CULTURAL AWARENESS IN NURSING JENNIFER KEAN MSN RN

CULTURAL AWARENESS IN NURSING JENNIFER KEAN MSN, RN, CCRN

MADELEINE LEININGER • FOUNDER OF TRANSCULTURAL NURSING • IN 1950 S, WAS WORKING IN CHILD PSYCHIATRIC NURSING WHEN SHE DISCOVERED DIFFERENCES OF CARE IN CHILDREN OF DIFFERENT ETHNIC BACKGROUNDS • THIS DEEPLY CONCERNED HER; SHE SAW THAT HER NURSING DECISIONS AND ACTIONS, AND THAT OF HER STAFF, DID NOT HELP THESE CHILDREN ADEQUATELY • AS A RESULT, SHE POSED MANY QUESTIONS TO HERSELF AND HER STAFF ABOUT CULTURAL DIFFERENCES AND THERAPY OUTCOMES • FEW STAFF MEMBERS WERE INTERESTED IN THESE FACTORS AND CLIENT OUTCOMES

MADELINE LEININGER • AFTER MEETING MARGARET MEAD, SHE BECAME INTERESTED IN PURSUING DOCTORAL STUDIES IN CULTURAL, SOCIAL AND PSYCHOLOGICAL ANTHROPOLOGY • AS A DOCTORAL STUDENT, SHE STUDIED MANY CULTURES, FOUND ANTHROPOLOGY FASCINATING AND BELIEVED IT WAS AN AREA ALL NURSES SHOULD BE EDUCATED IN • LIVED WITH THE NATIVE PEOPLE OF NEW GUINEA AND CONTINUED TO DEVELOP HER THEORY OF CULTURE CARE AND THE ETHNONURSING METHOD

MADELINE LEININGER • HER RESEARCH AND THEORY HAVE HELPED NURSING STUDENTS UNDERSTAND DIFFERENCES IN HUMAN CARE, HEALTH AND ILLNESS • HAS BEEN THE ONLY MAJOR NURSE LEADER TO ENCOURAGE MANY STUDENTS AND FACULTY TO PURSUE GRADUATE EDUCATION AND PRACTICE • HER ENTHUSIASM AND DEEP INTERESTS IN DEVELOPING THIS FIELD OF TRANSCULTURAL NURSING WITH A HUMAN FOCUS HAS BEEN SUSTAINED FOR 6 DECADES

TRANSCULTURAL NURSING THEORY • PURPOSE: TO DISCOVER HUMAN CARE AND DIVERSITIES AND UNIVERSALITIES IN RELATION TO WORLDVIEW AND SOCIAL STRUCTURE • TO DISCOVER WAYS TO PROVIDE CULTURALLY CONGRUENT CARE TO PEOPLE OF DIFFERENT OR SIMILAR CULTURES IN ORDER TO MAINTAIN OR REGAIN THEIR WELL-BEING, HEALTH, OR TO FACE DEATH IN A CULTURALLY APPROPRIATE WAY • GOAL: TO IMPROVE AND PROVIDE CULTURALLY CONGRUENT CARE TO PEOPLE THAT IS BENEFICIAL, WILL FIT WITH, AND BE USEFUL TO THE CLIENT, FAMILY, OR OTHER CULTURE GROUP

TRANSCULTURAL NURSING THEORY • IS DIFFERENT FROM OTHER NURSING THEORIES • IS THE ONLY THEORY THAT IS FOCUSED EXPLICITLY ON DISCOVERING HOLISTIC AND COMPREHENSIVE CULTURE CARE • CAN BE USED IN WESTERN AND NON-WESTERN CULTURES BECAUSE OF THE INCLUSION OF MULTIPLE HOLISTIC FEATURES FOUND IN NUMEROUS CULTURES • THE ONLY THEORY FOCUSED ON FACTORS INFLUENCING HUMAN CARE SUCH AS WORLDVIEW, SOCIAL STRUCTURE FACTORS, LANGUAGE, GENERIC AND PROFESSIONAL CARE, ETHNICITY AND ENVIRONMENT

