Transcultural Health Care A Culturally Competent Approach 4

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian American Culture Larry Purnell, Ph. D, RN, FAAN Copyright © 2013 F. A. Davis Company

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Overview/Heritage § This presentation focuses on Russians who are immigrants to the United States. § The Russian Federation, the largest country in the world, is composed of 21 republics and covers parts of two continents, Asia and Europe. § Under communism all media were controlled, disseminating only information that the government wanted people to know.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Overview/Heritage § Under Communism, everyone could attend higher education institutions, resulting in a welleducated population. § Many scientists, physicians, and other professionals who have immigrated to the United States find difficulty in continuing to practice their profession, necessitating employment in occupations that lower self-esteem.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Communication § The official language of Russia is Russian. § Most educated Russians in the United States speak English to some extent because professional literature in Russia was printed in English. § Many do not understand medical jargon and have difficulty communicating abstract concepts. Copyright © 2013 F. A. Davis Company

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Communication § Many older Russian Jewish immigrants speak Yiddish. § Younger Jewish immigrants usually do not speak Yiddish because it was strongly discouraged in Russia. Copyright © 2013 F. A. Davis Company

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Communication § Punctuality is the norm, and many arrive early. § Temporality is toward present and future orientation. § In Russia, many people concerned themselves with having food and other necessities, not just for that day, but also for the following days and weeks ahead. Copyright © 2013 F. A. Davis Company

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Communication § Direct eye-to-eye contact is the norm among family, friends, and others without distinction between genders. § Some may avoid eye contact when speaking with government officials, a practice common in Russia where making eye contact with government officials and other people in hierarchal positions could lead to questioning. Copyright © 2013 F. A. Davis Company

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Communication § Most individuals accept touch regardless of age and gender. § Vocal volume may be loud, extending to those nearby who are not part of the conversation. § Russians do not appreciate when others stand with their hands inserted into pockets, cross arms over their chests, and slouch. Copyright © 2013 F. A. Davis Company

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Communication § Until trust is established, many Russians stand at a distance and are aloof when speaking with health-care providers. § Many educated women keep their maiden names when they marry. Copyright © 2013 F. A. Davis Company

