The Cultural Aspects of
Community Nursing Practice
Lecture objectives:
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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.
" 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."
CULTURE
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Culture refers to the beliefs, values, and
behavior that are shared by members of a
society and provide a design or “map” for living.
It is culture that tells people what is acceptable
or unacceptable in a given situation. It is culture
that dictates what to do, say, or believe.
Culture is learned. As children grow up, they
learn from their parents and others around them
how to interpret the world. In turn, these
assimilated beliefs and values prescribe desired
behavior.
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Anthropologists describe culture as the acquired
knowledge that people use to generate behavior
and interpret experience (Spradley & McCurdy,
2000).
This knowledge is more than simply custom or ritual;
it is a way of organizing and thinking about life. It
gives people a sense of security about their
behavior; without having to consciously think about
it, they know how to act.
Culture also provides the underlying values and
beliefs on which people’s behavior is based. For
example, culture determines the value placed on
achievement, independence, work, and leisure. It
forms the basis for the definitions of male and
female roles.
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Culture is the systems of knowledge
shared by a relatively large group of
people.
Culture is communication, communication
is culture
Culture has also been described as
“the luggage that each of us carries
around for a lifetime”
THEORY OF CULTURAL
DETERMINISM
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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.
CULTURAL RELATIVISM
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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.
CULTURAL ETHNOCENTRISM
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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.
CULTURAL ETHNOCENTRISM
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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.
MANIFESTATIONS OF CULTURE
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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.).
MANIFESTATIONS OF CULTURE
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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, naturalunnatural). 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.
Manifestation of Culture at Different
Levels of Depth
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Cultural groups may have unique
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1) family structure
2) values and attitudes,
3) language,
4) arts,
5) child-rearing, and
6) religion and traditions.
A Value
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What is a value?
"A culturally prescribed criterion by which
individuals evaluate persons, behaviors,
objects, and ideas as to their relative
morality, desirability, merit, or correctness."
"conceptions of what is desirable; . . . the
underlying assumptions by which individual
and social goals are chosen."
Dominant Values
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The beliefs and sanctions of the dominant or majority
culture are called dominant values.
In the United States, the majority culture is made up
largely of Anglo-Saxons whose dominant values
include
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the work ethic,
thrift,
success,
independence,
initiative,
respect for others,
privacy,
cleanliness,
youthfulness,
attractive appearance, and
a focus on the future.
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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
Dominant Values
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Dominant values are important to consider in the
practice of community health nursing because they
shape people’s thoughts and behaviors.
Why are some client behaviors acceptable to health
professionals and others not?
Why do nurses have such difficulty persuading
certain clients to accept new ways of thinking and
acting?
Explanations can be found by examining the
concept of culture, especially its influence on health
and on community health nursing practice.
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Race refers to biologically designated groups of people whose
distinguishing features, such as skin color, are inherited;
examples include Asian, Black, and White.
An ethnic group is a collection of people who have common
origins and a shared culture and identity; they may share a
common geographic origin, race, language, religion, traditions,
values, and food preferences (Spector, 2000).
A person’s ethnicity is that group of qualities that mark his or
her association with a particular ethnic group. When a variety of
racial or ethnic groups join a common, larger group, cultural
diversity occurs.
Cultural diversity (also called cultural plurality) means that a
variety of cultural patterns coexist within a designated
geographic area. Cultural diversity occurs not only between
countries or continents, but also within many countries,
including the United States (Spector, 2000).
Racial and Ethnic Health Disparities
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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, to close the gaps between
racial and ethnic populations and white
Americans in six health categories where
disparities are recognized.
Racial and Ethnic Health Disparities
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Those areas are
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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 these areas by 2010 with interim
goals set for 2000.
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Other variations among cultural groups (as
far as organizational factors) include:
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Communication
Space
Social Organization
Time
Environment control
Biological variations
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Cultural competence in Nursing Care
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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.
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In a brief cultural assessment nurses ask clients about their
ethnic background, religious preference, family patterns,
food patterns, and health practices.
ASSIGNMENT 1: Exploring Your Own
Cultural Background
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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?
ASSIGNMENT 1: Exploring Your Own
Cultural Background
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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?
ASSIGNMENT 2: Cultural Awareness and
Health Considerations
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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?
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?
ASSIGNMENT 2: Cultural Awareness and
Health Considerations
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Now, think about your parents or whomever raised
you, or other people. 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?