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Cultural Awareness and Cultural Influences on Health

by Diana Shenefield, PhD
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    00:01 Welcome to NCLEX review. This topic we are gonna talk about today is Cultural Awareness and Cultural Influences on Health.

    00:09 A big part of the NCLEX exam.

    00:12 We know that in the United States we don't just treat one population of people.

    00:17 We treat many populations of people whether, its different cultures, ethics or religious groups.

    00:22 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.

    00:30 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.

    00:45 So what are our learning outcomes? First of all we need to assess the importance.

    00:49 You know some of the still have a lot of importance based on our culture.

    00:53 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?".

    01:04 We also need to recognize that different cultures have different issues.

    01:09 We can always assume that everybody beliefs like we belief.

    01:12 So we need to be make sure that we are being "the sensitive" and we need to recognize those differences.

    01:17 And then we need to respect those differences.

    01:20 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.

    01:31 The beliefs that gives to them, their meanings of life. So we are gonna talk a little bit about that.

    01:37 So first let's start with a question. This is a question that comes up a lot dietary questions in healthcare.

    01:44 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?".

    01:54 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.

    02:04 Especially if they have already told you that they are Jewish and they abide by the kosher diet.

    02:09 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.

    02:27 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.

    02:42 Remember in the Jewish faith in the kosher diet meat and no products can't be combined.

    02:48 They also don't eat pork and they only eat fish that has scales.

    02:53 So the only one of these trays that would be appropriate for your Jewish patient, would be C.

    03:00 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.

    03:09 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.

    03:17 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.

    03:27 If you just go in the room and just look at somebody and assume that they are belonged to a certain culture.

    03:33 That's when you get yourself in the trouble.

    03:35 So what we need to do is we need to ask.

    03:38 We need to be sensitive and we need to care about what they believe in and we need to respect that as well.

    03:46 It also is a avoiding stereotyping, like i have just mentioned.

    03:50 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.

    03:58 But you wouldn't wanna assume, you would wanna ask. Again that shows the person respect.

    04:03 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.

    04:11 So again watching stereotyping.

    04:15 So what are some tips to keep in mind? Number 1, you gotta listen to your patient.

    04:20 Sometimes patients don't tell us everything about their cultures or the religious beliefs.

    04:25 They assume that we will ask.

    04:27 Or they assume that we all believe the same way that they do.

    04:31 Just like we them.

    04:33 So again you have to listen. You have to ask the right questions and be sensitive.

    04:38 You need to take an interest.

    04:40 Again if you just say, "Are there any special diets?" and you go on to the next question. That doesn't show interest.

    04:46 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.

    04:57 Then ask and then make notes so that you can remember and pass on to the other healthcare providers.

    05:04 And then again show respect to tolerance.

    05:06 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.

    05:13 And sometimes their beliefs may be offensive to you.

    05:16 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.

    05:27 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.

    05:40 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.

    05:50 It's gonna make them feel little bit better during their health crisis.

    05:54 Again asking and then letting them know that it's okay to have those things.

    05:58 Sometimes people think that in the hospital you can't bring anything from home.

    06:02 So we need to make sure that we are allowing those things.

    06:05 But again we need to be the ones to initiate that with the patient.

    06:09 And then document, document.

    06:11 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.

    06:21 As a patient it will get really tiring to have to keep repeating over an over.

    06:26 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.

    06:33 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.

    06:42 So that you know that you can pass that on.

    06:45 And then pass it on to dietary and other departments that need to know.

    06:50 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?".

    07:00 And even if they seem to speak English we need to remember that if they don't understand English we need to provide interpreters.

    07:08 Now, remember from nursing school "who can interpret?".

    07:11 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.

    07:20 We need to use somebody who is a trained interpreter.

    07:23 So make sure you are watching that in your NCLEX questions.

    07:26 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.

    07:33 That family makes the decisions not just the individual.

    07:37 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.

    07:44 May be you should ask them if they would rather have the whole family there and call a family conference.

    07:50 What about biological variations? We know that a lot of different ethnic groups carry genetic predisposition to certain illnesses.

    07:58 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.

    08:08 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.

    08:18 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.

    08:30 So again just knowing that in the back of your mind, but again remembering not to assume.

    08:35 But knowing that and asking the patient, if that runs in their family it shows that you care.

    08:40 And then nutrition. As we talked about about before the kosher diet.

    08:43 Lots of different religions and different ethnic groups has special cultural foods.

    08:48 May be they like a lot of spices. May be they don't eat pork.

    08:53 So again be sensitive and ask specific questions.

    08:57 Don't just tell the patient "You are on regular diet".

