TRANSCULTURAL NURSING (MIDTERMS)
CULTURALLY MEDIATED CHARACTERISTICS understand a patient’s behavior and pro-vide an atmosphere in
• Nurses should be aware that patients act and behave in a
variety of ways, in part because of the influence of culture on
behaviors and attitudes.
• However, although certain attributes and attitudes are
frequently associated with particular cultural groups, it is
important to remember that not all people from the same
cultural background share the same behaviors and views.
• Although the nurse who fails to consider a patient’s cultural
preferences and beliefs is considered insensitive and possibly
indifferent, the nurse who assumes that all members of any one
culture act and behave in the same way runs the risk of
stereotyping people.
• The best way to avoid stereotyping is to view each patient as
an individual and to find out the patient’s cultural preferences.
INFORMATION DISCLOSURE
• Many aspects of care may be influenced by the diverse cultural
perspectives held by health care providers, patients, families,
or significant others.
• One example is the issue of communication and full disclosure.
In general, nurses may argue that patients have the right to full
disclosure concerning their disease and prognosis and may
believe that advocacy means working to provide that
disclosure. However, family members in some cultural
backgrounds may believe that it is their responsibility to protect
and spare the patient (their loved one) knowledge about a
terminal illness. In some cultures, the head of the family group,
elder, or husband is expected to receive all information and
make decisions.
• Nurses should not decide that a family or patient is simply
wrong or that a patient must know all of the details of their
illness regardless of the patient’s preference. Similar concerns
may be noted when patients refuse pain medication or
treatment because of cultural beliefs regarding pain or beliefs
in divine intervention or faith healing.
• Determining the most appropriate and ethical approach to
patient care requires an exploration of the cultural aspects of
these situations.
SPACE AND DISTANCE
• People tend to regard the space in their immediate vicinity as
an extension of themselves.
• The amount of space they need between themselves and
others to feel comfortable is a culturally
• determined phenomenon.
• Because nurses and patients usually are not consciously
aware of their personal space requirements,
• they frequently have difficulty understanding different
behaviors in this regard.
EYE CONTACT
• Eye contact is also a culturally determined behavior. Although
most nurses have been taught to maintain eye contact when
speaking with patients, some people from certain cultural
backgrounds may interpret this behavior differently. Some
Asians, Native Americans, Indo-Chinese, Arabs, and
Appalachians, for example, may consider direct eye contact
impolite or aggressive, and they may avert their own eyes when
talking with nurses and others whom they perceive to be in
positions of authority.
• Being aware that whether a person makes eye contact may be
a result of the culture from which they come will help the nurse
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which the patient can feel comfortable.
TIME
• Attitudes about time vary widely among cultures and can be a
barrier to effective communication between nurses and
patients.
• Views about punctuality and the use of time are culturally deter-
mined, as is the concept of waiting.
• Symbols of time, such as watches, sunrises, and sunsets,
represent methods for measuring the duration and passage of
time
TOUCH
• The meaning people associate with touching is culturally deter-
mined to a great degree.
• In some cultures (eg, Hispanic, Arab), male health care
providers may be prohibited from touching or examining certain
parts of the female body.
• Similarly, it may be inappropriate for females to care for males.
Among many Asian Americans, it is impolite to touch a person’s
head because the spirit is believed to reside there.
• Therefore, assessment of the head or evaluation of a head
injury requires alternative approaches.
COMMUNICATION
• Many aspects of care may be influenced by the diverse cultural
perspectives held by the health care providers, patient, family,
or significant others.
• One example is the issue of informed consent and full
disclosure. In general, a nurse may argue that patients have
the right to full disclosure about their disease and prognosis
and may feel that advocacy means working to provide that dis-
closure.
• Family members of some cultural backgrounds may believe it
is their responsibility to protect and spare the patient, their
loved one, the knowledge of a terminal illness. Similarly,
patients may, in fact, not want to know about their condition and
may expect their family members to “take the burden” of that
knowledge and related decision-making (Kudzma, 1999).
