Professional Documents
Culture Documents
Mallory White
Aspen University
November 2016
PROFESSIONAL DEVELOPMENT ASSESSMENT 2
Many nurses take a pledge to do no harm to patients, to maintain a standard of care in the
profession, and to care for all patients that we come in contact with. This includes caring for
patients of different cultures and backgrounds. This makes one wonder, what is cultural
diversity, how does it affect nursing care. The answers to these questions can range from simple
to highly abstract.
Cultural diversity is a norm for many nurses. Firelands Regional Medical Center is a
moderate size medical facility in Sandusky Ohio with a high tourist population. Patients from all
different walks of life and cultural backgrounds come into the facility. Patients that come
through the doors range from being homeless to CEO’s of large companies. Many patients are
born and raised in the United States, but some are from other countries. Most speak English, but
some have a different primary language. Being a culturally competent nurse means caring for
backgrounds. Amongst the heritages there are many similarities and many differences. As a
culturally competent nurse, it is highly important to build a rapport with patients to get a better
Patients may have cultural beliefs that affect nursing care, from the openness of sharing
medical information to the preference of providers. Cultural backgrounds may also affect
nursing care in the influence of holistic beliefs. Again, it is important to understand patient how a
Being a culturally competent nurse means providing care for all patients, regardless of
their religious, cultural, or socioeconomic backgrounds. Nurses who provide direct patient care
PROFESSIONAL DEVELOPMENT ASSESSMENT 3
should practice patient care without bias and preference. Nurses should care for all patients the
same way, whether they have similar of different backgrounds. Being a competent nurse means
understanding that there may be differences but caring for the patient anyways.
All nurses should strive to care for patients the way that they would like to be treated.
Nurses should provide care that complies with patient wishes. For example, some patients prefer
not to receive blood transfusions, nurses should accept patient wishes and suggest other
Another example may include how patients or their families handle death and dying.
Many cultures, like Jewish culture, believe death is a part of the natural life cycle, and instead of
preventing it, they accept and embrace it. It is important for nurses to accept patient wishes and
provide care that matches those wishes, instead of pushing their own views.
Nursing is a profession with great potential for learning. When caring for patients of
different backgrounds, nurses can not only learn about their patients, but they can also learn
about themselves. Listening to different perspectives can expand a nurse’s cultural tolerance. It
can also provide them with the opportunity to look within themselves and build upon their own
beliefs. Learning in nursing can occur through direct patient care and also through case studies.
Through this class, this writer has gained more insight into other cultures. This class has
offered this nurse with the opportunity to further develop an understanding for her own beliefs
and also understand the beliefs of the patients that are cared for. Having the belief that all
patients should be treated the same is important for all nurses. Whether a nurse is caring for a
patient with a specific cultural background or a diverse background, all patients should be treated
with dignity and respect. All patients should be offered the opportunity to have care that not
only meets their medical needs but also meets their cultural, spiritual, and personal beliefs.
PROFESSIONAL DEVELOPMENT ASSESSMENT 4
Amish Heritage
Elmer and Mary Miller are a middle-aged Amish couple who live on a family farm with
their five children in Indiana. They live in the main house while Mary’s parents live in the
attached grandparents’ cottage. Elmer has plans of taking over the family farm when Mary’s
father Aaron retires. The Miller’s youngest child was born prematurely and is currently having
respiratory problems. The couple does not carry medical insurance and is worried about
To guide in a better understanding of the Miller’s views on what health means to them, it
is important to ask what distances they are willing to travel to seek folk medicine. Going along
with that question, it is also important to understand what their beliefs about folk practices are
and when they will seek Western medicine. Finally, to better understand what health and caring
mean to the Miller’s it is important to know what role health plays in their religious beliefs.
One area of perinatal care to discuss with Mary is to discuss prenatal care. Along with
that, it is important to understand her physical post-partum care. It is also important to discuss
Mary’s choice on whether or not she chose to breastfeed or bottle-feed her son. Finally, it is
include abdominal discomfort and crying. To treat this ailment, Amish women carry their babies
on a pillow.
The Amish have health-care beliefs that include folk remedies. Because Amish folk
traditions involve herbal remedies, it is important to have an understand what remedies the
Millers are using as they can interfere with Western medicine. Purnell (2013) explains that
Amish patients are more likely to discuss folk beliefs when they feel accepted by a nurse or
PROFESSIONAL DEVELOPMENT ASSESSMENT 5
health care professional. To learn more about the Miller’s use of folk medicine, it is important to
To prepare the Millers for a consultation at the medical center, a nurse should encourage
them to be forthcoming about their folk practices. A nurse should also explain to the Miller
family things they may see or experience in the medical center. Because the Amish do not
traditionally seek Western medicine, they may be unfamiliar with equipment like x-ray
machines. It is also important to discuss with the Miller’s ways to prepare for the incoming
medical bills.
