Chapter 6
Culture and Ethnicity
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Definition of Culture
• Values, beliefs, and practices of a particular
group
• Incorporates attitudes and customs learned
through socialization
• Passed from one generation to the next
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
Currently there is a movement toward
acultural nursing care.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False.
Currently there is a movement toward
promoting culturally sensitive nursing care
and eliminating acultural nursing care.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Which of the following is a characteristic
of culture?
a. Acquired from other groups
b. Averse to environmental influences
c. Learned from birth
d. Constant and non-changing
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
c. Learned from birth
Culture is learned from birth. It is not
acquired from other groups, but shared by
members of a group. It is influenced by
environment, technology, and resources. It
is also dynamic and ever changing, not
constant.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Definition of Race
• Cultural groups: tend to share biologic and
physiologic similarities
• Biologic variations: used to categorize
people with genetically shared physical
characteristics
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Definition of Minority
• Collective people who differ from the
dominant group in terms of cultural
characteristics
• Refers to group’s status: power and control
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Definition of Ethnicity
• Bond or kinship: country of birth or place
of ancestral origin
• Pride in ethnicity
• Two or more cultural groups mix
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Ethnicity
• Stereotyping
– Fixed attitudes about all people who
share a common characteristic
– Developed with regard to age, gender,
race, sexual preference, or ethnicity
– Preconceived ideas are dangerous
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Ethnicity (cont’d)
• Generalization
– Supposition: person shares cultural
characteristics with others of a similar
background
– Different than stereotyping
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Ethnicity (cont’d)
• Ethnocentrism
– Belief: one’s own ethnicity is superior to
all others
– Interferes with intercultural relationships
– Treating anyone “different” as deviant
and undesirable
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
Minority implies that there are fewer group
members in comparison with others in the
society.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False.
Minority does not necessarily imply that there
are fewer group members in comparison with
others in the society. Rather, it refers to the
group’s status in regard to power and control.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Culture of the United States
• U.S. culture
– Anglicized, or English-based
– Evolved primarily from early English
settlers
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Culture of the United States (cont’d)
• 4 major subcultures in addition to AngloAmericans
– African Americans
– Latinos
– Asian Americans
– Native Americans
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Culture of the United States (cont’d)
• African Americans
– Those whose ancestral origin is Africa:
black Americans
• Latinos
– Those from Latin America or South
America: Hispanics or Chicanos (people
from Mexico)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Culture of the United States (cont’d)
• Asian Americans
– Those from China, Japan, Korea, the
Philippines, Thailand, Cambodia, Laos,
and Vietnam
• Native Americans
– Those from North America that include
Eskimos and Aleuts
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing
• Madeline Leininger coined the term
• Providing nursing care within the context
of another’s culture
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Aspects of transcultural nursing
– Assessments of a cultural nature
– Acceptance of each client as an individual
– Knowledge of health problems
– Planning of care within client’s health
belief system
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Nursing skills needed to provide
transcultural care
– Managing language differences
– Understanding biologic and physiologic
variations
– Promoting health teaching
– Respecting alternative health beliefs
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Cultural assessment
– Language and communication
– Eye contact; space and distance; touch;
emotional expressions
– Dietary customs and restrictions
– Time
– Beliefs about cause of illness
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Language and communication
– Native Americans: private
– Navajos: believe no person has the right
to speak for another
– African Americans: mistrustful of the
medical establishment
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Latinos: comfortable sitting close to
interviewer; let interactions unfold slowly
• Asian Americans: respond with brief, factual
answers; may not openly disagree with
authority figures (potentially fostering noncompliance)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Which of the following clients may provide
brief, factual answers with little elaboration
during a health care interview?
a. A Native American
b. An African American
c. A Latin American
d. An Asian American
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
d. An Asian American
Asian Americans tend to respond with brief
or more factual answers and little
elaboration. A Native American may be
private and may hesitate to share personal
information with strangers. An African
American may be mistrustful of the medical
establishment. A Latin American may be
comfortable sitting close to interviewers
and letting interactions unfold slowly.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Eye contact
– Anglo-Americans: make and maintain
eye contact throughout communication,
looking directly at a person while
speaking
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Asian Americans or Native Americans:
may believe direct eye contact is an
invasion of privacy or a sign of disrespect
• Arabs: may believe direct eye contact is
sexually suggestive
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Space and distance
– Providing personal care and performing
nursing procedures
– Asian Americans: more comfortable with
nurse at greater than an arm’s length
away
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Touch
– Native Americans: may interpret strong
handshake as offensive
– Southeast Asians: head is a sacred body
part that only close relatives can touch;
area between a female’s waist and knees
is private
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Emotional expression
– Anglo-Americans and African Americans:
freely expressive
– Asian Americans: control emotions and
expressions of physical discomfort
– Latino men: may not demonstrate
feelings
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Beliefs concerning illness
– Biomedical or scientific perspective
– Naturalistic or holistic perspective
– Yin/Yang theory; hot/cold theory
– Magico-religious perspective
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Biologic and physiologic variations
– Important biologic characteristics
o Skin
o Hair
o Certain physiologic enzymes
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Enzymatic variations
– Three inherited enzymatic variations:
members of various U.S. subcultures
– Absence or insufficiency of the enzymes
o Lactase; glucose-6-phosphate
dehydrogenase (G-6-PD)
o Alcohol dehydrogenase (ADH)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcultural Nursing (cont’d)
• Health beliefs and practices
– Many differences
– Folk medicine
– Treatment given by lay providers:
curandero, shaman, herbalist
– Alternative quasimedical therapy
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Culturally Sensitive Nursing
• Learn to speak a second language
• Use culturally sensitive techniques
• Become familiar with physical differences
among ethnic groups
• Perform appropriate skin assessment
techniques
• Learn or ask clients about cultural belief
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Culturally Sensitive Nursing (cont’d)
• Consult the client: ways to solve health
problems
• Never verbally or nonverbally ridicule a
cultural belief or practice
• Integrate helpful or harmless cultural
practices within the plan of care
• Modify or gradually change unsafe practices
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Culturally Sensitive Nursing (cont’d)
• Provide customarily eaten food
• Advocate routine screening for genetically/
culturally prone diseases
• Facilitate rituals by a healer identified by the
client
• Apologize if cultural traditions or beliefs are
violated
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins