Culture Chapter 2 PDF

7589_Ch02_017-028 29/08/17 12:05 PM Page 17 CHAPTER 2 Culture Key Words Chapter Outline acculturation beliefs cultural awareness cultural competence cultural sensitivity culture diffusion enculturation ethnicity folkways globalization individualism language laws mores norms race religion sancti...

7589_Ch02_017-028 29/08/17 12:05 PM Page 17 CHAPTER 2 Culture Key Words Chapter Outline acculturation beliefs cultural awareness cultural competence cultural sensitivity culture diffusion enculturation ethnicity folkways globalization individualism language laws mores norms race religion sanctions spirituality symbols technological innovation transcultural nursing values Culture, Race, and Ethnicity Characteristics of Culture Learned Shared Integrated or Patterned Adaptive Symbolic Cultural Elements Culture in Health Care Cultural Assessment in the Health Care Setting Cultural Barriers to Health Care Spirituality and Religion Summary Student Activity Critical Thinking Multiple-Choice Questions Learning Objectives A t th e e n d of th i s ch ap te r , y ou s h ou l d b e ab l e to: • • • • Define culture. Describe the difference between beliefs and values. State how culture is relevant to nursing practice. Identify the basic components in a cultural assessment. 17 7589_Ch02_017-028 29/08/17 12:05 PM Page 18 18 Journey Across the Life Span CULTURE, RACE, AND ETHNICITY Each family has its own history, structure, and style of functioning. Within the framework of the larger society, groups of families are connected to each other by race, religion, and geographical proximity. Their shared beliefs, values, ideas, and religious doctrines—from their common culture—are handed down from generation to generation and adapted or changed to meet the current needs of the group. Culture refers to all of the learned patterns of behavior passed down through the generations that influence our thinking, decisions, and actions. During recent years much attention has been given to cultural influences that affect health and health care (Fig. 2.1). The nurse can better understand patients’ behavior and response to health care by understanding their histories and beliefs. Failure to develop cultural awareness may lead to misperceptions about patients’ feelings and responses. These misunderstandings can increase the stress for both patient and caregiver. The definition of culture has been debated by anthropologists and sociologists since the 19th century. The points of agreement are that culture is not isolated but is universal to all society and populations despite variations in language. Similarities exist in all cultures including communication, social controls, family, marriage, education, and supernatural beliefs. To understand and study culture, researchers must first look at each culture’s geographic location, population size, language, religion, economy, and political organization. We believe that culture is broad and plays an important role in everything we do or think. Culture describes a social group within a society to which FIGURE 2.1 One’s neighborhood supports cultural needs. individuals belong and which gives meaning to their lives. It determines our own identity and forms the anchor for traditions, customs, and rituals. Culture determines how we view the world, how we practice religion, how we interact with each other, and how members understand their work roles and sexuality. Modern social anthropology theorists consider culture as a set of standards set forth in these statements: Culture decides what is, what can be, what one feels about it, what to do about it, and how to go about doing it. The levels of culture can be described as follows: • National culture: Learned patterns of behavior and values shared by a whole nation. • International culture: Learned patterns of behavior shared across national borders because of migration and globalization. • Subcultures: Subgroups within the dominant culture. Subcultures have common beliefs and interests. An example of a subculture would be health care workers as a group. CHARACTERISTICS OF CULTURE Social anthropologists have characterized culture as learned, shared, integrated or patterned, adaptive, and symbolic. See Table 2.1 for brief descriptions of these characteristics. Learned Culture is learned based on a human’s unique capacity to learn symbols and signs. Culture is learned from birth because behaviors, values, beliefs, and traditions are passed down from one generation to the next through the acquisition of language. The ability to learn a language is based on our biological makeup, but the language we speak is what we learned within our cultural group. Culture is not genetically inherited, evidenced by the newborn baby born into a culture equipped only with basic instinctive reflexes such as sucking that help babies’ survival. Newborn babies are not capable of caring for themselves and are totally dependent on their parents or guardians for food during the first few years of life. Newborn babies do not enter the world with a cultural template but learn culture through socialization within their respective groups. Newborn babies can learn the