Study Guide 5- CULTURAL INFLUENCES

Topic Outline
A. DIVERSITY OF THE OLDER ADULT POPULATION IN THE UNITED STATES
B. CULTURALLY SENSITIVE GERONTOLOGIC NURSING CARE
Awareness,
Knowledge,
Cultural Concepts, Course Code and Title
Beliefs about Health and Illness
Transcending Cultural Concepts
C. SKILLS
Handshake
Eye Contact
Interpreters
D. PUTTING IT TOGETHER
Leininger
The Explanatory Model
The LEARN Model

Learning Objectives
After studying this module, you will be able to:
1. Discuss the major demographic trends in the United States in relation to the various older adult ethnic
populations.
2. Analyze the nursing implications of ethnic demographic changes.
3. Differentiate among culture, ethnicity, and race.
4. Identify potential barriers to care for the ethnic older person.
5. Discuss cultural variations in beliefs about health, illness, and treatment.
6. Describe how differences in cultural patterns may result in a potential conflict between a gerontologic
nurse and an older person or his or her family member.
7. Propose how to increase the quality of the interaction between the nurse and the older adult through the
nurse’s knowledge of the concept of context as it relates to relationships and behavior.
8. Apply linguistically appropriate techniques in communicating with an ethnic older person.
9. Discuss ways in which planning and implementation of nursing interventions can be adapted to older
adults’ ethnicity.
Introduction
Good day to my dear students
The United States has seen a significant shift in the percentage of persons who identify with ethnic groups
other than those classified as white and of Northern European descent. It is projected that by 2050, those
persons from groups that have long been counted as statistical minorities will assume membership in what
has been called the emerging majority

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 Activating Prior Knowledge
Pls refer to ikonek questions.
What are the cultural influences that affects the older people.

1.1 Discussion of Key Concepts (Title of your topic)

DIVERSITY OF THE OLDER ADULT POPULATION IN THE UNITED STATES

Although older adults of color will still be outnumbered by their white counterparts for Course
yearsCode and Title
to come,
tremendous growth is anticipated (Gelfand, 2003)
. Between 2012 and 2050, the percentage of older African Americans is projected to grow from 8.3% to
13%; Asian/Pacific Islanders from 2.3% to 8.5%; American Indians/Alaskan Natives from 0.6% to 1.0%.
Finally, Hispanics of any race will increase from 6.6% to 19.7% (Administration on Aging [AOA], 2011). By
2030, the number of older Hispanics is expected to be the largest of any other group described as a
minority (Figure 5-1). It must be noted, however, that these and many of the figures we have today are
drawn from the U.S. Census, in which persons of color are often underrepresented and those who are in
the United States illegally are not included at all.
In reality, the numbers of ethnic older adults in the United States may be or may become substantially
higher.
Furthermore, within the broad census categories, considerable diversity exists. A person who identifies
himself or herself as a Native American or Alaskan Native is a member of one of more than 500 tribal
groups and may prefer to be referred to as a member of a specific tribe such as Navaho. Although
commonalities exist, each tribe also has unique cultural features and practices. Similarly, older adults who
consider themselves Asian/Pacific Islanders may be from one of more than a dozen from the Pacific Rim
and speak at least one of the thousand or more languages or dialects.

