CULTURE AND ETHNICITY
making all people have a socially
Patients do not live in isolation, they are part of
families communities cultures races and
countries. In order to truly understand our
patients needs, the nurse must assess them
within the context of this background culture,
determines interpersonal communication style,
as well as health beliefs, values, and practices.
In addition, individuals from the same culture
share a biologic inheritance and genetic
patterns that impact health assessment,
diagnosis, and medical treatment.
Learning Outcomes
 Explain why culture is important in the
health assessment process
 Define ethnicity and its relevance in the
health assessment process
 Define cultural competence and cultural
humility
 Demonstrate behaviors that show
sensitivity to a patient's culture during
the assessment process
 Explain the difference between
spirituality and religion
 Explain why the patient's spiritual needs
should be assessed and
 Utilize the Ignatian values in showing
respect to various cultures as Atenean
student nurses
Culture includes among its elements family
structure and function, spirituality and religion,
and community, together these form the major
contexts for seeing a client as an individual or
group but inseparable from the background
contexts. The influence of culture, family,
spirituality, and community on the health status
of the client cannot be emphasized enough.
The nurse must perceive the client within these
contexts and be able to assess aspects of
these contexts as necessary when performing
a health assessment.
Culture is defined as a shared system of values
beliefs and learned patterns of behavior.
According to Purnell and Polanka in 2003, they
(Culture) provide the following useful definition
 It is the totality of socially transmitted
behavioral patterns, arts, beliefs, values
customs, life ways, and all other
products of human work and thought,
characteristic of a population or people
that guide their worldview and decision
transmitted culture
 Our own culture forms our worldview
based on the values, beliefs, and
behaviors
Ethnicity
 a person's ethnic identity exists
 when the person identifies with a
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.
 describes subgroups that have a
common history ancestry or other
cultural identity and may relate to
geographical origin
Race
 race in humans is not a physical
characteristic but a socially constructed
concept that has meaning to a larger
group
 the concept of race originates from
societal desire to separate people based
on the looks and culture
 it is a vague unscientific term referring
to a group of genetically related
individuals who share certain physical
characteristics (Bigby, 2003), but
actually the genetic distinctiveness may
not exist
Minority
 refers to a group who has less power or
prestige within the society
 means a group with smaller population
numbers
 since caucasian-americans or
commonly known as whites are the
major ethnic group in the united states
and are expected to remain so for the
next 30 to 40 years, all other groups
would be minorities
 the term has a negative meaning in
most uses indicating a group that does
not hold the majority values or does not
behave in appropriate ways
Cultural Competence
 has a number of components and
allows nurse to integrate a cultural
 assessment into the health assessment
of each client
 the nurse sees herself or himself
becoming culturally competent not
being culturally competent
1. Cultural desire
2. Cultural awareness
3. Cultural knowledge
4. Cultural skill
5. Cultural encounters
Cultural Desire
 the motivation to engage in intercultural
encounters and acquire cultural
competence
 Campinha-Bacote’s revised model is
based on the assumption that the
starting point of cultural competence is
cultural desire. In other words, to be a
culturally competent healthcare
provider, the nurse, must sincerely
desire to acquire the cultural knowledge
and skill necessary for effectively
assessing the client
 the nurse must also seek repeated
encounters with people of the culture so
that awareness, knowledge, and skill
continually increase
 the cultural desire is motivation the
nurse needs to want to and not to need
to become culturally aware, culturally
knowledgeable, and culturally skilful,
and to seek cultural encounters
 In Campinha-Bacote's depiction of
cultural competence, she utilized a
volcano to depict cultural competence.
When cultural desire erupts, it gives
forth a desire to and to enter the
process of becoming culturally
competent by genuinely seeking cultural
encounters, obtaining cultural
knowledge, conducting culturally
sensitive assessments, and being
humble to the process of cultural
awareness
Cultural Awareness
 this is the deliberate cognitive process
in which the health care provider
becomes appreciative and sensitive to
the values, beliefs, life ways, practices,
and problem-solving strategies of a
client's culture
 cultural awareness involves self-
examination and in-depth exploration of
one's own cultural background. So,
healthcare providers need to examine
their own prejudices and biases toward
other cultures and explore how their
own cultural beliefs and background
may affect views of and interactions
with clients of different cultures
 part of cultural awareness are the terms
values and biases
Values- are the standards we use to measure
our own and other’s beliefs and behaviors.
