Chapter 3

Diversity
Characteristics Shared by Ethnic
Groups

• History
• Language
• Customs
• Beliefs
Factors Influenced by Ethnic
Norms

• Diet
• Response to pain
• Compliance with self-care activities and medical
treatments
• Trust in health care providers
Characteristics of Black Elderly

• Health problems accumulated over a lifetime due to a

poor standard of living and limited access to health care
services.
• Hold health beliefs and practices that may be
unconventional.
• Look to family members for decision-making
and care.
• May have a degree of caution in interacting with and
using health services as a defense against
prejudice.
Nursing Implications Related to
Black Skin Color

• Can complicate the use of skin color for the assessment

of health problems:
– To diagnose cyanosis effectively examine the nail
beds, palms, soles, gums, and under the
tongue.
– The absence of a red tone or glow to the skin can
indicate pallor.
– Petechiae are best detected on the conjunctiva,
abdomen, and buccal mucosa.
A Higher Prevalence of Disease in
Black Population Includes:

• Heart disease
• Cancer
• Diabetes
• HIV/AIDS
– A higher death rate occurs from these
diseases.
Statistics for Native American
Population
• Less than half live on reservations.
– Highest populations are found in Arizona, Oklahoma,
California, New Mexico, and Alaska.
• The Indian Health Service provides free, universal access
to health care to Native Americans who live on
reservations.
– More than half live in urban areas where access to
health care is inferior to that on reservations.
Statistics for Native American
Population (cont.)

• An estimated 250 different Native American languages

are spoken.
– English is listed as the first language.
• Although this population is increasing, less than 7% of
Native Americans are older than 65 years of age, less
than 1% of all older adults.
Common Native American
Medical Treatments

• Use of spiritual rituals for healing.

• Use of medicine men.
• Use of herbs and homemade drugs, and mechanical
interventions to treat illness.
Characteristics of Native
American Families

• Close family bonds.

• Respect for elders as leaders, teachers, and advisors to
the young.
• Belief that individuals have the right to make decisions
affecting their lives.
• Belief in being useful, doing for oneself, and relying on
spiritual powers to chart the course of life.
Nursing Implications/Native
Americans
• The typical nursing assessment process may be
offensive.
• Patients may be ambivalent about accepting services
from agencies and professionals.
• Patients often remain calm and controlled, even in the
most difficult circumstances.
– This behavior should not be mistaken for the absence
of feeling, caring, or discomfort.
Health Risks/Native American
Population
• Rise in certain preventable diseases, such as diabetes.
• Recent high prevalence of rheumatoid diseases.
– May be related to a genetic predisposition to
autoimmune rheumatic disease.
• Cancer survival rate is lower than any U.S.
population.
– Need for health education and early screening to
reduce risks and identify health conditions
early.
Native American
Culture
• Strong reverence for the Great Creator.
• State of health linked to good or evil forces or to
punishment for acts.
• Belief that a person must be balanced with nature for
good health and illness results from imbalance.
• Use of spiritual rituals, medicine men, herbs, homemade
drugs, and mechanical interventions for the treatment
of illness.
Jewish Culture: Historical
Perspective
 Luis de Torres, a Jewish man, accompanied Columbus on his voyage to
America.

 1654: The first Jewish Community in America (New Amsterdam) was

formed.

 Large numbers of German Jews entered America after the revolution of

1848 and the pogroms of 1881.

 Approximately 6 million Jewish people live in the U.S.

 – 2.2% of the total population, half of the world’s Jewish

population.
Jewish Religious
Traditions
• Sabbath is observed from sundown Friday to sundown
Saturday.
– Non-emergency medical procedures may be opposed
during that time.
• Many believe that the head and feet should always be
covered; some oppose shaving.
Jewish Religious Traditions
(cont.)

• Diet excludes pork and shellfish and prohibits the serving

of milk and meat products at the same meal.
• Fasting occurs on holy days (Yom Kippur and Tisha
B’Av).
Jewish Medical Practices

• Modern medical care is encouraged.

• Rabbinical consultation may be desired in decisions
involving organ transplantation or life-sustaining
measures.
• Certain rituals may be practiced at death:
– Washing and sitting with the body.
– Opposing autopsy.
Chinese Americans: Statistics

• More than 10 million Asian Americans reside in the

United States (about 4% of the population).
– Largest populations are in San Francisco, New York,
Los Angeles, Honolulu, and Chicago.
Chinese Americans: Statistics
(cont.)

• In the mid-1800s large-scale Chinese immigration

occurred.
– Over 40,000 left China to escape drought and
became cheap labor for the transcontinental railroad
construction.
– Prejudice and cultural differences promoted the
development of “Chinatowns.”
Chinese American Medical Traditions

• Care of the body and health are of utmost importance.

• Chinese medicine is based on the belief of the balance of
yin (female negative energy) and yang (male positive
energy).
• Chinese Americans use the senses for assessing medical
problems rather than machinery or invasive
procedures.
Chinese American Medical
Traditions (cont.)