TRANSCULTURAL NURSING • REFERS TO A FORMAL AREA OF HUMANISTIC AND SCIENTIFIC KNOWLEDGE AND PRACTICES FOCUSED ON HOLISTIC CULTURE CARE (CARING) PHENOMENA AND COMPETENCIES TO ASSIST INDIVIDUALS OR GROUPS (CLIENTS) TO MAINTAIN OR REGAIN THEIR HEALTH (OR WELL-BEING) AND TO DEAL WITH DISABILITIES, DYING OR OTHER HUMAN CONDITIONS IN CULTURALLY CONGRUENT AND BENEFICIAL WAYS

COMMON CULTURES IN THE UNITED STATES • HISPANIC AMERICAN • AFRICAN AMERICAN • EUROPEAN AMERICAN • ASIAN AMERICAN • ARAB AMERICAN • NATIVE AMERICAN

HISPANIC AMERICANS • MAJOR LANGUAGE: SPANISH • COUNTRIES OF ORIGIN: DOMINICAN REPUBLIC, PUERTO RICO, , CENTRAL AND SOUTH AMERICA, MEXICO • COMMON BELIEFS: MAL DE OJO (EVIL EYE), SUSTO (RESULT OF A FRIGHTENING OR TRAUMATIC EXPERIENCE), MAL PUESTO (HEX OR ILLNESS IMPOSED BY ANOTHER) • HEALTH IS BELIEVED TO BE A MATTER OF GOD’S WILL • ILLNESSES ARE BELIEVED TO BE HOT OR COLD

HISPANIC AMERICANS • COLD ILLNESSES ARE DUE TO AN INVASION OF THE BODY FROM THE EXTERIOR AND ARE GENERALLY INCAPACITATING (ALTERATIONS OF MOTOR AND SENSORY FUNCTIONS, PAIN, IMMOBILITY) • HOT ILLNESSES ARE BELIEVED TO BE GENERATED FROM WITHIN THE BODY (SKIN RASH, FEVER, COUGH) • ILLNESS MAY BE CAUSED BY CONTAGION, EXCESSIVE WORK, COLD OR “AIR” EXPOSURE, FOOD CONTAMINATION, PUNISHMENT FROM GOD, BEWITCHMENT OR TRANSGRESSION OF MORAL AND SOCIAL RULES

HISPANIC AMERICANS • SPIRITUAL LEADERS MAY BE USED, AS WELL AS AMULETS AND RELIGIOUS ARTICLES • GOOD HEALTH IN MEN IS PART OF MACHISMO, RESULTING IN MEN SEEKING HEALTH CARE LESS FREQUENTLY THAN WOMEN AND ARE REGARDED AS BEING HEALTHIER THAN WOMEN OR CHILDREN • FAMILY MEMBERS FREQUENTLY ACCOMPANY HOSPITALIZED PATIENTS • FAMILY STRUCTURE IS PATRIARCHAL • SUSTAINED DIRECT EYE CONTACT IS CONSIDERED RUDE

HISPANIC AMERICANS • TEND TO BE FOCUSED ON THE PRESENT AND TO BE RELATIVELY UNCONCERNED ABOUT THE FUTURE • TOUCH IS USED OFTEN; CLOSENESS AND PHYSICAL CONTACT ARE VALUED IN FAMILIAR SITUATIONS • PREGNANT WOMEN ARE ENCOURAGED TO STAY ACTIVE TO ENSURE A SMALL BABY • POST-PARTUM PRACTICES INCLUDE CUARETENA, A 40 -DAY LYING-IN PERIOD IN WHICH A WOMAN RESTS, STAYS WARM, AVOIDS BATHING AND EXERCISE, AND EATS SPECIAL FOODS THAT PROVIDE WARMTH

HISPANIC AMERICANS • DIET: GENERALLY HIGH IN CARBOHYDRATES, FAT AND SALT • MEXICAN: USE CORN IN EVERYDAY EATING • FRIED FOODS ARE COMMONLY EATEN • PUERTO RICAN: RICE AND BEANS, BARBECUED FOODS • HEALTH BELIEFS AND PRACTICES • PREDOMINANT BELIEF IS THAT ILLNESS IS CAUSED BY AN UPSET IN BODY BALANCE • COMMON DISEASES: DIABETES AND ITS COMPLICATIONS, CANCER, STROKE