OBSERVANCE OF HOLIDAYS
• People from all cultures celebrate civil and religious holidays.
Nurses should familiarize themselves with major holidays for
members of the cultural groups they serve.
• Information about these important celebrations is available
from various sources, including religious organizations,
hospital chaplains, and patients themselves.
• Routine health appointments, diagnostic tests, surgery, and
other major procedures should be scheduled to avoid those
holidays a patient identifies as significant.
• Efforts should also be made to accommodate patients and
family or significant others, when not contraindicated, as they
perform holiday rituals in the health care setting.
DIET
• The cultural meanings associated with food vary widely but
usually include one or more of the following: relief of hunger;
pro-motion of health and healing; prevention of disease or
illness; expression of caring for another; promotion of
interpersonal closeness among individuals, families, groups,
communities, or nations; and promotion of kinship and family
alliances.
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• Food may also be associated with solidification of social ties;
celebration of life events (eg, birthdays, marriages, funerals);
expression of gratitude or appreciation; recognition of
achievement or accomplishment; validation of social, cultural,
or religious ceremonial functions; facilitation of business
negotiations; and expression of affluence, wealth, or social
status.
BIOLOGICAL VARIATIONS
• Future genomic research may identify genetic underpinnings of
disease susceptibility, drug response, and health outcomes
• Biological variations in transcultural nursing relate to the
genetic difference between cultures that may or may not
predispose certain groups to specific diseases.
• These factors include race, body structure, genetic variations,
nutritional preferences and psychological characteristics.
Nursing examples include diseases related to specific ethnic
groups as well as rural versus urban health.
CAUSES OF ILLNESS
BIOMEDICAL OR SCIENTIFIC VIEW
• Prevails in most health care settings and is embraced by most
nurses and other health care providers.
• The basic assumptions underlying the biomedical perspective
are that all events in life have a cause and effect, that the
human body functions much like a machine, and that all of
reality can be observed and measured (eg, blood pressures,
PaO2 levels, intelligence tests).
• One example of the biomedical or scientific view is the bacterial
or viral explanation of communicable diseases.
NATURALISTIC OR HOLISTIC PERSPECTIVE
• A viewpoint that is found among many Native Americans,
Asians, and others. According to this view, the forces of nature
must be kept in natural balance or harmony.
• One example of a naturalistic belief, held by many Asian
groups, is the yin/yang theory, in which health is believed to
exist when all aspects of a person are in perfect balance or
harmony.
• Yin energy represents the female and negative forces, such as
emptiness, darkness, and cold, whereas the yang forces are
male and positive, emitting warmth and fullness.
• Foods are classified as cold (yin) or hot (yang) in this theory
and are transformed into yin and yang energy when
metabolized by the body. Cold foods are eaten when the
person has a hot illness (eg, fever, rash, sore throat, ulcer,
infection), and hot foods are eaten with a cold illness (eg,
cancer, headache, stomach cramps, colds).
MAGICO-RELIGIOUS VIEW
• People view the world and explain the causes of illness is the
magico-religious world view. This view’s basic premise is that
the world is an arena in which supernatural forces dominate
and that the fate of the world and those in it depends on the
action of supernatural forces for good or evil.
• Examples of magical causes of illness include belief in voodoo
or witchcraft among some African Americans and others from
Caribbean countries. Faith healing is based on religious beliefs
and is most prevalent among selected Christian religions,
including Christian Science, while various healing rituals may
be found in many other religions, such as Roman Catholicism
and Mormonism (Church of Jesus Christ of Latter Day Saints).
COMPLEMENTARY AND ALTERNATIVE THERAPIES
• Therapy used to supplement conventional medicine is referred
to as Complementary Therapy.
• Therapy used to replace conventional medicine is referred to
as Alternative Therapy.
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ALTERNATIVE MEDICAL SYSTEMS
Alternative Medicine- Any form of medicine or healing that does
not fall into conventional medical practice.
