Professional Documents
Culture Documents
Clients vary according to age, gender, race, health status, education, religion, occupation,
and economic level. Culture, the focus of this chapter, is yet another characteristic that
contributes to client diversity. Nurses have always cared for clients with differences of some
sort. Despite cultural differences, the traditional tendency has been to treat clients as
though none exist. Although equal treatment may be politically correct, many nurses now
believe that ignoring differences contradicts the best interests of clients. Consequently
there is a movement toward eliminating acultural nursing care (care that avoids concern
for cultural differences) and promoting culturally sensitive nursing care (care that respects
and is compatible with each clients culture). This chapter provides information about
cultural concepts, cultural variations among different ethnic and racial groups, and
intercultural communication. Although components of culture are specific to a particular
group of people, individual clients within each cultural group may deviate from the
collective norm. Therefore, nurses are advised to always consider cultural needs from an
individuals perspective. Every human being is in some ways like all others, like some
others, and like no other (Andrews, 1999).
TUGAS KELOMPOK II :
CULTURE
Culture (values, beliefs, and practices of a particular group; Giger & Davidhizar, 1999)
incorporates the attitudes and customs learned through socialization with others. It
includes, but is not limited to, language, communication style, traditions, religion, art, music,
dress, health beliefs, and health practices. A groups culture is passed from one generation
to the next. According to Smeltzer and Bare (2000), culture is (1) learned from birth; (2)
shared by members of a group; (3) influenced by environment, technology, and availability
of resources; and (4) dynamic and ever changing. Although the United States has been
described as a melting pot in which culturally diverse groups have become assimilated,
that is not the case. People from various cultural groups have settled, lived, and worked in
the United States while continuing to sustain their unique identities (Table 6-1).
RACE
Cultural groups tend to share biologic and physiologic similarities. Race (biologic variations)
is a term used to categorize people with genetically shared physical characteristics. Some
examples include skin color, eye shape, and hair texture. Despite wide ranges in physical
variations, skin color has traditionally been the chief, albeit imprecise, method for dividing
races into Mongoloid, Negroid, and Caucasian. Skin color is just one of a variety of inherited
traits. More importantly, nurses should not equate race with any particular cultural group.
To do so leads to two erroneous assumptions: (1) all people with common physical features
share the same culture and (2) all people with physical similarities have cultural values,
beliefs, and practices that differ from those of Anglo-Americans (U.S. Caucasians who trace
their ancestry to the United Kingdom and Western Europe).
TUGAS KELOMPOK IV :
MINORITY
The term minority is used when referring to groups of people who differ from the majority
in terms of cultural characteristics such as language, physical characteristics like skin color,
or both. Minority does not necessarily imply that there are fewer group members in
comparison with others in the society. Rather, it refers to the groups status in regard to
power and control. For example, men of European ancestry are the current majority in the
United States. Slightly more women than men are in the United States, yet women are
considered a minority. By the year 2020, the number of Latinos and Asian Americans living
in the United States is expected to triple, and the number of African Americans will double
(Andrews, 1999). Until these groups acquire more political and economic power in society,
they will continue to be classified as minorities.
TUGAS KELOMPOK V :
ETHNICITY
Ethnicity (bond or kinship a person feels with his or her country of birth or place of ancestral
origin) may exist regardless of whether or not a person has ever lived outside the United
States. Pride in ones ethnicity is demonstrated by valuing certain physical characteristics,
giving children ethnic names, wearing unique items of clothing, appreciating folk music and
dance, and eating native dishes (Fig. 6-1). Because cultural characteristics and ethnic pride
represent the norm in a homogeneous group, they tend to go unnoticed. When two or more
cultural groups mix, however, as often happens at the borders of various countries or
through the process of immigration, unique differences become more obvious. One or both
groups may experience cultural shock (bewilderment over behavior that is culturally
atypical). Consequently many ethnic groups have been victimized as a result of bigotry
based on stereotypical assumptions and ethnocentrism.
TUGAS KELOMPOK VI :
Stereotyping
Stereotypes (fixed attitudes about all people who share a common characteristic) develop
with regard to age, gender, race, sexual preference, or ethnicity. Because stereotypes are
preconceived ideas usually unsupported by facts, they tend to be neither real nor accurate.
In fact, they can be dangerous because they interfere with accepting others as unique
individuals.
Generalizing
Generalization (supposition that a person shares cultural characteristics with others of a
similar background) is different than stereotyping. Stereotyping prevents seeing and
TUGAS KELOMPOK IX :
BOX 6-1 Examples of U.S. Cultural Characteristics
a. English is the language of communication.
b. The pronunciation or meaning of some words varies according to regions within the United States.
c. The customary greeting is a handshake.
d. A distance of 4 to 12 feet is customary when interacting with strangers or doing business (Giger and Davidhizar,
1995).
e. In casual situations, it is acceptable for women as well as men to wear pants; blue jeans are a common mode of
dress.
f. Most Americans are Christians.
g. Sunday is recognized as the Sabbath.
h. Government is expected to remain separate from religion.
i. Guilt or innocence for alleged crimes is decided by a jury of ones peers.
j. Selection of a marriage partner is an individuals choice.
k. Legally, men and women are equals.
l. Marriage is monogamous (only one spouse); fidelity is expected.
m. Divorce and subsequent remarriages are common.
n. Parents are responsible for their minor children.
o. Aging adults live separately from their children.
p. Status is related to occupation, wealth, and education.
q. Common beliefs are that everyone has the potential for success and that hard work leads to prosperity.
r. Daily bathing and use of a deodorant are standard hygiene practices.
s. Anglo-American women shave the hair from their legs and underarms; most men shave their faces daily.
t. Licensed practitioners provide health care.
u. Drugs and surgery are the traditional forms of medical treatment.
v. Americans tend to value technology and equate it with quality.
w. As a whole, Americans are time oriented and, therefore, rigidly schedule their activities according to clock hours.
x. Forks, knives, and spoons are used, except when eating fast foods, for which the fingers are appropriate.