AFRICAN AMERICANS • OLDER AFRICAN AMERICANS MAY NOT TRUST HOSPITALS DUE TO A LONG HISTORY OF DISCRIMINATION/RACISM • MAY BE VERY SENSITIVE TO DISCRIMINATION, EVEN WHEN IT IS NOT INTENDED • RELIGION IS GENERALLY IMPORTANT • MAY HAVE A PRESENT-TIME ORIENTATION, WHICH MAY IMPEDE PREVENTIVE MEDICINE AND FOLLOW-UP CARE • EXPRESSION OF PAIN VARIES WIDELY

AFRICAN AMERICANS • FAMILY STRUCTURE MAY BE NUCLEAR, EXTENDED, OR MATRIARCHAL • HOUSEHOLDS HEADED BY WOMEN ARE COMMON • THE ELDEST MALE MAY BE THE SPOKESPERSON • GENERALLY, WOMEN ARE CONSIDERED EQUAL TO MEN • PRENATAL CARE IS COMMON; FATHERS ATTEND BIRTHS NOW • DELIVERY WAS TRADITIONALLY A FEMALE-ONLY EVENT

AFRICAN AMERICANS • SOME MAY BELIEVE THAT DISEASE IS DUE TO PUNISHMENT FOR SIN; MAY BE HELPFUL TO HAVE CLERGY INTERVENE • THIS CULTURE HAS A RICH TRADITION OF HERBAL REMEDIES • COMMON DISEASES: HYPERTENSION, DIABETES, CANCER, STROKE

EUROPEAN AMERICANS • INDEPENDENCE IS VALUED, AS ARE DIRECT EYE CONTACT AND EMOTIONAL CONTROL • PRIVACY IS IMPORTANT • LOWER-INCOME PEOPLE MAY BE PRESENT-ORIENTED, WHEREAS HIGHERINCOME PEOPLE MAY BE FUTURE-ORIENTED • STOICISM IS IMPORTANT WITH REGARDS TO EXPRESSING PAIN • FAMILY SIZE IS GENERALLY SMALL AND IS EXPRESSED IN TERMS OF SPOUSE, SIBLINGS, PARENTS AND CHILDREN

EUROPEAN AMERICANS • PRENATAL CARE IS GENERALLY SOUGHT, AND THE HUSBAND OR DOMESTIC PARTNER IS USUALLY PRESENT AT THE BIRTH, WHICH TAKES PLACE IN A HOSPITAL • PATIENTS MAY PREFER TO BE LEFT ALONE WHEN ILL, AND AN AGGRESSIVE APPROACH IS SOUGHT WHEN TREATING ILLNESS • GERMS ARE THOUGHT TO CAUSE DISEASE, AND PATIENTS EXPECT TREATMENT TO DESTROY GERMS • INTERNET SEARCHES ARE COMMON WHEN SEEKING HEALTH INFORMATION

ASIAN AMERICANS • HARMONY AND AVOIDANCE OF CONFLICT ARE HIGHLY VALUED; MAY IMPEDE MEDICAL TREATMENT • FILIAL PIETY IS AN IMPORTANT VALUE • GENERALLY AVOID EYE CONTACT AS A SIGN OF RESPECT • HAND GESTURES: BECKONING WITH THE FINGER MAY BE OFFENSIVE TO FILIPINOS AND KOREANS • PRONOUNS DO NOT EXIST IN MOST ASIAN LANGUAGES; MAY CONFUSE “SHE” AND “HE”

ASIAN AMERICANS • TIME ORIENTATION: MAY BE PAST ORIENTED; FILIPINOS MAY NOT ALWAYS ADHERE TO CLOCK TIME; JAPANESE MAY BE PAST AND FUTURE ORIENTED AND GENERALLY ON TIME; KOREANS ARE FUTURE ORIENTED • PAIN: STOICISM IS VALUED; MAY BE OVERLY CONCERNED ABOUT ADDICTION TO PAIN MEDICATION • FAMILY: MOST ASIAN CULTURES ARE HIERARCHAL; ALLOW FAMILY TIME TO BE WITH PATIENT, AS THIS MAY BE SEEN AS THEIR DUTY

