Welcome to NCLEX review. This
topic we are gonna talk about
today is Cultural Awareness and
Cultural Influences on Health.
A big part of the NCLEX exam.
We know that in the United States we don't
just treat one population of people.
We treat many populations of people whether,
its different cultures, ethics or religious groups.
So as nurses, we need to make sure that we
are attending to the needs of our patients
no matter where they have come from.
So what's are our overview for
this topic? We are gonna look at
diversity in healthcare. And
what are our responsibility
is as nurses? And what
do we have to know
to be able to take care of our patients? And
take care of them with respect and dignity.
So what are our learning outcomes? First
of all we need to assess the importance.
You know some of the still have a lot
of importance based on our culture.
Other cultures, culture is everything in their
home and their lives. And so we need
to assess right away, "which patients
are more sensitive to their culture
and may be which patients aren't?".
We also need to recognize that different
cultures have different issues.
We can always assume that everybody
beliefs like we belief.
So we need to be make sure that
we are being "the sensitive"
and we need to recognize those differences.
And then we need to
respect those differences.
A lot of times we get caught up in what
we think is right, what we believe
and we forget that the other people don't
always believe exactly like we do. And we
owe them the respect that
their cultures gives to them.
The beliefs that gives to them, their meanings
of life. So we are gonna talk a little bit about that.
So first let's start with a question.
This is a question that comes up a lot
dietary questions in healthcare.
So the question today is "which
of the following meal trays
would be appropriate for the nurse to
deliver to a patient of Jewish faith
who follows a kosher diet?".
Now remember in nursing school when you
talking about nutrition, kosher diets
is a very common diet and so you don't
wanna offend anybody of the Jewish faith
by bringing in the wrong foods.
Especially if they have already told you
that they are Jewish and they
abide by the kosher diet.
So would you tick an A. Pork roast,
rice, vegetables, mixed fruit, milk?
Would you tick a B. A
carb salad on a croissant,
vegetables with dip, potato salad and milk?
Or C. Sweet and sour chicken with
rice, vegetables, mixed fruit and juice.
Or D. Fettuccini alfredo
with shrimp, vegetables
mixed salad, mixed fruit and iced tea?
So think a minute about "what
is it about the kosher diet
that makes it special?".
Hopefully you pick C.
Remember in the Jewish
faith in the kosher diet
meat and no products can't be combined.
They also don't eat pork
and they only eat fish that has scales.
So the only one of these trays that would be
appropriate for your Jewish patient, would be C.
So Cultural Diversity. What
exactly is cultural diversity?
And I know all through nursing school we have highlighted
a lot about cultural diversity and different cultures.
And I know when you are in nursing
school, as my students did
far there is no way I can know
everything about every culture.
How to do I keep from offending people?
Well, one of the things
you need to keep in mind is,
is that people appreciate a nurse
who is sensitive to
their needs and asks.
If you just go in the room and
just look at somebody and assume
that they are belonged to a certain culture.
That's when you get
yourself in the trouble.
So what we need to
do is we need to ask.
We need to be sensitive and
we need to care about
what they believe in and we
need to respect that as well.
It also is a avoiding stereotyping,
like i have just mentioned.
It is so easy just like
the question that we had
before they think that all Jewish people
follow a kosher diet. May be they don't.
But you wouldn't wanna assume, you would wanna
ask. Again that shows the person respect.
It shows that you really
care about them as a person
and you want to follow
the best that you can
their cultural beliefs and religious beliefs.
So again watching stereotyping.
So what are some tips to keep in mind?
Number 1, you gotta listen to your patient.
Sometimes patients don't tell us everything
about their cultures or the religious beliefs.
They assume that we will ask.
Or they assume that we all
believe the same way that they do.
Just like we them.
So again you have to listen. You have to
ask the right questions and be sensitive.
You need to take an interest.
Again if you just say, "Are
there any special diets?"
and you go on to the next question.
That doesn't show interest.
