This document discusses culture, ethnicity, and how they relate to health care. It defines culture as the values, beliefs, and practices of a particular group that are learned and shared. Ethnicity refers to a sense of identity based on common heritage. The document examines concepts such as dominant and minority groups, assimilation, and stereotyping. It explores the influence of culture and ethnicity on health, including gender roles, language, nutrition, and views of poverty and family support. The need for cultural competence and assessments in providing transcultural care is also addressed.

1. Culture and EthnicityCulture and Ethnicity

2. CultureCulture
 Values, beliefs, norms & practices of aValues, beliefs, norms & practices of a
particular groupparticular group
 Learned and sharedLearned and shared
 Guide thinking, decisions, & actions in aGuide thinking, decisions, & actions in a
patterned waypatterned way

3. Concepts of Culture and EthnicityConcepts of Culture and Ethnicity
 Culture – a set of values, beliefs & traditions that are heldCulture – a set of values, beliefs & traditions that are held
by a specific social group and handed down fromby a specific social group and handed down from
generation to generationgeneration to generation
 Subculture – made up of people with a distinct identity, butSubculture – made up of people with a distinct identity, but
who have certain ethnic, occupational or physicalwho have certain ethnic, occupational or physical
characteristics that are found in the larger culturecharacteristics that are found in the larger culture
 Dominant group – the group within the culture that has theDominant group – the group within the culture that has the
authority to control the value system.authority to control the value system.
 Minority group – usually has some physical or culturalMinority group – usually has some physical or cultural
characteristic that identifies the people within it as differentcharacteristic that identifies the people within it as different

4. ““Despite being technicallyDespite being technically
competent, a nurse can becompetent, a nurse can be
incompetent, formulatingincompetent, formulating
unworkable interventions becauseunworkable interventions because
of an unwillingness or inability toof an unwillingness or inability to
understand the culturally differentunderstand the culturally different
patient.” (West, 1994, .232)patient.” (West, 1994, .232)

5. ““Having knowledge of a culture before tryingHaving knowledge of a culture before trying
to help a client and family is analogous to ato help a client and family is analogous to a
nurse or a physician having basicnurse or a physician having basic
knowledge of anatomy and physiologyknowledge of anatomy and physiology
before doing physical assessment orbefore doing physical assessment or
attempting to meet a patient’sattempting to meet a patient’s
physical needs.” Madeleine Leiningerphysical needs.” Madeleine Leininger

6. EthnicityEthnicity
 The sense ofThe sense of
identification that aidentification that a
cultural groupcultural group
collectively has, largelycollectively has, largely
based on the group’sbased on the group’s
common heritage.common heritage.
 Race – Subculture ofRace – Subculture of
people characterizedpeople characterized
by specificby specific
characteristics.characteristics.

7. CultureCulture
 Culture AssimilationCulture Assimilation
– AKA acculturationAKA acculturation
– When minority groups living within the dominantWhen minority groups living within the dominant
group loose the cultural characteristics thatgroup loose the cultural characteristics that
make them different.make them different.
– Stereotyping – involves assigningStereotyping – involves assigning
characteristics to a group of people withoutcharacteristics to a group of people without
considering specific individuality.considering specific individuality.

8. CultureCulture
 Cultural Imposition – the belief thatCultural Imposition – the belief that
everyone should conform to the majorityeveryone should conform to the majority
belief system.belief system.
 Cultural conflict – when one ridicules othersCultural conflict – when one ridicules others
beliefs and traditions in an effort to make hisbeliefs and traditions in an effort to make his
or her own values more secureor her own values more secure

9. Cultural and Ethnic Influences onCultural and Ethnic Influences on
Health CareHealth Care
 Gender Roles – It is important toGender Roles – It is important to
know who is the dominant figureknow who is the dominant figure
in a familyin a family
 Language and CommunicationLanguage and Communication
– Some clients may not be able– Some clients may not be able
to speak the English Languageto speak the English Language
 Orientation to Space and time –Orientation to Space and time –
personal spacepersonal space
 Food and NutritionFood and Nutrition
 SocioeconomicSocioeconomic

10. PovertyPoverty
 The culture of poverty-The culture of poverty-
the highest riskthe highest risk
families are headed byfamilies are headed by
one income singleone income single
females, fixed incomefemales, fixed income
elderly and futureelderly and future
generations of thosegenerations of those
living in povertyliving in poverty

11. CharacteristicsCharacteristics
 Feelings of despair, resignationFeelings of despair, resignation
& fatalism& fatalism
 Day to day attitude toward lifeDay to day attitude toward life
with no hope for the futurewith no hope for the future
 Unemployment and need forUnemployment and need for
financial or government aidfinancial or government aid
 Use of escape values such asUse of escape values such as
alcohol and drugsalcohol and drugs
 Unstable family structure withUnstable family structure with
abusiveness and abandonmentabusiveness and abandonment
 Decline in self respect andDecline in self respect and
retreat from communityretreat from community

12. Effects of Poverty on Health CareEffects of Poverty on Health Care
 Lack of affordable and adequate housingLack of affordable and adequate housing
 Crowded living conditionsCrowded living conditions
 The sick usually experience moreThe sick usually experience more
complicationcomplication
 Recovery time is longerRecovery time is longer
 Less likely to regain their preillness level ofLess likely to regain their preillness level of
functioningfunctioning
 Lack of access to health care insuranceLack of access to health care insurance