ASIAN AMERICANS • TRADITIONALLY, THE BIRTH PARTNER WAS THE MOTHER-IN-LAW OR ANOTHER FEMALE RELATIVE • PREGNANCY IS THOUGHT TO DEPLETE THE BODY OF HEAT, SO RESTORATION OF WARMTH IS IMPORTANT • TRADITIONALLY, BATHING IS AVOIDED FOR A MONTH AFTER GIVING BIRTH • PARENTS MAY NOT NAME THE BABY FOR 30 DAYS, TO AVOID THE ATTENTION OF SPIRITS WHO MAY WANT TO STEAL THE CHILD

ASIAN AMERICANS • TRADITIONALLY ADHERE TO ALTERNATIVE AND COMPLEMENTARY MEDICAL PRACTICES • MAY PREFER HOT LIQUIDS, SUCH AS TEA • THE USE OF HERBS IS COMMON • AVOID THE NUMBER 4; IT IS EQUAL TO THE WESTERN VIEW OF THE NUMBER 13 AND IS ASSOCIATED WITH DEATH • DO NOT PLACE ASIAN PATIENTS IN ROOMS NUMBERED “ 4”

ARAB AMERICANS • MUST HAVE SAME-SEX CAREGIVER, IF POSSIBLE • ISLAM IS THE DOMINANT FORCE; ALLOW PATIENTS TO PRAY SEVERAL TIMES A DAY • REPETITION OF DEMANDS IS USED TO SHOW EMPHASIS, AS IS A LOUD VOICE • FOR MANY IRANIANS, “THUMBS UP” IS A RUDE GESTURE • TEND TO HAVE PAST AND PRESENT TIME ORIENTATION • PATIENTS TEND TO BE VERY EXPRESSIVE ABOUT PAIN

ARAB AMERICANS • MIDDLE EASTERNERS ARE VERY FAMILY-ORIENTED • BE PATIENT WITH “DEMANDING” FAMILY MEMBERS; IT IS THEIR WAY OF ENSURING THEIR FAMILY MEMBER GETS THE BEST CARE POSSIBLE • TRADITIONALLY, THE ELDEST MALE IS THE DECISION MAKER; ACCEPT THE FACT THAT WOMEN MAY DEFER TO THEIR HUSBANDS WITH DECISIONS ABOUT THEIR CARE, AS THESE CULTURES ARE STRONGLY PATRIARCHAL

ARAB AMERICANS • AT THE TIME OF DEATH, PLACE THE BED TO FACE MECCA (TO THE EAST) • PLANNING FOR THEIR DEATH IS SEEN AS CHALLENGING ALLAH; MAY INTERFERE WITH DNR STATUS OR HOSPICE CARE • ISLAM GENERALLY DOES NOT ALLOW FOR ORGAN DONATION • ALLOW THE FAMILY TO CARE FOR AND TO WASH THE BODY OF THEIR DECEASED FAMILY MEMBER

ARAB AMERICANS • MOST MUSLIMS DO NOT EAT PORK • SMOKING AND CHEWING TOBACCO ARE COMMON PRACTICES • COMMON DISEASES: CANCER, HEART DISEASE, HYPERTENSION

NATIVE AMERICANS • MAY USE ANECDOTES ABOUT A FRIEND OR NEIGHBOR TO DESCRIBE THEIR SYMPTOMS/ILLNESS • LONG PAUSES OFTEN INDICATE THAT CAREFUL THOUGHT IS BEING GIVEN TO A QUESTION • AVOID LOUDNESS AND A FIRM HANDSHAKE; BOTH ARE ASSOCIATED WITH AGGRESSION • LACK OF DIRECT EYE CONTACT IS SEEN AS A SIGN OF RESPECT • MAY BE RELUCTANT TO SIGN FORMS OR CONSENTS DUE TO A HISTORY OF MISUSE OF SIGNED DOCUMENTS • A PRESENT-TIME ORIENTATION IS COMMON

NATIVE AMERICANS • STOICISM IS THE NORM WITH REGARDS TO EXPRESSION OF PAIN, BUT MAY SAY “I DON’T FEEL SO GOOD” OR “SOMETHING ISN’T RIGHT” • EXTENDED FAMILY IS IMPORTANT; PATIENTS USUALLY MAKE THEIR OWN DECISIONS • PRENATAL CARE IS UNCOMMON • A FEMALE RELATIVE IS USUALLY THE BIRTH ATTENDANT • POST-PARTUM, THE MOTHER AND INFANT WILL STAY INSIDE FOR 20 DAYS