TUGAS KELOMPOK X :
TRANSCULTURAL NURSING
Madeline Leininger coined the term transcultural nursing (providing nursing care within the
context of anothers culture) in the 1970s. Aspects of transcultural nursing include the
following:
Assessments of a cultural nature
Acceptance of each client as an individual
Knowledge of health problems that affect particular cultural groups
Planning of care within the clients health belief system to achieve the best health
outcomes
To provide culturally sensitive care, nurses must become skilled at managing language
differences, understanding biologic and physiologic variations, promoting health teaching
that will reduce prevalent diseases, and respecting alternative health beliefs or health
practices.
Cultural Assessment
To provide culturally sensitive care, the nurse strives to gather data about the unique
characteristics of clients.
Pertinent data include the following:
TUGAS KELOMPOK XI :
Language and Communication
Because language is the primary way to share and gather information, the inability to
communicate is one of the biggest deterrents to providing culturally sensitive care. Foreign
travelers and many residents in the United States do not speak English or they have learned
it as their second language and do not speak it well. Estimates are that 13.8% of those who
live in the United States speak a language other than English at home (Perkins et al., 1998).
Those who can communicate in English may still prefer to use their primary language
especially under stress.
EQUAL ACCESS.
Federal law, specifically Title IV of the Civil Rights Act of 1994, states that people with
limited English proficiency are entitled to the same health care and social services as those
who speak English fluently. In other words, all clients have a right to unencumbered
communication with a health provider. Using children as interpreters or requiring clients to
provide their own interpreters is a civil rights violation. The Joint Commission on
Accreditation of Healthcare Organizations requires that hospitals have a way to provide
effective communication for each client. The use of untrained interpreters, volunteers, or
family is considered inappropriate because it undermines confidentiality and privacy. It also
violates family roles and boundaries. It increases the potential for modifying, condensing,
omitting, or adding information or projecting the interpreters own values during
communication between client and health care provider. To comply with the laws and
accreditation requirements, health care agencies are strongly encouraged to train
professional interpreters. A competent trained interpreter demonstrates the skills listed in
Box 6-2.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
NURSECLIENT COMMUNICATION.
If the nurse is not bilingual (able to speak a second language), he or she must use an
alternative method for communicating. See Nursing Guidelines 6-1 for more information.
Understanding some unique cultural characteristics involving aspects of communication may
ease the transition toward culturally sensitive care. It is helpful to be aware of general
communication patterns among the major U.S. subcultures. Native Americans tend to be
private and may hesitate to share personal information with strangers. They may interpret
questioning as prying or meddling. The nurse should be patient when awaiting an answer and
listen carefully because people of this culture may consider impatience disrespectful (Lipson,
Dibble & Minarik, 1996). Navajos, currently the largest tribe of Native Americans, believe
that no person has the right to speak for another and may refuse to comment on a family
members health problems. Because Native Americans traditionally preserved their heritage
through oral rather than written history, they may be skeptical of Anglo-American nurses
who write down what they say. If possible, the nurse should write notes after, rather than
during, the interview.
with authority figures, such as physicians and nurses, because of their respect for harmony.
Such reticence can conceal disagreement or potential noncompliance with a particular
therapeutic regimen that is unacceptable from their perspective.
Providing personal care and performing nursing procedures often reduce personal space,
which causes discomfort for some cultural groups. For example, Asian Americans may feel
more comfortable with the nurse at more than an arms length away. The physical closeness
of a nurse in an effort to provide comfort and support may threaten clients from other
cultures. It is best, therefore, to provide explanations when close contact during procedures
and personal care is necessary.
TUGAS KELOMPOK XV :
Touch
Some Native Americans may interpret the Anglo-American custom of a strong handshake as
offensive. They may be more comfortable with just a light passing of the hands. People from
Southeast Asia consider the head to be a sacred body part that only close relatives can
touch. Nurses and other health care workers should ask permission before touching this
area. Southeast Asians also believe that the area between a females waist and knees is
particularly private and should not be touched by any other male than the womans
husband. Before doing so, a male nurse can relieve the clients anxiety by offering an
explanation, requesting permission, and allowing the clients husband to stay in the room.
Emotional Expression
Anglo-Americans, in general, freely express their positive and negative feelings. Asian
Americans, however, tend to control their emotions and expressions of physical discomfort
(Zborowski, 1952, 1969) especially among unfamiliar people. Similarly, Latino men may not
demonstrate their feelings or readily discuss their symptoms because they may interpret
doing so as less than manly (Andrews & Boyle, 2003). The Latino cultural response can be
attributed to machismo, a belief that virile men are physically strong and must deal with
emotions privately. Because this behavior is atypical from an Anglo-American perspective,
nurses may overlook the emotional and physical needs of people from these cultural
groups.