13. Family SupportFamily Support
 Some cultures have large extended familiesSome cultures have large extended families
and are unable to share private informationand are unable to share private information
with anyone outside the family.with anyone outside the family.
 Some cultures have great respect for elderlySome cultures have great respect for elderly
and will not consider institutional careand will not consider institutional care

14. Physical and Mental HealthPhysical and Mental Health
 Physiologic CharacteristicsPhysiologic Characteristics
– Keloid formation – overgrowth of connectiveKeloid formation – overgrowth of connective
tissue that occurs during healing process oftissue that occurs during healing process of
injury, surgery—African heritageinjury, surgery—African heritage
– Lactose intolerance - lack of lactase to breakLactose intolerance - lack of lactase to break
down lactose during digestion - Hispanic,down lactose during digestion - Hispanic,
African, Chinese, Thai.African, Chinese, Thai.
– Sickle Cell Anemia – sickle shaped red bloodSickle Cell Anemia – sickle shaped red blood
cells. Most common in African orcells. Most common in African or
Mediterranean ethnic background.Mediterranean ethnic background.

15. Continued…Continued…
Tay Sacks Disease – a gene for a hereditary disorder – haveTay Sacks Disease – a gene for a hereditary disorder – have
very short life span – Eastern European, Jewish descent.very short life span – Eastern European, Jewish descent.
G6PD deficiency – enzyme deficiency. Red blood cells haveG6PD deficiency – enzyme deficiency. Red blood cells have
no cell membrane they are easily destroyed , which leadsno cell membrane they are easily destroyed , which leads
to anemia and increased billirubin levels. - 10% of Africanto anemia and increased billirubin levels. - 10% of African
American populationAmerican population
Thalassemia – genetic disorder effecting the Hgb in RBCThalassemia – genetic disorder effecting the Hgb in RBC
function. Mediterranean, Asian, and African origin.function. Mediterranean, Asian, and African origin.
Sarcoidosis – formation of multiple tubercles or nodules onSarcoidosis – formation of multiple tubercles or nodules on
various parts of the body - African American population.various parts of the body - African American population.
Gout – An increase of uric acid in the blood -males especiallyGout – An increase of uric acid in the blood -males especially
from Puerto Rican or Filipino descent.from Puerto Rican or Filipino descent.

16. Psychological CharacteristicsPsychological Characteristics
 In most situations anIn most situations an
individual will relate theindividual will relate the
behavior of another personbehavior of another person
to the individual’s ownto the individual’s own
familiar culture.familiar culture.
 It is important to rememberIt is important to remember
that what may seemthat what may seem
perfectly reasonable &perfectly reasonable &
important to a client mayimportant to a client may
seem ridiculous andseem ridiculous and
irrelevant to a nurse. Theirrelevant to a nurse. The
reverse perception mayreverse perception may
also exist.also exist.

17. Culture ShockCulture Shock
 Feelings an individualFeelings an individual
experiences whenexperiences when
placed in a differentplaced in a different
and often strangeand often strange
culture and may resultculture and may result
in psychologicalin psychological
discomfort ordiscomfort or
disturbances.disturbances.

18. Cultural Imposition andCultural Imposition and
EthnocentrismEthnocentrism
 Cultural Imposition. – theCultural Imposition. – the
tendency for healthtendency for health
personnel to impose theirpersonnel to impose their
beliefs practices andbeliefs practices and
values of other cultures,values of other cultures,
because they believe thatbecause they believe that
their ideas are superior.their ideas are superior.
 Ethnocentrism – the beliefEthnocentrism – the belief
that one’s own ideas,that one’s own ideas,
beliefs and practices arebeliefs and practices are
the best and superior.the best and superior.

19. Providing Transcultural CareProviding Transcultural Care
 Major Theme – FocusMajor Theme – Focus
on caring practices ofon caring practices of
various culturesvarious cultures
 Nursing Role –Nursing Role –
Understand the client’sUnderstand the client’s
needs and to adaptneeds and to adapt
care to meet thosecare to meet those
needs.needs.

20. Cultural AssessmentCultural Assessment
 Identify factors that effect behavior byIdentify factors that effect behavior by
cultural assessmentcultural assessment
– Values, religion, dietary practices, family lines ofValues, religion, dietary practices, family lines of
authority, family life patterns and beliefs andauthority, family life patterns and beliefs and
practices related to health and illnesspractices related to health and illness
– See guidelines on pp 47 & 52See guidelines on pp 47 & 52
– See table 3-1 on page 48-51See table 3-1 on page 48-51

21. Reaction to PainReaction to Pain
 Reactions areReactions are
culturally prescribedculturally prescribed
……………….... Let’s discussLet’s discuss

22. Different Health PracticesDifferent Health Practices
Folk HealersFolk Healers
less expensive, moreless expensive, more
accessible and moreaccessible and more
understanding ofunderstanding of
cultural needs . Speakcultural needs . Speak
the client’s languagethe client’s language
Traditional Folk MedicineTraditional Folk Medicine
HerbsHerbs

23. Transcultural NursingTranscultural Nursing
 Nursing care planned and implemented in a wayNursing care planned and implemented in a way
that is sensitive to the needs of individuals,that is sensitive to the needs of individuals,
families, and groups representing diverse culturalfamilies, and groups representing diverse cultural
populations.populations.
 The culture of health care: Assess:The culture of health care: Assess:
– the cultural backgroundthe cultural background
– expectations and beliefs about healthcareexpectations and beliefs about healthcare
– Cultural context of the encounterCultural context of the encounter
– Degree of agreement between the 2 persons set ofDegree of agreement between the 2 persons set of
beliefs and valuesbeliefs and values