Chapter 11 Culture, Family, and CommunityCopyright ©

Chapter 11:
Culture, Family, and Community
Copyright © 2016 Wolters Kluwer Health | Lippincott Williams
& Wilkins
Copyright © 2020 Wolters Kluwer • All Rights Reserved
1
Community-Based Settings #1
An understanding of culture and cultural concepts contributes to
the nurse’s knowledge and facilitates culturally competent
nursing care in community-based settings.
Nurses are moving from acute care to community-based
settings, with the trend expected to increase.
2
Concepts such as health equality, diversity, partnership,
empowerment, and facilitation now form the basis for
community-based nursing practice with individuals, families,

and aggregates in the community.
An aggregate is a collection of people who can be thought of as
a whole simply because they happen to be in the same place at
the same time.
3
Community-based collaborative action research (CBCAR) is an
approach for nurses to partner with communities to address
health issues.
Care that is not congruent with the client’s value system is
likely to increase the cost of care because it compromises
quality and inhibits access to services.
4
Overview of Culturally Competent Nursing Care in Community
Settings
The use of cultural knowledge in community-based nursing
practice begins with a careful assessment of clients and families
in their own environments.
Cultural data are discussed with the client and family to develop
mutually shared goals.

Nurses must take into account the diverse cultural factors that
will motivate clients to make successful changes in lifestyle and
behavioral modifications.
5
A Transcultural Framework
Cultural/social/ecological approach:
Nursing focus is on the community as client.
A cultural/social/ecological framework facilitates a view of the
community as a complex collective yet allows for diversity
within the whole.
Assists the nurse to identify values and cultural norms of a
community.
6
Question #1
Is the following statement true or false?
The goal of practicing in a culturally sensitive manner is to
provide care that the client, family, and health care providers
are in agreement with.

7
Answer to Question #1
True
Rationale: The use of cultural knowledge in community-based
nursing practice begins with a careful assessment of clients and
families in their own environments. Cultural data that have
implications for nursing care are selected from clients, families,
and the environment during the assessment phase and are
discussed with the client and family to develop mutually shared
goals.
8
Cultural Issues in Community Nursing Practice #1
Cultural influences on individuals/families:
Family structure, roles, communication, decision-making
Health beliefs/practices, alternative therapies
Patterns of daily living
Social networks
9

Cultural influences on individuals/families (cont.):
Identification with a cultural group, language
Nutritional practices
Religious preferences
Culturally appropriate behavior styles
Cultural factors within communities:
Influence of demographics on health care; the United States is
more diverse; morbidity/mortality rates
Subcultures in the United States and diversity within them
Refugee and immigrant populations, asylees
Dinka community
11
12

Cultural factors within communities (cont.):
Maintenance of traditional cultural values and practices,
assimilation, acculturation, integration
Access to health and nursing care for diverse cultural groups :
Economic status
Discriminatory factors
Geographic location
Question #2
Assimilation and acculturation can be defined as the process by
which individuals shed their traditional culture and lifestyle and
embrace and adapt to their new culture—something all
successful immigrants and refugees experience.
14
False
Rationale: The terms assimilation and acculturation refer to
ways in which immigrants and refugees adapt and change over
time. These terms may imply giving up one’s traditional culture
for the dominant culture. Integration, incorporating some

aspects of the new culture while maintaining cultural traditions
and values, may better describe a successful immigrant or
refugee experience.
15
Assessment of Culturally Diverse Communities #1
The community nursing assessment often focuses on a broad
goal, such as improvement in the health status of a group of
people.
16
Basic Principles of Cultural Assessments:
All cultures must be viewed in the context in which they have
developed.
The meaning and purpose of the behavior must be interpreted
within the context of the specific culture.
There is such a phenomenon as intracultural variation.

17
Cultural competence in health maintenance and health
promotion:
Cultural competence in community settings begins with
anticipatory planning.
Cultural sensitivity, the ability to be aware of the needs and
emotions of others, is essential to meeting health needs that
exist within diverse cultural groups.
18
Cultural competence in health maintenance and health
promotion (cont.):
Requires knowledge about:
Family systems
Coping behaviors
Lifestyle practices
Cultural competence in primary, secondary, and tertiary
preventive programs:
The major aim of community-based preventive programs is to

reduce the risk for the population at large, rather than to prevent
illnesses in specific individuals.
In their daily practice, community nurses are often involved in
activities related to all three levels of prevention.
20
Cultural Competence in primary, secondary, and tertiary
preventive programs (cont.):
Primary—prevent the occurrence of an illness, disease, or
health risk
Secondary—early diagnosis and appropriate treatment of a
condition or disease
Tertiary—rehabilitation and the prevention of recurrences or
complications
21
Question #3
The community health nurse should target certain high-risk
behaviors for change during pregnancy, such as smoking, using
drugs, consuming alcohol, and maintaining poor nutritional
habits. Which of the following levels of prevention does this
demonstrate?

