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Week 7SECTION 3: CULTURE,HEALTH AND ILLNESS
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This section reviews how culture is related to health and
illness and examines the implications for nursing practice
At the end of this section you will be able to:
discuss culture and its importance as a concept within
nursing
consider how culture is related to health and illness
recognize and discuss your own culture
understand the implications of culture for nursing
discuss how to improve cultural care in nursing
CULTURE, HEALTH AND ILLNESS
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the recent explanation of cu lture provided by Papadopoulos
(2006) defined culture as the shared way of life of a group of
people, that includes beliefs, values, ideas, language,
communications, norms and visibly expressed forms such as
customs, art, music, clothing and etiquette So it will influencing behaviors of individuals and groups
requiring care
CULTURE
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Madeline Leininger (a Nursing theorist) shows
how culture is an integral part of nursing .
discusses transcultural nursing theory , that is how
individuals or groups of nurses can transcend cultures in
order to provide care that is meaningful to the individualand\or group being nursed.
Transcending cultures means that the nurse comes out of
her\his own cultural perspective and tries to understand the
world of the patient . It is simply good empathy ( is the
capacity to recognize feelings that are be ing experienced byanother) with those from other cultures
NURSING THEORY
(CULTURE, HEALTH AND ILLNESS )
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stimulate student thought about cultureand provide working
definitions that will help nurse assess the applicability of
culture to nursing.
student will think more about her own culture, how it
influences her behavior and how it will affect her interactionwith patients, families and communities.
student can be familiar with how can overcome the culture
diversity and to be more confident in providing care within
other cultures and plan care that is meaningful and sensitive
to that culture. student will be more recognize about the cultural needs of
individuals.
THIS SECTION AIMS TO
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Kim-Godwin et al. (2001)
cultural competence refers to the understanding of other
cultural beliefs and behaviors, and the ability to communicate
effectively, to conduct a cultural assessment and to advocatefor cultural groups.
KIM-GODWINS MODEL FOR DELIVERY OF
CULTURALLY COMPETENT COMMUNITY
CARE
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Most cultures provide unwritten and written guidance on how
to maintain balance or health in life.
This can range from the
Lun Yu sayings of Confucius to the guidance in the Koran
the Ten Commandments in the Old Testament to the health
promotion messages from the World Health Organization.
HOW IS CULTURE RELATED TO HEALTHAND ILLNESS?
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Response to illness is also influenced by culture
especially when the individual or group try to find meaning in
relation to why a particular illness occurred.
Just as there are lay beliefs about health there are also lay
beliefs about illness . This may range from viewing illness aspunishment from God to denying that there is an illness .
Cultural interpretations of causes of illness is an important
consideration when planning care as this will influence how
the individual or group view rehabilitation , recovery and living
with an illness.
CONT.
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Cultures are often associated with "core values and belie fs".
Try to determine what your core values and beliefs are
consider the thi ngs that you value most in life, your partner, your
family, your children, becoming a nurse
Do you believe in God? What is your religion? How does thisinfluence your life?
Are there feast days that you adhere to?
Consider your values in relation to communication with others.
discuss the similarities and differences with others culture
explain these differences. Close with a short reflection on "what
you learned" about your own culture and yourself.
RECOGNIZING YOUR OWN CULTURE
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Nurses are focused on the holis tic care of individuals and
groups.
As culture is an important part of l iving it is necessar y to
always consider cultural factors when planning care for
individuals and groups. In order to carry out a holistic assessment of a patient it is
necessary to attend to the cultural beliefs of the patient
and\or the family.
This however must be set in the full context of the person's
life, not only focusing on the cultural (see Kikuchi, 2005).
WHAT ARE THE IMPLICATIONS FORNURSING?
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the necessar y orientation for nurses in relation to culture and
planning care that requires a cultural focus.
This model may be applied to nursing in any setting that
requires you to take account of cultural factors in order to
gain a Transcultural Healthcare Perspective. Identification of existing cultural care patterns and
facilitating such patterns to achieve full potential are key to
the application of Leininger's philosophy.