These may appear to be absolutes.
Biases- are the attitudes or feelings that we
attach to perceived differences. Being attuned
to difference is normal, in fact, in the distant
past, detecting differences may have preserved
life. Intuitively knowing members of our own
group is a survival skill that we may have
outgrown as a society, but is still actively at
work today
4 Stages of Cultural Awareness
1. Unconscious Incompetence- this is when
one is not aware that one lacks cultural
knowledge and is not aware that cultural
differences exist
2. Conscious Incompetence- this is when one
is aware that he or she lacks knowledge
about another culture but is aware that
cultural differences exist but not knowing
what they are or how to communicate
effectively with clients from different
cultures
3. Conscious Competence- this is when one
consciously is learning about the client's
culture and providing culturally relevant
interventions. One is aware of differences
and is able to have effective trans-cultural
interactions
4. Unconscious Competence- when one is
able to automatically provide cultural
congruent care to clients from a different
culture and is having much experience with
a variety of cultural groups and having an
intuitive grasp of how to communicate
effectively in transcultural encounters
Cultural Humility-
 is another approach for caring for
clients from culturally diverse
backgrounds.
 It is defined as a process that requires
humility as individuals continually
engage in self-reflection and self-critic
as lifelong learners and reflective
practitioners.
 It is a process that includes the difficult
work of examining cultural beliefs and
cultural practices of both patients and
nurses to locate the points of cultural
dissonance or synergy that contribute to
patients health outcomes
 it calls for health care providers to
reduce the power imbalance that exists
in nurse-patient relationships and
maintain mutually respectful and
dynamic partnership with our patients
Sample vignette: Observe how cultural
differences and unconscious bias can
unwittingly lead to poor communication and
disrupt the quality and outcomes of patient
care
A 28-year-old taxi driver from Ghana who has
recently moved to the united states
complained to a friend about US medical care.
He had gone to the clinic because of fever and
fatigue. He described being weighed, having
his temperature taken, and having a cloth
wrapped tightly to the point of pain around his
arm. The nurse, a 36 year old woman from
Washington DC, had asked the patient many
questions, examined him, and wanted to take
blood, which the patient had refused. The
patient's final comment was “… and she didn't
even give me chloroquine!” His primary reason
for seeking care, the man from Ghana, was
expecting few questions, no examination, and
treatment for malaria, which is what fever
usually means in Ghana.
In this example, cross-cultural
miscommunication is understandable and thus
less threatening to explore. Unconscious bias
leading to miscommunication however occurs
in many clinical interactions.
Cultural Knowledge
 this is the process of seeking and
obtaining a sound and educational
foundation concerning the various
worldviews of different cultures
 this is the client's worldview, which is
the basis for his or her behaviors and
interpretations of the world
 for instance, the client's worldview will
help to clarify his or her belief about
what causes illness, what symptoms are
defined as illness, and what are
considered appropriate interactions
within cultural groups
 these characteristics based on world
view along with biological variations
comprise the content of cultural
knowledge useful for the nurse
assessing a client from a different
culture
Cultural Skill
 this is the ability to collect relevant
cultural data regarding the patient's
health history and presenting problem
as well as accurately performing a
physical assessment
 involves learning how to complete
cultural assessments and culturally
based physical assessments and to
interpret the data accurately
Cultural Encounters
 this is a process that allows the
healthcare provider to engage directly in
face-to-face interactions with clients
from culturally diverse backgrounds
 this process requires going beyond the
study of a culture and limited interaction
with three or four members of the
culture
 repeated face-to-face encounters help to
refine or modify the nurse's knowledge
of the culture
 the nurse must seek out many
encounters with a desire to understand
more and more about the culture
What will Cultural and Diversity Competence
do for the Client and the Provider?
