section 3 and4

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Week 7SECTION 3: CULTURE,HEALTH AND ILLNESS

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This section reviews how culture is related to health and

illness and examines the implications for nursing practice

At the end of this section you will be able to:

discuss culture and its importance as a concept within

nursing

consider how culture is related to health and illness

recognize and discuss your own culture

understand the implications of culture for nursing

discuss how to improve cultural care in nursing

CULTURE, HEALTH AND ILLNESS

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the recent explanation of cu lture provided by Papadopoulos

(2006) defined culture as the shared way of life of a group of

people, that includes beliefs, values, ideas, language,

communications, norms and visibly expressed forms such as

customs, art, music, clothing and etiquette So it will influencing behaviors of individuals and groups

requiring care

CULTURE

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Madeline Leininger (a Nursing theorist) shows

how culture is an integral part of nursing .

discusses transcultural nursing theory , that is how

individuals or groups of nurses can transcend cultures in

order to provide care that is meaningful to the individualand\or group being nursed.

Transcending cultures means that the nurse comes out of

her\his own cultural perspective and tries to understand the

world of the patient . It is simply good empathy ( is the

capacity to recognize feelings that are be ing experienced byanother) with those from other cultures

NURSING THEORY

(CULTURE, HEALTH AND ILLNESS )

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stimulate student thought about cultureand provide working

definitions that will help nurse assess the applicability of

culture to nursing.

student will think more about her own culture, how it

influences her behavior and how it will affect her interactionwith patients, families and communities.

student can be familiar with how can overcome the culture

diversity and to be more confident in providing care within

other cultures and plan care that is meaningful and sensitive

to that culture. student will be more recognize about the cultural needs of

individuals.

THIS SECTION AIMS TO

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Kim-Godwin et al. (2001)

cultural competence refers to the understanding of other

cultural beliefs and behaviors, and the ability to communicate

effectively, to conduct a cultural assessment and to advocatefor cultural groups.

KIM-GODWINS MODEL FOR DELIVERY OF

CULTURALLY COMPETENT COMMUNITY

CARE

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Most cultures provide unwritten and written guidance on how

to maintain balance or health in life.

This can range from the

Lun Yu sayings of Confucius to the guidance in the Koran

the Ten Commandments in the Old Testament to the health

promotion messages from the World Health Organization.

HOW IS CULTURE RELATED TO HEALTHAND ILLNESS?

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Response to illness is also influenced by culture

especially when the individual or group try to find meaning in

relation to why a particular illness occurred.

Just as there are lay beliefs about health there are also lay

beliefs about illness . This may range from viewing illness aspunishment from God to denying that there is an illness .

Cultural interpretations of causes of illness is an important

consideration when planning care as this will influence how

the individual or group view rehabilitation , recovery and living

with an illness.

CONT.

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Cultures are often associated with "core values and belie fs".

Try to determine what your core values and beliefs are

consider the thi ngs that you value most in life, your partner, your

family, your children, becoming a nurse

Do you believe in God? What is your religion? How does thisinfluence your life?

Are there feast days that you adhere to?

Consider your values in relation to communication with others.

discuss the similarities and differences with others culture

explain these differences. Close with a short reflection on "what

you learned" about your own culture and yourself.

RECOGNIZING YOUR OWN CULTURE

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Nurses are focused on the holis tic care of individuals and

groups.

As culture is an important part of l iving it is necessar y to

always consider cultural factors when planning care for

individuals and groups. In order to carry out a holistic assessment of a patient it is

necessary to attend to the cultural beliefs of the patient

and\or the family.

This however must be set in the full context of the person's

life, not only focusing on the cultural (see Kikuchi, 2005).

WHAT ARE THE IMPLICATIONS FORNURSING?

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the necessar y orientation for nurses in relation to culture and

planning care that requires a cultural focus.

This model may be applied to nursing in any setting that

requires you to take account of cultural factors in order to

gain a Transcultural Healthcare Perspective. Identification of existing cultural care patterns and

facilitating such patterns to achieve full potential are key to

the application of Leininger's philosophy.