Recognition of these cultural care patterns requires that the
nurse acts almost as an ethnographer, that is becomesimmersed in the cul ture to learn about the ways in which the
communities deal with stress and implement care patterns
LEININGER'S TRANSCULTURAL HEALTH
MODEL PROVIDES
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transcultural nursesThey are nurses who provide knowledgeable, competent, and
safe care to people of diverse cultu res to themselves and
others
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However you must remember that every indiv idual and every
group has a unique culture. To only focus on ethnic minorit ies
and non-light skinned groups may lead to stereotyping and
overlooking of important cultural needs of individuals and
groups within one's own culture. The cultural awareness component within Nursing courses will
improve understanding of other cultures but also causes
reflection on cultural needs within the dominant culture .
As Healthcare professionals, you have to have this broadknowledge of how culture impacts on all indi viduals and
groups irrespective of background .
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Research in relation to cultural issues . show
that nurses have great dif ficulty when it comes to dealing with
other cultures.
There is evidence that nurses are not equi table in relation to
caring for groups outside their own (light skinned) culture
This is a competence issue where nurses have not been
properly trained and educated in relation to cultural
awareness.
The research highlighting the poor care of ethnic minorities.
need to enhance equally as the number of nurses from other
countries and cultures increase
RESEARCH IN RELATION TO CULTURAL
ISSUES
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Advices to improve "Cultural awareness
address " ethnocentrism ", prevent "cultural clash
Being ethnocentric means that one only sees the world from oneperspective and normally this perception runs to a particularethnic group
Cultural clash is the term used to describe conflict of culturesand normally involves ethnocentric attitudes.
develop "cultural competency".
Cultural awareness is easy enough to address. A programmed of
education that incl udes culture and awareness of other cultures isnormally enough.
Tackling "ethnocentric attitudes" is more problematic becausenurses, like patients, are individuals.
.
WHAT IS THE BEST WAY TO IMPROVECULTURAL CARE IN NURSING?
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It is easier to focus on "cultural competence". Kim-Godwin et
al (2001) describe cultural competence as having four
dimensions;
Cultural Knowledge: Familiarization with selected cultural characteristics , history,values, belief systems, and behaviors of the members of
another ethnic group (Adams, 1995).
Cultural skillsCultural competence or skill and respect for others becomes
especially important for us in the nursing practice because we
are patient advocates
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Cultural Awarenessdeveloping sensitivity and understanding of another ethnic
group. This usually involves internal changes in terms of
attitudes and values . Awareness and sensitivity also refer tothe qualities of openness and flexibility that people develop inrelation to others . Cultural awareness must be supplementedwith cultural knowledge(Adams, 1995).
Caring : to provide affairs and equal care for all patient
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cultural competence, is defined as a set of congruentbehaviors, attitudes, and policies that come together in asystem, agency, or among professionals and enables thatsystem, agency, or those professionals to work ef fectively incross-cultural situations (Cross, Bazron, Dennis, & Isaacs,1989).
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Element ofculturalcompetence
What I am I good at? What do I need tolearn?Caring
Culturalsensitivity
Cultural
knowledge
Cultural skills
REFLECTION EXERCISE
Reflect on your ability as a nurse when caring for patients from
another culture
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Section four
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At the end of th is section STUDENT will be able to:
Know how to assess patients and families for cul tural needs.
Discuss how to improve cultural care in nursing.
ASSESSMENT THE CULTURAL NEEDS
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assessment of cultural factors and cultural needs:
open-ended approach where the patient and \or family inform
the nurse about the individual's belief system ( IT WILL HELP
THE NURSE TO BE MORE OREINTED ABOUT PATIENT BELIEF )
Asking the right question in a way that is ' non-prying' and
coupled with appropriate non-verbal communication that
conveys a real willingness on the part of the nurse to find out
more about the patient's cultural perspective is important.
HOW DO I ASSESS FOR CULTURALNEEDS?