1. It increases respect and trust
2. It promotes inclusion and community
involvement with the different health
issues
3. The client and the family can take
responsibility for their health
4. It improves efficiency of care and
outcomes and
5. It reduces legal risk if the provider has
unintentional barriers to care
ASKED Mnemonic
The nurse must seek out many such
encounters with a desire to understand more
and more about the culture. We use the ASKED
mnemonic or the ASKED to examine your
cultural competence. You need to ask yourself
about the level of your:
 AWARENESS
 SKILL
 KNOWLEDGE
 ENCOUNTERS
 DESIRE
for cultural competence and the number of
encounters you have had or desired to have
with the persons of cultures different from your
own together and in different order these make
the word ASKED to help you to remember, to
check up on your growing cultural competence
as you seek opportunities, to increase your
competence
To achieve cultural competence we healthcare
providers should:
 understand our own personal biases
 understand the major components of
culture
 learn about the customs of commonly
encountered cultures surrounding our
hospital or healthcare community
 respect and support the client's unique
cultural beliefs
Use of an Interpreter
Sometimes we may need to make use of an
interpreter. We should remember that the
interpreter
 should have knowledge of health
related terminology
 should read health materials in the
client's primary language.
We, healthcare providers should
 consider the client's preference when
selecting the interpreter, such as the
gender (male or female), the age (should
he be older or younger), and the dialect
 clarify with the client about the
interpreter's role but as they are
speaking we should observe non-verbal
cues in the client
 caution using the interpreter from the
client's own community or family
members as an interpreter
Interpreters can assist when language
differences are present, possibly the best
interpreter would be a culture expert or culture
broker. Consider the relationship of the
interpreter to the client again if the interpreter
is a client's child or a person for different sex,
age, or social status. Interpretation may be
impaired also keep in mind that
communication through the use of pictures
may be helpful when working with some
clients.
Aspects of Culture relevant to Health
Assessment
1. Communication and language
2. Kinship and social networks
3. Educational background and learning
style
4. Nutrition
5. Childbearing and child rearing practices
6. High risk behaviours
7. Health care beliefs and practices
8. Healthcare practitioners
9. Spirituality
Relationship between Nursing and Culture
 Nursing has long recognized and
practiced holistic care of the patient. An
attention to culture is a part of caring for
the whole patient. The nurse
communicates with and cares for
people of many different cultures. One
does not have to be versed in every
culture to provide culturally appropriate
care, but one must be open and
sensitive to other cultures.
Cultural Assessment
To know what and when to include cultural
components in a health assessment the nurse
has to know how to complete an entire cultural
assessment. For this reason, many categories
that may vary across cultures will be described.
The nurse can then be aware of the
possibilities for variation and select those that
are most important for assessing each client
2 Main Belief Categories that are included in a
Cultural Assessment:
1. Those that affect the client approaching
the health care system and provider
2. Those that affect the disease, illness, or
health state
 Educational Level: The ability to understand
spoken, written English. Is there an ability to
speak or write English? An acceptance of
an interpreter? or of an interpreter of a
different age or gender?
 Religion: Is there an acceptance of care by
the provider of a different gender, age, or
ethnic group? What's the level of modesty
during care? and the need for culturally
specific healer to participate in care
 Previous Experience of Care by Primary
Health Care System: or experience

Cultural Beliefs and Values  Occupation and Income level: This is the
ability to pay or use insurance
Dominant Value Orientation which are
 Beliefs about human nature  Time dimensions: Is a patient focused on
 Beliefs about relationship with nature the past present or future?
 Beliefs about the purpose of life
 Space: Is he oriented to space such as
Beliefs about Health, Illness, and healing such
personal space, distance? Is he or she
as
comfortable with touch?
 Beliefs about what causes the disease
 Beliefs about health
 Communication: Does the patient know
 Beliefs about who serves in the role of
how to do verbal or written language?
healer what practices bring about
Verbal and non-verbal language patterns? Is
healing
there eye contact who speaks?