So you need to make sure that
you show the person respect,
interest, you listen to them. If you
don't understand what kind of diets
they are talking about or what
kind of religious beliefs they have.
Then ask and then make notes so that you can
remember and pass on to the other healthcare providers.
And then again show
respect to tolerance.
There are people
out there that belief
a lot of differently than I do. There is people
around that believes a lot differently than you.
And sometimes their beliefs
may be offensive to you.
But again if we are gonna take care of the patient
and be a holistic nurse. We need to make sure
that we are giving them the respect and
that we are tolerating their beliefs.
And then looking at their needs.
Is there something that they need
to help them feel better? As holistic
nurses we especifically look at the whole
person which includes:
spiritual, cultural, behavioral.
So again is there something that they need?
Do they need their rosary beads?
Do they need their cross, their Bible
or whatever it is? It's gonna
make them feel comfortable.
It's gonna make them feel little bit
better during their health crisis.
Again asking and then letting them
know that it's okay to have those things.
Sometimes people think that in the hospital
you can't bring anything from home.
So we need to make sure that
we are allowing those things.
But again we need to be the ones to
initiate that with the patient.
And then document, document.
It doesn't do any good to do an assessment
and talk to this person and find out everything
that you need to know and
then not pass it on
to the other healthcare providers.
As a patient it will get really tiring
to have to keep repeating over an over.
And what that would say to me as
a patient is, "You really don't care
you didn't pass it on". So again
make sure you are documenting it.
And if you are online charting
your know there probably not a boxes
specific for every culture. So make sure
you are putting that in the comments.
So that you know that
you can pass that on.
And then pass it on to dietary and
other departments that need to know.
So what are our essential guidelines? What
are the things that we need to think about
when we have somebody
from different culture?
Communications: Usually the first thing we
think off, "Do they even speak our language?".
And even if they seem to speak English
we need to remember that if they don't understand
English we need to provide interpreters.
Now, remember from nursing
school "who can interpret?".
It's very easy to use family members
but according to NCLEX and according
to our accrediting bodies
we aren't to use family members.
We need to use somebody
who is a trained interpreter.
So make sure you are watching
that in your NCLEX questions.
And then what are the roles of the family
in this patient's life? We know there are
some cultures that family is very important.
That family makes the decisions
not just the individual.
So again if you have a patient
that may be isn't making decisions
or [inaudible 0:07:41.720] around because
they don't know what to do.
May be you should ask them if
they would rather have the whole
family there and call a family conference.
What about biological variations?
We know that a lot of different
ethnic groups carry genetic
predisposition to certain illnesses.
Again, so am I keeping that
in mind. Am I remembering that
if I have an African American that 80%
African American are lactose intolerant.
So it would be insensitive of
me to just keep bringing milk
and then saying to the patient,
"Aren't you are gonna drink your milk?"
without asking about if
they are lactose intolerant.
And then diseases and health
conditions. Again hypertension
sickle-cell disease or all ethnic
related. What about thalassemia?
Thalassemia is found more in
Mediterranean descents and Asian descents.
So again just knowing that in the back of your
mind, but again remembering not to assume.
But knowing that and asking the patient, if
that runs in their family it shows that you care.
And then nutrition. As we talked
about about before the kosher diet.
Lots of different religions and different
ethnic groups has special cultural foods.
May be they like a lot of spices.
May be they don't eat pork.
So again be sensitive and
ask specific questions.
Don't just tell the patient
"You are on regular diet".
and tell dietary that
"They are on regular diet".
You know find out what it is besides what they
like and don't like if there are special things.
You know you can always bring it
up on a tray and they cannot eat it.
But it's insensitive to keep all that
may be they don't respect eating pork.
and a piece of hanselling on their tray.
So again remember to look at
your diet. Remember to look at
certain religious groups. If there is
something really special about their diet
or their ethnic background. Make sure you
looking and that and understanding that.
And then pregnancy and childbearing.
Just like death rituals,
which is the next topic.
A lot of different cultures
have different values
and what I may think is normal is
definitely not normal for them.