Primary
Secondary
Tertiary
Assessment
22
A. Primary
Rationale: A program of primary prevention would focus on
preventing infant morbidity and mortality and other health
problems in mothers and their infants.
Early prenatal care may enhance pregnancy outcome and
maternal health by assessing risk, providing health advice, and
managing chronic and pregnancy-related health conditions.
23
Chapter 12:
Religion, Culture, and Nursing
Copyright © 2016 Wolters Kluwer Health | Lippincott Williams

& Wilkins
1
Religion, Culture, and Nursing
As an integral component of culture, religious, and spiritual
beliefs, influence a client’s explanation of the:
Cause(s) of illness
Perception of its severity
Decisions about healing intervention(s)
Choice of healer(s)
2
Dimensions of Religion #1
Five major dimensions of religion:
Experiential—emotion and/or feeling about purpose in life and
connection with a higher power
Ritualistic—religious practices
Ideologic—shared beliefs of members
Intellectual—cognitive understanding
Consequential—adherence to the prescribed standards of
conduct

3
Dimensions of Religion #2
Religious Dimensions in Relation to Health and Illness
Determine the dimensions important to the client for mutual
goal setting and priorities.
Determine what a given member of a specific religious
affiliation believes to be important.
Obtain accurate information.
Understand religious virtues of clients.
Assist clients to cope with differences between their own
behaviors and the norms of their religion.
Religion and Spiritual Nursing Care
Nurses endeavor to provide holistic health care, in which the
needs of the total person are recognized.
Religion is an organized system of beliefs about the cause,
nature, and purpose of the universe, often including the belief in
or worship of a Supreme Being and a unified truth.
Spirituality is a person’s personal effort to find meaning and
purpose in his or her life. It is more focused on individual
growth, more subjective, more emotionally based, and rising
from personal experience.

5
Question #1
Religion addresses questions related to what is true and right.
True
Rationale: Religion addresses questions related to what is true
and right and helps individuals determine where they belong in
the scheme of their life’s journey.
Spiritual Nursing Care #1
Spiritual intervention is as appropriate as any other form of
nursing intervention and recognizes that the balance of physical,
psychosocial, and spiritual aspects of life is essential to overall
good health.
Spiritual distress is disruption in the life principle that pervades
a person’s entire being and that integrates and transcends the
person’s biologic and psychosocial nature.
Cultural assessment includes assessment of religious and
spiritual issues.

8
Spiritual Nursing Care #2
Spiritual Nursing Care for the Dying or Bereaved Client and
Family
Death of a child
Death practices
Preparation of the body
Funeral practices
Taboos
Unexpected and violent death
Bereavement, grief, mourning
9
Question #2
While attention to a client’s spiritual needs is always important,
most clients view religion as a private matter, especially at a
time of crisis.

10
False
Rationale: The goal of spiritual nursing care is to assist
clients in integrating their own religious and spiritual beliefs
into the ultimate reality that gives meaning to their lives in
relation to the health care crisis that has precipitated the need
for nursing care.
11
Religious Trends in the United States and Canada #1
The United States and Canada are cosmopolitan nations to
which all of the major and many of the minor faiths of Europe
and other parts of the globe have been transplanted.
Religious identification among people from different racial and
ethnic groups is important because religion and culture are
interwoven.
12
Religious Trends in the United States and Canada #2

13
Contributions of Religious Groups to the Health Care Delivery
System
Many religious denominations own and operate health care
institutions and make significant fiscal contributions that help
control health care costs.
Roman Catholic Church–affiliated hospitals, health-related
centers, charities
Jewish hospitals, day care centers, extended care facilities, and
organizations
Lutheran, Mennonite, Methodist, Muslim, and Seventh-Day
Adventist groups also own and operate hospitals and health care
organizations
14
Question #3
The second most popular religious affiliation identified by
individuals in the United States is:
Christianity
Judaism
Islam
Atheism, Agnosticism, no affiliation

15
D. Atheism, Agnosticism, no affiliation
Rationale: In the United States, Christianity is the most popular
religious affiliation identified (at 78.5%). Second to that, at
17.3%, is the category Atheism, Agnosticism, no affiliation.
Worldwide, Islam is second to Christianity (at 19.6% and 33%,
respectively).
16
Health-Related Beliefs and Practices of Selected Religions #1
Health-related beliefs and practices of select religions are
important to understand, especially considering the diverse
religious groups in the United States and Canada.
A brief overview of the following religions can be found in the
text:
Amish
Baha’i International Community
Buddhist Churches of America
Catholicism According to the Roman Rite

text (cont.):
Christian Science
The Church of Jesus Christ of Latter-day Saints
Hinduism
Islam
Jehovah’s Witnesses
Judaism
Mennonite Church
text (cont.):
Mennonite Church
Native North American Churches
Protestantism
Seventh-Day Adventists
Unitarian Universalist Church

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