In most African groups a thin body is a sign of poor health. This is an example of what?
Anticipate conflicts and make adjustments when caring for ethnic groups that value _______ orientation.
________ populations are more likely to have poor health and die at an earlier age because of a complex interaction among genetic differences, environmental and socioeconomic factors, and specific health behaviors such as the use of herbs to prevent or treat illnesses.
Eliminating such disparities in health status of people from diverse racial, ethnic, and cultural backgrounds has become one of the two most important priorities of __________.
Healthy People 2020
Populations with health disparities have a significantly _________ incidence of diseases or increased morbidity and mortality when compared to the health status of the general population.
In any society there is a dominant _______ that exists along with other subcultures. Although subcultures have similarities with the dominant culture, they _________ their unique life patterns, values, and norms.
Rationale: In the United States the dominant culture is Anglo- American with origins from Western Europe
_________ characteristics include socioeconomic and immigration status, residential patterns, personal beliefs, and political orientation.
When caring for patients from _______ cultures, work with patients’ families as a group, looking for ways the family can participate in basic care activities. Understand the family’s social hierarchy and assume a ________ role with patients and their families.
It is important that the nurse advocates for the patient based on the patient’s _________. Plan and provide nursing care in partnership with the patient to ensure that it is safe, effective, and culturally sensitive.
Within _______ oriented cultures it is acceptable to be late to appointments. When making appointments and referrals, explore and manage anticipated barriers to time adherence with the patient.
Culture has both visible (easily seen) and invisible (less observable) components. The ______ value-belief system of a particular culture is often the major driving force behind visible practices.
Being able to assess social, cultural, and bio- physical factors influencing treatment and care of patients. What component of cultural competence is this?
This population is relocated without any choice in their initial residence, in contrast to immigrants, who have options as to where they go. They also experience greater dislocation and deprivation than immigrants who enter a new country with specialized skills and education and have the option to return to their homeland.
Unless the nurse seeks the patient’s ____ view, he or she is likely to suggest other varieties of soups available from the dietary department, disregarding the cultural meaning of the practice to the patient.
An adult patient is not expected to be solely responsible for his or her care and well-being; rather, family and kin are relied on to make decisions and provide care independently perform rehabilitation exercises after hip surgery until her daughter is present. What type of culture is this?
Engaging in cross-cultural interactions that provide learning of other cultures and opportunities for effective intercultural communication development. What component of cultural competence is this?
Avoid _________ or unwarranted generalizations about any particular group that prevents further assessment of the individual’s unique characteristics. It is also important to determine how many of an individual’s life patterns are consistent with his or her ______.
Effective nursing care care needs to _______ the cultural values and beliefs of individuals, families, and communities.
An in-depth self-examination of one’s own background, recognizing biases, prejudices, and assumptions about other people. What component of cultural competence is this?
On learning that Egyptians value female modesty and gender-congruent care, the nurse encourages female relatives to help the patient meet her needs for ________. The nurse’s cultural encounter enhances understanding of the nonverbal cues of the patient’s discomfort with lack of privacy
A nurse refuses to give prescribed pain medication to a young African male with sickle cell anemia because of the nurse’s belief (stereotyped bias) that young male Africans are likely to be drug abusers. This is an example of what?
Traditionally in Arab culture pregnancy is not a medical condition but rather a normal life transition; thus a pregnant woman does not always go to a health care provider unless she has a problem. This is an example of what?
Cultural beliefs highly influence what people believe to be the ______ of illness.
Many Hmong refugees (group of people who originated from the mountainous regions of Laos) believe that epilepsy is caused by the wandering of the soul. Treatment includes intervention by a ______ who performs a ritual to retrieve the patient’s soul.
Thus a nurse who believes that people should bear pain quietly as a demonstration of strong moral character is annoyed when a patient insists on having pain medication and denies the patient’s discomfort. This is an example of what?
In some Hispanic cultures a plump baby is perceived as healthy. This is an example of what?
A Hmong seeks a shaman, whereas a westerner seeks a __________.