CULTURALLY SENSITIVE GERONTOLOGIC NURSING CARE

The diversity of values, beliefs, languages, and historical life experiences of older adults today challenges
nurses to gain new awareness, knowledge, and skills to provide culturally and linguistically appropriate
care.
Awareness
Providing culturally appropriate care begins with increasing an awareness of our own beliefs and attitudes
and those commonly seen in the community at large and in the community of health care. Awareness of
one’s thoughts and feelings about others who are culturally different from oneself is necessary.
Awareness is also enhanced through the acquisition of new knowledge about cultures and the common
barriers to highquality health care too often faced by persons from ethnically distinct groups
Knowledge
Increased knowledge is a prerequisite for culturally appropriate care given to all persons, regardless of
race or ethnicity.
Cultural Concepts
Several key terms and concepts are discussed here in an attempt to clarify those that are often used
incorrectly or interchangeably in any discussion related to culture and ethnicity. Culture is a universal
phenomenon. It is the shared and learned beliefs, expectations, and behaviors of a group of people. Style
of dress, food preferences, language, and social systems are expressions of culture. Cultures may share
similarities, but no two are exactly alike. Cultural knowledge is transmitted from one member to another
through the process called enculturation. It provides individuals with a sense of security and a blueprint
for interacting within the family, community, and country.
A. ANGLO-AMERICAN (EUROPEAN AMERICAN) CULTURE (MAINLY U.S. MIDDLE AND UPPER
CLASS
Cultural Values
• Individualism—focus on a self-reliant person
• Independence and freedom
• Competition and achievement
• Materialism (items and money)
• Technologic dependence

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 • Instantaneous actions
• Youth and beauty
• Equal rights to both sexes
• Leisure time
• Reliance on scientific facts and numbers
• Less respect for authority and older adults
• Generosity in time of crisis
Culture Care Meanings and Action Modes
• Alleviating stress:
• Physical means Course Code and Title
• Emotional means
• Personalized acts:
• Doing special things
• Giving individual attention
• Self-reliance (individualism) by:
• Reliance on self
• Reliance on self (self-care)
• Becoming as independent as possible
• Reliance on technology
• Health instruction:
• Explaining how “to do” this care for self
• Giving the “medical” facts
B. BLACK CULTURE
Cultural Values
• Extended family networks
• Religion (many are Baptists)
• Interdependence with blacks
• Daily survival
• Technology (e.g., radio, car)
• Folk (soul) foods
• Folk healing modes
• Music and physical activities
Culture Care Meanings and Action Modes
• Concern for “my brothers and sisters”
• Being involved
• Providing a presence (physical)
• Family support and “get-togethers”
• Touching appropriately
• Reliance on folk home remedies
• Reliance on Jesus to “save us” with prayers and song
C. ARAB-AMERICAN MUSLIM CULTURE
Culture Care Meanings and Action Modes
• Providing family care and support—a responsibility
• Offering respect and private time for religious beliefs and prayers (five times each day) • Respecting and
protecting cultural differences in gender roles • Knowing cultural taboos and norms (e.g., no pork, alcohol,
or smoking) • Recognizing honor and obligation • Helping others to “save face” and preserve cultural
values • Obligation and responsibility to visit the sick • Following the teachings of the Koran • Helping
children and elderly when they are ill

The Spirit Catches You and You Fall Down by Anne Fadiman (2012) provides an excellent example of this.
Race is the outward expression of specific genetically influenced, hereditary traits such as skin color and
eye color, facial structures, hair texture, and body shape and proportions

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 Ethnicity is defined as a social differentiation of people based on group membership, shared history, and
common characteristics. For example, the term Hispanic or Latino is often applied to persons who speak
the Spanish language and practice the Catholic religion.
Ethnic identity refers to an individual’s identification with a particular group of persons who share similar
beliefs and values. Ethnic identity cannot be assumed by appearance, language, or other outward
features.

Beliefs about Health and Illness

Beliefs about health, disease causation, and appropriate treatment are grounded in culture. The
significance attached to illness symptoms and the expectation of outcomes is influenced by past
Course Code and Title
experiences. Knowledge about a person’s beliefs about health and illness is especially important in
gerontologic nursing because elders have had a lifetime of experience with illness of self, family, and
others within their ethnic and cultural groups (Spector, 2012)
In the magico-religious theory, health, illness, and effectiveness of treatment are believed to be caused
by the actions of a higher power (e.g., God, gods, or supernatural forces or agents)