• Traditional Chinese Medicine- It is a complex system based
on a belief in two opposite forces: yin and yang. For the body
and mind to be in good health, practitioners believe that yin and
yang must be in balance. Practitioners use a combination of
herbal, mind-body, and physical therapies to achieve this.
• Ayurvedic Medicine- It is a holistic health system that
developed in India. Practitioners believe that everyone is made
up of five elements: air, fire, water, earth, and ether (or space).
The way these elements combine dictates how the body works.
• Naturopathic Medicine- It focuses on using natural and
noninvasive ingredients and techniques, such as herbs,
exercise, therapy, dietary changes, and massage, among
many others.
• Homeopathy- A "treatment" based on the use of highly diluted
substances, which practitioners claim can cause the body to
heal itself.
MIND-BODY INTERVENTIONS
(HONOR CONNECTIONS BETWEEN THOUGHTS AND
PHYSIOLOGICAL FUNCTIONING USING EMOTION TO
INFLUENCE HEALTH AND WELL-BEING)
• Biofeedback- Process of providing a person with visual or
auditory information about autonomic physiological functions of
the body such as muscle tension, skin temperature, and brain
wave activity through the use of instruments.
• Breathwork- Using a variety of breathing patterns to relax,
invigorate, or open emotional channels.
• Guided Imagery- Concentrating on an image or series of
images to treat pathological conditions.
• Meditation- Self-directed practice for relaxing the body and
calming the mind with focused rhythmic breathing.
• Music Therapy- Using music to address physical,
psychological, cognitive, and social needs of individuals with
disabilities and illnesses; distracts people who are in pain.
• Tai Chi- Incorporating breath, movement, and meditation to
cleanse, strengthen, and circulate vital life energy and blood;
stimulate the immune system; and maintain external and
internal balance.
• Yoga- A mind-body exercise that originates in spiritual
practices. It involves moving through sequences of poses and
stretches while also focusing on breathing.
BIOLOGICALLY BASED THERAPIES
(NATURAL PRODUCTS)
• Dietary Supplements- Used to supplement dietary/nutritional
intake by mouth; contain one or more dietary ingredients,
including vitamins, minerals, herbs, or other botanical products.
• Herbal Medicines- Plant-based therapies used in whole
systems of medicine or as individual preparations by allopathic
providers and consumers for specific symptoms or issues.
• Mycotherapies- Fungi-based (mushroom) products
• Probiotics- Live microorganisms (in most cases, bacteria) that
are similar to beneficial microorganisms found in the human
gastrointestinal system; also called good bacteria.
MANIPULATIVE AND BODY-BASED METHODS
(INVOLVE MOVEMENT OF BODY WITH FOCUS ON BODY
STRUCTURE AND SYSTEMS)
• Acupressure- Applying digital pressure in a specified way on
designated points on the body to relieve pain, produce
analgesia, or regulate a body function.
• Chiropractic Medicine- Manipulating the spinal column;
includes physiotherapy and diet therapy
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• Craniosacral Therapy- Assessing the craniosacral motion for
rate, amplitude, symmetry, and quality and attuning/aligning
the spinal column, cerebrospinal fluid, and rhythmic processes,
releasing restrictions or abnormal barriers to motion.
• Massage Therapy- Manipulating soft tissue through stroking,
rubbing, or kneading to increase circulation, improve muscle
tone, and provide relaxation.
ENERGY THERAPIES
(USE OR MANIPULATION OF ENERGY FIELDS)
• Healing Touch- Biofield therapy; uses gentle touch directly on
or close to body to influence and support the human energy
system and bring balance to the whole body (physical, spiritual,
emotional, and mental).
• Reiki Therapy- Biofield therapy derived from ancient Buddhist
rituals; practitioner places hands on or above a body area and
transfers “universal life energy,” providing strength, harmony,
and balance to treat a patient’s health disturbances.
- During this treatment, practitioners try to control energy in
the body by using their hands. This may involve placing
them on someone, just above them, or even working at a
distance from a person. This aim is to free blocked energy
and improve the body’s natural healing abilities.