The ____________ of western cultures emphasizing scientific investigation and reducing the human body to distinct parts is in conflict with the holistic conceptualization of health and illness in nonwestern cultures.
A _______ uses rituals symbolizing the supernatural, spiritual, and naturalistic modalities of prayers, herbs, and incense burning.
The dominant value orientation in _________ society is individualism and self-reliance in achieving and maintaining health. ________ approaches generally promote the patient’s independence and ability for self-care.
In ________ cultures that value group reliance and interdependence such as traditional Asians, Hispanics, and Africans, ______ behaviors require actively providing physical and psychosocial support for family or community members.
The western health care provider interprets this as a lack of self-responsibility and motivation for her care. In contrast, the patient interprets the nurse’s insistence on self-care as uncaring behavior. What is this called?
_________ approaches also include naturalistic modalities such as massage, aromatherapy, and herbs
Many Southeast Asian cultures practice folk remedies such as coining (rubbing a coin roughly on the skin), cupping (placing heated cups on the skin), pinching, and burning to relieve aches and pains and remove bad wind or noxious elements that cause illness. These remedies leave peculiar visible markings on the skin in the form of ecchymosis, superficial burns, strap marks, or local tenderness. _________ of these practices causes a practitioner to call authorities for suspicion of abuse.
In _____ groups such as the Hispanic culture, physical presence of loved ones with the patient during illness demonstrates caring.
All cultures value ____ because it promotes continuity of the family and community. __________ is generally associated with caring practices that symbolize the significance of this life transition in women.
Some cultures that subscribe to the ________ theory of illness such as many Asian and Hispanic cultures view pregnancy as a hot state; thus they encourage cold foods such as milk and milk products, yogurt, sour foods, and vegetables. They believe that hot foods such as chilies, ginger, and animal products cause miscarriage and fetal abnormality.
hot and cold
__________ refers to “the way people tend to look out upon the world or their universe to form a picture or value stance about life or the world around them.
Religious beliefs sometimes interfere with prenatal testing, as in the case of a Filipino couple refusing amniocentesis because they believe that the outcome of pregnancy is _______ and not subject to testing.
Vietnamese women are often _____ regarding the pain of childbirth because their culture views childbirth pain as a normal part of life.
Puerto Rican and Mexican women often ______ their pain during labor and avoid breathing through their mouths because this causes the uterus to rise.
_______ in a woman is considered grounds for divorce and rejection among Arabs. Pregnancy that occurs outside of accepted societal norms is generally taboo. Among traditional Muslims pregnancy out of wedlock sometimes results in the family’s imposing severe ______ against the female member.
Traditional Arab Americans are sometimes physically or verbally more ________ when experiencing pain.
In ______ cultures, in which infant mortality is very high, the emotional distress over a child’s death is tempered by the reality of the commonly observed risks of growing up. Thus the untimely death of an adult is sometimes mourned more deeply.
Religious beliefs sometimes prohibit the presence of ______, including husbands, from the delivery room. This often occurs among devout Muslims, Hindus, and Orthodox Jews.
Naming ceremonies vary by culture. In the Yoruba tribes in Nigeria, the baby is named at the official naming ceremony that occurs __ days after birth and coincides with ________.
______ is a strong value among Afghan and Arab women. These women sometimes avoid or refuse to be examined by ____ health care providers because of embarrassment.
Many cultures around the world greatly celebrate the birth of a ___, including Chinese, Asian Indians, Islamic groups, and Igbos in West Africa.
The Chinese culture individuals trace descent only from the ______ side. Thus the name Chen Lu means that Lu is the daughter of Mr. Chen.
The motivation and commitment to caring that moves an individual to learn from others, accept the role as learner, be open and accepting of cultural differences, and build on cultural similarities. What component of cultural competence is this?
Jewish, Islamic, and Hindu cultures, bleeding is associated with __________. A woman goes into a ritual bath after bleeding stops before she is able to resume relations with her husband.
Fear of __________ and the belief that pain is a form of __________ for one’s past deeds motivate most Filipino mothers to tolerate pain without much complaining or asking for medication.
(Lewis, 2003). In some African cultures such as in Ghana and Sierra Leone some women do not resume sexual relations with their husbands until the baby is _________.