    08:59 and tell dietary that "They are on regular diet".

    09:02 You know find out what it is besides what they like and don't like if there are special things.

    09:07 You know you can always bring it up on a tray and they cannot eat it.

    09:10 But it's insensitive to keep all that may be they don't respect eating pork.

    09:15 and a piece of hanselling on their tray.

    09:17 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.

    09:30 And then pregnancy and childbearing.

    09:32 Just like death rituals, which is the next topic.

    09:35 A lot of different cultures have different values and what I may think is normal is definitely not normal for them.

    09:43 So again look at your NCLEX books, look at your OB books and there should be a section in there on culture.

    09:49 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.

    10:01 Spirituality: We need to find out what our patient's belief in and do they want the chaplain.

    10:09 Again we have chaplains that float around the hospital all the time that are really under used.

    10:13 So don't forget about assessing somebody's spirituality and looking at spirituality in your NCLEX questions as well.

    10:21 And then healthcare practices.

    10:24 Places that are abide by the yin and the yang, the hot and the cold.

    10:28 Again we may think as an Americans, Western Americans, that those things are kinda silly.

    10:34 But to some cultures that's very very important.

    10:37 And I am disrespectful as a nurse if I don't take it as seriously as they do.

    10:43 So again look those up in your books, your cultural books and just make sure that you are familiar with those.

    10:50 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.

    10:58 That doesn't make it any easier to understand.

    11:01 So what about volume? There are some cultures that talk really loud. That is their normal.

    11:06 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".

    11:13 if I haven't taken the time to understand that, that's part of their culture.

    11:17 Again interpreters watch your interpreters.

    11:21 Gestures: As you can tell eye speaks with my hands a lot.

    11:25 But we know that some gestures are offensive to other cultures.

    11:28 So you would wanna look that up.

    11:30 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.

    11:37 What about touch and eye contact? Some cultures, it's very offensive to look somebody in the eye, especially, somebody have the authority.

    11:45 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.

    11:52 And so to me that saying "You are not listening", but that's part of their culture.

    11:57 And so I don't wanna be offended and I don't want them to be offended if I don't understand that.

    12:02 Again communication between the sexes.

    12:05 In some cultures, women don't speak the men do.

    12:09 So again you would want to know that.

    12:11 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.

    12:18 Personal space: Some people are close talker. Some people need to have you far away.

    12:23 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.

    12:42 But again for NCLEX, just make sure that you generally know what different cultures, the main cultures, and their religious beliefs are.

    12:50 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.

    13:01 So again give them a some little bit leave way.

    13:04 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.

    13:13 And then gesturing with respect.

    13:15 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.

    13:28 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.

    13:37 To make sure that you are not offending that person.

    13:41 Gender: Again we have talked about. Some families the mother is in-charge. Some families the father is in-charge.

    13:48 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.

    13:57 But the father is the one that makes the decisions.

    14:00 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.

    14:08 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.

    14:20 Social status: That's pretty much across the board so you need to watch that.

    14:25 Not there is, you know, poor and rich make any difference.

    14:28 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.

    14:37 And then nontraditional families.

    14:40 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.

    14:48 So keeping that in mind. Making sure I ask before I open my mouth.

    14:53 But again watching for those nontraditional families.

    14:55 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.

    15:21 We know people that live in different climates have different illnesses.

    15:25 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.

    15:33 All of those things effect our health, effect our DNA.

    15:37 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.

    15:46 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.

    15:59 TB: People that live in close quarters, may be people that live in slums, or are drug users or in prisons.

    16:06 Again knowing where certain disease is seem to show up gives us an edge on how we are gonna take care of our patient.

    16:13 And then again genetics.

    16:15 Different cultures have different genetic make ups.

    16:18 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.

    16:32 Drug metabolism: Some medications are metabolized by different cultures differently.

    16:37 The example on the screen is Propranolol. Chinese People can have a cardiovascular effect that other people don't.

    16:46 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".

    16:56 And then blood groups.

    16:57 Different blood groups belong to different cultures.

    17:02 The example on the screen, the Native Americans are usually type O and are rarely every type B.

    17:09 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".

    17:20 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.

    17:34 Again food, "what's the meaning of food?".

    17:37 Most Americans meeting a food is a social thing.

    17:41 But in some cultures food is meets the specific need.

    17:45 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.

    17:53 So hospitals are getting better about allowing people to bring food in.

    17:57 Allowing families to eat together. But again keep that in mind as you are answering your questions.

    18:01 And then again common foods. We talked about kosher diet.

    18:05 We talked about, you know, is afternoon tea.

