A.

Cultural Factors/ethnicity such as regard to Elders,

Perception of Health

Cultural respect is vital to reduce health disparities and improve access to high-
quality healthcare that is responsive to patients’ needs, according to the National
Institutes of Health (NIH). Nurses must respond to changing patient demographics to
provide culturally sensitive care. This need is strikingly evident in critical care units.
Cultural competence can be defined as “developing an awareness of one’s own
existence, sensations, thoughts, and environment without letting it have an undue
influence on those from other backgrounds; demonstrating knowledge and
understanding of the client’s culture; accepting and respecting cultural differences;
adapting care to be congruent with the client’s culture,” according to Larry Purnell in
his book Transcultural Health Care: A Culturally Competent Approach (1998).
Differences of any kind: race, class, religion, gender, sexual preference, personal
habitat, physical ability, Good healthcare depends on sensitivity toward these
differences, Every patient is unique.
Individual is the “foreground”, culture is the “background”, All people share
common problems/situations, Not all people identify with their ethnic cultural
background, Every patient needs to be treated equally, Do not force someone
to have an intervention that is against their personal beliefs. Respect the integrity of
cultural beliefs, Patients may not share your explanation of causes of ill health and
not accept conventional treatments, Recognize your personal cultural assumptions,
prejudices and belief systems. Avoid letting your prejudices interfere with patient
care.
Another definition states that cultural competence “describes how to best meet
the needs of an increasingly diverse patient population and how to effectively
advocate for them,” says Barbara L. Nichols, former CEO of the Commission on
Graduates of Foreign Nursing Schools, in NSNA Imprint.
Explanations of culturally competent nursing care focus on recognizing a
patient’s individual needs, including language, customs, beliefs and perspectives.
Cultural sensitivity is foundational to all nurses. “The nurse practices with
compassion and respect for the inherent dignity, worth, and unique attributes of
every person,” states the American Nurses Association’s Code of Ethics for Nurses.
Relevance
More than one-third (37 percent) of the U.S. population consists of individuals
from ethnic and racial minority groups, and by 2043, minority groups will become the
majority, according to research from the American Association of Colleges of
 Nursing. However, nurses from minority backgrounds represent 19 percent of the
registered nursing (RN) workforce. Men account for 9.6 percent of the RN workforce.
There is a “challenge presented by the health care needs of a growing number of
diverse racial and ethnic communities and linguistic groups, each with its own
cultural traits and health challenges,” the NIH says. Nurses and other healthcare
providers must account for these differences through cultural respect to support
positive health outcomes and provide accuracy in medical research.
“The development of cultural competence in the nursing practice first requires us
to have an awareness of the fact that many belief systems exist,” says Lanette
Anderson, executive director of the West Virginia State Board of Examiners for
Licensed Practical Nurses. “The beliefs that others have about medical care in this
country, and sometimes their aversion to it, may be difficult for us to understand. We
must remember that we don’t need to understand these beliefs completely, but we
do need to respect them.”