culture into which they are born through direct observation, using all their senses, as well as by being taught by members of 7589_Ch02_017-028 29/08/17 12:05 PM Page 19 Culture 19 T A B L E 2.1 C h ar ac t er i s t i c s of C u l t u r e Characteristic Description Learned Culture is learned from birth as behaviors, values, beliefs, and traditions are passed down from one generation to the next through language. Shared Cultures share traditions, values, and beliefs. Shared values give cultures stability and security. Culture can be shared through interactions with members of the cultural group or by direct instruction. Integrated or Patterned Culture is integrated or patterned based on economics, social patterns, work ethics, and individualism. Adaptive Culture is a constantly adapting response to environmental and biological demands. Methods of change include diffusion, acculturation, technological innovation, and globalization. Symbolic Human culture uses symbols, especially language, gestures, and pictures, for communication among members. their social group. Newborns learn their culture from their parents, siblings, and other children. In today’s society culture is also learned through television shows such as Sesame Street and computer games. Cultural education and socialization occur in a more formal way in the school years. This process of learning is called enculturation. Enculturation means learning the culture through observation and instruction, thereby integrating oneself into the cultural group. Newborns will learn mealtimes, bedtime, types of foods, and manner of dress used by their culture. For example, in the dominant American culture, it is acceptable to eat pigs and cows, but in other cultures this is forbidden and would be considered a violation of cultural or religious practices. The cognitive level of an individual within the cultural group will determine his or her capacity for learning. For example, computers are widely used in the dominant American culture, and the ability to be skilled in the use of the computers reflects the individual’s upbringing and background. Culture is learned unconsciously because humans are able to think symbolically, meaning the object in reference need not be present. For example, we know the meaning of the peace sign without seeing it. Shared Culture is shared by members within that culture, and the most common practice shared by a cultural group is language. The language in a culture is shared by all members and is understood by all members of that group. Cultures also share the same ideas and ways of behaving, and the meaning of the behavior must be understood by individuals within that culture, thus providing a common experience and understanding. When a cultural behavior exists, that behavior is shared and must be practiced by more than one member in that cultural group. Cultures share traditions, values, and beliefs. Shared values give cultures stability and security. Culture can be shared through interactions with members of the cultural group or by direct instruction. The degree of sharing within a cultural group varies because of the individuality of each member of the culture. Variations of behavior and traits can be seen within a culture based on age, gender, class, and religion. In the United States, individuals share the feeling that they are special, and this fosters the common ideals of individualism. Individualism means that the individual’s interests and needs are the primary focus. Integrated or Patterned Culture is integrated or patterned based on economics, social patterns, work ethics, and individualism. Forming the core of an individual’s culture are the values, ideals, judgments, and symbols that are unique to each culture. All aspects must be integrated to comprise a whole culture. One anthropology theorist defined patterned and integrated culture as the following: elements or traits in a culture that are 7589_Ch02_017-028 29/08/17 12:05 PM Page 20 20 Journey Across the Life Span not a random collection of customs, but patterns that are mostly consistent with each other because they work together cognitively and emotionally help in adaptation. For example, child-rearing practices, expectations, and hopes for our offspring follow cultural patterns. Adaptive Culture is an adaptive response to environmental and biological demands. Humans must manipulate their environment to resolve problems of survival and reproduction. Humans are highly adaptive in comparison to other species. All cultures have demonstrated the abilities to develop tools to hunt for food initially and to adapt to climate changes, which have enabled the growth of cultural groups and populations. Given time, all cultures adjust and respond to environmental crises. As new rules are embraced by a cultural group, old ones are dropped. Culture is not static but adaptive to a dynamic world. One of the changes society has experienced since the 1960s is the increased number of women in the workforce. Because of economic demands, many women are working full-time hours in the United States. According to the U.S. Census Bureau, in 1967 only 14.8% of women were in the workforce, and