Chapter 5

Cultural Influences in Nursing in

Community Health

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 Objectives
 Discuss ways in which culture can affect nursing
practice.
 Describe methods for developing cultural
competence.
 Evaluate the effects of cultural organizational factors
on health and illness.
 Conduct a cultural assessment of a person from a
cultural group other than yours.
 Develop culturally competent nursing interventions
to promote positive health outcomes for clients.

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 Introduction
 United States population becoming
increasingly diverse
 Nurse and client often come from different
cultural background and may not
recognize or understand their differences
 Nurses must be able to provide culturally
competent care

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 Immigrant Health Issues
• Recent changes in immigration laws have
increased migration to the U.S.
• 1965 amendment of the Immigration and
Nationality Act
• Refugee Act of 1980
• 1986 Immigration Reform and Control
• Come to U.S. for religious and political freedom
and for economic opportunities

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 Immigrant Categories

• Legal immigrant: not a citizen but allowed to both live and

work in the U.S. Also known as lawful permanent residents
• Trend toward more immigrants being “low skill” workers,
and they compete with native low skill workers for jobs.
• Refugees: admitted outside the usual quota restrictions
based on fear of persecution due to their race, religion,
nationality, social group, or political views
• Nonimmigrants: admitted to the U.S. for a limited duration
and specific purpose (i.e., students, tourists)
• Unauthorized immigrant: may have crossed the border
illegally or legal permission expired; eligible only for
emergency medical services

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 Immigrant Health Issues
 It is estimated that immigrants in the U.S. add
about $10 billion to the economy annually, and
that an immigrant family will pay $80,000 more
in taxes than they consume in services.
 Foreign-born men are more likely to be working
or looking for employment than native born men
 September 11, 2001 attack

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 Factors to Consider for Providing
Health Care for Immigrants
 Financial constraints (uninsured)
 Language barriers
 Differences in social, religious, and cultural backgrounds
between the immigrant and the health care provider
 Providers’ lack of knowledge about high-risk diseases in
the specific immigrant groups for whom they care
 Traditional healing or folk health care practices that may
be unfamiliar to their U.S. health care providers
 When working with immigrant populations, consider how
your own background, beliefs, and knowledge may be
significantly different from those of the people receiving
care.

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 Culture, Race, and Ethnicity
 Culture: a set of beliefs, values, and
assumptions about life that are widely held
among a group of people and that are
transmitted across generations
 Race: a biological designation whereby group
members share features (e.g., skin color, bone
structure, genetic traits such as blood groupings)
 Ethnicity: shared feeling of peoplehood among a
group of individuals

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 Cultural Competence
 A combination of culturally congruent behaviors,
practice attitudes, and polices that allow nurses
to work effectively in cross-cultural situations
 Four Principles
 Care is designed for the specific client
 Care is based on the uniqueness of the person’s
culture and includes cultural norms and values
 Care includes self-employment strategies to facilitate
client decision making in regard to health behavior
 Care is provided with sensitivity and is based on the
cultural uniqueness of clients

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 Key Reasons Nurses Must Be
Culturally Competent
 The nurse’s culture often differs from that of the
client, leading to different understandings of
communication, behaviors, and plans for care.
 Non–culturally competent care may increase the
cost of health care and decrease the opportunity
for positive client outcomes.
 To meet some of the objectives for persons of
different cultures as outlined in Healthy People
2020, lifestyle and personal choices must be
considered.

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 Developing Cultural Competence
 Two Principles
 Maintain a broad, objective, and open attitude toward
individuals and their cultures.
 Avoid seeing all individuals as alike.
 Three Stages
 Culturally incompetent
 Culturally sensitive
 Culturally competent
 Three dimensions of each stage:
 Cognitive (thinking)
 Affective (feeling)
 Psychomotor (doing)

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 Concepts of Cultural Competence
 Cultural awareness
 Cultural knowledge
 Cultural skill
 Cultural encounter
 Cultural desire

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 Dimensions of Cultural
Competence
 Cultural preservation
 Cultural accommodation
 Cultural repatterning
 Cultural brokering

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 Inhibitors to Developing Cultural
Competence
 Stereotyping
 Prejudice
 Racism
 Ethnocentrism
 Cultural blindness
 Cultural imposition
 Cultural conflict
 Cultural shock

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 Cultural Nursing Assessment
 During initial contact with client, nurse asks
about the following issues:
 Ethnic background
 Religious preference
 Family patterns
 Cultural values
 Language
 Education
 Politics
 Health practices

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 Two Phases of an In-Depth
Cultural Assessment
 Data-collecting phase
 Organizing phase

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 In Conducting Cultural
Assessment:
 Be aware of the environment.
 Know about community social organizations.
 Know the specific areas that the nurse wants to focus on.
 Select a strategy to help gather cultural data.
 Identify a confidante.
 Know the appropriate questions to ask.
 Interview other nurses or health care professionals.
 Talk with formal and informal cultural leaders.
 Be aware that all information has both subjective and
objective data.
 Avoid pitfalls.
 Be sincere, open, and honest.

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 Cultural Groups’ Differences
 Although all cultures are not the same, all
cultures have the same basic organizing factors:
 Communication (verbal and nonverbal)
 Space
 Social organization
 Time perception
 Environmental control
 Biological variations
 Culture and nutrition

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Culture and Socioeconomic Status
 Members of minority groups are
overrepresented on the lower tiers of the
socioeconomic ladder.
 Poor economic achievement is also a common
characteristic among populations at risk, such as
those in poverty, the homeless, migrant workers,
and refugees.
 Nursing judgment

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