Recognition of these cultural care patterns requires that the

nurse acts almost as an ethnographer, that is becomesimmersed in the cul ture to learn about the ways in which the

communities deal with stress and implement care patterns

LEININGER'S TRANSCULTURAL HEALTH

MODEL PROVIDES

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transcultural nursesThey are nurses who provide knowledgeable, competent, and

safe care to people of diverse cultu res to themselves and

others

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However you must remember that every indiv idual and every

group has a unique culture. To only focus on ethnic minorit ies

and non-light skinned groups may lead to stereotyping and

overlooking of important cultural needs of individuals and

groups within one's own culture. The cultural awareness component within Nursing courses will

improve understanding of other cultures but also causes

reflection on cultural needs within the dominant culture .

As Healthcare professionals, you have to have this broadknowledge of how culture impacts on all indi viduals and

groups irrespective of background .

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Research in relation to cultural issues . show

that nurses have great dif ficulty when it comes to dealing with

other cultures.

There is evidence that nurses are not equi table in relation to

caring for groups outside their own (light skinned) culture

This is a competence issue where nurses have not been

properly trained and educated in relation to cultural

awareness.

The research highlighting the poor care of ethnic minorities.

need to enhance equally as the number of nurses from other

countries and cultures increase

RESEARCH IN RELATION TO CULTURAL

ISSUES

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Advices to improve "Cultural awareness

address " ethnocentrism ", prevent "cultural clash

Being ethnocentric means that one only sees the world from oneperspective and normally this perception runs to a particularethnic group

Cultural clash is the term used to describe conflict of culturesand normally involves ethnocentric attitudes.

develop "cultural competency".

Cultural awareness is easy enough to address. A programmed of

education that incl udes culture and awareness of other cultures isnormally enough.

Tackling "ethnocentric attitudes" is more problematic becausenurses, like patients, are individuals.

.

WHAT IS THE BEST WAY TO IMPROVECULTURAL CARE IN NURSING?

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It is easier to focus on "cultural competence". Kim-Godwin et

al (2001) describe cultural competence as having four

dimensions;

Cultural Knowledge: Familiarization with selected cultural characteristics , history,values, belief systems, and behaviors of the members of

another ethnic group (Adams, 1995).

Cultural skillsCultural competence or skill and respect for others becomes

especially important for us in the nursing practice because we

are patient advocates

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Cultural Awarenessdeveloping sensitivity and understanding of another ethnic

group. This usually involves internal changes in terms of

attitudes and values . Awareness and sensitivity also refer tothe qualities of openness and flexibility that people develop inrelation to others . Cultural awareness must be supplementedwith cultural knowledge(Adams, 1995).

Caring : to provide affairs and equal care for all patient

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cultural competence, is defined as a set of congruentbehaviors, attitudes, and policies that come together in asystem, agency, or among professionals and enables thatsystem, agency, or those professionals to work ef fectively incross-cultural situations (Cross, Bazron, Dennis, & Isaacs,1989).

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Element ofculturalcompetence

What I am I good at? What do I need tolearn?Caring

Culturalsensitivity

Cultural

knowledge

Cultural skills

REFLECTION EXERCISE

Reflect on your ability as a nurse when caring for patients from

another culture

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Section four

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At the end of th is section STUDENT will be able to:

Know how to assess patients and families for cul tural needs.

Discuss how to improve cultural care in nursing.

ASSESSMENT THE CULTURAL NEEDS

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assessment of cultural factors and cultural needs:

open-ended approach where the patient and \or family inform

the nurse about the individual's belief system ( IT WILL HELP

THE NURSE TO BE MORE OREINTED ABOUT PATIENT BELIEF )

Asking the right question in a way that is ' non-prying' and

coupled with appropriate non-verbal communication that

conveys a real willingness on the part of the nurse to find out

more about the patient's cultural perspective is important.

HOW DO I ASSESS FOR CULTURALNEEDS?