in 2009 that number had reached 43.2%. Changes in a culture occur because of diffusion, which means borrowing cultural traits from another culture. Diffusion is responsible for the greatest amount of change seen within a culture. We adopt practices from other cultures that will enrich our culture without going through years of trial and error. Today cultures, societies, and nations are linked together in a mutually competitive way to ensure survival. Change also occurs through acculturation, technological innovation, and globalization. Acculturation is when values and beliefs are exchanged as a result of continuous direct interactions between cultures. This occurs due to external pressures. An example of acculturation is when an individual immigrates to the United States and quickly adapts and believes in the U.S. right to free expression. Rapid changes in our society today are driven by technological innovation. Innovations developed to solve problems in society also create cultural change. For example, one of the first antibiotics discovered was penicillin, which has saved the lives of a large number of people throughout the world. Globalization is another cause of cultural changes. Globalization is change by a combination of diffusion, acculturation, migration patterns, and tourism. A culture can be maladaptive if it fails to change to meet the challenges of the group or goes through rapid changes that reduce the culture’s chance of survival and would make that culture become extinct. Symbolic Culture is symbolic because the most fundamental aspect of a culture is the ability to develop symbols that allow for communication among its members. The most important symbols in human culture are the language, gestures, and pictures that people use to communicate with each other. Each symbol has a specific meaning within a culture and can be verbal or nonverbal. For example, an alphabet represents the sounds used within a language. Symbols are not timeless and can change as the culture evolves to maintain internal stability of the culture. Symbols can be material or nonmaterial. Material symbols are objects made or built by the culture, such as clothes, art, or artifacts, that can identify how the culture was organized and how its people function and survive over time. An example of a material symbol in American culture is the stop sign. This red sign means a driver must stop and not proceed, and most Americans recognize that if they violate its implied meaning, they could face a fine by way of citation. Nonmaterial symbols are ideas that have no physical characteristics and tell us about the culture’s beliefs and values. Body language and other learned behaviors are examples of nonmaterial symbols. CULTURAL ELEMENTS Elements that make up all cultures are beliefs, values, norms, folkways, laws, mores, sanctions, race, and ethnicities. Beliefs are the truths held by a culture’s people. One’s beliefs determine and influence how one deals with and views social problems and concerns. Beliefs affect our thinking and organizing ability. They also influence our behavior and concepts about health, illness, and death. Women’s roles and child-rearing practices are also governed by cultural beliefs. Values are deeply embedded feelings that determine what is considered good or bad, right or 7589_Ch02_017-028 29/08/17 12:05 PM Page 21 Culture wrong. Cultural values give individuals direction and foundation for their decisions and actions. These values also provide a sense of stability and security. Absence of cultural values can lead to social problems. At an early age, children develop a sense of what is right or wrong and what behaviors are acceptable within their culture. Values can help to foster personal achievement. Conflicts may arise in an individual when his or her cultural values are challenged. For example, such conflict may occur when an individual moves out into the larger community and is then faced with the values of others. The individual must try to assimilate into the larger group without losing his or her own cultural beliefs and values. Norms are socially accepted rules and practices that guide an individual’s behavior and interactions within the culture. Norms also determine the role of each family member by age, gender, or ranking. Norms can be described in the following three ways: • Folkways are the customs within the culture that determine how we greet each other. For example, in some cultures people greet each other with a handshake, whereas in other cultures they greet others with a kiss. These are not formally written laws, but a person’s failure to extend the appropriate greeting may offend others in these cultural groups. • Laws are written policies supported and enforced by the government. Breaking the law carries specific punishment. Violating a person’s property and stealing are examples of breaking the law. • Mores are moral beliefs that are strongly held by members of the culture. Failure to abide by these mores may lead to ostracism from the cultural group. Incest and child abuse are examples of these strong beliefs, or mores. • Sanctions are the social remedies for violating any of the