Transcultural Nursing

Important Definitions
• Discrimination: It is differential treatment
of individuals because they belong to a
minority group.
• Generally refers to limiting of
opportunities, choices, or life
experiences because of prejudices
about individuals, cultures, or social
groups
 Important Definitions
• Stereotyping: is the assumption that all
people in a similar cultural, racial, or ethnic
group are alike and share the same values
and beliefs. An excellent example of
stereotyping is an African-American nurse
being assigned to care for an African-
American client simply because of
ethnicity and race.
 Important Definitions
• Ethnocentrism: Looking at the world from
their own particular cultural viewpoint.
• The universal tendency of human beings
to think that their ways of thinking, acting,
and believing are the only right, proper,
and natural ways.
• Can be a major barrier to providing
culturally conscious care
 Important Definitions
• Prejudice: It is a hostile attitude toward
individuals simply because they belong to a
particular group presumed to have
objectionable qualities.
• It refers to preconceived ideas, beliefs, or
opinions about an individual, group, or culture
that limit a full and accurate understanding of
the individual, culture, gender, race, event, or
situation.
 Important Definitions
• Culture: is a patterned behavioral
response that develops over time
through social and religious customs
and intellectual and artistic activities;
a result of acquired mechanisms that
may have innate influences but are
primarily affected by internal and
external environmental stimuli.
 Important Definitions
• Cultural values: unique, individual
expressions of a particular culture
that have been accepted as
appropriate over time. They guide
actions and decision making that
facilitate self-worth and self-esteem.
 Important Definitions
• Cultural behavior: how a person acts
in certain situations, is socially
acquired, not genetically inherited.
 Important Definitions
• Transcultural Nursing: is viewed as a
culturally competent practice field that is
client centered and research focused.
Every individual is culturally unique, and
nurses are no exception. Therefore,
nurses must use caution to avoid
projecting their own cultural uniqueness
and world views on the client if culturally
appropriate care is to be provided.
 Important Definitions
• Cultural values: unique, individual
expressions of a particular culture
that have been accepted as
appropriate over time. They guide
actions and decision making that
facilitate self-worth and self-esteem.
 Important Definitions
• Ethnicity: is frequently, and perhaps
incorrectly, used to mean race. The term
ethnicity includes more than biological
identification. Ethnicity in its broadest
sense refers to groups of whose members
share a common social and cultural
heritage that is passed on to successive
generations. The most important
characteristic of ethnicity is that members
of an ethnic group feel a sense of identity.
 Important Definitions
• Race: in contrast to ethnicity, race is
related to biology. Member of
particular group share distinguishing
physical features such as skin color,
bone structure, or blood group.
 Asian-Americans

• China • Japan
• Hawaii • Southeast
• Philippines Asia (Laos,
• Korea Cambodia,
Vietnam)
 Asians: Communication
• National language preference
• Dialects, written characters
• Use of silence
• Nonverbal and Contextual cuing
• Eye contact is considered rude
• Head nodding does not necessarily
mean agreement
 Asians: Space
• Noncontact people
• Social distance is important
• The head is considered to be
sacred; therefore touching
someone on the head is
disrespectful
Asians: Time Orientation

Present
 Asians: Social Organization
• Family: hierarchical structure,
loyalty
• Devotion to tradition
• Many religions, including
Taoism, Buddhism, Islam, and
Christianity
• Community Social Organizations
 Asians: Environmental
Control
• Traditional health and illness
beliefs
• Use of traditional medicines
• Traditional practitioners: Chinese
doctors and herbalists
 Asians: Biological Variations
• Health is a state of physical and spiritual
harmony with nature and a balance between
positive and negative forces (yin and yang)
• Yin foods are cold, and yang foods are hot.
• Liver cancer
• Stomach and liver cancer
• Coccidioidomycosis
• Hypertension
• Lactose intolerance
 African-Americans
• West coast (as slave)
• Many African countries
• West Indian Islands
• Dominican republic
• Haiti
• Jamaica
 Africans: Communication
• English and Black English
• It is considered to be intrusive
to ask personal questions of
someone on initial contact or
meeting
 Africans: Space
• Close personal space is
important
• Touching one’s hair is
sometimes viewed as offensive
Africans: Time Orientation

Present over future

Africans: Social Organization
• Family: many female, single parent
• Large, extended family networks
• Strong church affiliation within
community
• Religions is usually Protestant
(Baptist)
• Community social organizations
Africans: Environmental Control

