Chapter 4
Cultural Aspects of Health and Illness
Transcultural Nursing
• Focuses on care, health, illness patterns of people with
similarities and differences in cultural belief, values, practices
Culture
• Not restricted to race, ethnicity
• Refers to integrated patterns of behavior acquired over time
(e.g., beliefs, values, customs, norms, habits, language,
thoughts)
• Learned within family unit, generation, and/or other social
organizations
Cultural Diversity
• Differences among people; may or may not be visible
• Race – visible physical characteristics (e.g., skin tone, head
shape, hair texture)
• Ethnicity –common group social customs, values, beliefs
Cultural Competence
• Respecting all differences; not letting one’s own biases
influence others
• Understanding/responding effectively to cultural and linguistic
needs of patients
• Joint Commission and NPSGs require cultural differences be
respected
Cultural Sensitivity
• Aware of, respects; appreciation of cultural differences
• Avoid biased/offensive language and actions when interacting
with diverse cultures
• Avoid stereotyping
Health Care Disparities
• Differences in incidence of health care problems among
minority racial/ethnic groups when compared with white
majority
• Contributing factors – socioeconomic status, individual
discrimination, access to care, language barriers
Healthy People 2020
• Health promotion initiatives reflect assessments of major risks
to health and wellness
• Changing public priorities
• Emerging issues related to U.S. health preparedness and
prevention
Purnell’s Domains of Culture
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Culture overview and communication
Homelessness
Family and workplace issues
Lesbian, gay, bisexual, transgender health
Biologic ecology
Nutrition
Spirituality
Homeless
• Most avoid health care
• Prone to CV disease, hypertension, diabetes mellitus, high
cholesterol, infections
• Compensate for limited time
• Limit number of visits needed
Communication
• Language is largest barrier for non-English-speaking patients
• Interpreters must be available in health care facilities
• Determine which forms of patient communication are
acceptable
Family & Workplace Issues
• Family and gender roles influence plan of care
• Assess who makes decisions in the family
• Include questions about sexual identity/activity in health
assessment
LGBT Health
• Many fear prejudice; hesitant to seek medical care
• Establish patient’s gender identity; do not make assumption
based on appearance
• Ask questions about sexual identity
Biological Ecology
• Biologic variations, health disparities, drug metabolism
differences
• Common biological variation relates to adult body size and
type (e.g., dwarfism)
Dwarfism
• Height below 4’ 10”
• Disproportionate or proportionate
• Results from genetic mutation, hormone imbalance
Ethnopharmacology
• Study of effect of ethnicity on how drugs work in the body
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Absorption
Distribution
Metabolism
Excretion
Nutrition
• Part of comprehensive health assessment
• Respect patient’s food preferences/beliefs
• Assess rituals and customs
Spirituality
• Involves behaviors that give purpose to life, provide individual
strength
• Joint Commission requires all health care facilities to address
patients’ spiritual needs
• Chaplain is part of health care team
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Health Care Practices and
Practitioners
Assess patient’s health promotion and maintenance practices
Determine whether patient is able to afford health care
Use of alternative health care systems and healers
Folk health beliefs
Health Care Obstacles
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Transportation difficulties
High cost of care
Fear and distrust of health care workers
Poor communication between patients and professionals
Folk Health
Chapter 4
Audience Response System Questions
22
Question 1
What nursing priority ensures that culturally competent
care is provided to a homeless patient admitted for an
infected foot?
Contact the case manager to secure a shelter bed upon
discharge.
B. Provide education regarding foot care to prevent reinfection.
C. Help the patient choose a diet high in protein.
D. Provide empathetic and clear communication when
assessing the patient’s needs.
A.
Question 2
What is the fastest growing ethnic group in the United States?
A.
B.
C.
D.
Asian Americans
African Americans
Hispanic/Latino Americans
American Indian
Question 3
Which question illustrates the first step of becoming
culturally competent?
A. “Do I have the skill to conduct a cultural assessment?”
B. “How many face-to-face encounters have I had with
patients from diverse cultural backgrounds?”
C. “Do I have knowledge of my patient’s world view?”
D. “Am I aware of my own personal biases and prejudices
toward cultures that are different from my own?”