• Therapeutic Touch- Biofield therapy involving direction of a
practitioner’s balanced energies in an international manner
toward those of a patient; practitioner’s hands lay on or close
to a patient’s body.
FOLK HEALERS
• People of some cultures believe in folk or indigenous healers.
For example, nurses may find that some Hispanic patients may
seek help from a curandero or curandera (spiritual healer, folk
doctor, shaman), espiritualista (spiritualist), yuyero (herbalist),
or sanador (healer who manipulates bones and muscles).
• Nurses should not disregard the patient’s belief in folk healers
or try to undermine trust in the healers, because doing so may
alienate the patient and drive him or her away from receiving
the prescribed care. Instead, nurses should try to
accommodate the patient’s beliefs while advocating the
treatment indicated by the tenets of health science.
TRADITIONAL AND ALTERNATIVE HC
• RA 8423- PITAHC: Phil Institute of Traditional Alternative
Health Care
• Common modalities of Traditional HC in the Phil
o Acupressure- A method of healing and heath promotion
that uses the application of pressure on acupuncture
points without puncturing the skin.
o Acupuncture- A method of healing using special needles
to puncture and stimulate specific anatomical points on the
body.
o Aromatherapy- The art and science of the sense of smell
whereby essential aromatic oils are combined and then
applied to the body in some form of treatment.
o Chiropractic- A discipline of the healing arts concerned
with the pathogenesis, diagnosis, therapy, and
prophylaxis of functional disturbances, pathomechanical
states, pain syndromes, and neurophysiological effects
related to the static and dynamics of the locomotor
system, especially of the spine and pelvis.
o Herbal Medicine/Phytomedicine- Finished, labeled,
medicinal products that contain as active ingredient aerial
or underground parts of the plant or other materials or
combination thereof, either in the crude state or as plant
preparations.
o Massage- A method wherein the superficial soft parts of
the body are rubbed, stoked, kneaded, or tapped for
remedial, aesthetic, hygienic, or limited therapeutic
purposes.
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o Nutritional therapy- The use of food as medicine and to
improve health by enhancing the nutritional value of food
components that reduces the risk of a disease. It is
synonymous with nutritional healing.
o Pranic healing- A holistic approach of healing that follows
the principle of balancing energy.
o Reflexology- The application of therapeutic pressure on
the body’s reflex points to enhance the body’s natural
healing mechanisms and balance body functions. It is
based on the principle that internal glands and organs can
be influenced by properly applying pressure to the
corresponding reflex area on the body.
10 HERBAL MEDICINES APPROVED BY DOH
• Sambong- Anti-edema, Diuretic, Anti-urolithiasis
• Akapulko- Anti-fungal: Tinea Flava, Ringworm, Athlete’s Foot
and Scabies
• Niyog-niyogan- Anti-helminthic (used to expel parasitic
worms)
• Tsaang-gubat- Diarrhea, Stomachache
• Ampalaya- Lowers blood sugar levels, Diabetes Mellitus
• Lagundi- Asthma and cough, Fever, dysentery, colds & pain,
Skin diseases and wounds, Headache, Rheumatism, sprain,
contusions, and insect bites, Aromatic bath for sick patients
• Ulasimang bato- Lowers uric acid (Rheumatism and Gout)
• Bawang- For hypertension, Toothache, Lowers cholesterol
levels in the blood
• Bayabas- For washing wounds, toothache, diarrhea
• Yerba Buena- For pain in different parts of the body such as
headache, and stomachache, Rheumatism and arthritis,
Cough and cold, Swollen gums and toothache, Menstrual and
gas pain, Nausea and fainting, Insect bites and pruritus
METHODS OF HERBAL PREPARATION
• Decoction- boiling the recommended part of the plant material.
Boiling time is 20 mins.
• Infusion- Soaking of plant material in hot water. Soaking time
is 10-15 mins.
• Poultice- Direct application of the recommended plant material
on the affected part.