norms. These may be positive or negative. Positive sanctions may reward or honor an individual; negative sanctions exercise disapproval for violating the norm and may lead to imprisonment. Symbols are expressed as language, gestures, or objects that people within a culture use to communicate with each other. Symbols can have different meanings among different cultures. Race is defined as a group of people who share certain similar physical characteristics including skin color, hair texture, facial shape, and/or body 21 shape or size. Race (and ethnicity) can influence our socioeconomic status. Race has also been defined as a social construct that categorizes people socially rather than biologically. Biological researchers once believed that race genetically isolated people. Recent research disputes this belief of racial isolation and supports a theory that there are no pure or distinct races because of racial blending that has occurred over time. These theorists ascribe differences such as skin color as the result of, or adaptation to, physical elements such as climate and sun. In regions with warm climates, dark skin tones are the result of an increase in pigmentation and melanin and help protect the skin from the sun’s rays. In colder climates, less protection is needed; hence, skin is lighter in color. Racial categories emphasize physical characteristics rather than cultural differences. Children are not born with prejudice; instead, they have a natural innocence and curiosity (Fig. 2.2). This curiosity leads them to become aware of differences in race and color as early as age 3. At this age children cannot fully understand the social concept of race—being either black or white—but they are able to describe themselves as pink, peach, brown, or chocolate colored. One researcher found that by age 6 many children have already developed some racial biases. To foster racial and ethnic tolerance in children, the issue of prejudice must be addressed at an early age. Negative stereotypes of race and ethnicity can be learned and reinforced from media depiction and from family members and friends. It is not unusual for well-meaning parents who are trying to teach their children to be color-blind to avoid addressing the obvious differences children are able to see. Positive role modeling of racial and ethnic FIGURE 2.2 Children have a natural innocence and curiosity. 7589_Ch02_017-028 29/08/17 12:05 PM Page 22 22 Journey Across the Life Span tolerance by parents is essential. Parents or caregivers must also include open, accurate, and positive discussions of color and race. Activities such as helping children track their cultural heritage can be enriching. A priority issue is helping children to understand that although people may look different and come from different countries, all of them feel, enjoy, and aspire to some of the same things. Box 2.1 gives some hints on fostering racial tolerance in children. Ethnicity refers to stable cultural patterns shared by a group of families with the same historical roots. Ethnicity means that people have a shared cultural heritage and are from the same race and geographical area. They share the same language and other attributes peculiar to that group such as diet, customs, music and dance, family structure and roles, and religious beliefs or practices. These ethnic categories celebrate the diversity among racial groups. For example, people from the Caribbean have a diverse heritage consisting of African, Indian, French, Portuguese, English, and Dutch ethnicities, to name a few. We are all born B O 2.1 • • • • • • • • • • X P r o m ot i n g R ac i al S en s i t i vi t y i n Chi l d r en Use positive role models. Answer questions factually. Have honest, open conversations. Do not deny differences in color of skin, hair type, or shape of eyes. Do not make children feel ashamed when they question race or color. Foster positive feelings toward individual heritage. Expose children to people of other races and cultures. Select dolls from different cultural and ethnic groups. Read your child stories depicting different cultural and ethnic groups. Read some of the following books together: • The Hundred Dresses by Eleanor Estes, Harvest Books, 1998 • The People Could Fly: American Black Folktales by Virginia Hamilton, Random House, 2000 • Black Is Brown Is Tan by Arnold Adoff, HarperCollins Juvenile Books, 1992 • Children from Australia to Zimbabwe: A Photographic Journey Around the World by Maya Ajimera and Anna Rhesa Versola, Charlesbridge Publishing, 1997 • The Friendship by Mildred D. Taylor, Penguin Group, 1998 into a culture, race, and ethnic group. Although as individuals we are not totally defined by these categories, they are important elements in our lives. CULTURE IN HEALTH CARE Madeline Lenninger introduced the theory of transcultural nursing in the mid-1950s. Transcultural nursing is a formal area of study and practice focused on comparative human care and understanding the differences and similarities in beliefs, values, and practices among people. This theory uses a holistic care approach integrating concepts of humanistic caring philosophy grounded in scientific