Topic 1: Cultural Connections Topic 2: Cultural Diversity Within Groups. The Question. This week, we focus on culturally competent health assessment of groups. It is important to understand what a group is. A group can have many different definitions.
In the Pocket guide to culturally sensitive health care, Stuart, Cherry, and Stuart (2011) provide some interesting statistics on immigrants who came to the United States in 2008. During that year, the United States received about 38 million immigrants, which amounted to about 104,000 immigrants per day or 72 persons per minute (p.1). The intent of the immigrants was to live in the United States. These immigrants and other immigrants before and after them are incorporated in various groups/families/communities. At one time or other, these same individuals need healthcare, and nurses play a vital part in providing necessary nursing care. Nurses need to be able to provide culturally sensitive care to these groups of individuals who reside with a family and are part of a community.
Topic 3: Assessment of Culturally Diverse Groups
Larry Purnell developed a Model for Cultural Competence that shows the relationship of the person (patient), family (group), community, and global society. Through his initial work with pre-licensure student nurses, Dr. Purnell defined community as a group of people having a common interest or identity that goes beyond the physical environment. He further defined a family as two or more people who are emotionally connected to each other (Purnell & Paulanka, 2008). These individuals may reside in the same community or in a group.
If you have not yet taken the opportunity to do so, please listen to his interview.
An Interview with a Transcultural Nursing Theorist, Dr. Larry Purnell
The organizing framework for the Purnell Model for Cultural Competence includes 12 domains of culture (Purnell & Paulanka, p. 22). The domains may be used to assess the ethnocultural attributes of an individual, family, or group. These 12 domains include the following.
Overview and heritage: This is about the geographical impact of the country on health and wellness. For example, in mountainous areas, individuals may have difficulty accessing healthcare because of poor roads. These people may become isolated and delay seeking care.
Communication: This relates to the verbal, nonverbal, and paralanguage practices of the culture. For example, in Indian culture, nodding the head may mean no and shaking the head may mean yes. Although this may be well understood by others within this culture, these body language signals mean just the opposite of what they mean in Western cultures.
Family roles and organization: This encompasses concepts related to the family and the typical expectations of the roles, such as parent, adolescent, and child. How the elderly family members are perceived is related to culture. Cultural attitudes toward variations in the traditional family structure, such as single parents, childless marriages, and so forth, will vary widely. For example, in Korea, most elderly individuals are cared for in the home by their own children. The nursing home (long-term care) is seen as a place of last resort by the family, and therefore suggestions for placement in such a facility may be met with strong resistance.
Workforce issues: These issues include assimilation, acculturation, autonomy, and communication styles. For example, in some cultures individuals tend to ignore time and are not “clock watchers.” They may be late for work and not realize that this could be a workplace issue for their coworkers. Knowing characteristics of a diverse workforce is important when working with employees. This topic will be discussed later in our course.
Biocultural ecology: This refers to variations among cultures with respect to physiological, biological, genetic, and hereditary states. For example, some diseases occur at a much higher incidence in particular groups than others. Tay-Sachs disease mostly occurs in Jewish populations, whereas sickle cell anemia is seen more frequently in those of African descent.
High-risk behaviors: Cultural groups may engage in certain high-risk behaviors, such as drinking alcohol, smoking, promiscuity, drug use, obesity, nonuse of safety features such as seat belts, and others. For example, Brazilian people are known for their relaxed attitudes about sex and sexuality; therefore, they may be more likely to contract sexually transmitted diseases.
Nutrition: This pertains to how people in certain cultural groups view food. For example, in cultures where there has been a history of famine, eating well is of special importance from a cultural standpoint. In others, “thin is in” and obesity is viewed disparagingly.
Pregnancy and childbearing practices: These practices include birth control; views on pregnancy; and any prescriptive, restrictive, or taboo practices during pregnancy, birth, and the postpartum period. For example, in China, urban families are pressured to limit their families to only one child. Rural families may have two children. Societal pressure is placed on couples to meet these low birth-rate expectations.
Death rituals: These deal with issues such as how death is viewed, how the body is handled postmortem, views on euthanasia, approval of organ donation, burial practices, and rituals to prepare for death. For example, for those of the Muslim faith, burial takes place as soon as possible after death, preferably within 24 hours. The family may resist requests for an autopsy because they believe the body should be buried intact. In the Hindu culture, cremations are the norm.