Assessing these beliefs

Factors Affecting Disease, Illness, and Health
will help the nurse to
State
understand the client's
Knowing what issues a culturally different
approach to health care
client may have at work and what high-risk
providers, and to illness
behaviors are common to the cultural group as
and healing. For
well as the environment from which the client
instance, if an individual
comes can give clues to the different or the
believes that diseases are punishment from
current health status of the client.
god or gods then he or she may not seek help
quickly or even at all now. If the individual
Communication and the Culturally Competent
believes that health is something that can be
Interview
improved with exercise, eating the right foods,
and other healthy behaviors then seeking
The first phase of assessment begin with
health care for early symptoms is usual
meeting the client. This involves observation
and communication, the meeting itself, nurse-
Factors Affecting Approach to Providers
client communication, and observation include
 Ethnicity (Assimilation or acculturation)
many of the trans-cultural variations of time,
How close to the primary culture does the
space, and communication and biomedical
person feel to the ethnic group?
variations.

 General status: What's the age? Is the

1. Time- is perceived to be measurable in
patient a child? a parent? a grandparent? Is
the western countries or fluid and
he a family member? or patient?
flowing in eastern cultures. Cultural
 groups tend to value time in the past,
present, or future. Those focused on
past value practices that are unchanged
from ancestors and are often resistant
to new ways. Those focused on the
present put what is going on in the
present above what will occur in the
future
2. Space- studies show that Asians and
Americans tend to tend to keep more
space between themselves when
speaking. Latins, both Mediterranean
and Latin American stay closer to each
other. Middle easterners move in the
closest.
3. Eye Contact and Face Positioning-
Americans expect people talking to each
other to maintain a fairly high level of
eye contact. Those looking away and
not giving good eye contact are thought
to be rude or inattentive, but people
from eastern countries and native
Americans tend to look down to show
respect to the person talking. Also,
some African Americans look away
when being talked to but give a very high
level of eye contact when speaking.
4. Body Language and Hand Gestures-
There are too many elements of body
language and hand gestures to cover
them all. However, two major hand
gestures of note are those for indicating
height and those for indicating “okay”.
There are two types of silence, one is
simply remaining silent for long periods
the other is used to space talking
between two people carrying on a
conversation. There are three patterns
of the latter. In eastern cultures, there is
a pause or silence after each person
speaks, before the other does the pause
is thought to show respect
5. Touch- it is very culturally based how
much touch is comfortable and
allowable and by whom are all based on
culture. The most modest and
conservative cultures usually have
religious rules about this. Touch of
females by males is in many cultures
restricted and to male family members
and may also be restricted among them.
6. Autonomy- is assumed to be a right of
all healthcare consumers in the united
states, meaning that an individual has
the right to know about the diagnosis
and treatment plans and to make
decisions for himself or herself.
However, autonomy is not accepted
value in many societies in paternalistic
or patriarchal societies. The father or
the family is expected of the family is
expected to be told of the diagnosis and
to make decisions about the treatment.
In many societies women are not
decision makers. Do not assume that
the client expects autonomy, clarify this
with the client and the family
Diet and Nutrition
What we eat, how we eat it, and even when we
eat are all culturally based. Dietary
considerations in cultural assessment include
the
 meaning of food to the individual,
 common foods eaten, and rituals
surrounding the eating,
 distribution of food throughout a 24-
hour day
 religious beliefs about foods, beliefs
about food and health promotion
 nutritional deficiencies associated with
the ethnic group
It is very difficult to get a client to change the
usual dietary habits drastically even with the
knowledge of the interaction of diet and
disease. What food means to the individual
can also be very important, it may serve as a
comfort, as closeness to ethnic roots or family.
Providing food, may be considered to reflect
caring, love, and withdrawing food, may be
considered akin to torture.
Spirituality
 Many definitions of spirituality have
been proposed. The difficulty in defining
spirituality may lie in the lack of
conceptual clarity of the term.
 Spirituality is a dimension of culture and
it is culture-specific in how it is viewed
closely.
 It is closely associated with culture and
includes religious practices, faith, in a
relationship with god or a higher being,
and those things which bring meaning to
life

 Purnell and Paulanka say that
spirituality is all behaviors that give
meaning to life and provide strength to
the individual
 Buck defines spirituality as that most
human of experiences that seeks to
transcend itself and find meaning and
purpose through connection with others,
nature, and or a supreme being which
may or may not involve religious
structures or traditions
Spiritual Assessment
The nurse approaches spiritual assessment in
two tiers. Patients will not discuss deep
concerns until a trusting relationship has been
built with the nurse.