RELIGIOUS BELIEFS OF 23 DIFFERENT GROUPS THAT CAN AFFECT NURSING CARE

Adventist (Seventh Day Adventist; Church of God)
• May believe in divine healing and practice anointing with oil; use of prayer
• May desire communion or baptism when ill
• Believe in human choice and God’s sovereignty
• May oppose hypnosis as therapy
Baptist (27 Groups)
• Laying on of hands (some groups)
• May resist some therapies such as abortion
• Believe God functions through physician
• May believe in predestination; may respond passively to care
Black Muslim
• Faith healing unacceptable
• Always maintain personal habits of cleanliness
Buddhist Churches of America
• Believe illness to be a trial to aid development of soul; illness because of karmic causes
• May be reluctant to have surgery or certain treatments on holy days
• Believe cleanliness to be of great importance
• Family may request Buddhist priest for counselling
Church of Christ Scientist (Christian Science)
• Deny the existence of health crisis; see sickness and sin as errors of the mind that can be altered by
prayer
• Oppose human intervention with drugs or other therapies; however, accept legally required
immunizations
• Many believe that disease is a human mental concept that can be dispelled by “spiritual truth” to the
extent that they refuse all medical treatment
Church of Jesus Christ of Latter Day Saints (Mormon)
• Devout adherents believe in divine healing through anointment with oil, laying on of hands by certain
church members holding the priesthood, and prayers
• Medical therapy not prohibited; members have free will to choose treatments
Eastern Orthodox (in Turkey, Egypt, Syria, Romania, Bulgaria, Cyprus, Albania, and Other
Countries)
• Believe in anointing of the sick
• No conflict withmedical science Episcopal (Anglican)
• May believe in spiritual healing
• Rite for anointing sick available but not mandatory
Friends (Quakers)

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 • No special rites or restrictions Greek Orthodox
• Each health crisis handled by ordained priest; deacon may also serve in some cases • Holy
Communion administered in hospital
• May desire Sacrament of the Holy Unction performed by priest Hindu • Illness or injury believed
to represent sins committed in previous life
• Accept most modern medical practices
Islam (Muslim/Moslem)
• Faith healing not acceptable unless patient’s psychological condition is deteriorating; performed
Course forTitle
Code and
morale
• Ritual washing after prayer; prayer takes place five times daily (on rising, midday, afternoon, early
evening, and before bed); during prayer, face Mecca and kneel on prayer rug Jehovah’s Witness
• Generally, absolutely opposed to transfusions of whole blood, packed red blood cells, platelets,
and fresh or frozen plasma, including banking of own blood; individuals may sometimes be
persuaded in emergencies
• May be opposed to use of albumin, globulin, factor replacement (hemophilia), and vaccines
Not opposed to non–blood plasma expanders Judaism (Orthodox and Conservative)
• May resist surgical procedures on Sabbath, which extends from sundown Friday until sundown
Saturday • Seriously ill and pregnant women exempt from fasting
• Illness as grounds for violating dietary laws (e.g., patient with congestive heart failure does not
have to use kosher meats, which are high in sodium)
Lutheran
• Church or pastor notified of hospitalization
• Communion may be given before or after surgery or similar crisis Mennonite (Similar to Amish)
• No illness rituals
• Deep concern for dignity and self-determination of individual; would conflict with shock treatment
or medical treatment affecting personality or will
Methodist
• Communion may be requested before surgery or similar crisis
Nazarene
• Church official administers communion and laying on of hands • Believe in divine healing but
without excluding medical treatment
Pentecostal (Assembly of God, Four-Square)
• No restrictions regarding medical care
• Deliverance from sickness provided for by atonement; may pray for divine intervention in health
matters and seek God in prayer for themselves and others when ill
Orthodox Presbyterian
• Communion administered when appropriate and convenient • Blood transfusion accepted when
advisable
• Pastor or elder should be called for ill person
• Believe science should be used for relief of suffering
Roman Catholic
• Encourage anointing of sick, although older members of the church may see this as equivalent to
“extreme unction,” or “last rites”; may require careful explanation if reluctance is associated with
fear of imminent death • Traditional church teaching does not approve of contraceptives or abortion

