The Cultural Aspects of Community Nursing Practice

1. The Cultural Aspects of Community Nursing Practice By Nataliya Haliyash, MD, BSN TSMU, International Nursing School

2. Lecture objectives: • 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.

3. " 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."

4. CULTURE • 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.

5. THEORY OF CULTURAL DETERMINISM • 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.

6. CULTURAL RELATIVISM • 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.

7. CULTURAL ETHNOCENTRISM • 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.

8. CULTURAL ETHNOCENTRISM • 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.

10. MANIFESTATIONS OF CULTURE • 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.).

11. MANIFESTATIONS OF CULTURE • 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, natural-unnatural). 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.

12. Manifestation of Culture at Different Levels of Depth

13. Cultural groups may have unique • 1) family structure • 2) values and attitudes, • 3) language, • 4) arts, • 5) child-rearing, and • 6) religion and traditions.

14. Cultural Groups • Traditional cultural groups that have more economic difficulties, poorer health, and less accessibility to health care than other groups include: • African Americans • Asians • Hispanics • Native Americans • Migrant Workers • Refugees

15. A Value • What is a value? • "A culturally prescribed criterion by which individualsevaluate persons, behaviors, objects, and ideas as totheir relative morality, desirability, merit, or correctness." • "conceptions of what is desirable; . . . the underlyingassumptions by which individual and social goals arechosen."

16. Dominant Values • The beliefs and sanctions of the dominant ormajority culture are called dominant values. • In the UnitedStates, the majority culture is made up largely of Anglo-Saxons whose dominant values include • the work ethic, • thrift, • success, • independence, • initiative, • respect for others, • privacy, • cleanliness, • youthfulness, • attractive appearance, and • a focuson the future.

17. 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

18. Dominant Values • Dominant Values in American Society: An Exploratory Analysis. • http://eric.ed.gov/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=ED128502&ERICExtSearch_SearchType_0=no&accno=ED128502

19. Dominant Values • Dominant values are important to consider in the practiceof community health nursing because they shape people’sthoughts and behaviors. • Why are some client behaviorsacceptable to health professionals and others not? • Why donurses have such difficulty persuading certain clients to acceptnew ways of thinking and acting? • Explanations can befound by examining the concept of culture, especially its influenceon health and on community health nursing practice.

20. Racial and Ethnic Health Disparities • 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.

21. Racial and Ethnic Health Disparities • Those areas are • 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.

22. 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

23. Initiative to Eliminate Racial and Ethnic Disparities in Health of HHS • http://raceandhealth.hhs.gov/

24. Other variations among cultural groups (as far as organizational factors) include: • Communication • Space • Social Organization • Time • Environment control • Biological variations

25. Cultural competence in Nursing Care • 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. • In a brief cultural assessment nurses ask clients about their ethnic background, religious preference, family patterns, food patterns, and health practices.

26. ASSIGNMENT 1: Exploring Your Own Cultural Background • 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?

27. ASSIGNMENT 1: Exploring Your Own Cultural Background • 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?

28. ASSIGNMENT 2: Cultural Awareness and Health Considerations • To complete this assignment successfully, you should: • Study the assignment carefully • Remember back to your childhood and a significant episode of being ill and answer these questions: 1. Who decided what was wrong with you?

29. 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? • 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?

30. That’s all falks! Q & A ?