Conceptual Foundations

Albrecht et al. (2013, p.2) noyed that the anthropologists have distinguished among
these terms:
Disease- “deviations from a biomedical norm”
Illness- “the lived experience of culturallly constructed categories”
Sickness- “patients’ roles”
Based on the idea that everyone has cultural variations, and the number of variations is
increasing everywhere with the large number of immigrants moving from one country to
another, nurses must understand cultural variation as a basis for even minimally safe
and effective care.

Concepts and Terms Related to Culture

Culture
Ø defined as a shared system of values, beliefs, and learned patterns of behavior
Ø the totality of socially transmitted behavioral patters, arts, beliefs, values,
customs, lifeways, and all other product of human work and thought
characteristic of a population or people that guide their worldview and decision
making (Purnell, 2013)
Values
Ø learned beliefs about what is held good or bad
Norms
Ø learned behaviors that are perceived to be appropriate or inappropriate
Ethnocentrism
Ø The perception that one’s worldview is the only acceptable truth, and that one’s
beliefs, values, and sanctioned behaviors are superior to all others
Ethnicity
Ø “socially, culturally, and politically constructed group of individuals that holds a
common set of characteristics not shared by others with whom its members come in
contact.
Terms and Definitions of Culture

Acculturation- The circumstance when a Enculturation- A natural conscious and

person gives up the traits of his or her
culture of origin as a result of context
with another culture, to variable degrees.
Assimilation- The gradual adoption and
incorporation of characteristics of the
prevailing culture.
unconscious conditioning process of
learning accepted cultural norms, values
and roles in the society and achieving
competence in one’s culture through
socialization.
Ethnicity- A socially, culturally, and
Cultural Diversity- The co-existence of a
difference in behavior, traditions and
customs
Cultural Imposition- The intrusive
application of the majority group’s
cultural view upon individuals and
families.
Cultural Relativism- The belief that the
behaviors and practices of people should
be judged only from the context of their
cultural system.
Culture- The totality of socially trasmitted
behavioral patters, arts, beliefs, values,
customs, lifeways, and all other products
of human work.
politically constructed group that holds in
common set of characteristics not shared
by others with whom members of the
group come in contact.
Stereotyping- An oversimplified
conception, opinion, or belief about some
respec of an individual or group.
Subculture- A group of people with a
culture that differentiates them from the
larger culture pf which they are a part.
Worldview- The way individuals or groups
of people look at the universe to form
basic assumptions and values about their
lives and the world around them.

Cultural Competence
According to Campinha-Bacote (2015), there are five constructs in the cultural
competence process
ü Cultural Awareness
ü Cultural Skill
ü Cultural Knowledge
ü Cultural Encounters
ü Cultural Desire

Race
n not a physical characteristic but a socially constructed concept that has meaning
to a larger group
n originates from societal desire to separate people based on their looks and
culture
n a vague, inscientific term referring to a group of genetically related individuals
who share certain physical characteristics

Purposes and Scope of Assessment

u To learn about the client’s beliefs and usual behaviors associated with health and
illness, including beliefs about diseases , caregiving, expected treatments, daily
hygiene, food preferences and rituals, religious beliefs relative to health care
u To compare the client’s beliefs and practices with those of other persons from a
similar cultural background (to avoid stereotyping)
 u To assess the client’s health relative to diseases prevalent in the specific cultural
group

Cultural beliefs and values to assess include:

Ø Value Orientation
Ø Beliefs about human nature
Ø Beliefs about relationship with nature
Ø Beliefs about purpose of life
Ø Beliefs about health, illness and healing
Ø Belief about what causes disease
Ø Beliefs about who serves in the role of healer or what practices bring about
healing
Ø Beliefs about the meaning of suffering and pain

Factors Affecting Approach to Providers

l Ethnicity (of both client and health care provider)
l Generational Status (of both client and health care provider)
l Educational Level
l Religion
l Previous health care experiences
l Occupation and income level
l Beliefs about time and space
l Communication needs/preferences

Communication
All communication is culturally based. Verbal communication can have many variations
based on both language differences and usual tone of voice. Nonverbal communication
has the most often misinterpreted variations. These variations include:
n Space
n Eye contact
n Time
n Eye comtact and Face positioning
n Body Language and Hand Gestures
n Silence

