Chapter 5
Culture and Ethnicity
Culture
 Knowledge, beliefs, behaviors, ideas,
attitudes, values, habits, customs,
languages, symbols, rituals, ceremonies,
and practices that are unique to a
particular group of people.
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Concepts of Culture
 Each individual is culturally unique.
 Behavior, self-perception, and judgment
of others is dependent upon one’s
cultural perspective.
 Differences within cultural groups result
from individual perspectives and
practices.
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Characteristics of Culture
 Cultural knowledge is transmitted from
one generation to another.
 The sharing of common cultural practices
provides a group with part of its cultural
identity.
 Culture is social in nature.
 Culture is dynamic, adaptive, and
ever-changing.
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Ethnicity and Race
 Ethnicity
• A cultural group’s perception of themselves
(group identity)
 Race
• A grouping of people based on blood group,
facial features, color of skin, hair, eyes
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Ethnicity and Race
 The similarities of people in racial and
ethnic groups reinforce a sense of
commonality and cohesiveness.
 Problems arise when differences across
and within cultural groups are
misunderstood.
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Labeling and Stereotyping
 Stereotyping
• An expectation that all people within the
same racial, ethnic, or cultural group act
alike and share the same beliefs and
attitudes.
 Stereotyping results in labeling people
according to cultural preconceptions.
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Labeling and Stereotyping
 Ethnocentrism
• The belief that one’s own culture is superior
to all others.
 Oppression
• Occurs when the rules, modes, and ideals of
one group are imposed on another group.
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Racism
 Racism is a form of oppression.
 Racism is discrimination directed toward
individuals who are perceived to be
inferior due to biological differences.
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Dominant Values in the U.S.
 A dominant culture is the group whose
values prevail within a society.
 A subculture is a group of people who
have experiences different from those of
the dominant culture.
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Dominant Values in the U.S.
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Competition, achievement success
Individualism, independence, self-reliance
Activity, work, ownership
Efficiency, practicality, reliance on
technology
 Material comfort
 Youth and beauty
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Multiculturalism in the U.S.
 At present, the dominant culture of the
U.S. is composed of white, middle-class
Protestants of European ancestry.
 The U.S. is becoming increasingly
multicultural and multilingual.
 White Americans will decline from 75% to
under 50% of the total population by the
year 2050.
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Dominant Values in the U.S.
 Dominant values may conflict with the
values of minority groups.
 Minority groups can be composed of an
ethnic, racial, or religious group that
constitutes less than a numerical majority
of the population.
 Minority groups are considered to hold
less power than the dominant group.
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Dominant Values in the U.S.
 Acculturation is the process of learning
norms, beliefs, and behavioral
expectations of a group.
 People assume the characteristics of the
dominant culture through acculturation.
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Dominant Values in the U.S.
 Assimilation is cultural and structural
blending into a dominant entity.
 Cultural assimilation occurs when
individuals from a minority group are
absorbed by the dominant culture and
take on its characteristics.
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Value of Diversity
 Cultural diversity refers to differences
between people based on their cultural
variables that result in a shared ideology
and way of life.
 New ideas and increased tolerance of
other viewpoints are outcomes of a
diverse population.
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Organizing Phenomena of
Culture
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Communication
Space
Orientation to Time
Social Organization
Environmental Control
Biological Variations
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Communication
 Communication refers to words, facial
expressions, posture, and gestures that
have different meanings to different
people in varying cultures.
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Space
 Personal space includes one’s body and
the surrounding environment.
 Space, distance, and use of touch are
viewed in the context of personal space.
 Touch may be perceived as invasive by
clients from some cultures.
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Orientation to Time
 Orientation to time includes concepts of
past, present, and future.
 Different cultures place different values
on the ideas of tardiness, quickness, and
efficiency.
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Social Organization
 Social organization refers to the ways in
which groups determine rules of
acceptable behavior and roles.
 Social organizations include family,
religious groups, and ethnic groups.
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Social Organization
 Family
• Types of family structures include nuclear,
extended, attenuated, incipient,
and blended.
• Family patterns include linear, collateral, and
individualist.
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Social Organization
 There are diverse family structures and types as shown
in these photographs.
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Social Organization
 There are diverse family structures and types as shown
in these photographs.
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Social Organization
 There are diverse family structures and types as shown
in these photographs.
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Social Organization
 Gender Roles
• Vary according to cultural context.
• In families with a patriarchal structure, the
man is the chief authority figure.
• In a matriarchal structure, the woman is the
chief authority figure.
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Social Organization
 Examples of alternative lifestyles in the
United States include homosexual
couples, single parent families, and
communal groups.
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Social Organization
 Religion
• Religious practices influence a person’s
response to major life events such as birth,
illness, and death.