• Tincture- Mixing plant material in alcohol
CULTURAL DIVERSITY
• The view that cultures, races, and ethnicities, particularly those
of minority groups, deserve special acknowledgment of their
differences within a dominant political culture.”
• The importance of cultural diversity can be interpreted on the
basis of these related actions:
o Recognizing that there is a large amount of cultures that exist
o Respecting each other’s differences
o Acknowledging that all cultural expressions are valid
o Valuing what cultures have to bring to the table
o Empowering diverse groups to contribute
o Celebrating differences, not just tolerating them
PRINCIPLES OF CULTURAL DIVERSITY
• It develops over time and is responsive to its members and their
familial and social environments.
• Its members learn it and share it,
• It’s essential for survival and acceptance.
• It changes with difficulty for the nurse leader or manager.
BENEFITS OF CULTURAL DIVERSITY
• Compassion: Communication and understanding of
differences leads to increased compassion instead of
judgment.
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• Innovation: Varied perspectives and lens of looking at the
world lend to innovative thinking.
• Productivity: People who come together and bring their own
style of working together tend to support a more productive
team.
• New Opportunities: The diversity opens the door to new
opportunities and the blending of ideas which would otherwise
have been homogeneous.
• Problem-Solving: Challenges are layered, so having people
with different backgrounds can lead to better problem-solving
with richness of opinions.
BENEFITS OF DIVERSITY IN THE WORKPLACE
1. Variety of different perspectives
• Since diversity in the workplace means that employees will
have different characteristics and backgrounds, they are also
more likely to have a variety of different skills and experiences.
2. Increased creativity
• People with different background tends to have different
experiences and thus different perspectives. Exposure to a
variety of different perspectives and views leads to higher
creativity.
3. Higher innovation
• In a diverse workplace, employees are exposed to multiple
perspectives and worldviews.
• When these various perspectives combine, they often come
together in novel ways, opening doors to innovation.
4. Faster problem-solving
• Harvard Business Review found diverse teams are able to
solve problems faster than cognitively similar people.
5. Better decision making
• When employees with different background and perspectives
come together, they come up with more solutions, which leads
to more informed and improved decision-making process and
results.
6. Increased profits
• Hospitals with diverse workforce make better decisions faster,
which gives them a serious advantage over their competitors
• As a result, hospitals with diversity in the workplace achieve
better business results and reap more profit.
7. Higher employee engagement
• The link between workplace diversity and employee
engagement is pretty straightforward – when employees feel
included, they are more engaged.
8. Reduced employee turnover
• Diversity and inclusion in the workplace cause all employees to
feel accepted and valued,
• When employees feel accepted and valued, they are also
happier in their workplace and stay longer with a hospital.
• As a result, hospitals with greater diversity in the workplace
have lower turnover rates.
9. Better company reputation
• Hospitals who are dedicated to building and promoting diversity
in the workplace are seen as good, more human and socially
responsible organization.
• Workplace diversity also makes your hospital look more
interesting.
THE IMPORTANCE OF CULTURAL COMPETENCE IN
NURSING
• Cultural competence is the bedrock of a great nurse-patient
relationship.
• Every nurse should make it a priority in their care.
CULTURAL COMPETENCE IN NURSING
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• Cultural competence in nursing aids the growth and
development of nurses while also incorporating relevant
societal values. Nursing as a career is versatile—from caring
for the sick, providing treatment plans, taking care of the elderly
in a home, and more.
• The best nurses are not only technically sound but also experts
in cultural competence.
• Cultural competence in nursing implies the ability of health care
workers to give the best medical care to patients while
demonstrating cultural awareness for their beliefs, race, and
values. It entails having knowledge of patients’ cultural diversity
and treating them with this in mind.
• Cultural competence prepares nurses to empathize, relate
more to patients, and attend more deeply to their needs.
Hospital patients can often be agitated or stressed. Having
someone on their care team who speaks their language or
understands their unique background may help them to relax,
leading to greater therapy and overall care.