The length of the postpartum period is generally much longer (30 to 40 days) in _______ cultures to provide support for the mother and her baby. In these cultures the postpartum period is associated with vulnerability of the mother to ____. To restore balance mothers do not shower and take sponge baths. Some groups have special dietary practices to restore _______.
In ________ cultures with strong future time orientation and in which a child is expected to survive his or her parents, death of a young person is devastating.
The definition of newborn and how age is counted in children varies in some cultures. Among traditional Vietnamese and Koreans a newborn is 1 year old at birth. Once ___ to the U.S. culture, they assume a _______ view, deducting 1 year from the age of the child when speaking to an outsider.
________ generally believe that life is suffering and suffering ends when a person moves beyond the earthly desires and atones for past misdeeds.
Filipino, Mexicans, and Pacific Islanders use an ________ to prevent air from entering the woman’s uterus and to promote healing after pregnancy.
When a _____ dies, the body is bathed, massaged in oil, dressed in clean clothes, and cremated before the next sunrise to ensure that the soul passes quickly from this life to the next.
A typical American believes that individual freedom and autonomy are ________ with freedom from pain and suffering, but other groups accept suffering. Do not assume that all people value _______ equally.
The meaning and expressions of grief vary from culture to culture. The color black is not always a symbol of grief. ______ mourners wear white.
Hindus and Buddhists believe in ________. The family prays and reads religious scriptures to the patient to improve his or her chances in the next cycle.
______ beliefs also affect attitudes toward cremation, organ donation, and the treatment of body parts.
Among the usually reserved ______, the extent to which mourners publicly express grief reflects the social position and status of the deceased.
Some groups such as African Americans, Asian Americans, and Hispanics ______ their families to make decisions for them; and family members prefer to protect the individual from unnecessary suffering by knowing the reality of imminent death. These cultures value group _______ and view individual autonomy as an unnecessary burden for a loved one who is ill.
The family of a dying ______ remains at the bedside to place a drop of the holy water from the River Ganges on the patient’s lips immediately after death to help his or her soul.
________ families sometimes hire people to lead the open grieving. Loud crying and screaming are common.
The goal of _________ is to gather significant information from the patient that enables the nurse to implement culturally congruent and safe patient care.
Ex. it allows the nurse to gather information about which foods are culturally acceptable and whether the person practices alternative medicine and to assess pain.
In the United States “going postal,” which refers to extreme and uncontrollable anger in the workplace that may result in shooting people, is now considered a __________ syndrome.
Inability of Orthodox Jews to pray in groups at the bedside with the dying patient because of limitations in the number of visitors allowed causes ______ in the patient and family. Working with the family and their religious/spiritual leader facilitates _________ care.
_________ demonstrates the inclusiveness of culture in everyday life and helps to explain why cultural assessment needs to be comprehensive. The model assumes that cultural care values, beliefs, and practices are fixed in the cultural and social structural dimensions of society, which include environmental context, language, and ethnohistory.
Leininger’s Sunrise Model
Many older Americans tend to be frugal and save everything because of their experience with the Great Depression. What is this an example of?
Devout _______ refuse an autopsy or organ donation for fear of desecrating the dead and because of their belief that one has to be whole to appear in front of the creator. Many prefer burial over cremation.
Women unconsciously avoid expressions of symp- toms that counter the cultural ideal of females as the caretaker of older adults, husbands, and children. Symptoms reflect the cultural definition of illness as imbalance between heat (yang) and cold (yin). What is this an example of?
________ differentiates folk care, which is caring as defined by the people, from health care, which is provided by health care professionals and based on the scientific, biomedical caring system.
Leininger’s Sunrise Model
Gather demographics from the local and regional data and from the demographic breakdown of patients who come to the health care setting. Population demographics include the distribution of ethnic groups, education, occupations, and incidence of the most common illnesses. Comprehensive cultural assessment requires skill and time; preparation and anticipation of need are important. What type of data is this?
