Cultural Diversity

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

2. Russian Culture Objectives: Upon completion of this session, the participants will be able to …. • Briefly discuss the history of the fall of the Former Soviet Union and understand the current geographic location of the countries that make up Eastern Europe. • Discuss the role of religion, traditional health care beliefs, social values, and family structure of Russia Culture and the impact these factors have on health care. • Identify specific culturally sensitive practices that can be incorporated into your work with Russia patients and Russian American patients. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

3. Russian Culture Introduction: • The Russian population in the U.S. has grown by 254% since 1990 and they are the second largest foreign-born ethnic group in the U.S. • As a culture, they have one of the highest household incomes at an average of $51,000 and have the highest level of education: • 52% have a bachelor’s degree or higher and • 80.3% have high school diplomas. • It is a rich culture, full of pride. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

4. Russian Culture Introduction: • Russia is sometimes referred to the Former Soviet Union which includes the following states that gained independence after the fall of the Soviet Union in 1991: Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

5. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

6. Russian Culture Introduction: • The Former Yugoslavia which was made up of 20 ethnic groups and also gained independence with the fall of the Soviet Union in 1991. However, this took several wars where 250,000 people of many ethnic backgrounds were killed. Those countries include: Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

7. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

8. Russian Culture Introduction: • Many Eastern European countries were freed from the Former Soviet Union, but were not part of the U.S.S.R include: • Poland • East Germany • Czechoslovakia • Romania • Bulgaria • Hungary • Yugoslavia Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

9. Russian Culture Introduction: • Our discussion will concentrate on people from the Former Soviet Union. • The following cultural patterns may represent many immigrants from Russia and Eastern Europe, but do not represent them all. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

10. Russian Culture Communication: • Russian is the primary language. • However, there are 27 co-official languages recognized in the republics. • People typically speak the language of the republic they were from—Ukrainian, Belorussian, Uzbek, and Polish. • Yiddish and Ladino – a combination of Hebrew and the Native language may also be spoken in the home. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

11. Russian Culture Communication: • Common greeting used by men is a firm handshake with direct eye contact. They use a less firm handshake with women. • Men will greet a close male friend by patting each other on the back and hug. • Women kiss each other on the cheek three times when they meet. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

12. Russian Culture Communication: • In public, the Russian person may appear cold and unemotional, but are known to be warm and hospitable and use a great deal of touch and communicate in private. • Speech is typically in loud voices, even in regular conversation. • Communication can be very verbal and direct when speaking with others. • Elders are much respected and titles such as Mr., Mrs., Aunt and Uncle are used to refer to them. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

13. Russian Culture Family and Social Structure: • The family is the most important institution in the Russian culture. • Russian values center around the family, married life and altruism (self- sacrifice). • Strong kinship bonds are seen: • They will support each other in crisis and will often consult family members during healthcare planning; especially if consents are needed. • The male is the dominate figure in society. • The woman’s life revolves around her husband and her family. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

14. Russian Culture Family and Social Structure: • Strong family bonds exist. • Typically families are small: one child • It is common for the woman to work outside the home. • Elders are expected to help raise the grandchildren if the parents work. • Many generations may live together. • The family is a source of stability Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

15. Russian Culture Family and Social Structure: • Children are expected to care for their elders. • Placement in a long term care facility can be viewed as abandonment of the parents. • Values include education, professionalism, and efficiency on the job. • They are known as hard working people. • The spokesperson and decision-making is usually the strongest personality in the family: • This may be the mother, father, eldest son or eldest daughter. • Many Russians living in the U.S. will live in Russian communities. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

16. Russian Culture View of Illness: • Illness may be believed to be caused by: • weather OR • social experiences such as: • stress from a living situation • arguing with family • not doing the right thing e.g. not eating well or not dressing warm enough • Good health is viewed as the absence of pain – as a result, illnesses that do not cause pain often go undiagnosed. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

17. Russian Culture View of Illness: • Mental illness is considered a disgrace and the family will avoid talking about it. • Coming down with a cold is thought to be caused by being physically cold, rather than by viruses or bacteria. • With regards to bad news regarding an ill family member: • The information is not usually given to the ill person - the decision is left to the family whether or not to tell the patient. • The belief is that the ill person needs to be at peace so their condition does not worsen. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

18. Russian Culture Folk Medicine: • The use of home remedies, such as oil rubs, mud or steam baths, exposure to fresh air and/or sunlight, is often used before going to the doctor. • “Bonki” is a common cold and flu remedy where glass cups are pressed on the back and shoulders of the sick person to ease symptoms. • This approach often leaves bruises and welts that can be interpreted as abuse. • Alternative medicine such as massage, aromatherapy and chiropractic care is commonly accepted. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