• Illness and treatments are often the catalyst
for increased spiritual needs.
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Cultural Disparities in Health
and Health Care Delivery
 Disparities in Health
• Minorities experience some diseases at a
much higher rate than white Americans.
 Disparities in Health Care Delivery
• Cultural insensitivity can create barriers to
health care and inequities in services.
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Biological Variations
 Biological variations that distinguish one
cultural group from another include:
• Enzymatic differences
• Susceptibility to disease
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Vulnerable Populations
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The Poor
The Homeless
Migrant Workers
Abused Individuals
The Elderly
Pregnant Adolescents
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Vulnerable Populations
 The poor have more complex health
problems.
 The poor have higher incidences of
chronic illnesses.
 Childhood poverty has long-lasting
negative effects on health.
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Vulnerable Populations
 The Homeless
• Lack of affordable housing
• Increasingly stringent criteria for public
assistance
• Decreased availability of social services
• Lack of employment
• History of psychosocial trauma
• Lack of mental health facilities
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Vulnerable Populations
 The homeless are at greater risk for
diabetes, AIDS, respiratory diseases,
cardiovascular diseases and parasitic
infestations, mental illness, and
substance abuse.
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Cultural Disparities in Health
and Health Care Delivery
 Environmental Control
• Relationships between people and nature
• One’s perceived ability to control activities of
nature
• Beliefs about causation of disease may
influence the type of treatment sought
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Folk Medicine (Alternative
Medicine)
 Most cultures have preferences for their
own caregivers.
 Caregivers
• Folk healers, root doctor, granny, voodoo
healer, spiritualist, herbalist, shaman
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Cultural Disparities in Health
and Health Care Delivery
 Biological variations that distinguish one
cultural group from another include:
• Enzymatic differences
• Susceptibility to disease
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Transcultural Nursing
 Health behavior is culturally determined.
 A thorough understanding of culturally
relevant information is essential for
delivery of competent nursing care.
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Transcultural Nursing
 Leininger’s transcultural nursing theory is
the conceptual framework for
understanding cultural diversity and
providing culturally competent care.
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Transcultural Nursing Theory
 Every culture has some kind of system
for health care based on values and
behaviors.
 Cultures have certain methods for
providing health care, often unknown to
nurses from other cultures.
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Cultural Competence
 Cultural competence is the process
through which the nurse provides care
that is appropriate to the client’s cultural
context.
 Culturally competent nurses demonstrate
knowledge and respect for cultural values
related to health and illness.
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Cultural Competence
 Five Elements of Cultural Competence
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Cultural Awareness
Cultural Knowledge
Cultural Skill
Cultural Encounters
Cultural Desire
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Cultural Competence and the
Nursing Process
 Assessment
• The nurse must acknowledge the
importance of validating the meaning of and
interpreting the intended verbal or nonverbal
message.
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Cultural Assessment Factors
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Client’s Ethnic Heritage
Family Role and Function
Religious Practices
Food Preferences
Native Language
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Cultural Assessment Factors
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Social Networks
Health Care Beliefs
Family Patterns of Health Care
Educational Experiences (both formal
and informal)
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Cultural Assessment Interview
 Click the link below to view the Cultural
Assessment Interview Guide
• Cultural Assessment Interview Guide
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Culturally-Based Nursing
Diagnoses
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Noncompliance
Impaired Verbal Communication
Impaired Social Interaction
Deficient Knowledge
Disturbed Thought Processes
Powerlessness
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Planning and Outcome
Identification
 When planning culturally competent care,
the nurse views the client as a partner of
the health care team.
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Planning and Outcome
Identification
 Cultural factors that may impact the plan
of care:
• Perspectives on health, life, and death
• Perspectives on causes of illness, and
maintenance of wellness
• Perceptions about the significance of
symptoms
• Treatment approaches
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Implementation
 Caring for culturally diverse clients
requires three major nursing
interventions:
• Self-Awareness
• Nonjudgmental Approach
• Client Education
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Client Education
 Through self-awareness, the nurse
recognizes the influence that one’s
cultural background may have on the
delivery of care.
 A nonjudgmental approach is one that
avoids using stereotypical, judgmental
words.
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Client Education
 Observe the interaction between the
client and family to determine family roles
and authority figures.
 Use language easily understood by the
client.
 Clarify your verbal and nonverbal
messages with the client.
 Have the client repeat the information
taught.
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Evaluation
 Determines client achievement of
expected outcomes.
 Determines efficacy of culturally
sensitive nursing care to achieve
client outcomes.
• It is important to demonstrate caring
behaviors rather than just tolerate cultural
variations.
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Chapter 3