One problem in cultural assessment is failing to assess the _____ perspective of patients and interpret information during the assessment. Use open-ended, focused, and contrast questions. The aim is to encourage patients to describe values, beliefs, and practices that are significant to their care that health care providers will take for ______ unless otherwise uncovered.
In contrast to other types of interviews, cultural assessment is intrusive and time consuming and requires a _________ relationship between participants.
_________ commonly occurs in intercultural interactions. This is because of language and communication differences between and among participants and differences in interpreting each other’s behaviors.
The Joint Commission requires that informed consent materials be in the patient’s language whenever possible and that an ________ be available whenever discussing informed consent with a patient. If informed consent documents are not available in the patient’s language.
_________ do not encourage wailing, but crying is permitted. The women are discouraged from visiting cemeteries.
Among ______ cultures face-saving communication promotes harmony by indirect, ambiguous communication and conflict avoidance.
Nurses use this skill to interpret the patient’s behavior within his or her own context of meanings and to behave in a culturally congruent way. _________ communication manages the impression the nurse makes on the patient to achieve desired outcomes of communication.
The Joint Commission also recommends that the health care provider obtain _______ from the patient via the interpreter and that this is thoroughly documented in the patient’s medical record.
It is ____ suitable for family members to translate health care information, but they can assist with ongoing interaction during the patient’s care.
Federal mandates for culturally sensitive health care delivery require accommodation for _________ differences.
In some societies, adults occupy a ______ status than the young. Children in immigrant groups learn the English language _______ than their parents because of their schooling experience in the new culture when they immigrate at a young age. However, assuming that children are ideal interpreters for their parents is an ______ to the authority of the parent who has to take directions from a child.
In some _____ and _______ groups a woman’s breasts and genitals generally are not discussed with members of the opposite sex, including male members of one’s family.
_______ between the ethnic backgrounds of the interpreter and patient is another consideration to facilitate trust.
Rationale: An Israeli interpreter may cause much anxiety and distrust in a Palestinian immigrant who experienced violence from these groups in the home country.
_________ and ________ differences between interpreters and patients sometimes become barriers to effective interpretation. Interpreters need training not only in interpretation but also in knowing their role, which is to repeat back what the patient said without judging the content.
Socioeconomic and educational
In many cultures caretaking tasks are the primary responsibility of _____. ____ provide financial support and make major decisions. Culture differentiates caring roles of males and females.
Knowledge of a patient’s country of origin and its _____ and ______ contexts are significant to health care.
Rationale: Haitian immigrants have linguistic and communication patterns distinct from those of Jamaicans, even though they both come from the Caribbean and have a common history of slavery.
In ________ cultures caring means active involvement of the group, emphasizing mutual and reciprocal obligations of members to care for one another.
Although acculturation and length of residence in the new culture are related, other factors such as _______, ______ characteristics, and __________ with the language affect the extent of a person’s acculturation. Ask patients about the condition or situation that brought them to the United States and how they think they are adjusting.
_________ status in the new society is often not comparable to one’s previous status in the country of origin. New immigrants often begin with small resources but keep the values and desires of their previous economic status. Assess for problems (such as _______ hardships, becoming comfortable with the language, or understanding the routines used to set medical appointments) to make reasonable and appropriate adjustments to care. Refer patients to _______ resources when possible.
__________ is frequently observed among Asians, Africans, and Hispanics
Immigrants originating from the region near the ________ are generally at risk for parasitic infestations that are prevalent in that area. Immigrants from the Third World with poor ______ conditions and _____ supply are at risk for infections such as hepatitis.
Certain genetic disorders are also linked with specific ethnic groups such as Tay-Sachs among ________ and malignant hypertension among __________.
In the dominant American society the most common unit of social organization is the _______, in which married children and adults establish separate residences from their parents. Although different configurations of a family exist, the most common is the nuclear household made up of _________ and ________.
Consider all options when determining a patient’s next of kin. This is especially relevant to new immigrants and refugees, who often have not relocated with all members of their family. ___________ groups often regard members of their ethnic group as closest kin and want to consult them for health care decisions and permit them to speak on their behalf.