19. Russian Culture Folk Medicine: • The belief of prayer as a powerful healing tool is very important. • The belief in good nutrition as a primary determinant of health is valued and the family places great emphasis on eating when a patient is ill. • Herbal and folk medicine are used alongside of Western medicine. • In Russian culture, the focus of medical care is on treating the cause rather than on the symptoms or on the disease itself. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

20. Russian Culture Folk Medicine: • The patient, family and physician relationship: • It is important to form trusting relationship with the physician or the patient and family may ignore the advice of that physician. • It is customary to attempt to maintain a good relationship with physicians, often by the way of offering bribe • Compassion and emotional closeness with the physician is expected and in their homeland, this relationship is tantamount to confiding in the priest. • Russians appreciate the quality of care in America and especially value: • the right to choose their own doctor, AND • the availability of services in cities and more remote areas Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

21. Russian Culture Dietary Habits: • The Russian culture is typically agrarian based in the homeland, a diet based on foods from the garden and farm. • The diet is high in fat, carbohydrates and sodium, which contributes to diabetes, hypertension, heart disease and gastrointestinal disease. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

22. Russian Culture Dietary Habits: • Due to the early years of communism and food shortages in the former Soviet Union, many had to concern themselves about eating enough to stay alive. • The ideal meal for the working person was heavy, fatty and salty and made up of buckwheat with lard and black bread to give enough energy to work all day. • It is believed the richer and more fatty the food, the harder one worked. • As result, they tend not to be concerned with being overweight. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

23. Russian Culture Dietary Habits: • Traditional Russian Americans eat picked and dried meats, fish, bread, potatoes, dumplings, porridge, cabbage, beet soup and vegetables. • Breakfast is the quick meal made up of egg omelet, sandwich, kasha, coffee or tea. • Hearty breakfasts are seen as giving the person energy to work. • Lunch is the main meal consisting of salad, soup and a main course of meat or fish with two side dishes of vegetables and cabbage, potatoes or porridge (kasha) from wheat, rye, rice, oats or buckwheat. • Pelmeni is the most common traditional dish made of minced meat wrapped in thin dough. • Dinner is when the family eats together and shares the events of the day. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

24. Russian Culture Time Orientation: • Due to the agricultural heritage of the Russian culture, they do not view time as important. • They do not consider themselves as being late. • Communism reinforced their disrespect for time since workers could not be fired and there was no incentive to do things on time. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

25. Russian Culture Religious Beliefs: • The traditional and largest religion of the culture is Eastern Orthodox, Christian faith. The second largest religion is that of the Greek Catholic Church. • Other faiths practiced within the culture include: • Pentecostal • Ukrainian Baptist • Armenian Gregorian • Various Protestant denominations • Jewish Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

26. Russian Culture Religious Beliefs: • The practices of Islam and Buddhism have declined significantly making this culture one that is predominantly Christian. • The church is seen as a symbol of Russian heritage and culture. • Many people are atheists secondary to the anti-religious policy of the former Soviet Union. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

27. Russian Culture Conclusion: • Immigrants from Russia and the former Soviet Union came to the U.S. in several great waves in search of a better life. • The current Russian-American environment blends lifestyles and aspirations of both cultures assimilating well into mainstream American life. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

28. Reference • Ex-U.S.S.R. and Iron Curtain Countries. Retrieved on April 8th, 2010 from http://www.yourchildlearns.com/online-atlas/cold-war-map.htm • Russians and Other Immigrants from the Former Soviet Union. Retrieved February 13, 2011 from www.iowahealthdisparities.org/documents/russian.pdf. • Stratis Health. (2008). Culture Matters: The Cultural Competency Initiative. Retrieved February 13, 2011 from www.stratishealth.org/documents/cc_easterneuropean_061108.pdf. • The Cross Cultural Healthcare Program. Voices of the Soviet Jewish Community. Retrieved February 3, 2011 from http”//www.xculture.org/files/sovietjewish.pdf. • The Cross Cultural Healthcare Program. Voices of the Ukrainian Community. Retrieved February 3, 2011 from http”//www.xculture.org/files/Ukraine.pdf. • The Former Yugoslavia. Retrieved on April 8th, 2010 from http://geography.about.com/od/politicalgeography/a/fmryugoslavia.htm • University of Washington Medical Center. (2007). Communicating with Your Russian Patient. Retrieved February 11, 2011 from http://depts.washington.edu/pfes/pdfs/russiancultureclue.pdf • University of Washington Medical Center. (2007). End of Life Care: The Russian Culture. Retrieved February 11, 2011 from http://depts.washington.edu/pfes/pdfs/end%20of%20life%20care-russian.pdf Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

29. 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