NURSING AND CULTURAL WELLNESS

Definition of Culture and Subculture of Nursing
‡ Culture of nursing - the learned and transmitted lifeways, values, symbols, patterns, and normative practices of members of the nursing profession of a particular society. ‡ Subculture of nursing - a subgroup of nurses who show distinctive values and lifeways that differ from the dominant or mainstream culture of nursing. ‡ Nursing - a learned profession with a disciplined focus on care phenomena. Central purpose is to serve human beings in health, illness, and if dying.

Cultural Wellness
‡ cultural groups have their own culturally-defined ways of maintaining and promoting health ‡ health promoting behaviors can be understood only by considering persons within their social, cultural, and environmental contexts ‡ importance of cultural knowledge - promotion and maintenance of health occurs in the context of everyday lives rather than in the doctor¶s office or in a hospital

‡ the range of cultural influences on health maintenance and promotion programs is implemented for culturally diverse groups

churches. and community worksites need to be involved in supporting health education program. employers.Culturally Competent Nursing Interventions to Help Maintain Wellness ‡ involve local community leaders who are members of the cultural group being targeted promote acceptance of health promotion programs ‡ family members. .

local volunteers should be used to disseminate messages in their own language and to help organize and present information that is culturally appropriate and understood by community members ‡ sensitivity is essential to meeting health needs that exist within diverse cultural groups.‡ health messages are more readily accepted if they do not conflict with existing cultural beliefs ‡ language barriers and cultural differences . .

CAUSES OF ILLNESS (CULTURAL BELIEFS AND SCIENTIFIC) .

the locus of control tends to be more internally oriented .Traditional Concepts of Health and Disease ‡ Health concepts held by many cultural groups may result in people choosing not to seek Western medical treatment procedures because they do not view the illness or disease as coming from within themselves ‡ The locus of control for disease causality often is centered outside the individual. whereas in Western cultures.

‡ ‡ Individuals from other cultures might not follow through with health-promoting or treatment recommendations because they perceive the medical or other health .promoting encounter as a negative or perhaps even hostile experience. and services to meet the needs and concerns of the culturally diverse population. . groups that are likely to be encountered. policies. The need to be flexible in the design of programs.

diagnostic procedures. treatment. and traditional healing or curing practices. ‡ Most cases of lay illness have multiple causalities and may require several different approaches to diagnosis. prevention methods.Traditional Concepts of Illness Causality ‡ Folk illnesses are generally learned syndromes that individuals from particular cultural groups claim to have and from which their culture defines the etiology. behaviors. and cure including folk and Western medical interventions .

. shaman. often require the services of a folk healer who may be a local corianders. which are perceived to arise from a variety of causes. native healer. ‡ The use of traditional or alternate models of health care delivery is widely varied and may come into conflict with Western models of health care practice. or other specialized healer. root doctor.‡ Folk illnesses. spiritualist.

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Reductionism .Determinism .Objective Materialism . life is controlled by a series of physical and biochemical processes that can be studied and manipulated by humans ‡ 4 specific forms of symbolic thought processes characterize the scientific paradigm .Mechanism .Scientific Concepts of Health and Illness ‡ the newest and most removed from the interpersonal human arena of life ‡ according to the worldview.

what is real can be observed and measured .relates life to the structure and function of machines ‡ Reductionism .the mind and the body can be separated into two distinct entities ‡ Objective materialism .4 specific forms of symbolic thought processes ‡ Determinism .according to which all life can be reduced or divided into smaller parts Cartesian dualism .states that a cause-and-effect relationship exists for all natural phenomena ‡ Mechanism .

scientific paradigm is applied to matters of health .‡ Disavows the metaphysical and ignores the holistic forces of the universe ‡ Western cultures (e.g. US and Canadian cultural groups) espouse this paradigm ‡ Biomedical model .

must be understood to appreciate the practice of modern health care ‡ All aspects of human health can be understood in physical and chemical terms ‡ Fosters the belief that psychological processes can be reduced to the study of biochemical exchanges ‡ Effective treatment consists of physical and chemical interventions .Biomedical Model ‡ Biomedical beliefs and concepts dominate medical thought in Western societies.

a predictable time course and set of treatment requirements . accident) ± external invasion (pathogens) ± internal damages (fluid and chemical imbalances or structural changes) ‡ Disease is held to cause illness ± has more or less specific cause.‡ In this model. disease is viewed metaphorically as the breakdown of the human machine as a result of: ± wear and tear (stress) ± external trauma (injury.

and illness is a . money is donated for the campaign against cancer.‡ Instead of supernatural forces as explained by the traditional concepts. the biomedical model supports that diseases are caused by infectious agents ‡ uses specialists to take care of the ³parts´. war is raged against these invaders. ³fixing´ a part enables the machine to function ± Western medicine ‡ discuss health and disease reflect the North American cultural values of aggression and mastery: microorganisms attack the body.

struggle in which the patient must put up a good defense ‡ defines health as the absence of disease or the signs and symptoms of disease. to be healthy. one must be free of all disease .

