Cultural Diversity

Cultural Diversity ELDER Project Fairfield University School of Nursing African American Culture Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Objectives: Upon completion of this session, the participants will be able to …. • Discuss the role of religion, traditional health care beliefs, social values, and family structure of African Americans and the impact these factors have on health care. • Identify specific culturally sensitive practices that can be incorporated into your work with African American patients. • Examine historical influences that shape the attitudes of some African Americans in relation to current day healthcare. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Introduction: • Today the African American population is comprised of individuals of mixed ethnicity and cultural heritage. The slave trade brought people from Africa to many parts of the world, including the West Indies, South America, Central America and the United States. In America, intermixing has been largely with American Indians and European Americans. • The African American population is an extremely varied group on almost any dimension, including income, profession, location, religion and education. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Introduction: • Many are low income, but there are very large and growing segments in the middle and upper income categories. • Some are retired professionals; many others have children with professional careers. • Education levels vary from almost no years of school to doctorates. • While many in their 70s and 80s are dependent on care from children, grandchildren or fictive kin, others are raising grandchildren or great-grandchildren. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Communication: • The use of formal titles such as Mr., Ms. or Miss is used to show respect and establish ease and rapport. • For example, many people will refer to a teacher as Ms. or Miss Monica • Oral communication is viewed as more important than written communication. • Acceptable nomenclature of this culture group includes African American, Black American or People-of-Color. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Family and Social Structure: • Family supports behavior grounded in respect for each generation. • High levels of respect for the elderly can be related to ancestral worship: the belief that older adults are closest to their ancestors. • High levels of social interaction and strong emotional bonds exist between the elderly and their extended families. • Quality of life and life satisfaction are enriched by contact with family and friends. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Family and Social Structure: • Intergenerational family support and support from the extended family is the hallmark of healthcare in the African American community. • These intergenerational and interfamily relationships take precedence and are of high importance. As a result, one may see many family members visiting and or being involved in care. • Family members support each other in healthcare rather than formal support providers. The family is primarily supported by family, church and community. • Care giving for relatives is a traditional female role and considered an act of love. • One primary caregiver becomes the sole decision-maker. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture View of Illness: • Good health is viewed as a state of individual well being and sustained through internal bodily processes and life style choices. This includes good health practices like exercise and diet and being in harmony with nature. • Illness can be viewed as an expression of divine punishment for sinful behaviors; others consider illness a result of exposure to cold air or various environmental impurities. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture View of Illness: • Three types of illnesses: • Natural illnesses - the result of a physical cause, such as an infection, disease, weather, or environmental factors. They are generally treated with herbs, barks and teas. • Occult illnesses - the result of supernatural forces, such as evil spirits, not physical causes. • Spiritual illnesses - the result of willful violation of sacred beliefs or of sin, such as adultery, theft or murder. They are treated by the power of God through religious healers. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Folk Medicine: • Use of home remedies, such as salves, teas, herbs and over-the-counter medications for self treatment before seeking medical advice. • Use of faith or spiritual healers (vessels through which divine will is manifested) • Two types of healers: • Those who learned the ability to heal from others. • Those who receive the gift of healing and operate through the laying on of hands, prayer and incantations. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Folk Medicine: • Traditional healers believe spiritual forces can intervene in human affairs to influence sustaining and restoring the health of an individual. • Root and herb doctors are types of conjurers (magician) • They can put a hex or induce illness or ward off evil. • They are also sought to change a person’s luck especially in interpersonal relationships. • It is believed that roots have magical powers and take many forms. • Others use more of a crisis oriented approach to healthcare services, such as using the emergency room instead of a primary care provider. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Time Orientation: • While it will vary from individual to individual, lower socioeconomic class African Americans tend to have a present time orientation. • This does not mean that they do not recognize the past or the future, but that living in the present is more important to them. • For example, African Americans are more likely to say "I'll see you" than "I'll see you tomorrow." The former implies the future but is not specific. The future arrives in its own time. From this point of view, one cannot be late. Conflict may occur in interactions with others for whom time is very specific. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Time Orientation: • African Americans with a present-time orientation may not see the need to take preventative medication (e.g. for hypertension) or to finish antibiotics when symptoms disappear. Detailed explanations may be particularly important. • Another result of a present time orientation is that some individuals may delay seeing a physician until symptoms are severe, and begin interfering with their work or life. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Dietary Habits: • African American food is diverse and flavorful. • There are many dietary similarities to the Puerto Rican, Haitian, Dominican and all Caribbean cultures; this is primarily due to the slave routes as described previously. • Many popular foods in the African American diet are directly associated with foods in Africa. • African yams are very similar to American sweet potatoes. • White rice is popular in West Africa and has remained a staple food of the African American. • Okra, sesame seeds, peanuts and black-eyed peas were also brought to this country. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Dietary Habits: • Popular term for African American cooking is “soul food”. • “Soul food” traditionally represents Southern roots and African American ancestral experience. • Many of these foods are rich in nutrients, such as • Collard greens, legumes, beans, rice, potatoes • Other parts of the diet are low in fiber, calcium and potassium and high in fat. • Soul food typically involves fried foods and fatty meats prepared with rich gravies and sweetened with molasses. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Dietary Habits: • African Americans have dietary preferences born from cultural influences and necessity. • African Americans associate their foods with social interactions and their history of slavery. Food is about preserving cultural traditions and fostering strong familial ties. • Efforts to get them to change their dietary habits are perceived as efforts to eradicate the Black culture. • Their diet has contributed to increased rates of obesity and cardiovascular disease. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Religious Beliefs: • Black religion provides significant insights into the social condition of black people in U.S. society. Black churches function as centers of social life, ethnic identity and cultural expression in the African American community. • African Americans practice a variety of religions such as Protestantism, Catholicism and Islam. • Religion, reading religious materials, listening to religious programs and prayer are important aspects of life. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Religious Beliefs: • African religious concepts and rituals are enlivened by rhythmic dancing, drumming and singing. • These practices are found in African American religion blended with diverse European American elements, such as: • Ancestor worship • Initiation rites • Spirit possession • Healing and funeral rituals • Magical rituals for obtaining spiritual power • Jubilant ceremonies Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Religious Beliefs: • Church based programs enhance the social integration for the older African American and building community-based infrastructure of supportive and health related services. • In many communities, the church is the site for senior nutrition and medical day care programs, health screenings, outreach programs, homecare services or subsidized housing. • Churches act as supplement to informal family care giving and referrals to other community-based agencies. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Religious Beliefs: • Many of their personal histories and experiences have shaped their view of receiving healthcare as a degrading, demeaning or humiliating experience. • Some fear or resent clinics due to long waits, medical jargon, feelings of racism or segregation, loss of identity and feelings of powerlessness and alienation in the system. • Historical events have also influenced their attitudes, such as the Tuskegee Syphilis Study. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Tuskegee Syphilis Study: • This study is the most important reason why many African Americans distrust the institutions of medicine and public health. • This 40 year government study took place from 1932-1972 in which 399 Black men from Macon County Alabama were deliberately denied effective treatment for syphilis in order to document the natural history of the disease. • It has come to symbolize racism in medicine, misconduct in human research and the arrogance of physicians and government abuse of Black people. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Tuskegee Syphilis Study: • African American fear of exploitation by the medical profession dates back to slavery. Slaves found themselves as subjects of medical experiments because doctors needed bodies and the state considered them property and denied them legal right to refuse to participate. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Examples of Medical Abuse: • A Black man was taken and forced to sit naked on a stool in a pit that was heated to a high temperature with only his head above the ground. Over a period of 2-3 weeks, he was placed in this pit 5-6 times to determine what enabled him best to withstand the heat. Each ordeal ended with him fainting and needing to be revived. The purpose was to make it possible for masters to force slaves to work longer hours on the hottest of days. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Examples of Medical Abuse: • Gynecological surgeries were being performed on Black women before the days of anesthetics to perfect procedures to repair vesicovaginal fistulas. Slaves would go through numerous surgeries that were extremely painful in order for the doctor to perfect his technique before he would perform them on white women. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Tuskegee Syphilis Study: • In recent years there have been links made between Tuskegee, AIDS and genocide. It has been questioned by some in the Black community if AIDS was manufactured to erase their people. • Racism can influence the practice of medicine. Social disparities may be occurring despite the lack of any intent or purposeful efforts to treat patients differently on the basis of race. • Healthcare providers should examine their own practices to ensure that inappropriate considerations do not affect their clinical judgments. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Holidays – Kwanza: • Cultural holiday conceived and developed by Dr. Maulana Ron Karenga in 1966. • Celebrated from December 26-January 1. • Derived from Swahili phrase “matundaya kwanza” (first fruits) as well as from Christian beliefs from the Old Testament (first fruits) a term related to an offering to God. • Rooted in first harvest celebrations practiced in various cultures in Africa. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Holidays – Kwanza: • Each day focuses on the seven principles: • Mkeka(the Mat): foundation on which we build • Muhindi (the Corn): embodiment of the future • Kinara (the Candle-holder): roots of our people • Kikombe Cha Umoja (the Unity Cup): the practice of unity • Mshumaa (the Seven Candles): sets of values by which we live • Zawadi (the Gifts): symbols of labor, love of parents and commitments • Karamu (the Feast): rewards or fruits of productive labor Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

African American Culture Holidays – Kwanza: • Seeks to enforce a connectedness to African cultural identity; celebration of the oneness and goodness of life. • Practiced by African Americans of all religious faiths and backgrounds. Conclusion: • It is important to recognize the vast array of characteristics represented in all ages of Black culture as the beliefs are embedded in their daily life. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Reference • Baer, H. African American Religious Experience. Retrieved December 16, 2010 from http://hirr.hartsem.edu/ency/african.htm. • Hargrave, R. (2010). Health and Healthcare of African American Older Adults. Retrieved December 16, 2010 from http://geriatrics.stanford.edu/ethnomed/african_american. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Power Point Presentation Created by: Joyce Cunneen, MSN, RN Fairfield University School of Nursing ELDER Project Education Coordinator Monica Starr, BSN, RN Fairfield University School of Nursing ELDER Project Program Coordinator Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Cultural Diversity