CULTURAL COMPETENT CARE IN NURSING
• Cultural competence helps the nurse to understand,
communicate, and interact with people effectively. More
specifically, it centers around:
o Understanding the relationship between nurses and
patient
o Acquiring knowledge of various cultural practices and
views of the world
o Developing communication skills to promote and
achieve interaction among cultures
o Ensuring a positive attitude is displayed toward
differences and various cultures
• Cultural competence expects more than just tolerating
another’s cultures and practices. Instead, it aims to celebrate
them through bridging gaps and personalizing care.
• Practicing culturally competent care in nursing means taking a
holistic approach that spans across all parts of the world. As a
nurse, you should always work to respect the diverse cultures
you come across when handling patients. It goes a long way to
impact the capability and quality of your work.
Five Core Building Blocks:
• Cultural awareness involves examining yourself, dropping
prejudices that you have previously formed against foreign
cultures, and developing the right attitude toward giving the
best health service to all patients and clients.
• Cultural knowledge involves searching for information about
the culture and beliefs of your patients to better understand and
interact with them.
• Cultural skills involves your ability to collect relevant data and
process it to help engage a patient in meaningful cross-cultural
interaction.
• Cultural encounter encourages nurses to venture out of the
environment they are conversant with and try new cultures and
places. They improve their competence by interacting with
people from different backgrounds, cultures, and ethnicities.
• Cultural desire requires a strong motivation to learn more
about other cultures. It is a strong force that involves the ability
to be open to new people, to accept and understand cultures
that are different from yours and be willing to learn.
Here are many examples of what a nurse who exhibits cultural
competence looks like. A few key traits include:
1. Speaking in terms that are easy for the patient to follow and
understand.
2. Not judging or disregarding a patient’s belief and religious
background but encouraging them to do what works best for
them.
3. Empathizing with the patient at all times.
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4. Valuing the individual and applauding strengths and
individuality.
IMPORTANCE OF CULTURAL COMPETENCE IN
NURSING CARE
• Cultural competence is necessary because it helps the nurse
offer the best services to every patient, leading to high
satisfaction and care on the side of the patient. Without cultural
competence, the health sector will suffer a great loss and
ultimately limit the services that it can offer.
• A strong background and knowledge of cultural competence
prevents professional health caregivers from possessing
stereotypes and being myopic in their thoughts. It also helps
them offer the best service to all, regardless of their social
status or belief.
• Health care workers can strengthen their cultural competence
by pursuing continuing education, cross-cultural interactions,
or specific assessments. These efforts help to keep their minds
open and free of judgment or preformed notions about certain
cultures or locations.
• The world becomes better with more culturally competent
service providers in each sector. Culturally competent nurses
are essential to providing top-quality services to their patients—
translating to better health care in every community.
ROLES AND ATTRIBUTES OF A TRANSCULTURAL
NURSE
• Transcultural nurses provide culturally sensitive nursing care to
patients from around the world who have different religions,
ethnicities, and cultural backgrounds.
• The field of transcultural nursing was officially established in
1955 and is considered a cognitive specialty which focuses
mainly on global cultures and relative cultural caring, health,
and nursing experience.
• Not only should transcultural nurses be familiar with a patient's
values, traditions, beliefs, and cultural customs, they should
also be familiar with the way a person's modes of thinking and
their way of life can affect the way that they deal with sickness
and death.
• Becoming a transcultural nurse means learning about the
differences between cultures around the world, nursing
practices in other countries, global health issues, and
becoming familiar with the various international health
organizations
WHAT ARE SOME TRANSCULTURAL NURSE
DUTIES?
