while
understanding how these beliefs can be used to
promote health in the patient’s environment.
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6. Biological variations:
This element refers to biological differences in people
from various racial and ethnic groups, such as body size
and shape, skin and hair color, physiologic responses to
medications, susceptibility to disease, and nutritional
preferences. A new field called ethnopharmacology is
addressing different responses to medications.
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CULTURAL ASSESSMENT
 A cultural assessment helps the nurse gather and use
other information related to culture that is vital in
providing culturally sensitive care.
 The nurse must be aware that beliefs about health
and the causes of illness, appropriate care, and who
should provide that care, can differ among cultures.
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CULTURAL ASSESSMENT
 Cultural assessment may take several hours. The list of
questions (in the next 2 slides) can provide a brief but
helpful focus for a relevant cultural assessment.
Answers to these questions do not guarantee culturally
competent care, but nevertheless good care cannot be
provided without specific cultural and ethnic
information
 When patient and health-care professionals are from
different cultures, questions must be asked that
respectfully acknowledge differences and build trust
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Cultural Assessment—Questions to Ask
 Where was the patient born? If an immigrant, how long in this
country?
 What is the patient’s ethnic affiliation, how strong is the ethnic
identity?
 Who are the patient’s major support people? Does patient live in
an ethnic community?
 Who in the family takes responsibility for health concerns and
decisions?
 Any activities in which the client may decline to participate
because of culture, religious taboos?
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Cultural Assessment—Questions to Ask
 Any special food preferences, food refusals because of culture,
religion?
 What are the primary and secondary languages, speaking and reading
abilities?
 What is patient’s religion, its importance in daily life, current practices?
 What is the patient’s economic situation, is income adequate for
needs?
 What are the patient’s health beliefs and practices?
 What are patient’s perceptions of health problem and expectations of
health care?
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 Ethnocentrism is defined as the belief that one’s
own cultural beliefs and health-care practices
are superior to those of other cultures.
 To provide quality care to all individuals, nurses
must be sensitive to patients’ cultural
differences and as aware as possible of their
own cultural beliefs and behaviors
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 Culture often influences what a patient
believes about his or her illness, its causes, and
when and from whom to seek care.
 Although you may not be able to be aware of
the specific beliefs of every culture, having
some general information about the culture
and ethnicity of patients for whom you
frequently care for is important.
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Enhancing Cultural Sensitivity
• Be aware of your own ethnocentrism.
• Be aware of your own prejudices that may influence your
assessment.
• Maintain an open mind and seek out more information
about your patient’s
culture, beliefs, and values.
• Communicate your interest about the patient’s beliefs and
values.
• Approach each patient as an individual. Avoid assuming
people from one
cultural background all hold the same beliefs
.
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Respect the role of the family in the patient’s treatment. In some
cultures, the family is responsible for protecting the patient,
especially when the patient is the parent. In their role, family
members may want to protect the patient from bad news. This may
be contrary to your own belief in patient autonomy and, therefore,
may lead to conflicts between the health-care providers and the
family.
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CULTURAL AND ETHNIC INFLUENCE ON
COMMUNICATION
• Verbal and nonverbal communication patterns are closely
tied to cultural beliefs and practices.
• Eye contact, hand gestures, facial expressions, and
personal space, as well as how words or slang are used
and what can be discussed, are defined by our culture and
environment.
• For many people, eye contact indicates honesty, openness,
and alertness. However, people in some cultures do not
value eye contact and, in fact, even avoid it.
• Some nonverbal behaviors such as facial expressions,
hand gestures, and social distance vary among
cultures.
• Also, some patients may be extremely uncomfortable
when asked intimate, very personal questions, no
matter how accepting and professional the nurse
may be. If this information is vital to patient care,
efforts need to be made to explain how the
information will be used