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SOME TIME you can referral you patient to do 'ethnographicinterview ' . With specialist researchers who are describing theculture and wish to capture the essence of the values and

beliefs inherent in the culture.

Colloquial descriptions are a very important part of this type

of research. Which is consider an important descriptors for a

nursing assessment as they provide the nurse with the exact

words and terms used by the patient and \or the family.

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HOW DO I ASSESS FOR CULTURALNEEDS?


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learning about culture assessment the nurse needs to spend

time getting to know the individual

Sometimes it is necessary to work with an interpreter and, while

interpreters may speak the same language as the patient, they

can be from a different ethni c group and this may cause further

communication difficulties. If possible use an interpreter of the same gender as there may

be difficulties with communication between men and woman in

certain cultures

It is important to appreciate that culture relates to all individuals

not just those from 'other' ethnic groups.

When dealing with people from simi lar cultures to your own you

must still attend to cultural matters. Do not assume that you

know their cultural needs just because you are from the same

community and\or same ethnic group.

DO NOT FORGET THIS DURING DOING

CULTURE ASSESSMENT

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culture is assessed under three main headings:

Values.

Beliefs.

Special Considerations.

MAIN HEADING TO ASSESS CULTURE

NEED

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values means :principles or standards of behavior; ones judgment

of what is important in l i fe

You want to find out during assessment of your patient culture

need:

what and who is important in their l i fe?

What types of things are 'valued'?

For example they may say :

"being at home with the family"

or "going on holidays with the family"or "being able to walk the dog"

or "being able to climb a mountain "

or "read a good book",

or "going out for a nice meal",

VALUES

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You might have to use the word "like" as opposed to "value" but

do not start with "what do you like?" as this will miss the

point about things of value. Also note that he \she may be

reluctant to tell you about things from his \her own culture

thinking

that you would not understand. You have to say " there are

things associated with your own culture that are impor tant to

you, please tell me about these? Thiswill help me plan your

care."

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bel iefs mean assumptions and convictions that are he ld to be true ,byan individual or group regarding concepts events ,people ,and things

To assess belief Star ting with religious type of bel iefs you should notbe frightened to explore other beliefs such as beliefs about the il lness.

A good question to start with is What about your beliefs ?

Wait for a response and let the person talk .

Are you religious?

What is your religion?

There are important things and events associated with your rel igion thatyou may have dif f iculty carrying out while you are in hospital \nursing

home.

What sort of things should I know about in order to plan your care? Doyou wish to see your rel igious leader or guide

BELIEFS

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In relation to beliefs about the illness, it is only necessary to

begin with the question

" what do you think caused your illness?

"do you believe that you will get better? If not why not? Are

there any important things such as religious relics or 'cures'in your culture that you think might help?

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Language: What are the main lan guages spoken and do you require aninterpreter all of the t im e or only for com plicated topics?

Diet and Food Presentation: Are there any special considerations inrelation to food. For example , " no meat on a Friday", "No pork" , "only

Gender of Carers: Does the person only want males or females lookingafter him\her?

Particular Hygiene Requirements: Are there special considerationsbefore any garments are removed or bath\sh ower assistance? For

example "will a pubic shave be required at particular t imes for cultural

reasons? Can beard trimming only be car ried out by people of the same

religion?"

Implications for treatment: This is very impor tant and must bediscussed with all individuals and\o r the family. For example, "Is theindividual permitted to receive blood products? Does there need to bediscussion about fasting and par ticular rel igious feasts? Do some

people need a longer consultation period regarding a decision becausethe extended family has to be consulted?"

SPECIAL CONSIDERATIONS

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s a future reg istered nurse you need to focus on self-awareness

and sensitivity to cultural needs . Reflect on your own culture

and this will help you improve awareness of other cultures .

Concentrate on assessment of cultural needs when you areformulating care plans and very quickly you will find that your

competency in this area improves. Competency in working

with other cultures is princ ipally about awareness of self and

others and applying this awareness and sensitivity to ordinary

everyday communication. Be patient and quiet and learn from

those in your care. If in doubt always ask advice .

DONT FORGET

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section 3 and4

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