To help promote culturally congruent care when consulting with the medical center, it is
important to encourage the medical center staff to research Amish health-care beliefs. Purnell
(2013) explains that Amish prefer receiving care from providers who give consideration to their
The Amish do not have any religious reasons for not vaccinating their children. Instead,
they do not vaccinate because of lack of knowledge. Wombwell, Fangman, Yoder, and Spero
(2015) conducted research on the barriers against vaccinating against the measles. They
concluded that the Amish community could benefit from improved immunization education.
Working with state and local health department officials to provide education within Amish
communities can help improve immunization rates. If the Amish receive proper education and
vaccinations are offered within the community, they are more likely to choose that option.
Members of the Older Amish community choose to not carry traditional health insurance.
One reason behind this is because the Amish don’t traditionally seek outside medical care
(Schroeder, 2006). Within the Amish community, they have their own healers and practitioners.
PROFESSIONAL DEVELOPMENT ASSESSMENT 6
Purnell (2013) describes diseases and health conditions that are prevalent in the Amish
community. One condition prevalent in the Amish community is dwarfism. Another condition
is cartilage-hair hypoplasia. Purnell (2013) explains that this disorder is found within nearly all
Amish communities in Canada and the United States. Finally, phenylketonuria [PKU] is found
The Amish use their elders as a source of strength and wisdom. Because the Amish
usually do not seek Western medicine, when they travel for medical care, it is typically done as a
multigenerational group. This is evident by the Miller’s traveling to Fort Wayne with Aaron and
some of their children. For a medical professional, it is important to understand this and plan
care for all members of the Miller family. It is important to understand that younger Amish
may use Amish and non-Amish midwives during their prenatal care. This is important for
healthcare providers to understand because treatments may contradict each other. Another
Amish value important to consider during prenatal education classes is the Amish preference for
home births. Home births can put the mother and baby at risk for complications. It is important
to educate Amish women on safe home birthing practices and when to seek outside medical care.
Finally, it is important to involve Amish husbands in prenatal classes. Purnell (2013) explains
that often times, Amish husbands are involved in prenatal classes. Amish men may not feel
comfortable viewing photos or videos of the childbirth process, but they can be educated through
discussion.
Amish diets are high in carbohydrates and fats. The Amish use meals as an opportunity
to spend time together as a family. Throughout the day, all members of the family are busy
PROFESSIONAL DEVELOPMENT ASSESSMENT 7
either at school, work, or both. Meals are a time of coming together. When developing a
nutritional guide for an Amish woman interested in losing weight, it is important to teach
moderation. All foods are okay in moderation. Amish are avid farmers and grow their own
fruits and vegetables. To encourage an Amish woman to lose weight, teach her to eat fresh fruits
Amish people typically do not openly show emotion. Purnell (2013) explains that love
and fondness for family members are held privately. Amish people use nonverbal
communications to express caring for others as well. For example, Amish men may tilt their hat
as a sign of expression. Amish express caring by giving to others. By donating money, food, or
a service, Amish show they care for others in their community by giving back.
Jewish Heritage
widowed after being married for 50 years. She is the mother of three children. Sarah practices
some variations of kosher-style eating, but her home is not kosher. Sarah has been diagnosed
with pancreatic cancer two months ago and is currently undergoing chemotherapy.
Many Jews believe that each day is a blessing and should be lived to its fullest. They also
believe that anything that artificially prevents death or prolongs the dying process should not be
used. Sarah has rapidly progressing pancreatic cancer that is not responding to chemotherapy
and causing complications within her gastrointestinal tract. Given this information, and the
Jewish belief on preventing death or prolonging the dying process, a nurse would expect Sarah to
sign a do not resuscitate [DNR] while continuing chemotherapy in an effort to cure her cancer.
PROFESSIONAL DEVELOPMENT ASSESSMENT 8
Purnell (2013) explains that Judaism teaches its members to choose life and considers the
refusal of life-saving medical treatments as suicide. It is this belief that helped Sarah make her
decision to undergo surgery and begin chemotherapy. A culturally competent nurse would
respect Sarah’s decision and help keep her informed on the risks and benefits of medical
that are not necessary to preserve life are viewed as unacceptable. It is important to understand if
Sarah practices Orthodox Judaism she may need more education to stress the need for
Purnell (2013) explains “the dying person should not be left alone” (p. 349). Sarah is
very ill and her cancer is not responding to medications or surgery. These factors are the reason
for her family members visiting. Popovsky (2007) describes the Hebrew phrase bikkur holim
which translates to “visiting the sick”. In Judaism, this refers to the obligations of healthy
family and friends to provide a range of care for those who are sick.