NURSING CARE .

values. spirituality and culture regarding illness. suffering and death. respect and appreciation for the individuality and diversity of patients beliefs. its meaning. .Purposes of Knowing the Patient¶s Culture and Religion for Health Care Personnel ‡ To heighten awareness of ways in which their own faith system. treatment. ‡ To foster understanding. Provides resources for encounters with illness. cause. and outcome.

emotional and spiritual selfcare introduce therapies from the East .‡ To strengthen in their commitment to relationship-centered medicine that emphasizes care of the suffering person rather than attention simply more to the pathophysiology of disease. and recognizes the physician as a dynamic component of that relationship. ‡ To encourage in developing and maintaining a program of physical. ‡ To facilitate in recognizing the role of the hospital chaplain and the patient's clergy as partners in the health care team in providing care for the patient.

generated from the people themselves ‡ Discovering client's culture care values. meanings. beliefs and practices as they relate to nursing and health care and requires nurses to assumes the roles of learners of client¶s culture and co-partners with client's and families in defining the characteristics of meaningful and beneficial care .Culturally Congruent care ‡ Care that fits the people's valued life patterns and set of meanings .

skills. work with cultural differences and enable clients and families to achieve meaningful and supportive caring. . and attitudes in the delivery of culturally congruent care and awareness.Culturally Competent Care ‡ It is the ability of the practitioner to bridge cultural gaps in caring. ‡ Requires specific knowledge.

and strives to increase knowledge and sensitivity associated with this essential nursing concern . environmental and cultural needs/beliefs into the plan of care wherever possible ‡ respects and appreciates cultural diversity. social.‡ A culturally competent nurse is someone who: ‡ consciously addresses the fact that culture affects nurse-client exchanges ‡ with compassion and clarity. asks each client what their cultural practices and preferences are ‡ incorporates the client¶s personal.

‡ Culturally competent nursing care can only occur when client beliefs and values are thoughtfully and skillfully incorporated into nursing care plans. . along with an awareness of current research findings.‡ Nurses who understand and value the practice of culturally competent care are able to effect positive changes in healthcare practices for clients of designated cultures ‡ Sharing a cultural identity requires a knowledge transcultural nursing and principles.

‡ Today. culturally based care. Commitment to learning and practicing culturally competent care offers great satisfaction and many other rewards to those who can provide wholistic supportive care to all patients . These practices also help the client to care for himself and others within a familiar. and meaningful cultural context. supportive. nurses are faced daily with unprecedented cultural diversity because of the increasing number of immigrants and refugees.‡ Culturally competent nursing guides the nurse to provide optimal wholistic.

Nursing Decisions ‡ Leininger (1991) identified three nursing decision and action modes to achieve culturally congruent care ‡ All three modes of professional decisions and actions are aimed to assist. support. or to face illness and death. . or enable people of particular cultures ‡ predicted to lead to health and well being. facilitate.

different and beneficial health care pattern . or face handicaps and/or death. Cultural care accommodation or negotiation . recover from illness. Cultural preservation or maintenance: Retain and or preserve relevant care values so that clients can maintain their well-being. or greatly modify client¶s life ways for a new. change.Adapt or negotiate with the others for a beneficial or satisfying health outcome ‡ 3. Cultural care repatterning or restructuring: Records. ‡ 2.The THREE modes: ‡ 1.

Purpose and Goal of the Theory ‡ The central purpose of the theory . . ‡ The purpose and goal of the theory . or death of individuals or groups.to use research findings to provide culturally congruent. safe. illness. well-being. and meaningful care to clients of diverse or similar cultures.discover and explain diverse and universal culturally based care factors influencing the health.

‡ Belief regarding medical care .Sociocultural Factors and the Nursing Process Religious belief that affect the nursing care: ‡ Belief about birth & death. ‡ Belief about diet and food practices.

they impede the nursing process by not asking questions about areas of difference or by asking so many questions that they seem to try into the client' personal life .Role of Nurse ‡ begin the assessment by attempting to determine the client's cultural heritage and language skills ‡ should evaluate their attitudes toward ethnic nursing care ‡ inexperienced nurses are so self-conscious about cultural differences and so afraid of making a mistake .