• Traditional health and illness

beliefs
• Folk medicine tradition
• Traditional health: rootworker
Africans: Biological Variations
• Sickle cell anemia
• Hypertension
• Cancer of the esophagus
• Stomach and esophageal cancer
• Lactose intolerance
 European-Americans
• Europe
• Germany
• England
• Italy
• Ireland
• Other European
Countries
 Europeans: Communication
• National languages
• Many learn English immediately
• Eye contact is viewed as
indicating trustworthiness
 Europeans: Space
• Noncontact people
• Aloof
• Distant
• Southern countries: closer
contact and touch
Europeans: Time Orientation

Future over present

 Europeans: Social Organization

• Nuclear families
• Extended families
• Judeo-Christian religions
• Community social organizations
 Europeans: Environmental
Control
• Primary reliance on modern
health care system
• Traditional health and illness
beliefs
• Some remaining folk medicine
traditions
Europeans: Biological Variations

• Breast cancer
• Heart disease
• Diabetes mellitus
• Thalassemia
 American Indians
Native Americans
• 500 American
Indian tribes
• Aleuts
• Eskimos
NATIVE AMERICANS
 American Indians:
Communication
• Tribal languages (Includes Navajo
language)
• Use of silence and body language
• Speak in low tone of voice and expect
others to be attentive
• Eye contact is avoided because it is a
sign of disrespect
• Body language is important
 American Indians: Space
• Personal space is very important
• Will lightly touch another person’s hand
during greetings
• Massage is used for the newborn infant
to promote bonding between infant and
mother
• Touching a dead body is prohibited in
some tribes
American Indians: Time
Orientation

Present
 American Indians:
Social Organization
• Extremely family oriented
• Biological and extended families
• Father does all the work outside the
house and the mother assumes
responsibility for domestic duties
• Children taught to respect traditions
• Community social organizations
 American Indians:
Environmental Control
• Traditional health and illness
beliefs
• Folk medicine tradition
• Traditional healer: medicine
man or woman
 American Indians:
Biological Variations
• Prone to Accidents
• Alcohol abuse
• Tuberculosis
• Arthritis
• Heart disease
• Cirrhosis of the liver
• Diabetes mellitus
• Gallbladder disease
• American Eskimos are susceptible to glaucoma
 Hispanic-Americans
• Spain
• Cuba
• Mexico
• Central and
South
America
 Latinos: Communication
• Spanish or Portuguese primary language
• Tend to be verbally expressive, yet confidentiality
is important
• Eye behavior is significant, for example, the “evil
eye” can be given to a child is a person looks at
and admires a child without touching the child
• Direct confrontation is disrespectful, and the
expression of negative feelings is impolite
• Dramatic body language, such as gestures or
facial expressions , is used to express emotion or
pain
 Latinos: Space
• Tactile relationships:
• Touch
• Handshakes
• Embracing
• Value of physical presence
Latinos: Time Orientation

Present
 Latinos: Social Organization
• Nuclear family is the basic unit
• Extended families are highly regarded
• Men are the decision makers and
breadwinners and woman are caretakers
and homemakers
• Catholicism is the dominant religion
• Community social organizations are
strong
 Latinos: Environmental Control