 During the first meeting, the nurse
obtains a brief assessment of general
information such as the client's or the
patient's religion and whether the patient
would like a minister, priest, rabbi, or
other religious person
 Listening is an important part of being
present with the patient since nursing
presence is a holistic and reciprocal
exchange between the nurse and patient
that involves a sincere connection and
sharing of human experience through
active listening, attentiveness and
intimacy, and therapeutic touch, spiritual
exploration, empathy, caring and
compassion, and recognition of the
patient's psychological, psychosocial,
and physiological needs.
 You need to observe the clients non-
verbal cues that may indicate the patient
is distressed such as little or no affect
pitch or voice posture facial expression,
crying or inappropriate anger. Sitting
with the patient and reflecting with the
nurses may encourage the patient to
express concerns. The key nursing
action here is to listen, not talk, allow the
patient to talk. If more help is needed,
the nurse can refer the patient to a
specialist
Death Rituals
 As noted by Purnell and Paulanka in 2003,
death rituals include views of death,
euthanasia, and rituals for dying, burial, and
bereavement and are unlikely to vary from
the original ethnic groups practices
 Practices that affect healthcare include
such customs
o ritual washing of the body
o the number of family members
present at the death of a family
member
o religious practices required during or
after dying
o acceptance of life or death
prolonging treatments
o beliefs about withdrawing life
support
o beliefs about autopsy
Interviewing and caring for the dying patient is
challenging for a student or a new nurse. Many
students avoid talking about death because of
their own discomfort and anxiety. It is
important to work through your feelings with
the help of reading and discussion.
Kubler-Ross Five Stages of Grief of Impending
Death
1. Denial and isolation
2. Anger
3. Bargaining
4. Depression or sadness
5. Acceptance
Later, researchers discovered that these stages
may occur sequentially or overlap in any order
or combination. At each stage, follow the same
approach, be sensitive to the patient's feelings
about dying, watch for cues that the client is
open to talking about them
Death and the Dying Patient
 Setting up a meeting with a physician,
therapist, and other team members will
help everyone understand the patient's
issues and develop a cohesive plan of
care we need to avoid false reassurance
accepting the patient's feelings
 Answering questions truthfully and
being present during difficult times will
reassure the patient
 Dying patients rarely want to talk about
their illness at each encounter nor do
they wish to confide in everyone they
meet
 Give them opportunities to talk and
listen but if they choose to stay at the
social level, respect their preference
 Remember that illness even a terminal
one is only a part of the total person.
Understanding the patient's wishes
about treatment at the end of life is an
important nursing responsibility.
Failing to establish a communication about
end-of-life decisions is viewed as a flaw in
nursing care. Even if the discussions of
death and dying are difficult for you, you
must learn to ask specific questions.
Pregnancy and Childbearing
 Accepted practices for getting pregnant
delivery and child care vary across
cultures
 As Purnell and Paulanka noted in 2003,
more traditional folk and
magicoreligious beliefs surround fertility
control pregnancy, child bearing, and
post-partum practices in this cultural
domain than any other
 Beliefs about conception, pregnancy,
childbearing are passed from generation
to generation
 Fertility control varies by culture and
religion
 The use of sterilization is accepted by
some, rejected by others, and forcibly
used in other cultures
 Rituals touristic restricts sexuality are
used in some cultures including female
circumcision, the removal of the clitoris
or the vulva with sewing together of the
surrounding skin leaving only a small
hall for urination and menstruation.
Stoning or other forms of killing women
who become pregnant out of wedlock is
common in some Islamic cultures. The
US culture has pregnancy taboos just as
others do. Pregnant women are
expected to avoid environments with
very loud noises, avoid smoking and
alcohol, avoid high caffeine and drug
intake, and be cautious about taking
prescription and over-the-counter
medications. Other cultures have
pregnancy taboos such as having the
mother avoid reaching over her head to
prevent the umbilical cord from going
around the baby's neck, not buying baby
clothes before birth for the Navajo, not
permitting the father to see the mother
or baby until the baby is clean in Belize
and Panama, and many other beliefs
Culture-Based Treatments
 culture-based treatments are often
misinterpreted
 In western healthcare settings as i often
produce marks on the skin that are
interpreted as evidence of abuse. Some
standard western treatments are
unacceptable in other cultures.