knowledge to deliver culturally congruent care. Culturally congruent care is care that incorporates the key values and beliefs of a culture. This was developed in response to changing demographics and globalization, or the movement of people from different cultures to different countries in the world. Major challenges in health care today include globalization and the new health care initiatives for cultural care. Other disciplines—such as medicine, social work, pharmacy, and physical therapy—now have become interested in providing culturally competent care to a rapidly growing multicultural population. The U.S. Census Bureau projection for 2020 is that one-third of the U.S. population will be composed of ethnic and racial minority groups. Presently, one-fifth of the U.S. population speaks a language other than English. Because of the increasing cultural diversity of our nation, health care workers interact on a daily basis with patients from many cultural and ethnic groups. In response to our nation’s increasing diversity, the emphasis must be on nurses and health care delivery systems that provide culturally competent care. Culturally competent care requires an understanding of culture, race and ethnicity, and diversity in all groups. The central purpose of transcultural nursing is to provide nurses with the education that was missing in nursing practice to promote and maintain the cultural care needs of the individual. This would benefit the individual and increase client satisfaction, promote an early recovery from disease, or support a meaningful death experience. Culturally congruent care is the ultimate goal of transcultural nursing. In transcultural nursing theory, Lenninger viewed the patient as belonging to one world with many cultures and believed that nurses must be prepared to 7589_Ch02_017-028 29/08/17 12:05 PM Page 23 Culture care for anyone anywhere in the world. This worldview is a new way for nurses to learn about their clients’ cultures and provide care that is culturally congruent and meaningful to the world’s population. Without the knowledge of culture and a commitment to give culturally congruent care, nurses will be handicapped and culturally ignorant to care for people whose cultural values and beliefs are different from their own. Culturally specific care is the art of using knowledge specific to the client’s culture to determine the client’s values and needs to plan and deliver care for a more positive outcome. For example, knowing that clients from some cultures may prefer same-sex caregivers and planning their care consistently will prevent unnecessary stress. Health care workers must be careful not to become ethnocentric, believing that their culture, values, and patterns of behavior are superior to those of others. This type of belief breeds intolerance and insensitivity. Health care workers should practice cultural relativism, which means that the worker must learn and apply the other person’s cultural standard to each situation. Furthermore, health care workers should respect and be open to new cultural experiences. Because we respect the individual’s culture, we try not to stereotype and limit the person. Cultural theorists believe that cultural challenges and health care disparities occur when health care providers do not understand the unique health values and beliefs of an individual’s culture, race, or ethnic background. Traditionally, the health care system is organized in a paternalistic pattern, meaning male dominance of the greater society, and does not provide for the needs of women or minorities. To provide competent care, the health care system must be able to promote and maintain the health of all its patients. In this system the patient must be able to understand, interpret, and analyze health information that can complement his or her lifestyle. Individuals should be able to navigate the health care system, interact with health care providers, and advocate for their own rights. This will provide an outcome where client satisfaction, healing, and recovery take priority. A culturally competent health care worker tries to understand the values, beliefs, traditions, and customs of diverse groups. The health care worker must understand each client’s health problems, ethnic practices, language, literacy, and religious beliefs that will influence that client’s attitudes and behavior. Health care workers should be able to appreciate the health practices of their patients without judgment, even if 23 the practices go against their own beliefs. The care provided must be patient centered, taking into consideration a person’s beliefs and priorities. Cultural competence is a conscious process, which means the health care worker must apply knowledge and skills to enhance interaction with clients. Cultural competence is the ongoing and continuous self-evaluation and development of cultural skills, which can only be acquired by interacting with or learning about diverse cultural groups. This can be accomplished by health care workers while remaining true to their own cultural identities. To be culturally competent the health care worker is not required to have detailed knowledge