Spirituality: These are beliefs related to one’s faith and religious affiliation. This includes prayer practices. For example, Buddhists believe that the individual should be in harmony with themselves, the universe, and society in order to have good health. Some patients and families may or may not welcome a referral to the Pastoral Services Department.
Healthcare practices: These focus on attitudes toward health and illness, including acute and preventative healthcare, responsibility for wellness and illness, self-medicating practices, views on mental illness, acceptance of blood and blood products, and organ transplantation. For example, there are tribal cultures that believe that mental illness is the result of bad spirits inhabiting the mind. This influences the ways in which the illness is treated.
Healthcare practitioners: This refers to the use of healthcare practitioners, their status, and cultural perceptions. For example, in some third-world areas, the “witch doctor” practices a form of healing that relies on natural remedies and is viewed as an alternative to contemporary medicine. Some groups welcome nurse midwives whereas others feel their care is substandard.
Topic 4: Refugees: Should We Be Concerned?
Anyone who pays attention to what is happening on the world stage must be concerned about the universal refugee situation. Of late, millions have fled from Syria. The European Union and nearby countries such as Greece have been particularly impacted by the influx of these refugees.
Andrews and Boyle (2016) share information on planning care for refugee families and communities. Although we may never be responsible for care of refugees, nurses and other healthcare providers should be aware of their various needs. As citizens of a global community, we are likely to be impacted at least indirectly.
Topic 5: The Gullah—A Cultural Example
Let’s look at a very interesting group in the southern portion of the United States near Charleston, South Carolina (commonly referred to as low country). This group has many natural remedies to treat illnesses and diseases, including skin wounds and infections.
In the Gullah culture, the native language is called Geechee. They have three types of “root doctors,” or folk healers. Many of these use natural healing techniques whereas others use spiritual guidance, and some—known as “witch doctors”—may practice voodoo. The three types of root doctors use various techniques to treat conditions or illnesses. Some wear necklaces and use special coins to help protect them from being hexed by illness. This is a very brief description of a culture, and through a more extensive investigation, one can see the 12 domains described above.
Last week, Chana was considering whether to ask Dr. T if he would agree to be assessed for the Course Project. Let’s find out whether she was successful.
Click the link to learn more.
Play media comment. (Cultural Connections)
Topic 7: Summary (Cultural Connections)
This week’s lesson made us aware that no person is alone. All are members of groups. Some groups have very different cultural practices from others. The nurse must recognize these differences and adapt care accordingly.
The Purnell Model for Cultural Competence served as a framework for understanding how 12 domains impact healthcare beliefs and practices. The case study discussed Chana’s continued journey through this course and her preparation of a culturally competent assessment.
Test Your Knowledge (Cultural Connections)
- A female refugee who has recently emigrated from a war-torn African country presents at a clinic reporting a chronic vaginal drainage. Which assessment question best demonstrates the nurse’s sensitivity to the client’s community culture?
- “Does your culture believe in safe-sex practices?”
B. “Have you been sexually active since the drainage began?”
C. “Do you want a family member present during your vaginal examination?”
D. “Have you ever been the victim of a physical or sexual assault?”
View Answer (Cultural Connections)
- An African immigrant is being physically abused by her husband. She remains reluctant to consider divorcing him in spite of having the benefits of doing so explained to her. Which assessment question best demonstrates the nurse’s cultural sensitivity regarding this situation?
- “Does your culture accept divorce?”
B. “How does your culture view domestic violence?”
C. “Can you financially support yourself without your husband’s help?”
D. “How would you expect your family to react if you were to divorce him?”
View Answer (Cultural Connections)
- What question demonstrates that the community health nurse understands the importance of being culturally sensitive to both the client and the client’s family community?
- “Does your neighborhood have good public transportation so you can get to your doctor’s office?”
B. “Will your son be able to take off work to meet with your physical therapist?”
C. “Will your daughter-in-law be willing to change your dressing until the wound heals?”
D. “Are the special foods on your diet stocked in your neighborhood’s ethnic grocery store?”
View Answer (Cultural Connections)
- Which informational intervention best demonstrates the nurse’s attempt to minimize the cultural isolation that can result when a client lives in an ethnic neighborhood?
- The telephone numbers of the neighborhood’s nearest hospital
B. After-school programs in the neighborhood for children of single parents
C. The locations of English language classes in the client’s neighborhood
D. Contact information for the religious institutes located in the neighborhood