 Counseling or psychiatric treatments are
resisted by Asians and many others
because psychological or psychiatric
illness is considered shameful
 Asian Treatments: Cupping often used
to treat back pain involves placing
heated glass jars on the skin. Cooling
causes suction that leaves redness and
bruising. Coining involves rubbing
ointment into the skin with a spoon or
coin, it leaves bruises or red marks but
does not cause pain it is used for wind
illness which is a fear of being cold or of
wind which causes loss of yang, fever,
and stress-related illnesses such as
headache. Moxibustion is the
attachment of smoldering herbs to the
end of acupuncture needles or placing
the herbs on the skin; this causes scars
that look like cigarette burns; it is used
to strengthen one's blood and the flow
of energy and generally to maintain
good health
Culture-Bound Syndromes
There is much debate about whether these
syndromes are folk illnesses with behavior
changes, local variations of western psychiatric
disorders, or whether they are not syndromes
at all but locally accepted ways of explaining
negative events in life
 these are conditions that are specific to
various cultures and occur as a
combination of psychiatric or
psychological and physical symptoms
 we should acknowledge a client's belief
that the symptoms form a disorder even
if western medicine calls it something
else or does not see it as a specific
disease
Health Care Practices
Pernell and Paulanka divided the assessment
of healthcare practices into six categories
1. Health-Seeking Beliefs and Behaviors
2. Responsibility for health care
3. Folklore folklore practices
4. Barriers to healthcare
5. Cultural responses to health and illness
6. Blood transfusion and organ donation
The six healthcare practices are further
divided into 14 indicators
Biological Variations
Genetics and environment and their interaction
cause humans to vary biologically. The
environment also has been proved to cause
disease but modern western thought on
disease causation leans toward a mingling of
genetics and environment.
 Gene variations cause obvious
differences like eye color and genetic
diseases
 Environment has also been proved to
cause disease, this is so-called
biocultural ecology
Biocultural Ecology
 this category refers to the client's
physical, biological, and physiological
variations such as variations in drug
metabolism disease and health
conditions
 the term biocultural ecology presents an
interesting perspective as shown below
Geographical and Ethnic Disease Variation
 In general, chronic diseases
predominate in developed countries, and
infectious diseases predominate in third
world countries
 Knowing that some groups will be more
prone to a disease or condition can help
the nurse to more carefully assess each
client
 For the skin, hair, and nails
Skin cancer is highly feared among skin
diseases. Fair-kinned people especially
those with light eyes and freckles are at
highest risk for developing skin cancers.
Although, all people who are exposed to
high levels of intense sunlight are at risk
because ozone depletion is a factor in
skin cancer risk. People living in
Australia and Southern Africa are at
greater risk
The conditions that are more common
in darker skinned people are post
inflammatory hyperpigmentation, vitiligo
pityriasis, alba, dry or “ashy” skin,
dermatosis papillose or flesh moles,
keloids, keloid-like acne from shaving
the neck, and hair loss if tightly curled in
fragile hair and use of relaxers or tight
rollers
 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 unsafe
housing, and unsafe celebratory
practices such as shooting guns to
welcome the new year
 Eye
Visual impairment varies across age
(greater after 50), gender (more in
females), angiography (higher in
southeast Asia, western pacific, and
Africa) according to WHO, 2004
In all but highly developed countries,
cataract is a leading cause of visual
disease and blindness, followed by
glaucoma and age-related macular
degeneration which is the leading cause
in developed countries
 Ear and Hearing Loss
The WHO recorded that of the 278
million people across the world with
hearing loss in both ears, 80 percent live
in low to middle income countries. The
number is rising as the population's age.
The main cause of hearing loss in
children is chronic middle ear infection.
There have been reports that
populations with shorter, wider, and
more horizontal eustachian tubes, in
native Americans, Eskimos, New
Zealand, Maoris, one Nigerian
population and some aborigines, have
higher rates of otitis media
 Mouth, Nose, Sinus
Oral diseases are prevalent in poor
populations. In developed and
developing countries, they include dental
caries, periodontal disease, tooth loss,
oral mucosal and or pharyngeal lesions,
and cancers, HIV-related diseases, and
trauma
Poor living conditions including diet,
nutrition, hygiene, and the use of
alcohol, tobacco, and tobacco related
products, and limited oral health care
contribute to developing oral disease
Sinusitis is widespread, however, the
prevalence is higher in whites and
African Americans than in Hispanics
 Thorax and Lungs
Lung cancer is directly related to
smoking and so the quantity of cigarette
smoked.