about all cultures that exist, but he or she must have cultural sensitivity and cultural awareness. These two concepts are sometimes discussed as one and other times discussed separately. Cultural awareness means understanding of culture, race, and ethnicity of diverse minority groups. This is not as easy as it sounds. You must enter the individual’s world to learn about him or her. We must learn the history of the patient’s ancestry and appreciate and celebrate cultural differences. Cultural awareness also means learning the cultural values and beliefs of the client and how he or she copes with difficulties and solve problems. Celebration of a culture can be seen in the food and clothing choices people make. This involves knowing their cultural expectations and needs from their point of view. Cultural sensitivity recognizes that diversity exists and one needs to respect a person’s uniqueness. It also means being correct in your language and interaction to avoid offending anyone’s belief or practices. It is essential for nurses to understand differences in communication styles, use of space and time, and family roles so that they may provide competent nursing care. Being culturally sensitive when giving care provides the client with satisfaction and a quick recovery. The client can quickly become frustrated, resentful, and dissatisfied with nurses who are unable to provide culturally sensitive care. In this climate, healing can be compromised. Box 2.2 lists ways to express cultural sensitivity toward your patients. CULTURAL ASSESSMENT IN THE HEALTH CARE SETTING To provide an optimal level of health care, the nurse should complete cultural assessments for all patients as they enter the health care environment. A cultural 7589_Ch02_017-028 29/08/17 12:05 PM Page 24 24 B Journey Across the Life Span O X Cu l t u r al S en s i t i vi t y 2.2 • • • • • • • • • • Listen carefully and show a sincere interest. Be nonjudgmental. Determine the individual’s level of understanding. Determine the person’s health beliefs and practices. Identify beliefs about gender and age. Determine family roles and expectations. Use interpersonal space carefully. Determine how eye contact is interpreted. Use touch, tone, and volume of voice carefully. Determine if the individual prefers a certain gender for his or her caregivers. • Identify the predominant language of comfort. • Determine food observances. assessment should include determination of the patient’s ethnic and racial origin, the patient’s language of origin and language he or she is most comfortable using, the decision maker for the family, and if there is a preference in gender of the health care worker who will provide direct care. It is also important to understand how to use personal space in the communication process. The health care worker must be aware of the person’s beliefs about medicine, pregnancy, and healing. Dietary laws and preferences need to be considered and respected. Box 2.3 contains an exercise to practice obtaining a cultural assessment. CULTURAL BARRIERS TO HEALTH CARE The social, cultural, and ethnic differences between the client and the health care providers may contribute to many different attitudes and beliefs. These differences may either help support or conflict with the client’s adherence to the medical plan of care. Common cultural barriers to health care include the following: • Difficulties with the host language • Lack of health insurance • Knowledge deficit B O 2.3 X Cu l t u r al A s s es s m en t Ex er c i s e Sit with the oldest member of your family and trace your family history. Be sure to determine country of origin, cultural practices, food preferences, and dress protocol particular to your culture. • Reluctance to question the health provider • Adherence to old cultural practices Health care providers can minimize cultural and ethnic barriers by becoming culturally sensitive to clients’ needs. To minimize language barriers, trained interpreters must be used along with translation sheets or devices. Food served should take into consideration common cultural preferences. Health providers should acknowledge the importance of other cultural health practices. Nurses can encourage clients to ask questions regarding their treatment as a means of becoming empowered. Last, health care providers must be sensitive to the client’s socioeconomic status and insurance coverage status. SPIRITUALITY AND RELIGION Religion is a specific system of beliefs and worship that is closely integrated with culture, ethnicity, and spirituality. Religion is an organized practice with rituals and symbols based on specific beliefs taken from the scriptures that provides a code of conduct for its members. Religion and spirituality are used interchangeably but are not the same. Religion is only one dimension of spirituality. Spirituality is concerned with how each individual finds a purpose and meaning to his or her life (Fig. 2.3 and Fig. 2.4). The outcome of spirituality is inner peace and a feeling of well-being with the world. Spirituality includes how one connects with nature or a supreme being. Nurses who practice from a holistic perspective must make every