‡ Important sub culture influences on children include ethnicity social class. ‡ A child's self concepts evolves from ideas about his or her social roles ‡ Primary groups are characterized by intimate contact mutual support and pressure for conformity. occupation school peers and mass culture .Roles of Nurses on the Cultural Aspect of a Community ‡ Nurses have a responsibility to understand the influence of culture. race &ethnicity on the development of social emotional relationship child rearing practices &attitude toward health.

. and values depends on many factors and thus is not the same for different members of a cultural group. ‡ Many ethnic and cultural groups in country retain the cultural heritage of their original culture ‡ How culture influences behaviors.‡ Socioeconomic influences play major role in ability to seek opportunity for health promotion for wellness ‡ Religious practices greatly influence health promotion belief in families. attitudes.

when per-vasive. but should always individualize care rather than generalize about all clients in these groups. ‡ Stereotyping ethnic group members can lead to mistaken assumptions about a client. .‡ Ethnocentrism can impede the delivery of care to ethnic minority clients and. can become cultural racism. ‡ The nurse should have an understanding of the general characteristics of the major ethnic groups. ‡ Before assessing the cultural background of a client. nurses should assess how they are influenced by their own culture.

.‡ The nursing diagnosis for clients should include potential problems in their interaction with the health care system and problems involving the effects of culture. ‡ The planning and implementation of nursing interventions should be adapted as much as possible to the client's cultural background. ‡ Evaluation should include the nurse's selfevaluation of attitudes and emotions toward providing nursing care to clients from diverse sociocultural backgrounds.

ethnic. ‡ The nursing process enables the nurse to provide individualized care . or religious values and health care beliefs.  and respect and not challenge cultural.‡ When nurses provide care to clients from a background other than their own:  they must be aware of and sensitive to the clients' sociocultural background.  assess and listen carefully to health and illness beliefs and practices.

Culturally Congruent Nursing Process  The nurse should begin the assessment by attempting to determine the client's cultural heritage and language skills.  The client should be asked if any of his health beliefs relate to the cause of the illness or to the problem.  The nurse should then determine if any home remedies the person is taking to treat the symptoms .

 Assessment enables the nurse to cluster relevant data and develop actual or potential nursing diagnoses related to the cultural or ethnic need of the client. .cultural variables as they relate to the client.  The extended family should be involved in the care the client's strongest support group.  The nursing diagnosis should state the probable cause .The identification of the cause of the problem further individualizes the nursing care plan and encourages selection of appropriate interventions . Cultural beliefs and practices can be incorporate into therapy.

misunderstanding. or cultural conflict. . A client who is modest and self-conscious about the body may need psychological preparation before some procedures and tests. ‡ The nurse may have to alter her usual ways of interacting with clients to avoid offend ignore alienating a client with different attitudes toward social interaction and etiquette.aspects of care usually not questioned by acculturated clients may be required for non-English speaking or nonacculturated clients to avoid confusion. ‡ Explanations of and practices into nursing therapies .‡ Educational level and language skills should be considered when planning teaching activities.

even if the nursing care cannot be modified. This should be done in every case.‡ The nurse can find out what care the client considers appropriate by involving him and his family in planning care and asking about their expectations. ‡ Discussing cultural questions related to care with the client and family during the planning stage helps the nurse understand how cultural variables are related to the client's health beliefs . Because both the nurse and the client are likely to take many aspects of their cultures for granted. questions should be clear and explanations should be explicit.

so that interventions can be individualized for the client. .and practices. ‡ The nurse evaluates the results of nursing care for ethnic clients as for all clients. determining the extent to which the goals of care have been met. self-evaluation by the nurse is crucial as he or she increases skills for interaction.  Evaluation continues throughout the nursing process and should include feedback from the client and family. With an ethnic minority client.

and it is imperative that nurses from all cultural backgrounds be aware of nursing implications in this area. .Conclusion ‡ Nurses need to be aware of and sensitive to the cultural needs of clients. ‡ The body of knowledge relevant to this sensitive area is growing.

and identify and use resources acceptable to the client (Boyle. and community. develop expertise to implement culturally acceptable strategies to provide nursing care. . family.‡ The practice of nursing today demands that the nurse identify and meet the cultural needs of diverse groups. understand the social and cultural reality of the client. 1987).

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