Factors Affecting Disease, Illness, Health State

ü Biomedical Variations
ü Nutrition/Dietary Habits
ü Family roles and organizations, patterns
ü Workforce issues
ü High-risk behaviors
ü Pregnancy and childbirth practices
ü Death rituals
ü Religious and spiritual beliefs and practices
ü Health care practices
ü Health care practitioners
ü Environment
Health Care Beliefs
Cultural beliefs that affect health care involve beliefs about communication (which affect
the culturally competent interview process), beliefs about the appropriate categories of
persons to whom an individual goes to seek health care and beliefs about health and
illness.
Cultural Variations of Traditional Healers and Practices

Culture Traditional Healers Preventive and Healing

Practices
Asian Traditions Chinese medical Prevent or rebalance yin/yang,
practitioners, herbalists hot/cold foods and conditions,
wear amulets, acupuncture,
cupping, moxibustion
African Traditions Magico herbalists, Hoodoo Magical and herbal mix of
(also known as conjurers), herbs, roots, and rituals,
or other traditional healers talismans or amulets
known as “Old Lady,”
“granny,” or lay midwife
Native American/ Alaska Medicine men and shamans Respect for nature and avoid
Native Traditions evil spirits, use masks, herbs,
sand painting, amulets
Hispanic Traditions Folk Healers (curandero/a, Hot/cold balance for diet,
bruja/o, yerbero/a, partera) herbs, amulets, prayers to God
and saints amd spiritual
reparation for sins, avoidinf “evil
eye” caused by jealousy and
envy
Western European Homeopathic physicians, Maintain physical and
 Traditions physicians, and other health emotional well-being with
professionals proper science-based modern
nutrition, exercise, cleanliness,
belief in and faith in God

Cause of Illness
Western health care and medicine use the biomedical model as a basis for defining
illness and treatments. This model is based on what science can investigate and conclude
and assumes that all disease or illness has a cause and effect that can be studied. Other
beliefs about disease and illness causation, often based on Asian or indigeneous
populations’ beliefs are categorized as holistic and magicoreligious.

Culture-Bound Syndromes
These are conditions that are perceived to exist in various cultures and occur as a
combination of psychiatric or psychological and physical symptoms. It is important to
acknowledge the client’s belief tbat the symptoms form a disorder.

Culture-Based Treatments
These are often misinterpreted in Western health care settings, as they frequently
produce marks on the skin that are interpreted as evidence of abuse. Some of the more
common Asian treatments are cupping, coining and moxibustion.

Death Rituals
As noted by Purnell (2013), death rituals include views on death and euthanasia along
with rituals for dying, burial and bereavement, and are unlikely to vary from the practices
of the client’s original ethnic group. Practices that affect health care include such
customs as ritual washing of the body, the number of family members present at the
death of a family member, and religious practices required during and after dying.

Pregnancy and Childbearing

Cultural variation concerning pregnancy and childbearing includes “sanctioned amd
unsanctioned fertility practices; views towards pregnancy; and prescriptive, restrictive,
and taboo practices related to pregnancy, birthing and the postpartum period” (Purnell,
2013, p. 32).

Pain
Assessing pain is necessary for each client. However, the experience of pain may vary by
cultural conditioning. Some believe that pain is punishment for wrongdoing; others
believe it is atonement for wrongdoing. The response to pain is based on cultural values.

Blood Products, Transfusions, and Blood Donations

Use of blood products and blood transfusions is accepted by most religions except
Jehovah’s Witnesses. Organ donations and autopsy are not accepted by certain cultural
groups, including Christian Scientist, Orthodox Jews, Greeks, and some Spanish
speaking groups.

DIet and Nutrition

Dietary considerations in cultural assessment include the meaning of food to the
individual, common foods eaten and rituals surrounding the eating, the distribution of
food throughout a 24-hour day, religious beliefs about foods, beliefs about foods about
food and health promotion, and nutrotional deficiencies associated with the ethnic
group.

Spirituality
It is closely associated with culture and includes religious practices, faith, and a
relationship with God or a higher being and those things that bring meaning to life.

Biologic Variation
Often, biologic variations are grouped under the heading of culture; some aspects of
biologic variation, in fact, affect and are affected by cultural beliefs and behaviors.
Genetics and environment, and their interaction, cause humans to vary biologically.

Body Surface Variation

It can be seen in the following secretions: variation in apocrine and eccrine sweat
secretions and the apocrine secretion of earwax. Sebaceous gland activity and secretion
composition do not show significant variation.

Anatomic Variation
Lower extremity venous valves vary between Caucasians and African Blacks. African
Blacks have been noted to have fewer valves in the external iliac veins but many more
valves lower In leg than do Caucasians.