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 Russian Orthodox
• Cross necklace is important and should be removed only when necessary and replaced as soon as
possible
• Believe in divine healing but without excluding medical treatment
Unitarian Universalist
• Most believe in general goodness of fellow humans and appreciate expression of that goodness
through visits from clergy and fellow parishioner.
Course Code and Title
SKILLS
The most important skills are those associated with sensitive intercultural communication. The
linguistically competent gerontologic nurse will be able to appropriately use the conventions of the
handshake, silence, and eye contact. He or she will also have fundamental skills related to working
with interpreters.
A. Handshake The customary greeting in the business world in the United States consists of
smiling, extending the hand, and grasping the other person’s hand. The quality of the handshake
is open to varied interpretation. A firm handshake in European American culture is considered a
sign of good character and strength. A weak handshake may be viewed negatively.
B. Eye Contact In the European American culture, direct eye contact is a sign of honesty and
trustworthiness. Nursing students are taught to establish and maintain eye contact when
interacting with patients.

Leininger
Leininger’s theory of cultural care diversity and universality is unique and has been recommended
for use with the older adult population; it was designed primarily to assist nurses in discovering ways
to provide culturally appropriate care to people who have different cultural perspectives than those
of the professional nurse (Leininger & McFarland, 2002).

Leininger theorizes three modes of action for the professional nurse to provide culturally
congruent care:
(1) cultural care preservation or maintenance,
(2) cultural care accommodation or negotiation, and
(3) cultural care repatterning or restructuring.
Leininger defines the three modes of nurse decisions and actions as follows:
1. Cultural care preservation or maintenance refers to those assistive, supportive, facilitative, or
enabling professional actions and decisions that help people of a particular culture to retain and to
maintain their well-being, to recover from illness, or face handicaps or death.
2. Cultural care accommodation or negotiation refers to those assistive, supportive, facilitative, or
enabling creative professional actions and decisions that help people of a designated culture adapt to
or negotiate with others for a beneficial or satisfying health outcome.
3. Cultural care repatterning or restructuring refers to those assistive, supportive, facilitative, or
enabling professional actions and decisions that help patients reorder, change, or greatly modify their
lifeways for new, different, and beneficial health care patterns while respecting their cultural values
and beliefs and still providing beneficial or healthier lifeways than existed before the changes were
established (Leininger, 1991).

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 1-The Explanatory Model
Kleinman, Eisenberg, and Good (1978) presented an alternative far-reaching proposition. They
suggested that to provide culturally sensitive and competent care, the gerontologic nurse should
explore the meaning of the health problem from the patient’s perspective.

The LEARN Model

The LEARN Model (Berlin & Folkes, 1992) uses the same approach as the Explanatory Model. The
LEARN Model is a useful tool in guiding the nurse who is interacting with older adults
Course of and
Code any Title
ethnicity in the clinical setting. Through it, the nurse increases his or her cultural sensitivity,
becomes instrumental in providing more culturally competent care, and consequently contributes to
the reduction of health disparities.
The model consists of these steps:
L Listen carefully to what the older person is saying. Attend not just to the words but to the
nonverbal communication and the meaning behind the stories. Listen to the person’s perception of
the situation, desired goals, and ideas for treatment.
E Explain your perception of the situation and the problem(s).
A Acknowledge and discuss both the similarities and the differences between your perceptions and
goals and those of the older person.
R Recommend a plan of action that takes both perspectives into account.
N Negotiate a plan that is mutually acceptable.

Activity (can also be Critical Thinking and Review Questions)

1. In what ways do you value diversity in the world around you?
2. What are the limitations of using only race or ethnicity in identifying older patients?
3. Interview two or more older patients from the same ethnic group and discuss their cultural
adaptation. 4. Identify your ethnocentric views toward certain groups and the basis on which you
have formulated them.
5. What knowledge must the nurse possess to avoid stereotyping or generalizing about older
patients?