Hospice care may be appropriate for Sarah. As previously stated, many Jews do not
believe in measures that may prolong death. They also believe that the ill should be kept
comfortable and pain-free. Popovsky (2007) explains that hospice reflects the values that
Judaism has regarding caregivers at the end of life. Values such as respecting dignity, providing
Purnell (2013) explains that the period of time between death and burial are short. It is
also unacceptable to cry, express anger, or talk about the deceased person’s life immediately
PROFESSIONAL DEVELOPMENT ASSESSMENT 9
after death. A culturally competent nurse should be aware of this and refrain from these actions
or expressions in front of family. It is acceptable for the nearest relative to gently close the
mouth and eyes at the time of death then cover the face with a sheet. It is the job of a nurse to
allow relatives to have this opportunity. Purnell (2013) also explains that Orthodox Jews may
wrap the body, place it on the floor with feet pointing toward the door, and light a candle near
the head. While the body may not be able to be placed on the floor, a nurse can position the
hospital bed with the patient’s feet touching the door. The nurse may also have a flameless
candle available to be placed near the head. With all deaths, communication about patient and
Bloom syndrome is a rare genetic condition with genes carried by 1:110 Ashkenazi Jews.
abnormal breakage of chromosomes. Gaucher’s disease is the most common disease affecting
disorder that results in weakening bones, anemia, and platelet deficiencies. Gaucher’s disease is
carried by 1 in 10 Ashkenazi Jews. Another disease that is seen in 1:1000 to 1:3000 Ashkenazi
Jews in the United States is torsion dystonia. Torsion dystonia is a musculoskeletal disease that
Jewish funerals usually occur within 24-48 hours after death (Purnell, 2013). Caskets are
usually a simple pine box and flowers and fists are not usually seen. Purnell (2013) explains that
simplicity and realism are characteristics of the Jewish burial. Shiva is the 7-day period that
begins with the burial. During Shiva, mourners do not work and no activities are permitted as
not to divert the attention away from thinking about the deceased.
PROFESSIONAL DEVELOPMENT ASSESSMENT 10
Laws of Kashrut refer to the Jewish laws that dictate what foods are permissible to
consume. It is important for a nurse to understand a Jewish patient’s belief in Kashruth when
discussing meal options. Purnell (2013) explains that permitted meats must be slaughtered,
cooked, and served properly as all life, including animals, is sacred. Another example of a
Kashrut law is that milk and meat may not be mixed together in eating, serving, or cooking. To
follow this law, separate plates and utensils are used. They also believe that fruits and vegetables
When entering a Jewish home to provide care, it is important to not bring in any outside
food without knowing whether it is kosher. It is also important not to prepare any food in a
patient’s kosher kitchen without discussing with the patient what items are used for meats or
dairy.
Sephardic and Ashkenazic Jews represent two different subcultures of Judaism. While
they both share the same basic beliefs, there are some differences in practices. Sephardic Jews
are from the Middle East, North Africa, Spain, and Portugal. Ashkenazic Jews are from Eastern
Europe, Germany, and France. Some differences between the groups include food preferences.
Rich (2011) explains that during Pesach, Sephardic Jews eat rice, corn, beans, and peanuts while
Ashkenazic Jews avoid them. She also explains that Sephardic Jews have become more
integrated with non-Jewish cultures in the United States, while Ashkenazic Jews remain more
traditional.
meal restrictions. Facilities can choose to celebrate holidays celebrated by all employees. By
preparing or purchasing foods that were prepared in a kosher manner, Jewish coworkers can
PROFESSIONAL DEVELOPMENT ASSESSMENT 11
share in the holidays. One example is during Rosh Hashana, Jewish people wish for a sweet year
by eating apples and honey. This is a tradition that many, if not all, cultures can participate in.
Purnell (2013) explains that Hebrew is the language used for Jewish prayers for all Jes
wherever they live. Hebrew is the official language of the state of Israel.
Conclusion
Understanding different cultures can not only help personally, it can help a nurse
professionally become more competent and deliver better care. Having an understanding of
different cultures can help guide care or help a family grieve the loss of a loved one. Providing
care to patients with differing backgrounds can not only help a nurse better understand their
patients, but it can also help them better understand themselves and their own personal beliefs.
PROFESSIONAL DEVELOPMENT ASSESSMENT 12
References
Popovsky, M. A. (2007). Jewish ritual, reality and response at the end of life: A guide to caring for Jewish
patients and their families. The Duke Institute on Care at the End of Life. Retrieved from
https://divinity.duke.edu/sites/divinity.duke.edu/files/documents/tmc/Jewish-Ritual.pdf
Purnell, L. D. (2013). Transcultural health care: A culturally competent approach. Philadelphia: F.A. Davis
Company.
Schroeder, M. (2006). Health of a community rising medical costs tax Amish tradition of self-reliance.
http://search.proquest.com/docview/411328625?accountid=34574
Wombwell, E., Fangman, M. T., Yoder, A. K., & Spero, D. L. (2015). Religious barriers to measles
014-9956-1