So again look at your NCLEX
books, look at your OB books
and there should be a
section in there on culture.
Is there certain cultural aspects of
childbearing and contraception,
or barrier rituals, autopsies. Those kind
of things is there something special
there that you need to be aware of.
Spirituality: We need to find out
what our patient's belief in
and do they want the chaplain.
Again we have chaplains that float around the
hospital all the time that are really under used.
So don't forget about assessing
and looking at spirituality in
your NCLEX questions as well.
And then healthcare practices.
Places that are abide by the yin
and the yang, the hot and the cold.
Again we may think as an
Americans, Western Americans,
that those things are kinda silly.
But to some cultures
that's very very important.
And I am disrespectful as a nurse
if I don't take it as
seriously as they do.
So again look those up in
your books, your cultural books
and just make sure that
you are familiar with those.
And again as you are
talking to people, always think it's
funny when somebody doesn't speak the same language
as you do and we found ourselves talking really loud.
That doesn't make it
any easier to understand.
So what about volume?
There are some cultures that talk
really loud. That is their normal.
And then there are some that talk really
soft. I don't wanna offend anybody by
you know saying "Don't yell
at me", or "I can't hear you".
if I haven't taken the time to understand
that, that's part of their culture.
watch your interpreters.
Gestures: As you can tell
eye speaks with my hands a lot.
But we know that some gestures
are offensive to other cultures.
So you would wanna look that up.
You know, you can't watch everything that
you do. But there are certain gestures
that are knowing as in some cultures.
So you might wanna take a look at that.
What about touch and eye contact?
Some cultures, it's very offensive to look somebody
in the eye, especially, somebody have the authority.
So if they are coming into the hospital and
I am talking to them as a nurse
they may look at me as an authority figure
or they many not look at me.
And so to me that saying "You are not
listening", but that's part of their culture.
And so I don't wanna be offended and I don't want
them to be offended if I don't understand that.
Again communication between the sexes.
In some cultures, women
don't speak the men do.
So again you would want to know that.
If you are only talking to the woman
and man is making the decisions,
again you are gonna offend their
culture and their family system.
Personal space: Some people are close talker.
Some people need to have you far away.
So as you are doing your assessment
you don't want to offend somebody by
getting right up in their face. Or you don't wanna
offend somebody by staring on the other side
of the room and kinda yelling questions.
Again as you become a nurse
these things become more comfortable
as you deal with the populations
that you are used to or in your area.
But again for NCLEX, just make
sure that you generally know
what different cultures, the main cultures,
and their religious beliefs are.
And then clock time,
in the hospital its not so much. But remember
if you are working in the doctor's offices
some people are as so much clock
watchers as we are in America.
So again give them a
some little bit leave way.
If you are teaching
them about medications
don't just say, "do it in the morning
and afternoon" but give them a specific
time that they can attach.
And then gesturing with respect.
Again things like touching somebody on the head,
shaking hands. Again
you know that's a signs of respect for Americans.
But it's not a sign of respect for everybody else.
So keep that in mind and
look for NCLEX questions
that are about a specific culture
and then make sure you reads
the questions really well.
To make sure that you are
not offending that person.
Gender: Again we have
talked about. Some families
the mother is in-charge. Some
families the father is in-charge.
So depending on who is in the hospital who
is making the decisions. Especially in pediatrics
where you have the child that may be
mom is spending the day with the child.
But the father is the one
that makes the decisions.
Again if you know that ahead of the
time if the doctor is coming in and
consents need to be signed. You need to
arrange for the other family member to be there.
Generational: There are
some cultures where
the elders make the decisions.
Again if decisions need to be made
you need to find that out. So that those people
can be in the hospital when decisions need to be made.
Social status: That's pretty much across
the board so you need to watch that.
Not there is, you know, poor
and rich make any difference.
But again who is their
decision makers? Where they do
live? All of those kinds of
things taken to account what I do as a nurse.
And then nontraditional families.
More and more we are
saying nontraditional families
so I see that a lot in pediatrics. I can't
just walk in and assume that it's mom and dad.