effort to attend to patients’ spiritual needs. This includes respecting patients’ expressions of their spirituality. The nurse need not share the same spiritual ideals of his or her patients but must recognize them and allow freedom of expression. The nurse must be careful not to impose his or her own spiritual values on patients. The nurse should be able to identify a client in spiritual distress. This distress may be manifested in feelings of hopelessness, anger, depression, and withdrawal. Allowing the patient to get in touch with his or her spirituality is one way of providing emotional support. Spiritual and religious assessment must include the patient’s preference for religious or spiritual practice and needs. Spiritual support is demonstrated in the nurse’s ability to listen to the patient while being nonjudgmental as the patient works through his or her spiritual issues. Some of the documented benefits of spiritual and religious expressions are a decrease in stress and relief from diseases such as hypertension, allergy, depression, and nausea. Patients known to engage in these 7589_Ch02_017-028 29/08/17 12:05 PM Page 25 Culture FIGURE 2.3 Holidays are special. FIGURE 2.4 Religious practices are important in some families. little else in common. Religion defines various rituals and rites of passage such as baptisms, confirmations, bar and bat mitzvahs, weddings, and funerals. The partaking of rituals and the sharing of religious beliefs help assist persons in overcoming adversities, thereby contributing to their wellbeing. Religious affiliations may serve to reduce social isolation by bringing people together to worship. Friendships, community support, and other social networks are often outgrowths of religious affiliations. Religion may encourage the community toward a healthy lifestyle and healthy behavior. Some religions promote health behaviors by supporting abstinence from smoking or alcohol usage. Most religions promote the family unit and the maintenance of marriage, family, and parenting. Religion also provides its followers with a moral guide that promotes wellbeing. One’s religious faith or lack of it is most often handed down by the family from generation to generation, linking the past and the future. Several different Christian denominations are practiced in the United States: Protestants are the largest religious group and Catholics are the second largest. Protestants include subgroups such as Baptists, Episcopalians, Lutherans, Methodists, Presbyterians, and Seventh-Day Adventists. While Christianity remains the largest practiced religion in the United States, a minority of people practice other faiths, including Judaism, Buddhism, and Islam, and a growing percentage of individuals are unaffiliated with any organized religious group. Health care workers can best meet their patients’ needs by exercising tolerance and understanding of the religious beliefs and practices influencing health and illness. Religious beliefs may offer people support during crises such as illness, family problems, or other stressors. Box 2.4 offers an exercise to help you practice religious sensitivity. B O 2.4 practices may enjoy an increased life span, healthy self-concept, and improved mental health. Religion also serves to satisfy several basic needs. Religion attempts to define the spiritual and give an explanation for otherwise incomprehensible events. Religion offers a sense of hope and the strength to endure. Religion guides individuals in the belief in a power greater than themselves. Individuals are brought together through a common belief system without which they may share 25 X R elig io us Sensitiv ity E x ercise The following questions should help to heighten your sensitivity to your own religious beliefs: • • • • • Are you affiliated with any religious organization? How important is religion to your daily activities? What helps you renew your strength and hope? Is religion a source of comfort to you? What religious practices do you adhere to in your own life? • How do you feel about other religions? 7589_Ch02_017-028 29/08/17 12:05 PM Page 26 26 Journey Across the Life Span SUMMARY 1. Culture can be defined as socially acquired patterns of behavior that are learned and passed down through generations. 7. Cultural sensitivity means being correct in your language and interaction to avoid offending anyone’s beliefs or practices. 2. Culture is learned within the home and community. All groups have cultural beliefs and practices that they maintain. These cultural beliefs and patterns distinguish one cultural group from the other. The primary elements of culture are beliefs, values, norms, sanctions, symbols, race, and ethnicity. 8. Transcultural nursing involves understanding the differences and similarities in beliefs, values, and practices among people. This theory was developed to bring about client satisfaction, early recovery from illness, or a meaningful death experience. 3. Race is defined as a group of people sharing certain similar physical characteristics including skin color, hair texture, facial shape, and/or body shape or size. Race and ethnicity can further determine socioeconomic status. 