• Traditional health and illness

beliefs
• Folk medicine tradition
• Traditional healers: curandero,
espiritista, partera, senora
Latinos: Biological Variations
• Diabetes mellitus
• Parasites
• Lactose intolerance
Cultural Groups
Additional Information
 African-Americans
• Dialect and slang terms require careful
communication to prevent error (e.g.,
“bad” may mean “good”)
• Nursing Implications: Question the
client’s meaning or intent
 Mexican Americans
• Eye behavior is important. An individual
who looks at and admires a child
without touching the child has given the
child the “evil eye.”
• Nursing Implications: Always touch the
child you are examining or admiring
 American Indians
• Eye contact is a sign of disrespect and
is thus avoided
• Nursing Implications: Recognize that
the client may be attentive and
interested even though eye contact is
avoided
 Appalachians
• Eye contact is considered impolite or a
sign of hostility. Verbal pattern may be
confusing.
• Nursing Implications: Avoid excessive
eye contact. Clarify statements.
 American Eskimos
• Body language is very important.
• The individual seldom disagrees
publicly with others. Client may nod yes
to yes to be polite, even if not in
agreement.
• Nursing Implications: Monitor own body
language closely as well as client’s to
detect meaning.
 Jewish Americans
• Orthodox Jews consider excess
touching, particularly from members of
the opposite sex, offensive.
• Nursing Implications: Establish whether
client is an Orthodox Jew and avoid
excessive touch.
 Chinese Americans
• Individual may nod head to indicate yes
or shake head to indicate no.
• Excessive eye contact indicates
rudeness.
• Excessive touch is offensive
• Nursing Implications: Ask questions
carefully and clarify responses. Avoid
excessive eye contact and touch.
 Filipino Americans
• Offending people is to be avoided at all
cost.
• Nonverbal behavior is very important.
• Nursing Implications: Monitor nonverbal
behaviors of self and client, being
sensitive to physical and emotional
discomfort or concerns of the client.
 Haitain Americans
• Touch is used in conversation.
• Direct eye contact is used to gain
attention and respect during
communication.
• Nursing Implications: Use direct eye
contact when communicating.
East Indian Hindu Americans
• Women avoid eye contact as a sign of
respect.
• Nursing Implications: Be aware that
men may view eye contact by women
as offensive. Avoid eye contact.
 Vietnamese Americans
• Avoidance of eye contact is a sign of respect.
• The head is considered sacred; it is not polite
to pat the head.
• An upturned palm is offensive in
communication.
• Nursing Implications: Limit eye contact. Touch
the hand only when mandated and explain
clearly before proceeding to do so. Avoid
hand gesturing.
Religions in the USA
 Orthodox Jews
• Women is considered impure whenever blood
is coming from the uterus, husband will not
have physical contact.
• An Orthodox Jewish men will not touch any
woman other than his wife, daughters, and
mother
• Kosher Dietary laws prohibit mixing of milk
and meat at a meal
• When death occurs, the body should be
untouched for 8 to 30 minutes
 Orthodox Jews
• Meats allowed include animals that are
vegetable eaters, cloven-hoofed animals, and
animals that are ritually slaughtered
• Fish that have scales and fins are allowed
• During Yom Kippur, 24-hour fasting
• During Passover week, only unleavened
bread is eaten
 Seventh-Day Adventist
(Church of God)
• Use of alcohol, tobacco, coffee, and tea
and the promiscuous use of drugs are
prohibited.
• Some groups prohibit meat, Gluten
instead are eaten.
 Jehovah’s Witness
• Blood transfusions violate God’s laws
and are therefore not allowed. They
prefer to die than to break God’s law.
• Prohibition of food to which blood has
been added.
• Can consume animal flesh that has
been drained.
 The Church of the Latter Day
Saints (Mormon)
• Abstinence from the use of tobacco,
beverages with caffeine such as cola,
coffee, and tea; alcohol and other
substances considered injurious.
• Cleanliness is very important
• First Sunday of the month is time for
fasting.
 Islam
• No pork is allowed, nor alcoholic beverages
• They prefer foods with HALAL seal.
• Prior to death, family members are ask to be
present so they can read the Koran and pray
with the client
• Clients must face Mecca and confess sins
and beg forgiveness, in the presence of their
family, prior to death
• Burial is performed as soon as possible
• Donation of body parts is not allowed
 Islam
• Koran must not be touched by anyone
spiritually unclean
• Woman are not allowed to sign consent
forms or make decision regarding family
planning.
• Muslim woman prefer female doctors
 Russian Orthodox
• Abstention from meat and dairy
products on Wednesday, Friday, and
during Lent
• During Lent, all animal products,
including dairy products, are forbidden
• Fasting during Advent
• Exceptions from fasting include illness
and pregnancy
Dietary Preferences
 African-Americans

Fried foods
Porks, greens, rice
Some pregnant women engage in pica
Asian-Americans

Soy sauce-based foods

Raw fish
Rice
European-Americans

Carbohydrates (potatoes and

pastas)
Red meat
Hispanic-Americans
Beans
Fried foods
Spicy foods
Chili
Carbonated beverages
American Indians, Aleuts,
Eskimos
Blue cornmeal
Fish
Fruits and berries
Raw meat
Navajos prefer meat and blue
cornmeal and tend to avoid
consumption of milk
• Acupuncture- inserting needle to restores the
flow of energy to obtain good health
• Aromatherapy- controlled used of essential
oils for specific measurable outcomes
• Meditative guided imagery- application of the
conscious use of the power of the imagination
with the intention of activating biological,
psychological or spiritual healing