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Family Roles & Organization § Family, children, and older adults are highly valued. Russians, accustomed to extended family living in their home country, continue the practice when they emigrate. § Decision-making among current immigrants is usually egalitarian with decisions being made by the parents or by the oldest child.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Family Roles and Organization § While parents work, grandparents care for grandchildren. § Older people live with their children when selfcare is a concern. § Nursing homes are rare and are of poor quality in Russia; thus, children may fear placing parents in long-term care facilities.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Family Roles & Organization § Children of all ages are expected to do well in school, go on for higher education, help care for older family members, and tend to household chores, according to traditional gender roles. § Teens are expected not to engage in sexual activity. § Sex and contraceptive education are not traditionally provided.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Family Roles & Organization § Single and divorced relationship statuses are accepted without stigma. § Gay and lesbian relationships are not recognized or discussed and are still stigmatized by a large part of the population.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Workforce Issues § The concept of teamwork is new to Russian nurses as is critical thinking and sensitive caregiving. § When communicating in the workplace, Russians promote the value of positive politeness, a technique that employs rules of positive social communication.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Clicker. Check The nurse is conducting an intake assessment on a 76 year old Russian immigrant. She does not maintain eye contact with the nurse. The lack of eye contact is most likely due to a. Respect for the nurse. b. Lack of trust. c. Does not want to tell the truth. d. Most Russians do not maintain eye contact when conversing.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Correct Answer Correct answer: B Many older Russian immigrants do not maintain eye contact with governmental officials or people in hierarchal positions because they could not be trusted.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Workforce Issues § The employee, using positive politeness, will say nice things that show that the person is accepted, while simultaneously providing support, empathy, and avoiding negative discourse with coworkers. § When negotiating compromise, Russians express emotion and invest considerable time and effort into supporting decisions.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Workforce Issues § With colleagues and friends, Russians communicate directly, which is considered a sign of sincerity.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Biocultural Ecology § Russians in the US are predominately white making them prone to skin cancer. § Common health conditions of Russians include alcoholism, depression, gastrointestinal disorders, respiratory diseases, cardiovascular diseases, cancer due to radiation, dental disease, tuberculosis, diabetes mellitus, and hyperlipedemia.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Biocultural Ecology § Many who come from Eastern Europe were exposed to the radiation effects of the Chernobyl disaster in 1986, resulting in a high incidence of cancer among this immigrant group.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian High-Risk Behaviors § Both men and women have high smoking rates. § Domestic violence is common and is related mostly to high rates of alcohol consumption. § Domestic violence support services are not available in Russia; thus, patients are reluctant to report or seek help for domestic violence in the United States.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Nutrition § Common foods include cucumbers in sour cream, pickles, hard-boiled eggs as well as eggs served in a variety of other ways, marinated or pickled vegetables, soup made from beets (borscht), cabbage, buckwheat, potatoes, yogurt, soups, stews, and hot milk with honey. § Cold drinks are not favored.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Nutrition § Meat choices include pickled herring, smoked fish, anchovies, sardines, cold tongue, chicken, ham, sausage, and salami. § Bread is a staple with every meal. § The diet overall is high in fat and salt.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Pregnancy and Childbearing Practices § Many new immigrants may not be aware of different methods of fertility control. § Abortion is very common in Russia, and some may choose this option in the United States. § Russian condoms are made of thick rubber, discouraging their use by men. § Pregnant women have regular prenatal checkups, which are mandatory in Russia.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Pregnancy and Childbearing Practices § During pregnancy, women are discouraged from heavy lifting and from engaging in strenuous physical activities; they are also protected from bad news that can be harmful to the fetus. § They are encouraged to eat foods that are high in iron, calcium, and vitamins. § Strawberries, citrus fruits, peanuts, and chocolate are avoided to prevent allergies in the newborn.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Pregnancy and Childbearing Practices § As labor approaches, women take laxatives and enemas to facilitate delivery. § Traditionally in Russia, husbands and relatives could not participate in the delivery or visit the hospital postpartum. § There are no cultural restrictions for fathers or female relatives not to participate in delivery. § The delivery room should not have bright lights because many individuals believe that bright lights will harm the newborn’s eyes.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Pregnancy and Childbearing Practices § Many women breast-feed until the infant reaches the toddler stage. § Many women believe the breasts must be kept warm during feeding lest the mother get breast cancer later in life. § Peri-care with warm water is important, and a binder is worn to help the mother’s figure return to its state prior to pregnancy.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Pregnancy and Childbearing Practices § In Russia, women were accustomed to 8 weeks of maternity leave before delivery and up to 3 years leave following delivery.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Death Rituals § Families want to be notified about impending death first, before the patient is told. § Most families prefer to have the dying family member cared for at home. § Do-not-resuscitate orders are appropriate; many families want their loved one to die in comfort. § Few believe in cremation; most prefer interment.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Death Rituals § Both men and women may wear black as a sign of mourning. § Black wreaths are hung on the door of the deceased’s home. § Expression of grief varies greatly.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Spirituality § Most who practice a religion are Eastern Orthodox or Jewish, with smaller numbers of Molokans, Tartar Muslims, Seventh Day Adventists, Pentecostals, and Baptists. § Sixty percent of Russian people are nonreligious. § The state-controlled Russian Orthodox Church was the only accepted religion in Russia (other religions were prohibited) until perestroika and glasnost.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Spirituality § Russian Americans pray in their own way, which may be different from that of the dominant religion with which they identify. § Because Judaism was forbidden in Russia, many Jewish Russian in the US are unfamiliar with many of the Jewish religious practices.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Health-care Practices § Because health care is free at the point of entry in Russia, newer immigrants might not be aware of the need for insurance in the United States. § Hospital stays in Russia average 3 weeks. Some clients may expect this in the United States. § Unmarried women are not accustomed to Pap tests because in Russia only married women get them. Mammography is uncommon in Russia.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Health-care Practices § Many individuals are preoccupied with remaining warm to prevent colds and other illnesses. § Most do not want breezes from fans or drafts from an open window to blow directly on them. § They may also be reluctant to apply ice at the recommendation of a health-care provider. § Most Russians are stoical with pain and may not ask for pain medicine.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Health-care Practices § Some individuals may be reluctant to wash their hair for fear of catching a cold if the room is not warm or has a draft. § Because of high radiation in parts of Russia, many fear having an x-ray. § Clients are not accustomed to being told about cancer, terminal illnesses, or grave diagnoses; many believe it makes the condition worse.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Health-care Practices § A primary treatment for a variety of respiratory illnesses is cupping. § A small glass cup, a bonzuk or bonki, has alcohol-saturated cotton or other materials in it. § The material is lighted and then the cup is turned upside down on the patient’s back. The skin is drawn into the cup, leaving round ecchymotic areas when it is removed.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Health-care Practices § Common cultural practices include taking vodka with sugar for a cough; soaking one’s feet in warm water for a sore throat; aromatherapy for a variety of respiratory illnesses; mud and mineral baths to promote healing; and herbs and teas for fever, colds, and minor ailments.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Health-care Practices § People are accustomed to not telling healthcare providers about depression or any other emotional or mental health concerns because mental illness carries a significant stigma and mental health facilities are very poor in Russia. § Inadequate screening of blood in Russia creates fear of contracting HIV from blood transfusions. § Most do not believe in organ donation.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Russian Health-care Practitioners § Health-care providers are respected. § Because nurses function in higher roles in the United States than in Russia, they may be mistaken for physicians. § Men and women are accustomed to living together in very small physical quarters; thus, most do not have a problem with privacy. § Gender is not generally a concern in care.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Clicker. Check A 42 year old Russian immigrant has been ordered a chest x-ray suspected pneumonia. He is very reluctant to have the x-ray. A probably reason for his reluctance is a. High radiation in some parts of Russia. b. He is unaware of the procedure. c. He is modest and does not want to disrobe. d. The physical environment is cold.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Correct Answer Correct answer: A Many Russians, especially recent immigrants, are fearful of x-rays because of high radiation levels in parts of Russia.