4. Ethnicity refers to stable cultural patterns shared by a group of families with the same historical roots. 5. Ethnicity means that people have a shared cultural heritage and are from the same race and geographical area. They share the same language and other attributes peculiar to that group such as diet, customs, music and dance, family structure and roles, and religious beliefs or practices. 6. Cultural awareness means learning the history of the patient’s ancestry and appreciating and celebrating cultural differences. Cultural awareness also means learning the cultural values and beliefs of clients and how they cope with difficulties and solve problems. 9. Common cultural barriers to health care include difficulties with the host language, lack of health insurance, knowledge deficit, reluctance to question health providers, and adherence to old cultural practices. 10. To provide an optimal level of health care, cultural assessments should be completed for all patients as they enter the health care environment. 11. Religion is a specific system of beliefs and worship and is closely integrated with culture and ethnicity. Spirituality helps individuals find purpose and meaning to life, often through nature or a supreme being. 12. Health care workers can best meet their patients’ needs by exercising tolerance and understanding of their religious beliefs and practices that influence health and illness. Student Activity Observe a person of a different cultural or ethnic background and list six beliefs that you have about this cultural group. 7589_Ch02_017-028 29/08/17 12:05 PM Page 27 Culture CRITICAL THINKING Exercise #1 Juan Perez, age 70 and of Hispanic ancestry, is admitted to the nursing home with a history of heart failure. What questions would you include while conducting a cultural history for Mr. Perez? Exercise #2 An 18-year-old male of Arabic descent with a history of diabetes mellitus comes to the emergency room during a hypoglycemic reaction. He has little mastery of English. The nurse orders a snack for the patient. The kitchen sends a ham sandwich and milk. The LPN hears the client speaking rapidly and angrily in broken English but cannot clearly understand the content of the speech. She asks another member of the staff to interpret the patient’s concerns. He expressed this food as a violation of his religious practice. 1. 2. 3. 4. 5. How was the patient violated? What is the first action that the LPN should take? What action should the nurse take before placing an order for food? Is there anything that the diet kitchen could have done to prevent this outcome? What knowledge deficit did the nurse show? MULTIPLE-CHOICE QUESTIONS 1. Culture is learned because of which of the following? a. It is genetically inherited. b. Instinctive human reflexes c. Traditions passed down from one generation to the next d. The culture contains a smaller number of people. 2. The ability to learn one’s culture within the cultural group is an example of: a. Sanction b. Mores c. Diffusion d. Enculturation 3. Nurses who respect the patient’s cultural difference: a. Are less effective practitioners b. Deliver competent care c. Give low-level care d. Tend to stereotype patients 4. Culture includes one’s: a. Age b. Handicap c. Disease d. Customs 5. Transcultural nursing theory states: a. One world, one culture b. One world, many cultures c. Socially relevant nursing d. Nursing of foreign people 6. Behavior that is correct within a culture is called a: a. More b. Value c. Sanction d. Symbol 27 7589_Ch02_017-028 29/08/17 12:05 PM Page 28 28 Journey Across the Life Span 7. The best way to provide culturally competent health care is to: a. Use only scientific knowledge to plan health care b. Involve patient and family in developing a plan of care c. Use only the medical information from the doctor d. Use folk laws and stories to guide your choices 8. Which of the following statements is true? a. Knowing a person’s culture will help you understand his or her response to illness. b. Race is the sole predictor of disease and life expectancy. c. Elderly persons seek health care based on their cultural values. d. All cultures take responsibility for their members. 11. The expected patient outcome when the nurse is culturally sensitive is: a. Frustration b. Recovery c. Dissatisfaction d. Resentfulness 12. The nurse is correct when completing a physical assessment on a newly admitted client if he or she includes elements of the client’s culture such as: (Choose all that apply.) a. The client’s connection to his or her supreme being b. Meaning of gender roles c. The use of touch d. Use of eye contact e. How the client derives meaning or purpose from life 9. How an infant is treated after birth depends on the cultural background of his or her parents. a. True b. False 10. A client expresses a cultural belief that prayer and faith heal better than any medicine. The nurse assigned to care for this client can provide culturally competent care by: a. Challenging his belief b. Seeking to change his belief with education c. Attempting to use his family to persuade him d. Respecting his belief Visit www.DavisPlus.com for Student Resources.