Developmental Variation
Maturity differences appear to be related to both genetics and environment. Caribbean
Black, African Black, and Indian children are less likely to experience delayed motor
development than Caucasian children, but Pakistani and Bangladesh do not fit into this
pattern.

Biochemical Variation and Differential Disease Susceptibility

Drug metabolism differences, lactose intolerance, and malaria-related conditions such as
sickle cell anemia, thalassemia, gkucose 6 phopshate dehydrogenase (G6PD) deficiency,
and Duffy blood group are considered biochemical variations.

Geographical and Ethnic Disease Variation

In general, chronic diseasees predominate in developed countries and infectious diseases
predominate in third-world countries. However, there is some genetic and ethnic
variation in addition to the chronic versus infection pattern.

Skin, Hair, Nails

Fair-skinned people, especially those with light eyes and freckles, are at higher risk for
developing skin cancers , although all people who are exposed to high level of intense
sunlight are at risk. The conditions that are common in darker skin are postinflammatory
hyperpigmentation, vitiligo, pityriasis alba, dry or ashy skin, dermatosis papulosanigra
and etc.

Head and Neck

The few cultural considerations that come into play are related to dependence on poorly
maintained automobiles or bicycles, lack of use of protective gear, inadequate and
ubsafe housing, and unsafe celebratory practices.

Eyes
Visual impairment varies across age (greater after 50), gender (more in females), and
geography (more that 90% live in developing countries). In all but highly developed
countries, cataract is the leadinf cause of visual disease followed by glaucoma and age
related macular degeneration.

Ears
Hearing loss may result from genetic causes, complications at birth, certain infectious
diseases, chronic ear infections, the use of particular drugs, and exposure to excessive
noise and aging.
Mouth, Nose, Sinuses
Oral diseases are prevalent in poorer populations in developed and developing countries.
They include dental caries, periodontal disease, tooth loss, oral mucosal and
oropharyngeal lesions and cancers, HIV related diseases and trauma.

Thorax and Lungs

Lung Cancer is directly related to smoking and to the quantity of cigarettes smoked. The
highest rates for lung cancer in the United States in a study from 2013 (CDC, 2016), are
among African American men, followed by Caucasian, American Indian/Alaska Native,
Asian/Pacific Islandee, and Hispanic men.

Breast and Lymphatic System

The CDC (2016) reported a study of female breast cancer survivors and incidence and
prevalence of breast cancer in the United States, noting results as follows: In 2013,
Caucasian women had the highest rate of developimg breast cancer, followed by African
American, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women.

Head and Neck Vessels

The Harvard Health Letter (2015) described rates of hypertension, diabetes, and heart
disease variations among ethnic groups, concluding that many intertwined factors likely
contribute to the higher heart disease rates seen among some groups. Findings include
that nearly half of all African American adults have some form of cardiovascular disease,
compared with about one third of all Caucasian adults, and ever after adjustment for
factors related to socioeconomic, disparities in rates of heart disease and its risk factors
persist.

Peripheral Vascular System

Studies of risks for chronic venous disease have remained hard to determine, according
to Criqui et al (2007). However, African American ethnicity seems to confer a protective
effect.

Abdomen
Gallbladder disease and gallbladder cancer vary by ethnic group in the United States.
Native Americans and Mexican Americans have higher rates of disease and cancer in this
organ (ACS, 2014). The highest incidence of stomach cancer is in Asia, Latin America,
and the Carribean, and the lowest incidence in North America and Africa.

Genitalia, Anus, Rectum

Sexually trasmitted infections (chlamydia, herpes, human papilloma virus [HPV], syphilis,
gonorrhea, and HIV/AIDS) vary across US populations. Ethnic variation is thought to be
due to rates of poverty, income inequality, unemployment, low educational attainment,
use of drugs, and other factors, but essentially to risky sexual behavior.

Muscoskeletal System
Up to 90% of bone mass density peaks around 18 in females and by age 20 in males.
Bone mass in women remains stable until after menopause, when it begins to decrease.
Bone mass decreases in both sexes with age and some specific conditions, including lack
of weight-bearing exercise.

Nervous System
Occurence of dementia, including Alzheimer disease, is rising rapidly, especially in
developing countries where the number of elderly is increasing (China, India, other
South Asian and Pacific Island countries). Over 50 % of dementia cases in Caucasians
are Alzheimer’s, but the rate in developing countries and in other ethnic groups has not
been well studied.