2: Essay: Discuss the two Leininger’s model.

1. Explanatory model
2. Learn model

Interactive Link
Leininger’s model for discovering transcultural nursing care and performing cultural assessments.
(From Leininger, M. (Ed.). [1991]. Culture care diversity and universality: A theory of nursing. New
York: National League for Nursing, Jones and Bartlett. Reprinted with permission from the National
League for Nursing [NLN].
M. & McFarland, M. (2002). Transcultural nursing: Concepts, theories and practice (3rd ed.). New
York: McGraw-Hill; Purnell, L. (2012). Transcultural health care: A culturally competent approach
(4th ed.). New York: FA Davis; Spector, R. (2012). Cultural diversity in health and illness (8th ed.).
Upper Saddle River, NJ: Prentice-Hall

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transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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 Everyday Connection
Synchronous and asynchronous

Key Terms
Course Code and Title
Awareness is also enhanced through the acquisition of new knowledge about cultures and the
common barriers to highquality health care too often faced by persons from ethnically distinct
groups
Race is the outward expression of specific genetically influenced, hereditary traits such as skin color
and eye color, facial structures, hair texture, and body shape and proportions
Ethnicity is defined as a social differentiation of people based on group membership, shared history,
and common characteristics. For example, the term Hispanic or Latino is often applied to persons
who speak the Spanish language and practice the Catholic religion.
Ethnic identity refers to an individual’s identification with a particular group of persons who share
similar beliefs and values. Ethnic identity cannot be assumed by appearance, language, or other
outward features.
Handshake The customary greeting in the business world in the United States consists of smiling,
extending the hand, and grasping the other person’s hand. The quality of the handshake is open to
varied interpretation. A firm handshake in European American culture is considered a sign of good
character and strength. A weak handshake may be viewed negatively.
Eye Contact In the European American culture, direct eye contact is a sign of honesty and
trustworthiness. Nursing students are taught to establish and maintain eye contact when interacting
with patients.

Summary
Gerontologic nurses develop awareness, sensitivity, knowledge, and skills in the delivery of
culturally sensitive and linguistically competent care to a steadily diversifying older adult
population. Conducting a self-assessment enables nurses to become aware of their strengths and
weak areas in their knowledge and skills needed in cross-cultural caring and communication. The
positive stereotypical information provided in this chapter, for example, common health beliefs or
death practices, may be used as a starting point for communication. For example, the nurse might
ask, “It is my understanding that remaining active in the church is important to many in the black
community. Is this important to you? If so, how is your stroke affecting this aspect of your life?”
Culturally sensitive care for the patient, resident, or patient begins with an understanding of the
health care practices, values, and beliefs of the older adult and his or her family. The Sunrise,
Explanatory, and LEARN models may be useful approaches in identifying the health care needs and
preferences of persons from cultures different from the nurse’s.
Members of distinct ethnic and racial groups across the globe are suffering from compromised
outcomes in their pursuit and receipt of health care. Gerontologic nurses are in a unique position to

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or
transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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 take the lead in providing culturally and linguistically appropriate care. In doing so, they can
contribute to the national agenda to reduce health disparities

Readings and References

Gerontologic Nursing,5th edition, Meiner,Sue
Administration on Aging. (June 6, 2011). Minority aging. Retrieved September 24, 2013 from:
http://www.aoa.gov/AoARoot/Aging_ Statistics/minority aging/Index.aspx. American Bar Association
(ABA). (2014). Patient self-determination act. Course Codefrom:
Retrieved and Title
www.americanbar.org/groups/public_education/
resources/law_issues_for_consumers/patient_self_determination_ act.html. Accessed on July 11, 2014.
Berlin, E., & Folkes, W. (1992). A teaching framework for cross-cultural health care: Application in family
practice. The Western Journal of Medicine, 39, 934. Betancourt, J. R., & Maina, A. W. (2004). The Institute
of Medicine re

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or
transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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