The eldest male is next to his father in terms of authority in many _____ and _____ cultures.Determine who has authority for making decisions within the family and how to communicate with the proper individuals.
Asian and African
Differences come from their colonial history and intermingling with the local indigenous people. As a result of cultural differences between India and Jamaica, Hindu immigrants from Jamaica have different cultural characteristics from those originating from India. Hindu immigrants from Jamaica often have nutritional, communication, and health patterns more similar to African Jamaicans than South Asian Hindus. In caring for an Indian Hindu who grew up in Jamaica, expect the patient to interact more like a Jamaican, even though the person looks like he or she is from south India. What is this an example of?
The dominant culture in the United States emphasizes achievement as the determinant of _____, whereas most ______ cultures give higher priority to age and gender.
Sometimes an adult _____ woman will not sign informed consent for surgery or other medical procedures without consulting her husband, oldest son, or brothers.
________ occupy higher status in some societies, resulting in grandparents forcing their decisions over their married children regarding the care of the grandchildren.
A ______ mother is subject to the authority of her oldest son in the absence of her husband.
However, do not assume that, just because the woman is the primary caregiver, she will make decisions independently. Determine the family _______ as soon as possible to prevent offending patients and their families. Cultural competence when dealing with family prevents delays and achieves better patient outcomes.
In some cultures older women are the _____ group consulted during illness of family members and in the care of women and children.
Determine the patient’s religious and spiritual beliefs and their effect on health care during admission. Also understand the ___ perspective of your patients.
Ex. Hmong animist spirits are dead ancestors or forces external to the person. To some Americans spirituality means an inner, personal relationship with God.
Devout _____ pray five times daily and undergo an obligatory ritual cleansing of some parts of their body before praying. Anticipate the ritual cleansing needs of the patient and provide privacy for praying.
Ex. Reschedule diagnostic procedures to allow Buddhist patients to participate in the festivities of their New Year.
Anticipating the needs of _________ patients during the Sabbath, when they refrain from using electrical appliances, requires creative accommodations by the staff such as placing articles of care near the patient so he or she does not need to use the call light or telephone to get assistance. Determine how to contact the patient’s next of kin who are unreachable by telephone during the Sabbath in case emergencies arise
Devout _____ avoid beef, and many are vegetarians. Many _______ are vegetarians as well.
Halal foods, which include meat, fish, fresh fruit, vegetables, eggs, milk, and cheese, are permissible for ______. Halal meat comes from animals slaughtered during a prayer ritual. Prohibited, or Haram, foods include non-Halal meat, animals with fangs, pork products, gelatin products, and alcohol. This group fast during the daylight hours for the 28 days of Ramadan, which occurs during the ninth lunar month. Although children and sick and frail individuals are exempt from fasting, do not assume that these individuals eat regular meals during Ramadan. Rescheduling treatments and medications is often necessary to prevent complications such as hypoglycemia.
_______ patients who follow a kosher diet avoid meat from carnivores, pork products, and fish without scales or fins. Kosher meat comes from permissible animals that are slaughtered with the least amount of suffering. Kosher foods must not be contaminated by nonkosher foods. Thus meat is served separately from dairy, and dishes used for serving and eating these products are also separated.
The ________ needs to have background information available about major holy days and practices for commonly encountered religions.
Life transitions are often manifested in religious and spiritual beliefs. Male circumcision occurs among ______ and _____ groups. Female circumcision is common among some _____ and ______ groups.
Jewish and Islamic
African and Muslim
A dying _______ patient is not left alone so a close kin is able to hear the patient’s wishes, allowing the soul to leave in peace.
In _____ it is a tradition to eat eel on Christmas Eve. It symbolizes a new beginning because eels replace their skin as they shed it.
In some cultures time is oriented to the present, and events take place when the person arrives. _______ orientation is in conflict with the dominant future-time orientation in health care that emphasizes punctuality and adherence to appointments.
In _____ the smorgasbord is an important part of special events such as holidays and weddings.
African Americans, Puerto Ricans, Mexicans, Chinese, and Native Americans are some of the groups that value ________ orientation.