So keeping that in mind. Making
sure I ask before I open my mouth.
But again watching for those
And again who can give consent? Who is
gonna be making the decisions?
Body size and shape:
We know that some cultures
have a specific size, shape
hair color, eye color.
Again that's okay to
put that in the back of your mind.
Just make sure that you are not assuming
that somebody's beliefs or religious
belief or from a certain part of the world.
Just because they way they look.
We know people that live in different
climates have different illnesses.
Where it's warmer, where it's
colder, the bacteria, the insects,
whether you live up in the mountains,
or whether you live below sea level.
All of those things effect
our health, effect our DNA.
So again as a nurse, I don't have to know everybody
that lives on the mountain what they are exposed to
but I need to keep that in mind when I am trying
to figure out what's going on with the patient.
Looking at risk groups: Again if they are
from somewhere, where it's really
hot. Is malaria a problem?
Infectious blindness: We know a lot of
places where they don't have clean
water. Infectious blindness is a problem.
TB: People that live
in close quarters,
may be people that live in slums,
or are drug users or in prisons.
Again knowing where certain
disease is seem to show up
gives us an edge on how we are
gonna take care of our patient.
And then again genetics.
Different cultures have
different genetic make ups.
They have different DNA and so we need
to be aware of that. Again not assuming
that everybody is belongs to that culture.
But again if i am trying to figure out
what's going on with my patient
that's information that i am
gonna use in my critical thinking.
Drug metabolism: Some medications are
metabolized by different cultures differently.
The example on the screen is
Propranolol. Chinese People can have
a cardiovascular effect
that other people don't.
So again if I kind of
know that in the back
of my mind and I am
gonna give Propranolol
I am gonna be thinking "I need
to watch that patient".
And then blood groups.
Different blood groups
belong to different cultures.
The example on the screen, the
Native Americans are usually type O
and are rarely every type B.
So in emergency, if I know
somebody is a Native America
Native American, I would keep that in the
back of my mind and I would think "okay
don't even bother with the B.
They are probably not".
So it's just kind of helps.
It helps me show respect
to my cultures and to the other
people of the world. And it shows
that as a nurse I am not just looking
at what drugs I am gonna give you
but that I really care
about you as a person.
Again food, "what's
the meaning of food?".
Most Americans meeting a
food is a social thing.
But in some cultures food
is meets the specific need.
So when we serve
food in the hospital
you know may not everybody eats breakfast
at 7. It means something different. They
need to have their whole family.
So hospitals are getting better about
allowing people to bring food in.
Allowing families to eat together.
But again keep that in mind as you
are answering your questions.
And then again common foods. We
talked about kosher diet.
We talked about, you
know, is afternoon tea.
Or is fasting at a certain
day or a certain time
important to this person for their
spirituality and observing that.
You know we can't just go and say, "You have
got to eat" if today is a day of fasting.
And "How would I need to know that?", is
I need to assess my patient and I need to talk to them.
And then nutritional deficiencies
going along with that.
If I have a culture that doesn't drink milk,
I need to be watching their calcium.
So again there is a lot of examples out
there of different cultures and what
food they eat and don't eat.
But if I am aware of that or if
I ask my patient and they say,
"I don't eat the certain food"
I can go do an Internet search
and find out what
kind of deficiencies.
Again that goes back to, "You don't have to
know everything". But you need to ask
and you need to show respect by looking it
up. And coming back and asking your patient
you know "Is there
information you have correct?".
Use of food for health problems: Again
kinda and go back to the hot and cold.
A lot of cultures believe if you have
certain illnesses, you should drink or eat hot foods
and the opposite cold foods. Again
if that's important to the person
I need to understand that. So that I
can help them feel better themselves.
We know whether it works or not,
isn't what this discussion is about
But in our minds it makes
us feel better if we can
follow our cultures and
follow to spiritual believes.
Pregnancy: Again we talked about
pregnancy a little bit. But things like
when the woman is pregnant. What
can she do? Can she go to work?
