Cultural Implications (Discussion forum)
Nursing 458: Genetics
Case Study 1 – African American
Mrs. S. is a 52-year-old African American woman from a rural town in east North Carolina. This
area has a history of having had the highest population density of enslaved Africans brought to
the United States as plantation labor. The culture of this area includes strong West African
traditions, customs and beliefs from a number of different ethnic groups. Mrs. S’s daughter
brings her to a women’s health clinic because her mother has begun to lose her appetite and
lose weight. The nurse takes a family history at the initial visit and learns that Mrs. S’s mother
died in her late 40’s from a cancer tumor "that spread quickly to all parts of her body." Mrs. S.
has a sister who lives in Charlotte, North Carolina who is currently being treated for breast
cancer at age 48 years. She has had genetic testing for hereditary breast/ovarian cancer and
has been found to have a mutation in one of the BRCA genes. Mrs. S’s daughter tells the nurse
that she is concerned about her mother and the possibility of breast cancer in her, but her
mother has been reluctant to seek care. Mrs. S says that she is afraid of doctors because "they
cut into my mother and when the cancer hit the air it spread all around her body and killed her."
Mrs. S explains that she is only at the clinic "because my daughter insisted." She says she
believes that if she continues her prayers and the laying on of hands by the elders in her church
she will be cured. If she is not cured, Mrs. S tells the nurse, then it is time for her to pass from
the evils of the world to another place to join her mother.
The Communities of Color & Genetics Policy Project’s - Focus Group Content Report, July 2000
http://www.sph.umich.edu/genpolicy/current/reports
Cultural Competency (scroll down to African-American Sites)
http://www.culturalcompetency.homestead.com/
Psychosocial predictors of BRCA counseling and testing decisions among urban AfricanAmerican women. http://cebp.aacrjournals.org/cgi/content/full/11/12/1579
Provider’s Guide to Quality and Culture
http://erc.msh.org/mainpage.cfm?file=5.4.1.htm&module=provider&language=English
To effectively assess the client, I will import Campinha-Bacote’s model which will enable me to
understand the client’s concerns from their own cultural perspective and rid myself of any bias I may
have against the client’s culture.
After that, I will use transcultural communication skills such greeting her appropriately, and maintain
normal personal space and appropriate eye contact. She has already stated her preference for prayers and
laying hands on her by the elders of her church. I will let her know that she can combine prayers with
conventional medications and procedures.
It has been found that some African-American women underuse genetic testing and counseling and this is
partly because of fear of stigmatization, shame, concerns about confidentiality, and emotional difficulties
of coping with a positive result(Thompson et al., 2002). However, most African-American women who
refuse counseling and testing have little knowledge about genetic testing (Thompson et al., 2002). With
this in mind, I will provide Mrs. S more education about BRCA testing and also share statistics of
African-American women who have benefitted from counseling and testing.
Nursing Implications
The United States is becoming increasingly diverse with people from across the globe migrating to the
US. This means that nurses will continue to care for patients from different cultures. The implication is
that nurses should become culturally competent in order to provide services that are culturally
appropriate. Fortunately, nursing schools have recognized that and have placed great emphasis on training
culturally competent nurses.
Reference
Thompson S.H., Valdimarsdottir, B.H, Duteau-Buck, C., Guevarra, J., Bovbjerg, D.H., RichmondAvellaneda, C., …. Offit, L. (2002). Psychosocial predictors of BRCA counseling and testing decisions
among urban African-American women. Cancer Epidemiology, Biomarkers and Prevention. Retrieved
from http://cebp.aacrjournals.org/cgi/content/full/11/12/1579