Anointing of the sick is a _________ sacrament. Hospitalized Catholic patients often receive daily ________. The family of a critically ill _______ patient turns his or her head eastward or to the right side.
________ consider honey to have healing qualities and use it to treat colds and coughs.
_____ is a part of birthday and wedding celebrations in the United States.
Many _______ follow traditional beliefs that food should be consumed as close to its natural state as possible, for instance raw fish (sashimi) used in making sushi.
_________ and _______ characteristics of culture are defined by the degree to which an individual identifies with his or her cultural group.
Primary and Secondary
In a ___________ the goal is to generate knowledge about the patient’s values, beliefs, and practices about nursing and health care. If the nurse’s behavior is offensive to the patient, he or she will not likely participate in the interaction.
Cultural groups have distinct ________ and _________ patterns. These patterns reflect core cultural values of a society.
In the dominant _______ culture that supports individualism, people value assertive communication because it manifests the ideal of individual autonomy and self- determination.
In this culture spoken messages often have little to do with their meanings. Saying “no” to a superior or older person is not permissible. An affirmative response only means that “I heard you”; it is not full agreement. This type of response is likely to happen in a health care setting because a health care provider is perceived as a person of authority to some Asian, African, or Hispanic patients. What population has this defining characteristic?
Observing a patient’s behavior and clarifying messages heard from a trusted insider prevents ________.
In cultures with highly differentiated gender roles some patients place more value on the advice of a man than a woman. By recognizing and working within this cultural context, nurses become more effective in achieving outcomes.
Culture also shapes _______ communication. It influences the distance between participants in an interaction, the degree of eye contact, the extent of touching, and how much private information the patient shares. Patients use _____ distance when speaking to trusted insiders and persons of the same age, gender, and position in the social hierarchy.
Many ethnic groups tend to speak their own _____ with insiders for ease and privacy and as a marker of insider status. To minimize _____ when communicating with patients, nurses establish rapport and behave in a culturally congruent manner through impression management.
All cultures have ____, _____, and _____ time dimensions. This information is useful in planning a day of care, setting up appointments for procedures, and helping a patient plan self-care activities in the home.
past, present, and future
Understanding the ___ perspective of the patient about professional health care is valuable in correcting misconceptions and preventing culturally offensive actions.
The dominant _____ culture is future-time oriented, and people from this culture tend to schedule their time. When working with patients who are future-time oriented, it is important to plan and adhere to a schedule.
Obtain information about ____ remedies and cultural _____ that the patient uses. Assessment data yield information about the patient’s beliefs about the illness and the meaning of the signs and symptoms. Focus assessment on the ____ perspective of the patient.
_____ between health care professionals and the community provides proactive and open feedback from culturally diverse patient groups.
Ex. If a patient had problems with male caregivers, assign female caregivers to the patient whenever possible. If a patient perceives an essential health care resource to be inaccessible, help to find a way to connect the patient with the resource.
To provide _________ care it is important to identify potential conflicts between patients’ health care needs and their health care practices and cultural values.
In ________ cultures the context of relationships among participants shapes communication.
_______ orientation is associated with adaptive cultures and populations who are exposed to situations that require immediate action such as immigrant populations. Improving a patient’s access to health services mandates culturally congruent time schedules that accommodate cultural patterns.
________ orientation minimizes present time; thus communication tends to be direct and focused on task achievement. The rushed, hurried, and businesslike communication of this time oriented person may appear uncaring or disrespectful to those who are oriented to alternative times.
______ characteristics include nationality, race, gender, age, and religious beliefs.
Significant influences such as historical and social realities shape an individual’s or group’s _______. This is woven into the fabric of one’s culture. It determines how people perceive others, how they interact and relate with reality, and how they process information.
Obtaining sufficient comparative knowledge of diverse groups, including their indigenous values, health beliefs, care practices, worldview, and bicultural ecology. What component of cultural competence is this?
_________ is the way in which groups of people make sense of their experiences relevant to life transitions such as birth, illness, and dying.
Avoid making rash judgments about patients’ practices when they use both healing systems at the same time. In addition, gain knowledge and understanding of remedies used by patients to prevent ___________.