Is she made to be on bed rest?
Sexual intercourse is a big
one on whether it's a known or not.
Not that it bothers me in the
hospital. We don't usually see that.
But again as an understanding of may be what
else could be going on with that person.
What about the birthing process for
you nurses that wanna work in the OB?
Different cultures have different ideas
about birthing. And where they should be?
And who should be in the room?
So again being re-mindful of that
being respectful of that and then trying
to accommodate as much as possible
so that the person feels comfortable
in their surroundings and we are not
taking things away from them. At a
time when it could be very stressful.
Back on the screen 2. Circumcision
is another big one.
Don't assume that every
male child would be circumcised
when you assume you can offend
certain people of certain phase.
So what are the cultural expectations
in response to death and grief?
Does the family believe in autopsies?
There are certain rules/laws that
we have to abide by as nurses
but we can't just go in and say,
"There is going to be an autopsy".
We need to talk to them and we need to
help them to understand that it has nothing to do
with offending them and their
religious beliefs. But that is the law.
So again it's how we communicate with
our patient and the respect and the
care that we show to them,
if we can't follow their beliefs.
Why it is? So that they
feels like we have tried.
What about euthanasia?
Most people don't believe
in euthanasia. But there is
cultures out there that
don't believe in suffering.
So again being cognizant of that.
Preparing the body: There is some cultures
where the family members prepare the body.
So as a nurse if I have a patient
that dies in the hospital
and the family wants to be in their. I
need to make sure that they have education
and they are allowed to do as much as they
are allowed to do, again, for that peace.
So that, that person can have some
comfort. It will decrease their stress
and make the disease
process not exacerbated.
Again what about prayer?
It's okay to pray
with patients. It's
okay to have family members
come in and pray. Again
what about the patient? What about
helping the patient through this illness?
So as you are looking at
questions on NCLEX, again,
look for things that are
not going to be offensive.
And they are gonna help
your patient recover better.
Health seeking beliefs: Again I know in
pediatrics we talked a lot about coining,
and a lot of beliefs
that people have. Again
it's okay as long as
it's not causing harm.
But again as you are
reading questions on NCLEX
make sure that you
are not being offensive.
And that it's causing harm
and it's not a safely issue.
Make sure that your healthcare
provider, your physician know
and find out if anything that they are gonna
do is going to interact with any medications.
So again it's asking and then not
just saying "you can't do that".
But how can we work with the family? How can
we work with the patient to help them
put the two together
as much as possible.
Barriers to healthcare: We know
some people belief that the healthcare,
you don't go to the healthcare.
And so sometimes when
they get into our doors
their disease has exacerbated
to a very acute stage.
Again giving them the lecture about,
"How you should have been here earlier"
without understanding their beliefs
about healthcare is offensive.
And then cultural
beliefs to illness.
Some patients hide their pain
and as I nurses and I may
walk in and we do our good
"0 to 10 what's your pain?"
and we try to rate it.
And the person says, "1"
and if we go by that then we
dis-servicing our patient.
Again may it's according to their culture
that they don't discuss their pain.
But if I am doing a good physical
assessment and I can tell my patient
in pain. I can offer
them pain medicine.
Again they are not saying
"Please, don't treat me".
They are saying "because of my
culture, because of my beliefs
I don't show pain". That's
just one example, But again
make sure that you are
asking and you are not assuming
that just because somebody tells you
something or doesn't tell you something
than you still go do your assessment and
follow the skills that you have been taught.
So in closing, we have talked
a lot about culture and again
there is no way you can
know everything about culture.
And the people that
write NCLEX know that.
But there are certain main
cultures and certain main ideas
that are pretty common in
your area, wherever you work.
And so they gonna want
you to understand that.
But most of all the questions
are gonna be looking at
"are you looking
at person holistically?".
"Are you keeping the person safe?"
"Are you being respectful?" And
again giving them credit and
understanding on what their beliefs are.
So as you are studying
in culture, Good Luck.
And Good Luck on the NCLEX.