• Acting as a liaison between patients, their loved ones, and
other healthcare providers
• Providing patients and their loved ones with physical,
emotional, and spiritual support
• Helping to educate families on patients' health status
• Bridging the gap between a patient's culture and the nursing
practice
• Understanding a patient's cultural, religious, and ethnic
background
• Gathering information regarding home healthcare remedies a
patient may need to help alleviate their symptoms
• Understanding the relationship between a patient's beliefs
regarding health and their medical illness
• Gathering information on the patient's socioeconomic status
• Understanding how race, ethnicity, religion, and culture affect
outlooks on health and child-rearing practices
CONSENT
• A communication process between a patient and a health care
in which patients are given important information, including
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possible risks and benefits, about a medical procedure or
treatment. This is to help them decide if they want to be treated.
It is given verbally or in writing.
3 Elements of Giving a Consent to a Patient:
• Voluntary
• Informed
• Capacity
BLOOD TRANSFUSION
Medical Management:
• Explain the procedure
• Parental consent is needed if the patient is a child
• Respect the patient's decision
• Advise clinical opinion but do not pressure the patient to accept
our advice.
• Alternative medicine for blood transfusion to proceed with the
procedure
Surgical Management:
• If a surrogate decision is involved, assess the decision maker’s
capacity for decision-making, their attitude towards patients,
their level of commitment, and justifications that they hold to
refuse treatment.
• For managing emergency situations, hospital management
should take a legal stand and ensure treatment continuity by
transfusing the donor’s blood (someone else’s screened blood)
or obtain a court order to impose medical care.
• Health team should negotiate with the patient’s family and
empower them to select a safest treatment option.
• Use of alternative treatments that are acceptable, like
pharmacological agents such as intravenous iron or tranexamic
acid.
LABOR AND DELIVERY
• Different cultures have different values, beliefs and practices.
A woman’s cultural background can affect her needs and
expectations during pregnancy and childbirth, as well as how
she and her family raise children.
o During pregnancy, women from some cultures do not eat
certain foods.
o During labour, women from some cultures avoid moving too
much; some stay lying down, some prefer to sit or squat.
o In some cultures, the father does not attend the birth, but the
mother or mother-in-law does.
o After childbirth, some women follow strict rules, such as staying
in bed for several days.
POSTPARTUM CARE
• Determine the infant’s data and profile to help with planning the
care of the newborn and promote bonding between the
parents.
• Assess the woman’s general appearance because it is a
reflection of how well the woman is moving into the taking hold
phase of recovery.
• Assess for facial edema, especially for a woman with
pregnancy-induced hypertension.
• Assess the woman’s breast for any cracks or fissures and avoid
squeezing the nipple. Also, assess for signs of mastitis such as
inflammation of a certain part of the breast.
• If the uterus is not firm upon palpation, massage it gently.
Placing the infant on the mother’s breast also aids in
stimulating contractions
• Observe the perineum for ecchymosis, hematoma. Edema or
any drainage and bleeding from the stitches.
• Educate the mother about normal physiological changes after
birth.
• Monitor vital signs such as temperature, pulse rate, and blood
pressure (decrease bp may indicate bleeding).
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DIET AND NUTRITION
People from different cultural backgrounds eat different foods.
These food preferences result in patterns of food choices within a
cultural or regional group.
Hispanic
• Homemade traditional foods
• Beans, rice, corn, protein sources are incorporated into meals
• Rich in protein, high in sodium and fat
Chinese
• Grouped as hot or cold (yin/yang balance principle)
• Protein sources: beef, lamb, tofu, chicken
• Food behaviors differ from each country (south-rice, north-bread
and buns)
• High sodium, high protein, high refined carbohydrates
Japanese
• Washoku – balance
• Protein sources: fish and other seafoods, typically served grilled
or raw, and soybeans.
• High protein, high omega-3 fatty acid
Indian
• Lacto-vegetarian diet (allows dairy, excludes meat, eggs and fish)
• Grains: beans and lentils
• High protein, high calcium, high fiber, high carbohydrates, lack
vitamin b12
Middle East
• Protein sources: lamb, goat, fish, chicken, fermented dairy
products. High protein, fiber, iron, monounsaturated and
polyunsaturated fats
HYGIENE
The client’s preferences of personal hygiene shall always be
respected. Cleanliness is valued and fused into the daily lives of
other cultures, such as the removal of one's shoes once entering a
home. Religion is an important contribution to proper hygiene and
cleanliness. Enforcing certain hygienic practices demonstrates
proper hygiene and cleanliness is embedded not only for health
purposes.
PHYSICAL EXAMINATION
Assess symptoms within the client's sociocultural and
ethnohistorical context. Awareness on normal biocultural variations
among healthy members of the selected population. Nurse must
have assessment skills that will enable them to recognize variations
that occur in illness.
POSTMORTEM CARE
Postmortem care, which can be provided in the home and in health
care facilities, involves caring for a deceased patient's body with
sensitivity and in a manner that is consistent with the patient's
religious or cultural beliefs.
DEVELOPMENTAL MODEL OF INTERCULTURAL
SENSITIVITY
• Developed by Milton Bennett in 1986; “Bennett Scale”
• Developmental stages along which people can progress
toward a deeper understanding and appreciation of cross-
cultural differences.
• ethnocentric (denial, defensive, and minimization)
• ethnorelative (acceptance, adaptation, and integration)
• ethnocentric orientations - avoiding cultural difference
• ethnorelative worldviews - seeking cultural difference
LEVELS OF CULTURAL COMPETENCE
• Cultural Destructiveness- characterized by attitudes,
policies, structures, and practices within a system or
organization that are destructive to a cultural group.
BSN
• Cultural Incapacity- lack of capacity of systems and
organizations to respond effectively to the needs, interests and
preferences of culturally and linguistically diverse groups.
• Cultural Blindness- an expressed philosophy of viewing and
treating all people as the same.
• Cultural Pre-Competence- a level of awareness within
systems or organizations of their strengths and areas for
growth to respond effectively to culturally and linguistically
diverse populations.
• Cultural Competence- Systems and organizations that
exemplify cultural competence demonstrate an acceptance
and respect for cultural differences
• Cultural Proficiency- Systems and organizations hold culture
in high esteem, use this a foundation to guide all of their
endeavors
PERSONAL GUIDELINES FOR DEVELOPING
CULTURAL COMPETENCY
1. Respect diversity
2. Promote awareness and education
3. Dynamics of differences
4. Accept responsibility
5. Include family and community
6. Members in health care decision making
ADDITIONAL CULTURAL CONSIDERATIONS: KNOW
THY SELF
Because the nurse–patient interaction is the focal point of nursing,
nurses must consider their own cultural orientation when conducting
assessments of patients and their families and friends. To provide
culturally appropriate care:
• Know your own cultural attitudes, values, beliefs, and practices.
• Recognize that despite “good intentions,” everyone has cultural
“baggage” that ultimately results in ethnocentrism (i.e., judging
another culture based upon standards from one’s own culture).
• Acknowledge that it is generally easier to understand those
whose cultural heritage is similar to your own, while viewing
those who are unlike you as strange and different.
• Maintain a broad, open attitude. Expect the unexpected. Enjoy
surprises.
• Avoid seeing all people as alike—that is, avoid cultural
stereotypes, such as “all Chinese like rice” or “all Italians eat
spaghetti.”
• Try to understand the reasons for any behavior by discussing
commonalities and differences with representatives of ethnic
groups different from your own.
• If a patient has said or done something that you do not
understand, ask for clarification. Be a good listener. Most
patients will respond positively to questions that arise from a
genuine concern for and interest in them.
• If at all possible, speak the patient’s language (even simple
greetings and social courtesies are appreciated). Avoid
feigning an accent or using words that are ordinarily not part of
your vocabulary.
• Be yourself. There are no right ways or wrong ways to learn
about cultural diversity.
o Language Barriers
o Unfamiliarity with the Concept of Palliative Care/Hospice
Settings
o Distrust of Health Care Services/Clinicians
o Personal Experiences/Past Trauma
o Religious Differences
o Belief In Alternative Medicines
o Meaning of Death and Dying
o Meaning of Pain and Suffering
o Patient's Race
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