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SOME TIME you can referral you patient to do 'ethnographicinterview ' . With specialist researchers who are describing theculture and wish to capture the essence of the values and
beliefs inherent in the culture.
Colloquial descriptions are a very important part of this type
of research. Which is consider an important descriptors for a
nursing assessment as they provide the nurse with the exact
words and terms used by the patient and \or the family.
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HOW DO I ASSESS FOR CULTURALNEEDS?
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learning about culture assessment the nurse needs to spend
time getting to know the individual
Sometimes it is necessary to work with an interpreter and, while
interpreters may speak the same language as the patient, they
can be from a different ethni c group and this may cause further
communication difficulties. If possible use an interpreter of the same gender as there may
be difficulties with communication between men and woman in
certain cultures
It is important to appreciate that culture relates to all individuals
not just those from 'other' ethnic groups.
When dealing with people from simi lar cultures to your own you
must still attend to cultural matters. Do not assume that you
know their cultural needs just because you are from the same
community and\or same ethnic group.
DO NOT FORGET THIS DURING DOING
CULTURE ASSESSMENT
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culture is assessed under three main headings:
Values.
Beliefs.
Special Considerations.
MAIN HEADING TO ASSESS CULTURE
NEED
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values means :principles or standards of behavior; ones judgment
of what is important in l i fe
You want to find out during assessment of your patient culture
need:
what and who is important in their l i fe?
What types of things are 'valued'?
For example they may say :
"being at home with the family"
or "going on holidays with the family"or "being able to walk the dog"
or "being able to climb a mountain "
or "read a good book",
or "going out for a nice meal",
VALUES
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You might have to use the word "like" as opposed to "value" but
do not start with "what do you like?" as this will miss the
point about things of value. Also note that he \she may be
reluctant to tell you about things from his \her own culture
thinking
that you would not understand. You have to say " there are
things associated with your own culture that are impor tant to
you, please tell me about these? Thiswill help me plan your
care."
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bel iefs mean assumptions and convictions that are he ld to be true ,byan individual or group regarding concepts events ,people ,and things
To assess belief Star ting with religious type of bel iefs you should notbe frightened to explore other beliefs such as beliefs about the il lness.
A good question to start with is What about your beliefs ?
Wait for a response and let the person talk .
Are you religious?
What is your religion?
There are important things and events associated with your rel igion thatyou may have dif f iculty carrying out while you are in hospital \nursing
home.
What sort of things should I know about in order to plan your care? Doyou wish to see your rel igious leader or guide
BELIEFS
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In relation to beliefs about the illness, it is only necessary to
begin with the question
" what do you think caused your illness?
"do you believe that you will get better? If not why not? Are
there any important things such as religious relics or 'cures'in your culture that you think might help?
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Language: What are the main lan guages spoken and do you require aninterpreter all of the t im e or only for com plicated topics?
Diet and Food Presentation: Are there any special considerations inrelation to food. For example , " no meat on a Friday", "No pork" , "only
Gender of Carers: Does the person only want males or females lookingafter him\her?
Particular Hygiene Requirements: Are there special considerationsbefore any garments are removed or bath\sh ower assistance? For
example "will a pubic shave be required at particular t imes for cultural
reasons? Can beard trimming only be car ried out by people of the same
religion?"
Implications for treatment: This is very impor tant and must bediscussed with all individuals and\o r the family. For example, "Is theindividual permitted to receive blood products? Does there need to bediscussion about fasting and par ticular rel igious feasts? Do some
people need a longer consultation period regarding a decision becausethe extended family has to be consulted?"
SPECIAL CONSIDERATIONS
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s a future reg istered nurse you need to focus on self-awareness
and sensitivity to cultural needs . Reflect on your own culture
and this will help you improve awareness of other cultures .
Concentrate on assessment of cultural needs when you areformulating care plans and very quickly you will find that your
competency in this area improves. Competency in working
with other cultures is princ ipally about awareness of self and
others and applying this awareness and sensitivity to ordinary
everyday communication. Be patient and quiet and learn from
those in your care. If in doubt always ask advice .
DONT FORGET
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