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R.C. Ngalande UPG 2010 DATE: JUNE 2010

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Midwives need to

recognise respect appreciate the positive aspect of the folk health system in order to provide comprehensive therapeutic and meaningful health services to clients and their families
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Identify 2 harmful and 2 harmless cultural beliefs, and practices from each region related to Pregnancy, L&D and puerperium
Discuss the benefits and risks of the identified practices and environmental issues Describe the strategies midwives can use to reinforce and discourage the harmful practices Explain the challenges of culture of a professional midwife




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2. 3. 4.
5. 6.

Define the following terms a. Culture b. Acculturation c. Assimilation d. Cultural Imposition e. Cultural Exclusion f. Trans-culture g. Ethnocentrism Explain the trans-cultural theory and its significance Differentiate profession and folk health care systems Explain how a midwife would assess cultural system of a client Discuss how midwives can develop cultural awareness in the community they work Discuss environmental issues that influence the outcome of pregnancy
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Definition of Some Terms

Culture: Acquired knowledge people use to interpret experiences and is passed and consists of 3 overlapping factors; shared characteristics, tradition and beliefs
Accultiration: Process of reforming ones cultural beliefs customs because of mixing with other people Assimilation: Process of loosing cultural identity to a bigger group
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Taboo: A ban or prohibition made by religion or social custom (law) Belief: Something an individual does accept to be true and do not ask questions. This is because you have faith in the existence of that thing or issue and becomes implanted in the individual Custom: The usual way of behaving or acting Myth: Explanation of natural events handed down from olden times in connection with beliefs and is mostly imaginary, fictions or inverted with an intention to protect
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Definition Of Some Terms cont.

These are practices that have been maintained for a long time and is passed down to children by parents through socialization issues passed on are language, habits, values, beliefs and rules of behavior
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Definition Of Some Terms cont

Ethnocentrism: Assumption that own beliefs are the best and are superior therefore it creates rigidity and lack of trying other things

Cultural Imposition: Ones values, beliefs and practices that have been, imposed on you/ client
Cultural Exclusion: Conscious or unconscious omission of cultural values and practices as they are viewed as CB&P _ RCN 2010 inferior, incompetent, too difficult for an individual 8

Transculture Theory
Developed by Leninger in mid 1960s Aim: To be aware that different cultures knowledge, perceive, practice care differently To note common and similar norms and practice as a guide for midwifery knowledge, care and decisions
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Cultural factors are one major force that influence quality of care

Lack of inclusion of culture in care creates a gap that reduce mothers using health facilities

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Culture Of Poverty
Developed by Lewis in 1966

Provides with designs of living

A set of solution to problems, attitude values for individuals to adapt and survive within the culture Victims of poverty suffer from personality handicaps that may lead to persistent to lack of change and can affect lifestyle The belief system differ with that of care givers as they are viewed to be in middle class as the latter do react when giving the services
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Feelings: Fatalism Helplessness Dependency Inferiority Inability: Delay gratification Plan for future Belief systems differ with that of care givers
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Social cultural Factors

Dignity Respect for elders Sensitive Care:

Ethnicity Professional

Respect for clients

Curiosity to learn other peoples culture

Cultural Awareness

Conduct a small scale profile of the community and attend an event

Explore own background and how it differs with professional and others Study norms of people in nursing practice Learn about other cultures

Be part of the community
Understand the community

Health Systems Types


Folk health system Profession health system



The difference between the two

EFFECTS: Promotes cultural accommodation Provide culturally sensitive therapy care

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Folk/Traditional Health System

Local indigenous/rural people Local beliefs, practices and values

Reflect local cultural health beliefs

Assumed services roles to help

people in their community

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Folk/Traditional Health System

Prepared through informal and

experimental methods
Practices developed through daily life

experiences and related to the groups social structure

recognised members of the community
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Generally they are known and

Profession Health System

Health care providers Educated family

Different roles
Fail to recognise folk healthy system as it is regarded as non scientific, superstitious
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Effects Of Professional Health

Care system professional providers

Stress resulting in
- malpractice
- ignoring instructions

Ignore clients cultural beliefs and folk health care system

lack of - flexibility - respect

Factors That Influence Culturally Sensitive Care

Beliefs and practices related to child bearing Relationship to health system Variation of the role of midwives Availability of rich heritage vs. technology, resources and education

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Factors That Influence Culturally Sensitive Care cont.

1. Language 2. Use of interpreters

3. Voice tone
4. Teaching aids 5. Cadre of providers
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Assessment Of Cultural System

Griffith identified four different ways of assessing cultural system as follows 1. Morals and value system based on duty obligations Desirability
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Assessment Of Cultural System

Griffith identified four different ways of assessing cultural system as follows 2. Kinship system: Rights of people are of paramount and should be respected like the morals assigning of duty is of paramount obligation is related to linkage to marriage and family ancestry
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Assessment Of Cultural System cont.

3. Knowledge and belief system defining
of conception e.g. who should attend to issues concerning labour and childbearing

4. Ceremonial and ritual system e.g.

proper defining of type and time of performing and who should perform and attend
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Important Points To Remember

Be aware of the culture of the community you work

Understanding other cultures is a vital component of care giving

Diversity of cultures and mobilisation makes it difficult for midwives to understand and be experts
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Role Of A Midwife
Learn and understand the culture of the community and of the clients
Avoid reflecting your culture in your care

Pick harmful and beneficial traditions

Find strategies to discourage harmful practices in a positive way
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Role Of A Midwife cont.

Assess cultural and spiritual needs of client/family Significance: - Preparation can be easy - Conformity - Use of services - Trust - Support because you have cultural history
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