Chapter 6
Cultural and Ethnic
Considerations
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United States described as “melting pot”
from many different countries
 According to 2010 census, 34.6% of
population is of African, Asian, Hispanic,
American Indian, or some other ancestry
(U. S. Census Bureau, 2010)

Overview
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Set of learned values, beliefs, customs,
and practices that are shared by a group
and passed from one generation to
another
 Subculture

◦ Share characteristics with primary culture
◦ Has characteristic patterns of behavior and
ideals that distinguish it from the rest of
cultural group
Culture Defined
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








Characteristics
Differences
Age
Religion
Dialect or language spoken
Gender identity and roles
Socioeconomic background
Geographic location of country of origin or current
residence
Amount and type of interaction between younger and older
generations
◦ Degree to which values in current country are adopted
Culture Defined cont’d
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Nurses need to deliver culturally
competent care and avoid stereotyping
 Stereotype

◦ Generalized expectation about forms of
behavior, an individual, or a group

Ethnic stereotype
◦ Fixed concept of how all members of an ethnic
group act or think
Culture Defined cont’d
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
Transcultural nursing
◦ Understanding and integrating variables into all
aspects of nursing care
◦ Nursing areas influenced by culture
 Treatment methods
 Responses to illness and death
 Childbirth
 Diet and nutrition
Culture Defined cont’d
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
Race and ethnicity
◦ Race
 Group of people who share biologic physical
characteristics and hereditary factors
◦ Ethnicity
 Group of people who share a common social and
cultural heritage based on shared traditions,
national origin, and physical and biologic
characteristics
Culture Defined cont’d
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
Ethnic and racial groups in the United
States
◦ Many cultures
 Belong to one or more subculture

Important not to make assumptions about
a patient’s belief or practice based on
name, skin color, or language
Culture Defined cont’d
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Culture is defined as a:
1. set of learned values, beliefs, customs, and
practices that are shared by a group and
passed from one generation to another.
2. set of values that has been passed on from
one generation to another.
3. group that shares biologic physical
characteristics.
Question 1
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
Communication
◦
◦
◦
◦
Nurse and patient must understand each other
Do not assume patient/family understand
Keep questions brief and simple
Nurse is responsible for providing information
to patient
◦ Different cultural groups interpret different
meanings for same words
Cultural-Related Assessment
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
Communication
◦ Silence—May indicate lack of understanding,
stubbornness, apprehension, discomfort,
agreement, disagreement, respect, or disdain
 In American Indian, Chinese, and Japanese
cultures, silence allows listener to consider what
speaker has said
 For Russians, French, and Spanish, silence
indicates consensus among parties
 In Asian cultures, silence is a sign of respect
 In Mexican culture, silence may indicate
disagreement with person of authority
Cultural-Related Assessment
cont’d
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
Communication
◦ Nonverbal
 Some cultures more comfortable with touching or
maintaining eye contact
 Touch is culturally related
 Eye contact has significant cultural interpretations
Cultural-Related Assessment
cont’d
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
Communication
◦ Nonverbal
 In United States, maintaining eye contact
indicates openness, interest in others,
attentiveness, and honesty. Lack of eye
contact—sign of shyness, humility, guilt,
embarrassment, rudeness, thoughtlessness, or
dishonesty
 Asians and American Indians: sustained eye
contact—impoliteness or invasion of privacy
 East Indian cultures: avoid with people of
lower or higher socioeconomic classes
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 Appalachian: sustained eye contact—hostility
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or aggressiveness
Cultural-Related Assessment
cont’d
13

Space
◦ Different comfort areas for personal space
 Western culture: more comfortable when
maintaining 3-6 feet during conversation
 Body movements are culturally related
Cultural-Related Assessment
cont’d
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
Time
◦ Different meanings in various cultures
 Northern European and United States give high
priority to being on time
 Eastern cultures more flexible
 Asians spend time getting to know someone and
view abrupt endings as rude
 Mexican-Americans focus on current activity
rather than previously planned activities
Cultural-Related Assessment
cont’d
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
Social organization
◦ Socially acquired, not genetically inherited
 Patriarchal: men (often oldest) make most
decisions
 Matriarchal: women make decisions about health
care, provide care, and discipline
 Knowing family structure assists in understanding
the patient
Cultural-Related Assessment
cont’d
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
Religious beliefs and health care
◦ Entwined with cultural beliefs
◦ Some expect members to adhere to religion
◦ Nursing care affected by religious beliefs and
practices
◦ Be aware of such beliefs to ensure care
provided is sensitive to patient’s needs
Cultural-Related Assessment
cont’d
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
Health practices
◦
◦
◦
◦
Biomedical health belief system
Folk health belief system
Holistic health belief system
Alternative or complementary belief system
Cultural-Related Assessment
cont’d
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
Biological variations
◦ Cultural groups are identified in various ways
 Characteristics
◦ Body structure
◦ Skin color
◦ Hair color and texture
◦ Family history of disease
◦ Dietary practices
Cultural-Related Assessment
cont’d
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Today you are caring for an American
Indian patient. During your communication,
you maintain eye contact, which is
perceived by this population as being:
1.
2.
3.
4.
impolite or invading privacy.
interested.
attentive.
honest.
Question 2
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Nurse develops a care plan based on cultural
background after assessing patient
 North American Nursing Diagnosis Association
(NANDA) nursing diagnoses may not apply to
culturally diverse patients
 To provide care and lessen limitations of the
NANDA nursing diagnoses, the nurse must
evaluate behavior of the prospective patient’s
culture
Nursing
and or both may
 The nurse,Process
health care system,
be requiredFactors
to change in order to
Cultural
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accommodate, maintain, or reinforce
patients’
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health beliefs and practices

21

See Table 6-4 in Foundations text

Mexican Americans
◦
◦
◦
◦
Health belief system
Language
Communication
Family roles
Cultural Practices of
Specific Groups
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
Mexican Americans
◦ Birth rites
◦ Death rites
◦ Dietary practices
Cultural Practices of Specific
Groups cont’d
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
African Americans
◦
◦
◦
◦
Health belief system
Language
Communication
Family roles
Cultural Practices of Specific
Groups cont’d
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
African-Americans
◦ Birth rites
◦ Death rites
◦ Dietary practices
Cultural Practices of Specific
Groups cont’d
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
Chinese Americans
◦ Health belief system
◦ Language
◦ Communication
Cultural Practices of Specific
Groups cont’d
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
Chinese Americans
◦
◦
◦
◦
Family roles
Birth rites
Death rites
Dietary practices
Cultural Practices of Specific
Groups cont’d
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
Muslim Americans
◦ Health belief system
◦ Language
◦ Communication
Cultural Practices of Specific
Groups cont’d
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
Muslim Americans
◦
◦
◦
◦
Family roles
Birth rites
Death rites
Dietary practices
Cultural Practices of Specific
Groups cont’d
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
American Indians
◦ Health belief system
◦ Language
◦ Communication
Cultural Practices of Specific
Groups cont’d
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
American Indians
◦
◦
◦
◦
Family roles
Birth rites
Death rites
Dietary practices
Cultural Practices of Specific
Groups cont’d
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Which culture allows fathers in labor and
delivery?
1.
2.
3.
4.
Chinese
American Indian
Mexican Americans
Muslim
Question 3
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