Chapter 4

Cultural Aspects of Health and Illness

Transcultural Nursing• Focuses on care, health, illness patterns of people with

similarities and differences in cultural belief, values, practices

Culture• Not restricted to race, ethnicity• Refers to integrated patterns of behavior acquired over time

(e.g., beliefs, values, customs, norms, habits, language, thoughts)

• Learned within family unit, generation, and/or other social organizations

Cultural Diversity • Differences among people; may or may not be visible• Race – visible physical characteristics (e.g., skin tone, head

shape, hair texture)• Ethnicity –common group social customs, values, beliefs

Cultural Competence • Respecting all differences; not letting one’s own biases

influence others• Understanding/responding effectively to cultural and linguistic

needs of patients• Joint Commission and NPSGs require cultural differences be

respected

Cultural Sensitivity • Aware of, respects; appreciation of cultural differences• Avoid biased/offensive language and actions when interacting

with diverse cultures• Avoid stereotyping

Health Care Disparities • Differences in incidence of health care problems among

minority racial/ethnic groups when compared with white majority

• Contributing factors – socioeconomic status, individual discrimination, access to care, language barriers

Healthy People 2020• Health promotion initiatives reflect assessments of major risks

to health and wellness• Changing public priorities• Emerging issues related to U.S. health preparedness and

prevention

Purnell’s Domains of Culture• Culture overview and communication• Homelessness• Family and workplace issues• Lesbian, gay, bisexual, transgender health• Biologic ecology• Nutrition• Spirituality

Homeless• Most avoid health care • Prone to CV disease, hypertension, diabetes mellitus, high

cholesterol, infections• Compensate for limited time• Limit number of visits needed

Communication• Language is largest barrier for non-English-speaking patients• Interpreters must be available in health care facilities• Determine which forms of patient communication are

acceptable

Family & Workplace Issues• Family and gender roles influence plan of care• Assess who makes decisions in the family• Include questions about sexual identity/activity in health

assessment

LGBT Health• Many fear prejudice; hesitant to seek medical care• Establish patient’s gender identity; do not make assumption

based on appearance• Ask questions about sexual identity

Biological Ecology• Biologic variations, health disparities, drug metabolism

differences• Common biological variation relates to adult body size and

type (e.g., dwarfism)

Dwarfism• Height below 4’ 10”• Disproportionate or proportionate• Results from genetic mutation, hormone imbalance

Ethnopharmacology• Study of effect of ethnicity on how drugs work in the body• Absorption• Distribution• Metabolism• Excretion

Nutrition• Part of comprehensive health assessment• Respect patient’s food preferences/beliefs• Assess rituals and customs

Spirituality• Involves behaviors that give purpose to life, provide individual

strength• Joint Commission requires all health care facilities to address

patients’ spiritual needs• Chaplain is part of health care team

Health Care Practices and Practitioners• Assess patient’s health promotion and maintenance practices• Determine whether patient is able to afford health care• Use of alternative health care systems and healers• Folk health beliefs

Health Care Obstacles• Transportation difficulties• High cost of care• Fear and distrust of health care workers• Poor communication between patients and professionals

Folk Health

Chapter 4

Audience Response System Questions

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Question 1What nursing priority ensures that culturally competent care is provided to a homeless patient admitted for an infected foot?

A. Contact the case manager to secure a shelter bed upon discharge.

B. Provide education regarding foot care to prevent re-infection.

C. Help the patient choose a diet high in protein.D. Provide empathetic and clear communication when

assessing the patient’s needs.

Question 2What is the fastest growing ethnic group in the United States?

A. Asian AmericansB. African AmericansC. Hispanic/Latino AmericansD. American Indian

Question 3Which question illustrates the first step of becoming culturally competent?

A. “Do I have the skill to conduct a cultural assessment?”B. “How many face-to-face encounters have I had with

patients from diverse cultural backgrounds?”C. “Do I have knowledge of my patient’s world view?” D. “Am I aware of my own personal biases and prejudices

toward cultures that are different from my own?”