• Herbs, acupuncture, and acupressure are preferred

treatments.
• It was inappropriate for the male physician to touch a
woman.
– Modern Chinese women still may be embarrassed to
receive a physical examination or care from a man.
– Disagreement or discomfort is not openly displayed.
• Nurses may need to observe more closely
and ask specific questions.
Chinese American Attitude
Towards the Elderly

• Achieving old age is a blessing.

– The elderly are held in high esteem.
– The elderly are respected and sought for advice.
• The family unit is expected to take care of its elder
members.
– There may be a reluctance to use service agencies
for the elderly.
Japanese Americans:
Immigration

• Immigration began in the mid-1800s.

– By the 1890s, over 25,000 Japanese immigrants
lived in America.
• A restrictive immigration quota was enacted at the turn
of the last century.
• Laws forbade Japanese Americans to own property and
discouraged inter-marriage.
Japanese Americans: Immigration
(cont.)

• During World War II, over 70,000 American-born

Japanese people were confined to “relocation camps.”
– Japanese people were barred from entering the
United States (restriction was lifted in 1950).
• Today there are about 750,000 Japanese
Americans.
– Most live in California and Hawaii.
Japanese American Culture

• Preserve many of their traditions.

• Feel a close bond with one another.
• Highly value the family.
• May subscribe to traditional health practices and reject
modern technology.
• May not express their feelings openly or challenge the
health professional.
– Nursing sensitivity to covert needs is crucial.
Generations of Japanese
Americans

• Issei: first generation (immigrant to America).

• Nisei: second generation (first American-born).
• Sansei: third generation.
• Yonsei: fourth generation.
Other Asian
Americans
• Filipino: Began immigrating to America in the early
1700s. Most arrived in the early 1900s to work as farm
laborers.
– From 1934–1965, an annual immigration quota of 50
was enacted.
• Korean: Began immigrating to America in the early
1900s, to work on plantations.
– Many settled in Hawaii.
– Another large influx of Koreans immigrated after the
Korean War.
Other Asian Americans (cont.)

• Vietnamese and Cambodian:

– The most recent Asian American immigrants.
– Most came to the United States to seek political
refuge after the Vietnam War.
Hispanic Americans: Statistics

• Approximately 250,000 Spanish Americans live in the

United States.
– The term Hispanic denotes Spaniards, Mexicans,
Cubans, and Puerto Ricans.
– Hispanic people now represent approximately 6% of
the older population.
Hispanic Immigration to
the U.S.
• Spanish:
– In 1565, the Spanish founded the first permanent
European colony in America in St. Augustine, Florida.
– Approximately 250,000 Spanish Americans live in the
United States.
Hispanic Immigration to the U.S.
(cont.)
• Mexican:
– Most immigration occurred during the 20th century
due to the Mexican Revolution and poor economic
conditions in Mexico.
– The Mexican population totals more than 8 million
plus an estimated 3 to 5 million illegal immigrants.
– The majority reside in California and Texas.
Hispanic Immigration to the U.S.
(cont.)
• Puerto Rican: Most immigration occurred after the
United States granted citizenship to all Puerto Ricans.
– An estimated 1 million Puerto Ricans live in New York
City, where most of them have settled.
• Cuban: Most are recent newcomers to America—most of
the 1 million plus Cuban Americans fled Cuba after
Castro seized power.
– More than 25% reside in Florida, with other large
groups in New York and New Jersey.
Traditional Hispanic
Practitioners

• Curranderos: women who have special knowledge and

charismatic qualities.
• Sobadoras: persons who give massages and manipulate
bones and muscles.
• Espiritualistas: persons who analyze dreams, cards,
and premonitions.
• Brujos: women who control witchcraft.
• Señoras: older women who have learned special healing
measures.
Hispanic Cultural Aspects

• Hold older relatives in high esteem.

– Old age is viewed as a positive time.
• Expect children to take care of their elderly parents,
avoiding institutionalization.
• English may be a second language.
– During illness stress may revive the native
tongue.
Elderly Prison
Population
• Inmates age 50 and older make up approximately 11%
of the prison population.
• Inmates tend to have poorer health status due to:
– Poor socioeconomic status.
– Inaccessibility to health care.
– Stress of imprisonment.
– Prevalence of chronic conditions with advanced
age.
Nursing Implications for Diverse
Populations

• Respect the beauty of diversity and make every effort to

preserve it.
• Accommodate dietary preferences.
• Make adaptations for special practices and unique ways
of managing illness.
• Invite family members or contact churches or ethnic
associations for information on ethnic practices.
Needs of Future Aged Populations

• Institutional meal planning that incorporates ethnic

foods.
• Multilingual health education literature.
• Readily available translators.
• Provisions for celebration of holidays.
• Special-interest groups for residents of long-term care
facilities.