African Americans and native Hawaiians
who smoke are more susceptible to lung
cancer than in whites, Japanese,
Americans, or Latinos.
African Americans have the highest
prevalence rate of asthma and are more
likely to die from the disease than
members of other US racial or ethnic
groups.
Although African Americans smoke at
rates similar to those of whites, they are
less likely to have or die from chronic
obstructive pulmonary disease or COPD
 Breasts and Lymphatic System
Cultural beliefs about the causes of
breast cancer, the meaning of breast
cancer to the client and partner, the
availability of or knowledge of services,
fear due to illegal status of some
immigrants, and other barriers affect the
lower use of screening methods for
breast cancer.
 Heart and Neck Vessels
African American ethnicity and
socioeconomic status are factors along
with obesity diabetes millitus, smoking,
and high alcohol consumption rates
Other ethnic groups shown to have high
rates of risk factors and cardiovascular
disease are South Asians such as
Indians, Pakistanis, Bangladeshis, and
Sri Lankans
 Peripheral Vascular System
A higher risk of peripheral artery disease
has been found for black Americans
even when controlling for risk factors
of diabetes, hypertension, and obesity.
 Varicose veins, on the other hand, are
found in equal numbers and vary only by
lifestyle
 Abdomen
Gallbladder disease and cancer vary by
ethnic group. In the United States, Native
Americans, and Mexican Americans
have higher rates of disease in cancer.
Stomach ulcer or stomach cancer has
an association with the prevalence of
helicobacter pylori which also causes
ulcers and is highest in Korea and
Japan, intermediate in Italy and lowest
in the United States
Ashkenazi jews have been found to have
the highest lifetime risk for developing
colorectal cancer
 Female and Male Genitalia, Anus,
Rectum, Prostate
Sexually transmitted diseases such as
chlamydia, herpes, human papilloma
virus or HPV, syphilis, gonorrhoea, and
HIV-AIDS vary across US populations.
Ethnic variation is thought to be due to
rates of poverty, use of drugs, hygiene,
and greater reporting in poorer
community clinics. HIV-AIDS infection in
parts of Southern Africa is higher than
that in any other area of the world
 Musculoskeletal System
Bone mass density is higher in men and
blacks, and lowest in Asians except for
Polynesians. Weight is associated with
bone mass density.
Osteoporosis and bone fractures are
related to bone mass density and the
Middle East, Latin America, and Asia are
expecting dramatic increases in the next
20 years.
Ethnic variation in arthritis in the United
States indicates that African Americans
and whites have similar rates while
Hispanics have lower rates diagnosed
by physicians, but higher work-related
limitations and severe joint pain on
diagnosis
 Nervous System
Cerebrovascular disease or CVA has
neurological effects but the cause is
vascular. The same patterns of ethnic
variation that occur in cardiovascular
disease occur with stroke. In the united
states, the “stroke belt”: North Carolina,
South Carolina, Georgia, Alabama,
Mississippi, Louisiana, Arkansas
Tennessee, have greater occurrence of
stroke and vascular disease which may
be due to high percentages of older
adult and african-american dietary
factors
The occurrence of dementia including
Alzheimer’s disease is rising rapidly
especially in developing countries with a
number of elderlies is increasing such
as China, India, other South Asian and
Pacific island countries. Over 50 percent
of dementia cases in Caucasians are
Alzheimer’s but the rate in developing
countries and other ethnic groups has
not been well studied at all.
To complete a cultural competent assessment
it is essential to interact with a client, showing
respect for the person, the family, and their
beliefs, you need to challenge yourself to learn
about many of the cultural groups in your
geographical area and interact with them
enough to gain some understanding and
appreciation for their world views, use your
knowledge about meeting and assessing your
clients but be alert for behaviors descriptions
or physical variations that need to be clarified
as normal for their culture or abnormal and
needing further