    18:07 Or is fasting at a certain day or a certain time important to this person for their spirituality and observing that.

    18:17 You know we can't just go and say, "You have got to eat" if today is a day of fasting.

    18:21 And "How would I need to know that?", is I need to assess my patient and I need to talk to them.

    18:27 And then nutritional deficiencies going along with that.

    18:30 If I have a culture that doesn't drink milk, I need to be watching their calcium.

    18:35 So again there is a lot of examples out there of different cultures and what food they eat and don't eat.

    18:40 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.

    18:51 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?".

    19:04 Use of food for health problems: Again kinda and go back to the hot and cold.

    19:08 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.

    19:23 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.

    19:34 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.

    19:48 Not that it bothers me in the hospital. We don't usually see that.

    19:52 But again as an understanding of may be what else could be going on with that person.

    19:57 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.

    20:23 Back on the screen 2. Circumcision is another big one.

    20:26 Don't assume that every male child would be circumcised when you assume you can offend certain people of certain phase.

    20:34 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".

    20:48 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.

    20:56 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.

    21:05 Why it is? So that they feels like we have tried.

    21:08 What about euthanasia? Most people don't believe in euthanasia. But there is cultures out there that don't believe in suffering.

    21:16 So again being cognizant of that.

    21:19 Preparing the body: There is some cultures where the family members prepare the body.

    21:24 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.

    21:37 So that, that person can have some comfort. It will decrease their stress and make the disease process not exacerbated.

    21:45 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.

    22:03 And they are gonna help your patient recover better.

    22:07 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.

    22:18 But again as you are reading questions on NCLEX make sure that you are not being offensive.

    22:23 And that it's causing harm and it's not a safely issue.

    22:27 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.

    22:36 So again it's asking and then not just saying "you can't do that".

    22:40 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.

    22:48 Barriers to healthcare: We know some people belief that the healthcare, you don't go to the healthcare.

    22:54 And so sometimes when they get into our doors their disease has exacerbated to a very acute stage.

    23:01 Again giving them the lecture about, "How you should have been here earlier" without understanding their beliefs about healthcare is offensive.

    23:09 And then cultural beliefs to illness.

    23:11 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.

    23:20 And the person says, "1" and if we go by that then we dis-servicing our patient.

    23:26 Again may it's according to their culture that they don't discuss their pain.

    23:30 But if I am doing a good physical assessment and I can tell my patient in pain. I can offer them pain medicine.

    23:35 Again they are not saying "Please, don't treat me".

    23:38 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.

    23:56 So in closing, we have talked a lot about culture and again there is no way you can know everything about culture.

    24:04 And the people that write NCLEX know that.

    24:06 But there are certain main cultures and certain main ideas that are pretty common in your area, wherever you work.

    24:14 And so they gonna want you to understand that.

    24:16 But most of all the questions are gonna be looking at "are you looking at person holistically?".

    24:21 "Are you keeping the person safe?" "Are you being respectful?" And again giving them credit and understanding on what their beliefs are.

    24:30 So as you are studying in culture, Good Luck.

    24:33 And Good Luck on the NCLEX.


    About the Lecture

    The lecture Cultural Awareness and Cultural Influences on Health by Diana Shenefield, PhD is from the course Psychosocial Integrity. It contains the following chapters:

    • Cultural Awareness
    • Cultural Diversity
    • Essential Guidelines
    • Family Roles
    • Pregnancy and Childbearing Practices
    • Health-Care Practices

    Included Quiz Questions

    1. Asking questions that require the patient to give a simple “yes” or “no” answer, such as “Do you have trouble breathing?” or “Does your knee hurt?”
    2. Encouraging the patient to give a description of her/his medical situation, and beliefs about health and illness.
    3. Asking the patient whether he or she would like to have a qualified interpreter for the medical visit.
    4. Asking the patient questions such as “How has your condition changed over the past two days?” or “What makes your condition get better or worse?”
    1. Making eye contact with the interpreter when you are speaking, then looking at the patient while the interpreter is telling the patient what you said.
    2. Speaking slowly, pausing between words.
    3. Asking the interpreter to further explain the patient’s statement in order to get a more complete picture of the patient’s condition.
    4. None of the above.
    1. Most African people are either Christian or follow a traditional religion.
    2. Friendly (non-sexual) physical contact is an important part of communication for many Latin American people.
    3. Many Asian people think it is disrespectful to ask questions of a health provider.
    4. Eastern Europeans are highly diverse in terms of customs, language and religion.

    Author of lecture Cultural Awareness and Cultural Influences on Health

     Diana Shenefield, PhD

    Diana Shenefield, PhD


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