Cultural Awareness for Nursing Practices: Enhancing Self-Concept and Understanding Grief in Diverse Populations

1. Psychosocial Needs

2. Culture & Ethnicity

3. Culture • Socially transmitted knowledge of values, beliefs, norms, and lifeways of a particular group that guides their thoughts and behaviors— (Purnell and Paulanka, 1998 & Leininger 2002a)

4. Visible and Invisible Components • Visible—easily seen • Clothing, jewelry, charms, hairstyles • Invisible—less observable • Value belief system that drives visible practices

5. Cultural Processes • Enculturation • Acculturation • Assimilation • Biculturalism

6. Transcultural Nursing • Comparative study of cultures to understand similarities and differences across human groups— (Leininger,1991, 2002a)

7. Cultural Competence • Cultural awareness • Cultural knowledge • Cultural skills • Cultural encounters • Cultural desire

8. Cultural and Life Transitions • Pregnancy • Childbirth • Newborn care • Postpartum • Grief and loss

9. Cultural Assessment • Cultural identity/ethnohistory • Biocultural history • Social organization

10. Cultural Assessment (cont.) • Language and communication • Religion and spirituality • Caring beliefs and practices • Experience with health care system

11. Nursing Decision and Action Modes • Cultural care preservation or maintenance • Cultural care accommodation or negotiation • Cultural care repatterning or restructuring

12. Self-Concept

13. Self-Concept • How one thinks and feels about oneself • Development of self-concept is a complex, lifelong process

14. Components • Identity • Body image • Role performance • Self-esteem

15. Role Performance Behaviors • Reinforcement-extinction • Inhibition • Substitution • Imitation • Identification

16. Self-Concept Stressors • Identity stressors • Body image stressors • Role performance stressors • Conflict • Ambiguity • Strain • Overload • Self-esteem stressors

17. Effects on Self-Concept • Family • Nurse

18. Assessment • Coping behaviors • Significant others • Client expectations

19. Nursing Diagnoses • Examples • Impaired adjustment • Ineffective coping

20. Planning • Goals and outcomes • Priorities • Continuity of care

21. Implementation • Health promotion • Acute care • Restorative care

22. Evaluation • Client care • Client expectations

23. The Experience of Loss, Death, and Grief

24. Grief • Mourning • Bereavement

25. Theories of Grief • Kubler-Ross’s stages of dying • Bowlby’s phases of mourning • Worden’s four tasks of mourning • Application of theories to other types of loss

26. Kubler-Ross Stages of Dying • DENIAL • ANGER • BARGAINING • DEPRESSION • ACCEPTANCE

28. Types of Grief • Anticipatory grief • Complicated grief • Disenfranchised grief

29. Assessment • Type and stage of grief • Grief reactions • Factors that affect grief • End-of-life decisions • Nurse’s experiences • Client expectations

30. Factors Influencing Loss and Grief • Human development • Psychosocial perspectives • Socioeconomic status • Personal relationships • Nature of the loss • Culture and ethnicity • Spiritual beliefs

31. Nursing Diagnoses • Anticipatory grieving • Dysfunctional grieving • Hopelessness • Powerlessness • Spiritual distress

32. Planning • Goals and outcomes • Setting priorities • Continuity of care

33. Implementation • Therapeutic communication • Promoting hope • Facilitating mourning • Postmortem Care

34. Palliative Care • Symptom control • Maintaining dignity and self-esteem • Preventing abandonment and isolation • Providing a comfortable and peaceful environment

35. Supportive Care • Support for the grieving family • Hospice care • Care after death (postmortem care) • Grieving nurse

36. Evaluation • Client care • Client expectations

37. Sexuality

38. Sexual Development • Infancy and early childhood • School-age years • Puberty/adolescence • Young adulthood • Middle adulthood • Older adulthood

39. Sexual Response Cycle • Desire • Arousal • Orgasm

40. Sexual Orientation • Heterosexual • Homosexual • Bisexual

41. Contraception • Nonprescription methods • Abstinence • Barrier methods • Timing methods

42. Contraception (cont'd) • Prescription/health care intervention methods • Hormonal • Intrauterine devices • Diaphragm/cervical cap • Sterilization

43. Sexually Transmitted Diseases • Syphilis • Gonorrhea • Chlamydia • Trichomoniasis • Human papillomavirus (HPV) • Herpes simplex virus (HSV)

44. Sexually Transmitted Diseases (cont'd) • Human immunodeficiency virus (HIV) • AIDS • Transmission • Exposure categories • Education

45. Sociocultural Influences on Sexuality • Pregnancy and menstruation • Discussing sexual issues

46. Decisional Issues Related to Sexuality • Contraception • Abortion • STD prevention ARE WE HONEST WHEN WE TALK ABOUT THIS!!!!

47. Alterations in Sexual Health • Infertility • Sexual abuse • Personal and emotional conflicts • Sexual dysfunction

48. Assessment • Factors affecting sexuality • Sexual health history • Sexual dysfunction • Physical assessment • Client expectations • Nursing diagnosis

49. Planning • Goals and outcomes • Priorities • Continuity of care

50. Implementation • Health promotion • Acute care • Restorative care