Language barriers
Your assessment and accuracy of interpretation will be hindered when language
barrier is present if an interpreter is used, document their name and relationship in
some cultures, use of children is insulting to adults and seen as too much
responsibility placed on the child.
Locale of practice
Get to know the predominate cultures of your area the more you understand the
culture, the more effective a practitioner you can be know resources available in your
community.
Components of Body Language:
 eye contact
 facial expressions
 proximity
 posture
 gestures
Body Language - Eye Contact
Can play a key role in establishing rapport, Failure to make eye contact can be a
sign of dishonesty, Making eye contact can be a sign of disrespect in some cultures
(Chinese), Asians may be reluctant to make eye contact with a figure of authority.
Body Language - Facial Expressions
One of the most obvious forms of body language Can convey mood, attitude,
understanding, confusion, other emotions, Smiles are usually universally understood,
Smiling and winking can have different connotations
Smiling and Winking
 Japanese - may smile when confused or angry
 Others Asians - smile in friendly greeting
 Latin Americans - winking is romantic, sexual
 Nigerians - parents wink at children to have them leave the room
 Chinese - winking is rude
 Hong Kong - blinking is sign of disrespect and boredom
 Filipinos - point to objects with eyes, not fingers
 Venezuelans - finger pointing is impolite
Body Language – Proximity
Acceptability varies widely culture to culture, In the United States, twice the arm
length is a comfortable social distance - 4-12 feet, Personal space is 1.5 - 4 feet,
Different messages are interpreted when standing above, at, or below eye level, above
eye level shows authority, can be intimidating, at eye level indicates equality, below eye
level shows willingness to let patient have some control over the situation.
Body Language – Posture
Range of attitudes conveyed from interest, respect, subordination, disrespect
Argentina - standing hands on hips suggests anger or a challenge
Taiwan - good posture extremely important
Some cultures impolite to show the bottom of the shoe because it is dirty; will not sit
with a foot resting on opposite knee.
Body Language – Gestures
Can replace or accompany verbal communication
Japan - rude to pass an item with one hand.
Middle & Far Eastern cultures - left hand considered unclean - rude to pass items with
left hand.
In Europe, waving goodbye is raising the hand palm facing out, wiggling fingers back
and forth.
In Nigeria, this is an insult if the hand is too close to another’s face.
In Bulgaria & Greece, head nodding means no
In the USA, beckoning with 1 finger means “come here”. In some cultures it is insulting
or obscene.
Indonesia - pointing is done with a thumb
Middle East - pointing with 1 finger is impolite
“OK” sign obscene in Germany and Bulgaria
in Japan means zero or worthless
Cultural Diversity - Physical Contact
Eastern Europeans are comfortable with touching, Asians prefer less physical
contact, Chinese are uncomfortable with physical contact but will use a handshake for
greeting. Latin Americans show affection easily and handshakes are strong & warm
Egypt - tend to be touch oriented
Cultural Diversity - Gestures
Middle East - left hand reserved for hygiene. Don’t shake hands left-handed or
accept a gift with left hand
Native Americans - offensive to step on a foot - apologize immediately
Culturally Diverse Patients - African Americans
Handshaking is appropriate, Eye contact is appropriate, Culture vocally
expressive. Close friends tend to be viewed as “family”, Tends to be matriarchal society
Skeptical of westernized medicine
Culturally Diverse Patients - Arab Americans
Prefer handshaking, Direct eye contact acceptable, Verbally expressive, Family
shares in decision making process, Folk remedies are common, soup, prayer, Fond of
westernized medicine.
Culturally Diverse Patients - Chinese Americans
Direct eye contact and speaking out may be viewed as being disrespectful,
Nodding is a sign of respect and not understanding. Oldest males in the group make
decisions, Folk remedies are common. May interact with westernized medicine
Culturally Diverse Patients - Mexican Americans
Handshaking is appropriate. May avoid eye contact out of respect. Tends to not
complain of pain. Silence is maintained out of respect or due to not understanding.
Males usually head of the household. Folk remedies are common
Culturally Diverse Patients - Financially Challenged
May refuse health care due to its costs. We need to be an advocate for these
people and make sure they are offered initial medical screening. Know your community
and county resources to offer to this group of people. As a reminder, use your own
resources wisely.
Signs of impairment
 homelessness
 chronic illness with frequent hospitalizations
 poor personal hygiene
 self-employment
During Assessment and Management
 Recognize need for assistive devices
 Respect the patient’s beliefs
 Ask permission to initiate procedures
 Obtain interpreter if unable to communicate because of language barrier
 Allow ample time and area of privacy
 Notify receiving hospital of special needs
Challenges in the Geriatric Population
Fear of losing autonomy/independence
 mobility - walking and by car
 want to continue to live on own.
 Patient fears financial burden of hospitalization.
 Patient is embarrassed by burden they become to family and friends.
 Multiple disease processes affecting health.
 Difficulty in communicating pain and fears.
 Often suffer from concurrent illnesses.
 Chronic problems make assessment of acute problems difficult.
 Aging affects response to illness/injury.
 Social/emotional factors have great impact on health.
 Depression & isolation - highest suicide rates in people over 65.
Communicating with the Geriatric Population
Make eye contact before speaking. Always identify yourself. Position yourself at
the patient’s eye level. Locate hearing aid, eyeglasses, dentures. Turn on lights, turn off
TV to minimize distractions. Use surname (Mr., Mrs., Ms.) until permission given to
address patient otherwise. Be patient and gentle - give time for the patient to respond to
your questions.