Cultural Influences : Nursing Class Essays

Chapter 5

Cultural Influences

It is projected that by 2044 those persons from groups that have long been counted as statistical minorities will become the emerging majority.

Immigrant population is growing at a faster rate than that of the native born.

Senior communities and health care facilities will need to advance their cultural competence.

It is likely that many of these older adults will not speak the same language as the nurse.

Diversity of the Older Adult Population in the United States

Nurses are challenged to gain new awareness, knowledge, and skills to provide culturally and linguistically appropriate care.

Culturally compassionate care reduces health disparities.

Culturally appropriate care begins with an increasing awareness of our own beliefs and attitudes.

Conduct a cultural self-assessment

Culturally Sensitive Gerontologic Nursing Care

Cultural Concepts

Culture

Enculturation

Values

Acculturation

Race

Ethnicity and ethnic identity

Ethnocentrism

Racism

Cultural conflict

Are grounded in culture and influenced by past experience

Magico-religious theory

Health, illness, and effectiveness of treatment are believed to be caused by the actions of a higher power.

Health is viewed as a blessing or a reward, and illness is viewed as a punishment.

Treatments may involve religious practices such as praying, meditating, fasting, wearing amulets, burning candles, or establishing family altars.

Beliefs About Health and Illness

The right amount of exercise, food, sleep, evacuation, interpersonal relationships, or geophysical and metaphysical forces in the universe

Disturbances balance results in disharmony and subsequent illness.

Interventions aim at restoring balance.

Yin/yang theory

Hot/cold theory

Balance and Harmony

The body is viewed as a functioning machine.

Health is a state of optimum functioning along with the absence of microorganisms such as bacteria or viruses.

Treatment is directed at repair or removal of the damaged part or administration of drugs to kill or retard the growth of the causative organism.

The Biomedical or Western Perspective

Time orientation

Past

Perceive present health and health problems as the result of past actions, from a past life, from earlier in this life, or from events and circumstances related to one’s ancestors

Present

Perceive a new health problem to need attention in the immediate present

Future

Holders of a future orientation accept that what we do now affects our future health.

Transcending Cultural Concepts

Autonomy and individual responsibility are paramount.

Identity and self-esteem are bound to the self rather than to a group.

Decisions should be made autonomously.

The Patient Self-Determination Act (PSDA)

The Health Insurance Portability and Accountability Act (HIPAA)

Individualist Orientation

An individual derives identity from affiliation with and participation in a social group such as a family or clan.

Needs of the group are more important than the individual, and decisions are made with consideration of the effect on the whole.

Collectivist Orientation

Theory that refers to the characteristics of relationships and behaviors toward others

High context (universalism)

A more personal relationship is expected.

Body language is more important than spoken words.

Low context (particularism)

Task oriented

Individual identity is not as important

Direct approach is expected.

Context

The effective nurse is careful to follow correct etiquette with his or her patients whenever possible

Handshake

Eye contact

Interpreters

Skills

Patients have the right to an interpreter.

The more complex the decision making, the more important it is to have an interpreter.

Use only those trained in medical interpretation.

Avoid using children of patients.

Speak to the patient, not the interpreter.

Interpreters

The nurse works in a large metropolitan hospital that provides care for older adults of many different cultures. Discuss the ways a nurse can provide culturally competent care.

Case Study

Answers will vary

Theory of cultural care diversity and universality—recommended for use with the older adult population

Theorizes three modes of action for the professional nurse to provide culturally congruent care

Cultural care preservation or maintenance

Cultural care accommodation or negotiation

Cultural care repatterning or restructuring

Leininger

Kleinman, Eisenberg & Good (1978)

Suggested that to provide culturally sensitive and competent care, the gerontologic nurse explores the meaning of the health problem from the patient’s perspective.

The Explanatory Model

L—Listen carefully to what the older person is saying, including the person’s perception of the situation, desired goals, and ideas for treatment

E—Explain your perception of the situation and the problem(s)

A—Acknowledge and discuss both the similarities and the differences between your perceptions and goals and those of the older person

The LEARN Model (1 of 2)

R—Recommend a plan of action that takes both perspectives into account

N—Negotiate a plan that is mutually acceptable

The LEARN Model (2 of 2)

E—Explanation

T—Treatment

H—Healers

N—Negotiate

I—Intervention

C—Collaboration

The Ethnic Model